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CP1 > Alimentary > Flashcards

Alimentary Flashcards

1
Q

Common drugs which cause DILI

A

Paracetamol
Co-amoxiclav
Flucloxacillin

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2
Q

Types of DILI

A

Cholestatic - raised bili, ALP, GGT

Hepatocellular - raised bili, ALT, AST

Mixed

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3
Q

Complications of cirrhosis

A 
Portal hypertension 
Varices 
Low albumin
Deranged clotting 
Ascites 
HE
Renal hypoperfusion 
Secondary hyperaldoesteronism 
Hepatorenal syndrome
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4
Q

Causes of chronic hepatitis

A

HBV, HCV, HDV

Autoimmune hepatitis

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5
Q

Causes of acute hepatitis

A 
DILI
AIH
HAV, HBV, HCV, HDV, HEV
Haemochromotosis 
Wilson's
Toxins
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6
Q

Symptoms of acute appendicitis

A 
RLF/RIF pain 
Vomiting
Tense, ridgid abdomen 
Pyrexia 
Tachycardia 
Hypotension
Palpable mass 
Urinary or bowel symptoms
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7
Q

Diagnosing acute appendicitis

A

Bedside - rule out pregnancy and renal causes with urinalysis

Bloods - hCG for ectopic pregnancy, FBC, U&E, CRP

Abdo US or CT may be used if not clear picture clinically

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8
Q

Complications of ruptured appendix

A

Sepsis
Shock
Peritonitis
Abscess

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9
Q

Examination signs suggestive of appendicitis

A

McBurney’s point - tenderness between umbilicus and lilac spine which may suggest appendicitis

Roysing’s sign - RIF pain when pushing on LIF

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10
Q

Gallstone types

A

Mixed (75%)
Cholesterol (20%)
Bile Pigment (5%)

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11
Q

Causes of gallstones

A

Cholesterol supersaturation - pregnancy, obesity, OCP etc.

Bile stasis - TPN, fasting etc.

Increased Hb breakdown - haemolytic disorders

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12
Q

Biliary colic symptoms

A

NO Jaundice as bile can still flow

RUQ pain which can radiate to shoulder and is worse after eating

Nausea and vomiting

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13
Q

Cholecystitis symptoms

A 
NO jaundice 
Fever 
RUQ pain 
Nausea and vomiting 
Murphy's sign may be positive 
Guarding may suggest perforation
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14
Q

Cholecystitis lab signs

A

Raised ALP
Raised inflammatory markers
Thickened gallbladder wall on US

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15
Q

Charcot’s triad

A

RUQ pain
Fever
Jaundice

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16
Q

Cholangitis symptoms

A 
RUQ pain
Fever
Jaundice 
Dark urine
Pale stools
Pruitis 
Swinging fever and sepsis in more severe cases
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17
Q

Cholangitis investigation findings

A 
Positive blood cultures 
Raised WCC
Raised bilirubin 
Cholestatic picture with high ALP and GGT
AST and ALT may be mildly deranged 
Dilated bile ducts +/- gallstones on US
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18
Q

Cholangitis treatment

A 
IV ABX
Fluids
Analgesia 
ERCP
Sepsis protocol if needed 
May need lap or open surgery
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19
Q

Common pathogens in cholecystitis

A

Gut bacteria such as E. coli and Klebsiella

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20
Q

Causes of pancreatitis

A 
Idiopathic 
Gallstones 
Ethanol
Trauma
Scorpion 
Mumps 
Autoimmune
Steroids
Hypercalcaemia/hypertriglyceridaemia 
ERCP
Drugs
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21
Q

Complications of pancreatitis

A 
Necrosis 
Digesting of pancreatic fat by activated lipase
Pseudocysts and abscesses 
Disseminated intravascular coagulation 
Hypovolaemic shock 
ARDS
Abdominal compartment syndrome 
AKI
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22
Q

