Pancreatitis + coeliac disease Flashcards
Symptoms of acute pan
Stabbing-like, epigastric pain radiating to the back. Vomiting
Signs of acute pan
hypovolaemia
Fever
Severity of acute pancreatitis
modified Glasgow criteria
Score of >=3 is bad
What amkes up the MGC?
PaO2 < 8kPa (60mmHg)
Age > 55 years
Neutrophils - WBC >15 x109/l
Calcium < 2mmol/l
Renal function - Urea > 16mmol/l
Enzymes - AST/ALT > 200 iu/L or LDH > 600 iu/L
Albumin < 32g/l
Sugar - Glucose >10mmol/L
Management of acute pancreatitis
Aggressive fluid resuscitation with crystalloids to maintain urine output > 30 mL/hour.
Catheterisation.
Analgesia: Strong opioids are often necessary.
Anti-emetics
What indicates severe diarrhoae in patients with coeliac disease
Steatorrhoea
Weight loss or failure to thrive in children
Management of coeliac disease
lifelong commitment to a gluten-free diet
Serum amylase is used for what
Acute pan
Faecal elastase is used for what
Chronic pan
Investigation to identify the underlying cause for his change in bowel habit
Faecal elastase
definitive test for diagnosing celiac disease is what?
duodenal biopsy
First line investigations for coeliac disease is wat
serum immunoglobulin IgA TTGA and total IgA
A 32-year-old patient presents in clinic with a 2 month history of persistent diarrhoea, bloating and weight loss. She has not had any fevers. On examination, her abdomen is soft and non-tender throughout. Bowel sounds are present. There are a number of itchy red vesicles on her elbows and knees bilaterally. Blood tests reveal the diagnosis of coeliac disease.
What is the most likely diagnosis of her skin condition?
Dermatitis herpetiformis
Clinical features of upper GI bleed
haematemesis (vomiting of blood or coffee-ground-like material) and/or melena (black, tarry stools).
A 46-year-old woman receives a new diagnosis and attends her GP for follow-up and advice. Which diagnoses would require the GP to carry out serological testing for coeliac disease?
autoimmune thyroid disease or type 1 diabetes. Graves dieseae
Definitive diagnosis for Mallory–Weiss tear
oesophagogastroduodenoscopy (OGD)
What is Mallory Weiss tear?
a small tear in the mucosa of the lower oesophagus and is usually caused by violent vomiting. The history is typically that of a prolonged period of severe vomiting, followed by an episode of haematemesis. non tender
Dermatitis herpetiformis is managed with what?
dapsone
A 66 year old male with a history of alcohol excess presents with a 2 month history of upper abdominal pain and weight loss. He also describes pale stools that are difficult to flush away.
What is the most likely cause of his symptoms?
Chronic pancreatitis
Rectal involvement suggests what?
UC
A 67-year-old gentleman with known cirrhosis secondary to alcohol liver disease is admitted to the Emergency Department with haematemesis. He is haemodynamically unstable with a heart rate of 120bpm and a blood pressure of 100/60 mmHg. He is treated for a variceal bleed with intravenous fluids, given one unit of blood and started on antibiotics. His observations stabilise and he is listed for an oesophago-gastro-duodenoscopy (OGD) later that day.
What is the most appropriate medical management prior to OGD?
Piperacillin/ Tazobactam/ Terlipressin
A 30-year-old man presents to his GP complaining of 2 weeks of burning chest pain which he experiences only when laying down in bed at night. His partner has also told him he has notable halitosis in recent months, which he finds embarrassing.
What is the most likely diagnosis?
Gastro-oesophageal reflux
A 57-year-old male presents to the Emergency Department with confusion and abdominal pain. He is unable to give any information about his medical history, due to his confusion. Blood tests identify significantly deranged liver function tests.
On examination, what clinical sign may suggest that this is an acute rather than chronic form of liver disease?
Tender, smooth hepatomegaly
A 39 year old woman collapses in the corridor of the cardiology ward. It is safe to approach and a nearby doctor goes to her aid.
First step to perform is what?
Try to elicit a response from the patient
A 42-year-old man presents with chronic diarrhoea, weight loss, and abdominal bloating. Which of the following is a common cause of gastrointestinal malabsorption, and therefore responsible for his symptoms?
Coeliac disease
A 32 year old female is seen in the gastroenterology clinic. She has had symptoms of recurrent abdominal pain for the last seven months that seem to occur approximately every other day. She is passing loose stools three times per day, and feels that the pain is relieved by defaecation. She denies any rectal bleeding or weight loss, and does not have a family history of bowel cancer. Next best investigation is what?
Tissue transglutaminase antibodies
definitive diagnostic test for coeliac disease
Oesophagogastroduodenoscopy (OGD) with small bowel biopsy - gold standard
