Revision List GI/Liver Flashcards
1
Q
What is iron haemochromatosis?
A
Inherited disorder of iron metabolism leading to increased intestinal absorption so increased iron deposition in joints, liver, heart, pancreas, pituitary –> eventual fibrosis and organ failure.
AR
2
Q
Cause of iron haemochromatosis?
A
- HFE gene mutation on chromosome 6 - AR
- High intake of iron/ chelating agents
- Alcoholics may have iron overload
3
Q
What is hepicidin?
A
Regulates iron absorption - decreased in HFE mutation
4
Q
Clinical presentation of haemochromatosis?
A
- Fatigue
- Joint pain
- Slate grey skin pigmentation, white flat nails
- Koilonychia
- Hepatomegaly, cirrhosis,
- Osteoporosis
- DM
- Skin dryness, melanoderma
5
Q
Diagnosis of haematochromatosis?
A
Homozygous e.g. HFE genotyping
- increased serum ferritin, transferrin saturation, iron,
Liver biopsy for confirmation
6
Q
Treatment of haematochromatosis?
A
Venesection - regular removal of blood - may regress fibrosis
7
Q
Which part of the bowel tract does UC affect?
A
Only Colon
8
Q
Which part of the bowel tract layer does UC affect?
A
Only mucosal inflammation
9
Q
Which IBD is smoking protective in?
A
Ulcerative colitis
10
Q
Risk factors for UC and Crohn’s?
A
- Fhx
- NSAIDs
- Chronic depression
- Stress
11
Q
Clinical presentation of UC?
A
- Diarrhoea - often bloody and mucus
- Colicky LLQ pain
- Tenesmus
12
Q
Pathophysiology of UC?
A
- Continuous mucosal inflammation spread from rectum to ileocaecal valve
- No granulomata
- Goblet cell decrease, crypt abscess increase
13
Q
Clinical presentation of Crohn’s?
A
Colon: bloody mucus diarrhoea
Ileum - RIF
Small bowel - weight loss, abdominal pain
Extra GI symptoms: anorexia, tender abdomen, joint eye problems, oral ulcerations
14
Q
Pathophysiology of Crohn’s?
A
- Transmural granulomatous inflammation –> epitheloid macrophages surrounded by lymphocytes
- Skip lesions
- Cobblestone mucosa
15
Q
Diagnostic tests for IBD?
A
- Raised ESR, CRP, WCC and platelets
- Iron deficiency anaemia in UC
- Stool: exclude: campylobacter, c.diff, salmonella, shigella, E.coli
- Colonoscopy/ Sigmoidoscopy/ Rectal Biopsy:
- -> UC: inflammatory infilitrate, decreased goblet cells, mucosal ulcers
- -> Crohn’s spot lesion, granulomatous transmural inflammation - Faecal calprotein
16
Q
Treatment for UC?
A
- Topical 5 aminosalicyclate - mesalazine
- Oral 5ASA - if remission not achieved
- Topical/ oral corticosteroid - prednisolone
- Calcineurin inhibitors
- Immunosuppresive - thioprine, methotrexate, TNF a inhibitor
17
Q
Surgery for UC?
A
Colectomy - ileoanal anastomoses
Panproctocolectomy with ileostomy
18
Q
Treatment for Crohn’s?
A
- Smoking stop
- iron/b12/folate anaemia - replacement therapy
- Monotherapy: conventional glucocorticoids ve.g. prednisolone, hydrocortisone
- Thiopurines: azathioprine add SE: bone marrow suppression, acute pancreatitis
- Anti-TNF Ab - immunosuppressive drug - influximab, adalimumab
19
Q
Complications of Crohn’s?
A
Malabsorption –> small bowel obstruction
Anal skin tags, fissure, fistula
Systemic: colorectal cancer, amyloidosis, neoplasia
20
Q
Irritable Bowel Syndrome
A
Relapsing functional disorder, change in bowel habits
21
Q
Causes of IBS?
