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C21 Phase 1 > Case 6 - Upper GI and Hepatitis > Flashcards

Case 6 - Upper GI and Hepatitis Flashcards

1
Q

What does the Celiac artery supply

A

stomach, spleen and pancreas

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2
Q

What does the superior mesenteric artery supply

A

Pancreas, small intestines, colon

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3
Q

What does the inferior mesenteric artery supply

A

colon

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4
Q

What are the layers of gut tissue

A

Mucosa
Submucosa
Muscularis
Serosa

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5
Q

Causes for burning feeling behind sternum

A 
Oesophagitis
GORD
Acute pancreatitis 
Hiatus hernia
Stomach ulcer
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6
Q

What is the impact of smoking on the GI tract

A

Smoking relaxes the lower oesophageal sphincter allowing reflux more easily. Smoking also increases your risk of H.pyolori and Crohns and gallstones

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7
Q

How can mental health impact GI conditions

A

Stress and anxiety activate the sympathetic nervous system which can cause stomach cramping and/or diarrhoea and constipation.

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8
Q

Causes for vomiting blood

A 
oesophagus irritation 
nosebleeds
swallowing blood 
tear in the oesophagus due to chronic coughing or vomiting
swallowing a foreign object
stomach ulcers
gastritis, or stomach inflammation
NSAIDS side effects
Pancreatitis
cirrhosis
oesophageal cancer
erosion of the stomach lining
pancreatic cancer
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9
Q

Medications to reduce stomach acid

A

Omeprazole and Lansoprazole

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10
Q

Anti sickness medication

A

Cyclizine and Metoclopramide

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11
Q

Effect of ghrelin

A

appetite stimulator

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12
Q

Effect of leptin

A

appetite suppressor

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13
Q

Function of gastrin

A

stimulates the production of gastric acid

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14
Q

Function of CCK

A

stimulates bile secretion and pancreatic enzyme secretion

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15
Q

Function of secretin

A

Stimulates secretion of HCO3

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16
Q

Chronic GI conditions

A

Ulcerative colitis
IBS
Diverticulitis
Crohns

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17
Q

Types of jaundice

A

pre-hepatic
hepatic
post-hepatic

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18
Q

Complications of alcoholism

A 
Wernicke-Korsakoff syndrome, also called Wernicke’s encephalopathy and Korsakoff psychosis
alcoholic neuropathy
alcoholic cerebellar degeneration
alcoholic myopathy
fetal alcohol syndrome
alcohol withdrawal syndrome
dementia, and other cognitive deficits
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19
Q

What is Zollinger Ellison Syndrome

A

The exact cause is unknown, but the condition develops with tumours called gastrinomas- which are found at the head of the pancreas and upper small intestine that secrete gastrin

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20
Q

Sympathetic innervation of the abdominal viscera

A

Branches of the thoracic splanchnic nerves

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21
Q

Parasympathetic innervation of the abdominal viscera

A

Vagus nerve

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22
Q

Significance of coffee ground vomit

A

Coagulated blood that has been sat for a while. Potential causes include esophagitis, gastritis, gastric stasis or bowel obstruction

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23
Q

Significance of bright red blood in vomit

A

Fresh blood, may be due to oesophageal tear or vomiting after nose bleed

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24
Q

Potential indicators of domestic abuse

A
  • symptoms of depression, anxiety, post-traumatic stress disorder, sleep disorders
  • suicidal tendencies or self-harming
  • alcohol or other substance misuse
  • unexplained chronic gastrointestinal symptoms
  • unexplained gynaecological symptoms, including pelvic pain and sexual dysfunction
  • adverse reproductive outcomes, including multiple unintended pregnancies or terminations
  • delayed pregnancy care, miscarriage, premature labour and stillbirth or concealed pregnancy
  • genitourinary symptoms, including frequent bladder or kidney infections
  • vaginal bleeding or sexually transmitted infections
  • chronic unexplained pain
  • traumatic injury, particularly if repeated and with vague or implausible explanations
  • problems with the central nervous system – headaches, cognitive problems, hearing loss
  • repeated health consultations with no clear diagnosis. The person may describe themselves as ‘accident prone’ ‘silly’
  • intrusive ‘other person’ in consultations, including partner or spouse, parent, grandparent or an adult child (for elder abuse)
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25
Q

