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Phase 1c: Conditions > Upper GI and hepatobiliary > Flashcards

Upper GI and hepatobiliary Flashcards

1
Q

what are the risk factors for biliary colic?

A

obesity
female
pregnancy
middle age
diabetes mellitus
Crohn’s disease
rapid weight loss, e.g. weight reduction surgery
drugs: fibrates, combined oral contraceptive pill

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2
Q

what are the features of biliary colic?

A

colicky RUQ pain - worse after eating fatty foods
pain may radiate to right shoulder
nausea and vomiting
no fever, normal CRP and LFTs

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3
Q

how is biliary colic investigated?

A

ultrasound

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4
Q

how is biliary colic treated?

A

elective laparoscopic cholecystecomy

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5
Q

what are the causes of chronic pancreatitis?

A

alcohol
cystic fibrosis
haemochromatosis
ductal obstruction: tumours, stones

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6
Q

what are the features of chronic pancreatitis?

A

pain typically worse 15 to 30 minutes after meal
steatorrhoea
diabetes mellitus - more than 20 years after symptoms begin

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7
Q

how is chronic pancreatitis investigated?

A

abdominal X-ray - shows calcification
CT scan (more sensitive, preferred diagnostic test)
faecal elastase - shows exocrine insufficiency

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8
Q

how is chronic pancreatitis treated?

A

pancreatic enzyme supplements
analgesia

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9
Q

what is ascending cholangitis?

A

bacterial infection (typically E. coli) of the biliary tree

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10
Q

what are the features of ascending cholangitis?

A

fever
jaundice
RUQ pain
hypotension, confusion
raised CRP

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11
Q

how is ascending cholangitis investigated?

A

ultrasound

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12
Q

how is ascending cholangitis treated?

A

IV antibiotics
ERCP after 24-48 hours to relieve obstruction

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13
Q

what are the causes of acute pancreatitis?

A

gallstones
ethanol
trauma
steroids
mumps
autoimmune
snake/scorpion bite
hypercalcaemia, hypothermia, hypertriglyceridaemia
ERCP
drugs

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14
Q

what drugs can cause acute pancreatitis?

A

azathioprine
mesalazine
bendroflumethiazide
furosemide
sodium valproate
steroids

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15
Q

what are the features of acute pancreatitis?

A

severe epigastric pain that radiates to the back
nausea, vomiting
fever
Cullen’s sign and Grey-Turner’s sign (rare)

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16
Q

how is acute pancreatitis investigated?

A

serum amylase and lipase (lipase more sensitive and specific)
ultrasound to determine aetiology
contrast-enhanced CT

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17
Q

what factors indicate severe pancreatitis?

A

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

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18
Q

what are the complications of acute pancreatitis?

A

peripancreatic fluid collections (most resolve, may develop into pseudocysts or abscesses)
pseudocyst (conservative management)
pancreatic necrosis
pancreatic abscess (infected pseudocyst)
haemorrhage

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19
Q

what is Boerhaave’s syndrome?

A

spontaneous rupture of the oesophagus as a result of repeated episodes of vomiting

20
Q

what are the features of Boerhaave’s syndrome?

A

sudden onset severe chest pain that may complicate severe vomiting
subcutaneous emphysema on chest wall

21
Q

how is Boerhaave’s syndrome diagnosed?

A

CT contrast swallow

22
Q

how is Boerhaave’s syndrome managed?

A

thoracotomy and lavage

23
Q

what are the features of acute cholecystitis?

A

RUQ pain that may radiate to right shoulder
fever
Murphy’s sign: pain on palpation of RUQ during inspiration
normal LFTs - deranged LFTs suggest Mirizzi syndrome

24
Q

how is acute cholecystitis investigated?

A

ultrasound

25
Q

how is acute cholecystitis treated?

A

IV antibiotics
early laparoscopic cholecystectomy, within 1 week of diagnosis

26
Q

what is Mirizzi syndrome?

A

gallstone impacted in the distal cystic duct causing extrinsic compression of the common bile duct

27
Q

how can the cause of ascites be determined?

A

calculate SAAG
if SAAG >11g/L, portal hypertension (transudate, low protein content)
if SAAG <11g/L, exudate

28
Q

what are the causes of a high SAAG?

A

cirrhosis/alcoholic liver disease
acute liver failure
liver metastases
right heart failure
constrictive pericarditis
Budd Chiari syndrome

29
Q

what are the causes of a low SAAG?

A

malignancy
infection
pancreatitis
nephrotic syndrome

30
Q

what are the features of PSC?

A

cholestasis: jaundice, pruritus
raised bilirubin and ALP
RUQ pain
fatigue
increased risk of cholangiocarcinoma and colorectal cancer

31
Q

how is PSC investigated?

A

ERCP or MRCP showing ‘beaded’ appearance
p-ANCA may be positive

32
Q

what are the investigation findings of alcoholic liver disease?

A

raised gamma-GT
ratio of AST: ALT is normally > 2

33
Q

how is alcoholic liver disease treated?

A

prednisolone - Maddrey’s discriminant function used to determine who would benefit (uses PT and bilirubin concentration)
sometimes pentoxyphylline

34
Q

what is the inheritance pattern of haemochromatosis?

A

autosomal recessive - HFE gene

35
Q

what are the features of haemochromatosis?

A

fatigue, erectile dysfunction, arthralgia
bronze skin pigmentation
diabetes mellitus
hepatomegaly, cirrhosis
cardiac failure (dilated cardiomyopathy)
hypogonadism

36
Q

what are the investigation findings of haemochromatosis?

A

raised iron, ferritin and transferrin saturation (ts considered most useful)
low transferrin
low TIBC
genetic testing for HFE gene

37
Q

how is haemochromatosis managed?

A

venesection
desferrioxamine second-line

38
Q

what are the medical associations with primary biliary cholangitis?

A

Sjogren’s syndrome (seen in up to 80% of patients)
rheumatoid arthritis
systemic sclerosis
thyroid disease

39
Q

what are the features of primary biliary cholangitis?

A

early: may be asymptomatic (e.g. raised ALP on routine LFTs) or fatigue, pruritus
cholestatic jaundice
hyperpigmentation, especially over pressure points
around 10% of patients have right upper quadrant pain
xanthelasmas, xanthomata
also: clubbing, hepatosplenomegaly
late: may progress to liver failure

40
Q

how is primary biliary cholangitis investigated?

A

raised IgM and anti-mitochondrial antibodies
RUQ ultrasound or MRCP to exclude extrahepatic biliary obstruction

41
Q

how is primary bilary cholangitis managed?

A

ursodeoxycholic acid
cholestyramine for pruritus

42
Q

what is Budd-Chiari syndrome?

A

hepatic vein thrombosis
can be caused by polycythaemia rubra vera, thrombophilia, pregnancy

43
Q

what are the features of Budd-Chiari syndrome?

A

acute hepatitis
sudden onset, severe abdominal pain
ascites
tender hepatomegaly

44
Q

how is Budd-Chiari syndrome investigated?

A

ultrasound with Doppler flow studies

45
Q

what are the features of autoimmune hepatitis?

A

acute hepatitis: fever, jaundice
signs of chronic liver disease
amenorrhoea
raised IgG
ALKM1/ANAs/ASMAs

Phase 1c: Conditions (18 decks)

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