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Year 4 Final > Upper GI and hepatobiliary > Flashcards

Upper GI and hepatobiliary Flashcards

1
Q

What is gastric MALT lymphoma associated with?

A

H.pylori in 95% of cases

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2
Q

Features of carcinoma of the pancreas?

A

Development of jaundice in association with a smooth right upper quadrant mass is typical of distal biliary obstruction secondary to pancreatic malignancy.

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3
Q

Features of gallstones?

A

biliary colic or episodes of chlolecystitis

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4
Q

Prefered diagnositc test for chronic pancreatitis?

A

CT abdomen

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5
Q

Features of acute pancreatitis?

A

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

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6
Q

What is acute pancreatitis usually due to?

A

Alcohol or gallstones

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7
Q

What is the pathophysiology of acute pancreatitis?

A

autodigestion of pancreatic tissue by the pancreatic enzymes, leading to necrosis

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8
Q

Investigations for acute pancreatitis?

A

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

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9
Q

What is Boehaave’s syndrome?

A

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.

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10
Q

Diagnosis of Boehaave’s syndrome?

A

CT contrast swallow

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11
Q

Ascending cholagnitis features?

A

Charcot’s triad of right upper quadrant (RUQ) pain, fever and jaundice occurs in about 20-50% of patients

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12
Q

Systemic complication of acute pancreatitis

A

Acute respiratory distress syndrome

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13
Q

Aetiology of acute pancreatitis?

A

GET SMASHED
Gallstones
Ethanol
tRAUMA
Steroids
Mumps
Autoimmune
Scorpiton
Hypercalacemia and hyperlipidaemia
ERCP
Drugs

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14
Q

Drugs that induce acute pancreatitis?

A

azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate

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15
Q

WCC in ascending cholangitis?

A

Raised

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16
Q

Is primary biliary cholangitis painful or painless?

A

Painless

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17
Q

What is acute cholecystitis?

A

Inflammation of the gallbladder

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18
Q

Treatment of acute cholecytitis?

A

intravenous antibiotics
cholecystectomy- within 1 week of diagnosis

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19
Q

Risk factors for severe pancreatitis?

A

age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST

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20
Q

Investigations for chronic pancreatitis?

A

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

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21
Q

What is Reynold’s pentad?

A

Charcot’s triad (RUQ pain, fever and jaundice) plus hypotension and confusion

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22
Q

Acute pancreatitis management?

A

Fluid resuscitation
Analgesia
Nutrition

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23
Q

What is primary sclerosing cholangitis?

A

chronic liver disease in which the bile ducts inside and outside the liver become inflamed and scarred, and eventually narrowed or blocked.

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24
Q

Investigation used to screen for malignancy in patient’s with primary sclerosing cholangitis?

A

Raised CA 19-9 levels

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25
Q

Blood results in bilary colic?

A

Normal

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26
Q

What is bilary colic caused by?

A

gallstones passing through the biliary tree.

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27
Q

Pathogenesis of cholangitis?

A

Ascending infection of the bile ducts usually by E. coli and by definition occurring in a pool of stagnant bile.

28
Q

Pathophysiplpgy of cholangiocarcinoma?

A

Direct occlusion by disease and also extrinsic compression by nodal disease at the porta hepatis.

29
Q

Management of ascending cholangitis?

A

intravenous antibiotics
endoscopic retrograde cholangiopancreatography (ERCP) after 24-48 hours to relieve any obstruction

30
Q

Mnemonic for modified glasgow score to predict severity on pancreatitis?

A

PANCREAS

31
Q

Most common complication of ERCP?

A

Pancreatitis

32
Q

What is more useful for late acute pancreatitis presentations? Lipase or amylase?

A

Lipase

33
Q

Best investigation for chronic pancreatitis?

A

CT pancreas

34
Q

What is MALT lymhoma?

A

affects the mucosa-associated lymphoid tissue, usually around the stomach. It is associated with H. pylori infection.

35
Q

What is acute cholecytitis?

A

Swelling of the gallbladder

36
Q

What is Boerrhaves syndrome?

A

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.

37
Q

Management of bilary colic?

A

elective laparoscopic cholecystectomy

38
Q

Management of pseudocysts?

A

Observe for 12 weeks. May resolve. If not endoscopic or surgical cystagrsotomy or aspiration

39
Q

best ways for differentiating between acute cholecystitis and biliary colic?

A

People with cholecystitis are systemically unwell

40
Q

What is a hernia?

A

Protrusion of an organ into an abnormal space

41
Q

What is affected In a hiatus hernia?

A

Most common hernia of the stomach herniating into the oesophageal

42
Q

Why does hernia not often happen near diaphragm?

A

Liver blocks

43
Q

Umbilical hernia vs paraumbilical hernia?

A

Umbilical is congenital

44
Q

Why do hernias occur at Linea alba?

A

Thin area of abdomen

45
Q

What is a spiegelian hernia?

A

Occurs where recutus abdomins stops (semilunar membrane)

46
Q

Commonest incisions in surgery?

A

Putting lapdascopic ports in. Most common one is in umbilicus

47
Q

Features you need to know about the hernia?

A

What is it
Is it fixable
Is it an emergency- obstructed or incaracerated

48
Q

What is an obstructed hernia?

A

If the viscus In the hernia is obstructed

49
Q

Why does an indirect inguinal hernia occur

A

Organ goes through deep and superficial inguinal

50
Q

If can’t get above scrotal swelling what is that?

A

Hernia

51
Q

Best way to check for reducibability?

A

Get patient to lie down and ask them if they can push the hernia back in

52
Q

How to check if indirect hernia

A

Block deep ring. Get patient to cough. If hernia doesn’t come out it is an indirect hernia

53
Q

How to complete a inguinal hernia exam?

A

Examine abdomen and scrotum

54
Q

How to tell femoral hernia?

A

Lateral to inguinal ligament
Could also feel for femoral artery

55
Q

Most common hernia in both genders?

A

Indirect inguinal hernia

56
Q

Questions while examining hernia-

A

does it go in? Any other symptoms? How much trouble is it causing you?

57
Q

Symptoms of oesophageal blockage

A

Dysphagia
Regurgitation
May still be having some bowel movements
Still produce wind

58
Q

Symptoms of blockage at stomach?

A

Vomiting up more digested foods
Could be up to a day that the bowel blockage occurs
Acidic- Burn when coming up
Projectile vomiting

59
Q

Symptoms of blockage at duodenum?

A

Bile
Vomiting up more digested foods
Could be up to a day that the bowel blockage occurs
Acidic- Burn when coming up
Projectile vomiting
Pancreatic juice- So more digested food

60
Q

Symptoms of blockage at low part of small intestine?

A

Bile coloured vomit
Few days after meals so probably no particular relation you can spot
Wind and some stools possible
Distended abdomen

61
Q

Symptoms of blockage at descending colon

A

Could present before even vomiting
Constipated
Possibly nothing or overflow diarrohea
Faecal vomit
Distended abdomen

62
Q

Causes of oesophageal blockage

A

Tumour
Achlasia- Equal of solids and liquids and is much longer standing

63
Q

Causes of stomach and duodenal blockage

A

Tumours- Stomach, duodenum, pancreas
In children pyloric stensois
Volvulus
Gallstone ileus

64
Q

Causes of small bowel obstruction

A

Ileus
Tumours
Hernia
Volvulus
Gallstone ileus
Adhesions from previous surgeries

65
Q

Causes of large bowel obstruction?

A

Tumour
Diverticulitis
Scarring

66
Q

Signs in an obstruction of any part of GI system

A

Dehydrates
Low GCS
A- Worry of aspiration so put NG tube in. Could also give antiemetics. NBM
B
C- IV fluids
D- GCS- Vomiting metabolic alkalosis
E- Glucose. Low as vomiting and not eating

67
Q

Investigations of obstruction of GI systems

A

AXR
CT would really pin point where and why

Year 4 Final (39 decks)

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