Treatment of biliary colic?
Analgesia, rehydrate, elective laproscopic cholecystectomy, may need a MRCP before if the liver biochemistry is abnormal
What is the treatment of functional diarrhoea?
Loperamide and an tricyclic antidepressant e.g. clomipramine
What part is mainly affected in crohns?
caecum and ileum (40%) SI (30%) - has skip lesions
Symptoms of ascites?
painful abdominal distension, SOB, nausea, vomiting, loss of appetite, constipation, cachexia, weight loss, jaundice
What causes diverticulosis?
low fibre, constipation, straining with bowel movements due to increased pressure causing the mucosa and sub mucosa to herniate through the weakened part, forming a diverticulum
What are common micro organisms in a pyogenic liver abscess?
E.coli, K.pneumoniae, Streptococcus milleri, bacterioides spp.
What causes pre hepatic portal hypertension?
Blockage of the portal vein due to thrombosis caused by secondary congenital portal venous abnormality.
How does H.pylori cause a peptic ulcer?
It is adapted to live in gastric mucus (antrum) as it has urease which generates ammonium to buffer acidity and neutralise it so H.pylori can move down to the epithelial cells and adhere. It then excretes Cag A and Vac A, breaking down the tight junctions of epithelial cells and induces inflammation by mononuclear and neutrophil cellular infiltrate in lamina propria so the HCl acid layer can reach the epithelial cells and damage them causing an ulcer. This promotes gastric acid secretion and spread to the duodenum.
What is the treatment for midgut dysmotility?
avoid narcotics, FODMAP diet, SSRI paroxetine and smooth muscle relaxant
What are the symptoms of a liver abscess?
Fever, weight loss, nausea, vomiting, leucocytosis, RUQ pain radiating to right shoulder and scapula, jaundice (more severe than in cholencytitis, tender hepatomegaly
What makes up black pigment stones and in what kind of patient would you find them?
Calcium biliruibinate, mucin glycoproteins and calcium carbonate, in haemolytic patients
What causes calcification in chronic pancreatitis?
The prolonged intra pancreatic enzyme activity, leads to precipitation of proteins forming plugs and a nidus for calcification and ductal obstruction and hypertension
Epidemiology of primary biliary cirrhosis?
90% are female, aged 35-55years
If H.pylori decreases gastric acid in a patient, what does this suggest?
What is a varice?
Elevated pressure in the portal renal system causes dilated veins to become engorged which can rupture if the pressure becomes more than >12mmHG, leading to haemorrhage
What is haemorrhoids and what is it caused by?
Disruption and dilation of the 3 anal cushions which line the anus to help with anal closure. Caused by gravity, pregnancy, pelvis tumour, CCF, portal hypertension, increased anal tone and straining at the stool.
What causes an amoebic liver abscess?
From food contaminated with faeces in endemic areas, swallow cyst into intestines, reaches caecum and grows and goes into mesenteric vein, portal vein and liver
Complications of diverticulosis?
Diverticulitis, abscess in pelvis from spreading pus which can erode into the urinary bladder causing bladder infection and passing of intestinal gas in the urine, colon obstruction, bacterial peritonitis, bleeding into colon, fistula formation
What factors would lead you to do surgery in varice treatment?
Severe bleeding or bleeding despite transfusing 6U if >60. Active of uncontrollable bleeding at endoscopy. Initial Rockall score >=3 or final Rockall score >6.
What can cause a false positive result in a Heliobactor test?
Previous Heliobacter treatment
What does the rate of cholesterol stone formation depend on?
Cholesterol supersaturation of bile, crystallization promoting factors in bile (mucus and calcium) and motility of gall bladder.
What is pruritus ani and what are its primary and secondary causes?
Itching and scratching of the perianal due to haemorrhoids or overactive sweat glands or secondary to threadworm, a fungal infection or perianal eczema.
What is type B chronic gastritis?
Caused by H.pylori infection, and is the most commo chronic cause
Treatment of hepatic encephalopathy?
Nursing, NBM, ranitidine to reduce acid secretion, sucralfate to decrease oesophageal ulceration post endoscope
What test would differentiate between amoebic and pyogenic liver abscess?
Stool microscopy, antigen (fresh), culture, serology EIA
What investigations would be used for a hernia?
Endoscopy, barium swallow, ultrasound
Diagnosis of peritonitis?
CXR shows free air and fluid under diaphragm and perforation, increased WBC, US and CT show location, peritoneal aspiration, serum amylase for pancreatitis
What are the symptoms specific to hydatid abscess?
asymptomatic until 5cm. The symptom depends on where the cyst is. Diagnose by serology ELISA
Treatment of acute cholecystitis?
NBM, IV fluids, opiate analgesia, IV antibiotics (Cefotaxime), drain if empyema, delayed cholecystectomy to allow symptoms to settle.
What are complications of Achalasia?
Aspiration pneumonia, increased risk of oesophagus squamous carcinoma and reflux esophagitis risk.