Upper GI Flashcards
Describe the different types of gall stones
Pigment stones (<10%) - small friable and irregular. Caused by haemolysis.
Cholesterol stones - large, often solitary.
More common in F, obesity.
Mixed stones - faceted (calcium salts, pigment, and cholesterol.
What is the difference between biliary colic, cholescystitis, and cholangitis?
Biliary colic - pain from gallstones obstructing the CBD or passing through the CBD. Causes pain in the RUQ, radiating to the back (can have jaundice).
Cholescysitis - inflammation of the gall bladder due to gall stone or sludge. patients have local peritonism, fever and raised WCC.
Cholangitis - inflammation of the bile duct, (caused by gall stone, ERCP, tumours) Charcots triad = RQU pain, jaundice and rigors. V serious.
What is the treatment of acute cholescysitis?
NBM, pain relief, IV fluids, Abx, (consider cholecystectomy if <72hrs if not operate in 6-8 weeks)
What causes pneumobilia?
Gall stone ileus - the gall stone erode from the gall bladder into the duodenum.
Name three atypical types of cholecystitis:
Non calculous cholecycstitis:
presents in elderly and critically ill patients, caused by reflux of pancreatic enzymes, causing chemical inflammation
Cholesterolosis of the gall bladder:
cholesterol and other lipids deposit into macrophages within the lamina propria of the gall bladder.
Adenmyomatosis of the gall bladder:
hyperplasia of the mucosa and thickening of the muscle wall and multiple inframural diverticular.
What pain relief is contra indicated in biliary colic?
Opioids as can exacerbate it
What are the causes of pancreatitis?
Gall stones Ethanol Trauma Steroids Mumps Auto-immune Scorpion sting Hyper - lipidaemia, calcaemia, hypothermia ERCP Drugs
pregnancy, neoplasia and idiopathic
What conditions cause a rise in amylase?
Pancreatitis (>1000 or 3x upper limit), cholecystitis, mesenteric infarction, GI perforation, intestinal obstruction, ruptured ectopic, DKA, liver failure, renal failure, ruptured AAA (all cause lower rises)
Amylase may be normal in pancreatitis as it starts to fall in the first 24-48hrs.
Name two criteria used to predict the severity of pancreatitis:
Modified Glasgow criteria >3 needs ITU: PO2 55 Neutrophillia WBC >15 Calcium 16 Enzymes LDH >600, AST >200 Albumin 10
Ranson's criteria (for alcohol induced). Mortality risk 0-2 = 2%, 3-4 = 15%, 5-6 = 40%, >7 = 100% On admission: Age >55 WCC >16 LDH >600 AST >120 Glucose >10 Fluid sequestration >6L Within 48hrs: Haemtocrit fall >10% Urea rise >0.9 Calcium 4
What are the complications of pancreatitis?
Systemic - SIRS MOD
Pancreas - fluid collections, necrosis, abscesses, pseudocyst, fistula formation
Lungs - pleural effusion, ARDs, pneumonia
Kidney - AKI
GI - bleeding, paralytic ileus
Hepatobiliary - jaundice, CBD obstruction, portal vein thrombosis
Metabolic - hypoglycaemia, hyperglycaemia, hypercalcimia
What are the classical symptoms of pancreatitis?
epigastric pain radiating to the back, relived by sitting forward. vomiting +++
What are the comon causes of cholangitis?
E.Coli, Klesiella, Enterobacter, enterococci, group D strep.
What diameter is the CBD normally and how big does it have to get to indicated obstruction?
5mm
7mm = obstruction
What are the two emergency presentations of ulcers?
Haemorrhage - caused by posterior ulcers that erode into the gastroduodenal artery
Perforation - caused by an anterior ulcer on the duodenal wall
What are the causes of pneumoperitoneum?
Ruptured hollow viscus - perforated ulcer or diverticulum, necrotizing enterocolitis, toxic megacolon, IBD
Infection - infection of the peritoneal cavitiy with gas forming organisims and/or rupture of an adjacent abscess
Iatrogenic - recent abdominal surgery, abdominal trauma, leaking anastomosis, misplaced chest drain, endoscopic perforation.
