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Revision all topics > Gastro, Hepatobiliary, Surgery > Flashcards

Gastro, Hepatobiliary, Surgery Flashcards

1
Q

What is the epithelium lining for the oesophagus? The stomach?

A

Oesophagus: stratified squamous

Stomach: columnar

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2
Q

Symptoms of dyspepsia?

A

Heartburn
Acid regurgitation
Retrosternal pain
Hoarse voice
Bloating

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3
Q

Red flag symtoms for GORD?

A

DYSPHAGIA of any kind, any age
Symptoms at >55
Anaemia
Weight loss
Anorexia
Recent onset
Malaena/haematemesis

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4
Q

Conservative management for GORD?

A

Conservative:
Avoid alcohol, spicy foods
Weight loss
Stop smoking
Stay upright after eating
Smaller, lighter meals

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5
Q

Medical management for GORD?

A

Gaviscon/Rennie to neutralise acid
PPIs
Ranitidine (H2 antagonist) if PPI not tolerated

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6
Q

Surgical management of GORD?

A

Laparoscopic fundoplication

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7
Q

Tests for H pylori?

A

Urea breath test (drink radiolabelled C13)
Stool antigen test
CLO test (endoscopy and biopsy)

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8
Q

1st line treatment for H pylori? Duration?

A

triple therapy: omeprazole, amoxicillin, clarithromycin for 7 days

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9
Q

Treatment for H pylori if 1st line is ineffective after 4-8 weeks?

A

Omeprazole, amoxicillin, metronidazole

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10
Q

Treatment for H pylori if penicillin allergy?

A

Omeprazole, metronidazole, clarithromycin

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11
Q

When is retesting for H pylori done? Which test is used?

A

4-8 weeks after by urea breath test

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12
Q

Strongest risk factor for Barretts?

A

GORD

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13
Q

Treatment for Barretts?

A

-PPI
-ANY kind of dysplasia is treated endoscopically (mucosal resection/radiofrequency ablation)

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14
Q

What is the management of dyspepsia symptoms?

A

One of:
1. Full dose PPI 1 month

  1. Test for H pylori and treat if positive.

If symptoms persist, do the other option

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15
Q

What core symptoms must be present for diagnosis of IBS? For how long?

A

ABC:
Abdominal pain, bloating, change in bowel habit.
For at least 6 months

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16
Q

Other symptoms of IBS?

A
  • Change in stool passage (straining, urgency, incomplete evacuation)
  • Abdo pain relieved by defecation
  • Passage of mucus
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17
Q

What other tests must be done before diagnosing IBS?

A
  • Anti tTG
  • Faecal calprotectin
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18
Q

Conservative management for IBS?

A
  • exercise
  • good diet (fluid, small regular meals, reduced processed food, reduce caffeine and alcohol, avoid triggers)
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19
Q

Medical management for IBS?

A

-Loperamide for diarrhoea
-Laxatives for constipation (avoid lactulose –> bloating)
-TCA 2nd line
-SSRI 3rd line

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20
Q

Peak incidence of ulcerative colitis?

A

15-25 and 55-65

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21
Q

Most common site of inflammation in UC?

A

Rectum

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22
Q

Symptoms of UC?

A

-Bloody diarrhoea
-Tenesmus
-Abdominal pain in LLQ
-Fever, malaise, weight loss, anorexia

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23
Q

Extra-intestinal signs of UC?

A

-Erythema nodosum
-Pyoderma gangrenosum
-Uveitis
-Large joint arthritis/AS
-PRIMARY SCLEROSING CHOLANGITIS

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24
Q

What imaging is done for UC? How does this change for those with severe UC?

A

-Colonoscopy and biopsy. If severe, flexible sigmoidoscopy
-Barium enema shows loss of haustration
-AXR shows lead pipe appearance

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25
Q

Medication to induce remission in UC? How does induction change in severe UC?

A

-Topical/oral 5ASA
-Topical/oral steroid
Step up as required, with topical then oral

If severe,
-Admit for IV steroids
-IV ciclosporin if not responding

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26
Q

What do you give if there are >2 exacerbations of UC in 1 year?

