GI + Liver Flashcards
Describe the pathophysiology of acute cholangitis
Ascending cholangitis is a bacterial infection (typically E. coli) of the biliary tree. The most common predisposing factors are gallstones and benign/cancerous structures.
Charcot’s Triad : Fever, jaundice RUQ pain (not always present in all patients)
Raised inflam markers will also be present
What are the initial investigation that need to be done to confirm suspicions of acute cholangitis?
Bloods: FBC, LFT . Raised LFTs and WBC + CRP
US abdomen, if nothing detected Ct can also be used.
MRCP most accurate method to detect disease (stones and cancer)
What would the management for a patient with acute cholangitis look like?
Resus through IV fluids + antibiotics
Gold standard is ERCP (Endoscopic retrograde cholangiopancreatography)
Assessment and management of predisposing cause – for example, if gallstones – consider cholecystectomy. If malignant stricture, this would need further investigation and management as appropriate.
Describe the pathophysiology of cholecystitis
Inflammation of the gallbladder. It usually occurs when a gallstone completely obstructs the gallbladder neck or cystic duct.
It typically occurs in critically ill people due to a combination of risk factors that result in bile stasis (due to gallbladder hypomotility/dysmotility) or bile thickening (due to dehydration).
Investigations + management for someone with cholecystitis
abdominal US and blood tests (such as a white blood cell count, C-reactive protein, and serum amylase).
Monitoring (for example blood pressure, pulse, and urinary output).
Treatment (may include intravenous fluids, antibiotics, and analgesia)
Surgical assessment for cholecystectomy.
Describe the pathophysiology of acute pancreatitis.
Pancreatitis is inflammation of the pancreas.
GET SMASHED:
Gallstones (most common worldwide)
Ethanol (most common cause in Europe)
Trauma
Steroids
Mumps
Autoimmune disease (Polyarteritis Nodosa/SLE)
Scorpion bite
Hypercalcaemia, hypertriglycerideaemia, hypothermia
ERCP
Drugs (Furosemide, Azathioprine/Asparaginase
Thiazides/Tetracycline
Statins/Sulfonamides/Sodium Valproate
Hydrochlorothiazide
Estrogens
Ethanol
Protease inhibitors and NRTIs)
Symptoms include:
Stabbing-like, epigastric pain which radiates to the back that is relieved by sitting forward or lying in the fetal position.
Vomiting
Recent alcohol binge/ history of gallstones
Investigations + management for someone with acute pancreatitis.
Describe the pathophysiology of coeliac disease
Coeliac disease is a T cell-mediated inflammatory autoimmune disease affecting the small bowel in which sensitivity to prolamin results in villous atrophy and malabsorption.
Gastro Symptoms:
Abdominal pain
Distension
Nausea and vomiting
Diarrhoea
Steatorrhoea
Systemic Symptoms:
Fatigue
Weight loss or failure to thrive in children
General appearance: check for pallor (secondary to anaemia), short stature and wasted buttocks (secondary to malnutrition), and features of vitamin deficiency secondary to malabsorption (e.g. bruising due to vitamin K deficiency).
Dermatological manifestations: dermatitis herpetiformis (pruritic papulovesicular lesions over the buttocks and extensor surfaces of the arms, legs, and trunk).
Abdominal examination: there may be abdominal distension.
Investigations for coeliac disease
Basics:
FBC (anaemia)
U&E and bone profile (vit d absorbtion impaired)
LFT (low albumin, malabsorption)
Iron, B12, folate
Anti-TTG IgA antibody measured + IgA level (some patients deficient)
If IgA deficient : check Anti-TTG IgG
Management for coeliac disease
Life long gluten free diet
Education on diet restrictions
Regular monitoring to check adherence
What is appendicitis and what are the common presentations?
lymphoid hyperplasia or a faecolith → obstruction of appendiceal lumen → gut organisms invading the appendix wall → oedema, ischaemia +/- perforation
Peri-umbilical pain that migrates to the right iliac fossa
Migration of pain to RIF is strongest indicator of appendicitis
Pain worse on coughing/going over speed bumps
Mild pyrexia
Anorexia
On examination rebound and percussion tenderness, guarding and rigidity
Investigations for appendicitis
FBC, raised WBC + inflam markers
Neutrophil dominant leucocytosis seen in >80% of patients
Urine analysis to rule out pregnancy in women, renal colic and UTI
No definite rules on the use of imaging and its use is often determined by the patient’s gender, age, body habitus and the likelihood of appendicitis
Management for appendicitis
appendicectomy - open/laparoscopic. Laparoscopic treatment of choice
administration of prophylactic intravenous antibiotics reduces wound infection rates
What is ascites and how does it present
Ascites is the abnormal accumulation of fluid in the abdomen
The serum ascites albumin gradient (SAAG) can help to determine the cause of ascites.
It is calculated by subtracting the albumin concentration of the ascitic fluid from the serum albumin concentration.
Swollen abdomen, shifting dullness
Causes of high SAAG (>11g/L)
PORTAL HYPERTENSION
cirrhosis/alcoholic liver disease
acute liver failure
liver metastases
right heart failure
constrictive pericarditis
Budd-Chiari syndrome
portal vein thrombosis
veno-occlusive disease
myxoedema
A high SAAG suggests that the cause of the ascites is due to raised portal pressure. Raised hydrostatic pressure forces water into the peritoneal cavity whilst albumin remains within the vessels, thus resulting in a higher difference in the albumin concentration between the serum and ascitic fluid.
