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MBChB > Gastro > Flashcards

Gastro Flashcards

1
Q

What is the presentation of an upper GI bleed?

A

Haematemesis
Coffee ground vomiting
Malaena

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2
Q

What are some causes of upper GI bleed?

A

Peptic ulcer (acid, H.pylori, NSAIDs)
Gastritis
Oesophagitis
Varices

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3
Q

Describe the resuscitation required for a patient with upper GI bleed

A 
Pulse + HR - haemodynamically unstable if SBP <100mmHg or HR >100bpm
IV access - fluids and blood (if needed)
Bloods - FBCs, U&amp;Es (urea)
Lie flat
Give O2
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4
Q

What scoring systems can be used to assess how high risk a patient with a GI bleed is? How does this determine clinical management?

A

Rockall and Glasgow Blatchford

High risk = emergency endoscopy
Moderate risk = admit and endoscopy next day
Low risk = out-patient management

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5
Q

If a patient has a bleed due to an ulcer, what should they receive after their bleed?

A

IV PPI for 72 hours

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6
Q

If a patient has a GI bleed, how does this affect Aspirin, NSAIDs, Clopidogrel, Warfarin and DOACs?

A

Aspirin - continue low dose once haemostasis achieved with PPI

NSAIDs - discontinue

Clopidogrel etc - discuss with cardiologist

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7
Q

When should a patient with a GI bleed be given blood?

A

Once Hb is <7-8g/dl

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8
Q

When should a patient with a GI bleed be transfused platelets?

A

Actively bleeding and platelet count <50 x 10^9/L

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9
Q

When should FFP be given to a patient with a GI bleed?

A

INR >1.5

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10
Q

How can oesophageal varies be treated?

A

Endoscopic banding
TIPs
Beta-blockers

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11
Q

How should a patient with oesophageal varies be resuscitated?

A

Restore circulating volume
Transfuse once Hb <7g/dl
Consider airway protection

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12
Q

What drugs should be given in A&E to a patient with oesophageal varies bleed?

A 
Abx
Terlipressin (vasopressin) - constricts the portal vessels
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13
Q

What is the criteria for the diagnosis of acute pancreatitis?

A

2/3 of the following:

  1. Pain in keeping with pancreatitis - pain in central abdomen, radiates to back
  2. Amylase 3x the upper limit of normal (>300)
  3. Characteristic CT appearance
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14
Q

Define mild pancreatitis

A

Absence of organ failure/local/systemic complications

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15
Q

Define moderately-severe pancreatitis

A

Transient organ failure or presence of local/systemic complications in the absence of organ failure

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16
Q

Define severe pancreatitis

A

Persistent organ failure

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17
Q

What are some causes of pancreatitis?

A 
Gallstones - most common
Ethanol 
Trauma
Drugs
Hyperlipidaemia
Mumps
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18
Q

Describe the initial management of pancreatitis

A 
ABCs
Fluid
O2 
Organ support 
Abx - debatable
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19
Q

Why might an NG tube be needed in managing pancreatitis?

A

Acute pancreatitis is a hyper metabolic state
Patient needs calories
May need NG tube

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20
Q

What investigations are needed in managing acute pancreatitis?

A

US to assess for gallstones
MRCP to assess for CBD stones
CT if diagnostic doubt/concerns about complications
Monitor LFTs

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21
Q

What differential diagnoses are there for symptoms relating to acute pancreatitis?

A

Pancreatitis
Perforated DU
Ischaemic bowel

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22
Q

What are the phases of acute pancreatitis?

A

Early phase: systemic disturbance from host response to local pancreatic injury

Late phase: local and septic complications

(Death can occur in either phase)

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23
Q

Describe the management of acute pancreatitis

A 
Treat cause:
ERCP 
Lap Chole
Alcohol addiction advice
Stop meds responsible - often biologics
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24
Q

What is the sequalae associated with pancreatitis?

A 
Complete resolution with/without organ dysfunction
Necrosis with/without infection 
Fluid collection:
Peripancreatic fluid collection
Pseudocyst
Pancreatic fistula
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25
Q

Describe pancreatic necrosis

A

Detected by serial CT
If ongoing sepsis and presence of gas in pancreas - intervention needed:
Percutaneous necrosectomy
Radiological draining

Complications: bleeding/erosion to surrounding structures

26
Q

Describe pancreatic pseudocyst

A

May settle without intervention (take up to 12 weeks)

If symptomatic drain

27
Q

Describe pancreatic fistula

A

May require parenteral feeding
Endoscopic treatment
Salvage distal pancreatomy

28
Q

What are the longterm consequences of acute pancreatitis?

A

May be diabetic
May require creon pancreatic enzyme supplements
Significant impact on QoL
If gallstones - lap chole

29
Q

Other than liver disease, what could cause a raised ALT and a normal GGT?

