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Med Finals - Medicine > Gastro > Flashcards

Gastro Flashcards

1
Q

Define alcoholic liver disease

A

Stepwise progression of liver disease resulting from the long term effects of excessive alcohol consumption

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2
Q

Progression of alcoholic liver disease

A

Alcohol related fatty liver
Alcoholic hepatitis
Live cirrhosis

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3
Q

Complications of alcohol

A

Alcoholic liver disease
Cirrhosis
Hepatocellular carcinoma
Alcohol dependence
Wernicke-korsakoff syndrome
Pancreatitis
Alcoholic cardiomyopathy

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4
Q

Clinical signs of liver disease

A

Jaundice
Hepatomegaly
Spider naevi
Palmar erythema
Gynaecomastia
Bruising
Ascites
Caput medusae - engorged superficial epigastric veins
Asterixis a

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5
Q

Investigations in alcoholic liver disease

A

FBC - Raised MCV
LFTs - elevated transaminases, raised GGT. ALP raised in late disease. Bilirubin raised in cirrhosis
Clotting - raised pt
UE - hepatorenal syndrome
US - fatty changes
Endoscopy - varices
CT/MRI - fatty infiltration
Liver biopstu

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6
Q

Management of alcoholic liver disease

A

Stop drinking!
Detox?
Nutritional support
Steroids
Treat complications

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7
Q

Alcohol withdrawal times

A

6-12 hours - tremor, sweating, headache, craving and anxiety
12-24 - hallucinations
24-48 - seizure
24-72 - delirium tremens

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8
Q

Define delirium tremens

A

Medical emergency caused by alcohol withdrawal
Alcohol stimulates gaba and inhibits glutamate, as a result the glutamate is upregulated.
When removed glutamate overfunctions causing excess adrenergic activity

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9
Q

Presentation of delirium tremens

A

Acute confusion
Severe agitation
Delusions and hallucinations
Tremor
Tachycardia
Hypertension
Hyperthermia
Ataxia
Arrhythmias

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10
Q

Management of alcohol withdrawal

A

Chlordiazepoxide - benzo
Pabrinex - IV thiamine

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11
Q

Define wernicke-korsakoff syndrome

A

Encephalopathy caused by lack of thiamine.
Wernickes encephalopathy leads to kordakoff syndrome

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12
Q

Features of Wernicke’s encephalopathy

A

Confusoin
Oculomotor disturbance - movement
Ataxia - coordination

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13
Q

Features of Korsakoff’s syndrome

A

Memory impairment
Behavioural change
Often irreversible

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14
Q

Define liver cirrhosis

A

Damage to hepatocytes resulting in scar tissue forming. Results from chronic inflammation.

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15
Q

Common causes of liver cirrhosis

A

Alcoholic liver disease
Non alcoholic liver disease
Hepatitis B
Hepatitis C
(AI, PBC, Haemochromatosis, Wilsons, alph-1 antitrypsin, cystic fibrosis, drugs)

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16
Q

Clinical signs of liver cirrhosis

A

Jaundice
Hepatomegaly
Splenomegaly
Spider naevi
Palmar erythema
Gynaecomastia
Bruising
Ascites
Caput medusae
Aterixis

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17
Q

Investigations in liver cirrhosis

A

LFTS - often normal, maybe deranged
Albumin and PT useful markers of synthetic function
Hyponatraemia
Urea and creatinine deranged
Alpha-fetoprotein
Enhanced liver fibrosis blood test
US
Fibroscan
Endoscopy
CT/MRI
Biopsy

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18
Q

Tumour marker for hepatocellular carcinoma

A

Alph-fetoprotein

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19
Q

Scoring system for severity of Cirrhosis

A

Child-Pugh score
Bilirubin
Albumin
INR
Ascites
Encephalopathy

MELD score - 3 month mortality

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20
Q

Management of liver cirrhosis

A

US and alpha-fetoprotein every 6 months
Endoscopy every 3 years
High protein
Low sodium
MELD score every 6 months
Consideration of liver transplant
Managing complications

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21
Q

Common complications of liver cirrhosis

A

Malnutrition
Portal hypertension, varices and variceal bleeding
Ascites and SBP
Hepato-renal syndrome
Hepatic encephalopathy
Hepatocellular carcinoma

