Gastro Flashcards
what is mesenteric ischaemia
sudden decrease in the blood supply to the bowel
- patient will be acutely unwell
- raised lactate - IMPORTANT AS THIS IS A SIGN OF ISCHAEMIA
- diarrhoea and painful
abdo will be soft
symptoms of small bowel ishaemia
severe abdo pain
shock
nausea
vomiting
metabolic acidosis
what is mcburneys point
point where the appendix lies
draw a line from the anterior superior iliac spine to the umbilicus
it is 1/3 of the way along the line from he ASIL
Metabolic acidosis can be due to?
Diabetic ketoacidosis
What does aspirin overdose present as
High rates of salicylic acid
Causes respiratory alkalosis
then goes onto causing metabolic acidosis
Which test checks for cortisol levels
Synacthen test
Can check for addisonian crisis
Low cortisol levels are found in?
Sepsis
4 symptoms of diabetic ketoacidosis
- Hyperglycaemia
- High anion gap
- Metabolic acidosis
- Abdomen pain
Iron is best absorbed in?
Proximal small bowel
Duodenum
Where does PICC catheter line go
Basilic vein
what are calcified gallstones and why do they form
- pigment stones
- form due to raised bilirubin levels + altered PH levels
what is hepatitis
inflammation of the liver can be due to infections
features of hepatitis
fatigue
nausea and vomiting
diarrhoea
jaundice
what is hepatitis A and presentation
transmitted by fecal-oral route
dark urine
abdo pain
jaundice
which test is best used to investigate hiatal hernia
barium swallow
what is variceal bleeding
arises through portal hypertension
veins get dilated and are more likely to bleed
what is the best prevention method for variceal bleeding
give non-selective beta blockers and edoscopic ligation band
what are carcinoid tumours
rare, slow growing malignant tumours that develop in the neuroendocrine system
what are carcinoid tumours
rare, slow growing malignant tumours that develop in the neuroendocrine system
the tumour releases serotonin
effects of that are: flushing, diarrhea, wheezing, abdominal pain, and heart palpitations
also causes pellagra
management of carcinoid tumours
octreotide
they inhibit the secretion of serotonin by the tumours which cause symptoms like flushing and abdo pain
what is crohns disease
chronic relapsing inflammatory bowel disease
inflammation of the GI tract - mostly the ileum
symptoms of crohns disease
crampy abdo pain and diarrhoea
weight loss and fever
abdo will be swollen and distended and severe guarding
symptoms of diverticulitis
left lower quadrant abdomen pain and nausea
pain, fever, nausea, vomiting, constipation or diarrhea, and a change in bowel habits
common in low fibre diets
what is diverticulitis
inflammation and out pouching of the mucosa in the sigmoid colon
these pouches get infected and inflammed
what is achalasia
failure of the oesophageal sphincter to relax
makes it hard for food to go to the stomach
symptoms of achalasia
regurgitation of food
aspiration
retrosternal pain
treatment for achalasia
hellers cardiomyotomy
best investigation for mesenteric ischaemia
CT abdo
what can this patient be at risk for?
he has had a change in bowel habit,
losing weight
more frequency when passing stool
colorectal cancer
what is achalasia
failure of the oesophageal peristalsis and relaxation of the Lower oesophageal spincter
features of achalasia
dysphagia
heart burn
regurgitation of food
investigation for achalasia
barium swallow test
oesophageal cancer features
dysphagia
anorexia
weight loss
vomiting
hoarseness
two types of oesophageal cancer
adenocarcinoma
squamous cell carcinoma
adenocarcinoma - oesopagheal cancer
most cmmm in UK
risk factor : GORD
smoking
squamous cell carcinoma of oesophageal cancer
most common in the developing world
smoking
aclohol
investigation of oesophageal cancer
upper GI endoscopy
CT chest, abdo and pelvis
management of oesophageal cancer
surgical resection
Ivor-Lewis oesophagectomy
coeliac disease what is it
autoimmune condition where gluten causes a reaction
presentation of coeliac disease
failure to thrive
diarrhoea
fatigue
weight loss
nausea and vomiting
dermatitis herpertiformis - pink rash on children
anaemia
what is the investigation of coeliac disease
check for TTG antibodies
IgA antibodies - deficiency of can cause a false negative result
- patient has to be on gluten diet in order to carry out the tests
always check diabetic patients
what are uncomplicated peptic ulcers
ulceration of the stomach mucosa
risk factors of uncomplicated peptic ulcers
h pylori
drugs - NSAIDS
increased acid
factos that increase acid secretion in stomach
alcohol
caffeine
spicy food
smoking
stress
presentation of uncomplicated peptic ulcers
epigastric pain
nausea and vomiting
dyspepsia - indigestion
features of duodenal ulcers
pain when hungry
pain goes away when eating
features of gastric ulcer
painful after eating
investigation for uncomplicated peptic ulcers
test for h pylori - stool test
management of uncomplicated peptic ulcers
if there is no H pylori - then give PPI
if there is H pylori - eradication therapy
eradication therapy for uncomplicated peptic ulcers
PPI and amoxicillin and clarithromycin
give methroniazaole instead of amoxicillin if patient is allergic to penicillin
what are LFT markers
serum markers of liver cell damage
help localise site of damage
hepatic picture - LFT markers in this?
