14. CCs in brief - others Flashcards
What causes chronic liver failure?
Viral hepatitis (B, C, CMV) Alcohol abuse Budd-Chiari syndrome NAFLD Primary biliary cholangitis
What are signs and symptoms of chronic liver disease?
Jaundice
Hepatic encephalopathy
Fetor hepaticus (pear drops)
Asterixis / hepatic flap
What defines chronic and acute liver failure?
Liver failure = recognised by the development of coagulopathy and encephalopathy
Acute = occurring suddenly in a previously healthy liver
Chronic = occurring in a cirrhotic liver
What causes ascites?
Malignancy Infection, esp. TB Low albumin Pericarditis Pancreatitis Myxoedema Cirrhosis Portal vein occlusion (Budd-Chiari) / thrombosis
What are other causes of abdominal distension?
Five Fs Fat Fluid (dull - ascites, distended bladder, AAA) Faeces (solid mass, obstruction) Flatus (air, resonant) Foetus
How do you investigate ascites?
Fluid thrill / shifting dullness
Aspirate ascitic fluid and send for cytology, culture and albumin
USS
Why are so many patients in hospital malnourished?
1 Increased requirements (burns, sepsis, surgery)
2 Increased losses (malabsorption)
3 Decreased intake (dysphagia, nausea, sedation)
4 Effect of treatment (N+V)
5 Enforced starvation (nil by mouth)
6 Missing meals (eg investigations)
What is the preferred management of malnourished patients?
Enteral nutrition (into GI tract) Nutrition by mouth where possible
What are the main causes of GI perforation?
Chemical: peptic ulcer, foreign body eg battery
Infection: diverticulitis, cholecystitis, mocker’s diverticulum
Ischaemia: mesenteric ischaemia, obstructing lesions
Colitis: toxic megacolon
Traumatic: recent surgery, endoscopy, penetrating trauma, excessive vomiting (Boerhaave syndrome)
How does GI perforation present?
Rapid onset, sharp pain
Systemic malaise, lethargy, vomiting
Rigid abdomen
What are some important differential diagnoses when considering GI perforation?
Acute pancreatitis
MI
Tubo-ovarian pathology
Ruptured AAA
What is the pathophysiology of coeliac disease?
T cell response to gluten in small bowel causes villous atrophy and malabsorption
How does coeliac disease present?
Steatorrhoea Diarrhoea Abdo pain / bloating N+V Aphthous ulcers Angular stomatitis Weight loss Fatigue
How common is coeliac disease?
1 in 100-300
What structures are retroperitoneal?
Suprarenal gland
Aorta / IVC
Duodenum (2nd and 3rd part)
Pancreas (except tail) Ureters Colon (ascending and descending) Kidneys Oesophagus Rectum
