Gastro Flashcards
What investigation would you get for suspected appendicitis?
Normally a clinical dx
You may need to get a pelvic USS to exclude ovarian cyst accident
CT abdomen - if uncertain
What score can you use for appendicitis
Alvarado score
>4 is high likelyhood of it being appendicitis
What are the three signs you can get in appendicitis
Rosvig’s sign
Cope’s sign
Psoas sign
What is Rosvig sign
Pain worse in RIF when pressing down on LIF
What is Cope sign
Pain on passive flexion and internal rotation of hip
What is Psoas sign, and what does it indicate exactly
Pain on extending hip
Indicates RETROCAECAL APPENDIX
How would you manage appendicitis
start prophylactic antibiotics before surgery
THEN laparoscopic appendicectomy
what extra thing must you do if appendicitis is perforated
ABDOMINAL LAVAGE
What is ascending cholangitis
INFECTION of the biliary traact
What causes ascending cholangitis
Obstruction + infection
Obstruction can be caused by:
- gallstones
- ERCP
- cholaangiocarcinoma
- pancreatitis
- PSC
How will pt with ascending cholangitis present
ACUTELY UNWELL - MAY BE SEPTIC
Charcot’s triad: fever + RUQ pain + jaundice
Reynaud’s pentad: + hypotension + confusion
How do you investigate and manage suspected ascending cholangirtis
Bloods: Raised ALP and GGT
Ix: USS biliary tract (will show thickened wall and bile duct dilatation)
ERCP (ix and mx) - to clear obstruction
If cause was gall stones, may need cholecystectomy
How do you manage acute cholangitis
IV Abx AND ERCP within 24-48h
What are the three types of gallbladder disease you can get?
BILIARY COLIC: stones causing pain in gallbladder neck
CHOLECYSTITIS: inflammation of gallbladder
ASCENDING CHOLANGITIS: inflammation of bile duct
Describe the three types of gall stones
cholesterol (if fat, poor diet)
pigment (if haemolytiic anaemia)
mixed
What are RF for gallstones
Fat Fair Fourty Female FH
+ OCP, pregnancy, haemolytic anaemia
What is a biliary colicj
stones in the neck of gallbladder causing pain on contraction
Describe the pain in a biliary colic
Colicky (intermittent)
Triggered by eatiing fatty foods
Sudden, dull
In RUQ
How do you investigate for gallbladder pathology
Abdo USS of gallbladder and bile ducts
MRCP if nothing visible (and suspected cholecystitis / biliary colic)
what do you see on USS of gallbladder in pathology
thickened wall
Bile duct dilatation
Gallstones
How do you manage biliary colic
IV analgesia
elective cholecystectomy within 6 weeks
What are symptoms of cholecystitis
Pain (constant, RUQ) + fever
How do you manage acute cholecystitis
IV Abx
IV analgesia, antiemetics
Laparoscopic cholecystectomy (<72h)
What are symptoms and signs of pancreatitis
severe epigastric pain radiating to back, N&V
Cullen’s (periumbilical), grey turner sign (retroperitoneal=