GI Revision Lectures Flashcards
What week does the buccopharyngeal membrane rupture at?
Week 4
What week does the cloacal membrane rupture at?
Week 7
What part of the gut gives rise to the respiratory tract?
Foregut
What structure cleaves off the ventral bud to form the trachea?
Tracheoesophageal septum
What is Gastroschisis?
When abdominal contents herniate out without being covered by peritoneum
What week does recanalisation happen?
Between week 8-10
What are thee intraperitoneal organs?
Stomach
Appendix
Liver
Transverese colon
Duodenu
Small intestine
Pancreas (tail)
Rectum
Spleen
Sigmoid colon
SALTDSPRSS
What is the connection between the greater and lesser sac?
Foramen of Winslow
What mesentry does the liver form in?
Ventral mesentry
What mesentry does the spleen develop in?
Dorsal mesentry
What blood vessel does the small intestine and large intestine rotate around/use as an axis of rotation?
Superior Mesenteric Artery
What is the name of the condition where the gut contents fail to return back to the abdomen after being pushed through the umbilicus?
Omphalocele (contents covered in peritoneum)
What intestine sits above the SMA before roatition and below?
Above = small
Below = large
What enzymes are released with hepatocyte damage?
ALT
AST
What enzymes are elevated with biliary duct damage and bone damage?
What enzymes shows a raised ALP is due to biliary duct damage?
ALP
GGT
What gives colour to urine?
Conjugate bilirubin
What is the main cause of pre-hepatic jaundice?
Haemolytic anaemias (excess haemolysis)
What levels of bilirubin are high with pre-hepatic jaundice?
UNCONJUGATED bilirubin
Go to slide 29 and identify the causes of pre-hepatic jaundice on blood films 1 and then 2:
1 = hereditary Spherocytosis
2 = Microangiopathic haemolytic anaemia (like DIC, can see schistocytes)
What is hepatic jaundice?
When the liver is damaged reducing the Hepatocyte eats ability to conjugate bilirubin
What levels of bilirubin I’ll be high in hepatic jaundice?
Both conjugated and UNCONJUGATED bilirubin
What can cause hepatic jaundice?
Paracetamol OD
Wilsons disease (see Fleischers ring (brown ring around iris)
Alcoholic liver disease
Cirrhosis
What is post hepatic jaundice?
Anything that obstructs thhe pathway preventing conjugated bilirubin from reaching the intestine
What levels of bilirubin will be raised in post hepatic jaundice?
Conjugated bilirubin (makes the urine dark and stools light)
What are the 5 Fs for the risk factors of gall stone formation?
Fat
Femal
Forty
Fertile
FHx
What can form gallstones?
Cholesterol
Bile pigment
Mixture of both
What is biliary colic?
The pain that comes in waves from gallstones
What causes biliary colic?
Cholecystokinin released by small instance during digestion
CCK causes contraction of gall bladder to release stored bile
Gallstones irritation the entrance of the gall blade as the stone pushes against it
Where is the pain in biliary colic?
RUQ
What is cholecystitis?
When na gallstone becomes stuck in the cystic duct
Fluid stasis inside gall bladder leads to inflammation and infection of the gallbladder causing pain in RUQ and fever
What is Murphys sign?
When you palpate the RUQ and ask the patient to breathe in
Pain I causes arrest of inspiration indicating cholecystitis
What is ascending cholangitis?
Gallstone becomes stuck in CBD
Causes inflammation and infection of the biliary system
What is the triad for ascending cholangitis?
Charcots triad
What ae the 3 signs of Charcots triad indicating ascending cholangitis?
Fever
Jaundice
RUQ pain
What causes acute pancreatitis?
Pancreatic duct obstructed
Enzymatic autodigestion occurs
What type of pain is seen in acute pancreatitis?
Epigastric pain radiating to the back
What are some causes of acute pancreatitis?
Gallstones
Ethanol
Trauma
Autoimmune
Drugs
What are some signs of acute pancreatitis>
Cullens sign
Grey turners sign
What is Cullen’s sign (acute pancreatitis) ?
Bruising around umbilicus
What is grey turners sign (acute pancreatitis)?
Bruising on flank
How do you invest age cholecystitis and ascending cholangitis?
Ultrasound of abdomen
Magnetic resonance cholangiopancreatography
How do you manage cholecystitis and ascending cholangitis?
IV fluids
IV antibiotics
Laparoscopic cholecystectomy
Endoscopic retrograde cholangiopancreatography
What test is done for acute pancreatitis?
Serum AMYLASE (+ lipase) the pancreatic enzymes
USS abdo
CT abdo and pelvis
How do you manage acute pancreatitis?
IV fluids
Endoscopic retrograde cholangiopancreatography
Laparoscopic cholecystectomy
What triad can be used to diagnose ascending cholangitis?
Charcots triad
What it’s the definition of cirrhosis?
Progressive fibrotic changes within hte liver de to damage that has occured over a number of years
What is meant by saying the liver is decmopensated in cirrhosis?
Liver can no longer be able to function
What are some preventable causes of liver cirrhosis?
Alcohol
Non alcohol related fatty liver disease (obesity or T2DM)
Hepatitis B/C, CMV, EBV
what are some non preventable causes of cirrhosis?