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22
Q

Define portal hypertension

A

Liver cirrhosis increases resistance to blood flow as a result there is increased back pressure in the portal system causing anastomoses with the systemic venous system. These can become swollen and tortuous - varices

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23
Q

Management of stable varices

A

Propranolol - reduce portal hypertension
Elastic band ligation
Injection of sclerosant
Trans jugular intra-hepatic portosystemic shunt

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24
Q

Management of bleeding oesophageal varices

A

Resus - vasopressing (vasoconstriction)
Vit K - Correct coagulopathy
Broard spectrum antibiotics - prophylactic
Intubation and ITU
Urgent endoscopy - ligation, sclerosant, sengstaken-blakemore tube

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25
Q

Define ascites

A

FLuid in the peritoneal cavity - Increases pressure on the portal system causes fluid to leak out of capillaries in the liver and bowel.

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26
Q

Management of ascites

A

Low sodium diet
Anti-aldosterone diuretics - spironolactone
Paracentesis - tap or drain
Prophylactic abx - SBP
Consider TIPS
Consider transplant

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27
Q

Define spontaneous bacterial peritonitis

A

Infection developing in ascitic fluid and peritoneal lining without any clear causes - ie not secondary to perforation/drain.

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28
Q

Presentation of SBP

A

Fever
Abdo pain
Deranged bloods
Ileus
Hypotension

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29
Q

Management of SBP

A

Ascitic culture
IV Abx

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30
Q

Define hepatorenal syndrome

A

Hypertension in the portal system leads to dilation of blood vessels. Causes reduction in blood volume else where including kidneys. Rapid deterioration in kidney function and is fatal within a week

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31
Q

Management of hepatorenal syndrome

A

Liver transplant!

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32
Q

Define hepatic encephalopathy

A

Caused by build up of toxins within the brain - mainly ammonia which is produced by intestinal bacteria breaking down proteins. Liver metabolises into harmless waste product. If liver not working collects in blood. Colateral vessels created by portal hypertension allow ammonia to enter normal circulation.

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33
Q

Prevention of hepatic encephalopathy

A

Laxatives - clears ammonia from gut before absorption.

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34
Q

History of hepatic encephalopathy

A

Constipation
Electrolyte imballance
Infection
GI blees
High protein diet
Medication - sedatives
Liver cirrhosis

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35
Q

Management of hepatic encephalopathy

A

Laxatives - lactulose
Antibiotics - rifaximin
Nutritional support

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36
Q

Define non alcoholic fatty liver disease

A

Fat deposits in liver cells interfere with the functioning of the liver cells and can progress to hepatitis and cirrhosis
Part of the metabolic syndrome group of chronic health conditions relating to processing and storing energy that increase risk of heart disease

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37
Q

Stages of non alcoholic fatty liver disease

A

Non-alcoholic fatty liver disease
Non-alcoholic steatohepatitis
Fibrosis
Cirrhosis

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38
Q

Risk factors for NAFLD

A

30% of adults!
Obesity
Poor diet and low activity
TIIDM
High cholesterol
Middle age onwards
Smoking
High blood pressure

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39
Q

What is included in a liver screen

A

US liver
Hep B and C serology
Autoantibodies - hpetitis, pbc, psc
Immunoglobulins - AI hep, pbc
Ceruloplasmin - wilsons
Alpha 1 Anti-trypsin
Ferritin and transferrin
Coagulation
EBV
CMV
AMA, ASMA, Anti-LKM, ANA, p-ANCA

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40
Q

Investigations in NAFLD

A

Liver US
Enhanced liver fibrosis bloods - first line.
NAFLD fibrosis scores
Fibroscan

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41
Q

Management of NAFLD

A

Weight loss
Exercise
Stop smoking
Control diabetes
Avoid alcohol
Vit E
Pioglitazone

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42
Q

Define hepatitis

A

Inflammation of the liver

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43
Q

Common causes of hepatitis

A

Alcohol
NAFLD
Viral
Autoimmune
Drug induced

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44
Q

History of hepatitis

A

Abdo pain
Fatigue
Pruritis
Muscle and joing aches
Nausea and vomiting
Jaundice
Fever - viral

