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
Medication
Surgery
Diltiazem, lidocaine, GTN, Botox
Lateral sphincterotomy- relax anal sphincter
Appendicitis aetiology
Gut organisms invade the appendix wall after lumen obstruction e.g by lymphoid hyperplasia, faecolith, filarial worms
Leads to oedema, ischaemic necrossis and perforation
Symptoms of appendicitis
Anorexia, Constipation, Diarrhoea
Signs of appendicitis
Tachycardia, fever, furred tongue, foetus, shallow breaths, guarding
3 signs of appendicitis
Rovsings- Palpaton of left iliac fossa
Psoas-Pain on extending the hip
Cope- Flexion and internal rotation of the hip
Bloods
wcc- neutrophils and CRP
Imaging for appendicitis
CT and US may help
Medication
Cefuroxime and metronidazole
Complications of appendicitis
Perforation
Appendix mass – covered with momentum
Appendix abscess = may occur if appendix mass fails to resolve
Autoimmune hepatitis is
Chronic hep with hyperglobulinaemia
May lead to hepatocyte expression of HLA antigens– focus of T cell mediated
2 types of autoimmune hepatitis
Type 1
Type 2
Type 1 ANA ASMA Anti Actin Antibodies Anti SLA
Type 2
Antibodies to liver/kidney microsomes = ALKM-1
Antibodies to liver cytosol antigen ALC-1
Presentation of autoimmune hepatitis
insiduous
Acute hepatitis
Malaise, fatigue, anorexia, weight loss, nausea, amenorrhoea, epistaxis
Fever, anorexia, nausea/diarrhoea, serum sickness- arthralgia polyarthritis, maculopapular
Signs of autoimmune hepatitis on physical examination
> chronic liver disease stigmata e.g spider naevi
Ascites, oedema and hepatic encephalopathy are late features
Cushingoid features may be present even before steroids are given
Investigations results
bloods: high LFTs and bilirubin, low albumin
clotting- PT increased
FBC low Hb, platelets and WCC
Hyper gamma globulinaemia ANA, ASMA and Anti LKM
To rule out other liver conditions
Biopsy: hep vs cirrhosis
Viral serology Urinary copper/caeruloplasmin fERRITIN AND TRANSFERRIN SATURIATION a1 antitrypsin anti mitochondrial antibodies