A
- Stress
- Eating disorders
- Depression
- GI infections
- Sexual/physical/verbal abuse
22
Q
Clinical presentation of IBS?
A
- Abdominal symptoms: pain/discomfort - relieve by defecation linked to bowel frequency altered
Others: urgency, incomplete evacuation, abdominal distension/bloating, mucous in stools, worsen by food.
Non-intestinal: nocturia, back pain, joint hypermobility
23
Q
Diagnosis of IBS?
A
- Bloods: anaemia, ESR, CRP raised
- Coeliac serology testing tissue transglutinase Ab
- Faecal calprotein - raised in IBD
24
Q
Treatment of IBS?
A
- Mild IBS: education, reassurance, dietary modifications - frequent small meals, avoid alcohol
- Moderate IBS: pharmacotherapy, psychology Tx
- antispasmodic - mebeverine
Constipation: laxative e.g. mavicol; linaclotide, 5 HT4 receptor agonist
- Diarrhoea - anti-motility agents - loperamide
25
What are the 5 Fs? What do they indicate?
Someone presenting with RUQ --> fat/female/fair/fertile/forty = could be cholelithiases
26
What is peptic ulcer disease?
Break in epithelial lining of stomach/ duodenum --> penetrate muscularis mucosa
27
Where are gastric ulcers the most common?
Lesser curve of stomach
28
Where are duodenal ulcers most common?
Duodenal cap
29
What are the causes of peptic ulcer disease?
1. Helicobacter pylori
2. NSAIDs - steroids and SSRI too
3. Excess acid secretion
4. Delayed gastric emptying
5. Smoking
30
How does mucosal ischaemia lead to ulcers?
1. Atherosclerosis or decreased BP
2. Decreased mucin production
3. Damage --> ulcer
31
How do NSAIDs cause ulcers?
1. NSAIDs are COX1/COX2 inhibitors and thus inhibit prostaglandin synthesis.
2. Decreased mucus secretion
32
How does H. Pylori cause ulcer
1. H. pylori inhibits mucus layer
2. Decreased duodenal bicarbonate and increased acidiity
3. Secretes urease to convert urea to ammonia + carbon dioxide.
4. NH3 reacts with H+ to form ammonium which is toxic to the gastric mucosa
5. Also secretes protease, phospholipase and vacuolating toxin A --> attack gastric epithelum --> decreased mucosal production
33
Clinical presentation of peptic ulcer disease?
1. Recurrent burning epigastric pain - worse when hungry/night
2. Nausea
34
Complications of PUD?
1. Haemorrhage
2. Peritonitis
3. Pancreatitis
35
Lifestyle changes of PUD?
1. Stop smoking
2. Avoid stress
3. Avoid irritating foods - caffeine/ spicy
4. Stop NSAIDs
36
Helicobacter pylori Tx?
1. 2 ABx + PPI
| 2. Clarithyromycin, metronidazole and omeprazole
37
What are the upper GI tumours you can get and which part of the tract do they affect?
1. Oesophageal tumours
- Squamous cell carcinoma - middle and upper 1/3rd of oesophagus
- Adenocarcinoma - lower 1/3rd of oesophagus and cardia
2. Gastric tumours
- Adenocarcinoma
38
Investigations of PUD?
1. Serology - detect IgG Ab
2. C-urea breath test - measure CO2 in breath after ingesting urea
3. Stool antigen test
4. Endoscopy if - iron deficiency anaemia, weight decrease, persistent vomiting, epigastric mass
39
Aetiology of squamous cell carcinoma oesophageal tumours?
1. High level of alcohol consumption
2. Obesity --> increase reflux
3. Decrease fruit and veg
4. Smoking
40
What decreases the risk of oesophageal squamous cell carcinoma?
1. Diet rich in fibres
2. Carotene
3. Folate
4. Vitamin C
41
Aetiology/Causes of adenocarcinoma (oesophageal)?
1. Smoking/tobacco
2. GORD
3. Obesity
4. Barrett's oesophagus
5. Alcohol
42
How does oesophageal epithelium becomes neoplastic?