A

Oral azathioprine

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27
Q

What to give to maintain remission of UC?

A

topical +-/ oral 5ASA

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28
Q

Features of UC (U C CLOSEUP)?

A

-Continuous inflammation
-Limited to rectum and colon (up to ileocaecal valve)
-Only superficial mucosa affected
-Smoking protective
-Excrete blood + mucus
-Use aminosalicylates
-PSC

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29
Q

Symptoms of CD?

A

-Diarrhoea most common +/- blood
-Abdo pain
-Perianal disease
-Systemic unwellness
-Cobblestone appearance of gut

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30
Q

Extra-intestinal symptoms of CD?

A

-Erythema nodosum
-Pyoderma gangrenosum
-Apthous ulcers
-Episcleritis
-Large joint arthritis

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31
Q

What is seen on biopsy in UC vs CD?

A

UC: inflammation up to submucosa, crypt abscess

CD: transmural inflammation, goblet cells, granulomas

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32
Q

What is seen on enema of CD?

A

-Kantor string sign - strictures in terminal ileum
-Proximal bowel dilation
-Rose thorn ulcer (contrast highlights ulcers that poke deep into bowel wall like a rose thorn)

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33
Q

Important lifestyle change for CD?

A

Stop smoking

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34
Q

What is used to induce remission in CD?

A

Glucocorticoids

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35
Q

What is used to maintain remission in CD?

A

Azathioprine
Methotrexate 2nd line

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36
Q

Features of CD? (NESTS)

A

No blood mucus
Entire GI tract
Skip lesions on endoscopy
Terminal ileum most affected/transmural inflammation
Smoking risk factor

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37
Q

2 most common causes of peptic ulcers?

A

H pylori
NSAIDs/steroids

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38
Q

Treatment for confirmed peptic ulcer?

A

Full dose PPI for 4-8 weeks
H pylori eradication if positive

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39
Q

Follow up after treatment gastric ulcers? Duodenal ulcers?

A

Gastric: endoscopy 6-8 weeks after PPI to check healing and malignancy

Duodenal: no endoscopy needed

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40
Q

Presentation of upper GI bleed?

A

Haematemesis
Melaena
Signs of hypovolaemic shock

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41
Q

What is seen on blood test in upper GI bleed?

A

Raised urea

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42
Q

Scoring systems used to assess risk of upper GI bleed?

A

Glasgow Blatchford before endoscopy
Rockall score after endoscopy for rebleeding

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43
Q

Management of upper GI bleed? (ABATED)

A

ABCDE
Bloods
Access (2 large bore)
Transfuse (FFP/platelets/prothrombin)
Endoscopy (OGD)
Drugs (stop anticoagulants/NSAIDs)

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44
Q

Recommended alcohol intake per week?

A

14 units weekly men and women

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45
Q

Signs of liver disease?

A

-Jaundice
-Ascites
-Varices (oesophageal, rectal)
-Caput medusae
-Spider naevi
-Encephalopathy
-Palmar erythema
-Asterixis
-Bruising
-Gynaecomastia

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46
Q

Pattern of LFTs in alcoholic liver disease?

A

AST and ALT raised (AST:ALT >3)
-GGT raised
-Low albumin
-Raised PT

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47
Q

Imaging done in alcoholic liver disease?

A

US - increased echogenicity, cirrhotic changes, Fibroscan

Endoscopy - assess and treat oesophageal varices

CT/MRI - fatty infiltration, HCC, organomegaly, ascites

Liver biopsy - can confirm diagnosis

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48
Q

Management of alcoholic liver disease?

A

-Stop drinking
-Detox regime + thiamine
-High protein, low salt diet
-Steroids improve short term outcomes
-Treat complications of cirrhosis

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49
Q

Incidence of Coeliac?

A

1%

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50
Q

Which antibodies are associated with Coeliacs?

A

anti TTG
anti EMA

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51
Q

Which part of the bowel is most affected by Coeliacs?

A

Jejunum

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52
Q

Which HLA types are most associated with Coeliacs?

A

HLADR2 and HLADR8

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53
Q

Presentation of Coeliacs?

