Gastro Flashcards
What are oesophageal varices?
Dilated veins at the junction between the portal and systemic venous systems
Where are varices found?
Distal oesophagus
Proximal stomach
How do varices present?
Haematemesis
Malaena
Abdo pain
Shock
What are the causes of oesophageal varices?
Portal hypertension from alcoholic and viral cirrhosis
Portal vein thrombosis
Budd-Chiari syndrome
How are varices diagnosed?
Endoscopy
Clotting and INR
FBC, G&S
LFTs
What are the principles of management of oesophageal varices?
Resuscitation
Early risk stratification with Blatchford and Rockall score
Control variceal bleeding
How is a patient with oesophageal varices resuscitated?
ABCDE
Crystalloid bolus
Transfusion: platelets (if active bleeding and count <50x10^9) or FFP (if fibrinogen <1g/L)
How is arrest of variceal bleeding implemented?
Terlipressin
Stop after definitive haemostasis/after 5 days
What are other management options to stop variceal bleeding?
Balloon tamponade if uncontrolled haemorrhage
Band ligation
Transjugular intrahepatic portosystemic shunts (TIPS)
What are the causes of pancreatitis?
Gallstones Alcohol Hypothermia Post ERCP Hyperparathyroidism Malignancy IBD Uraemia Thromboembolism
What are the symptoms of pancreatitis?
Severe epigastric/LUQ pain, penetrates to the back which steadily decreases over 72h, vomiting
What are the main signs of pancreatitis?
Cullen’s: bruising around the umbilicus
Grey Turner’s: bruising around the flanks
Both signs of retroperitoneal haemorrhage
Pyrexia, tachycardia, abdo tenderness with rigidity, hypotension
Why is morphine CI in pancreatitis?
Spastic effect on Sphincter of Oddi
How is pancreatitis diagnosed?
Serum amylase >3x normal
Lipase
CT with contrast
How is pancreatitis managed?
Pethidine or buprenorphine
IV fluids
NBM
IV abx if pancreatic necrosis
Name three complications of pancreatitis?
Pancreatic abscess/pseudocyst/necrosis
DIC, haemorrhage
Sepsis and renal failure
What is chronic pancreatitis and how does it occur?
Chronic inflammation of the pancreas which results in irreversible damage
Obstruction/reduction in bicarbonate excretion which activates pancreatic enzymes, leading to pancreatic tissue necrosis with fibrosis
What are the risk factors for chronic pancreatitis?
Alcohol
Smoking
Biliary tract disease
Cystic fibrosis
What are the symptoms of chronic pancreatitis?
Epigastric pain radiating to the back
Nausea and vomiting
Exocrine dysfunction (malabsorption, weight loss, diarrhoea, steatorrhoea)
Endocrine dysfunction (diabetes mellitus)
How is chronic pancreatitis diagnosed?
Normal amylase
Secretin stimulation test positive if 60% exocrine function damaged
CT or MRCP
Faecal elastase
What is the treatment of chronic pancreatitis?
Opiates/coeliac plexus block
Creon - replace pancreatic enzymes
SC octreotide
Pancreatoduodenoectomy
What is the treatment of IBS diarrhoea?
Loperamide
What is the treatment of IBS constipation?
Laxatives (not lactulose)
What is the treatment of IBS abdominal pain?
Anti-spasmodics - mebeverine
Hyoscine
What are the characteristics of globus pharyngis?
Sensation of having a lump in the throat, intermittent, relieved by food and drink, swallowing saliva is difficult.
What is achalasia?
Disorder of motility of lower oesophageal sphincter
Smooth muscle layer of oesophagus has impaired peristalsis and fails to relax
Reduced secretion of nitric oxide
What are the symptoms of achalasia?
Dysphagia of solids
Regurgitation
Retrosternal chest pain/heartburn
What is seen on barium swallow in achalasia?
Dilated oesophagus
Contrast passes slowly into the stomach as the sphincter opens intermittently
Distal oesophagus - Bird’s beak
Then, oesophageal manometry
What is the treatment of achalasia?
CCB/nitrates
Balloon dilatation of the LOS
Heller myotomy
What is the appearance of oesophageal carcinoma on barium swallow?
Rat’s tail
What is a pharyngeal pouch?
Posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
What are the symptoms of pharyngeal pouch?
Halitosis
Dysphagia
Regurgitation
Aspiration and chronic cough
What are two risk factors for oesophageal candidiasis?
History of HIV
Steroid inhaler use
What are the oesophageal characteristics of systemic sclerosis?
Oeosphageal dysmotility and decreased pressure of LOS.
What are the symptoms of oesophageal carcinoma?
Weight loss
Progressive dysphagia
Anorexia
Vomiting during eating
What is Wilson’s disease?
Hepatic copper deposition caused by mutations in the ATP7B gene on chromosome 13
What is the inheritance of Wilson’s disease?
Autosomal recessive
What is the pathophysiology of Wilson’s disease?
Hepatocytes cannot move copper across intracellular membranes; serum copper concentrations are low and hepatic retention of copper develops