gastro Flashcards
lethargy, pruritus, minor inc in AST, GGT and inc in ALP
primary biliary colangitis
post mortem liver cirrhosis pathology
many nodules of liver tissues trhoughout liver with intervening bands (septa) of fibrous tissue
hgih anti smooth muscle antibodies
autoimmune hepatitis
high antimicrobial antibodies
primary biliary cholangitis
high serum transferrin saturation
haemochromatosis
steaotosis and mallory hyaline on liver biopsy
alcoholic hepatitis
ERCP
Endoscopic retrograde cholgangiopancratography. Useful if stunting is needed and can obtain tissue diagnosis for biopsy
MRCP
Diagnostic tool and best suited for suspected choledocholithiasis
Metastatic Gastric cancer treatment
Chemo may improve survival and QOL, palliative radiotherapy for treatment of GI bleed. Surgery only for non metastatic cancer
Stomach cancer RF
Adenocarcinoma most common. Inc age, male, poor SES, h. Pylori, smoking, poor diet, pernicious anaemia, blood group A, FH.
Can also present with ovarian masses
Large bowel in between diaphragm and liver
Normal!
8mm calculus in CBD Mx
Urgent ERCP and sphincterotomy stones retrieval. Stone can lead to sepsis and unlikely to pass unaided
Gastric cancer T2
tumour has grown into (but not through ) muscularis propria
Gastric cancer T4
Tumour has penetrated through Sherpas and peritoneal surface. N2= 4 or more lymph node involvement. N1 3 or less lymph nodes involved
Pseudo obstruction
Rectal air makes left sided obstruction less likely (in low left obstruction air is normally absent in rectum. A febrile and normal WCC suggests sepsis so making megacolon and abscess unlikely
generalised peritonitis
abdo pain, ridgidity, quiet bowel sounds, guarding= peritonitis
but usually localised (eg RIF- appendicitis, RUQ- cholecystitis.
generalised peritonitis in unwell pt: perforation of abdominal viscus
CXR for perforated vsicus
pneumoperitoneum. need metronidazole(anti anaerobic) and cefuroxime=for both gram + and - but pen is for gram + bacteria whilst gentamycin is good for gram -
incarcerated inguinal hernai exam
mass in scrotum: you can’t palpate above lump so not confined to scrotum and originate form abdomen- wither hydrocele of spermatic cord or inguinal hernia
loop ileostomy
defunctioning ileostomy.
The colon has been reconnected and so the ileostomy is temporary. This enables the point at which the bowel is joined (anastomosis) to heal prior to receiving faecal load. Then the surgeon will decide (~6months) to close the ileostomy (join the two ends), and replace the ileum into the abdominal cavity and close the abdominal wound. The loop ileostomy will have two orifices to it, compared to an end ileostomy which will have one.
end ileostomy
this means that everything distal to the ileum has been removed. i.e. colectomy. This is required in severe ulcerative colitis and some colon cancers.
when would you not do liver biopsy
extensive ascites, INR 2.5, HB 60, acute confusional state
