Gastro II Flashcards
Symptoms of barrett’s
Waterbrash, Nausea, abLOATING, belching, Burning pain when swallowing
High grade dysplasia/ pre-malignant barrets management
oesophageal resection, eradicative mucosectomy
endoscopic targeted mucosectomy, mucosal ablation by epithelial laser, radiofrequency HALO or photodynamic ablation PD
Low grade barretts
annual endoscopic surveillance,
no premalignant changes: surveillance endoscopy and biopsy performed, anti reflux measures–PPI
Biliary colic is
Pain due to obstruction of gallbladder or common bile duct, usually by a stone. Felt in Upper abdomen- in the midline or the right.
Aetiology of biliary colic
Due to contractions of the biliary tree
4F’s risk factors to which condition
Biliary colic
Forty, female, fat, fertile, fair
Symptoms of biliary colic
Nausea, pain in Right UQ/epigastric pain, Pain may radiate to right scapula, pain does not fluctuate and has a tendency to persist
When may biliary colic patients present with pain
After having a fatty meal
Imaging for biliary colic and look for
US– dilatation of CBD, gallbladder wall may be thickened
ERCP- Diagnostic and therapeutic for stones, stent for blocked bile duct
CT may be useful if other forms of imaging have been insufficient
Management of biliary colic
Analgesics IV NBM Surgical: laparoscopic cholecystectomy ERCP- Diagnostic and therapeutic for stones, stent for blocked bile duct
Complications of surgery–injury to bile duct, fat intolerance- due to inability to secrete large amounts of bile into intestine due to absence of gall bladder
Post cholecystectomy syndrome- presence of abdominal symptoms e.g dyspepsia
Cholecystitis is
Inflammation of the gall bladder
Types of stones with cholecystitis
Mixed: Contains cholesterol, calcium bilirubinate, phosphate and protein - due to imbalance between bile salts, phopholipids, cholesterol. nucleation factors and gallbladder
Pure cholesterol stones
Pigment stones:black stones made of calcium bilirubinate – formed due to increased bilirubin
Risk factors of cholecystitis
Diabetes mellitus, Drugs (OCP, Octreotide) Family history
Pigment stone RF: Haemolytic disorders
Presenting symptoms of cholecystitis
Systemically unwell, fever, prolonged abdominal pain, pain may be referred to right shoulder
Signs of cholescystitis
Murphy’s sign
RUQ pain or epigastric tenderness
Tachycardia
Pyrexia
Bloods for cholecystitis
High WCC: in cholecystitis and cholangitis
LFT: High ALP and GGY in ascending cholangitis
Blood cultures, Amylase to exclude pancreatitis
Imaging for cholecystitits
USS-shows gallstones
Increased thickness of gallbladder wall
Dilation of biliary tree
AXR-but only 10% are radio opaque
Management for cholecystitis
Mild/Conservative: Low-fat diet
Medical: NBM IV fluids Analgesia ANTI EMETICS ANTIBIOTICS-if infection is present, if symptoms persist despite this suspect a localised abscess or empyema
If obstruction is present-urgent biliary drainage by ERCP
Surgical:
laparoscopic cholecystectomy
Complications of stones within the gallbladder
Biliary colic
Cholecystitis
Gallbladder empyema
Gallbladder cancer
Complication of stones outside the gallbladder
Obstructive jaundice Pancreatitis Ascending cholangitis Cholecystoduodenal fistula Gallstone ileus Bouveret syndrome - Gallstones cause gastric outlet obstruction Mirizzi syndrome
Complications of Cholecystectomy
Infection Bleeding Bile leak Post cholecystectomy syndrome Port-site hernia
Decompensated cirrhosis
Ascites, Jaundice, Encephelopathy, GI bleed
Decompensation precipitated by
infection, GI bleeding, constipation, high protein meal, electrolyte imbalances, tumour development or portal vein thormbosis
Risk factor drugs for cirrhosis
Methotrexate hepatoxic drugs