Wilsons disease, hereditary Haemochromatosis,
Autoimmune - primary sclerosing cholangitis, autoimmune hepatitis
alpha 1 antitrypsin disease
What are some signs of chronic liver disease/cirrhosis?
Leukonichia (whitening of nails)
Hepatic flap (sign of due compensation)
Palmar ertythema
Jaundice
Ascites
Caput medusa
Spider naevi
Hepatic encephalopathy (confusion)
How can you treat the Ascites from chronic liver disease?
Diuretics like furosemide and Spironolactone
How can you help prevent variceal formation (caput medusa, oesophageal Varices)?
Beta blockers
Regular oesophageal disease surveillance
What drugs can be given to help treat hepatic encephalopathy?
How do they work?
Lactulose
Rifaximin
Reduce the amount of ammonia reabsorbed into the body
Why do you need to do 6 monthly ultrasound on patients with chronic liver disease/cirrhosis?
Increased risk of hepatocellular carcinoma
What symptoms do you get due to decreased protein synthesis on chronic liver disease?
Bleeding/easy bruising = less clotting factors
Ascites = low albumin
What symptoms are caused by decreased breakdown by the h liver?
Encephalopathy = due to inc ammonia
Jaundice = inc bilirubin
What is a diverticulum?
Small outpouching of large intestine
What is diverticulosis?
The presence of diverticula
Is an asymptomatic disease
What is the most common location of diverticula to form?
Large colon (sigmoid colon)
What is diverticula disease?
Having symptoms but not having infectio nor inflammtion
What is diverticulitis?
When a single diverticulum/a become inflammed or infected
What are the symtoms of acute diverticulitis?
Abdominal pain on left hand side
Fever
Bloating + constipation
Haemotochezia (blood in stool)
What are the complications of diverticulitis?
Haemorrhage
Fistula
Inflammation
Abscess
Perforation (can lead to peritonitis)
What investigations are done for diverticulitis?
Blood tests
USS
Colonoscopy
CT
Pregnancy test
How is acute diverticulitis managed?
Abx
Fluid resus
Analgesia
If complicated surgery (partial colectomy)
Why can the location of pain for appendicitis differ?
Different positions possible
What are the possible locations for the appendix?
Pelvic
Retrocaecal
Post ileal
Pre-ileal
Sub Cecil
What are the 3 stages to appendicitis?
Acute (mucosal oedema)
Gangrenous (transmural inflammtion and necrosis)
Perforated
What causes appendicitis?
Faecoltih blocks appendix
Inc venous pressure then makes harder for arterial blood to supply leading to ischaemic damage then bacteria can invade
What causes appendicitis?
Faecoltih blocks appendix
Inc venous pressure then makes harder for arterial blood to supply leading to ischaemic damage then bacteria can invade
How does the pain change as the appendicitis develops?
More diffuse at start when inflamed appendix compresses visceral peritoneum
As it becomes larger becomes more localised as it compresses parietal peritoneum
Pain goes from supra pubic region to right iliac fossa
How does appendicitis presetn?
Sudden right sided pain of abdominal
Fever
Constipation or diarrhoea
Loss of appetitie
Nausea and vomiting
What point do you palpate/rebound tenderness for appendicitis?
McBurney’s point
Where is McBurney’s point?
2/3s distance from umbilicus to right ASIS
How is appendicitis treated?
Laparoscopic appendectomy
How can you tell you are looking and small bowel in a radiograph?
Central
Full thickness Plica circularis
How can you tell you are looking and large bowel in a radiograph?
Peripheral
Non full thickness haustral folds
What can cause small bowel obstruction?
Adhesions
Hernias
Crohns
What can cause obstruction of the large bowel?
Cancer (colorectal most common)
Diverticular disease
Volvulus
What type of sign is seen on a radiograph with a volvulus?
Coffee bean sign
Where is the most common location for a volvulus?
Sigmoid colon
What is intussusception?
Part of the gut type telescopes into the distal section
How does intussusception cause ischaemia?
Compression impairs lymphatic drainage
Pressure increases then arterial insufficiency leading to ischameia
What is visible on a CXR if the bowel is perforated?
Air under diaphragm
Go to the last slide and look at image 1:
What vertebral level are is this taken at?
L1 or L2
What is bright white in a Type 2 MRI?
Water
H20
What artery can be perforated by a peptic ulcer perforating posteriorly?
Gastroduodenal artery
Splenic artery perforation would be a very end stage of the perforation
Go to last slide image 2:
What is this sign?
What does it indicate?
Coffee bean sign
Volvulus
Look at last slide:
Image 3, what bowel is obstructed?
Small intestine
Look at last slide:
Image 4 what bowel is obstructed?
Large bowel
Why can patients with ALD develop hepatic encephalopathy?
Build up of ammonia in blood travellling to brain
What is going to be raised in a patient that is jaundiced with haemolytic anaemia?
UNCONJUGATED bilirubin
Where is a gallstone likely to be when a patient has yellow sclera, dark urine, pale stools?
Distal commmon bile duct
What part of hte colon do diverticular typically form?
Sigmoid colon
Where is appendicitis pain localised to?
Right iliac fossa
Look at image 2 on the last slide:
What type of volvulus is this?
Sigmoid volvulus
What is Murphy’s sign indicative of?
Acute cholecystitis
