clinical Flashcards
chronic pancreatitis signs
Asymptomatic weight loss pain steatorrhea diabetes malabsorption jaundice duodenal obstruction (uncommon) upper GI haemorrhage Men ages 30-40 long term heavy drinking Cystic fibrosis gallstones high triglycerides lupus
chronic pancreatitis symptoms
Pain exacerbated by food and alcohol
chronic pancreatitis investigations
AXR Ultrasound EUS CT blood tests (low albumin, increased glucose, LFT) pancreatic function tests. faecal serum enzymes (elastase) ERCP/MRCP
chronic pancreatitis diagnosis
MRCP/CT
chronic pancreatitis treatment
Abstinence enzyme supplements analgesia coelic plexus block ERCP for pain relief it stones or strictures surgery antioxidant therapy low fat diet and insulin in necessary
stenting, bypass, thoracoscopic, splanchnectomy, resection
pancreatic carcinoma signs
Hepatomegaly jaundice mass tenderness splenomegaly Virchow’s lymphadenopathy palpable gallbladder
pancreatic carcinoma symptoms
Pain jaundice weight loss anorexia, fatigue, steatorrhea tender fat nodules thrombophlebitis ascites portal hypertension
pancreatic carcinoma investigations
Blood tests & tumour markers USS, CT, MRI if jaundice then ERCP and stent if not then percutaneous biopsy then laparoscopy/laparotomy
pancreatic carcinoma treatment
Staging; (fitness, ECg, CXR)
Often advanced disease. Radicle surgery (whipple’s). palliation of jaundice; cholechoduodensotomy
pain control
dyspepsia signs
Anorexia Loss of weight Anaemia Recent onset Melaena Swallowing problems
dyspepsia symtpoms
Pain in upper abdomen, retrosternal pain. Anorexia, nausea, vomiting, bloating, fullness, early satiety and heartburn
dyspepsia investigations
History and examination bloods (serology, ferritin, IgA) drug history (steroids, nitrates, NSAIDS) >55yrs Endoscopy <55 test for H. Pylori
gastritis symptoms
Nausea bloating Pain vomiting indigestion burning hiccups loss of appetite
gastritis investigations
Serology of IgG
urea breath test
ELISA stool antigen test
biopsy for rapid urease test from endoscopy.
gastritis signs
Vomiting blood
black stools
peptic ulcer pains and signs
Epigastric pain nocturnal hunger nausea, vomiting weight loss anorexia haematemesis, melaena or anaemia
peptic ulcer investigations
endoscopy
peptic ulcer treatment
Eradication therapy
antacid medication (omeprazole, PPI)
cease NSAIDS
peptic ulcer complications
Bleeding, perforation
Fibrosis, strictures, obstruction
gastric outlet obstruction symtpoms and signs
Vomiting fermented food, early satiety, distension, weight loss, gastric splash, dehydration, alkalosis
gastric outlet obstruction investigations
Bloods; low Cl, Na, K renal impairment
Endoscopy, aspiration of gastric contents
gastric outlet obstruction treatment
Endoscopic balloon dilatation surgery
gastric cancer pathology
Adenocarcinomas
maybe GALT or GIST
gastric cancer symtpoms and signs
Dyspepsia, early satiety, nausea, vomiting, weight loss, GI bleeding, iron deficiency, gastric outlet obstruction
gastric cancer investigations
Staging; CT MDT discussion regarding fitness, imaging
Endoscopy and biopsy to make a histological diagnosis
gastric cancer treatment
chemo and surgery
ulcerative colitis signs
Fever >37
tachycardia >90/min
ulcerative colitis symptoms
Bloody diarrhoea, abdominal pain, weight loss, anaemia
ulcerative colitis investigations
Albumin <30g/; Hb <10g/dl raised CRP blood tests stool calprotectin biopsy
ulcerative colitis diagnosis
frequency >6 stools a day/blood
ulcerative coliti treatment
Surveillance colonoscopy 5ASA, then prednisone, then immunomodulators, then biologic agents then surgery nutritional support total colectomy ileostomy
ulcerative colitis complications
Colonic carcinoma
haemorrhage
perforation
toxic dilatation
Crohn’s disease symptoms and signs
Diarrhoea, abdominal pain, weight loss, malaise, lethargy, anorexia, low grade fever, malabsorption
Crohn’s disease investigations
Blood tests
stool calprotectin
biopsy
Crohn’s disease diagnosis
Presence of non-caseating granulomas
Crohn’s disease treatment
Steroids (5ASA?) thiopurines methotrexate immunosuppressants biologics (anti TNF alpha) elemental feeding antibiotics for peri anal disease resection
Crohn’s disease complications
Cancer strictures malabsorption fistula abscesses
ischaemic enteritis symtpoms
Gut pain
bloody diarrhoea
ischaemic enteritis signs
60 constipation atherosclerosis hypotension blood clots blockage
ischaemic enteritis investigations
Ct angiogram
stool sample
colonoscopy
ischaemic enteritis diagnosis
colonoscopy
ischaemic enteritis treatment
IV fluids
antibiotics
surgery
colonoscopy
colorectal cancer symtpoms and signs
Right sided; anaemia, polypoid, vague pain, weakness, obstruction
left sided; annular, bleeding, altered bowel habit, obstruction
colorectal cancer investigations
FOBT sigmoidoscopy barium colonoscopy enema digital rectal exam fecal occult blood testing CT
colorectal cancer treatment
Surgery
post op chemo
radiotherapy for rectal
spontaneous bacterial peritonitis pathology and aetiology
Aerobic gram negative organisms
Endotoxins in ascites
spontaneous bacterial peritonitis signs and symptoms
Abdominal pain, fever, rigors, renal impairment, sepsis, tachycardia, temperature.
