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what are the acute calculus causes of cholecystitis?
- 1. post op biliary strictures after non biliary surgery
- 2. severe trauma, burns, MOF, post partum
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Why is Crohn's disease associated with a higher risk of gallstones?
because it commonly affects the TI and so you get altered enterohepatic circulation of bile and an increased incidence of GS
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which drugs commonly cause acute pancreatitis?
- Valproate
- Azathioprine
- L-asparaginase
- Steroids
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Why do you get non diabetic retinopathy in chronic pancreatitis?
due to zinc or vitamin A deficiency
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what are complications of chronic pancreatitis? 7
- pseudocyst
- diabetes
- splenic vein thrombosis due to inflammation of tail of pancreas
- gastric varices and can bleed
- non diabetic retinopathy due to zinc or vit A deficiency
- biliary obstruction
- local arterial aneurysm
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what would you find in the urine of haemolytic anaemia jaundice?
- no bilirubin
- but presence of excess urobilinogen
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What is Rovsing's sign?
palpation in LIF causes more pain in RIF - sign in appendicitis
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Which age group are affected in type1 AIH and what are the antibodies?
- affects adults or children (bimodal distribution)
- anti smooth muscle Ab in 80% and ANA in 10%
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Which age group are affected in type2 AIH and what are the antibodies?
- affects children
- anti LKM1 (liver kidney microsomal type1) Ab
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what do investigations show for autoimmune hepatitis?
- blood: increased AST, hypergammaglobulinaemia esp. IgG
- low Wcc, anaemia and low platelets indicates hypersplenism
- liver biopsy: mononuclear infiltrate
- need to exclude other autoimmune liver disease e.g. PSC, PBC and chronic viral hepatitis
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what is the treatment of AIH?
- immunosuppressant: steroids (prednisolone)
- other steroid sparing: ciclosporin, azathioprine
- liver transplant if decompensated cirrhosis but recurrence may occur
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What are the autoAb for SLE?
anti dsDNA
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what are the autoAb for wegener's granulomatosis?
- cANCA (anti neutrophil cytoplasmic antibodies) (proteinase 3 ANCA)
- vasculitis affects lung, kidney, joints
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What are autoAb for microscopic polyangiitis and Churg Strauss?
cANCA (myeloperoxidase ANCA)
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what is churg strauss syndrome?
- medium vessel autoimmune vasculitis
- get granulomas and eosinophils
- involves lungs, heart, skin, kidney
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how do you treat churg strauss?
immunosuppression with prednisolone and azathioprine
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WHat is biliary colic?
When the gallbladder tries to empty its contents against pressure, eg stones, then it produces a colic
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what is cholecystitis?
when GB is inflamed
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A 78-year-old man admitted by the medical team has been on antibiotics to treat a chest infection. A week later and he is complaining of dysphagia, why?
candida oesophagitis happens in immunocompromised
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why would you get a palpable mass in the RIGHT upper quadrant in pancreatic carcinoma?
Courvoisier's law: palpable gallbladder in the presence of painless jaundice is unlikely to be GS
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what are 4 causes of xanthelasma?
- hypercholesterolaemia
- diabetes
- sarcoid
- PBC
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in post hepatic obstructive jaundice what would USS and urine tests show?
- US: dilated bile duct
- urine: lots of bilirubin, NO UROBILINOGEN
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What is the treatment for chronic pancreatitis?
- Diet: low fat, no alcohol
- Drugs: analgesia (+coeliac plexus block), lipase e.g. Creon, fat sol vitamins, insulin
- Surgery: if unremitting pain or wt loss do pancreatectomy
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What are the causes of chronic pancreatitis?
- congenital: pancreas divisum
- familial: cystic fibrosis, haemochromatosis,
- acquired: alcohol, pancreatic duct obstruction by stones or tumour
- hyperparathyroidism
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What investigations for chronic pancretitis?
- blood: high glucose
- US: pseudocyst
- CT, MRCP, ERCP but risk acute attack
- AXR: speckled pancreatic calcification
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WHat are the three most common causes of malabsorption in UK?
- Coeliac disease
- chronic pancreatitis
- Crohn's
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