raised ALT and AST
cholestatic picture - LFT markers in this?
raised ALP and GGT
what is ALT
enzyme found in the hepatocytes that is involved in amino acid and group transfer
damage to heptaoctes causes raised ALT
where is ALT found
liver
heart
pancreas
kidneys
hepatic causes of raised ALT
hepatitis
liver ishaemia
paracetamol OD
extrahepatic causes of raised ALT
MI
pancreatitis
kidney disease
what is AST
enzyme involved in amino acid and group transfer
raised when hepatocytes are damaged
if AST:ALT RATIO IS AST>ALT then what is the cause?
alcohol is the cause
what is ALP
elevated obstructive jaundice and bile duct damage
what is the biliary cause of raised ALP
gallstones - causes jaundice
pancreatic cancer - painful
extra biliary causes of raised ALP
pagets disease
low vitamin D
what is GGT - when is it raised
liver enzyme and is raised In chronic alcohol use and gallstone diseases
what are gallstones
blockage of of the bile duct which causes stones
4 Fs for gallstones
Fat
Fertility
Female
Forty
common complications of gallstones
biliary colic - the stones are outside the bile duct
cholecystitis
cholangitis
biliary colic - what is it
when a gallstone blocks the bile duct
colicky abdo pain
worse after fatty meals
lasts 15mins to 5 hours
acute cholecystitis
inflammation of the gall bladder
right upper quadrant pain
fever and murpheys sign
complications of cholecystectomy
bleeding
infection
pain
stones left in the bile duct
what is acute cholangitis
patient will be unwell with a fever
jaundice
right upper quadrant pain
management of acute cholangitis
iv antibiotics
analgesia
what is acute pancreatitis
rapid inflammation of the pancreas
presentation of acute pancreatitis
severe epigastric pain
radiates to the back
vomitng
abdo tenderness
charchots triad - what is it:
bilary colic - RUQ pain
cholecystis - RUQ pain and Fever
Cholangitis - RUQ pain and fever and jaundice
causes of acute pancreatitis
acronym (I GET SMASHED)
IDIOPATHIC
GALLSTONES
ETHANOL (ALCOHOL)
TRAUMA
STEROIDS
MUMPS
AUTOIMMUNE
SCORPION STING
HYPERLIPIDEAMA
ERCP
DRUGS
investigation for acute pancreatitis
amylase
lipase
CRP
gallstones
FBC and LFTs
why does fatty cause pain in biliary colic
CCK is released from the duodenum when fatty foods are eaten
this contracts the gall bladder
if there is stones there then it will hurt
management of acute pancreatitis
Iv fluids
analgesia
treatment of the gallstones
antibiotics
complications of acute pancreatitis
necrosis
fluid collection
pancreatitis
what is small bowel obstruction
blockage in passing stool fluid and gas in the bowel
which bowel obstruction is more common
small
presentation of small bowel obstruction
central abdo pain
nausea and vomiting
constipation and no flautence
abdo distention
TINKLING BOWEL SOUNDS
causes of small bowel obstruction
hernia
adhesions
malignancy
x ray findings of small bowel obstruction
dilated small bowel
investigations for small bowel obstruction
CT and erect chest x ray
what is C difficile
gram positive rod
causes of C difficile
clindamycin
PPIs
co-amox
management of small bowel obstruction
iv fluids
emergency managemt
surgery
NG tube
features of C difficile
diarrhoea
abdo pain
raised WCC
diagnosis of C difficile
test for the bacteria in stool
management of C difficile
1st line oral vancomycin (if its the first episode)
life threatening - oral vancomycin and iv metronidazole
crohns disease - what is it
can be anywhere in the GI tract
more common in terminal ileum
cobble stone appearance
increased goblet cells
colorectal cancer
sporadic - runs in family
unexplained weight loss
rectal bleeding
addo pain