1. Normal oesophageal squamous epithelium
2. Metaplastic oesophageal glandular epithelium
3. Dysplastic oesophageal glandular epithelium
4. Neoplastic oesophageal glandular epithelium
43
Clinical presentation of adenocarcinoma of oesophageal epithelium?
1. Progressive dysphagia - hoarse, cough
2. Weight loss
3. Lymphadenopathy
3. Anorexia/ oesophageal obstruction
44
Diagnosis of oesophageal adenocarcinoma?
1. Oesophagoscopy with biopsy
2. Barium swallow
3. CT/MRI/PET
45
Treatment of oesophageal adenocarcinoma?
1. Surgical resection +/- chemo/radio
| 2. Treatment of dysphagia: endoscopy insertion of expanding metal stent
46
Main causes of gastric adenocarcinoma?
1. Smoking
2. H. pylori
3. Decrease p53/APC gene
4. Pernicious anaemia
47
Two major types of gastric tumours?
1. Type 1: intestinal
| 2. Type 2: Difffuse
48
What is the Type 1: intestinal tumour?
Intestinal metaplasia in mucosa surrounding tumour - polypoid/ulcerating lesions
--> more likely to involve distal stomach.
49
Type 2: diffuse tumour?
Poorly cohesive undifferentiated cells --> infiltrate gastric wall --> can affect any part of cardia --> worse prognosis
50
Clinical presentation of gastric tumours?
1. Epigastric pain - indistinguishable from PUD, pain = constant and severe
2. Nausea/vomiting
3. Anorexia/Weight loss
51
Diagnosis of gastric cancer?
1. Gastroscopy and biopsy
2. Endoscopic US
3. CT/MRI for staging
4. PET scan
52
Treatment of gastric tumours?
1. Nutrition support
2. Surgical resection + combination chemo
+post op radiotherapy
53
Combination chemo used for gastric tumour?
1. Epirubicin
2. Cisplatin
3. 5-fluoro-uracil
54
What are the common small intestine tumours?
1. Adenocarcinoma - 50%
| 2. Lymphoma
55
Clinical presentation of small intestine tumours?
1. Pain, diarrhoea, anorexia, weight loss, anaemia, palpable mass
56
Diagnosis of small intestinal tumours?
1. US
2. Endoscopic biopsy
3. CT scan
57
Treatment of small intestinal tumours?
1. Surgical resection
| 2. Radiotherapy
58
What are colonic polyps?
Abnormal growth of tissue projects from colonic mucosa
59
What are adenomas?
Precursor lesions in most cases of colon cancer
| Benign dysplastic tumour of columnar cells of glandular tissue.
60
What are two genetic linked colonic tumours?
1. Familial adenomatous polyposis
| 2. Hereditary non-polyposis colon cancer
61
What is FAP?
AD mutation in APC gene where cysts form over teen years and can lead to cancer in 40s
62
What is HNPCC?
AD inheritance of hmSH1/hmSH2 mismatch repair gene mutations --> instability of DNA --> rapidly progressing colorectal carcinoma.
63
What is colorectal carcinoma?
Most commonly an adenocarcinoma
64
Risk factors of colorectal carcinoma?
1. Smoking + alcohol
2. Increase age
3. Low fibre diet
4. Animal fat and red meat consumption
5. Sugar consumption
6. Colorectal polyps
65
How to diagnose colorectal carcinoma?
1. Faecal Occult Blood Test
2. Tumour markers e.g. CEA
3. Colonoscopy: allow biopsy, remove polyps
4. Double contrast barium enema
5. DRE
6. CT colonoscopy
7. MRI
66
Treatment of colorectal carcinoma?
1. Surgery
2. Endoscopic stenting - malignant obstruction, decreased need for colostomy
3. Radiotherapy
4. Chemo - Dukes C chemo post decreases mortality risk.
67
Classification of Duke's criteria?
