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Upper GI conditions > Upper GI conditions > Flashcards

Upper GI conditions Flashcards

1
Q

How do you treat a variceal bleed?

A
  1. Resuscitation - maintain pulse, blood pressure, antibiotics
  2. Terlipressin - vasoconstrictor, predominantly splanchnic
  3. Endoscopic variceal ligation (EVL)
  4. sengtaken-blakemore tube- to delay until EVL, or delay until TIPS if EVL fails
  5. TIPS

Secondary prophylaxis

  • EVL
  • BB (Propanolol)
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2
Q

What is haemolytic uremic syndrome?

A

Condition where the small blood vessels in your kidneys become damaged and inflamed- this causes clots to form. The clots clog the filtering system in the kidneys and lead to kidney failure.

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3
Q

What causes haemolytic uremic syndrome?

A

E Cloli, specifically EHEC

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4
Q

What does haemolytic uremic syndrome present as?

A 
Abdominal pain
Fever 
pallor
petechiae - tiny spots of bleeding under the skin or in the mucous membranes (mouth or eyelids)
Oliguria - pee less than usual 
Bloody diarrhoea
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5
Q

What is seen in the blood count of a patient with haemolytic uremic syndrome?

A 
High WBC 
Low platelets 
Low Hb 
RBC fragments 
LDH greater than 1.5x normal
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6
Q

What is haemangioma

A

A benign liver lesion - single hypervascularised tumour

No treatment

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7
Q

What is a focal nodular hyperplasia lesion?

A

A begnin nodule formation of normal liver tissue. There is a central scar containing a large artery and branches. There is a hyperplastic response to abnormal arterial flow. The cells in this lesion can be sinudoidal, kupffer, hepatocytes etc

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8
Q

Do focal nodular hyperplasia cause pain?

A

Can cause pain but most are asymptomatic.

More common in young and middle aged women

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9
Q

What is a hepatic adenoma lesion?

A

A benign neoplasm composed of normal hepatocytes (no portal tract, central veins or bile ducts). Associated with contraceptive pill

Far more common in women but men have a greater risk of malignancy

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10
Q

Hoe does hepatic adenoma lesion present?

A

Asymptomatic
RUQ pain
rupture, haemorrhage
malignant transformation (rare)

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11
Q

What is the treatment for hepatic adenoma lesion?

A

Women:
Stop contraceptive, weight loss
imaging after 6 months (<5cm = annual MRI, >5cm surgery)

Males:
Surgery irrespective of size

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12
Q

What is a simple liver cyst? And what treatment is given

A

Liquid collection lined by an epithelium

None
imaging 3-6 months
can do surgical intervention

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13
Q

What are some symptoms of a simple liver cyst?

A 
asymptomatic (mostly)
intracystic haemorrhage 
infection 
rupture - rare
compression
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14
Q

What is a hydatid cyst?

A

develop these cysts when ingest the eggs of the tapeworm Enchinococcus granulosus.

Presents as disseminated disease (throughout body) or erosion of cysts into adjacent structures

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15
Q

How ids a hydatid cyst treated?

A 
Albendazole (stops worms from absorbing sugar)
percutaneous drainage 
Surgery:
-opening and letting it drain 
-removing cyst/liver lobe
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16
Q

What are some symptoms of polycystic liver disease?

A

Abdominal pain
Abdominal distension
Aytpical symptoms due to voluminous cysts resulting in compression of adjacent tissue or failure of the affected organ

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17
Q

What are symptoms of a liver abcess (cyst filled with pus)

A 
High fever 
leukocytosis 
abdominal pain 
complex liver lesion on imaging 
Hx of abdominal or biliary infection/dental procedure
18
Q

What is the management of liver abscess?

A

Amoxicillin, gentamycin, metronidazole
aspiration/ drainage
surgery if no improvement

19
Q

What is cholelithiasis?

A

Gallstones

20
Q

What are the different kind of gallstones?

A

Cholesterol gall stones
Pigment gallstones- excess of bilirubin
mixture gallstones

21
Q

What are some complications of gallstones?

