Plain X - Ray Abdomen in Gall Bladder Diseases

An easy was to remember findings is - 
1. Gas 
2. Opacity 
3. Gas in Opacity 

1. Gas - 
- Outside Gall Bladder (Perforation of Gall Bladder) 
- In Wall of Gall Bladder (Emphysematous Cholecystitis) 
- Within Gallbladder lumen (also Known as Pneumobilia) 
(seen in Cholecystenteric fistula, Post ERCP) 

2. Opacity - 
- Outside Gall Bladder (Gallstone ileus) 
- In Wall of Gall bladder (Calcified Gallbladder) 
- In lumen (Limey bile, Gall Stones, Calcification in Tumor) 

3. Gas in Opacity - Mercedez Benz Sign / Seagull's Sign 

Diverticulitis complications

Please Fix His Arse SOon!

• Perforation (leading to peritonitis)
• Fistulae (colovaginal, colovesicle)
• Haemorrhage (large haemorrhage)
• Abscess (swinging fever)
• Strictures / Obstruction (large bowel)

MORE SURGERY MNEMONICS

Lower GI bleed causes

MORE SURGERY MNEMONICS

H-DRAIN

• Haemorrhoids
• Diverticular disease
• Radiation colitis
• Angiodysplasia
• Infection / Inflammatory Bowel Disease / Ischaemia
• Neoplasm (cancer)

CHAND

• Colitis (radiation, ischaemia, infection, IBD (UC>CD)
• Haemorrhoids/fissures
• Angiodysplasia
• Neoplastic
• Diverticular disease

Upper GI endoscopy indications

How Gastroenterology Doctors Visualise Inside The Duodenum

• Haematemesis
• Gastric biopsy (?cancer)
• Dyspepsia
• Vomiting, persistent
• Iron-deficiency anaemia
• Therapeutic e.g. banding, sclerotherapy, stent, laser therapy
• Duodenal biopsy

Dyspepsia symptoms

ALARM Symptoms

• Anaemia (iron deficiency)
• Loss of weight
• Anorexia
• Recent onset of progressive symptoms
• Melaena / haematemesis

• Swallowing difficulty

If dyspepsia and either >55yrs or ALARM Symptoms then ENDOSCOPY

Gastroenteritis Causes

LESS GERMS

L Listeria
E Escherichia coli
S Staphylococcus aureus
S Salmonella
G Giardia lamblia
E Entamoeba histolytica
R Rotavirus
M Mushrooms
S Shigella

Ulcerative colitis treatment options

SAACS

• Steroids – oral prednisolone or IV hydrocortisone if severe
• 5-Aminosalicyclic acid (5-ASA) e.g. mesalazine, sulfasalazine
• Azathioprine (immunosuppressant)
• Cyclosporin (immunosuppressant)
• Surgery if perforation, cancer or poor response to medical therapy

Ulcerative colitis (UC) complications

How To Perform Gi Colonoscopy

• Haemorrhage
• Toxic megacolon
• Perforation / Pseudopolyps
• Gallstones / Gangrene
• Colorectal carcinoma (if extensive and lasting >10 years)

Ulcerative colitis (UC) features

ULCERS IN ABDomen

• Ulcers (mucosal and submucosal)
• Large intestine involved (rectum always involved)
• Clubbing of fingers
• Extra-intestinal manifestations (e.g. Erythema nodosum)
• Remnants of old ulcers (pseudopolyps)
• Stools bloody

• Inflamed, red granular mucosa/submucosa
• Neutrophil invasion

• Abscesses in crypts
• Biochemical markers of inflammation e.g. ESR raised
• Diarrhoea (esp. in pancolitis)

Chronic pancreatitis causes

PACE

• Pancreas divisum (congenital)
• Autoimmune
• Cystic fibrosis
• Ethanol, chronic abuse

Acute pancreatitis complications

Early - GRASS

• Glucose elevated
• Renal failure
• ARDS
• Sepsis
• Shock

Late – NAP

• Necrosis of pancreas
• Abscess
• Pseudocyst

Ranson’s criteria for pancreatitis

On admission: Andy Was Late After Gym

• Age >55yrs
• WCC >16
• LDH >600iU/L
• AST >120iU/L
• Glucose >10

After 48 hours: He Clumsily Fell Playing Basketball Unsupervised

• Haematocrit fall >10%
• Calcium <2mmol/L
• Fluid >6L
• PaO2 <8kPa
• Base deficit <-4
• Urea rise >0.9mmol/L

Pancreatitis severity score

The modified Glasgow criteria.  3 or more of the following detected within 48 hours of admission is suggestive of severe pancreatitis and may require ITU input.

