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gastro Flashcards

1
Q

how does alcohol related fatty liver progress

A

alcohol related fatty liver (reverse in 2w if stop)->alcoholic hepatitis (reversible with permanent abstinence)-> cirrhosis=scar tissue, irreversible

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2
Q

signs liver disease

A

jaundice
hepatomegaly
spider naivi
palmar eryhthema
gynaecomastea
bruising
ascities
caput medusae (engorged superficial epigastric veins)
asterixis

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3
Q

ix alcoholic liver disease

A

FBC=increased MCV
LFTS=increased ALT, AST, GGT, low albumin
increased prothrombin time
deranged U+Es
USS=increased echogenicity
endoscopy for oesophageal varices
CT/MRI
biopsy

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4
Q

mx alcoholic liver disease

A

detox
thiamine
steroids: improve short term outcome
tx complications
liver transplant: requires 3m abstinence

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5
Q

alcohol withdrawal

A

6-12h: tremor, sweating, headache, craving, anxiety
12-24h: hallucinations
24-48h: seizures
24-72h: delerium tremens

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6
Q

delerium tremens pathophysiology

A

alcohol removed so GABA underfunctions and glutamate over functions = excitability and excessive adrenergic activity

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7
Q

features delierium tremens

A

confusion
agitation
delusion
tremor
increased HR and BP
temp
ataxia
arrhythmia

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8
Q

what does low thiamine cause

A

wernickes: confusion, occulomotor problem, ataxia
korsakoffs: amnesia, behavioural change

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9
Q

common causes cirrhosis

A

alcoholic liver disease
NAFLD
hep b and c

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10
Q

uncommon causes cirrhosis

A

AI hepatitis
primary biliary cirrhosis
haemochromatosis
wilsons
alpha1antitripsin deficiency
CF
drugs: amiodarone, methotrexate, sodium valproate

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11
Q

what does USS show in cirrhosis

A

nodular
corkscrew arteries
enlarged portal vein with decreased flow
ascites
splenomegaly

screen for HCC every 6m

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12
Q

what is a fibro-scan

A

assess degree cirrhosis
transient elastography
have every 2y

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13
Q

score to estimate cirrhosis severity

A

child pugh score

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14
Q

child pugh score

A

bilirubin: 1= <34, 2= 34-50, 3= >50
albumin: 1= >35, 2= 28-35, 3=<28
INR: 1= <1.7, 2=1.7-2.3, 3= >2.3
ascites: 1=none, 2=mild, 3=mod/sev
encephalopathy: 1=none, 2=mild, 3=mod/sev

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15
Q

mx liver cirrhosis

A

USS and alpha fetoprotein every 6m for HCC
endoscopy every 3y
high protein and low sodium diet
MELD score (bilirubin, creatinine, INR, Na) every 6m
consider transplant

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16
Q

complications cirrhosis

A

malnutrition
mortal HTN and varices
ascites
spontaneois bacterial peritonitis
hepatorenal syndrome
hepatic encephalopathy

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17
Q

malnutrition and cirrhosis

A

reduced ability of protein metabolism and glycogen storage

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18
Q

mx stable portal HTN and varices

A

propanolol
elastic band ligation
injection sclerosant
TIPS

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19
Q

mx bleeding/ unstable portal HTN and varices

A

vasopressin analogue (terlipressin)
vit k and fresh frozen plasma
broad spectrum abx
endoscopy and injection sclerosant/band ligation
sengstaken-blakemore tube if endoscopy fails

