Upper GI and hepatobiliary Flashcards
What is gastric MALT lymphoma associated with?
H.pylori in 95% of cases
Features of carcinoma of the pancreas?
Development of jaundice in association with a smooth right upper quadrant mass is typical of distal biliary obstruction secondary to pancreatic malignancy.
Features of gallstones?
biliary colic or episodes of chlolecystitis
Prefered diagnositc test for chronic pancreatitis?
CT abdomen
Features of acute pancreatitis?
severe epigastric pain that may radiate through to the back
vomiting is common
examination may reveal epigastric tenderness, ileus and low-grade fever
periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign) is described but rare
What is acute pancreatitis usually due to?
Alcohol or gallstones
What is the pathophysiology of acute pancreatitis?
autodigestion of pancreatic tissue by the pancreatic enzymes, leading to necrosis
Investigations for acute pancreatitis?
serum amylase
raised in 75% of patients - typically > 3 times the upper limit of normal
levels do not correlate with disease severity
specificity for pancreatitis is around 90%.
serum lipase
more sensitive and specific than serum amylase
it also has a longer half-life than amylase and may be useful for late presentations > 24 hours
imaging
a diagnosis of acute pancreatits can be made without imaging if characteristic pain + amylase/lipase > 3 times normal level
however, early ultrasound imaging is important to assess the aetiology as this may affect management - e.g. patients with gallstones/biliary obstruction
other options include contrast-enhanced CT
What is Boehaave’s syndrome?
spontaneous rupture of the oesophagus that occurs as a result of repeated episodes of vomiting. The rupture is usually distally sited and on the left side.
Diagnosis of Boehaave’s syndrome?
CT contrast swallow
Ascending cholagnitis features?
Charcot’s triad of right upper quadrant (RUQ) pain, fever and jaundice occurs in about 20-50% of patients
Systemic complication of acute pancreatitis
Acute respiratory distress syndrome
Aetiology of acute pancreatitis?
GET SMASHED
Gallstones
Ethanol
tRAUMA
Steroids
Mumps
Autoimmune
Scorpiton
Hypercalacemia and hyperlipidaemia
ERCP
Drugs
Drugs that induce acute pancreatitis?
azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate
WCC in ascending cholangitis?
Raised
Is primary biliary cholangitis painful or painless?
Painless
What is acute cholecystitis?
Inflammation of the gallbladder
Treatment of acute cholecytitis?
intravenous antibiotics
cholecystectomy- within 1 week of diagnosis
Risk factors for severe pancreatitis?
age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST
Investigations for chronic pancreatitis?
abdominal x-ray shows pancreatic calcification in 30% of cases
CT is more sensitive at detecting pancreatic calcification. Sensitivity is 80%, specificity is 85%
functional tests: faecal elastase may be used to assess exocrine function if imaging inconclusive
What is Reynold’s pentad?
Charcot’s triad (RUQ pain, fever and jaundice) plus hypotension and confusion
Acute pancreatitis management?
Fluid resuscitation
Analgesia
Nutrition
What is primary sclerosing cholangitis?
chronic liver disease in which the bile ducts inside and outside the liver become inflamed and scarred, and eventually narrowed or blocked.
Investigation used to screen for malignancy in patient’s with primary sclerosing cholangitis?
Raised CA 19-9 levels