A 
Acute cholecystitis 
Chronic cholecystitis 
Mucocoele (build up of mucous as blocked)
Empyema - mucous sac infected
Carcinoma 
Asecinding cholangitis 
Obstructive jaundice 
Gallstone ileus 
Acute pancreatitis 
Chronic pancreatitis
22
Q

What is the treatment of gallstones?

A

Cholecystectomy
Ursodexycholic acid (dissolves stones but should only be used in patients with small stones and unimpaired gallbladder)
Buprenorphine/pethidine (analgesia for biliary colic)
Atropine/GTN for biliary spasm

23
Q

What is biliary colic?

A

Waxing/waining postprandial epigastric/RUQ pain due to transient cystic duct obstruction by gallstones

24
Q

What are some symptoms of biliary colic?

A

RUQ pain that radiates to the back
4-6/8hrs pain duration, settles on its own
No fever, no leukocytosis, raised ALP

25
Q

What ttreatment is given in biliary colic?

A

Analgesics - not morphine
low fat diet
consider cholecystectomy if recurrent

26
Q

What is cholecystitis?

A

Inflammation of the gallbladder

27
Q

What pathogenesis occurs in acute cholecystitis?

A

GB wall distension, inflammation and oedema due to the obstruction - initialy sterile then will become infected due to bacteria. Can cause adhesions, empyema, rupture, peritonitis

28
Q

What signs are expected in acute cholecystitis?

A

RUQ pain >24hrs +/- fever
tender in RUQ
Murphy’s sign - if you press below R costal margin, the patient won’t be able to breath in
elevated WBC expected but not reliable

29
Q

What is the Tokyo guidelines?

A

Grading for acute cholecystitis
Grade 1 - mild inflammation
Grade 2- inflammation
Grade 3 - organ dysfunction

30
Q

What investigations are carried out in acute cholecystitis?

A

US (1st line)
Nuclear HIDA scan - dye in biliary system and no filling of GB
MRCP

31
Q

What will be seen on an ultrasound in acute cholecystitis?

A

Distended gallbladder
increased wall thickness
peri-cholecystic fluid - fluid around GB
Positive sonographic Murphy’s sign

32
Q

What treatment is given in acute cholecystitis?

A
  • Early cholecystectomy for acute 48-72hrs
  • elective cholecystectomy for acute >72hrs and chronic
  • if patient too sick then cholecystostomy (drain GB)
33
Q

What is Choledocholithiasis?

A

Presence of gallstones in the CBD

34
Q

What is the treatment for choledocholithiasis?

A

ERCP - for stone extraction

Eary/interval cholecystectomy is considered after recovery from ERCP

35
Q

What is Cholangitis?

A

Inflammation of the bile duct due to obstruction in the CBD. Can be due to stones or strictures.

Can lead to sepsis and septic shock

36
Q

What are symptoms/signs of cholangitis

A

Charcot’s triad: persistant RUQ pain, fever, jaundice
Raised WBC
Obstructive LFTS (high bilirubin and ALP)
For suppurative - hepatic encephalopathy and hypotension

37
Q

What is the treatment for cholangitis?

A 
IV fluids 
IV antibiotics 
If emergency decompression is required:
-ERCP 
-Percutaneous transhepatic drainage
38
Q

What is gallstone pancreatitis?

A

Acute inflammation of the pancreas due to gallstones- reflux of bile into pancreatic duct or obstruction of ampulla of Vater by stone

39
Q

What LFT is commonly high in gallstone pancreatiits?

A

ALT >150 (3x normal value)

40
Q

What is the treatment for gallstone pancreatitis?

A

IV fluids, light diet, analgesia
Once resolving ERCP and stone extraction
Mild cases - cholecystectomy on adomission
Severe - cholecystectomy within 4 weeks

41
Q

What are some DDs of RUQ pain?

A 
Biliary disease
-Acute/chronic cholecytits
-CBD stone 
-Cholangitis 
Inflammed/perforated peptic ulcer
Pancreatitis
Hepatitis
Rule out:
-appendicitis 
-renal colic
-pneumonia
-pleurisy
-AAA

Upper GI conditions (1 decks)

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