change on bowle habits
iron deficiency anaemia
what is HNPCC
Lynch syndrome
autosomal dominant
proximal colon
what is the Amsterdam criteria
3 family members had some similar cancer
what is FAP
autosomal dominant
2 types - clasic and attenuated
polyps that form
due to mutations APC
features of crohns disease
weight loss
diarrhoea
RUQ pain
perianal disease
investigations for crohns disease
bloods
colonoscopy
history
small bowel enema
management of crohns disease
stop smoking
what is ulcerative colitis
rectum to ileocecal valve
bloody diarrhoea
urgency and tenesmus
abdo pain LLQ
arthritis
investigation of ulcerative colitis
barium meal
mild ulcerative colitis
<4stools daily
ESR AND CRP are all normal
moderate ulcerative colitis
4-6 stools a day
systemic disturbance
severe ulcerative colitis
> 6 stools a day
blood in stool
management of mild to moderate ulcerative colitis
corticosteroids
what is IBD
inflammation of the GI tract
what is diverticulosis
presence of many outpouchings of the bowel wall
most common in sigmoid
risk factors for diverticulosis
increasing age
low fibre diet
features of diverticulosis
LIF pain
nausea and vomiting
diarrhoea
features of infection
management of diverticulosis
admit
NBM
IV fluids
Iv antibiotics
anorectal abcess - what is it?
perianal swelling and pain
it has to be immediately drained under local anaesthetic in A&E to stop it from spreading and becoming septic
what is Gilbert syndrome
when the liver produces bile very slowly
what is a Mallory-Weiss tear
superficial tear in the oesophageal lining that occurs after a long period of vomiting.
causes of upper GI bleeds
Oesophageal/gastric varices
Peptic ulcer disease (H. pylori, NSAID use, smoking)
Malignancy
Aorto-enteric fistula (previous abdominal aortic aneurysm or an aortic graft)
Mallory Weiss tear
symptoms of Boerhaave’s syndrome
rupture of the oesophageal due to vomiting
patient has retrosternal chest pain and vomiting
ruptured oesophageal varices - symtoms
seen in patients with portal hypertension due to chronic liver disease and cirrhosis
what is niacin
vitamin b3
what is niacin deficiency seen as?
Diarrhoea
Dermatitis
Dementia
what is pellagra?
Diarrhoea
Dermatitis
Dementia
who is vitamin b3 deficiency common in?
common in underdeveloped countries
vitamin c deficiency features
spontaneous bleeding
bruising
coiled hairs
teeth loss
vitamin b1 deficiency features
wernicke’s encephalopathy (confusion, ataxia)
high output cardiac failure
peripheral neuropathy
vitamin a deficiency
developing countries
night blindness
corneal ulceration
what is nicotinamide used for
treatment for vitamin b3 deficiency
what is Zollinger-ellison syndrome
several ulcerations develop in the stomach and duodenum
uncontrolled release of gastrin
symptoms of Zollinger Ellison syndrome
abdo pain
diarrhoea
ulceration of duodenum
GI bleeding
don’t respond to PPIs
raised faecal cal protein is raised in what?
ulcerative colitis
colonoscopy findings of ulcerative colitis
surface inflammation with loss of goblet cells and crypt abscess
colonoscopy findings of diverticulosis
constipation and left lower abdo pain
colonic diverticula with central lumen and surrounding mucosa
colonoscopy findings of crohns disease
transmural inflammation with non-caveating granulomas
colonoscopy findings of infective colitis
multiple polymorphic nuclear leukocytes extending into the lamina
sub-total vilous atrophy and crypy hyperplasisia - seen in what?
coeliac disease
signs of oesphageal cancer
progressively worse dysphagia - due to cancerous growth
odynophagia - painful swallowing
red flag symptoms for bowel cancer?
