Summary Gastroenterology Conditions - DEARSIM Format

Gastrointestinal Conditions




Acute Pancreatitis
Definition Inflammation of pancreas

Epidemiology Very common – late diagnosis = high mortality and morbidity

Aetiology Causes:
 Gallstones
 Alcohol
 Trauma
 Autoimmune disease
 Drugs – furosemide, thiazides, statins, estrogens

Inflammation in pancreas > digestive enzymes activated > enzymes auto-
digest pancreatic tissue = inflammation and damage

Risk Factors

Symptoms  Stabbing-like, epigastric pain (high middle or left) radiating to back
Relieved by sitting forward and fetal position
 Vomiting
 Hypovolaemia (tachycardia)
 Fever (indicating complication with infection)

, PMH of alcohol and gallstones suggestive

Signs  Grey-Turner’s sign (bruising along flanks) – indicates retroperitoneal
bleed
 Cullen’s sign (bruising around umbilical area – below belly button)

Investigations Diagnostic:
 FBC and U&Es (elevated WBC – necrotising pancreatitis)
 LFT (abnormalities – gall-stone related pancreatitis)
 Lipase
 Amylase (three-fold elevation strongly indicative)

Imaging:
 Ultrasound of abdomen – gallstone detection
 MRCP (magnetic) – obstructive pancreatitis
 ERCP (endoscopic) – diagnostic and therapeutic
 CT – complications

Management Aim: to maintain electrolyte balance and compensate fluid loss
 Aggressive fluid resus with crystalloids (maintain urine output
>30mL/hr)
 Catheterisation
 Analgesia (strong opioids)
 Antinausea
 Supplemental oxygen
 Antibiotics – only necessary in necrotising pancreatitis

Severity Glasgow Criteria – done at admission and 48 hours (true score)
 P: PaO2 <8kPa
 A: Age >55
 N: Neutrophils WBC >15 x 109
 C: Calcium <2
 R: Renal function >16
 E: Enzymes AST/ALT >200 (or LDH > 600)
 A: Albumin <32
 S: Sugar >10
*3 or more positive factors = ITU/HDU admission for monitoring and
fluid resus


Chronic Pancreatitis
Definition Persistent inflammation and fibrosis of exocrine and endocrine
components of pancreas

Epidemiology
Aetiology Primarily caused by alcohol excess (80%)
Other causes: genetics (CF), obstruction (cancer), metabolic (elevated

, trigacylglycerides)
Risk Factors
Symptoms  Epigastric pain (exacerbated by fatty food consumption + alleviated
by sitting forward)
 Exocrine dysfunction: malabsorption (abdominal discomfort),
steatorrhea (fat excretion in stool)
 Endocrine dysfunction: diabetes (thirst and polyuria)

Signs  Epigastric tenderness

Investigations  Abdominal X-ray (calcifications)
 CT scan (calcifications)
 Faecal elastase (exocrine dysfunction)
 Fasting glucose (endocrine dysfunction)
*Amylase and lipase not typically raised

Management  Management of diet and alcohol
 Pain control
 Insulin (if diabetic)
 Pancreatic enzyme replacement therapy (Creon)
 If ^^ fail – invasive procedures like pancreatectomy and celiac
plexus block (nerve block to ease abdominal pain)


Pancreatic Cancer
Definition Malignancy in the pancreas – most common being pancreatic
adenocarcinoma

Epidemiology 5th most common cancer in UK – poor 5-year survival rate <5%

Aetiology
Risk Factors  Age – elder
 Smoking
 Obesity
 Diabetes
 Chronic pancreatitis
 Family history
 Genetic mutations

Symptoms Early signs (non-specific):
 Malaise
 Abdominal pain
 Nausea
 Weight loss
 Jaundice (no pain) with palpable gallbladder (Courvoisier’s sign)

Advanced signs:

,  Obstructive jaundice
 Diabetes
 Pancreatic infiltration
 Pancreoplastic syndromes
 Disseminated intravascular coagulation

*Often metastasises early to lung, liver and bowel

Signs
Investigations  Refer using suspected cancer pathway referral (within two weeks)
for pancreatic cancer IF 1. Aged above 40 and 2. Have jaundice
 Consider urgent CT or ultrasound scan (within two weeks) if 1. Aged
over 60 WITH weight loss and 2. ANY OF: diarrhoea, back pain,
abdominal pain, nausea, vomiting, constipation, new-onset diabetes

 Abdominal ultrasound – detect tumours >2cm > liver metastases >
dilation of common bile duct
(Endoscopic ultrasound for small lesions + biopsy if needed)
 CT scan – disease staging and prediction of surgical resectability
 MRCP – investigation of bile ducts

Management Only curative treatment is surgical resection – only 15-20% as late diagnosis
- No evidence of superior mesenteric artery or celiac involvement
- No evidence of metastases

Palliative therapy:
 Endoscopic stent insertion in common bile duct > palliative surgery
if failed
 Chemotherapy
 Radiotherapy (localised advanced disease only)


Acute Liver Failure
Definition Sudden onset of liver dysfunction that causes encephalopathy within 8
weeks
- Absence of prior liver disease

*Encephalopathy – brain function is affected due to accumulation of
ammonia (greatly increases mortality rate)

Epidemiology
Aetiology Main cause of ALF is paracetamol overdose
Non-paracetamol aetiologies include: viral, ischemia, pregnancy,
malignancy