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45
Q

How are the hep viruses spreas

A

Hep A - Faeco-oral
Hep B - Blood
Hep C - Blood
Hep D - Blood
Hep E - Faeco-oral

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46
Q

Which hep viruses go together

A

A and E
B and D

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47
Q

Which hep biruses have vaccines

A

Hep A
Hep B

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48
Q

Which hep viruses are RNA

A

Hep A - RNA
Hep B - DNA
Hep C - RNA
Hep D - RNA

49
Q

Management of Hep A

A

Self resolving in 1-3 months
Simple analgesia

50
Q

Viral markers of Hep B

A

Surface antigen HBsAg - active infection
E antigen HBeAg - marker of viral repliaction - high infectivity
Core antibodies HBcAb - past infection
Surface antibodies HBsAb - vaccination or current infection
Hpatitis B virus DNA HBV DNA - direct count of the viral load

51
Q

Management of Hep B

A

Screen for other viruses and HIV
Notify public health england
Stop smoking and alcohol
Test for complications
Antiviral meds can be used
Liver transplant

52
Q

Management of hep c

A

Same as b
Direct acting antivirals

53
Q

Which hep viruses are notifiable

A

All of them!

54
Q

Define haemochromatosis

A

Iron storage disorder that results in excessive total iron and deposition of iron in tissues. The biggest cause in an autosomal recessive mutation in the HFE gene on chromosome 6

55
Q

History of haemochromatosis

A

40 yo
Chronic tiredness
Joint pain
Pigmentation
Hair loss
Erectile dysfunction
Amenorrhoea
Cognitive symptoms

56
Q

Investigations in haemochromatosis

A

Serum ferritin - raised in inflammation
Transferrin saturation - iron overload will be high - distinguish from inflammation
Genetic testing
(previously biopsy with perl’s stain)
CT abdo
MRI

57
Q

Complications of haemochromatosis

A

Type 1 diabetes
Liver cirrhosis
Iron deposits in the pituitary - endocrine
Cardiomyopathy
Hepatocellular carcinoma
Hypothyroidism
Chronocalcinosis/pseudogout - calcium deposits in joint

58
Q

Management of haemochromatosis

A

Venesection - therapeutic blood removal
Monitoring ferritin
Avoid alcohol
Genetic counselling
Monitoring and treatment of complications

59
Q

Define Wilson’s disease

A

The excessive accumulation of copper in the body and tissues - caused by an autosomal recessive mutation in the wilson disease protein on chromosome 13.

60
Q

Features of Wilson’s disease

A

Hepatic problems - Chronic hepatitis, Cirrhosis
Neurological problems - dysarthria, dystonia, parkinsonism.
Psychiatric problems - depression, psychosis
Kayser fleischer rings
Haemolytic anaemia
Renal tubular damage - renal tubular acidosis
Osteopenia

61
Q

Investigations in Wilson’s disease

A

Serum caeruloplasmin - will be low i wilson
Liver biopsy - gold standard
24 hr urine copper assay
MRI brain

62
Q

Management of wilsons disease

A

Penicillamine
Trientene
(copper chelation)

63
Q

Define alpha-1 antitrypsin deficiency

A

Condition caused by an abnormality in the gene for protease inhibitor called alpha-1 antitrypsin.
Autosomal recessive condiont affecting chromosome 14

64
Q

Main organs affected by A1AT

A

Liver - cirrhosis
Lung - bronchiectasis and emphysema

65
Q

Investigations in A1AT

A

DSerum levels
Liver biopsy
Genetic testing
High resolution CT thorax

66
Q

Management of A1AT

A

Stop smoking
Symptomatic management
Don’t replace
Organ transplant
Monitor complications

67
Q

Define primary biliary cirrhosis

A

A condition where the immune system attacks the small bile ducts within the liver. It first affects the interlobar ducts obstructing the outflow of bile (cholestasis). Back pressure of bile and the disease process leads to fibrosis and cirrhosis and liver failure.

