What is shown in investigations for chronic pancreatitis?
raised serum amylase and lipase, decreases faecal elastase, mutations in genes, CT shows calcification, US and MRI, pancreatic stimulation test using secretin
What main viruses can cause infective diarrhoea?
Norovirus (contact with other cases) and rotavirus (small children), CMV (transplant)
What is the treatment of diverticulitis?
Drainage of abscess, surgery to remove affected colon segment (may need stoma), clear liquid diet, oral antibiotics (amoxicillin-clavulinic acid)
What is classed as diarrhoea?
6 loose bowel movements a day. More than 1 month is chronic. Less than 1 month means it could be infection.
What happens in the space of Disse in cirrhosis?
Collagen replaces the matrix and loss of endothelial fenestrations (openings) cause impairment of liver function. Increase in tissue inhibitors of metalloproteinases cause inhibition of collagen degradation.
What is the function of mucus in the stomach?
Acts as a barrier to acid
What are systemic complications of IBD?
conjunctivitis, iritis, mouth ulcer, fatty liver, liver abscess, thrombosis, large joint arthritis, erythema nodosum and pyodema gangrenosum due to cytokine release
How do gallstones cause acute pancreatitis?
They block the ampulla drainage, causing ductular hypertension and increase in ca2+, causing early activation of trypsinogen
How can bacteria get into the liver in pyogenic abscess?
Via portal vein (appendicitis, diverticulitis), biliary tract (cholangitis), hematogenous (bacteramia), trauma or infection of tumour/cyst
What do COX 1 enzymes do in the stomach?
Make prostaglandins in the mucosal lining of the stomach to protect it from the stomach
What are the main two types IBD and their main differentiation?
Crohns (discontinuous and patchy with skip lesions, transmura, granulomasl) and ulcerative colitis (continuous and restricted to the mucosa, moving distal to proximal with pseudopolyps, petichae exudates oedema, crypt abscesses, mucin depletion, goblet cell depletion)
What do investigations show in acute pancreatitis?
increased serum amylase and lipase, US and CT to look for cause, LFTs, FBC, MRI to assess pancreatic damage
DD for upper GI bleeds?
oesophageal varices, gastritis, peptic ulcers, malignancy, Mallory Weiss tear
What is gastropathy?
injury to gastric mucosa, associated with epithelial damage and regeneration with little of no accompanying inflammation
What is systemic sclerosis (scleroderma) and what does it cause?
Dimished peristalsis and oesophageal clearance caused by smooth muscle replacement with fibrous tissue. This decreases LOS pressure, causing reflux and mucosal damage, so deep strictures develop with dysphagia and heartburn.
What are parasitic causes of infective diarrhoea?
Giardia (well water), cryptosporidium (HIV or transplant or flooding), entamoeba (travellers)
Investigations in ascites?
serum ascites albumin gradient (SAAG), microscopy, diagnostic aspiration of ascitic fluid, cytology for malignant cells, amylase to exclude pancreatic ascites, neutrophil count, US and CT, protein count, sodium
Where are the most common places for ischaemic colitis to occur?
In watershed areas, in the splenic flexure and caecum
Complications of acute pancreatitis?
haemorrhage, DIC, ARDS, multi organ failure, necrosis
What is the treatment of an amoebic liver abscess?
Metronidazole and luminal agent, aspirate if large
What causes chronic pancreatitis?
CF, alcohol, malnourishment, pancreatic duct obstruction, genetic, autoimmune, smoking, elevated triglycerides, hereditary pancreatitis
What cause post hepatic portal hypertension?
Prolonged severe heart failure with tricuspid incompetence and constrictive pericarditis.
What does IL-8 do in the formation of peptic ulcers?
It is a cytokine that promotes inflammation
Treatment of acute cholangitis?
MRCP and ERCP for further assessment, biliary drainage and biopsy cultures. IV antibiotics (cefotaxime, metronidazole, amoxicillin, and gentamicin) and bile duct drainage with cholecystectomy, remove stones via balloon or basket catheter, if it can’t be removed, place a stent in the biliary tree. Mechanical lithotripsy.
Investigations for gastritis?
H.pylori urea breath test, endoscopy with biopsy of stomach lining, stool microscopy, urinalysis, blood, H.pylori antibody
What is a peptic ulcer?
A break in the superficial epithelial cells, penetrating down to the muscularis mucosa of the stomach or duodenum (mainly in duodenal cap or lesser curvature near incisura)
What is a Mallory-Weiss tear and what is it caused by?
A linear mucosal tear at the oesophageal junction caused by a sudden increase in intra abdominal pressure. Occurs after a bout of coughing, retching and after an alcohol dry heaves. It is the cause of 10% of upper GI bleeds.
Complications of ascites?
Spontaneous bacterial peritonitis e.g. E.coli, treat with antibiotics and liver transplant
What is the treatment of ulcerative colitis in a flare up?
5-AminoSalicylicAcid therapy e.g. sulfasalazine if mild, IV fluids, IV corticosteroids to reduce flare, IV antibiotics if all unresponsive
What are causes of acute pancreatitis and how?
Gallstones, alcohol (trauma, mumps, autoimmune disease, drugs, hyperlipidaemia, steroids) - an acute increase in pancreas intracellular calcium ions, causing an early activation of trypsinogen to trypsin and an impairment of trypsin degradation by chymotrypsin C, leading to cellular necrosis and haemorrhage.