Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Progression of alcoholic liver disease

A

Alcohol related fatty liver
Alcoholic hepatitis
Live cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Complications of alcohol

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Management of alcoholic liver disease

A

Stop drinking!
Detox?
Nutritional support
Steroids
Treat complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Presentation of delirium tremens

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of alcohol withdrawal

A

Chlordiazepoxide - benzo
Pabrinex - IV thiamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define wernicke-korsakoff syndrome

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Features of Wernicke’s encephalopathy

A

Confusoin
Oculomotor disturbance - movement
Ataxia - coordination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Features of Korsakoff’s syndrome

A

Memory impairment
Behavioural change
Often irreversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Define liver cirrhosis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Clinical signs of liver cirrhosis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Tumour marker for hepatocellular carcinoma

A

Alph-fetoprotein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Scoring system for severity of Cirrhosis

A

Child-Pugh score
Bilirubin
Albumin
INR
Ascites
Encephalopathy

MELD score - 3 month mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Management of stable varices

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Define ascites
FLuid in the peritoneal cavity - Increases pressure on the portal system causes fluid to leak out of capillaries in the liver and bowel.
26
Management of ascites
Low sodium diet Anti-aldosterone diuretics - spironolactone Paracentesis - tap or drain Prophylactic abx - SBP Consider TIPS Consider transplant
27
Define spontaneous bacterial peritonitis
Infection developing in ascitic fluid and peritoneal lining without any clear causes - ie not secondary to perforation/drain.
28
Presentation of SBP
Fever Abdo pain Deranged bloods Ileus Hypotension
29
Management of SBP
Ascitic culture IV Abx
30
Define hepatorenal syndrome
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
31
Management of hepatorenal syndrome
Liver transplant!
32
Define hepatic encephalopathy
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.
33
Prevention of hepatic encephalopathy
Laxatives - clears ammonia from gut before absorption.
34
History of hepatic encephalopathy
Constipation Electrolyte imballance Infection GI blees High protein diet Medication - sedatives Liver cirrhosis
35
Management of hepatic encephalopathy
Laxatives - lactulose Antibiotics - rifaximin Nutritional support
36
Define non alcoholic fatty liver disease
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
37
Stages of non alcoholic fatty liver disease
Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis Fibrosis Cirrhosis
38
Risk factors for NAFLD
30% of adults! Obesity Poor diet and low activity TIIDM High cholesterol Middle age onwards Smoking High blood pressure
39
What is included in a liver screen
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
40
Investigations in NAFLD
Liver US Enhanced liver fibrosis bloods - first line. NAFLD fibrosis scores Fibroscan
41
Management of NAFLD
Weight loss Exercise Stop smoking Control diabetes Avoid alcohol Vit E Pioglitazone
42
Define hepatitis
Inflammation of the liver
43
Common causes of hepatitis
Alcohol NAFLD Viral Autoimmune Drug induced
44
History of hepatitis
Abdo pain Fatigue Pruritis Muscle and joing aches Nausea and vomiting Jaundice Fever - viral
45
How are the hep viruses spreas
Hep A - Faeco-oral Hep B - Blood Hep C - Blood Hep D - Blood Hep E - Faeco-oral
46
Which hep viruses go together
A and E B and D
47
Which hep biruses have vaccines
Hep A Hep B
48
Which hep viruses are RNA
Hep A - RNA Hep B - DNA Hep C - RNA Hep D - RNA
49
Management of Hep A
Self resolving in 1-3 months Simple analgesia
50
Viral markers of Hep B
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
Management of Hep B