68
Q

History of primary biliary cirrhosis

A

Fatigue
Pruritus
GI disturbance Jaundice
Pale stool
Xanthelasma - cholesterol deposits in the skin
Signs of cirrhosis

69
Q

Risk factors for primary biliary cirrhosis

A

Middle aged
Other auto immune conditions
Rheumatoid conditions

70
Q

Investigations in primary biliary cirrhosis

A

LFTs - raised alp
Autoantibodies - antimitochondrial, ANA
Raised ESR
Raised IgM
Liver biopsy - staging

71
Q

Management of primary biliary cirrhosis

A

Ursodeoxycholic acid
Cholestyramine -
Liver transplant
Immunosuppression

72
Q

Define primary sclerosing cholangitis

A

Condition where the intra/extra hepatic ducts become strictured and fibrotic. This causes obstruction tot eh flow of bile out of the liver and into the intestines. Leading to inflammation fibrosis and cirrhosis

73
Q

Risk factors for primary sclerosing cholangitis

A

Male
Age 30-40
Ulcerative colitis
FH

74
Q

History of primary sclerosing cholangitis

A

Jaunice
Chronic right upper quadrant pain
Pruritus
Fatigue
Hepatomegaly

75
Q

Investigations in primary sclerosing cholangitis

A

LFTs - cholestatic pucture - ALP most deranged
Autoantibodies - pANCA, ANA, aCL
MRCP - gold standard diagnostic

76
Q

Complicaions of primary sclerosing cholangitis

A

Acute bacterial cholangitis
Cholangiocarcinoma
Colorectal cancer
Cirrhosis and liver failure
Biliary strictures
Fat soluble vitamin deficiencies

77
Q

Management of primary sclerosing cholangitis

A

ERCP - dilate strictures
Cholestyramine
Monitoring
Transplant

78
Q

What are the main types of liver cancer

A

Hepatocellular carcinoma (80%)
Cholangiocarcinoma (20%)
(metastases)

79
Q

Risk factors for hepatocellular carcinoma

A

Cirrhosis - hepatitis B,C, Alcohol, NAFLD

80
Q

Risk factors for cholangiocarcinoma

A

Primary sclerosing cholangitis

81
Q

History of liver carncer

A

Weight loss
Abdo pain
Anorexia
Nausea and vomiting
Jaundice
Pruritus
Cholangiocarcinoma - painless jaundice

82
Q

Investigations in liver cancer

A

Alpha-fetoprotein - hepatocellular carcinoma
CA19-9 - cholangiocarcinoma
US
CT/MRI
ERCP

83
Q

Management of hepatocellular carcinoma

A

Resection in early disease
Transplant
Kinase inhibitors - something-nib
Not chemo and radio

84
Q

Management of cholangiocarcinoma

A

ERCP
Early surgical resection
Not chemo and radio

85
Q

Define haemangioma

A

Common benign tumour of the liver - often found incidentally.
No symptoms and no threat of becoming cancerous

86
Q

Define focal nodular hyperplasia

A

Benign tumour made of fibrotic tissue - found incidentally.
Asymptomatic and no malignant potential.
Often related to oestrogen - COCP

87
Q

Define gastro oesophageal reflux disease

A

GORD is where acid from the stomach refluxes through the lower oesophageal sphincter and irritates the lining of the oesophagus

88
Q

History of GORD

A

Heart burn
Acid regurgitation
Bloating
Nocturnal cough
Hoarse voice

89
Q

Red flags of GORD

A

Dysphagia
Aged >55
Weight loss
Upper abdo pain
Treatment resistant
Nausea and vomiting
Low haemoglobin
Raised platelet count

90
Q

Management of GORD

A

Reduce tea, coffee and alcohol
Weight loss
Avoid smoking
Smaller lighter meals
Stay upright
Gaviscon/rennie
Omeprazole
Ranitidine
Laparoscopic fundoplication

91
Q

How does h.pylori cause GORD

A

Bacteria tries to avoid acidic environment so forces way into mucosa breaking it and exposing epithelial cells. Also produces ammonia that damages cells - breath test

92
Q

Investigations for h.pylori

A

Urea breath test
Tool antigen tests
Rapid urease test on endoscopy

93
Q

Management of h.pylor

A

Tripple therapy with ppi and 2 abx
Amox and clari and omeprazole

94
Q

Define barrets oedophagus

A

Metaplasia of the squamous epithilium lining the oesophagus to columnar (like the stomach) after repeat exposure to acid.

95
Q

Management of barretts oesohagus

A

PPI
Regular aspirin?
Ablation therapy

96
Q

Define peptic ulcers

A

Ulceration of the mucosa of the stomach, or duodenum.

