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Phase 3b > Gastro-Intestinal > Flashcards

Gastro-Intestinal Flashcards

1
Q

Define acute pancreatitis

A

Acute inflammation of the pancreas

Exocrine enzymes are released that cause autodigestion of the organ

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2
Q

Causes of acute pancreatitis

A 
iGET SMASHED
Idiopathic
Gallstones
Ethanol (Alcohol)
Trauma
Steroids
Mumps
Autoimmune disease
Scorpion Sting
Hypercalcaemia/hyperlipidaemia
ERCP
Drugs (thiazides, azathioprine, valporate)

Neoplasms
Pregnancy

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3
Q

Symptoms of acute pancreatitis

A

Sudden onset abdominal pain (epigastric)
Vomiting
Pain radiates to the back
Leaning forward relieves the pain

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4
Q

Signs of acute pancreatitis

A 
Fever
Jaundice
Tachycardia
Cullen's sign - umbilical bruising
Grey Turner's sign - flank bruising
Ascites
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5
Q

Investigations for acute pancreatitis

A 
Serum amylase 3x higher than normal
Serum lipase
FBC 
U&E's
CRP
X-ray
CT scan
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6
Q

What scoring system measures the severity of acute pancreatitis

A

Glasgow prognostic score

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7
Q

What is the glasgow prognostic score

A

PANCREAS

PaO2 <60
Age >55
Neutrophils >15
Calcium <2
uRea >16
Enzymes (LDH>600 or AST/ALT >200)
Albumin <32
Suger (glucose >10)
<2 = mild
2 = moderate
>2 = severe
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8
Q

Management for acute pancreatitis

A

IV fluids
Analgesia

Endoscopic drainage of large pseudocysts
Antibiotics if infection causing pancreatic necrosis
Surgery to remove infected pancreatic necrosis

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9
Q

Early complications of acute pancreatitis

A 
Shock
ARDS
Renal failure
DIC
Sepsis
Low calcium
Increased glucose
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10
Q

Late complications of acute pancreatitis

A 
Pancreatic necrosis
Infected necrosis
Pseudocyst
Pancreatic abscess
Chronic pancreatitis
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11
Q

Causes of small bowel obstruction

A

Adhesions
Hernias
Malignancy

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12
Q

Causes of large bowel obstruction

A 
Adhesions
Hernias
Colon cancer
Constipation
Volvulus
Neoplasm
Intussusception
Gallstone ileus
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13
Q

Symptoms of bowel obstruction

A

Vomiting - occurs earlier in small bowel obstruction
Nausea
Anorexia
Abdominal distension - pain is higher in small bowel obstruction
Constipation

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14
Q

Investigations for bowel obstruction

A

Abdominal x-ray - small bowel has valvulae conniventes and haustra. no gas in large bowel. dilated bowel loops centrally

CT scan

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15
Q

Management for bowel obstruction

A 
NG tube and suction
IV fluids
Analgesia
Antibiotics e.g. metronidazole
Antiemetics
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16
Q

Define volvulus

A

When the bowel twists on its mesentery, which can produce severe, rapid, strangulated obstruction

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17
Q

What are the two main types of volvulus

A

Sigmoid - counter-clockwise twisting

Caecal - clockwise twisting

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18
Q

Complications of volvulus

A

Obstruction
Ischaemia
Perforation

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19
Q

What would you see on abdominal x-ray for a volvulus

A

Coffee bean sign

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20
Q

Treatment for a volvulus

A 
Laparotomy - Hartmann's procedure (sigmoid)
Right hemicolectomy (caecal)
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21
Q

Most common type of colorectal cancer

A

Adenocarcinoma

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22
Q

Risk factors for colorectal cancer

A 
Age
Smoking
Alcohol
Family history
Diet (low fibre, red meat)
Previous cancer
Inflammatory bowel disease (Crohn's and UC)
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23
Q

Symptoms for colorectal cancer

A

Left sided = Bleeding/mucus PR
Altered bowel habit. Tenesmus. Mass PR

Right sided = Weight loss. Low haemoglobin - iron deficiency anaemia. Abdominal pain.

Either = Abdominal mass. Perforation. Haemorrhage. Fistula.

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24
Q

Investigations for colorectal cancer

A 
FBC - microcytic anaemia
Faecal occult blood
Colonoscopy - Gold standard
CT colonoscopy
CT scan - staging
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25
Q

What staging system is used to grade colorectal cancer

A

Duke’s classification

Being replaced by TNM now

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26
Q

Treatment for colorectal cancer

A

Surgery - Right/Left hemicolectomy, sigmoid colectomy, anterior resection, abdominoperineal resection
Radiotherapy
Chemotherapy

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27
Q

Complications for colorectal cancer

A 
Bleeding/infection/pain
Damage to nerves. bladder, ureter or bowel
Requirement for a stoma
Hernia
Adhesions
DVT/PE
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28
Q

Where are the majority of pancreatic cancers (adenocarcinomas) located?