30
Q

If AST is raised, what could be a cause of this (other than liver)?

31
Q

If there is an isolated increase in bilirubin, what does this suggest?

A

Haemolysis

32
Q

What investigations should be performed in acute liver disease?

A

US
Acute viral Hep - specific IgG increase is very suggestive of acute hepatitis
Autoimmune disease - ANA, SMA, LKM
Paracetamol levels

33
Q

What investigations should be performed in chronic liver disease?

A 
US
Chronic viral hep (HBV, HCV)
Autoimmune - AMA in PBC (increased IgM)
Metabolic:
Ferritin - haemochromatosis
Caeruloplasmin - Wilson's disease
34
Q

What are the most common causes of liver disease?

A

Fatty liver
Chronic hepatitis - chronic Hep C
Autoimmune liver disease
Haemochromatosis

35
Q

What are the common causes of fatty liver disease?

A

Alcoholic Liver Disease

Non-alcoholic Fatty Liver Disease

36
Q

What are the most common autoimmune liver disease?

A

Primary biliary cholangitis

Autoimmune hepatitis

37
Q

What are the microscopic features of FLD?

A

Microvascular stenosis
Steatohepatitis
Pericellular fibrosis

38
Q

What AST/ALT ratio is seen in ALD?

A

High AST/ALT ratio >1.5 (AST > ALT)

39
Q

What AST/ALT ratio is seen in NAFLD?

A

Low AST/ALT ratio <0.8 (ALT > AST)

40
Q

What are the essential features of alcoholic hepatitis?

A 
Excess alcohol within 2 months
Bilirubin >80umol/L for <2 months
Exclusion of other liver disease
Treatment of sepsis/GI bleed
AST/ALT ratio >1.5 (AST <500)
41
Q

What are the characteristic features of alcoholic hepatitis?

A

Hepatomegaly ± fever ±leucocytosis ± hepatic bruit

42
Q

What are the parameters of the Glasgow Alcoholic Hepatitis Score (GAHS)?

A 
Age
WCC
Urea
PT ratio
Bilirubin
43
Q

What is the non-invasive technique which can be used to assess the degree of liver fibrosis?

A

Fibroscan
The firmer the liver, the greater the degree of fibrosis and the higher the score

F4 = cirrhosis

44
Q

What are the blood based assessments of liver fibrosis?

A

APBI
FIB-4
NAFLD fibrosis score

45
Q

Describe some of the physical features of chronic liver disease

A

Stigmata: spider naevi, foetar (sweet biscuit smelling breath), encephalopathy

Prolonged PT, hypoalbuminaemia

46
Q

Describe some of the features of portal hypertension

A

Caput medusa

Hypersplenism - thrombocytopenia, pancytopenia

47
Q

What scoring system can be used to assess the severity of liver disease?

A

Childs-Turcotte-Pugh Score

48
Q

What parameters are used in the Childs-Turcotte-Pugh Score?

A 
Encephalopathy
Ascites
Bilirubin
Albumin
PT prolongation
49
Q

What is the scoring system of the Childs-Turcotte-Pugh Score?

A

Grade A: 5-6 = mild
Grade B: 7-9 = moderate
Grade C: 10-15 = severe

50
Q

What is the criteria for Spontaneous Bacterial Peritonitis?

A

Cell count of ascites:

>500 WBC/cm3 or >250 neutrophils/cm3

51
Q

If lymphocytes are present in the ascites, what does this suggest?

A

TB

Peritoneal carcinomatosis

52
Q

What is SAAG?

A

Serum ascites albumin gradient

Serum albumin - ascitic albumin

53
Q

If SAAG >11g/l, what is it indicative of?

A

Portal hypertension

54
Q

If SAAG <11g/l, what is it indicative of?

A

Infection etc

55
Q

Describe the management of ascites

A 
Low NaCl diet
Diuretics
Paracentesis
TIPS
Liver transplant
56
Q

What diuretics can be used in the management of ascites?

A

Spironolactone

Frusemide

57
Q

What side effects are associated with Spironolactone?

A

Gynaecomastia
Hyperkalaemia
Hyponatraemia
Impotence

58
Q

What side effects are associated with Frusemide?

A

Hyponatraemia

59
Q

When a patient has ascites, what needs to be regularly assessed?

A

Renal Function

Electrolytes

60
Q

What are common precipitating factors of hepatic encephalopathy?

A 
GI bleeding
Infections
Constipation
Electrolye disturbance
Excessive dietary protein
61
Q

As a doctor, what can you do to prevent making hepatic encephalopathy worse?

A

Avoid regular sedation
Caution with opiates
Avoid hyponatraemia
Aim for multiple bowel movements per day

MBChB (14 decks)

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