A

-Failure to thrive
-Abdominal pain
-Foul smelling diarrhoea difficult to flush
-Weight loss
-Fatigue
-Iron deficient anaemia

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54
Q

Complications that can occur from Coeliacs?

A

-Anaemia
-Osteoporosis
-Hyposplenism
-Lactose intolerance
-T cell lymphoma of small intestine if continuing to eat gluten
-GI malignancy

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55
Q

What tests for Coeliac? What must the patient do prior to testing?

A

Patient must be eating gluten for at least 6 week to prove presence of inflammation
-Total IgA levels
-Specific coeliac antibodies (anti TTG, anti EMA)
-Endoscopy with intestinal biopsy is gold standard (crypt hyperplasia, villous atrophy, intraepithelial lymphocytosis)

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56
Q

Management of Coeliac?

A

Gluten free diet
Offer pneumococcal vaccine if hyposplenism

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57
Q

Causes of liver cirrhosis?

A

NAFLD
Alcoholic liver disease
Hepatitis B and C

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58
Q

Blood results in someone with liver cirrhosis?

A

-LFTs all deranged
-Low albumin and prolonged PT
-Hyponatraemia in fluid retention (Ascites)
-Urea and creatinine raised in hepatorenal syndrome
-AFP used to screen for HCC
-ELF test in NAFLD

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59
Q

What might US show in liver cirrhosis?

A

-Nodular liver surface
-Corkscrew appearance of arteries that have increased flow
-Enlarged portal vein with reduced flow
-Ascites
-Organomegaly

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60
Q

What scoring system is used to assess severity and prognosis of liver cirrhosis?

A

Child-Pugh score

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61
Q

What scoring system is used to assess for mortality in those with compensated cirrhosis?

A

MELD score

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62
Q

Management of liver cirrhosis?

A

-US and AFP every 6 months for HCC
-Endoscopy if varices
-High protein, low sodium diet
-MELD score 6 monthly

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63
Q

Complications of liver cirrhosis?

A

-Malnutrition
-Ascites
-Varices
-Hepatic encephalopathy
-Spontaneous bacterial peritonitis
-Hepatorenal syndrome

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64
Q

What is SAAG and how is it calculated

A

Serum Ascites Albumin Gradient helps to clarify the cause of ascites.

serum albumin conc - ascites albumin conc

High SAAG (raised portal pressure)
Low SAAG (cancer, infection)

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65
Q

What criteria diagnoses SBP?

A

Neutrophils in ascitic fluid >250cells/microlitre

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66
Q

Most common cause of SBP? Treatment?

A

E.coli
Cefotaxime

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67
Q

What is seen on bloods in hepatorenal syndrome?

A

Raised urea and creatinine

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68
Q

What is given to treat hepatic encephalopathy?

A

Lactulose to remove ammonia
Rifaximin to kill bacteria that creates ammonia

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69
Q

How does hepatorenal syndrome occur?

A

Dilation of portal vessels reduces blood flow to other areas. In kidneys, reduction of blood flow causes RAAS. There is vasoconstriction leading to further reduction in blood flow to kidneys, resulting in rapid deterioration in kidney function

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70
Q

Risk factors for NAFLD?

A

NAFLD is part of the metabolic syndrome, so risk factors:
-OBESITY
-Hyperlipidaemia
-T2DM
-Smoking
-Hypertension

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71
Q

What is shown on US of NAFLD?

A

-Hepatomegaly
-Increased echogenicity

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72
Q

Pattern of LFTs in NAFLD?

A

ALT > AST (opposite of alcoholic liver disease)

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73
Q

Management of NAFLD?

A

Lifestyle changes and monitoring
-Stop smoking
-Exercise/weight loss
-Control diabetes, BP, cholesterol
-Avoid alcohol

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74
Q

Causes of hepatitis?

A

-Alcoholic hepatitis
-NAFLD
-Viral hepatitis
-Autoimmune hepatitis
-Drug induced hepatitis

75
Q

Symptoms of hepatitis?