- weight loss
- change in bowel habits
- anaemia
- loss of appetite
inflammatory bowel conditions cause what to be found in the stool?
mucus
hyperparathyroidism can cause increased CA levels - how?
it brings Ca into the circulation from the bones
- Ca comes out of the bones and into the blood
- it can suck up the fluid and cause tiredness, constipation and thirst
symptoms of hypercalcaemia
bones - increased bone pain and fragility
stones - renal stones
moans - depression
groans - constipation/anorexia
alcoholic liver injury - what is it
alcohol is a common cause behind liver injury
there is an increase in the metabolism of fatty acids
this causes the sinusoid cells to be replaced with collagen
- they cannot do their role
- cirrhosis
acute biliary obstruction - what is it
when the bile duct gets blocked - mainly due to gallstones
- causes colicky pain and jaundice
- if the ducts get inflamed then it is called CHOLANGITIS
- this would cause a fever too
- bile builds up into the liver
- if this ruptures and releases = bile infarct
what happens to the liver after repeated acute biliary obstruction
secondary biliary cirrhosis
- damage to the liver due to fibrosis because of the frequent bile release
chronic hepatitis
hepatitis that has been lasting longer than 6 months
- very severe inflammation
- cause high levels of liver enzymes
iron overload and the liver
- liver goes dark brown
can be in two forms - heamosiderosis or haemochromatasosis
what is heamosiderosis
too much iron in the liver but no damage to the actual liver
- in patients with aplastic anaemia, blood transfusion are given
- this means this iron is accumulated in Kupffer cells
- can cause liver damage
primary heamochromatasosis
too much iron in the liver with cirrhosis
it is due to a genetic abnormality - it causes more absorption of iron
- iron becomes too much
- starts to involve other cells too
- causes hepatic fibrosis
secondary heamochromatasosis
- this is when there is too much iron in the diet
- or in patients who receive multiple blood transfusions
what is Wilsons disease
too much copper in the blood
- autosomal recessive disorder
- too much copper builds up in the liver and basal ganglia of the brain
- coper cannot be then released from the bile
- this can then cause hepatitis and then cirrhosis
- in the brain it can cause disability
autoimmune liver disease
primary biliary cirrhosis
autoimmune disease of the liver
females > males
- causes slow destruction of the bile duct
- this is when the toxins build up in the liver = this is called cholestatis
- it causes further damage and fibrosis
- causes copper to build up too
autoimmune hepatitis
more common in females than males
- swollen liver cells
- anti nuclear antibodies are present
sclerosing cholangitis
acute inflammation of the bile ducts
- at first the ducts get surrounded with inflammatory cells
- overtime these get replaced with fibrotic cells
cirrhosis - what is it
- liver is really good at restoring damaging
- despite liver damage, the liver cells can be resorted and normal function can be maintained
- cirrhosis happens when the liver cells are damaged repeatedly
what is cirrhosis characterised by
fibrosis
nodular regeneration
- the liver cells that get replaced with fibrosis cannot carry normal function
- it is characterised by the size of the nodules
- most common cause is alcohol
- hypoalbuminaemia and oedema
- clotting factors deficiency,
- bruising
complications of liver cirrhosis
liver failure
portal hypertension
liver cell carcinoma
hepatic encephalopathy
failure of the liver to excrete toxins so they build up
- can cause renal failure
- not removing steroid hormone causes too much aldosterone in the blood
- too much sodium and water
- in males can cause gynaecomastia
portal hypertension
common cause - cirrhosis
- increased BP in the hepatic portal vein
- due to more hepatic resistance and portal blood flow
- this can cause oesophageal varices - enlarged veins which can bleed
- can cause ascites
-
why does oedema happen in the liver
less synthesis of albumin so there is less levels of it
why do ascites happen
too less albumin which causes less aldosterone
- this causes sodium and water to be retained
why does it haematesmesis happen
portal hypertension can cause oesophageal varies which can bleed
liver cell adenoma
benign tumour
cause swelling of the liver
malignant tumours
- present with jaundice and fevers and weight loss
- most common place of metastasises is GI tract, pancreas and bowel and breast
liver cell carcinoma markers
- the foetal liver produces alpha feta-protein
- when the baby is born this production declines and albumin is made
- so in liver cancer, alpha fetoprotein is produced
- this is an important tumour marker
cholangiocarcinoma
adenocarcinoma of the bile duct
- found more commonly in this with ulcerative colitis
symptoms
- pale stools
-itchy skin
- jaundice
bile pathway
produced by the liver
travels via the left and right bile ducts - these fuse to make the common bile duct
- contains: cholesterol, phopholipid and bilirubin
- bile is stored in the gall bladder
- when fatty foodsa are eaten the gall bladder releases the bile into the duodenum to digest it
cholelithiasis - what is it
gall stones
risk factors:
female
obesity
diabetes
the stones form from excessive cholesterol
acute cholecystitis
gallbladder is inflamed - can be due to gallstones
- the gall bladder wall lining can get infected and filled with pus
- the gall bladder wall may rupture and stones may pass along to the duodenum
- these can block the intestine - gallstone ileus
gall stone filled with pus is called?
