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y3 > Gastro I > Flashcards

Gastro I Flashcards

1
Q

Symptoms of Achalasia

A

Heartburn, regurgitation particularly at night, chest pain- cramping

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2
Q

Achalasia- Shown on CXR

A

Air fluid level in in upper chest

Absence of normal gastric air bubble

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3
Q

Barium Swallow shows

A

Dilated oesophagus which smoothly tapers down to the sphincter

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4
Q

Manometry shows

A

Absence of peristalsis in the smooth muscle portion of the oesophagus and >45mmhg

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5
Q

What is Acute Cholangitis

A

infection of the bile duct

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6
Q

causes of Acute Cholangitis

A

Tumours pancreatic/cholangiocarcinoma , bile duct strictures or stenosis, obstruction of gall bladder or bile duct due to stones, parasitic infection ascariasis, ercp

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7
Q

Uncommon presentation in acute cholangitis

A

peritonitis

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8
Q

Bloods of acute cholangitis

A 
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
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9
Q

Why might the Amylase be raised

A

Due to involvement of lower part of common bile duct

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10
Q

What to look for in imaging

A

Stones and enlarged bile duct

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11
Q

overall management

A

Antibiotics Cefuroxime and metronidazole

Endoscopic biliary drainage

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12
Q

Management for different stages

What might indicate a severe stage

A

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
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13
Q

Alcoholic hepatitis- histopathological features

A

Centrilobular ballooning, degeneration and necrosis of hepatocytes, steatosis, neutrophilic inflammation, cholestasis, mallory hyaline inclusions-eosinophilic intracytomplasmic aggregates of cytokeratin intermediate filaments, giant mitochondria

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14
Q

Presenting symptoms: mild, more severe

A

Mild:Epigastric pain, nausea, malaise, low grade fever

More severe: Swollen ankles, GI bleeding

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15
Q

Signs of alcohol excess

A

Testicular atrophy, gynaecomastia, parotid enlargment

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16
Q

Signs of severe alcoholic hepatitis

A

Febrile, tachycardia, splenomegaly

17
Q

Bloods for alcoholic hepatitis

Clotting

A

Low hb, high mcv, high wcc, low platelets, high LFT, high bilirubin low albumin

Prolonged pt

18
Q

U and e for alcoholic hep

A

low K+, LOW urea

19
Q

Imaging

A

Ultrasound for possible malignancy, Upper GI endoscopy for varices, liver biopsy possible malignancy, EEC for encephalitis

20
Q

Management

A

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

21
Q

Management nutrition

A

oral/ng feeding

protein restriction avoided unless patient is encephalopathic

22
Q

Hepatorenal sydrome

A

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.

23
Q

Anal fissure second cause

A

Anal sphincter spasm can constrict the inferior renal artery causing ischaemia and impairing healing process

24
Q

Tears on which lining

A

Squamous lining

25
Q

Medication

Surgery

A

Diltiazem, lidocaine, GTN, Botox

Lateral sphincterotomy- relax anal sphincter

26
Q

Appendicitis aetiology

A

Gut organisms invade the appendix wall after lumen obstruction e.g by lymphoid hyperplasia, faecolith, filarial worms

Leads to oedema, ischaemic necrossis and perforation

27
Q

Symptoms of appendicitis

A

Anorexia, Constipation, Diarrhoea

28
Q

Signs of appendicitis

A

Tachycardia, fever, furred tongue, foetus, shallow breaths, guarding

29
Q

3 signs of appendicitis

A

Rovsings- Palpaton of left iliac fossa
Psoas-Pain on extending the hip
Cope- Flexion and internal rotation of the hip

30
Q

Bloods

A

wcc- neutrophils and CRP

31
Q

Imaging for appendicitis

A

CT and US may help

32
Q

Medication

A

Cefuroxime and metronidazole

33
Q

Complications of appendicitis

A

Perforation
Appendix mass – covered with momentum
Appendix abscess = may occur if appendix mass fails to resolve

34
Q

Autoimmune hepatitis is

A

Chronic hep with hyperglobulinaemia

May lead to hepatocyte expression of HLA antigens– focus of T cell mediated

35
Q

2 types of autoimmune hepatitis
Type 1

Type 2

A 
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

36
Q

Presentation of autoimmune hepatitis
insiduous

Acute hepatitis

A

Malaise, fatigue, anorexia, weight loss, nausea, amenorrhoea, epistaxis

Fever, anorexia, nausea/diarrhoea, serum sickness- arthralgia polyarthritis, maculopapular

37
Q

Signs of autoimmune hepatitis on physical examination

A

> 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

38
Q

Investigations results

A

bloods: high LFTs and bilirubin, low albumin
clotting- PT increased
FBC low Hb, platelets and WCC
Hyper gamma globulinaemia ANA, ASMA and Anti LKM

39
Q

To rule out other liver conditions

A

Biopsy: hep vs cirrhosis

Viral serology
Urinary copper/caeruloplasmin
fERRITIN AND TRANSFERRIN SATURIATION
a1 antitrypsin
anti mitochondrial antibodies

y3 (4 decks)

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