Gastro Flashcards
Anatomy and function of oesophagus
From mouth to cardiac sphincter/ inlet of stomach
Carries food and liquid from mouth to stomach via gravity and peristalsis
Anatomy and function of stomach
Storage for food/ liquid
Digestion via mechanical breakdown and chemical breakdown
Top sphincter = cardiac sphincter
Bottom sphincter = pylorus
Anatomy and function of small intestine
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
Anatomy and function of large intestine
Begins in right iliac fossa,Appendix at base
Ascending> transverse> descending>sigmoid> rectum
Absorbs water and salts
Anatomy and function of liver
Upper right quadrant below diaphragm
Falciform ligament
Metabolism (Carbs, protein, bilirubin, drugs)
Storage (glucagon)
Synthesis (proteins, clotting factors, bile)
Immunological (kupffer cells)
What are kupfer cells
Large star shaped phagocytes (engulf and digests particles/old or dying cells such as red cells)
Release pro inflammatory cytokines
Gall bladder
Storage for bile before excretion during digestion
Describe anatomy and function of pancreas
Sits below stomach
Endocrine and exocrine function
Exocrine - digestive enzymes (amylase, lipase, protease, bicarb)
Endocrine - blood sugar regulation (insulin, glucagon, somatostatin, pancreatic polypeptide)
Describe billary system and function at each section
Right and left hepatic ducts
Common bile duct
Gall bladder > cystic duct
Pancreatic duct
Ampulla of vater
Describe pancreatic enzymes and functions
Amylase: carbs (measure to check pancreatitis)
Lipase: fats
Protease: proteins
Bicarb: neutralise stomach acid for optimal environment enzymes to breakdown chyme
Causes of acute liver failure
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
Symptoms of acute liver failure
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)
Describe HELLP syndrome
Severe preeclampsia
Haemolysis
Elevated Liver enzymes
Low Platelets
Life threatening emergency for baby and mum
Acute liver failure treatment
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
Causes of chronic liver disease
Alcohol, viral, NASH/fatty liver disease, autoimmune / hepatitis, cholestatic, metabolic
Define decompensated chronic liver disease
Encephalopathy, ascites, jaundice, renal failure, variceal haemorrhage
Stigmata /signs of CLD
Spider nevi, palmar erythema, gynecomastia, caput medusae, dupuytrens contracture, testicular atrophy
Causes of decompensation CLD
GI bleed, infections, constipation, drugs, portal vein thrombosis, alcohol intake
Management of hepatic encephalopathy
Exclude other causes (CT, Seizures, Infection)
Ammonia level raised in 90%
Severity score - west haven 1-4
Treatment of hepatic encephalopathy
Cultures
Empiric antibiotics
Correct electrolytes
Treat constipation
Drugs: neomycin (ABX), lactulose, rifaximin (ABX)
Management of ascites
?spont bacterial peritonitis (tap)
?resp compromise (ACS)
Paracentesis for tense ascites
Fluid/na restriction & spironolactone
Describe alcoholic hepatitis
Hepatomegaly
Jaundice
Fever
50% mortality if severe
Stop alcohol, nutritional support, steroids
Manage complications
Describe Hepatorenal failure
Exclude common AKI causes
Urinary na < 10mmol/L without hypov
Caused by reduced renal blood flow
Treatment terlipressin and albumin
Norad
Describe types of liver function test
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
