Gastro Flashcards

1
Q

how does liver cirrhosis affect the portal system

A

portal hypertension

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2
Q

causes of liver cirrhosis

A

NAFLD
alcoholic liver disease
hep B
hep C

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3
Q

size of liver in cirrhosis

A

can be small or large

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4
Q

nail change in cirrhosis and why

A

leukonychia due to hypoalbuminaemia

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5
Q

what test is used for assessing extent of fibrosis in NAFLD

A

enhanced liver fibrosis blood test

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6
Q

examination signs of liver disease

A

jaundice
bruising
palmar erythema
spider naevi
gynacomastia
ascites
splenomegaly
asterixis
caput medusae
leukonychia

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7
Q

what happens to platelets in cirrhosis

A

thrombocytopenia

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8
Q

what is transient elastography

A

test for assessing degree of liver fibrosis

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9
Q

components of child pugh score pneumonic and scoring

A

ABCDE

albumin
bilirubin
clotting (INR)
dilated (ascites)
encephalopathy

each scored 1-3 so max score 15

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10
Q

what score is used in cirrhosis patients to assess mortality

how often is it done

A

MELD score

done every 6 months

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11
Q

how often should cirrhosis patients have an endoscopy

A

every 3 yrs

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12
Q

dietary advice in cirrhosis

A

high protein and high calorie diet (pts have appetite loss and protein metabolism is affected)
reduced sodium intake
avoid alcohol

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13
Q

what organ is enlarged as a result of portal hypertension

A

spleen

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14
Q

what type of ascites do you get in cirrhosis

A

transudate

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15
Q

what prophylactic abx are given for ascites and when

A

cipro or norfloxacin

when protein in fluid <15g

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16
Q

hepatic encephalopathy mx

A

lactulose
abx (rifaximin)
nutritional support (NG feeds)

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17
Q

stages of alcoholic liver diease

A

alcoholic fatty liver
alcoholic hepatitis
cirrhosis

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18
Q

recommended alcohol intake and over what time

A

no more than 14 units/ week
spread out over 3 or more days
not more than 5 units a day

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19
Q

dietary advice for alcoholic liver disease

A

thiamine supplementation
high protein diet

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20
Q

CAGE questions

A

cut down- do you feel the need to down

annoyed- do you get annoyed at people for commenting about your drinking

guilty- do you feel guilty about how much you drink

eye opener- do you ever drink first thing in the morning

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21
Q

AUDIT questionnaire is used for

A

screening for harmful alcohol use

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22
Q

AUDIT questionnaire score above what is concerning

A

8

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23
Q

in alcohol withdrawal when do people get hallucinations

A

12-24 hrs after last drink

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24
Q

in alcohol withdrawal when do people get seizures

A

24-48 hrs after last drink

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25
Q

in alcohol withdrawal when do people get delirium tremens

A

24-72 hrs after last drink

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26
Q

what receptors does alcohol stimulate

A

GABA

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27
Q

what receptors does alcohol inhibit

A

glutamate

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28
Q

what tool is used to score patients on alcohol related symptoms

A

CIWA-Ar

29
Q

what drug is used to prevent alcohol withdrawal

A

chlordiazepoxide

30
Q

wernickes encephalopathy triad

A

confusion
opthalmoplegia
ataxia

31
Q

korsakoff syndrome features

A

memory impairment
behavioural changes

32
Q

wernicke/korsakoff arises due to deficiency in

A

thiamine

33
Q

stages of non alcoholic fatty liver disease

A

normal
fatty liver
steatohepatitis
fibrosis
cirrhosis

34
Q

rf for NAFLD

A

same as cardiovasc disease:

diabetes
age
smoking
obesity
sedentary lifestyle
poor diet
hypertension
hypercholesterolaemia

35
Q

what LFT is raised in NAFLD

A

ALT

36
Q

enhanced liver fibrosis test what level indicates advanced fibrosis

A

> 10.51

37
Q

gold standard ix for NAFLD

A

liver biopsy

38
Q

what types of virus are hep A-E

A

all RNA apart from hep B is DNA

39
Q

vaccines for what hepatitis virus exist

A

A and B

40
Q

how is hep A treated

A

supportive care

41
Q

how is hep B treated

A

supportive care

42
Q

how is hep C treated

A

antiviral

43
Q

how is hep D treated

A

pegylated interferon alpha

44
Q

how is hep E treated

A

supportive care

45
Q

which hepatitis viruses are notifiable

A

all of them

46
Q

what does HBeAg indicate

A

if the person has active infection and wether they are infectious currently

it will be high when the virus is replicating

47
Q

what antibody is raised in autoimmune hepatitis

A

IgG

48
Q

autoantibodies for type 2 autoimmune hep

A

anti LKM-1
anti LC1

49
Q

how do type 1 and 2 autoimmune hepatitis differ

A

1 is usually in older post menopausal women and is less aggressive

2 is usually in younger girls and is more acute

50
Q

haemochromatosis inheritance

A

autosomal recessive

51
Q

haemochromatosis gene and chromosome

A

HFE gene on chromosome 6

52
Q

what stain is used to look at iron deposition in the liver

A

perls stain

53
Q

how does haemochromatosis affect the thyroid

A

hypothyroidism

54
Q

complications of haemochromatosis

A

diabetes
erectile dysfunction
reduced fertility
hepatocellular carcinoma
hypothyroidism
cirrhosis
cardiomyopathy
arthritis

55
Q

wilsons disease inheritance

A

autosomal recessive

56
Q

wilsons disease gene and chromosome

A

ATP7B gene
chromosome 13

57
Q

what neuro sx are seen in wilsons disease

A

dysarthria
tremor
dystonia
parkinsonism (rigidity, tremor, bradykinesia)
depression
cognitive impairment
psychosis

58
Q

what anaemia can you get in wilsons disease

A

haemolytic

59
Q

initial screening test in wilsons disease and result

A

serum caeruloplasmin

it will be low

60
Q

double panda sign on MRI brain

A

wilsons disease

61
Q

wilsons disease mx

A

penicillamine or trientine
zinc salts

62
Q

what 2 main organs does alpha 1 antitripsin deficiency affect and how

A

lungs- causes COPD and bronchiectasis

liver- fibrosis, cirrhosis

63
Q

what does alpha 1 antitripsin do

A

inhibits proteases

64
Q

stain used for alpha 1 antitripsin deficiency in liver biopsy

A

periodic acid schiff

65
Q

what is attacked in PBC

A

small bile ducts in liver

66
Q

how does PBC affect cholsterol

A

its high

67
Q

PBC sx

A

white middle aged woman
fatigue
pruritus
abod pain
jaundice
pale greasy stools
dark urine

68
Q
A