1. A = limited to muscularis mucosa
2. B = extend to muscularis mucosa
3. C = involve regional lymph nodes
4. D = distant metastases
68
What is coeliac disease?
1. Inflammation of duodenum/ small bowel obstruction
| 2. Gluten sensitive enteropathy
69
Epidemiology of coeliac disease?
1. Infancy and 50s
| 2. Strong association with HLA DQ2 and DQ8
70
Pathophysiology of coeliac disease?
1. Alpha gliadin is resistant to proteases chymotrypsin and pepsin and so pass through epithelium.
2. Deaminated by tissue transglutaminases --> interacts with APC with CD4 T cells in lamina propria via HLA class DQ2/DQ8
3. Release of pro-inflammatory cytokines and inflammatory cascade
4. Villous atrophy and crypt hyperplasia and intraepithelial lymphocytes.
71
Risk factors for coeliac disease?
1. Other autoimmune disease: T1DM, thyroid disease, Sjorgren
72
Clinical presentation of coeliac disease?
1. 1/3 asymptomatic --> increased MCV
2. Stinking stool/ fatty stool
3. Diarrhoea, abdominal pain, bloating, nausea, vomiting
Systemically: prolonged fatigue, unexplained weight loss, iron/b12/folate deficiency
73
Diagnosing coeliac disease?
1. Serology IgA Ab: tissue transglutaminase Ab, endomysial Ab
2. FBC: decrease Hb, B12, ferritin
3. Duodenal biopsy at endoscopy - histological changes
74
Treatment of coeliac disease?
1. Gluten free diet
2. Nutrient replacement = correct vitD and mineral deficiency
3. DEXA - osteoporosis risk
75
Complications of coeliac disease?
1. Anaemia
2. Secondary lactose intolerance
3. Osteoporosis
76
Presentation of acute liver injury
1. Malaise, nausea, anorexia
2. Jaundice
3. Abdominal pain
4. Confusion, bleeding, hypoglycaemia
77
Presentation of chronic liver injury?
1. Ascites/oedema
2. Haematemesis
3. Malaise/anorexia
4. Easy bruising, itching
5. Hepatomegaly
Rare jaundice
78
What are the causes of unconjugated jaundice
Haemolysis
| Gilbert's - deficiency in UDP glucoronyl transferases --> usually harmless, no specific treatment
79
What causes of hepatic jaundice?
1. Hepatitis
2. Ischaemia
3. Neoplasm
4. Congestion
80
Causes of post-hepatic jaundice?
Obstruction due to
Stones
Strictures - malignancy, ischaemic inflammatory
81
Symptoms of jaundice?
Rigor
Billiary pain
Weight loss
Abdominal swelling
82
What are black pigment gallstones?
Calcium bilirubinate and network of mucin glycoproteins
| Seen in haemolysis, spherocytosis, sickle cell and thalassaemia
83
What are brown pigment gallstones?
Calcium salts e.g. calcium bicarb
Almost always in presence of bile stasis and/or biliary infection
Commonly recurs
84
What are 3 things gall stones are not associated with?
Fat intolerance
Indigestion
Bowel Upset
85
How does biliary colic present?
Epigastrium pain first then RUQ
| Radiation to right shoulder
86
How does gall stones lead to acute cholecystis?
1. Gall bladder obstruction leads to increase gall bladder secretion which leads to progressive distension --> may compromise supply to gall bladder.
2. Inflammatory response = secondary to bile retention within gall bladder
87
RUQ pain, fever, jaundice in biliary colic?
Only RUQ pain
88
RUQ pain, fever, jaundice in acute cholecystitis?
RUQ pain
| Fever
89
RUQ pain, fever, jaundice in cholangitis?
YES all three - CHARCOT's triad
90
Describe the pathway of paracetamol overdose?
Acetaminophen --> Phase I (CYP2E1) ---> NAPQI (toxic metabolite) --> oxidative stress --> hepatocyte damage
91
Early symptoms of paracetamol overdose?
Initially asymptomatic/ nausea/ vomiting +/- RUQ pain
92
Late symptoms of paracetamol overdose?