A

-Abdo pain
-Fatigue
-Pruritus
-Muscle and joint pain
-N&V
-Jaundice
-Fever

76
Q

Pattern of LFTs seen in hepatitis?

A

-Deranged, raised AST and ALT, smaller increase in ALP
-Increase in bilirubin

77
Q

Transmission of HepA?
Typical history?

A

-Faecal-oral route (contaminated water/food)
-Typically recent travel, eating potentially dirty foods and presenting a few weeks later with hepatitis symptoms

78
Q

Transmission of HepB?

A

Contact with blood/bodily fluids

79
Q

Presence of HBsAg means?

A

Active infection

80
Q

Presence of HBeAg means?

A

Viral replication, high infectivity

81
Q

Presence of HBcAb IgM means?

A

Recent/acute infection <6 months ago

82
Q

Presence of HBcAb IgG means?

A

Past infection >6 months ago

83
Q

Presence of HBsAb means?

A

Past/current infection with antibodies or vaccinated

84
Q

What HepB serology would you see in those immunised?

A

HBsAb, all others negative

85
Q

What HepB serology would you see in someone who has had previous infection but not a carrier?

A

HBcAb +ive
HBsAg -ive

86
Q

What HepB serology would you see in someone who has had previous infection and is a carrier?

A

HBcAb +ive
HbsAg +ive

87
Q

Early symptoms of haemochromatosis?

A

Fatigue
Erectile dysfunction
Arthralgia

88
Q

Other symptoms of haemochromatosis?

A

Bronze skin
T1DM
symptoms of liver disease
Hypothyroidism
Cardiac deposits

89
Q

Investigations for haemochromatosis?

A

-Transferrin saturation (>55% men, >50% women)
-Serum ferritin and iron raised
-Genetic testing
-Liver biopsy with Perl’s stain
-Joint Xray shows chondrocalcinosis

90
Q

Management of haemochromatosis?

A

-Venesection
Desferrioxamine 2nd line
-Avoid alcohol

91
Q

Usual onset of Wilson’s disease?

A

10-25 years

92
Q

Symptoms of Wilsons?

A

Brain: dysarthria, dementia, parkinsonism, depression, psychosis, chorea

Liver: hepatitis, cirrhosis

Cornea: Kayser-Fleischer rings

Renal tubular acidosis
Haemolysis
Blue nails

93
Q

Investigations for Wilson’s disease?

A

-Serum caeruloplasmin is low, serum free copper is high

-Slit lamp
-Genetic testing
-Liver biopsy is gold standard, looking for copper content

94
Q

Management for Wilsons?

A

Penicillamine to chelate copper

Trientine if penicillamine not tolerated

95
Q

Ratio of M:F for primary biliary cholangitis?

A

1:9

96
Q

What is PBC?

A

Intrahepatic inflammation of small bile ducts in liver

97
Q

Which condition is most associated with PBC?

A

Sjogren’s (80%)
RA

98
Q

Features of PBC?

A

-Middle aged woman with itching
-Fatigue
-Cholestatic jaundice, pale stool, steatorrhoea
-RUQ pain
-Xanthelasma, xanthomata

99
Q

What immunology is seen in PBC?

A

-serum IgM raised
-anti-mitochondrial M2 in 98%
-smooth muscle antibodies

100
Q

Pattern of LFTs in PBC?

A

ALP raised as obstructive pathology

101
Q

What complications of PBC?

A

RISK OF HCC x20
Cirrhosis

102
Q

Management of PBC?

A

1st line is ursodeoxycholic acid that slows disease progression and improves symptoms

Cholestyramine helps hyperbilirubinaemia and pruritus

Fat soluble vitamin supplementation

103
Q

What is primary sclerosing cholangitis?

A

Intra/extra hepatic ducts become sclerosed and fibrotic, causing obstruction to bile flow out of the liver

104
Q

What condition is associated with PSC?

A

UC

105
Q

Typical PSC patient?

A

Male, Aged 30-40 with UC and family history

106
Q

Symptoms of PSC?

A

Cholestasis (jaundice, pruritis, raised bilirubin and ALP)
RUQ pain
Fatigue
Hepatomegaly

107
Q

What is seen on LFTs in PSC?

