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)