97
Q

History of peptic ulcers

A

Epigastric discomfort
Nausea and vomiting
Dyspepsia
Bleeding causing haematemesis - coffee ground vomiting
Melaena
Iron deficiency anaemia

98
Q

Management of peptic ulcers

A

PPIs
Endoscopy to monitor?

99
Q

Complications of peptic ulcers

A

Bleeding
Perforation
Scarring - pyloric stenosis

100
Q

Commo causes of upper GI bleeds

A

Oesophageal varices
Mallory-Weiss tear
Ulcers
Cancers

101
Q

History of upper gi bleed

A

Haematemesis - coffee ground vomit
Melaena
Haemodynamic instability
Epigastric pain
Jaundice

102
Q

What scoring system is used to assess the risk of having an upper GI bleed

A

Glasgow-Blatchford score
Drop in Hb
Rise in urea
Blood pressure
HR
Melaena
Syncope

103
Q

What score is used to assess the risk of rebleeding and overall mortality of upper gi bleeds

A

Rockall score - after endoscopy
Age
Features of shock (tachycardia or hypotension)
Co-morbidities
Cause of bleed
Endoscopic stigmata of recent haemorrhage

104
Q

Management of upper GI bleed

A

ABATED
ABCDE
Bloods
Access
Transfuse
Endoscopy
Drugs

105
Q

Investigations in upper gi bleed

A

Haemaglobin
Urea
Coagulation
Liver disease
Crossmatch

106
Q

Define inflammatory bowel disease

A

The umbrella term for two main diseases causing inflammation to the GI tract

107
Q

What are the conditions that make up inflammatory bowel disease

A

Ulcerative colitis
Crohn’s

108
Q

Features of Crohn’s disease

A

NESTS
No blood or mucus - less common
Entire GI tract
Skip lesions on endoscopy
Terminal ileum most commonly affected
Transmural - full thickness
Smoking is risk factor - don’t set the nest on fire

109
Q

Features of ulcerative colitis

A

UC-CLOSEUP
Continuous inflammation
Limited to colon and rectum
Only superficial mucosa
Smoking is protective
Excrete blood and mucus
Use aminosalicylates
Primary sclerosing cholangitis

110
Q

History of inflammatory bowel disease

A

DIarrhoea
Abdo pain
Passing blood
Weight loss

111
Q

Investigations in IBD

A

Routine bloods - anaemia, infection, thyroid, kidney and liver function
CRP
Faecal calprotectin
Endoscopy
US, CT, MRI

112
Q

Management of Crohn’s disease

A

Induce remission - steroids
Consider adding immunosuppression - azathioprine
Maintaining remission - azathioprine, mercaptopurine (methotrexate, infliximab, adalimumab)
Surgery - if only affecting distal ileum can be removed.

113
Q

Management of ulcerative collitis

A

Induce remission - aminosalicylate (mesalazine)
2nd line 0 corticosteroids
Maintain remission - mesalazine, azathioprine, mercaptopurine
Surgery - ileostomy

114
Q

Define coeliac disease

A

Auto immune condition where gluten causes inflammation to the small bowel. Particularly affects the jejunum where it causes intestinal villi atrophy leading to malabsorption.

115
Q

History of coeliac disease

A

Failure to thrive - young!
Diarrhoea
Fatigue
Weight loss
Mouth ulcers
Anaemia - iron, b12 or folate deficiency
Dermatitis herpetiformis
Neurological signs - neuropathy, ataxia and epilepsy
Very linked to TIDM

116
Q

Investigations in coeliac disease

A

Must be carried out whilst eating a gluten containing diet
anti-TTG
antiEMA
Endoscopy

117
Q

What will be seen on endoscopy in coeliac disease

A

Crypt hypertrophy
Villous atrophy

118
Q

What conditions are often associated with coeliac disease

A

Autoimmune conditions
TIDM
Thyroid disease
Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis

119
Q

Complications of coeliac disease

A

Vitamin deficinecy
Anaemia
Osteoporosis
Ulcerative jejunitits
Enteropathy associated t cell lymphoma
Non hodgkin lymphoma
Small bowel adenocarcinoma

Med Finals - Medicine (10 decks)

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