Causes of coughing blood (haemoptysis)

A 
oesophagus irritation 
nosebleeds
swallowing blood 
tear in the oesophagus due to chronic coughing or vomiting
swallowing a foreign object
stomach ulcers
gastritis, or stomach inflammation
NSAIDS side effects
Pancreatitis
cirrhosis
oesophageal cancer
erosion of the stomach lining
pancreatic cancer
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26
Q

Drug to relieve bloating and gut spasm

A

gabapentin

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27
Q

Drug to relieve diarrhoea

A

Loperamide

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28
Q

Drug to relieve gut spasm

A

Dicyclomine

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29
Q

Diagnostic criteria for anorexia

A

Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health
Intense fear of gaining weight or becoming fat, even when significantly underweight
Disturbance about body weight or shape, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of current low body weight

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30
Q

Diagnostic criteria for bulimia

A

Recurrent episodes of binge eating:
An episode of binge eating is characterized by both of the following:
Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).

Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise:
The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for three months.
Self-evaluation is unduly influenced by body shape and weight.
The disturbance does not occur exclusively during episodes of anorexia nervosa.

31
Q

Diagnostic criteria for ARFID

A

An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
Significant nutritional deficiency.
Dependence on enteral feeding or oral nutritional supplements.
Marked interference with psychosocial functioning.

32
Q

Diagnostic criteria for binge eating disorder

A

Recurrent episodes of binge eating:
An episode of binge eating is characterized by both of the following:
Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

The binge eating episodes are associated with three (or more) of the following:
Eating much more rapidly than normal.
Eating until feeling uncomfortably full.
Eating large amounts of food when not feeling physically hungry.
Eating alone because of feeling embarrassed by how much one is eating.
Feeling disgusted with oneself, depressed, or very guilty afterward.
Marked distress regarding binge eating is present.
The binge eating occurs, on average, at least once a week for 3 months.

33
Q

Investigations for suspected stomach ulcer

A

H.Pylori test
Endoscopy
Trial medication

34
Q

What is ulcerative collitis and how is it diagnosed

A

a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary symptoms of active disease are abdominal pain and diarrhoea mixed with blood. Weight loss, fever, and anaemia may also occur. Often, symptoms come on slowly and can range from mild to severe. It is typically diagnosed with a colonoscopy and biopsies.

35
Q

Treatment for ulcerative collitis

A

Aminosalicylates - reduce inflammation
Corticosteroids - stronger drug to reduce inflammation
Immunosuppressants
Ciclosporin (immunosuppressant used to treat flare up intravenously)
Ileostomy

36
Q

What is Crohn’s disease

A

Crohn’s disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract from the mouth to the anus. While the causes of Crohn’s disease are unknown, it is believed to be due to a combination of environmental, immune, and bacterial factors in genetically susceptible individuals. Smokers are 2x more likely to get Crohn’s.

37
Q

Treatment for Crohn’s disease

A

Steroids - reduce inflammation
Liquid diet
Immunosuppressants
Ileostomy

38
Q

What is diverticulitis

A

Diverticula are small bulges or pockets that can develop in the lining of the intestine as you get older. If the diverticula become inflamed or infected, causing more severe symptoms, it’s called diverticulitis. Symptoms of diverticular disease include:
tummy pain, usually in your lower left side, that tends to come and go and gets worse during or shortly after eating (emptying your bowels or passing wind eases it)
constipation, diarrhoea, or both
occasionally, blood in your poo

39
Q

Treatment for diverticulitis

A

Antibiotics
Fluid diet
High fibre diet
Colectomy

40
Q

What is prehepatic jaundice and what are the signs

A

Excessive amount of bilirubin is presented to the liver due to excessive haemolysis

There’s an elevated unconjugated bilirubin in LFTs

41
Q

What is hepatic jaundice and what are the signs

A

Impaired cellular uptake, defective conjugation or abnormal secretion of bilirubin by liver cells

