buzzwords - GI

Question 1

red flags

Answer 1

dysphagia, GI blood loss, persistent vomiting, unexplained weight loss, upper abdominal mass

Question 2

what things should you ask about diarrhoea

Answer 2

frequency, nocturnal diarrhoea, colour and consistency, blood

Question 3

herbal and ‘food supplements’, possible toxins, alcohol

Answer 3

liver

Question 4

what should be suspected in known liver, pancreas, small bowel disease

Answer 4

malabsorption

Question 5

gynaecomastia ->

Answer 5

hyperoestrogenism (cirrhosis)

Question 6

easy brusing is due to

Answer 6

vit c deficiency (scurvy)

Question 7

major functions of liver

Answer 7

detoxification and degradation, excretion of cholesterol and bilirubin, production of hepatic bile

Question 8

where does blood go to liver

Answer 8

from hepatic portal vein (75%), hep artery (25%)

Question 9

where does venous and arterial blood mix in liver

Answer 9

sinusoids

Question 10

what is the direction of blood in liver

Answer 10

flows inwards towards the central vein through the sinusoids

Question 11

what is contained in the sinusoidal space

Answer 11

endothelial cells to form fenestrated structure
kuppfer cells - macrophages resident to sinuoidal vascular space (remove particulate matter eg bacteria and senescent RBCs)
stellate (ito) cells in space of disse - storage of vitA

Question 12

what is phase 1 of drug oxidation

Answer 12

oxidation/reduction/hydrolysis

makes drug more polar, adds a chemically reactive group (a handle) permitting conjugation (functionalisation)

Question 13

what is phase 2 of drug oxidation

Answer 13

conjugation

adds endogenous compunds increasing polarity eg glucuronyl, sulphate, methyl, acetyl, glycyl, glutathione groups

Question 14

what are the 3 plasma proteins

Answer 14

albumin
alpha-globulins
beta-globulins

Question 15

what does albumin do

Answer 15

transports fatty acids, bilirubin, thyroid, aspirin

Question 16

what does alpha-globulin do

Answer 16

transport lipoproteins, lipids, hormones, and bilirubin

Question 17

what does beta-globulin do

Answer 17

transferrin (fe3+), fibrinogen

Question 18

what does liver store

Answer 18

vits A, D, B12, iron

Question 19

what is the livers nearest central vein

Answer 19

zone 1 = periportal

Question 20

the rapid developent of hepatic dysfunction without prior liver disease causing encephalopathy and prolonged coagulation (<6 months)

Answer 20

acute liver disease

Question 21

causes of acute liver disease

Answer 21

viral (hepA/B/C/D/E, CMV, EBV and toxoplasmosis)
drug, shock liver, cholangitis, alcohol, malignancy, chronic liver disease, paracetamol overdose, rare (budd chiari, AFLP, cholestasis of pregnancy)

Question 22

what investigations would you carry out for acute liver disease

Answer 22

LFT's (inc albumin, bilirubin)
prothrombin time
Hx
examination
U/S
virology
rarely liver biopsy