Gastro Flashcards

Question

investigations cholecystitis

Answer 1

``` FBC -leukocytosis LFTs -cholestatic CRP ``` Ultrasound - positive murphys - gallstone - thickening - >gall bladder wall - >cystic duct Consider - HIDA scan - >hepatobiliary iminodiacetic acid - >if ultrasound equivocal - >delayed takeup into gallbladder >60mins - MRCP - >if raised LFTs - >intra and extra hepatic ducts - CT - >if concern for local complications

Answer 2

HCG if female Urinalysis - genitourinary mimics - >UTI - can be abnormal in appendicitis FBC - leukocytosis - lactate ``` CT -large, with wall thickening ->diameter >6mm -inflammed -appendicolith may be present Ultrasound -lower sensitivity and specificity ->avoids radiation in women and children -diameter >6mm ```

Answer 3

complications - perforation - >usually after 12 hours with delayed medical treatment - leads to - >abscess and mass - >peritonitis - infective suppurative thrombosis of portal vein - >hepatic abscess

Answer 4

``` treatment -antibiotics alone ->avoids surgery in approx 75% ->at risk of significant cost with failure -antibiotics alone is less effective than appendicectomy with or without antibiotics ->failure for antibiotics within 1 year = 30% ->failure for appendicectomy <2% -antibiotics (Gently Manage Appendicitis) ->gentamycin IV ->metronidazole IV ->amp/amoxicilin IV -additional ->nil by mouth ->IV fluids -surgery -open or laparoscopic ```

Answer 5

``` risk factors -slight male to female -common in teenagers >predominately young adults -low fibre diet -smoking -<6 months of breast feeding ``` aetiology - obstruction - >faecolith - >normal stool - >lymphoid hyperplasia pathophys - closed loop obstruction - >fills with mucous - >intraluminal and intramural pressure - pressure greater than venules but not arterioles - >thrombosis of veins - >engorgement of appendix - distension - >reflex anorexia - >nausea, vom - >visceral pain (T10) - overgrowth of bacteria - >bacterioides fragilis - >e coli - suppurative inflammation involves serosa - >irritation of parietal pleura - >localised RLQ pain

Answer 6

Aetiology - almost always associated with gallstone in cystic duct - 5% alcalculous - >trauma, sepsis/infection, pregnancy, TPN - >gall bladder stasis, biliary sludge - >usually bacterial secondary infection Pathophys - gall stone lodged in cystic duct - >leads to gall bladder inflammation by three means - >release of prostaglandins drives local inflamm - mechanical inflammation - >increased pressure in lumen - >resulting in ischaemia and necrosis of mucosa and wall - chemical inflammation - >conversion of lethicin to lysolethicin by phospholipase - >lysolethicin acts as an irritant to mucosa - bacterial inflammtion - >secondary infection with gram negatives - >E coli, klebsiella, enterococcus

Answer 7

- if left untreated, may resolve after 1 week - gangrenous - >abscess - >perforation - >peritonitis - >sepsis - emphysematous - >gas forming organism (eg. clostridium) - enteric fistula - >adhesions - >gall stone ileus - >barnards = ileocaecal valve obstruction - >bouveret = gastric outlet obstruction - recurrent acute - chronic - >empyema - >hydrops - >porcelain gallbladder->carcinoma

Answer 8

``` Blood: FBC -anaemia -leukocytosis -thrombocytosis EUC -hypokalaemia -high Na -high urea LFTs (primary scerlosing cholangitis) ESR, CRP (flare, degree of severity for CD) Anti-saccharomyces (CD) and pANCA (UC) ``` Stool studies: - culture - microscopy for ova and parasites - histolytic antigen for amebiasis - c diff toxin - giadia antigen if travel - if appropriate sexual hx, PCR for chlam/gon and dark field microsopy for treponema - calprotecrin or lactoferrin for IBS Colonoscopy with biopsy Imaging - abo xray (dilated loops with air fluid level, lead pipe) - double contrast barium enema (in UC, granular appearance --> ulceration, thumbprinting with mucosal edema, narrowing/shortening of bowel)

Answer 9

IBD Infective colitis - bacterial (salmona, shigella, camp, c diff, e coli [haemorrhagic, adhesive, invasive]) - viral (immunosuppressed, CMV, HIV, HSV) - fungal (candida, asperigillus) - protozoa (giardia, water) - parasite (amebiasis, travel) - STD - >chlam, gon, syph Inflammatory (DR AIDS) - diverticular - radiation colitis - atypical colitides (collagenous, lymphacytic) - ischaemic - diversion - solitary rectal ulcer syndrome Neoplasm, carcinoma, polyps Drugs - NSAIDS - mycophenolate mofetil - ipilimumab

Answer 10

Steatosis - macrovesicular - intracellular displacing nucleus - perivenular zone (3) - 90% of alcoholics - approx. 5% go on to cirrhosis Alcoholic hepatitis: - 10-20% of alcoholics - approx 15% go on to cirrhosis - inflammation with ballooning degeneration - mallory-denk body (misfolded intermediate filaments or cytokeratin) - perivenular fibrosis (sclerosing hyaline necrosis) --> bridging fribrosis Alcoholic cirrhosis: - classically micronodular cirrhosis - fibrosis with regenerative nodules

Answer 11

``` Toxic megacolon (both, mainly UC) Bleeding Perforation, abscess, peritonitis (mainly CD) Fistulae (CD) Colorectal cancer (UC) Adhesions (CD) Bowel obstruction (CD) Gallstones (CD) SIBO (CD) Gastric outlet obstruction (CD) Death ```

Answer 12

eyeBD Has Peripheral Manifestations - Eye: episcleritis, uveitis - Blood: venous and arterial thrombosis, autoimmune haemolytic anaemia - Dermatological: pyoderma gangrenosum, erythema nodosum - Hepatic: primary sclerosing cholangitis, steatosis, autoimmune hepatitis - Pulmonary: interstitial, airway, parenchymal lung disease - Musculoskeletal: arthritis (non-erosive), anklyosing spondylitis, osteoporosis/osteopaenia, osteonecrosis

Answer 13

``` Young adult White/Jewish Family history Smoking increased CD, decreased UC Appendicectomy decreased UC OCP for UC (in smokers) Antibiotic use as child Previous infective gastroenteritis Diet high in animal protein/fat, sugar, fish and shellfish ```

Answer 14

HAD bloody CRAPS - Haemorrhoids - Anal fissure - Diverticulosis - Colitis (ischaemic, inflammatory, infectious) - Radiation induced telangectasia - Angiodysplasia - Polyps/neoplasia - Solitary rectal ulcer syndrome

Gastro Flashcards

(40 cards)