Gastro extra Flashcards
What is the strict definition of acute liver failure and what are the top causes?
Liver failure <8 weeks in those with no previous liver disease.
otherwise it is Decompensated liver failure.
Causes:
- paracetamol overdose
- Viral hepatitis
- Idiosyncratic drug reaction
- Budd Chairi
- Autoimmune
- Ischemia
What are the clinical findings and you’re major investigations in a patient with acute liver failure (someone with no known liver disease)?
Encephalopathy Jaundice Hepatic Foetor Metabolic acidosis Coagulopathy Circulatory collapse
Bloods:
- FBC
- Coagulation
- Glucose
- U&Es
- LFTs
- viral serology
- paracetamol levels
- autoimmune markers
Orifices:
- urine cultures
X-rays:
- US of liver
- Doppler for Budd Chiari
Special tests:
- ascitic tap
- EEG if in doubt about encephalopathy
General management of Acute liver failure?
ITU support:
General:
- Monitor fluid output
- Monitor Glucose
Encephalopathy:
- Nurse 30 degree angle
- Manitol
Hypoglycaemia
- Dextrose with Saline between
Coagulopathy
- Vitamin K
Renal failure:
- Dialysis
**liver transplant?
When draining Ascites when should albumin be given?
Every 2.5L drained
other management prior to paracentesis is:
- fluid/ salt restriction
- spirolactone
- albumin
Which drug should be avoided in decompensated liver disease?
Gentamicin
In someone with decompensated liver disease with encephalopathy - what things do you want to screen for?
Sepsis
- systemic
- SBP
Bleeding
Renal failure
Constipation
Medication/ drugs
- anything causing sedation
What can be used to assess a patient in A&E for their alcohol consumption?
FAST screening tool
Fast Alcohol Screening Tool *
What is the general management for patients with drawing of alcohol?
Screen them using FAST screen
- if low risk they can be discharged with follow up to addiction services
High risk: (previous seizure, high scoring FAST):
Unexceptional group:
(no liver disease, jaundice, COPD, >70, pregnant, head injury)
- fixed dose diazepam for 48 hours
Exceptional group:
(live disease, jaundice, COPD, >70 pregnant, head injury)
- symptom triggered lorazepam
What are the endoscopic findings of coeliac and what is the management
Endoscopically:
- Absence of mucosal folds
- Scalloping of mucosa
Management:
- Gluten free diet (wheat, Barley, rae)
- Ca2+, Vit D and Iron
- Pneumococcal vaccine
Follow up 12 months
What are the main causes of gastritis?
H. Pylori NSAIDs Alcohol Pernicious anaemia Critically ill - reduces gastrointestinal flow
What are the major types of gastritis?
H.Pylori
- urease - creates Co2 and ammonia which induces more gastrin.
Erosive:
- NSAIDs
- Alcohol
Autoimmune:
- anti - parietal cell antibodies
- Anti- intrinsic factor
- atrophic type
Stress/ Ischemic
- prolonged critical illness
- Raise ICP
What are the key symptoms of PBC, what investigations are done and what is the treatment?
Female typically:
Fatigue Hepatosplenomegaly Jaundice pigmented xanthelesma Athropathy
Investigations:
- LFTs (obstructive)
- IgM Anti - mitochondrial antibodies
Management:
- cholestyramine
- Ursodeoxycholic acid
- liver transplant
What are the key symptoms of PSC, what investigations are done and what is the treatment?
Male
Jaundice
RUQ pain
Heptosplenomeglay
Investigations:
- MCRP
Management:
- liver transplant
- Ursodeoxycholic acid
What investigations should be done into constipation?
Bloods:
- FBC (malignancy)
- ESR
- U&Es - dehydration? Obstruction to kidneys?
- Ca2+
- TFTS
Orifices:
- Colonoscopy if suspicion of malignancy
X-ray
- abdominal x-ray for any obstruction
List some causes of constipation:
General:
- Poor diet and excersies
- Dehydration
- pain
Colorectal disease:
- colorectal cancer
- Anal fissure
Metabolic:
- Hypercalcemia
- hypothyroidism
Drugs:
- opioids
- Tricyclics (anti-cholinergic)
What are some laxatives which can be used?
Bulking agents:
- Ispaghula husk
- contraindicated in intestinal obstruction
Stimulator laxatives:
- Senna
- Bisacodyl
- avoided in intestinal obstruction
Osmotic:
- lactulose
- avoided in intestinal obstruction
- electrolyte imbalances
What are two methods used to investigate the staging of gastric cancer, and what are the complications of a gastrectomy?
CT scan. C/A/P
If negative an oesophageal US can be done to stage locally.
Complications:
- B12 deficiency
- CA2+ deficiency
- Dumping syndrome
In an elderly person with achalasia - what can be a cause?
Reduced vagal stimulation
What investigations can be done to diagnose a hiatus hernia?
Endoscopy
- Z line will be seen
CXR
- Bubble sign
Barium swallow
Treatments:
- lifestyle
- PPIs
Surgery:
- Cruroplasty
- Nissan’s fundoplication
List two causes of bowel obstruction seen in HIV and infection which affect G.I system:
Enteropathy lymphoma - Burkits
Kaposi’s sarcoma
*typically lead to an intussusception like pathology
CMV
Cryptosporidium Parvum
Mycobacterium avium (TB)
What are the causes of chronic pancreatitis and how is it investigated?
Alcohol abuse CF Autoimmune (requires steroids) Metabolic - hyperlipidaemia, hypercalcemia Strictures
Investigations:
- Serum lipases
- faecal elastase
- serum amylase (might be moderately raised)
- HbA1c
- CT abdomen - calcification
- note that often neuropathic analgesia is used as treatment
What are the stages of liver disease in alcohol? Histologically what is seen in alcohol hepatitis?
Steatosis
Hepatitis - painful and enlarged
Cirrhosis (nodular, fibrotic and diffuse)
Hepatocellular carcinoma
Mallory Bodies
Neutrophil infiltration