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20
Q

mx ascites

A

spironolactone
ascitic tap
ciprofloxacin
TIPS

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21
Q

features spontaneous bacterial peritonitis

A

fever
abdo pain
ileus
low BP

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22
Q

cause spontaneous bacterial peritonitis

A

e.coli
klebsiella pneumoniae
Staph

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23
Q

mx spontaneous bacterial peritonitis

A

ascitic culture
IV cefotaxime

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24
Q

hepatorenal syndrome

A

decreased blood flow to kidnet
need transplant within 1wk

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25
what causes hepatic encephalopathy
build up of ammonia
26
features hepatic encephalopathy
LOC confused changes to personality/memory/mood
27
mx hepatic encephalopathy
laxatives abx-rifaximin nutritional support
28
progression NAFLD
NAFLD->non alcoholic steatohepatitis->fibrosis->cirrhosis
29
NAFLD fibrosis score
age BMI liver enzymes platelets alubmin DM fibroscan ELF blood test
30
mx NAFLD
mx RF if fibrosis: vit E or pioglitazone
31
non invasive liver screen
USS hep B and C serology auto Ab: ANA, SMA, AMA, LKM-1 immunoglobulins coeruloplasmin alpha 1 antitrypsin levels ferritin and transferrin saturation
32
causes hepatitis
alcoholic NAFLD viral AI drug induced - paracetamol
33
hepatic picture LFTs
increased AST and ALT smaller increase in ALP
34
Hep A spread
RNA virus faeco oral
35
mx hep a
vaccine analgesia resolves 1-3m
36
hep b spread
DNA virus blood or bodily fluids
37
mx hep b
some have chronic sx vaccine antivirals transplant if end stage
38
HBsAg
surface antigen =active infection
39
HBeAg
E Ag =marker viral replication, high infectivity
40
HBcAb
core Ab =past or current infection
41
HBcAb
surface Ab =vaccination or past or current infection
42
HBV DNA
viral load
43
Hep C spread
RNA virus blood and bodily fluids
44
hep c mx
no vaccine direct acting antiviral meds
45
hep c compliations
cirrhosis HCC
46
hep D spread
RNA virus cant survive without Hep B
47
what does hep D do
increase complications and severity hep b
48
hep E spread
RNA virus faeco oral
49
mx hep E
no vaccine supportibe - usually mild
50
features type 1 AI hep
adults 40-50y: fatigue and liver sx, ANA, anti-actin, anti-SLA/LP
51
feaures AI hep type 2
children - teens, acute hep and jaundice. anti-LKM1, anti-LC1
52
mx AI hep
pred azathioprine usually tx for life
53
haemochromatosis
excessive iron deposition autosomal recessive - chrom 6 HFE gene
54
sx haemochromatosis
tired joint pain bronze hair loss erectile dysfunction amenorrhoea memory/mood
55
ix haemochromatosis
serum ferritin transferrin saturation liver biopsy with pearls stain
56
mx haemochromatosis
venesection
57
complications haemochromatosis
T1DM cirrhosis cardiomyopathy HCC hypothyroid arthritis-chondrocalcinosis
58
wilsons disease
genetic excess copper
59
sx wilsons disease
cirrhosis neuro: dyasrthria, dystoia, parkinsonism psych: depression, psychosis kayser-fleischer rings haemolytic anaemia renal tubular acidosis osteopenia
60
ix wilsons disease
serum coeruloplasmin liver biopsy 24h urine copper assay
61
mx wilsons disease
copper chelation (penicilamine, trientene)
62
alpha 1 antitrypsin deficiency
autoromal recessive leads to excess protease enzymes->liver cirrhosis and pulmonary basal emohysema
63
ix alpha 1 antitrypsin deficiency
serum alpha 1 antitrypsin liver biopsy with acid-schiff positive staining globules genetocs CT thorax
64
mx alpha 1 antitrypsin deficiency
transplant
65
primary biliary cirrhosis
immune system attacks small bile ducts in liver
66
sx primary biliary cirrhosis
fatigue pruritis abdo pain jaundice pale and greasy stool xanthoma xanthelasma cirrhosis
67
ix primary biliary cirrhosis
increased ALP, AMA, ANA, increased ESR, increased IgM biopsy
68
mx primary biliary cirrhosis
ursodeoxycholic acid, colestyramine +/- steroids +/- transplant
69
associations with primary biliary cirrhosus
middle aged F other AI rheum
70
complications primary biliary cirrhosis
steatorrhoea distal renal tubular acidosis hypothyroid osteoporosis HCC
71
primary sclerosisng cholangitis
intrahepatic or extrahepatic ducts strictured and fibrotic therefore obstruct bile outflow leading to liver cirrhosis
72
RF primary sclerosisng cholangitis
UC M
73
sx primary sclerosing cholangitis
jaundice RUQ pain pruritis fatigue hepatomegaly
74
ix primary sclerosing cholangitis
cholestatic bloods=increased ALP p-ANCA, ANA, aCP MRCP
75
mx primary sclerosing cholangitis
ERCP ursodeoxycholic acid colestyramine transplant
76
complocations primaru sclerosing cholangitis
bacterial cholangitis cholangiocarcinoma colorectal ca fat sol vitamin deficiency
77
liver cancers
HCC cholangiocarcinoma haemangioma focal nodular hyperplasia
78
RF HCC
cirrhosis
79
marker for HCC
alpha fetoprotein