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
Management of hep c
Same as b Direct acting antivirals
53
Which hep viruses are notifiable
All of them!
54
Define haemochromatosis
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
History of haemochromatosis
40 yo Chronic tiredness Joint pain Pigmentation Hair loss Erectile dysfunction Amenorrhoea Cognitive symptoms
56
Investigations in haemochromatosis
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
Complications of haemochromatosis
Type 1 diabetes Liver cirrhosis Iron deposits in the pituitary - endocrine Cardiomyopathy Hepatocellular carcinoma Hypothyroidism Chronocalcinosis/pseudogout - calcium deposits in joint
58
Management of haemochromatosis
Venesection - therapeutic blood removal Monitoring ferritin Avoid alcohol Genetic counselling Monitoring and treatment of complications
59
Define Wilson's disease
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
Features of Wilson's disease
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
Investigations in Wilson's disease
Serum caeruloplasmin - will be low i wilson Liver biopsy - gold standard 24 hr urine copper assay MRI brain
62
Management of wilsons disease
Penicillamine Trientene (copper chelation)
63
Define alpha-1 antitrypsin deficiency
Condition caused by an abnormality in the gene for protease inhibitor called alpha-1 antitrypsin. Autosomal recessive condiont affecting chromosome 14
64
Main organs affected by A1AT
Liver - cirrhosis Lung - bronchiectasis and emphysema
65
Investigations in A1AT
DSerum levels Liver biopsy Genetic testing High resolution CT thorax
66
Management of A1AT
Stop smoking Symptomatic management Don't replace Organ transplant Monitor complications
67
Define primary biliary cirrhosis
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
History of primary biliary cirrhosis
Fatigue Pruritus GI disturbance Jaundice Pale stool Xanthelasma - cholesterol deposits in the skin Signs of cirrhosis
69
Risk factors for primary biliary cirrhosis
Middle aged Other auto immune conditions Rheumatoid conditions
70
Investigations in primary biliary cirrhosis
LFTs - raised alp Autoantibodies - antimitochondrial, ANA Raised ESR Raised IgM Liver biopsy - staging
71
Management of primary biliary cirrhosis
Ursodeoxycholic acid Cholestyramine - Liver transplant Immunosuppression
72
Define primary sclerosing cholangitis
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
Risk factors for primary sclerosing cholangitis
Male Age 30-40 Ulcerative colitis FH
74
History of primary sclerosing cholangitis
Jaunice Chronic right upper quadrant pain Pruritus Fatigue Hepatomegaly
75
Investigations in primary sclerosing cholangitis
LFTs - cholestatic pucture - ALP most deranged Autoantibodies - pANCA, ANA, aCL MRCP - gold standard diagnostic
76
Complicaions of primary sclerosing cholangitis
Acute bacterial cholangitis Cholangiocarcinoma Colorectal cancer Cirrhosis and liver failure Biliary strictures Fat soluble vitamin deficiencies
77
Management of primary sclerosing cholangitis
ERCP - dilate strictures Cholestyramine Monitoring Transplant
78
What are the main types of liver cancer
Hepatocellular carcinoma (80%) Cholangiocarcinoma (20%) (metastases)
79
Risk factors for hepatocellular carcinoma
Cirrhosis - hepatitis B,C, Alcohol, NAFLD
80
Risk factors for cholangiocarcinoma
Primary sclerosing cholangitis
81
History of liver carncer
Weight loss Abdo pain Anorexia Nausea and vomiting Jaundice Pruritus Cholangiocarcinoma - painless jaundice
82
Investigations in liver cancer
Alpha-fetoprotein - hepatocellular carcinoma CA19-9 - cholangiocarcinoma US CT/MRI ERCP
83
Management of hepatocellular carcinoma
Resection in early disease Transplant Kinase inhibitors - something-nib Not chemo and radio
84
Management of cholangiocarcinoma
ERCP Early surgical resection Not chemo and radio
85
Define haemangioma
Common benign tumour of the liver - often found incidentally. No symptoms and no threat of becoming cancerous
86
Define focal nodular hyperplasia
Benign tumour made of fibrotic tissue - found incidentally. Asymptomatic and no malignant potential. Often related to oestrogen - COCP
87
