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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
Q

what causes hepatic encephalopathy

A

build up of ammonia

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26
Q

features hepatic encephalopathy

A

LOC
confused
changes to personality/memory/mood

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27
Q

mx hepatic encephalopathy

A

laxatives
abx-rifaximin
nutritional support

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28
Q

progression NAFLD

A

NAFLD->non alcoholic steatohepatitis->fibrosis->cirrhosis

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29
Q

NAFLD fibrosis score

A

age
BMI
liver enzymes
platelets
alubmin
DM
fibroscan
ELF blood test

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30
Q

mx NAFLD

A

mx RF
if fibrosis: vit E or pioglitazone

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31
Q

non invasive liver screen

A

USS
hep B and C serology
auto Ab: ANA, SMA, AMA, LKM-1
immunoglobulins
coeruloplasmin
alpha 1 antitrypsin levels
ferritin and transferrin saturation

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32
Q

causes hepatitis

A

alcoholic
NAFLD
viral
AI
drug induced - paracetamol

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33
Q

hepatic picture LFTs

A

increased AST and ALT
smaller increase in ALP

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34
Q

Hep A spread

A

RNA virus
faeco oral

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35
Q

mx hep a

A

vaccine
analgesia
resolves 1-3m

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36
Q

hep b spread

A

DNA virus
blood or bodily fluids

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37
Q

mx hep b

A

some have chronic sx
vaccine
antivirals
transplant if end stage

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38
Q

HBsAg

A

surface antigen
=active infection

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39
Q

HBeAg

A

E Ag
=marker viral replication, high infectivity

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40
Q

HBcAb

A

core Ab
=past or current infection

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41
Q

HBcAb

A

surface Ab
=vaccination or past or current infection

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42
Q

HBV DNA

A

viral load

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43
Q

Hep C spread

A

RNA virus
blood and bodily fluids

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44
Q

hep c mx

A

no vaccine
direct acting antiviral meds

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45
Q

hep c compliations

A

cirrhosis
HCC

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46
Q

hep D spread

A

RNA virus
cant survive without Hep B

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47
Q

what does hep D do

A

increase complications and severity hep b

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48
Q

hep E spread

A

RNA virus
faeco oral

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49
Q

mx hep E

A

no vaccine
supportibe - usually mild

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50
Q

features type 1 AI hep

A

adults 40-50y: fatigue and liver sx, ANA, anti-actin, anti-SLA/LP

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51
Q

feaures AI hep type 2

A

children - teens, acute hep and jaundice. anti-LKM1, anti-LC1

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52
Q

mx AI hep

A

pred
azathioprine
usually tx for life

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53
Q

haemochromatosis

A

excessive iron deposition
autosomal recessive - chrom 6 HFE gene

54
Q

sx haemochromatosis

A

tired
joint pain
bronze
hair loss
erectile dysfunction
amenorrhoea
memory/mood

55
Q

ix haemochromatosis

A

serum ferritin
transferrin saturation
liver biopsy with pearls stain

56
Q

mx haemochromatosis

A

venesection

57
Q

complications haemochromatosis

A

T1DM
cirrhosis
cardiomyopathy
HCC
hypothyroid
arthritis-chondrocalcinosis

58
Q

wilsons disease

A

genetic
excess copper

59
Q

sx wilsons disease

A

cirrhosis
neuro: dyasrthria, dystoia, parkinsonism
psych: depression, psychosis
kayser-fleischer rings
haemolytic anaemia
renal tubular acidosis
osteopenia

60
Q

ix wilsons disease

A

serum coeruloplasmin
liver biopsy
24h urine copper assay

61
Q

mx wilsons disease

A

copper chelation (penicilamine, trientene)

62
Q

alpha 1 antitrypsin deficiency

A

autoromal recessive
leads to excess protease enzymes->liver cirrhosis and pulmonary basal emohysema

63
Q

ix alpha 1 antitrypsin deficiency

A

serum alpha 1 antitrypsin
liver biopsy with acid-schiff positive staining globules
genetocs
CT thorax

64
Q

mx alpha 1 antitrypsin deficiency

A

transplant

65
Q

primary biliary cirrhosis

A

immune system attacks small bile ducts in liver

66
Q

sx primary biliary cirrhosis

A

fatigue
pruritis
abdo pain
jaundice
pale and greasy stool
xanthoma
xanthelasma
cirrhosis

67
Q

ix primary biliary cirrhosis

A

increased ALP, AMA, ANA, increased ESR, increased IgM
biopsy

68
Q

mx primary biliary cirrhosis

A

ursodeoxycholic acid, colestyramine +/- steroids +/- transplant

69
Q

associations with primary biliary cirrhosus

A

middle aged
F
other AI
rheum

70
Q

complications primary biliary cirrhosis

A

steatorrhoea
distal renal tubular acidosis
hypothyroid
osteoporosis
HCC

71
Q

primary sclerosisng cholangitis

A

intrahepatic or extrahepatic ducts strictured and fibrotic therefore obstruct bile outflow leading to liver cirrhosis

72
Q

RF primary sclerosisng cholangitis

A

UC
M

73
Q

sx primary sclerosing cholangitis

A

jaundice
RUQ pain
pruritis
fatigue
hepatomegaly

74
Q

ix primary sclerosing cholangitis

A

cholestatic bloods=increased ALP
p-ANCA, ANA, aCP
MRCP

75
Q

mx primary sclerosing cholangitis

A

ERCP
ursodeoxycholic acid
colestyramine
transplant

76
Q

complocations primaru sclerosing cholangitis

A

bacterial cholangitis
cholangiocarcinoma
colorectal ca
fat sol vitamin deficiency