80
mx HCC
resection transplant kinase i e.g. scrafenib
81
marker for cholangiocarcinoma
CA19-9
82
mx cholangiocarcinoma
resection ERCP
83
features haemangioma
no sx benign
84
features focal nodular hyperplasia
benign asx related to oestrogen
85
who is unsuitable for liver transplant
malnourished active hep b/c end stage HIV active alcohol use
86
meds post liver transplant
steroids and azathioprine for life
87
features GORD
heartburn, acid regurg, epigastric pain, bloating, nocturnal cough, hoarse voice
88
mx GORD
lifestyle gaviscon/rennie PPI=omeprazole (reduces acid secretion) H2 antagonist=ranitidine
89
when to 2ww for endoscopy
dysphagia >55 and wt loss, upper ando pain and reflux, resistant dyspepsia, N+V, low Hb, high platelets
90
link between h.pylori and GORD
ammonia released damages epithelial cells
91
ix h.pylori GORD
urea breath test stool Ag rapid urease test in endoscopy
92
mx h.pylori GORD
7d PPI (omeprazole) and 2 abx (amoxicillin and clarithromycin) test eradication=urea breath
93
barrets oesophagus
lower oesophageal epithelium changes from squamous to columnar precursor adenocarcinoma
94
mx barrets oesophagus
PPI +/- ablation
95
peptic ulcer cause
due to breakdown of wall - h.pylori or nsaids increased acid - stress, alcohol, smoking, caffeine, spice
96
sx peptic ulcer
epigastric pain N+V dyspepsia bleeding=haematemesis low iron=anaemia
97
what type of peptic ulcer worsens with food
gastric
98
what type of peptic ulcer is worse when hungry/improves with food
duodenal
99
ix peptic ulcer
endoscopy check for h.pylori-urea breath test, rapid urease test in endoscopy
100
mx peptic ulcer
PPI if perforates ->peritonitis->surgery
101
causes upper GI bleed
oesophageal varices mallory-weis tear ulcers-stomach/duodenum cancer - stomach/duodenum
102
features upper GI bleed
haematemesis (vom blood) melaena (black stool due to blood) pain
103
mx upper GI bleed
A-E bloods: Hb, urea (U+E), coag (INR), LFTs, crossmatch 2 units access transfuse if needed endoscopy within 24h stop anticoags and nsaids definitive mx: OGD to intervene/stop bleeding
104
what is glascow-blatchford score for
risk upper GI bleed
105
components glascow blatchford score
Hb urea BP HR melaena syncope
106
what is rockall score for
risk re-bleed after endoscopy
107
components rockall score
age shock (HR and BP) co-morbidities cause endoscopic stigmata
108
features crohns
entire GI tract skip lesions transmural thickness wt loss strictures smoking is a RF less common for blood/mucus
109
features UC
continuous inflamamtion superficial mucosa colon and rectum only blood and mucus excreted smoking is protective
110
ix IBD
increased CRP faecal calprotectin endoscopy and biopsy
111
inducing remission in crohns
steroids: oral pred, IV hydrocortisone +/- azathioprine, inlfiximab, methotrexate
112
maintenance in crohns
nothing azathioprine mercaptopurine methotrexate
113
surgical options crohn
resect distal ileum tx strictures and fistulas
114
inducing remission UC
mild/mod: aminosalicylate e.g. mesalazine or pred sev: IV hydrocortisone, IV ciclosporin
115
maintenance in UC
mesalazine azathioprine
116
surgical option sUC
remove colon and rectum leaving with ileostomy or j-pouch
117
IBS diagnosis
exclude other pathology: FBC, ESR, CRP, faecal calprotectin, anti-TTG Ab sx of abdo pain relieved on defecation or associated wth change in bowels +2 of: abnormal stool passage, bloating, worse after eating, mucus
118
mx IBS
lifestyle: reduce caffeien and alcohol, FODMAP, probiotics 1st line: loperamide if diarrhoea, laxatives if constipated, antispasmodic=buscapan 2nd line=amitryptiline 3rd line =SSRI CBT
119
pathophysiology coeliac
anti-TTG and anti-EMA target epithelial cells
120
sx coeliac disease
asx FTT diarrhoea aneamia dermatitis herpetiformis peripheral neuropathy
121
genes associated with coeliac disease
HLA-DQ2 HLA-DQ8
122
auto ab associated with coeliac disease
anti-TTG anti-EMA anti-DGP
123
diagnosis coeliac disease
exclude IgA deficiency icreased anti-TTG or EMA endoscopy=crypt hypertrophy, villous atrophy
124
conditions associated with coeliac disease
AI-T1DM, thyroid, AI hep, primary biliary cirhhosis, primary sclerosing cholangitis
125
complications coeliac disease
vit deficiencies anaemia osteoporosis ulcerative jejunitis enteropathy associated T cell lymphoma NHL small bowel adenocarcinoma
126
positive serology acute hep B infection
HBsAg HBeAg Anti-HBc IgM HBV DNA plus elevated transaminases
127
positive serology active chronic hep b infection
HBsAg (HBeAg Anti-HBc IgG HBV DNA plus elevated transaminases
128
positive serology inactive hep b infection/carrier
HBsAg anti-HBe HBc IgG HBV DNA - low
129
positive serology hep b Immunity (following acute infection)
anti-HBs anti-HBe Anti-HBc IgG
130
positiver serology hep b Immunity (following vaccination)
anti-HBs

finals (31 decks)

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