GI Flashcards
Describe appendicitis
- Appendix is a small, thin tube of bowel sprouting from the caecum
- appendicitis is inflammation of the appendix
- results from obstruction of the appendix and subsequent infection and inflammation of the appendix
- peak incidence in ages 10-20
What are the symptoms of appendicitis?
- abdominal pain, typically central then settling in the right iliac fossa
- loss of appetite, N+V
What are the signs of appendicitis?
- tender to McBurney’s point
- guarding to RIF
- rebound tenderness and percussion tenderness indicate peritonitis
- rovsing’s sign positive
Describe the diagnosis of appendicitis
- mostly clinical based on signs and raised inflammatory markers
- CT can be useful in confirming diagnosis
- USS can be useful to exclude ovarian and gynae pathology
- if clinically appendicitis but tests negative, proceed to diagnostic laparoscopy
What are the common differential diagnoses for appedicitis?
- ectopic pregnancy
- ovarian cysts
- meckel’s diverticulitis
- mesenteric adenitis
What are the possible complications fo an appendicectomy?
- bleeding/ infection/ pain/ scars
- damage to bowel, bladder or other organs
- removal of normal appendix
- anaesthetic risk
- DVT/PE
Laparoscopic is associated with fewer risks and faster recovery
Describe the management of appendicitis
Appendicectomy is the definitive management for acute appendicitis.
Laparoscopic surgery is associated with fewer risks and faster recovery compared to laparotomy.
Define haemochromatosis
Haemochromatosis is an iron storage disorder that results in excessive total body iron and deposition of iron in tissues.
The human haemochromatosis protein (HFE) gene is located on chromosome 6.
Majority of cases are due to mutation in the HFE gene. Mutation is autosomal recessive.
What are the symptoms of haemochromatosis?
Usually presents after the age of 40 when the iron overload becomes symptomatic.
Chronic tiredness Joint pain Pigmentation Hair loss Erectile dysfunction Amenorrhoea Cognitive symptoms
What is the diagnosis of haemochromatosis?
Serum ferritin.
Ferritin is an acute phase reactant meaning that it goes up with inflammatory conditions such as infection.
Transferrin saturation is helpful in distinguishing between iron overload and other causes of high ferritin.
If both are high, do genetic testing to confirm.
What are the complications of haemochromatosis?
Type 1 DM
Liver cirrhosis
Iron deposits in the pituitary and gonads lead to endocrine and sexual problems
Cardiomyopathy
Hepatocellular carcinoma
Hypothyroidism
Chrondocalcinosis
What is the management of haemochromatosis?
Venesection Monitoring serum ferritin Avoid alcohol Genetic counselling Monitoring and treatment of complications
Define acute cholangitis
Acute cholangitis is infection and inflammation in the bile ducts.
What are the causes of acute cholangitis?
- Obstruction int he bile ducts stopping bile flow (i.e. gallstones in the common bile duct)
- Infection introduced during an ERCP procedure
What are the most common organisms that cause acute cholangitis?
- E. coli
- Klebsiella species
- Enterococcus species
Describe the presentation of acute cholangitis
charcot’s triad:
- RUQ pain
- Jaundice
- Fever
What is the management of patients with acute cholangitis?
Acute management of sepsis ad acute abdo:
- Nil by mouth
- IV fluids
- Blood culture
- IV antibiotics
Imaging to diagnose CBD stones and cholanditis:
- Abdo US
- CT
- MRCP
ERCP
Define acute pancreatitis
Pancreatitis refers to inflammation of the pancreas. Presents with rapid onset of symptoms
What are the key causes of pancreatitis?
- Gallstones
- Alcohol
- Post ERCP
What are the full list of causes of pancreatitis?
I GET SMASHED
Idiopathic Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion sting Hyperlipidaemia ERCP Drugs
Describe the presentation of acute pancreatitis
- Severe epigastric pain
- Radiating through to the back
- Associated vomiting
- Abdominal tenderness
- Systemically unwell
What are the investigations of acute pancreatitis?
- FBC
- U+E
- LFT
- Calcium
- ABG
- Amylase if raised more than 3 times upper limit, it is acute pancreatitis
- CRP
- USS
- CT abdo
What is the glasgow score in terms of pancreatitis?
Used to determine severity of pancreatitis:
0-1 mild
2 moderate
3 or more severe
PANCREAS PaO2 <60 Age >55 Neutrophils >15 Calcium <2 uRea >16 Enzymes (LDH>600 or AST/ALT>200) Albumin <32 Sugar (glucose>10)
What is the management of acute pancreatitis?
ABCDE IV fluids Nil by mouth Analgesia Monitor
Tx of gallstones: ERCP/cholecystectomy
Abs for infection
Tx of complications