Both conjugated and unconjugated bilirubin levels may be raised

42
Q

What is post-hepatic jaundice and what are the signs

A

Impaired excretion due to obstruction of the bile duct

Raised conjugated bilirubin in LFTs

43
Q

Causes of prehepatic jaundice

A
  • malaria, a blood infection caused by a parasite
  • sickle cell anemia, a genetic condition in which red blood cells become crescent-shaped rather than the typical disc shape
  • spherocytosis, a genetic condition of the red blood cell membrane that causes them to be sphere-shaped rather than disc-shaped
  • thalassemia, a genetic condition that causes your body to make an irregular type of hemoglobin that limits the number of healthy red blood cells in your bloodstream
44
Q

Causes of hepatic jaundice

A
  • liver cirrhosis, which means that liver tissues are scarred by long-term exposure to infections or toxic substances, such as high levels of alcohol
  • viral hepatitis, an inflammation of the liver caused by one of several viruses that can get into your body through infected food, water, blood, stool, or sexual contact
  • primary biliary cirrhosis, which happens when bile ducts are damaged and can’t process bile, causing it to build up in your liver and damage liver tissue
    alcoholic hepatitis, in which your liver tissues are scarred by the heavy, long-term drinking of alcohol
  • leptospirosis, is a bacterial infection that can be spread by infected animals or infected animal urine or feces
  • liver cancer, in which cancerous cells develop and multiply within liver tissues
45
Q

Causes of post hepatic jaundice

A
  • gallstones, hard calcium deposits in the gallbladder that can block bile ducts
  • pancreatic cancer, the development and spread of cancer cells in the pancreas, an organ that helps produce digestive substances
  • bile duct cancer, the development and spread of cancer cells in your bile ducts
  • pancreatitis, an inflammation or infection of your pancreas
  • biliary atresia, a genetic condition in which you have narrow or missing bile ducts
46
Q

What does a raised ALP (Alkaline phosphatase) indicate

A

Hepatocellular damage

47
Q

What does a raised ALT (Alanine transaminase) indicate

A

Indirect marker for cholestasis

48
Q

What does isolated raised ALP indicate

A

Bony metastases or primary bone tumours (e.g. sarcoma)
Vitamin D deficiency
Recent bone fractures
Renal osteodystrophy

49
Q

What does raised ALP and GGT (gamma-glutamyl transferase) indicated together

A

cholestasis

50
Q

What does a raised GGT (gamma-glutamyl transferase) indicate

A

biliary epithelial damage and bile flow obstruction

51
Q

What is an isolated rise in bilirubin indicate

A

Gilbert’s syndrome

Haemolysis

52
Q

What does decreased levels of albumin indicate

A

Liver disease resulting in a decreased production of albumin (e.g. cirrhosis).
Inflammation triggering an acute phase response which temporarily decreases the liver’s production of albumin.
Excessive loss of albumin due to protein-losing enteropathies or nephrotic syndrome

53
Q

What does a ALT > AST ratio indicate

A

Chronic liver disease

54
Q

What does a AST > ALT ratio indicate

A

Acute alcoholic hepatitis

Cirrhosis

55
Q

What is concerning about impaired synthetic liver function

A

It is usually long term or severe liver damage if synthetic function is impaired

56
Q

Mode of transmission, symptoms and treatment of hepatitis A

A

Contaminated food and water

feeling tired and generally unwell
joint and muscle pain
a raised temperature
loss of appetite
feeling or being sick
pain in the upper right part of your tummy
a headache, sore throat and cough
constipation or diarrhoea
a raised, itchy rash (hives)
pale faeces
dark urine

treatment = self care, symptoms management

57
Q

Vaccine for hepatitis A

  • available
  • administered to?
A

There is a vaccine for Hep A but it is not commonly given.