Define gastro oesophageal reflux disease
GORD is where acid from the stomach refluxes through the lower oesophageal sphincter and irritates the lining of the oesophagus
88
History of GORD
Heart burn Acid regurgitation Bloating Nocturnal cough Hoarse voice
89
Red flags of GORD
Dysphagia Aged >55 Weight loss Upper abdo pain Treatment resistant Nausea and vomiting Low haemoglobin Raised platelet count
90
Management of GORD
Reduce tea, coffee and alcohol Weight loss Avoid smoking Smaller lighter meals Stay upright Gaviscon/rennie Omeprazole Ranitidine Laparoscopic fundoplication
91
How does h.pylori cause GORD
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
Investigations for h.pylori
Urea breath test Tool antigen tests Rapid urease test on endoscopy
93
Management of h.pylor
Tripple therapy with ppi and 2 abx Amox and clari and omeprazole
94
Define barrets oedophagus
Metaplasia of the squamous epithilium lining the oesophagus to columnar (like the stomach) after repeat exposure to acid.
95
Management of barretts oesohagus
PPI Regular aspirin? Ablation therapy
96
Define peptic ulcers
Ulceration of the mucosa of the stomach, or duodenum.
97
History of peptic ulcers
Epigastric discomfort Nausea and vomiting Dyspepsia Bleeding causing haematemesis - coffee ground vomiting Melaena Iron deficiency anaemia
98
Management of peptic ulcers
PPIs Endoscopy to monitor?
99
Complications of peptic ulcers
Bleeding Perforation Scarring - pyloric stenosis
100
Commo causes of upper GI bleeds
Oesophageal varices Mallory-Weiss tear Ulcers Cancers
101
History of upper gi bleed
Haematemesis - coffee ground vomit Melaena Haemodynamic instability Epigastric pain Jaundice
102
What scoring system is used to assess the risk of having an upper GI bleed
Glasgow-Blatchford score Drop in Hb Rise in urea Blood pressure HR Melaena Syncope
103
What score is used to assess the risk of rebleeding and overall mortality of upper gi bleeds
Rockall score - after endoscopy Age Features of shock (tachycardia or hypotension) Co-morbidities Cause of bleed Endoscopic stigmata of recent haemorrhage
104
Management of upper GI bleed
ABATED ABCDE Bloods Access Transfuse Endoscopy Drugs
105
Investigations in upper gi bleed
Haemaglobin Urea Coagulation Liver disease Crossmatch
106
Define inflammatory bowel disease
The umbrella term for two main diseases causing inflammation to the GI tract
107
What are the conditions that make up inflammatory bowel disease
Ulcerative colitis Crohn's
108
Features of Crohn's disease
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
Features of ulcerative colitis
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
History of inflammatory bowel disease
DIarrhoea Abdo pain Passing blood Weight loss
111
Investigations in IBD
Routine bloods - anaemia, infection, thyroid, kidney and liver function CRP Faecal calprotectin Endoscopy US, CT, MRI
112
Management of Crohn's disease
Induce remission - steroids Consider adding immunosuppression - azathioprine Maintaining remission - azathioprine, mercaptopurine (methotrexate, infliximab, adalimumab) Surgery - if only affecting distal ileum can be removed.
113
Management of ulcerative collitis
Induce remission - aminosalicylate (mesalazine) 2nd line 0 corticosteroids Maintain remission - mesalazine, azathioprine, mercaptopurine Surgery - ileostomy
114
Define coeliac disease
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
History of coeliac disease
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
Investigations in coeliac disease
Must be carried out whilst eating a gluten containing diet anti-TTG antiEMA Endoscopy
117
What will be seen on endoscopy in coeliac disease
Crypt hypertrophy Villous atrophy
118
What conditions are often associated with coeliac disease
Autoimmune conditions TIDM Thyroid disease Autoimmune hepatitis Primary biliary cirrhosis Primary sclerosing cholangitis
119
Complications of coeliac disease
Vitamin deficinecy Anaemia Osteoporosis Ulcerative jejunitits Enteropathy associated t cell lymphoma Non hodgkin lymphoma Small bowel adenocarcinoma

Med Finals - Medicine (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions