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ACCP > Gastro > Flashcards

Gastro Flashcards

1
Q

Anatomy and function of oesophagus

A

From mouth to cardiac sphincter/ inlet of stomach
Carries food and liquid from mouth to stomach via gravity and peristalsis

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2
Q

Anatomy and function of stomach

A

Storage for food/ liquid
Digestion via mechanical breakdown and chemical breakdown
Top sphincter = cardiac sphincter
Bottom sphincter = pylorus

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3
Q

Anatomy and function of small intestine

A

4m long
(DJV - duodenum, jejunum, ileum)
Main site for digestion and absorption of nutrients
Wall folded into Vili and itu microvili brush
High surface area
Venous drainage via mesenteric veins into hepatic portal vein

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4
Q

Anatomy and function of large intestine

A

Begins in right iliac fossa,Appendix at base
Ascending> transverse> descending>sigmoid> rectum
Absorbs water and salts

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5
Q

Anatomy and function of liver

A

Upper right quadrant below diaphragm
Falciform ligament
Metabolism (Carbs, protein, bilirubin, drugs)
Storage (glucagon)
Synthesis (proteins, clotting factors, bile)
Immunological (kupffer cells)

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6
Q

What are kupfer cells

A

Large star shaped phagocytes (engulf and digests particles/old or dying cells such as red cells)
Release pro inflammatory cytokines

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7
Q

Gall bladder

A

Storage for bile before excretion during digestion

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8
Q

Describe anatomy and function of pancreas

A

Sits below stomach
Endocrine and exocrine function
Exocrine - digestive enzymes (amylase, lipase, protease, bicarb)
Endocrine - blood sugar regulation (insulin, glucagon, somatostatin, pancreatic polypeptide)

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9
Q

Describe billary system and function at each section

A

Right and left hepatic ducts
Common bile duct
Gall bladder > cystic duct
Pancreatic duct
Ampulla of vater

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10
Q

Describe pancreatic enzymes and functions

A

Amylase: carbs (measure to check pancreatitis)
Lipase: fats
Protease: proteins
Bicarb: neutralise stomach acid for optimal environment enzymes to breakdown chyme

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11
Q

Causes of acute liver failure

A

NILS tests
Toxins (paracetamol, abx, anti epileptics etc)
Viral hepatitis ABCDE
Autoimmune hepatitis
Acute ischemic hepatitis
Pregnancy (HELLP, fatty liver)
Infections (bacterial / fungal)
Wilson’s disease (excess copper)
Trauma
Alcohol
Budd chiari - hepatic vascular occlusion
Malignancy
Hyperthermia

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12
Q

Symptoms of acute liver failure

A

Hepatic encephalopathy (west haven 0-4)
ARDS
Coagulopathy
Abdo pain - liver dysfunction (hypoglycaemia, lactic acidosis, high ammonia, coagulopathy)
Pancreatitis
Jaundice
Renal failure /AKI
Portal hypertension
Immune suppression (sepsis)

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13
Q

Describe HELLP syndrome

A

Severe preeclampsia
Haemolysis
Elevated Liver enzymes
Low Platelets

Life threatening emergency for baby and mum

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14
Q

Acute liver failure treatment

A

Supportive and treat cause / transplant

NAC
Viral = anti virals
Autoimmune = steroids
Wilson’s = remove copper
Infection = treat
Toxins/overdose: antidotes / remove(filter
Pregnancy = remove fetus
Ischemic = treat cause (02, vasoactive)

Plasmapheresis

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15
Q

Causes of chronic liver disease

A

Alcohol, viral, NASH/fatty liver disease, autoimmune / hepatitis, cholestatic, metabolic

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16
Q

Define decompensated chronic liver disease

A

Encephalopathy, ascites, jaundice, renal failure, variceal haemorrhage

17
Q

Stigmata /signs of CLD

A

Spider nevi, palmar erythema, gynecomastia, caput medusae, dupuytrens contracture, testicular atrophy

18
Q

Causes of decompensation CLD

A

GI bleed, infections, constipation, drugs, portal vein thrombosis, alcohol intake

19
Q

Management of hepatic encephalopathy

A

Exclude other causes (CT, Seizures, Infection)
Ammonia level raised in 90%
Severity score - west haven 1-4

20
Q

Treatment of hepatic encephalopathy

A

Cultures
Empiric antibiotics
Correct electrolytes
Treat constipation
Drugs: neomycin (ABX), lactulose, rifaximin (ABX)

21
Q

Management of ascites

A

?spont bacterial peritonitis (tap)
?resp compromise (ACS)
Paracentesis for tense ascites
Fluid/na restriction & spironolactone

22
Q

Describe alcoholic hepatitis

A

Hepatomegaly
Jaundice
Fever

50% mortality if severe

Stop alcohol, nutritional support, steroids
Manage complications

23
Q

Describe Hepatorenal failure

A

Exclude common AKI causes
Urinary na < 10mmol/L without hypov
Caused by reduced renal blood flow

Treatment terlipressin and albumin
Norad

24
Q

Describe types of liver function test

A

ALT - liver specific enzyme
AST - increases with cardiac, liver, renal and skeletal damage
ALP - biliary enzyme (& bone)
GGT - bike duct but also increases with alcohol consumption

Albumin - low in chronic liver or malnutrition
Ammonia - causes encephalopathy if liver can’t convert ammonia to urea (lactulose)
Bilirubin - broken down red cells in spleen that is joined to sugar in liver for excretion

ACCP (16 decks)

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