Gastroenterology 3.0 Flashcards
Which treatment is recommended acutely for a patient with severe alcoholic hepatitis?
Prednisolone.
Corticosteroids improve outcomes!
What is the main supplier of blood to the intestines?
Superior mesenteric artery
Why is there collateral circulation of the mesenteric arteries?
Because the small bowel has a high O2 demand and therefore a high ischaemic risk! COllateral circulation attempts to diminish that risk
Small bowel ischaemia can go be ____- and _______depending on the layers. What are the dangers of the second option?
- Mucosal
- Transmural
- ileus
- break on bowel wall >> peritoneal space leakage > potential sepsis
What are the subtypes of causes for small bowel ischaemia?
- Occlusive
- thrombus
- thromboembolus of SMA
- cancer
- hernia
- vulvular
- intersusseption
- Non-occlusive
- hypovolemia
- low CO
Grey turners is a sign of? (flank bruising)
patients with severe haemorrhagic pancreatitis.
In this situation the major vessels surrounding the pancreas bleed. The pancreatitis process also results in local fat destruction, this results in blood tracking in the tissue planes of the retroperitoneum and appearing as flank bruising.
Murphy’s sign is what, and what is it a sign of?
it’s a sign of cholecysitis where pain/catch of breath elicited on palpation of the right hypochondrium during inspiration.
Because the infected gallbladder causes inflammation of the parietal peritoneum
Above and medial to pubic tubercle
Strangulation is rare
What hernia is this??
Inguinal hernia! (most common)
What is the difference with direct and indirect hernias?
Indirect: come through the inguinal ring, lateral to the epigastric vessels
Direct: comes directly through abdo wall, medial to epigastric vessels
describe the classical picture of Hepatitis A
1-2 week incubation period
Flu like prior
Nausea, arthralgia, jaundice
organomegaly
****seafood, travelling all risks (faecal-oral route)
What does vitamin C deficiency (scurvy) do and how does it present
Causes defective collagen synthesis and poor capillary integrity >> poor wound healing and bleeding
- Bleeding gums/haematuria/epistaxis
- gingivitis/ loose teeth
- poor wound healing
- general malaise
clindamycin is associated with a high risk of….
clostridium difficile infection
what is “Globus pharyngis”
sensation of “lump in throat” when there is none.
saliva may be harder to swallow. Potential hx of anxiety
How does Loperamide actually work
through inhibition of opiod receptors within the bowel >> reducedgastric mobility
How do we test for liver cirrhosis
via transient elastography
brand name ‘Fibroscan’
A wave is passed into the liver from a small transducer on the end of an ultrasound probe
measures the ‘stiffness’ of the liver which is a proxy for fibrosis
Between cholangitis, choledocolithiasis, cholecysitis and cholelithiasis how do these rank in severity, brief summary of and what treatment is required
- Cholangitis: inflammation of whole biliary tree due to choledocolithiasis
- ERCP urgen (they will be in pain)
- Choledocolithiasis: CBD stone, causing obstructive jaundice and mild inflammation
- ERCP
- Cholecysitis: Cystic duct stone causing an inflammed gall bladder, constant RUQ pain
- cholecystectomy
- Cholelithiasis: gallbladder stone, colicky RUQ pain
- elective cholecystectomy
