GI 7 Flashcards
What is achalasia?
A rare disorder of the food pipe (oesophagus), which can make it difficult to swallow food and drink.
What are the signs of scurvy?
1) Listlessness, anorexia, cachexia
2) Gingivitis, loose teeth, halitosis
3) Bleeding from gums, nose, hair follicles or into joints, bladder or gut
4) Muscle pain or weakness
5) Oedema
What is Beriberi?
Heart failure with general oedema (wet beriberi) or neuropathy (dry beriberi) due to lack of vitamin B1 (thiamine)
What is Pellagra and how does it present?
Lack of nicotinic acid/nicotinamide which presents as the classic triad - diarrhoea, dementia, dermatitis (Casal’s necklace) - and additionally: neuropathy, depression, insomnia, tremor, rigidity, ataxia and fits
What is Xerophthalmia?
- Vitamin A deficiency syndrome which is a big cause of blindness in the tropics.
- Conjunctivae - dry and develop oval/triangular spots
- Corneas - cloudy and soft
What is Budd-Chiari syndrome?
A condition where there is obstruction to the venous outflow of the liver owing to occlusion of the hepatic vein
How does acute Budd-Chiari syndrome present?
- Abdominal pain
- Nausea and vomiting
- Tender hepatomegaly
- Ascites
How does chronic Budd-Chiari syndrome present?
Chronically: hepatomegaly, mild jaundice, ascites, negative hepatojugular reflex, splenomegaly with portal hypertension
What are the signs of chronic liver disease?
- stigmata: spiders, fetor, encephalopathy
- ‘synthetic dysfunction’
- prolonged prothrombin time, hypoalbuminaemia
What are the signs of portal hypertension?
- caput medusa
- hypersplenism
- Thrombocytopenia (pancytopenia)
What are the features of alcoholic hepatitis?
- recent excess alcohol
- Bilirubin > 80mol/l
- exclusion of other liver disease
- AST < 500 (AST: ALT ratio >1.5)
- hepatomegaly / fever / leucocytosis / hepatic bruit
What are the benign liver tumours?
- Haemangioma
- Focal nodular hyperplasia
- Adenoma
- Liver cysts
What are the malignant liver tumours?
- Primary liver cancers (HCC and cholangiocarcinomas)
- Secondary metastases
What is a liver haemangioma?
- Commonest liver tumour
- Hypervascular well demarcated capsule
- Diagnosed by imaging, no need for treatment
What are the types of cystic lesions in the liver?
- Simple
- Hyatid
- Atypical
- Polycystic lesion
- Pyogenic or amoebic abscess
What is a liver simple cyst?
- Liquid collection lined by epithelium
- No biliary tree communication
- Solitary and uniloculated
- Usually asymptomatic
- Symptoms relating to: intracystic haemorrhage, infection, rupture, compression
What is the management for a liver simple cyst?
- No follow up necessary
- If doubt, imaging in 3-6 mths
- If symptomatic or uncertain diagnosis (complex cystic lesion), then consider surgical intervention
What is a liver hyatid cyst?
- Echinoccocus granulosus
- Endemic regions
- Patients may present with disseminated disease, or erosion of cysts into adjacent structures and vessels (IVC)
- Clinical diagnosis based on history, appearance, and serologic testing-detection of anti-Echinococcus antibodies
What is the management for a liver hyatid cyst?
- Surgery (conservative or radical)
- Medical: Albendazole
- Percutaneous Drainage: PAIR
What is polycystic liver disease?
- Embryonic ductal plate malformation of the intrahepatic biliary tree
- Numerous cysts throughout liver parenchyma
What are the 3 types of polycystic liver disease?
1) Von Meyenburg complexes (VMC)
2) Autosomal dominant Polycystic Kidney disease
3) Isolated polycystic liver disease
What are the clinical features of a liver abscess?
- High fever
- Leukocytosis
- Abdominal Pain
- Complex liver lesion
- History: dental procedure or abdominal/biliary infection
What is the management for a liver abscess?
1) Initial empiric broad spectrum antibiotics
2) Aspiration/drainage percutaneously
3) Echocardiogram
4) Operation if no clinical improvement: Open drainage or Resection
5) 4 weeks antibiotic therapy with repeat imaging
What are Von Meyenburg complexes (VMC)?
- Benign cystic nodules throughout the liver + bile duct originating from the peripheral biliary tree
- Remnants develop into small hepatic cysts and usually remain silent during life
What is isolated polycystic liver disease (PCLD)?
- Liver function preserved renal failure rare
- Symptoms depend on size of cysts
- PCLD gene – PRKCSH and SEC63
What is autosomal dominant polycystic kidney disease (ADPKD)?
- Renal failure due to polycystic kidneys and non-renal extra-hepatic features are common in ADPKD
- Potential massive hepatic enlargement
- ADPKD genes – PKD1 and PKD2
What are the clinical observation in polycystic liver disease?
- Abdominal pain
- Abdominal distension
- Atypical symptoms due to voluminous cysts resulting in compression of adjacent tissue or failure of the affected organ
What is the treatment for polycystic liver disease?
1) Conservative treatment is recommended to halt cyst growth
2) Invasive procedures if symptomatic/advances (defenestration, aspiration, liver transplantation)
3) Pharmacological therapy - somatostatin analogues
What are the differentials for solid liver lesions in young patients?
1) Adenoma
2) Focal nodular hyperplasia
What is focal nodular hyperplasia?
- Hypervascular response to abnormal arterial flow
- Contains all liver ultrastructure, central scar
- Most common in young and middle aged women
- Usually asymptomatic but may cause pain
- No malignant risk, minimal bleeding risk
What is the diagnosis and management for focal nodular hyperplasia?
- Tests: USS, CT, MRI, FNA
- No treatment required
What is a hepatic adenoma?
- Benign neoplasm composed of normal hepatocytes no portal tract, central veins or bile ducts
- Most common in women 10:1
- Associated with contraceptive hormones and anabolic steroids
- Usually asymptomatic but may cause pain
- Risk: rupture, hemorrhage, or malignant transformation
What is the diagnosis and management for a hepatic adenoma?
- Tests: USS, CT, MRI, FNA
- Management: stop hormones, weight loss
- Males - surgical excision
- Females - imaging after 6 months
What is dyspepsia?
Group of 3 symptoms seen in peptic ulcers consisting of: epigastric pain, burping and bloating
What is the main symptom of gastroporesis?
Regurgitation of food/liquid
What is the treatment for H pylori?
Omeprazole + Amoxicillin + metronidazole
What is the first investigation for suspected GORD?
Trial lowest-dose PPI for 8/52 (omeprazole?)
What are the three hallmarks of IBS, for which 2 are needed for a definitive diagnosis?
1) Relief on defaecation/bowel movements
2) Change in stool consistency
3) Change in stool frequency
What is the tumour marker in pancreatic cancer?
CA-19.
