UGI&HPB Flashcards
Most common composition of gallstones?
Cholesterol
Who gets bile pigment stones?
Patients with increased bilirubin production e.g. haemolysis, most commonly patients with haemolytic anaemia or sickle-cell
Optimal treatment for oesophageal varices?
Banding is better than injection sclerotherapy
Presentation of acute appendicitis?
Gradual onset dull ache in umbilicus which becomes more intense and shifts to RIF. Patients usually nauseated and soft abdomen with localised peritonism in RIF
Indications for OLT in PSC?
Recurrent bacterial cholangitis, intractable pruritus
Treating acute ascending cholangitis?
Do emergency decompression of the CBD with ERCP
Indications for ERCP?
Obstructive jaundice, biliary/pancreatic duct disease, pancreatic cancer, pancreatitis of unknown origin, pancreatic pseudocysts (drainage), SoO dysfunction (sphincterotomy)
What are pancreatic pseudocysts?
Collections of necrotic-haemorrhagic material rich in enzymes, lacking epithelial lining. Most common cyst in pancreas. Usually arise after acute pancreatitis
Where do pancreatic cancers arise?
Mostly (60%) in the head, 15% in the body, 5% in the tail, 20% diffusely across whole gland
Most specific antibodies for PBC?
Anti-mitochondrial antibodies
p-ANCA antibodies occur in which three conditions?
Microscopic polyangitis (MPA), Churg-Strauss (EGPA), primary sclerosing cholangitis
Which two antibodies are associated with autoimmune hepatitis?
Anti-smooth muscle antibodies with type 1 AIH, anti-liver kidney microsomal antibodies with type 2 AIH
Using terlipressin and octreotide together?
Not done
When are terlipressin and octreotide indicated?
Management of variceal bleed, with octreotide sometimes preferred if have CV comorbidities
Giving PPI in UGI bleed?
Contentious - some argues that is may mask bleeding at endoscopy. Probably good to hold until OGD then give stat IV dose then IV infusion if peptic ulcer found to be cause
Using CT angiogram and percutaneous embolisation in UGI bleed?
Can be indicated if still apparently bleeding and OGD normal; done by IR
Differentiating oesophageal carcinoma and achalasia?
Both get dysphagia and weight loss, but dysphagia in carcinoma is progressive, and worse with solids, while achalasia is solids and liquids. Greater weight loss in cancer.
Features of pharyngeal pouch?
Palpable lump in the neck, may appear with meals or on examination, more common in older men. Dysphagia may occur when food accumulates in pouch and presses on oesophagus. May get regurgitation, halitosis, gurgling
What is bulbar palsy?
Neurological condition with a variety of causes such as MND, presents with palsy of the muscles of mastication, face and tongue
Identifying pneumoperitoneum if cannot tolerate erect CXR?
Can do supine abdo radiograph (see Rigler’s sign i.e. double wall), or lateral decubitus AXR
What is Hartmann’s pouch?
Region of the biliary tree at junction of GB and cystic duct
Features suggesting gastrinomas?
(Male aged 30-50), with multiple ulcers/ulcers in unusual locations, ulceration with diarrhoea, ulcers refractory to therapy, absence of H. pylori, severe complications like bleeding/perf.
What are gastrinomas and how are they diagnosed?
Neuroendocrine tumours normally found in duodenum, test serum gastrin. If have gastrinomas causing ulcers = ZES
Rapid urease test?
Aka CLO test,