empyema
chronic cholecystitis
- may happen due to repeated episodes of gall stones
- the wall of the gall bladder has been replaced by fibrosis
- so it is thicker and rigid
- stone is found its HARTMANNS POUCH
most common bile duct and gall bladder cancer
adenocarcinoma
biliary obstruction
obstruction can be for many reasons
- causes jaundice
- pale stools
dark urine
if this becomes infected then can cause cholangitis too
effects of cystic fibrosis on the pancreas
the mucus clogs the pores of the pancreas
- so then exocrine secretions cannot be made
pancreatitis
infllammation of the pancreas
- mainly due to alcohol
- amylase is released into the blood
- obstruction of the pancreatic duct
- epigastric pain that radiates to the back
- when the organ is obstructed, enzymes are released into the blood that can cause shock
- nausea and vomiting
effects of pancreatitis due to gall stones
- when the gall stone obstructs the pancreas or if there is biliary reflux into the pancreas
- it damages the pancreatic duct
- this can cause leakage of pancreatic enzymes
effects of pancreatitis due to less vascular supply:
- lack of oxygenated blood
- pancreatic enzymes are released
- causes more damage
- organ can bleed due to blood vessel break down
- amylase is released
- fatty acids that are released from the pancreas bind calciums = hypocalacaemia
- hyperglycaemia occurs
chronic pancreatitis
relapsing pancreatitis
- due to alcohol
- abdo pain with back pain and weight loss
x ray will show calcification
malabsorption of fat so faeces will contain more fat
which syndromes is associated with pancreatic cancer
trousseau syndrome - blood clotting disorder which causes inflammation of a vein due to a blood clot
- this is due to the tumour releasing contents into the blood
features:
DVT
endocarditis
and also pulmonary embolisms
what medication is used for typhoid fever
ceftriaxone
how does ranitidine work?
it is a H2 receptor antagonist
this inhibits histamine on the parietal cells - this reduces the secretion of hydrochloric acid from the parietal cells - so they release it less
- it can also mask the symptoms of gastric cancer
what do chief cells in the stomach release
pepsinogen
what do delta cells in the stomach release
somatostatin - this inhibits stomach acid production
what do g cells in the stomach do
they release gastrin which stimulates the release of stomach acid
what type of laxatives should be avoided in elderly patients who are frail
bulk laxatives like isphagula - it increases the risk of bowel obstruction
what is the side effect of long term omeprazole?
hypomagnesia
what is a cyclizine?
it is an antihistamine which can also be used to manage nausea and vomting
which laxatives can make IBS worse?
lactulose which causes more gas and bloating in the stomach
how do oesophageal varicose develop
when normal blood flow to the liver is blocked
this causes ALP to be raised
what medications are used in crohns disease
corticosteroids
they reduce the inflammation in the mucosa
what is the colposcopy findings of crohns disease
rose thorn ulcers
cobble stone mucosa
what is elevated in acute pancreatitis
serum amylase
which part of the colon does crohns disease effect that causes bile stones
the terminal ileum
the terminal ileum is responsible for the reabsorption of bile and have terminal ileitis can affect this
what is primary biliary cholangitis
it is an autoimmune condition which causes scarring and inflammation of the bile ducts
this can cause
tiredness
itchy skin\
common in women younger than 40
is the scarring of the small ducts
primary sclerosing cholangitis
scarring of the medium to larger sized bile ducts
causes tirendess
jaundice and itching
more common in men
and those with IBD
what is a risk factor for gallbladder carcinoma
ulcerative colitis - due to its association with primary scleoring cholangitis
- chronic inflammation that leads to cancer
what is the likely diagnosis
nephritic syndrome after an infection with blood in urine and high blood pressure and oedema
post strep a glomerulonephritis
what is bacterial perontinitis
it is the infection of the ascites
most common cause is Ecoli
what is the Cullens sign?
