Alimentary Flashcards
1
Q
Common drugs which cause DILI
A
Paracetamol
Co-amoxiclav
Flucloxacillin
2
Q
Types of DILI
A
Cholestatic - raised bili, ALP, GGT
Hepatocellular - raised bili, ALT, AST
Mixed
3
Q
Complications of cirrhosis
A
Portal hypertension Varices Low albumin Deranged clotting Ascites HE Renal hypoperfusion Secondary hyperaldoesteronism Hepatorenal syndrome
4
Q
Causes of chronic hepatitis
A
HBV, HCV, HDV
Autoimmune hepatitis
5
Q
Causes of acute hepatitis
A
DILI AIH HAV, HBV, HCV, HDV, HEV Haemochromotosis Wilson's Toxins
6
Q
Symptoms of acute appendicitis
A
RLF/RIF pain Vomiting Tense, ridgid abdomen Pyrexia Tachycardia Hypotension Palpable mass Urinary or bowel symptoms
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
8
Q
Complications of ruptured appendix
A
Sepsis
Shock
Peritonitis
Abscess
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
10
Q
Gallstone types
A
Mixed (75%)
Cholesterol (20%)
Bile Pigment (5%)
11
Q
Causes of gallstones
A
Cholesterol supersaturation - pregnancy, obesity, OCP etc.
Bile stasis - TPN, fasting etc.
Increased Hb breakdown - haemolytic disorders
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
13
Q
Cholecystitis symptoms
A
NO jaundice Fever RUQ pain Nausea and vomiting Murphy's sign may be positive Guarding may suggest perforation
14
Q
Cholecystitis lab signs
A
Raised ALP
Raised inflammatory markers
Thickened gallbladder wall on US
15
Q
Charcot’s triad
A
RUQ pain
Fever
Jaundice
16
Q
Cholangitis symptoms
A
RUQ pain Fever Jaundice Dark urine Pale stools Pruitis Swinging fever and sepsis in more severe cases
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
18
Q
Cholangitis treatment
A
IV ABX Fluids Analgesia ERCP Sepsis protocol if needed May need lap or open surgery
19
Q
Common pathogens in cholecystitis
A
Gut bacteria such as E. coli and Klebsiella
20
Q
Causes of pancreatitis
A
Idiopathic Gallstones Ethanol Trauma Scorpion Mumps Autoimmune Steroids Hypercalcaemia/hypertriglyceridaemia ERCP Drugs
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
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
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
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
25
Chronic pancreatitis symptoms
```
Dull, radiating epigastric pain
Steatorrhoea
Malnutrition and weight loss
Diabetes or glucose intolerance
Jaundice
Nausea and vomiting
```
26
Diagnosing chronic pancreatitis
CT or MRI first line
US if diagnoses is in question after cross-sectional imaging
Histology
27
Common primary cancers which metastasise to liver
```
Gastric
Pancreatic
Colorectal
Lung
Breast
```
28
Risk factors for cholangiocarcinoma
```
PSC
Anatomical liver abnormalities
Diabetes
Obesity and metabolic syndrome
Chronic hepatic stones
Chronic HBV/HCV
Parasitic liver flukes
```
29
Symptoms of a tumour in head of pancreas
```
Painless obstructive jaundice
Pruitis
Pale stools and dark urine
Cholangitis +/- sepsis
Ascites
Anaemia
Fatigue
Nausea
```
30
Symptoms of a tumour in the body or tail of pancreas
Vague symptoms of fatigue, nausea and weight loss
May have a boring pain which is relieved by sitting forward
May have ascites
31
Complications of pancreatic adenocarcinoma
Type 3c diabetes
Exocrine insufficiency causing malnutrition and steatorrhoea
VTE
Poor survival rate
32
Bowel cancer complications
```
Bowel obstruction
Bowel perforation
Iron deficiency anaemia
Hepatic and peritoneal mets
Bone and lung mets
Fistula formation
```
33
Types of tumour found in bowel cancer
Adenocarcinomas
Carcinoid
Stromal
Lymphoma
34
True diverticulum
