Reye syndrome

Encephalopathy following an acute viral illness  in a child due to aspirin use

high level of ammonia

liver biopsy shows fatty changes

No treatment. supportive care: correct hypoglycemia, anti emetics, electrolytes etc

Dieulafoy lesion

Upper GI bleeding with no risk factors and normal endoscopy findings: suspect Dieulafoy lesion- a submucosal vessel that fails to divide into capillaries but bleeds intermittently and retracts under the mucosa during non bleeding periods.

Remember

Bloody diarrhoea + leucocytosis post abdominal aortic aneurysm repair, think of ischemic colitis (desc and sigmoid)

Confirm with colonoscopy or flexible sigmoidoscopy

Do colonic resection + colostomy

Primary sclerosing cholangitis

Damage to both intra and extra hepatic bile ducts. ERCP or MRCP shows beading (segmental narrowing and dilatation)of both intra and extra hepatic ducts.

Anti smooth muscle antibodies (ASMA)(in 20%-50%), ANA, p-ANCA (not specific)

Young Man with itching, jaundice, malabsorption syndrome, signs of cirrhosis etc.

Biopsy may show periductal sclerosis (onion skinning)
Tmt: Ursodeoxycholic acid, cholestyramine, vitamin supplements



Note: ASMA and ANA + jaundice are also present in autoimmune hepatitis but Auto immune hepatitis is xterised by
female preponderance,
extrahepatic autoimmune diseases
hypergammaglobulinemia.

Treatment of autoimmune hepatitis is low dose steroids.

Primary biliary cirrhosis

interlobular bile duct destruction

itchy, yellow, middle aged woman with high alkaline phosphatase, normal transaminases, high GGT, high bilirubin and positive Anti mitochondrial antibodies, ANA

+signs of cirrhosis
Liver biopsy shows periductal mononuclear infilterate with bile duct destruction

Tmt: Ursodeoxycholic acid, cholestyramine (reduces itching)

no cure

Treatment of inflammatory bowel disease

Acute exacerbations: steroids

Chronic maintenance: mesalamine
note: mesalamine is an active  metaboliteof sulfasalazine. Sulfasalazine was previously used but stopped due to side effects (agranulocytosis, hypospermia) from its other metabolite sulfapyridine.


Note:
For perianal disease, give ciprofloxacin+metronidazole
Colectomy can cure UC but is not routine tmt.
Crohn's usually recurs at surgery site





P.S :
IBD serology-  ASk Crohn ANd Call it !
ASCA- Crohn
ANCA- Colitis (ulcerative colitis)  specifically p-ANCA

pronounce the underlined as one sentence.

Most accurate test however is endoscopy

Pancreatic cancer

Elderly

Painless jaundice (cancer head of pancreas, obstructing bile flow)

Upper abdo  pain, radiating to the back (cancer originating from the body or tail of pancreas)

weight loss

Abdo mass

steatorrhea

+/- pruritus



risk factors: Family history, Elderly, smoking, obesity, DM

Pyloric stenosis

Congenital
Infant 4-8 wks old with projectile vomitting which has become more frequent and more forceful
Vomittus is non bilous, occurs after feeding
Visible peristalsis in upper abdo
Failure to thrive
Olive shaped upper abdo mass palpable after vomitting (may however be absent)
Abdo USS  confirms diagnosis: shows thick hypoechogenic ring in pyloric area
Tmt: surgery

Intussusception

2yr old Child with abdo pain
presents with features of small bowel obstruction

red currant jelly stool

sausage shaped abdo mass

USS shows target sign (one tube inside another)

Air contast enema both diagnoses and reduces it in most cases