it is when there is bruising behind the umbilicus in acute pancreatitis
what ion abnormality is seen in metabolic acidosis
hyperkalaemia
due to H+ ions being transported into cells for the exchange of potassium
what is given to patients with acute severe dehydration?
IV Hartman’s solution
presentation of cholera
watery diarhhoea
dehydration
vomiting
drowsiness
how does Cholestyramine help with itching in Primary biliary cholnagitis
it binds to the bile salts in the GI tract and prevents them from being reabsorbed
why do you get itching in primary biliary cholnagitis
what is good pasture syndrome
many antibodies that attack the Type iV collagen
in the lungs and kidneys
causes blood in vomit and urine
nephritic syndrome blood and proteins in the urine
what is whipples disease
bacterial infection that affects the joints and digestive system
- causes diarrhoea
- joint pain
- hyper pigmentation
can cause endocarditis
do jejunal biopsy as investigation
Fournier’s gangrene - what is ti
it is an infection of the the deep fascia
it causes blackening of the skin
what happens in oesophageal spasm
pain when eating and drinking
do barium swallow
symptoms of spleen rupture
abdo pain
shoulder pain due to blood irritating the diaphragm - Kehr’s sign
what is seen on colonoscopy in ulcerative colitis
pseudopylps
Why do NSAIDS Pose a risk for GI bleeds
They inhibit prostaglandin, which is produced by the stomach to protect the lining of the stomach
what is gastric paresis
weakness of the stomach muscles
- delayed gastric emptying
- it is associated with type 2 diabetes
- presents with vomiting of undigested foods
what does metoclopramide do
Metoclopramide: This medication can increase the contractions of the stomach and intestines, helping to move food through the digestive system more quickly.
What is a good measure of liver failure
Prothrombin is a clotting factor synthesised in the liver. When there is liver failure then less prothrombin is released. It has a shorter half life, then albumin and so is a better marker for acute liver failure
what is a contraindication for laparoscopic surgery
raised intracranial pressure
why does pancreatitis lead to diabetes
it causes the breakdown of the beta langerhans cells which release insulin - it can cause diabetes
symptoms of irritable bowel syndrome
Abdominal pain, Bloating and Change in bowel habit are classic features of irritable bowel syndrome
and mucus in the stool
what is Lynch syndrome
an autosomal dominant condition, is the most common form of inherited colon cancer
due to mixmatched genes
so also holds a risk of endometrial cancer
what are the findings of Intussusception
- baby presents with vomit
abdo pain
abdo mass
baby keeps legs up to help with the pain
sausage shaped mass
what condition does H.pylori increase the chances of getting?
duodenal ulcer
and gastric carcinoma
what is management for cystic fibrosis
Creon supplement - aids digestions for pancreatic insufficiency
symptoms of Irritable bowel syndrome
- abdo pain and bloating
- it is better on defeacation
- worse by eating
- flares up worse during times of stress etc
what is Hereditary haemochromatosis
a disorder in which there is increased absorption of iron so food items containing vitamin C should be avoided as vitamin C increases the absorption levels of iron.
can cause liver cirrhosis
what is Pharyngeal pouch
herniation of the pharyngeal mucosa through a point of weakness
symptoms:
dysphagia
regurgitation of food
bad breath
lump in neck
weight loss
investigation for pharyngeal pouch
barium swallow
what are the risks of ERCP
acute pancreatitis
which tumour marker is used for pancreatic cancer
CA19-9
how long after last drinking alcohol does delirium tremens present
48-72 hours
peritonitis
it is the inflammation and infection of the peritoneum -
can cause fever and cloudy ascitic tap appearance
common in end stage liver diease
what is Gilberts syndrome
inherited condition that affects how the liver processes bilirubin
Bilirubin is a yellow pigment produced when red blood cells break down - normally processed by the liver and excreted in bile.
have a deficiency in an enzyme called UDP-glucuronosyltransferase, which is responsible for processing bilirubin.
