Gastroenterology Flashcards
What is achalasia?
An oesophageal motor disorder of unknown aetiology, characterised by oesophageal aperistalsis and insufficient lower oesophageal sphincter (LOS) relaxation in response to swallowing.
What are the risk factors of achalasia?
Allgrove syndrome Herpes and measles viruses Autoimmune disease HLA class II antigens Consanguineous parents
What are the symptoms of achalasia?
Dysphagia Weight loss Retrosternal pressure Recurrent chest infections Sensation of lump in throat Hiccups Heartburn
What are the signs of achalasia?
Regurgitation
Slow eating
Coughing while recumbent
Postural aid rqd while swallowing
What Investigations may be used for Achalasia?
OGD Barium swallow/ timed barium swallow CXR CT chest Oesophageal manometry Radionucleotide Oesophageal emptying studies
What may an OGD or Barium swallow show in someone with achalasia?
OGD- Obscured mucosa by frothy saliva, sigmoid oesophagus(Timed)
Barium swallow- Loss of peristalsis, delayed oesophageal emptying and transit, dilated oesophagus which tapers towards LOS
What may you see in a CXR or CT chest in achalasia?
CXR- Absence of gastric bubble or unusual oesophagus shape
CT Chest- dilation of oesophagus, potential wall thickening
What is acute cholangitis?
It is an infection of the biliary tree, most commonly caused by obstruction. (Also known as ascending cholangitis)
What are the risk factors of acute cholangitis?
Age >50 yrs Cholelithiasis Benign or Malignant Stricture Post procedure injury of bile ducts History of primary or secondary sclerosing cholangitis Also: HIV
How does acute cholangitis progress?
Usually caused by bacteria ascending from its junction with the duodenum (first part of the small intestine). It tends to occur if the bile duct is already partially obstructed by gallstones.
What are the presenting symptoms of acute cholangitis?
Alcoholic stools
Pruritis
Mental status change
[Plus Charcots triad]
What are the signs of acute cholangitis?
Charcots traid:
RUQ pain and tenderness
Jaundice
Fever
And Hypotension
What investigations would you consider for acute cholangitis?
Bloods
ERCP
Transabdominal US
Who gets acute cholangitis?
Relatively Uncommon
Both male and female
Median age is between 50-60
What is Charcot’s triad?
RUQ pain and tendernessJaundice Fever (often with rigors)
What is Reynolds pentad?
Charcot’s triad (right upper quadrant pain, jaundice, and fever) Shock (low blood pressure, tachycardia) Altered mental status
What Bloods would you do for acute cholangitis?
FBC (raised WCC, low plts)Cr (raised)LFTs (Raised transaminases, alk phos and BR)CRP (Raised)U&E’s (Raised U, decreased K and Mg)Coagulation panel (raised PT)ABG (met. acidosis)
How would you manage acute cholangitis?
IV antibioticsBiliary decompresssionLithotripsyOpioid analgesics
What are the possible complications of acute cholangitis?
Acute pancreatitisInadequate biliary drainageHepatic abscess
What is the prognosis/ indicators for acute cholangitis?
Improved drainage helpsPoor prognosis- hyperbilirubinaemia, high fever, leukocytosis, older age, hypoalbuminuria
Define Alcohol withdrawal
Alcohol withdrawal syndrome occurs when an alcohol dependent person decreases or stops their intake. It normally begins 4-12 hours after the patients last drink.
What is the aetiology of alcohol withdrawal?
Blood alcohol level drops below what the patient normally has causing withdrawal symptomsCommon where there is a family history or abrupt withdrawal
Who and where is alcohol withdrawal prevalent?
Over 15’s (more in 18-25 than over 26)Binge drinkers>excessive drinkers
What are the symptoms of alcohol withdrawal?
Alcohol useChange in mental status HallucinationsDelusions