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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
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
which drugs commonly cause acute pancreatitis?
Why do you get non diabetic retinopathy in chronic pancreatitis?
due to zinc or vitamin A deficiency
what are complications of chronic pancreatitis? 7
- 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
what would you find in the urine of haemolytic anaemia jaundice?
- no bilirubin
- but presence of excess urobilinogen
What is Rovsing's sign?
palpation in LIF causes more pain in RIF - sign in appendicitis
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%
Which age group are affected in type2 AIH and what are the antibodies?
- affects children
- anti LKM1 (liver kidney microsomal type1) Ab
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
what is the treatment of AIH?
- immunosuppressant: steroids (prednisolone)
- other steroid sparing: ciclosporin, azathioprine
- liver transplant if decompensated cirrhosis but recurrence may occur
What are the autoAb for SLE?
what are the autoAb for wegener's granulomatosis?
- cANCA (anti neutrophil cytoplasmic antibodies) (proteinase 3 ANCA)
- vasculitis affects lung, kidney, joints
What are autoAb for microscopic polyangiitis and Churg Strauss?
cANCA (myeloperoxidase ANCA)
what is churg strauss syndrome?
- medium vessel autoimmune vasculitis
- get granulomas and eosinophils
- involves lungs, heart, skin, kidney
how do you treat churg strauss?
immunosuppression with prednisolone and azathioprine
WHat is biliary colic?
When the gallbladder tries to empty its contents against pressure, eg stones, then it produces a colic
what is cholecystitis?
when GB is inflamed
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
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
what are 4 causes of xanthelasma?
in post hepatic obstructive jaundice what would USS and urine tests show?
- US: dilated bile duct
- urine: lots of bilirubin, NO UROBILINOGEN
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
What are the causes of chronic pancreatitis?
- congenital: pancreas divisum
- familial: cystic fibrosis, haemochromatosis,
- acquired: alcohol, pancreatic duct obstruction by stones or tumour
What investigations for chronic pancretitis?
- blood: high glucose
- US: pseudocyst
- CT, MRCP, ERCP but risk acute attack
- AXR: speckled pancreatic calcification
WHat are the three most common causes of malabsorption in UK?
- Coeliac disease
- chronic pancreatitis