A

-Deranged LFTs with ALP most raised
-Raised bilirubin

108
Q

What imaging is used to diagnose PSC and what feature is seen?

A

MRCP gold standard, can also do ERCP. Shows beads on a string appearance

109
Q

Immunology in PSC?

A

p-ANCA
anti smooth muscle
ANA

110
Q

Complications of PSC?

A

-Acute bacterial cholangitis
-Cholangiocarcinoma
-Increased risk of colorectoal cancer
-Cirrhosis and liver failure
-Fat soluble vitamin deficiency

111
Q

Management of PSC?

A

No definitive treatment
ERCP to stent strictures
Cholestyramine

112
Q

What types of liver cancer are there?

A

HCC (80%)
Cholangiocarcinoma (20%)

113
Q

Risk factors for liver cancer?

A

-Cirrhosis
-PSC
-PBC (20x)

114
Q

Painless jaundice associated with which cancer?

A

Pancreatic cancer
Cholangiocarcinoma

115
Q

Investigations for liver cancer

A

-AFP marker for HCC
-Ca19-9 marker for cholangiocarcinoma
-Liver US
-CT/MRI for diagnosis an dstaging
-ERCP for biopsies in cholangiocarcinoma

116
Q

Treatment for HCC and cholangiocarinoma?

A

-Poor prognosis
-Chemo/radio not effective
-Resection possible but needs to be early
-ERCP to relieve any obstructive symptoms in cholangiocarcinoma

117
Q

What can cause Budd Chiari syndrome?

A

-Polycythaemia rubra vera
-Thrombophilias
-Pregnancy
-COCP

118
Q

What triad of symptoms presents in Budd Chiari?

A

-Sudden onset, severe abdominal pain
-Ascites
-Tender hepatomegaly

119
Q

What is the first line investigation in Budd Chiari?

A

Doppler flow US

120
Q

What age range does acute appendicitis affect the most?

A

10-20

121
Q

Symptoms of acute appendicitis?

A

-Central abdominal pain radiating to RIF
-May have vomiting
-Mild pyrexia
-Anorexia

122
Q

Which signs can be elicited on examination of acute appendicitis?

A

Rovsing sign - palpation in LIF causes RIF pain

Psoas sign - pain on hip extension

McBurneys point is tender - 1/3 distance from ASIS to umbilicus

123
Q

What other conditions need to be excluded before diagnosing acute appendicitis?

A

Pregnancy, renal colic, UTI

124
Q

What does urinalysis show in acute appendicitis?

A

Leucocytes but no nitrites

125
Q

Management of acute appendicitis?

A

Laparoscopic appendicectomy with prophylactic IV antibiotics

126
Q

Complications of hernia?

A

Incarceration
Strangulation
Obstruction

127
Q

What are the main treatment options for hernia?

A

Conservative management if no symptoms and not suitable for surgery

Tension free repair preferred if surgical

128
Q

How to differentiate between direct and indirect inguinal hernia?

A

Reduce hernia, apply pressure to deep inguinal ring. Remains reduced if indirect hernia

129
Q

Risk factors for diverticulosis?

A

Age
Low fibre diet
Obesity
NSAIDs

130
Q

Presentation of acute diverticulosis?

A

LIF pain
Anorexia
N&V
Diarrhoea
Infection symptoms

131
Q

Management of chronic diverticulosis?

A

High fibre diet
Bulk forming laxatives (avoid stimulant)

132
Q

Management of acute diverticulosis?

A

NBM
IV fluids
IV antibiotics
Analgesia

133
Q

How much water is needed per day for maintenance fluids?

A

25-30ml/kg/day

134
Q

How much sodium, potassium and chloride is needed for maintenance per day?

A

1mmol/kg/day

135
Q

How much glucose is needed for maintenance per day?

A

50-100g/day

136
Q

What is the resuscitation fluid protocol?

A

-500ml bolus stat and reassess
-Repeat with boluses of 250-500ml and reassess
-Escalate if not responding after 2L

137
Q

Which medications need to be stopped/changed prior to surgery?