Jaundice, encephalopathy,
infection
investigations for spontaneous bacterial peritonitis
Ascitic tap; fluid proteins, cultures and WCC
neutrophil count >0.25109
protein <25g/L
treatment for spontaneous bacterial peritonitis
IV antibiotics, ascitic fluid drainage, IV albumin infusion
alcoholic hepatitis symptoms
Loss of appetite nausea abdominal tenderness vomiting fever fatigue weakness
alcoholic hepatitis signs
Ascites
confusion
liver and kidney failure
alcoholic hepatitis investigations and diagnosis
Low albumin, raised prothrombin time
Raised bilirubin
raised GGT and AlkP
alcohol history and exclusion of other causes.
Glasgow hepatitis score
alcoholic hepatitis treatment
Supportive treat infection treat encephalopathy treat alcohol withdrawal protect against GI bleeds airway protection and ITU. Nutritional support, thiamine. Frequent high energy feeds. only steroids of severe enough (>9).
fatty liver steatosis to steatohepatitis investigations
USS, biopsy, raised Alanine amino transferase
fatty liver steatosis to steatohepatitis complications
1/4 cirrhosis
radiation colitis symptoms
Anorexia, abdominal cramps, diarrhoea, malabsorption
radiation colitis investigations
Complete blood count bile acid conc. b12 absorption acid breath test lactose intolerance test colonoscopy CT MRI
appendicitis signs and symptoms
Dull pain vomiting swelling fever unable to pass gas painful urination cramps diarrhoea
appendicitis investigations
Rectal exam urine test blood test CT US
appendicitis management
appendectomy
hepatic encephalopathy signs
Hyperventilation
decreased body temperature
tremor
bradykineasia
hepatic encephalopathy investigations
Elevated blood ammonia
EEG
CT
hepatic encephalopathy treatment
Bowel clear out, lactulose, enema, antibiotics. Support through ITU, airways and nasogastric tubes
liver failure symptoms
Confusion to coma Nausea loss of appetite fatigue diarrhoea sleepy
liver failure signs
Jaundice bleeding easily swollen mental changes coma
investigations for liver failure
AST:ALT GGT ALP LDH platelets USS bilirubin albumin prothrombin creatine
liver failure treatment
liver transplant
acute liver injury signs and symptoms
Jaundice pain abdominal swelling nausea vomiting malaise disorientation sleepy
acute liver injury investigations
AST:ALT GGT ALP LDH platelets USS bilirubin albumin prothrombin creatine
acute liver injury treatment
Poison reversal
antibiotics
liver transplant
prevent severe bleeding
cholestasis investigations
Bile acid ALT ultrasound autoimmune screen virology screen
cholestasis treatment
Dietary substitution
vitamins
surgery
ursodeoxycholic acid
primary biliary cholangitis investigations
Raised serum alkaline phosphatase and anti-mitochondrial auto-antibody
primary biliary cholangitis diagnosis
MRCP
ERCP
US
primary biliary cholangitis treatment
Fibrates
urseodeoxycholic acid
liver transplant
antihistamines for itching
cholangio carcinoma symptoms
Obstructive jaundice (itching, painful, non-specific
cholangiocarcinoma investigations
Lab, radiology, angiography, ERCP, cytology.
cholangiocarcinoma treatment
Surgical only curative option
Palliative; bypass, stenting, chemotherapy, PDT.
