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FRACP Clinical > Gastro > Flashcards

Gastro Flashcards

1
Q

What are some causes of cirrhosis?

A
  • alcohol
  • hepatitis B, C, D
  • NAFLD
  • Haemochromatosis
  • PSC, PBC
  • Wilson’s
  • drugs: MTX, amiodarone
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2
Q

What are the investigations in cirrhosis? (For monitoring and etiology?)

A 
Bloods: LFT, albumin, FBC, creat, coags
Imaging: U/S, CT abdo, fibroscan
Hepatitis serology
Anti-mitochondrial Ab: PBC
ANA, smooth muscle Ab, Anti-LKM1
pANCA: PSC in assoc with UC
Iron studies
Caeruloplasmin
Alpha-1 AT
CMV
Ascitic tap
Liver biopsy
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3
Q

What are the components of Childs-Pugh classification?

A

Bili, albumin, ascites, encephalopathy, nutrition

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4
Q

Treatment for hepatitis C?

A 
Genotype 
1a/b: sufosbovir + daclatasvir
2: sufosbovir + ribavarin
3: sufosbovir + daclatasvir 
4,5,6: sufosbovir + PEG-IFN + ribavarin

12 weeks of treatment naive
12-24 if treatment experienced, cirrhosis

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5
Q

What are the criteria for listing for liver transplant?

A

End stage CLD with decompensation:

  • Childs > 6 (I.e B or C)
  • variceal bleeding
  • SBP
  • encephalopathy
  • MELD >10 (INR, Bili, creat)
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6
Q

What are the CI to liver transplant?

A
  • hepatorenal syndrome
  • coagulopathy
  • metastatic malignancy
  • sepsis
  • cholangiocarcinoma
  • HIV
  • hepatopulmonary syndrome
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7
Q

What are the causes of Hepatomegaly?

A
  • mets
  • alcoholic liver disease
  • haem: CML
  • fatty liver disease
  • RHF
  • haemochromatosis
  • amyloidosis
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8
Q

What are some causes of splenomegaly?

A
  • CML, leukemia
  • portal HTN
  • RA, SLE
  • infiltrative: sarcoidosis, amyloidosis
  • myoproliferative disorders: essential thrombocythemia, polycythemia
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9
Q

What are causes of hepatosplenomegaly?

A
  • chronic liver disease with portal HTN
  • haem: myeloproliferative disease, lymphoma, leukaemia
  • infective: acute hepatitis, EBV, CMV
  • infiltrative: sarcoidosis, amyloidosis
  • SLE
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10
Q

What are clinical features of hemochromatosis?

A
  • cirrhosis
  • bronze pigmentation
  • arthropathy of 2nd, 3rd MCP
  • dilated cardiomyopathy
  • glycosuria (“bronze diabetes”)
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11
Q

What are the peripheral signs if chronic liver disease?

A
  • clubbing
  • leuconychia
  • palmar erythema
  • dupuytren contracture
  • jaundice, scleralicterus
  • spider naevi
  • gynecomastia
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12
Q

What are signs of decompensated chronic liver disease?

A
  • hepatic flap
  • encephalopathy
  • variceal bleeding
  • ascites
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13
Q

How to distinguish a spleen from kidney?

A
  • no palpable upper border of spleen
  • spleen moves inferomedially on inspiration
  • spleen not ballotable
  • splenic notch
  • dull to percussion over splenic mass
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14
Q

What are the differences between UC and CD?

A 
UC:
- colon only
- mucosal inflammation 
- usually acute onset 
CD:
- anywhere in GI tract
- transmural inflammation
- usually indolent onset
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15
Q

What are extra colonic features of ulcerative colitis?

A
  • arthritis
  • ankylosing spondylitis
  • uveitis
  • oral ulcers
  • anaemia
  • liver: PSC
  • bowel cancer
  • skin: erythema nodosum, pyoderma gangrenosum
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16
Q

What are the causes of cirrhosis?

A
  1. Alcohol
  2. Viral hepatitis
  3. NASH
  4. Drugs: MTX, Isoniazid
  5. Autoimmune hepatitis
  6. Haemochromatosis and Wilson’s
  7. PSC
  8. PBC
17
Q

What is approach to management of chronic liver disease/cirrhosis?

A 
Hepatocellular failure:
- diet
- ascites: diuretics, low salt diet, paracentesis
- encephalopathy: treat infection, give lactulose
Portal HTN:
- band varices, propanolol
- TIPS procedure
Transplant
18
Q

What are findings on colonoscopy in CD vs UC?

A

CD: cobblestone appearance, skip lesions
UC: continuous, crypt abscesses

19
Q

What investigations for inflammatory bowel disease?

A
  • bloods: FBC, ESR/CRP, pANCA, nutritional, LFT
  • stool culture
  • AXR, CT
  • Colonoscopy
20
Q

How would you manage CD?

A 
GENERAL:
- stop smoking
LOW RISK DISEASE:
- colonic disease: 5ASA
- SB disease: oral budesonide
- if refractory, add AZA
HIGH RISK DISEASE:
- steroid+AZA or MTX
- if no response, add infliximab
- if no response to infliximab, add adalimumab
SURGERY:
- indicated if: fistula with abscess, intestinal obstruction
21
Q

How would you manage UC?

A
  • PO or PR 5ASA
  • PO or PR Steroid
  • severe: cyclosporin
  • Maintenance: AZA, 6MP
  • surgery is curative: though liver, ank spond, pyoderma still happen
22
Q

What are indications for colectomy in UC?

A
  • severe disease not responding within 7-10 days
  • perforation, bleeding
  • high risk of carcinoma(high grade dysplasia)
23
Q

How to monitor for CRC recurrence?

A
  • CEA q3-6m
  • CT C/A/P yearly
  • colonoscopy every 3 years
24
Q

What is you differential for jaundice?

A

Pre hepatic: hemolytic anemia
Hepatic: hepatitis, CLD
Post hepatic: obstructive jaundice, PBC, gallstones, cholangitis

25
Q

How to screen for CRC?

A
  • FOBT annually (in people with no Hx)
  • colonoscopy: age 50, then q10yr
  • if high risk (1’ relative
25
Q

What are the criteria for liver transplant in HCC?

A
  • x1 liver lesion

FRACP Clinical (11 decks)

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