Gastritis, Ulceration, Malabsorption and Gallstones Flashcards
Why do gastric ulcers get rescoped 6 weeks after being treated?
To ensure that they’ve healed, as indicator of malignancy if they haven’t
What is the main criteria for Dyspepsia and what are the main causes?
Criteria: Early satiation, post-prandial fullness, Epigastric burning/pain
Causes: Excess acid, prolonged NSAIDs, large volume meals, obesity, smoking/alcohol, pregnancy
What are the main red flag symptoms from someone with dyspepsia?
Anaemia, unexplained weight loss, dysphagia, upper abdominal mass and persistent vomiting
What are the investigations and management for someone with dyspepsia?
Inv: Endoscopy, Gastroscopy, Barium swallow and Capsule endoscopy
Man: NSAID use, medication review, endoscopy and referral to a specialist
How wold you treat someone for suspected dyspepsia without red flag symptoms?
1) Review medication
2) Lifestyle advice
3) Full PPI dose
4) Test for and treat Heliobacter Pylori infection
What lifestyle/public health advice given to someone with dyspepsia?
1) Cut down on alcohol and stop smoking
2) Lose weight and modify diet
How is GORD treated?
1) PPI
2) Anti-Reflux surgery
3) Lifestyle modification
What are the potential problems of either an anterior or posterior ulcer haemorrhage?
1) Anterior: Acute peritonitis
2) Posterior: Pancreatitis
What ways are the stomach mucin-layer broken down and cause gastritis?
1) Mucosal Ischaemia
2) H. Pylori
3) Aspirin/NSAIDs
4) Increased acid or Bile reflux
5) Alcohol
How is gastritis treated?
1) Enteric-coated aspirin
2) H2RA
3) PPI
4) Reduction of mucosal ischaemia
What are the main causes of malabsorption?
1) Defective I-L digestion
2) Insufficient absorptive area
3) Lack of digestive enzymes
4) Defective endothelial transport
5) Lymphatic absorption
How does pancreatitis cause malabsorption?
Pancreatic insufficiency arises so lack of pancreatic digestive enzymes, so defective I-L absorption which leads to malabsorption
What can result in defective I-L absorption?
1) P Ins: Lack of digestive enzymes (pancreatic enzymes and CF)
2) Bacterial Overgrowth
3) Defective bile secretion from biliary obstruction and ileal resection
What can cause insufficient absorptive areas?
1) Coeliac disease
2) Crohn’s disease
3) Extensive parasitisation
4) Small intestinal resection
What is an example of lack of digestive enzyme?
Lactose Intolerance: Disaccharide enzyme deficiency
What can cause lymphatic obstruction?
1) Lymphoma
2) TB
What are the main components in gallstones and investigations?
Bile pigment, cholesterol and phospholipids
INV: ERCP and Ultrasound
What disorders can gallstones cause?
Acute pancreatitis, Duct obstruction
What are the main risk factors for gallstone development?
Gender (Female), Weight and Fertility
How can gallstones be removed from the gallbladder?
Laparoscopic cholecystectomy
What are the main complications of gallstones in the bile duct?
1) Biliary Pain
2) Obstructive Jaundice
3) Pancreatitis
4) Cholangitis (Infection of the biliary tract)
What is ascending cholangitis?
Infection of the biliary tract leading to bacterial infection
What is Charcot’s triad?
Triad describing the three main common symptoms of AC:
1) RUQ pain
2) Fever
3) Jaundice (Cholestatic)
What investigations may be conducted for someone that has ascending cholangitis?
Ultrasound, Blood Test(LFT), ERCP (definitive investigation)
What is the treatment for ascending cholangitis?
IV fluid, IV antibiotics, ERCP to remove any stones and stenting
What is the difference between ascending cholangitis and acute cholecystitis?
A patient with cholangitis has jaundice
What is acute cholecystitis?
Inflammation of the gall bladder caused by blockage of the bile duct -> obstruction to bile emptying.
What are the main symptoms of acute cholecystitis?
1) RUQ pain
2) Raised inflammatory markers
3) Fever
[Obesity and Diabetes are RF]
What is biliary colic?
“Gallbladder attack” - RUQ pain from gallstone blocking the bile duct
(Triggered by eating a heavy meal with high fat content)
What are primary features and the PP of primary sclerosing cholangitis?
PF: Itching, Rigor, Pain and Jaundice (IBD in 75%)
PP: Bile duct gets inflamed, strictures and hardening, progressive obliterating fibrosis of bile duct branches –> Cirrhosis –> Liver failure