PANCREAS

• PaO2 <8kPa
• Age >55yrs
• Neutrophilia: WCC>15×109/L
• Calcium <2mmol/L (normal: 2.12mmol-2.65mmol/L)
• Renal function: urea>16mmol/L (normal: 2.5-6.7mmol/L)
• Enzymes: LDH >600iU/L (normal: 70-250iU/L); AST >200iU/L (normal: 5-35iU/L)
• Albumin <32g/L (serum)
• Sugar: blood glucose >10mmol/L

Pancreatitis (acute): causes

GET SMASHED: 

Gallstones 
Ethanol 
Trauma 
Steroids 
Mumps 
Autoimmune (PAN) 
Scorpion stings 
Hyperlipidemia/ Hypercalcemia 
ERCP 
Drugs (including azathioprine and diuretics 

COELIAC ARTERY BRANCHES

Love Her Smile Left Gastric Hepatic Splenic

Splenic Artery branches

Peter's Spleen Looks Small Peter's pancreatic Spleen splenic Looks left gastro epiploic Small short gastric

Gastroenterology

Extra-colonic manifestations of UC & Crohns A PIE SACK
Aphthous ulcers, pyoderma gangrenosum, Iritis (uveitis), Erythema nodosum
Sclerosing cholangitis, Ank spon & arthritis, clubbing, kidney - nephrotic

Hepatic Encephalopathy HEPATICUS
Haemorrhage, Electrolye imbalance (↓K+ alkalosis), protein XS (↑NH4
+ XS),
Alcohol/ Analgesics, Trauma, Infxn, Constipation, Uraemia, Surgery (post systemic shunt)

Haemorrhagic Ascites MARA
Malignancy, Acute pancreatitis, Ruptured ectopic, abdo trauma


Gallstones 5Fs
Fat, female, fair, fertile, forty

Gastric Malignancy 5As
Anaemia, Anorexia, Aesthenia, Acanthosis Nigricans, blood Group A

Jaundice ABCDEFGHIJ
Anaesthetics (halothane), Blood transfusions, Contacts, Drugs, Ethanol, Foreign travel,
Gallstones / Gilberts, Homosexual / Haemophilia / Hepatitis, Idiopathic / IVDA
Job - farmers, sewage workers (leptospirosis - Weils)

Mouth Ulcers DRAG TIE
Drug (gold, steroid), Rheumatological (bechet, reiter), Apthous, ??
Trauma, Infecion (HSV, VZV; syphilis, TB, Erythema Multiforme)

Causes of gastric carcinoma:

JAPAN'S SHAME:

Japanese
A Blood group
Pernicious anemia
Anemia-chronic atrophic gastritis
Nitrates
Smoked,Salted food,Scurvy,Surgery gastric
H.pylori
Adenomatous polyp
Menetrier's disease:glanduar hyperplasia,

Drugs causing pancreatitis

 

GLAD Organ Pancreas iS Traumatised n Destroyed Very Much

Glucocorticoids
L-asparaginase
Alcohol
Diuretics
Ocp's
Pentamidine
Sulfonamides
Didanosine
Tetracyclines
Valproate
Methyldopa

Vomiting: extra GI differential

VOMITING:

Vestibular disturbance/ Vagal (reflex pain)
Opiates
Migrane/ Metabolic (DKA, gastroparesis, hypercalcemia)
Infections
Toxicity (cytotoxic, digitalis toxicity)
Increased ICP, Ingested alcohol
Neurogenic, psychogenic
Gestation