Contains all layers of bowel wall - serosa, muscle, mucosa, submucosa
35
False diverticulum
Contains only mucosa and submucosa
36
Symptoms of Meckle's diverticulum
```
Rectal bleeding
Melena
Constipation
Abdominal pain
Vomiting
```
37
Complications of diverticula
```
Diverticulitis
Bowel perforation
Bowel obstruction
Recto-vaginal/vesicle fistula
Pericolic abscess
Perfuse bleeding
```
38
Saints Triad
Hernia
Gallbladder disease
Diverticula disease
39
Causes of dysphagia
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
Types of oesophageal tumour
Squamous Cell
| Adenocarcinoma
41
Assessing suspected gastric cancer
```
FBC (anaemia)
Folate and B12 (pernicious anaemia)
AXR
CT CAP
OGD with biopsies
CLO (urease) + HER2 testing on biopsies
```
42
Characteristics of diffuse gastric cancer
Poorly differentiated cells
Younger patient group
Aggressive
43
Characteristics of intestinal gastric cancer
Well differentiated
Form glands
Older patient group
Slow growing
44
ALARMS55
Worrying upper GI symptoms
```
Anaemia
Losing weight
Anorexia
Resistant dyspepsia
Melena or Haematemesis
Swallowing issues
55+
```
45
Sliding hernia
Gastroesophageal junction pushed up through hiatus
46
Rolling hernia
Fundus of stomach pushed up in a sac parallel to oesophagus
47
Investigating GORD
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
Causes of peptic ulcers
```
H.Pylori
NSAIDs
Steroids
Increased acid production (Zollinger- Ellisons, gastrin producing tumour)
Increased ICP
Post severe burns
```
49
H.Pylori eradication
Penicillin Safe
Amoxicillin + Clarithromycin/Metronidazole + PPI
Penicillin allergic
Clarithromycin + Metronidazole + PPI
50
Gastric ulcer symptoms
```
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
Duodenal ulcer symptoms
```
May improve after eating
Posterior ulcers may bleed
Anterior ulcers may perforate
Burning stomach pain
Feelings of fullness or bloating
Nausea
```
52
Top causes of small bowel obstruction
Previous abdominal surgery
Incarcerated inguinal hernia
Other hernias
Crohn's disease
53
Top causes of large bowel obstruction
Colorectal cancer
Diverticulae
Volvulus
54
What is ileus and when does it occur
Painless functional obstruction of bowel due to temporary paralysis
Occurs after surgery, sepsis, inflammation, hypokalaemia
55
Pre-hepatic causes of jaundice
```
Pernicious anaemia
Autoimmune haemolytic anaemia
Thalasaemia
Sickle cell disease
Gilbert's
Transfusion reaction
```
56
Hepatic causes of jaundice
```
Viral hepatits
Autoimune hepatitis
Alcoholic hepatitis
DILI
ALD
Wilson's
```
57
Post-hepatic causes of jaundice
```
Gallstones
PBC
PSC
Cholangiocarcinoma
Pancreatic cancer
Strictures
Lymphoma
Drug induced cholestasis
```
58
Markers of synthetic function
Bilirubin
Albumin
Prothrombin
59
When would ALP be raised
Biliary obstruction
Pregnancy
Bone pathology
60
If ALT is 10x higher than AST
Hepatocyte injury such as hepatitis
61
AST to ALT in a 2:1 ration
Alcoholic liver disease
62
Raised prothrombin time
Hepatocellular damage
Vitamin K deficiency
Anticoagulants
63
Low albumin
```
Cirrhosis
Malnutrition
Nephrotic syndrome
CCF
Sepsis
```
64
White and Red pulp of speed functions
Red - filters old and damaged RBCs and stores platelets
White - contains B and T cells
65
Causes of splenomegaly
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
Location of internal haemorrhoids
Proximal to dentate line
67
Location of external haemorrhoids
Distal to the dentate line
68
Control of internal anal sphincter
Involuntary control by rectal and hypogastric plexuses
69
Control of external anal sphincter
Voluntary control by pudendal nerve