Diagnosing acute pancreatitis

A 
Lipase and/or Amylase 
U&E's with creatinine 
Albumin
LFT's
ABG for lactate and PaO2
Calcium (raised may  be cause)
Triglycerides (raised may be cause)
US if biliary cause suspected
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23
Q

Managing acute pancreatitis

A 
Fluid resuscitation 
Analgesia 
Nutritional support
Severity assessment (Glasgow, SIRS) 
Consider oxygen, antibiotics, antiemetics on a case by case basis
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24
Q

Acute pancreatitis symptoms

A 
Epigastric/LUQ pain radiating into back
Nausea, vomiting and anorexia 
Hypovolaemia 
Bruising on flank or around umbilicus 
Pleural effusion
Jaundice 
Dyspnoa
Chostek's facial nerve sign
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25
Q

Chronic pancreatitis symptoms

A 
Dull, radiating epigastric pain
Steatorrhoea
Malnutrition and weight loss 
Diabetes or glucose intolerance 
Jaundice 
Nausea and vomiting
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26
Q

Diagnosing chronic pancreatitis

A

CT or MRI first line
US if diagnoses is in question after cross-sectional imaging
Histology

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27
Q

Common primary cancers which metastasise to liver

A 
Gastric
Pancreatic
Colorectal
Lung
Breast
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28
Q

Risk factors for cholangiocarcinoma

A 
PSC
Anatomical liver abnormalities 
Diabetes
Obesity and metabolic syndrome 
Chronic hepatic stones 
Chronic HBV/HCV
Parasitic liver flukes
29
Q

Symptoms of a tumour in head of pancreas

A 
Painless obstructive jaundice 
Pruitis 
Pale stools and dark urine 
Cholangitis +/- sepsis
Ascites 
Anaemia
Fatigue
Nausea
30
Q

Symptoms of a tumour in the body or tail of pancreas

A

Vague symptoms of fatigue, nausea and weight loss
May have a boring pain which is relieved by sitting forward
May have ascites

31
Q

Complications of pancreatic adenocarcinoma

A

Type 3c diabetes
Exocrine insufficiency causing malnutrition and steatorrhoea
VTE
Poor survival rate

32
Q

Bowel cancer complications

A 
Bowel obstruction
Bowel perforation
Iron deficiency anaemia 
Hepatic and peritoneal mets 
Bone and lung mets
Fistula formation
33
Q

Types of tumour found in bowel cancer

A

Adenocarcinomas
Carcinoid
Stromal
Lymphoma

34
Q

True diverticulum

A

Contains all layers of bowel wall - serosa, muscle, mucosa, submucosa

35
Q

False diverticulum

A

Contains only mucosa and submucosa

36
Q

Symptoms of Meckle’s diverticulum

A 
Rectal bleeding
Melena 
Constipation 
Abdominal pain
Vomiting
37
Q

Complications of diverticula

A 
Diverticulitis 
Bowel perforation 
Bowel obstruction
Recto-vaginal/vesicle fistula
Pericolic abscess 
Perfuse bleeding
38
Q

Saints Triad

A

Hernia
Gallbladder disease
Diverticula disease

39
Q

Causes of dysphagia

A

Physical obstruction - inhaled object, stricture, oesophagitis, malignancy, pressure

CNS - Parkinson’s, brain injury, MS, dementia

PNS - MND, myasthenia gravis

Muscular - spasms, connective tissue disorder, sphincter malfunctions

Globus sensation

40
Q

Types of oesophageal tumour

A

Squamous Cell

Adenocarcinoma

41
Q

Assessing suspected gastric cancer

A 
FBC (anaemia)
Folate and B12 (pernicious anaemia)
AXR
CT CAP
OGD with biopsies 
CLO (urease) + HER2 testing on biopsies
42
Q

Characteristics of diffuse gastric cancer

A

Poorly differentiated cells
Younger patient group
Aggressive

43
Q

Characteristics of intestinal gastric cancer

A

Well differentiated
Form glands
Older patient group
Slow growing

44
Q

ALARMS55

A

Worrying upper GI symptoms

Anaemia 
Losing weight 
Anorexia
Resistant dyspepsia
Melena or Haematemesis
Swallowing issues 
55+
45
Q

