Gen Surg / GI 2 Flashcards
What is primary biliary cholangitis?
chronic liver disorder
typically in middle aged females
damage of interlobular bile ducts
progressive cholestasis
What conditions is primary biliary cholangitis associated with?
Sjogren’s syndrome
rheumatoid arthritis
systemic sclerosis
thyroid disease
What are the clinical features of primary biliary cholangitis?
early: may be asymptomatic (e.g. raised ALP on routine LFTs) or fatigue, pruritus
cholestatic jaundice
hyperpigmentation, especially over pressure points
around 10% of patients have right upper quadrant pain
xanthelasmas, xanthomata
also: clubbing, hepatosplenomegaly
What is a possible late complication of primary biliary cholangitis?
liver failure
cirrhosis → portal hypertension → ascites, variceal haemorrhage
osteomalacia and osteoporosis
significantly increased risk of hepatocellular carcinoma (20-fold increased risk)
How is primary biliary cholangitis diagnosed?
immunology
- AMA M2 (anti-mitochondrial antibodies)
- raised serum IgM
imaging
- to exclude biliary obstruction
How is primary biliary cholangitis managed?
first line - ursodeoxycholic acid - slows disease progression, improves symptoms
What is the M rule in primary biliary cholangitis?
IgM
anti-mitochondrial antibodies M2
middle aged females
What patients typically present with autoimmune hepatitis?
young females
with other autoimmune conditions
What is the main cause of chronic pancreatitis?
alcohol excess
Which pancreatic function is affected in chronic pancreatitis?
both endocrine and exocrine
What are some non-alcohol related causes of chronic pancreatitis?
genetic - cystic fibrosis, haemochromatosis
ductal obstruction - annular pancreas, tumours, stones
What are the features of chronic pancreatitis?
pain - worse 15-30 mins following a meal
steatorrhoea - too much fat in stool - onset 5-25 years after onset of pain
DM - 20 years after onset of symptoms
How is chronic pancreatitis investigated?
abdo XR - calcification
CT - calcification
functional tests - faecal elastase
How is chronic pancreatitis managed?
pancreatic enzyme supplements
analgesia
antioxidants
What is primary sclerosis cholangitis?
inflammation and fibrosis of intra and extra-hepatic bile ducts
What condition is primary sclerosing cholangitis mostly associated with?
ulcerative colitis
What are the features of primary sclerosing cholangitis?
cholestasis - jaundice, raised ALP and bilirubin
RUQ pain
fatigue
How is primary sclerosing cholangitis diagnosed?
ERCP / MRCP - ‘beaded’ appearance of biliary tree (strictures)
How does pancreatic cancer present?
painless jaundice - pale stools, dark urine
cholestatic LFTs
abdominal mass - hepatomegaly (mets), gallbladder, epigastric mass
non-specific constitutional symptoms
loss of exocrine function - steatorrhoea
loss of endocrine function - DM
atypical back pain (mets?)
migratory thrombophlebitis
How is pancreatic cancer investigated?
USS
high res CT - double duct sign (simultaneous dilaatation of CBD and pancreatic duct)
How is pancreatic cancer managed?
Whipple’s resection - pancreaticoduodenectomy
adjuvant chemo
ERCP + stent
What is anal fissure?
tear in the mucosal lining of the anal canal
What is acute anal fissure?
less than 6 weeks
What is chronic anal fissure?
more than 6 weeks
What are the risk factors for anal fissure?
constipation
IBD
STI - e.g. HIV, syphillis, herpes
What are the features of anal fissure?
painful, bright red PR bleeding
Where does the majority of anal fissures occur?
posterior midline
What condition must be considered if anal fissure is in an unusual location (e.g. lateral)?
Crohn’s, other conditions
How is acute anal fissure managed?
soften stool
- high fibre, high fluid intake
- bulk-forming laxatives
lubricants prior to defecation (e.g. petroleum jelly)
topical anaesthetics
analgesia
How is chronic anal fissure managed?
continue with management as in acute
first line - topical GTN
second line - botulinum toxin / surgery (sphincterotomy)