cirrhosis symptoms
Leg swelling spider naevi poor appetite sickness weakness weight loss nosebleeds hair loss ascites forgetfullness jaundice
cirrhosis investigations
US
cirrhosis treatment
Liver transplant
treat underlying cause
Gastro-oesophageal reflux signs
Dysphagia, weight loss, vomiting Alarm features
Gastro-oesophageal reflux diagnosis
Diagnosed on characteristic symptoms
however an endoscopy may be performed
gastro-oesophageal reflux treatment
Lifestyle measures
pharmacological; alginates, H2RA, proton pump inhibitors
anti-reflux surgery if a anatomical cause or refractory
achalasia symptoms
Progressive dysphagia for solids and liquids, weight loss, chest pain, regurgitation and chest pain
achalasia investigations
Manometry
endoscopy
achalasia treatment
Pharmacological; nitrates, calcium channel blockers
endoscopic; botulinum toxin, pneumatic balloon dilatation
radiological balloon dilatation
surgical myotomy
achalasia complications
Aspiration pneumonia
lung disease
squamous cell carcinoma
hypermotility sigs and symptoms
Severe episodic chest pain with dysphagia
hypermotility investigations
Manometry, Ba swallow
hypermotility treatment
Smooth muscle relaxants
oesophageal cancer symptoms and signs
Progressive dysphagia weight loss anorexia chest pain cough Pneumonia vocal cord paralysis haematemesis
oesophageal cancer investigations
Staging by CT, endoscopic ultrasound, PET scan and bone scan.
oesophageal cancer diagnosis
Diagnosis by endoscopy and biopsy
oesophageal cancer treatment
Surgical oesophagectomy, either adjuvant or neoadjuvant chemotherapy
nutritional support
if non-operable then radiotherapy and chemotherapy.
palliation; endoscopic, chemo, radio, brachytherapy
Eosinophilic oesophagitis symptoms
Dysphagia
food bolus obstruction
eosinophilic oesophagitis investigations
endoscopy
eosinophilic oesophagitis diagnosis
Eosinophilic infiltration upon microscopy of biopsy
eosinophilic oesophagitis treatment
Topical/swallowed corticosteroids
dietary elimination
endoscopic dilatation
barrett’s oesophagus symptoms
Heartburn dysphagia vomiting blood pain weight loss loss of appetite
barrett’s oesophagus investigation
endoscopy
barrett’s oesophagus treatment
Endoscopic mucosal resection
radio-frequency ablation
oesphagectomy
gallstones symtpoms
Asymptomatic
dyspeptic symptoms
biliary colic
jaundice (maybe obstructive, painful
gallstone investigations
Blood tests, USS, EUS, cholecystography, CT, radioisotope scan, IV cholangiography, MRCP, PTC, ERCP
gallstone treatment
Asymptomatic
non-operative (dissolution, lithotripsy (risky)). Operative; laparoscopic cholecystectomy
gallstone complications
Empyema
perforation
acute pancreatitis
coeliac disease investigations
IgG Serology IgA distal dueodenal biopsy HLA
coeliac disease diagnosis
Gold standard is distal duodenal biopsy
coeliac disease treatment
Withdraw gluten refer to dietitian
bile duct obstruction symtpoms
Dark urine itching nausea vomiting fever light coloured stool
bile duct obstructions signs
Jaundice, steatorrhea, weight loss
bile duct obstruction investigations
Blood test MRI x-ray MRCP ERCP radionuclide scan
acute pancreatitis symptoms
Bending forward aids discomfort temporarily. pyrexia dehydration circulatory failure abdominal tenderness
acute pancreatitis signs
Intense Upper abdominal pain. Vomiting, nausea. Anorexia. Diarrhoea. Radiation to back.
collapse.
acute pancreatitis investigations
Elevation of serum amylase ERCP EUS blood tests AXR CT (contrast) LFT ABG
acute pancreatitis diagnosis
Glasgow criteria; PaO2 <8kPa Age 55 Neutrophils 15*109/l Calcium <2mmol/l renal function urea >16 mmol/l enzymes: AST/ALT >200iu/L or LDH >600iu/L albumin < 32g/l sugar: glucose >10mmol/L >3 criteria also CRP>150 mg/l
acute pancreatitis treatment
Analgesia, I.V fluids. Blood transfusion. Monitor urine. Naso-gastric tube. O2, maybe insulin. Nutritional support.
aspiration for necrosis. Cholecystectomy if gallstones.
support CV, resp. and renal
monitor BP, pulse, CVP
lipid lowering drugs
surgery; resection if malignancy,
acute pancreatitis complications
Mutlii-organ failure necrosis abscess (drain + antibiotics) pseudocyst (endoscopic drainage) – jaundice, infection, haemorrhage, rupture. Sepsis
