Gastrointestinal Conditions 1 Flashcards
1st/3rd of GI conditions Will redo them in summer to be the Hepatobiliary!
Define Achalasia?
Oesophageal motor disorder of unknown aetiology, characterised by oesophageal aperistalsis and insufficient lower oesophageal sphincter relaxation in response to swallowing
What Causes Achalasia?
Inflammatory destruction of inhibitory nitrinergic neurons in the Auerbach plexus results in loss of Peristalsis and incomplete lower oesophageal sphincter relaxation
What condition causes a similar disorder to Achalasia?
Chaga’s disease, an infection of trypanosoma cruzi seen in South america, also causes myocarditis
What are risk factors for Achalasia?
Allgrove syndrome (achalasia, alacrima and adrenal insufficiency) due to ACTH insensitivity
Herpes and Measles virus
AI disease
HLA class II antigens (increased in those with achalasia)
Consanguineous parents
What are the symptoms of Achalasia?
Insidious onset with gradual progression of:
Intermittent dysphagia for solids and liquids
Difficulty belching
Regurgitation
Heartburn
Chest pain
Weight loss
What are the signs of Achalasia?
May show signs of complications:
Aspiration pneumonia
Malnutrition
Weight loss
What are investigations for Achalasia?
Upper GI endoscopy (mucosa obscured by saliva) Barium swallow (Loss of peristalsis and delayed emptying) Oesophageal manometry (incomplete LOS relaxation with wet swallows) CXR (Absence of gastric gas bubble or unusual shape)
Define Acute Cholangitis?
Known as ascending cholangitis, is an infection of the biliary tree, most commonly caused by obstruction
In which type of people is Acute cholangitis more common?
Latin americans and American indians
Age between 50 and 60
1-3% after ERCP
What causes Acute cholangitis?
Most common: Cholelithiasis leading to choledocholithiasis and biliary obstruction
Iatrogenic biliary duct injury, most commonly caused by surgery
Leads to benign strictures leading to obstruction
What are the Risk Factors for Acute cholangitis?
Age >50 years Cholelithiasis Benign stricture Malignant stricture Post-procedure injury of bile ducts HIV infection History of sclerosing cholangitis
What are the signs of Acute cholangitis?
Raynaud’s Pentad and Prutitus
What Makes up Reynaud’s pentad?
Charcot’s triad
Mental confusion
Hypotension
What Makes up Charcot’s triad?
RUQ pain
Jaundice
Fever with Rigors
What are the signs of Acute cholangitis?
RUQ tenderness Positive Murphy's sign Mild hepatomegaly Jaundice Sepsis Mental status change Tachycardia Peritonitis Hypotension
Investigations for acute cholangitis?
Bloods FBC (Leucocytis, thrombocytopenia) Raised Serum Urea and Creatinine Raised Serum LFTs Raised CRP Low Serum Potassium and Magnesium Blood cultures (Gram negative bacteria) Coagulation panel (PT raised with sepsis)
Imaging
X-ray KUB (Stones)
Abdominal Ultrasound (Stones)
MRCP (Look for non-calcified stones)
How do you manage acute cholangitis?
Fluid resuscitation
Correct coagulopathy
Administer broad-spectrum ABx
How do you stage Acute cholangitis?
Comes down to 3 categories A. Systemic inflammation - A1 Fever and/or shaking chills, temp >38 - A2 Laboratory data of inflam response - abnormal WCC, increase CRP B. Cholestasis - B1 Jaundice - B2 Lab data raised LFTs C. Imaging - C1 Biliary dilatation - C2 Evidence of aetiology on imaging
One from A, B and C is a definitive diagnosis
What are complications of Acute Cholangitis?
Acute Pancreatitis
Inadequate biliary drainage following endoscopy, radiology or surgery
Hepatic abscess
Define alcoholic liver disease
3 stages of liver damage: Fatty liver (Steatosis), Alcoholic hepatitis and alcoholic liver cirrhosis
What are the Risk Factors for alcoholic liver disease?
Prolonged and heavy alcohol consumption Hep C Female sex Cigarette smoking Obesity Age >65 years Hispanic ethnicitiy Genetic predisposition
What are the symptoms of Alcoholic liver disease
Abdominal pain Haematemesis Malaena Weight loss Distension Fatigue Anorexia Confusion Itchiness Gynaecomastia Peripheral neuropathy
What are the signs of Alcoholic liver disease?
Hepatosplenomegaly Jaundice Palmar erythema Ascites Asterixis Dupuytren's contracture Finger clubbing
What investigations do you do for Alcoholic liver disease?
Raised LFTs and bilirubin
Low albumin
FBC (Anaemia, leucocytosis, thrombocytopenia, high MCV)
Serum Urea and Creatinine (Normal or elevated)
Serum ANA (Exclude PBC)
Imaging Hepatic ultrasound (hepatomegaly, fatty liver) Upper GI endoscopy Liver Biopsy EEG