Gastro I Flashcards
Symptoms of Achalasia
Heartburn, regurgitation particularly at night, chest pain- cramping
Achalasia- Shown on CXR
Air fluid level in in upper chest
Absence of normal gastric air bubble
Barium Swallow shows
Dilated oesophagus which smoothly tapers down to the sphincter
Manometry shows
Absence of peristalsis in the smooth muscle portion of the oesophagus and >45mmhg
What is Acute Cholangitis
infection of the bile duct
causes of Acute Cholangitis
Tumours pancreatic/cholangiocarcinoma , bile duct strictures or stenosis, obstruction of gall bladder or bile duct due to stones, parasitic infection ascariasis, ercp
Uncommon presentation in acute cholangitis
peritonitis
Bloods of acute cholangitis
increased WBC CRP/ESR POSSIBLE LFT - pattern of obstructive jaundice increased ALP and GGT UandE signs of renal dysfunction Blood cultures check for sepsis Amylase may be raised
Why might the Amylase be raised
Due to involvement of lower part of common bile duct
What to look for in imaging
Stones and enlarged bile duct
overall management
Antibiotics Cefuroxime and metronidazole
Endoscopic biliary drainage
Management for different stages
What might indicate a severe stage
Mild-antimicrobial therapy, percutaneous, endoscopic or operative intervention
Moderate-early percutaneous/endoscopic biliary drainage
Severe- sepsis, conscious disturbance, acute lung injury, AKI, hepatic injury or DIC
- Treatment of organ failure e.g vasopressors
- Urgent percutaneous or endoscopic drainage
Alcoholic hepatitis- histopathological features
Centrilobular ballooning, degeneration and necrosis of hepatocytes, steatosis, neutrophilic inflammation, cholestasis, mallory hyaline inclusions-eosinophilic intracytomplasmic aggregates of cytokeratin intermediate filaments, giant mitochondria
Presenting symptoms: mild, more severe
Mild:Epigastric pain, nausea, malaise, low grade fever
More severe: Swollen ankles, GI bleeding
Signs of alcohol excess
Testicular atrophy, gynaecomastia, parotid enlargment
Signs of severe alcoholic hepatitis
Febrile, tachycardia, splenomegaly
Bloods for alcoholic hepatitis
Clotting
Low hb, high mcv, high wcc, low platelets, high LFT, high bilirubin low albumin
Prolonged pt
U and e for alcoholic hep
low K+, LOW urea
Imaging
Ultrasound for possible malignancy, Upper GI endoscopy for varices, liver biopsy possible malignancy, EEC for encephalitis
Management
Pabrinex- vitamin c and others
Monitor and correct Mg 2+, k+ glucose
Urine output
Treat encephalopathy with lactulose or phosphate enemas
Ascites- diuretics spironolactone/ frusemide
Glypressin and N-acetylcyesteine for hepatorenal syndrome
vit b parenterally then orally
Steroid therapy
Management nutrition
oral/ng feeding
protein restriction avoided unless patient is encephalopathic
Hepatorenal sydrome
Renal failure.Abnormalities in blood vessel tone in kidneys. Blood vessels constrict because of dilation of blood vessels in splanchic circulation.
Leads to reduced effective volume of blood detected by juxtaglomerular apparatus, leads to activation of RAS and vasoconstriction of vessels in kidney.
Anal fissure second cause
Anal sphincter spasm can constrict the inferior renal artery causing ischaemia and impairing healing process
Tears on which lining
Squamous lining