People usually advised to have the hepatitis A vaccine include:

close contacts of someone with hepatitis A
people planning to travel to or live in parts of the world where hepatitis A is widespread, particularly if sanitation and food hygiene are expected to be poor
people with any type of long-term liver disease
men who have sex with other men
people who inject illegal drugs
people who may be exposed to hepatitis A through their job – this includes sewage workers, people who work for organisations where levels of personal hygiene may be poor, such as a homeless shelter, and people working with monkeys, apes and gorillas

58
Q

Test for Hep A

A

Anti-HAV IgM
Indicates recent infection

Anti-HAV IgG
Indicates past infection or immunisation

59
Q

Mode of transmission, symptoms and treatment of hepatitis B

A

Blood and bodily fluids

tiredness
general aches and pains
high temperature
a general sense of feeling unwell
loss of appetite
feeling and being sick
diarrhoea
tummy pain
yellowing of the skin and eyes (jaundice)
dark urine and pale, grey-coloured poo

treatment = acute infection usually does not need treatment, just symptom management

chronic infection - peginterferon alfa 2-a. This stimulates the immune system to attack the hepatitis B virus and regain control over it.
Antivirals.

60
Q

Vaccine for Hep B

  • available
  • administered to?
A

Routinely given to all babies as of recent change to vaccine schedule

Also should be given to:
people who inject drugs or have a partner who injects drugs
people who change their sexual partners frequently
men who have sex with men
babies born to infected mothers
close family or sexual partners of someone with hepatitis B
anyone who receives regular blood transfusions or blood products, and their carers
people with any form of chronic liver disease
people with chronic kidney disease
people travelling to high-risk countries
male and female sex workers
people whose work puts them at risk of contact with blood or body fluids, such as nurses, prison staff, doctors, dentists and laboratory staff
prisoners
families adopting or fostering children from high-risk countries

61
Q

Test for Hep B

A

Anti-HBcAg IgM indicates acute infection

Surface antibody (anti-HBsAg IgG):
Indicates viral clearance
Post vaccination

Persistent HBsAg or presence of HBeAg (part of viral core) - indicated chronic infection

62
Q

Mode of transmission, symptoms and treatment of hepatitis C

A

Blood and bodily fluids

a high temperature of 38C (100.4F) or above
tiredness
loss of appetite
tummy (abdominal) pains
feeling and being sick
jaundice

treatment:
- acute - body can usually attempt to fight on its own
- chronic:
simeprevir
sofosbuvir
a combination of ledipasvir and sofosbuvir
a combination of ombitasvir, paritaprevir and ritonavir, taken with or without dasabuvir
a combination of sofosbuvir and velpatasvir
a combination of sofosbuvir, velpatasvir and voxilaprevir
a combination of glecaprevir and pibrentasvir
ribavarin

63
Q

Vaccine for Hep C

  • available
  • administered to?
A

There is no vaccine for Hep C

64
Q

Test for Hep C

A

HCV RNA present = acute infection

IgG antibodies and HCV RNA = chronic infection

65
Q

Mode of transmission, symptoms and treatment of hepatitis D

A

Blood and bodily fluids
Can only be co-infected alongside HBV

Symptoms and treatment same as B

66
Q

Vaccine for Hep D

  • Available
  • Administered to?
A

No vaccine for Hep D, however if vaccinated against Hep B that will offer adequate protection

67
Q

test for Hep D

A

Acute infection of HDV detected with Anti-HDV IgM

68
Q

Mode of transmission, symptoms and treatment of hepatitis E

A

Contaminated food and water

muscle and joint pain
a high temperature
feeling and being sick
feeling unusually tired all the time
a general sense of feeling unwell
loss of appetite
tummy pain
dark urine
pale, grey-coloured poo
itchy skin
yellowing of the eyes and skin (jaundice)

treatment: not usually serious in most people but can be dangerous for people with compromised immune systems

69
Q

Vaccine for Hep E

  • available
  • administered to?
A

There is no vaccine available for Hep E

70
Q

Test for Hep E

A

Anti-HEV IgM
Indicates recent infection
Anti-HEV IgG
Indicates past infection or immunisation

71
Q

How does bile travel from the liver to the gallbladder

A

left and right hepatic duct

common hepatic duct

72
Q

How does bile travel from the gallbladder to the pancreas

A

cystic duct

common bile duct

73
Q

How does bile travel from the pancreas to the duodenum

A

common hepatopancreatic duct

74
Q

How are bile acids returned to the liver

A

it’s almost completely taken up again in the distal ileum and finally returned to the liver with portal blood in a process termed enterohepatic circulation

C21 Phase 1 (45 decks)

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