Jaundice + encephalopathy +/- AKI
93
Mechanism of DILI?
1. Disruption of intracellular Ca2+ homeostasis
2. Disruption of bile cannalicular transport
3. Induction apoptosis
4. Inhibited mitochondrial function --> prevent FA metabolism, accumulation of ROS and lactate
94
Histological changes seen in alcoholic hepatitis?
1. Infiltration by polymorphonuclear leukocytes - hepatocyte ballooning
2. Dense cytoplasmic inclusions - sometimes seen in hepatocytes
3. Progress to cirrhosis
95
Clinical presentation of fatty liver?
1. Often asymptomatic
2. Vague abdominal symptoms
3. Hepatomegaly
96
Clinical presentation of alcoholic hepatitis/cirrhosis?
1. Few symptoms - mild to moderate
2. Mild jaundice - signs of CLD
- ascites, bruising, clubbing, Dupuytren's contracture
3. Severe - jaundice, ascites, high fever etc
97
Alpha 1 anti-trypsin deficiency commonly presents with
1. Emphysema
2. Cirrhosis
3. Hepatocellular carcinoma
98
Treatment for chronic Hep B?
1. Pegylated interferon alpha - SC injection, long term control
2. Oral nucleotide analogue e.g. tenofavir - inhibit HBV DNA polymerase - viral replication
99
Treatment of HepC?
NS5a, NS5b, NS3/4a protease inhibitors
| Lifestyle modifications
100
Pre-hepatic causes of portal HTN?
Thrombus in splenic vein/ portal vein
101
Intra-hepatic causes of portal HTN?
1. Cirrhosis
2. Congenital hepatic fibrosis
3. Schistosomiasis
4. Sarcoidosis
102
Post-hepatic causes of portal HTN?
1. Budd Chiari syndrome
2. RHF
3. Constrictive pericarditis
103
What can obstruct lumen of appendix in appendicitis?
1. Faecolith
2. Normal stool
3. Lymphoid hyperplasia
4. Infective agents
104
Pathophysiology of appendicitis?
1. Distal to obstruction, mucous filled --> distension --> intraluminal and intramural pressure.
2. Resident bacteria multiply E.Coli
3. Pressure increase and exceed venous pressure --> small vessels thrombosed --> enlargement/cognestion of appendix --> RLQ when hits parietal peritoneum
105
Symptoms of appendicitis?
1. Periumbilical pain migrate to right iliac fossa with parietal peritoneum involvement
2. Mc BURNEY POINT
3. Anorexia, rare vomiting
106
Signs of appendicitis?
1. Abdomen tender
2. Guarding - abdominal wall tender - local peritonitis
3. Rebound and percussion tenderness
107
Appendicitis differential diagnosis?
UTI, Crohn's. ectopic pregnancy, PUD
108
Examining acute appendicitis?
1. Rovsing's sign: RIF>LIF - when LIF pressed
2. Psoas sign: extending hip if retrocaecal appendix
3. Obturator's sign: pain on flexion and internal rotation on hip
4. Decrease bowel sounds on Right
109
Investigation of acute appendicitis?
1. Blood tests - increase leukocytes, neutrophil count
2. ESR and CRP
3. US, CT
110
How to treat appendicitis?
1. Laparoscopic appendicectomy
2. IV Abx - metronidazole and cefuroxime
3. Decrease risk of wound infections
111
Complications of appendicitis?
Perforation
Appendix mass
Appendix abscess
112
What drugs can causes C. diff?
Clindamycin
Cephalosporins
Ciprofloxacin
Co-amoxiclav
113
What causes mucosal damamge in C .diff infection?
Toxin A and B leading pseudomembranous colitis - yellow plaques from over damaged epithelium
114
What is nosocomial diarrhoea?
Diarrhoea due to hospital cause
115
Presentation of C .diff
Fever,
Diarrhoea
Crampy abdominal pain
116
Treatment of C .diff?