A

-Stop warfarin/DOACs
-Stop oestrogen medications 4 weeks prior
-Increase steroids
-Stop sulfonylureas, be careful with other diabetic drugs

138
Q

Explain 3rd spacing fluid loss

A

Obstruction in the bowel means that the fluid that usually gets secreted in the lumen cannot get by. It doesnt get reabsorbed in the colon so remains in the gut

139
Q

Causes of small and large bowel obstruction?

A

Adhesion (small)
Hernia (small)
Malignancy (large)

140
Q

Presentation of bowel obstruction?

A

-Bilious vomiting
-Abdominal distension and pain
-Absolute constipation
-Tinkling bowel sounds

141
Q

What investigations to be done when there is bowel obstruction?

A

AXR 1st line - distended loops of bowel

CXR - pneumoperitoneum

Contrast CT - gold standard

142
Q

Management of bowel obstruction

A

-A-E
-Bloods (electrolyte imbalance, metabolic alkalosis)
-Drip and suck (IV fluids, NG tube with drainage)
-Surgery

143
Q

Which 2 inherited conditions are the strongest risk factors for bowel cancer?

A
  1. Hereditary nonpolyposis colorectal cancer (Lynch syndrome)
  2. Familial adenomatous polyposis (FAP)
144
Q

What are the red flags that should make you consider bowel cancer?

A

-Change in bowel habit
-Unexplained weight loss
-Rectal bleeding
-Unexplained abdominal pain
-Iron deficiency anaemia
-Abdominal/rectal mass

145
Q

What tumour markers are used for cancers: colorectal, pancreatic, HCC, cholangiocarcinoma, ovarian, breast, prostate?

A

Colorectal - CEA
Pancreatic - Ca19-9
HCC - AFP
Cholangiocarcinoma - Ca19-9
Ovarian - Ca125
Breast - Ca15-3
Prostate - PSA

146
Q

What type of cancers are cholangiocarcinoma?

A

Cancer of the bile ducts - usually adenocarcinoma

147
Q

Risk factors for cholangiocarcinoma?

A

Primary sclerosing cholangitis

148
Q

Presentation of cholangiocarcinoma?

A

-PAINLESS, OBSTRUCTIVE JAUNDICE
-Unexplained weight loss
-Palpable gallbladder
-Hepatomegaly

149
Q

What investigations for cholangiocarcinoma?

A

-CT/MRI and biopsy for diagnosis
-CTTAP for mets
-CA19-9 tumour marker
-MRCP/ERCP to insert stent and biopsy

150
Q

Where does pancreatic cancer usually affect? What type of cancer

A

Usually adenocarcinomas of head of pancreas

151
Q

Symptoms of pancreatic cancer?

A

-PAINLESS, OBSTRUCTIVE JAUNDICE
-Unintentional weight loss
-Palpable mass in epigastric region
-Change in bowel habit
-N&V
-New or worsening of diabetes

152
Q

What investigations for pancreatic cancer?

A

-US has high sensitivity
-CTTAP for mets
-Ca19-9 marker
MRCP/ERCP for stent and biopsy

153
Q

What sign may be seen on imaging of pancreatic cancer?

A

Double duct sign - simultaneously dilation of common bile duct and pancreatic duct

154
Q

What management for pancreatic cancer?

A

Surgery:
-Total pancreatectomy, distal pancreatectomy
-Whipple procedure (Radical pancreaticoduodenectomy)/modified Whipple procedure (preserves pylorus)

Palliative care

155
Q

Most common cause of acute cholecystitis?

A

Gallstones

156
Q

Symptoms of acute cholecystitis?

A

-RUQ pain (may radiate to right shoulder)
-Fever
-N&V
-Tachycardia, tachypnoea
-Murphy’s sign
-Raised inflammatory markers and WBC

157
Q

Investigations for acute cholecystitis?

A

-Abdo US 1st line (thickened gallbladder wall, stones, fluid around gallbladder)
-MRCP can show biliary tree if stone not seen on US but suspected

158
Q

Management for acute cholecystitis?

