gastro Flashcards
achalasia
loss of oesophageal peristalsis and inability for lower oesophageal sphincter to relax.
type 1- no contraction at all- gravity does it
type 2- pressure gradually builds- most common.
presents with dysphagia to both solids AND liquids.
unknown aetiology- possibly assoc with autoimmune destruction of myenteric plexus.
RF: triple A(allgrove) syndrome (adrenal + alacrmia insufficiency)
Ix: UGI endoscopy
barium swallow- bird beak sign.
high-res oesophageal mannometry.
Rx: CCB or nitrates pre meal to help (nifedipine, verapamil)
definitive rx is surgery- baloon dilation
or cardiomyotomy
can do botox if not for surgery.
ascites
collection of fluid within the peritoneal cavity
commonly caused by chirrosis (75%)
abnormalities in portal and splanchnic circulation combined with renal flow issues–> activate RAAS –> retain sodium –> increaced resistance to portal flow + leakage.
S+S: distending abdomen, shifting dullness, increaced weight.
CONCERN- spont bacterial peritonitis- emergency and needs washout surgically. Ascites polymorphonuclear leukocyte (PMN) count >250/mm³ is confirmatory.
Ix: serum ascitic albumin gradient testing- more than 11.1- portal hypertension
less than 11- not portal- think fungal, chlaymdia etc.
USS to confirm if there or not + grading (1-3)
diagnostic paracentesis
Rx: spironalactime 1-400 mg OD.
low Na diet.
eosinophilic eosophagitis
an immune/ allergen mediated condition- eosinophils infiltrate the oesoph.
children and young adults.
S+S: dysphgia, vom, reflux, abdo pain failure to thrive.
Rf: family history, male, atopic disease, white.
Ix:
OGD
to confirm- biopsy- need 15 per slice, without systemic eosinophilia.
Rx: topical (dissolve + swallow saliva) steroids -budesonide
or omep
or dietary elimination therapy.
complication: strictures can form causing permanent issues, fix with surgery.
haemochromocytosis
Iron overload
leads to organ damage via oxidative stress (free radicals)
iron deposition in the liver, panc, skin, hear, joints.
hepcidin is not made, meaning there is no inhibition of iron absorbtion
S+S: triad of liver chirrhosis, 2’ diabetes, bronze skin.
also malaise, arthralgia, hepatomegaly.
can be caused by recessive dirosder (1 in 200 carrier)
Ix: bloods- serum ferritin- inc.
total iron binding may be low.
liver biopsy-
Rx: phlebotomy
diet
chelating drugs- odd names.
hepatocellular carcinoma
usually due to chirrosis, chronic hep b can also cause.
often asymptomatic- requires screening.
S+S: RUQ pain, jaundice, distension, pede,a (leg), weight loss
Ix: mass on abdo imaging
increaced Alphafetoprotein (AFP)
biopsy not usually needed.
Rx: criteria for transplantation- one lesion 5cm or less
2-3 lesion 3cm or less
generally surgery- resection if liver still pretty good, or radio frequency ablation
transplant if appropriate.
end stage disease- chaemo stuff.
complications: jaundice, cachexia, hypoglycaemia.
malabsorbtion
signs- anaemia, bleeding disorders, oedema, metabolic bone disease, neuro features
symptoms: diarrhoea, wt loss, steatorrhoea, bloating
coeliac disease, chronic panc and chrons are the most common
Ix: test for coeleac, panc enxymes etc.
Rx: due to cause, either gluten avoidance, or other drugs.