As a result, bilirubin levels in the blood can become elevated, leading to jaundice (yellowing of the skin and eyes).
Gilbert’s syndrome is usually asymptomatic, but some people may experience fatigue, abdominal discomfort, or other mild symptoms.
Gilbert’s syndrome is usually diagnosed based on blood tests that show elevated levels of bilirubin, particularly after fasting or during illness.
signs of B12 deficiency
glossitis - swollen tongue
bleeding gums
and perphipheral neuropathy - tingling of the hands and feet
what is choledocholithiasis
the presence of a gallstone in the bile duct
presentation of choledocholithiasis
Abdominal pain in the upper right quadrant
Nausea and vomiting
Jaundice (yellowing of the skin and eyes)
Dark urine and pale stools
Fever and chills
what is ascending cholangitis
when the bile duct gets infected
presents with chariots triad - RUQ pain, fever and jaundice
what is acute cholecystitis
inflammation of the gall bladder
presents with RUG pain and fever
what is biliary colic
when a gall stone blocks the bile duct and the contraction of the bile duct causes pain
RUQ pain
what is gall stone pancreatitis
gallstone blocks the pancreatic duct
severe abdominal pain, nausea, vomiting, and fever.
what is gallstone ileus
gall stone blocks the small intestine and causes constipation and obstruction
presentation of small bowel obstruction
Cannot pass gas or stool and very painful
Presentation of large, bowel obstruction
Lower abdominal pain blood in the stool
Investigation and imaging for acute cholecystitis
Use ultrasound to see the stone
MRCP, for imaging of the gallstones and ER CP, for treatment of the gallstones to give IV fluids and cholecystectomy
What is the most common cause of ascending cholangitis?
E. coli
What analgesia do you get for gallstones?
NSAIDs, but more specifically diclofenac
In what condition do you not give NSAIDS
If the patient has ulcers
Presentation and features of appendicitis
Rovsing sign is positive Murphy. Sign is positive is the information of the appendix common in young/teenagers characterised by pain in the centre that radiates to the right side right iliac fossa pain colicky in nature.
What is the management of appendicitis?
Surgical removal if the appendix has ruptured, then do emergency operation, as can spread bacteria to the blood and cause sepsis
What is the pathophysiology of pancreatitis?
Trypsinogen is a precursor to trypsin, and is found in the pancreas and is released in the in active form
In pancreatitis, it can become active and turn into trypsin and attack the pancreas and caused it to break down
What is the investigation for pancreatitis?
Always check for lipase and amylase, as they are released when trypsin breaks down the pancreas
Why does pancreatitis cause hypocalcaemia?
On the breakdown of the pancreas, due to the trypsin free fatty acid is released, which binds to calcium causing hypocalcaemia
What are the symptoms of pancreatitis?
Epigastric pain that radiates to the back fever, nausea and vomiting. Pale stools increase in fatty acids.
What is an importer differential to rule out from a cute pancreatitis
AAA abdominal aortic aneurysm at present with epigastric/chest pain, make sure to do an ECG to rule this out
What is the management for AAA?
If the aneurysm is 4.5 to 5.5 but asymptomatic, then measure again in three months, if we aneurysm is symptomatic or more than 5.5 do surgery
What is primary biliary cholangitis?
It is an inflammation of the biliary ducts, autoimmune common.
In FAT FORTY Females
It causes cirrhosis of the bowel duct and jaundice severe itching
It is due to IgM antibodies
AMA antibodies
raised ALP
Associated with rheumatoid arthritis/thyroid disease/other autoimmune conditions
What is primary sclerosing cholangitis?
Inflammation of the right and left hepatic ducts of autoimmune cause
Caused by IgG antibodies and associated with IBD, so Crohn’s or ulcerative colitis
What is the presentation of primary sclerosing cholangitis?
Viva, jaundice figure, hepatic duct, itchiness, and liver problems
Investigation for primary sclerosing cholangitis
ERCP
Investigation for primary biliary cholangitis
MRCP and ultrasound to rule out anything else
Management of primary biliary cholangitis
urosodeoxycholic acid
and cholestyramine for the itching