Sliding hernia

A

Gastroesophageal junction pushed up through hiatus

46
Q

Rolling hernia

A

Fundus of stomach pushed up in a sac parallel to oesophagus

47
Q

Investigating GORD

A

8 week PPI trial if there are no concerning symptoms

OGD if PPI trial fails or there are concerning symptoms such as dysphagia or haematemesis

48
Q

Causes of peptic ulcers

A 
H.Pylori
NSAIDs
Steroids 
Increased acid production (Zollinger- Ellisons, gastrin producing tumour)
Increased ICP
Post severe burns
49
Q

H.Pylori eradication

A

Penicillin Safe
Amoxicillin + Clarithromycin/Metronidazole + PPI

Penicillin allergic
Clarithromycin + Metronidazole + PPI

50
Q

Gastric ulcer symptoms

A 
May be more painful after eating
May bleed a little 
May cause iron deficiency anaemia
May cause major haemorrhage with hematemesis 
Burning stomach pain 
Feelings of fullness or bloating 
Nausea
51
Q

Duodenal ulcer symptoms

A 
May improve after eating 
Posterior ulcers may bleed
Anterior ulcers may perforate
Burning stomach pain 
Feelings of fullness or bloating 
Nausea
52
Q

Top causes of small bowel obstruction

A

Previous abdominal surgery
Incarcerated inguinal hernia
Other hernias
Crohn’s disease

53
Q

Top causes of large bowel obstruction

A

Colorectal cancer
Diverticulae
Volvulus

54
Q

What is ileus and when does it occur

A

Painless functional obstruction of bowel due to temporary paralysis

Occurs after surgery, sepsis, inflammation, hypokalaemia

55
Q

Pre-hepatic causes of jaundice

A 
Pernicious anaemia 
Autoimmune haemolytic anaemia 
Thalasaemia 
Sickle cell disease 
Gilbert's
Transfusion reaction
56
Q

Hepatic causes of jaundice

A 
Viral hepatits 
Autoimune hepatitis 
Alcoholic hepatitis 
DILI
ALD
Wilson's
57
Q

Post-hepatic causes of jaundice

A 
Gallstones
PBC
PSC
Cholangiocarcinoma
Pancreatic cancer 
Strictures 
Lymphoma 
Drug induced cholestasis
58
Q

Markers of synthetic function

A

Bilirubin
Albumin
Prothrombin

59
Q

When would ALP be raised

A

Biliary obstruction
Pregnancy
Bone pathology

60
Q

If ALT is 10x higher than AST

A

Hepatocyte injury such as hepatitis

61
Q

AST to ALT in a 2:1 ration

A

Alcoholic liver disease

62
Q

Raised prothrombin time

A

Hepatocellular damage
Vitamin K deficiency
Anticoagulants

63
Q

Low albumin

A 
Cirrhosis 
Malnutrition 
Nephrotic syndrome 
CCF
Sepsis
64
Q

White and Red pulp of speed functions

A

Red - filters old and damaged RBCs and stores platelets

White - contains B and T cells

65
Q

Causes of splenomegaly

A

Increased RBC removal (e.g. sickle cell, thalassaemia)

Extramedullary haematopoiesis has resumed (e.g. due to bone marrow pathology such as leukaemia)

Infections - EBV, AIDs, TB, viral hepatitis, sepsis

Malignancy

Portal, splenic or hepatic vein obstruction

66
Q

Location of internal haemorrhoids

A

Proximal to dentate line

67
Q

Location of external haemorrhoids

A

Distal to the dentate line

68
Q

Control of internal anal sphincter

A

Involuntary control by rectal and hypogastric plexuses

69
Q

Control of external anal sphincter

A

Voluntary control by pudendal nerve

CP1 (13 decks)

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