Metronidazole
Vancomycin
Stool transplant
117
Time frame of acute vs chronic diarrhoea infections?
2 weeks
118
Clinical presentation of gastroenteric fever
Fever
RLQ pain
Bradycardia, headache, rose spots, constipation, diarrhoea
119
Complications of gastroenteric fever?
1. Myocarditis
2. Peritonitis/ perforation
3. GI bleed
4. Abscess
120
How to treat liver abscess
Albendazole + percutaneous aspiration injection repair
121
The 4 ways in which intestinal obstruction can be classified?
1. Site - large/small bowel/ gastric
2. Mechanism - functional/ mechanical
3. Extent of luminal obstruction - partial/complete
4. Pathology - simple, closed loop, strangulation, intussusception
122
What is a functional cause of intestinal obstruction?
Paralytic ileus - adynamic bowel due to absence of normal peristaltic contractions due to abdominal surgery/ acute pancreatitis
- No pain, constipation or vomiting
123
What are some causes of intraluminal obstruction?
1. Tumour
2. Diaphragmatic disease
3. Meconium ileus
4. Gallstone ileus
124
What are some diseases in the bowel wall which lead to acute obstruction?
1. Inflammatory - crohn's disease
2. Diverticular disease
3. Hirschsprung's disease
125
What is diverticular disease?
Herniation of mucosa through weakened walls where BV penetrate
126
Causes of extraluminal obstruction
1. Adhesions
2. Volvulus
3. Tumours
127
Causes of SBO in children?
1. Appendicitis
2. Volvulus
3. Intussusception
4. Atresia
128
Causes of SBO in adults?
1. Adhesion
2. Hernia
3. Crohn's
4. Malignancy
129
Dyspepsia is characterised by?
1. Postprandial fullness
2. Early satiation
3. Epigastric pain or burning for >4 weeks
130
Aetiology of malabsorption?
1. Defective intraluminal digestion
2. Defective epithelial transport
3. Insufficient absorptive area
4. Insufficient digestive enzymes
5. Lymphatic obstruction
131
Causes of defective intraluminal digestion
1. Pancreatic insufficiency
| 2. Defective bile secretion - biliary obstruction/ileal resection
132
Causes of insufficient absorptive area?
1. Coeliac disease
2. Crohn's
3. Giardia Lamblia - extensive surface parasitization of villi
4. Surgery - small bowel resection
133
Defective epithelial transport causes
Abetaliproteinaemia
| Primary bile acid malabsorption
134
Causes of insufficient digestive enzyme?
1. Disaccharidase deficiency -lactose intolerance
135
Causes of lymphatic obstruction
1. Lymphoma
| 2. TB
136
Causes of transudate ascites?
1. Low protein conc - nephrotic syndrome, malnutrition, protein losing enteropathy
2. Raised central venous pressure - congestive cardiac failure
3. Portal hypertension - portal vein thrombosis/cirrhosis
137
Causes of exudate ascites?
1. Pancreatic ascites
2. Peritoneal malignancy
3. Budd Chiari syndrome
4. Tubercular peritonitis
138
Clinical presentation of ascites?
1. Distended abdomen ~2L
2. Full flanks/ shifting dullness
3. Mild abdominal pain
4. Constipation
5. Itching due to jaundice?
139
Diagnosis of ascites?
1. Ascitic tap - ~20ml of fluid
| - raised WCC, gram stain and culture, microscopy and cytology, amylase to exclude pancreatic ascites
140
Treatment of ascites?
1. Treat underlying cause
2. Reduce Na intake and give aldosterone antagonist - spironolactone
3. Paracentesis to drain 5L at a time
4. Tranjugular intrahepatic portosystemic shunts
141
What are secondary bile acids?
Bacterial metabolites of bile acids formed in the colon
142
Cholestasis
Bile secretion obstruction
143
Signs of cholestasis?
1. Jaundice - cholestatic
2. RUQ pain - intermittent/painless
3. Itching
4. Weight loss/Lethargy
144
Tests of cholestasis?