A

-Conservative (NBM, IV fluids, Abx, NG tube)
- ERCP to remove stones in CBD
-Cholecystectomy

159
Q

What is acute cholangitis?

A

Infection and infection of bile ducts. High mortality due to sepsis

160
Q

Causes of acute cholangitis?

A

-Bile duct obstruction
-Infection from ERCP

161
Q

Most common organisms to cause acute cholangitis?

A

-E.coli
-Klebsiella
-Enterococcus

162
Q

Presentation of acute cholangitis?

A

Charcot’s triad
-RUQ pain
-Fever
-Jaundice

163
Q

Management of acute cholangitis?

A

-Emergency admission for sepsis and investigations
-NMB, IV fluids, blood culture, IV abx, HDU/ICU

164
Q

Risk factors for gallstones?

A

4F’s:
-Fat
-Fair
-Female
-Forty

165
Q

Symptoms of gallstones

A

Can be asymptomatic
-Biliary colic in RUQ
-Pain triggered by meals (especially high fat)
-N&V

166
Q

Complications of gallstones?

A

-Acute cholecystitis
-Acute cholangitis
-Obstructive jaundice
-Pancreatitis

167
Q

Imaging for gallstones?

A

-US 1st line
-MRCP
-ERCP can be done to stent

168
Q

Management of gallstones?

A

Only if asymptomatic
-Cholecystectomy

169
Q

Triad of symptoms in chronic mesenteric ischaemia?

A

-Central colicky abdo pain after eating
-Weight loss (food avoidance)
-Abdominal bruit

170
Q

Diagnosis and imaging for mesenteric ischaemia?

A

CT angiography

171
Q

Management for chronic mesenteric ischaemia?

A

-Treat modifiable risk factors
-Clopidogrel and statins
-Revascularisation to improve blood flow to intestines by endovascular procedures such as mesenteric artery stenting

172
Q

Presentation of acute mesenteric ischaemia?

A

-Acute abdo pain
-Shock, peritonitis, sepsis
-Necrosis and perforation if untreated

173
Q

Diagnosis and imaging for acute mesenteric ischaemia?

A

-Contrast CT
-Bloods (METABOLIC ACIDOSIS AND RAISED LACTATE are highly suggestive)

174
Q

Management for acute mesenteric ischaemia?

A

Surgery to remove necrotic bowel or remove/bypass thrombus

175
Q

Causes of pancreatitis?

A

I GET SMASHED:
-Idiopathic
-Gallstones
-Ethanol
-Trauma
-Steroids
-Mumps
-Autoimmune
-Scorpion sting
-Hyperlipidaemia, hypercalcaemia
-ERCP
-Drugs (furosemide, thiazide diuretics, azathioprine, mesalazine)

176
Q

Presentation of acute pancreatitis?

A

-Severe epigastric pain radiating to back
-Associated vomiting
-Abdominal tenderness
-Systemically unwell

177
Q

Which blood markers are indicative of acute pancreatitis?

A

-Amylase raised 3x normal in acute pancreatitis
-Lipase more sensitive
-CRP

178
Q

Imaging for acute pancreatitis?

A

-US for gallstones
-CT abdomen assesses for complications (necrosis, abscess, fluid collection

179
Q

Management for acute pancreatitis?

A

-A-E
-IV FLUIDS
-NMB
-Analgesia
-Monitoring
-ERCP/cholecystectomy to treat gallstones
-Abx if infection

180
Q

Complications of acute pancreatitis?

A

-Necrosis of pancreas which can become infected
-Abscess formation
-Peripancreatic fluid collection
-Chronic pancreatitis

181
Q

Most common cause of chronic pancreatitis?

A

Alcohol

182
Q

Monitoring of chronic pancreatitis disease progression?

A

-Exocrine function as measured by faecal elastase
-Endocrine function as measured by diabetes

183
Q

Complications of chronic pancreatitis?

A

-Diabetes
-Obstruction of pancreatic juice
-Formation of pseudocysts and abscesses

184
Q

Management of chronic pancreatitis?

A

-Stop smoking
-Stop drinking
-Analgesia
-CREON
-Insulin
-ERCP to treat strictures/obstruction

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