GASTRO Flashcards
Treatment for Wilson’s disease?
Penicillamine (chelates copper).
Wilson’s disease is caused by excessive deposition of what?
Copper.
Name the 3 tissues most commonly affected in Wilson’s disease.
Liver, brain and corneas.
Blood test used to diagnose Wilson’s disease?
Caeruloplasmin (reduced in Wilson’s disease).
**Note that there is also reduced total serum copper but free (non-bound) copper is increased.
3 types of ischaemia in the lower GIT?
1) Acute mesenteric ischaemia.
2) Chronic mesenteric ischaemia.
3) Ischaemic colitis.
Features of the abdominal pain in acute mesenteric ischaemia?
1) Sudden in onset
2) Severe
3) Pain out of keeping with clinical findings
Bloods results in lower bowel ischaemia?
Raised WCC associated with a lactic acidosis.
Ix of choice for bowel ischaemia?
CT.
Cause of acute mesenteric ischameia?
Commonly an embolism occluding an artery that supplies the small bowel (E.G. superior mesenteric artery).
Where does ischaemic colitis most commonly occur?
Splenic flexure (and other ‘watershed’ areas).
Why does ischaemic colitis most commonly occur at the splenic flexure?
This is the border of the territories supplied by the superior and inferior mesenteric arteries.
What sign may be seen on XR in a patient with ischaemic colitis?
‘Thumbprinting’ due to mucosal oedema or haemorrhage.
Indications for surgery in ischaemic colitis?
Perforation, ongoing haemorrhage, generalised peritonitis.
What should patients that have ascites with protein contents <15 be given and why?
Prophylactic antibiotics against SBP (normally ciprofloxacin or norfloxacin).
Prophylactic ABx should be continued until ascites have resolved.
3 main features of spontaneous bacterial peritonitis?
Ascites
Abdominal pain
Fever
How is SBP diagnosed?
Paracentesis demonstrating neutrophil count >250.
Most common organism isolated from ascitic drainage in those with SBP?
E. coli
Gold standard investigation for suspected oesophageal cancer?
Endoscopy.
Most common type of oesophageal cancer?
Adenocarcinoma.
Adenocarcinoma of the oesophagus is more likely in which patients?
Those with GORD or Barrett’s oesophagus.
Where does adenocarcinoma of the oesophagus most commonly occur?
Lower third of the oesophagus near the GOJ.
Briefly describe the pathogenesis of appendicitis.
1) Lymphoid hyperplasia of faecoliths.
2) Obstruction of appendices lumen.
3) Gut organisms invade appendix wall.
4) Causes oedema, ischaemia, infection ± perforation.
Why does pain from appendicitis begin at the umbilicus and migrate to the right iliac fossae?
Appendix is midgut structure.
Initially pain is caused by visceral stretching of the appendix lumen.
When appendix becomes inflamed, the inflammation spreads to the parietal peritoneum causing pain to localise to the RIF.
Features of appendicitis?
Umbilical pain localising to RIF
Anorexia
Mild pyrexia (37.5-38) - anything higher is more likely to be mesenteric adenitis.
1-2 episodes of vomiting (marked vomiting is unusual).
Perfuse diarrhoea is rare but pelvic appendicitis can cause local rectal irritation + some loose stools.
Main triad of symptoms in appendicitis?
Abdominal pain
Anorexia
Nausea
Signs of generalised peritonitis?
Rebound + percussion tenderness
Guarding + rigidity
What sign can a pelvic appendicitis cause?
Right sided tenderness upon DRE
What are the 2 classical signs of appendicitis that can be elicited?
Rovsing's sign Psoas sign (pain on extending hip if there is a retrocaecal appendix)