77
Q

liver cancers

A

HCC
cholangiocarcinoma
haemangioma
focal nodular hyperplasia

78
Q

RF HCC

A

cirrhosis

79
Q

marker for HCC

A

alpha fetoprotein

80
Q

mx HCC

A

resection
transplant
kinase i e.g. scrafenib

81
Q

marker for cholangiocarcinoma

A

CA19-9

82
Q

mx cholangiocarcinoma

A

resection
ERCP

83
Q

features haemangioma

A

no sx
benign

84
Q

features focal nodular hyperplasia

A

benign
asx
related to oestrogen

85
Q

who is unsuitable for liver transplant

A

malnourished
active hep b/c
end stage HIV
active alcohol use

86
Q

meds post liver transplant

A

steroids and azathioprine for life

87
Q

features GORD

A

heartburn, acid regurg, epigastric pain, bloating, nocturnal cough, hoarse voice

88
Q

mx GORD

A

lifestyle
gaviscon/rennie
PPI=omeprazole (reduces acid secretion)
H2 antagonist=ranitidine

89
Q

when to 2ww for endoscopy

A

dysphagia
>55 and wt loss, upper ando pain and reflux, resistant dyspepsia, N+V, low Hb, high platelets

90
Q

link between h.pylori and GORD

A

ammonia released damages epithelial cells

91
Q

ix h.pylori GORD

A

urea breath test
stool Ag
rapid urease test in endoscopy

92
Q

mx h.pylori GORD

A

7d PPI (omeprazole) and 2 abx (amoxicillin and clarithromycin)
test eradication=urea breath

93
Q

barrets oesophagus

A

lower oesophageal epithelium changes from squamous to columnar
precursor adenocarcinoma

94
Q

mx barrets oesophagus

A

PPI +/- ablation

95
Q

peptic ulcer cause

A

due to breakdown of wall - h.pylori or nsaids
increased acid - stress, alcohol, smoking, caffeine, spice

96
Q

sx peptic ulcer

A

epigastric pain
N+V
dyspepsia
bleeding=haematemesis
low iron=anaemia

97
Q

what type of peptic ulcer worsens with food

A

gastric

98
Q

what type of peptic ulcer is worse when hungry/improves with food

A

duodenal

99
Q

ix peptic ulcer

A

endoscopy
check for h.pylori-urea breath test, rapid urease test in endoscopy

100
Q

mx peptic ulcer

A

PPI
if perforates ->peritonitis->surgery

101
Q

causes upper GI bleed

A

oesophageal varices
mallory-weis tear
ulcers-stomach/duodenum
cancer - stomach/duodenum

102
Q

features upper GI bleed

A

haematemesis (vom blood)
melaena (black stool due to blood)
pain

103
Q

mx upper GI bleed

A

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
Q

what is glascow-blatchford score for

A

risk upper GI bleed

105
Q

components glascow blatchford score

A

Hb
urea
BP
HR
melaena
syncope

106
Q

what is rockall score for

A

risk re-bleed after endoscopy

107
Q

components rockall score

A

age
shock (HR and BP)
co-morbidities
cause
endoscopic stigmata

108
Q

features crohns

A

entire GI tract
skip lesions
transmural thickness
wt loss
strictures
smoking is a RF
less common for blood/mucus

109
Q

features UC

A

continuous inflamamtion superficial mucosa
colon and rectum only
blood and mucus excreted
smoking is protective

110
Q

ix IBD

A

increased CRP
faecal calprotectin
endoscopy and biopsy

111
Q

inducing remission in crohns

A

steroids: oral pred, IV hydrocortisone
+/- azathioprine, inlfiximab, methotrexate

112
Q

maintenance in crohns

A

nothing
azathioprine
mercaptopurine
methotrexate

113
Q

surgical options crohn

A

resect distal ileum
tx strictures and fistulas

114
Q

inducing remission UC

A

mild/mod: aminosalicylate e.g. mesalazine or pred
sev: IV hydrocortisone, IV ciclosporin

115
Q

maintenance in UC

A

mesalazine
azathioprine

116
Q

surgical option sUC

A

remove colon and rectum leaving with ileostomy or j-pouch

117
Q

IBS diagnosis

A

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
Q

mx IBS

A

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
Q

pathophysiology coeliac

A

anti-TTG and anti-EMA target epithelial cells

120
Q

sx coeliac disease

A

asx
FTT
diarrhoea
aneamia
dermatitis herpetiformis
peripheral neuropathy

121
Q

genes associated with coeliac disease

A

HLA-DQ2
HLA-DQ8

122
Q

auto ab associated with coeliac disease

A

anti-TTG
anti-EMA
anti-DGP

123
Q

diagnosis coeliac disease

A

exclude IgA deficiency
icreased anti-TTG or EMA
endoscopy=crypt hypertrophy, villous atrophy

124
Q

conditions associated with coeliac disease

A

AI-T1DM, thyroid, AI hep, primary biliary cirhhosis, primary sclerosing cholangitis

125
Q

complications coeliac disease

A

vit deficiencies
anaemia
osteoporosis
ulcerative jejunitis
enteropathy associated T cell lymphoma
NHL
small bowel adenocarcinoma

126
Q

positive serology acute hep B infection

A

HBsAg
HBeAg
Anti-HBc IgM
HBV DNA

plus elevated transaminases

127
Q

positive serology active chronic hep b infection

A

HBsAg
(HBeAg
Anti-HBc IgG
HBV DNA

plus elevated transaminases

128
Q

positive serology inactive hep b infection/carrier

A

HBsAg
anti-HBe
HBc IgG
HBV DNA - low

129
Q

positive serology hep b Immunity (following acute infection)

A

anti-HBs
anti-HBe
Anti-HBc IgG

130
Q

positiver serology hep b Immunity (following vaccination)

A

anti-HBs

finals (31 decks)

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