1. Obstructive blood test : alkphosphate raised, ALT raised, bilirubin raised
2. Imaging:
- a. US - dilated CBD - see stones, but not useful for obese patient
b. MRCP - less radiation but complex images and claustrophobia
c. CT - good for cancer, bad for stones, radiation
d. Endoscopic US
e. ERCP - diagnostic/not therapy!
145
Risk factors for cholelithiases?
1. Cholesterol
2. Rapid weight loss
3. Age
4. OCP/Pregnancy
5. Primary biliary cholangitis
Crohn's
146
Presentation of cholelithiases
1. Epigastric pain --> RUQ - biliary colic
2. Radiation to shoulder/axilla
3. Post prandial
4. Nocturnal
Most are ASYMPTOMATIC
147
Treatment of cholelithiases?
1. Laparoscopic cholecystectomy
| 2. Ursodeoxycholic acid: stone dissolution therapy
148
Clinical presentation of AC?
1. Biliary pain - progressive
2. Sepsis signs
3. Murphy's signs
4. Palpable GB
5. Mirizzi syndrome
149
Murphy's signs?
Expiration hitches when hand on gall bladder due to pain
150
How to test for AC?
1. WBC/CRP
2. Bilirubin, Alk Phos
3. USS - thick walled GB with stones
4. CBD dilatation - MRI
151
Differential diagnosis for acute cholecystitis?
1. Pancreatitis --> serum amylase
2. Appendicitis --> localising pain
3. PUD --> endoscopy
4. Liver abscess --> ultrasound
5. Pneumonia --> CXR
6. MI --> ECG
7. Perforated bowel --> CXR
152
Complication of acute cholecystitis?
1. Gangrene - perforation/abscess
2. Empyema
3. Chronic cholecystits
4. Cholangitis
5. Hydrops
6. Porcelain gall bladder
153
What is choledocolithiases
Common bile duct stone
154
What is ERCP? Complications?
1. Endoscopic retrograde cholangiopancreaticography
| Complications: pancreatitis, bleeding, failure
155
What are the functions of the peritoneum?
1. Visceral lubrication
2. Fluid and particulate absorption
3. Pain perception
4. Inflammatory and immune response
5. Fibrinolytic activity
156
Main causes of peritonitis?
1. Bacterial - E.Coli, Klebsiella, staphylococci
2. Chemical: bile, old clotted blood - leakage of intestinal contents, ruptured ectopic pregnancy
3. Traumatic
4. Ischaemia
5. Miscellaenous
Fx mediterannean fever
157
Clinical features of localised peritonitis?
1. Symptoms and signs of underlying conditions - abdominal pain, nausea, anorexia, vomiting
2. Fever and worse abdominal pain, tachycardia
3. Localised guarding, rebound tenderness, shoulder tip pain (subphrenic)
158
Clinical features of diffuse early peritonitis?
1. Abdominal pain
2. Tenderness/ generalised guarding
3. Infrequent bowel sounds
4. Fever, tachycardia
159
Clinical features of diffuse late peritonitis?
1. No resolution/ localisation - rigid abdomen
2. Distension due to paralytic ileus
3. Absent bowel sounds
4. Circulatory failure - cold clammy dry tongue
5. Loss of consciousness
160
Diagnose peritonitis?
1. Urinary dipstick
2. Blood test
3. Serum amylase
4. hCG/ ECG
6. erect CXR
7. Abdominal X ray
8. CT abdomen
161
Treatment of peritonitis?
1. ABC
2. Treat underlying cause.
3. IV fluid
4. Cefuroxime and metronidazole
5. Urinary catheterisation +/- GI depression
6. Specific treatment of cause:
- extension of perforated region +/- drainage
162
Complications of peritonitis?
1. Delayed treament: toxaemia, septicaemia
3. Local abscess formation
4. Kidney failure
5. Common pelvic/subphrenic - CT/US
6. Paralytic ileus - obstruction of intestine due to paralysis of intestinal