A

The head of the pancreas

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29
Q

Risk factors for pancreatic cancer

A 
Smoking 
Alcohol
Carcinogens
Diabetes mellitus
Chronic pancreatitis
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30
Q

Symptoms for pancreatic cancer

A 
Painless obstructive jaundice
Epigastric pain
Weight loss
Pale stools (due to lack of bile)
Steatorrhoea (greasy stools)
Dark urine
Palpable epigastric mass
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31
Q

What is Courvoisier’s Law?

A

Painless jaundice + non-tender palpable gallbladder = pancreatic cancer until proven/not gallstones

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32
Q

What tumour marker is raised in pancreatic cancer

A

CA19-9

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33
Q

Investigations for pancreatic cancer

A

CA19-9 tumour marker
CT scan
Endoscopic ultrasound with biopsy
ERCP

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34
Q

Treatment for pancreatic cancer

A

Whipple’s procedure (removing head of pancreas, gallbladder, duodenum and pylorus)
Chemotherapy

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35
Q

Associations with stomach cancer

A 
Pernicious anaemia
Blood group A
H.pylori
Atrophic gastritis
Adenomatous polyps
Smoking
Diet (high nitrate, high salt)
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36
Q

Symptoms of stomach cancer

A 
Dyspepsia
Weight loss
Vomiting
Dysphagia
Anaemia
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37
Q

Signs of stomach cancer

A 
Epigastric mass
Hepatomegaly
Jaundice
Ascites
Large left supraclavicular (Virchow's) node
Acanthosis nigricans
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38
Q

Investigations for stomach cancer

A

Gastroscopy + multiple ulcer edge biopsies

CT/MRI scan

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39
Q

Treatment for stomach cancer

A

Partial gastrectomy for distal tumours
Total gastrectomy for proximal
Combined chemotherapy

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40
Q

Risk factors for oesophageal cancer

A 
Diet
Alcohol
Smoking
Achalasia
Obesity
Reflux oesophagitis
Barrett's oesophagus
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41
Q

What are the two types of oesophageal cancer

A 
Squamous cell (proximal)
Adenocarcinoma (distal)
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42
Q

Symptoms of oesophageal cancer

A

Dysphagia
Weight loss
Retrosternal chest pain

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43
Q

Signs from upper 1/3rd of oesophagus

A

Hoarseness

Cough

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44
Q

Investigations for oesophageal cancer

A

Oesophagoscopy with biopsy

TNM staging

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45
Q

Treatment for oesophageal cancer

A

Poor survival rates
Radical curative oesophagectomy
Chemotherapy - cisplatin

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46
Q

What is the foregut and its blood supply

A

Stomach + part of the duodenum, biliary system, liver, pancreas

Blood supply = Celiac artery

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47
Q

What is the midgut and its blood supply

A

Duodenum to 1st half of the transverse colon

Blood supply = Superior mesenteric artery

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48
Q

What is the hindgut and its blood supply

A

2nd half of the transverse colon to rectum

Blood supply = interior mesenteric artery

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49
Q

What is acute mesenteric ischaemia

A

Almost always affects the small bowel and may follow SUPERIOR MESENTERIC ARTERY THROMBOSIS OR EMBOLISM
Caused by blood clots blocking blood supply in mesenteric vessels

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50
Q

Risk factors for acute mesenteric ischaemia

A

Old age
Atrial fibrillation
Atherosclerosis
Coagulation disorders

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51
Q

Symptoms for acute mesenteric ischaemia

A

Severe abdominal pain
Rapid hypovolaemia -> shock
Peritonitis

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52
Q

Investigations for acute mesenteric ischaemia

A 
Raised blood lactate
Raised haemoglobin
Raised WCC
X-ray = 'gasless'
CT angiogram
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53
Q

Treatment for acute mesenteric ischaemia

A

Fluid resuscitation + antibiotics
Thrombolysis
Surgical intervention - dead bowel removal
Poor prognosis

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54
Q

Complications of acute mesenteric ischaemia

A

Gangrene

Perforation

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55
Q

Define ulcerative colitis

A

Relapsing and remitting inflammatory disorder of the colonic mucosa
Limited to just the colon and rectum
Continuous inflammation
Smoking is protective

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56
Q

Symptoms of ulcerative colitis

A 
Diarrhoea + blood/mucus
Abdominal pain
Weight loss
Fever
Anorexia
Malaise
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57
Q

Signs of ulcerative colitis

A 
Clubbing 
Oral ulcers
Erythema nodosum
Conjunctivitis
Epscleritis
Sacroillitis
Ankylosing spondylitis
Primary sclerosing cholangitis
Fatty liver
Amyloidosis
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58
Q

Investigations for ulcerative colitis

A 
FBC - anaemia
ESR
CRP - inflammation
U&amp;E's
Stool MC&amp;S
Faecal calprotectin - released by inflammed intestines
Endoscopy + biopsy = diagnostic
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59
Q

What would show on endoscopy in ulcerative colitis

A

Crypt abscesses

Depletion of goblet cells

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60
Q

How do you induce remission in ulcerative colitis

A

Mild = Sulfasalazine or Mesalazine
Prednisolone

Severe = IV Hydrocortisone, IV ciclosporin

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61
Q

How do you maintain remission in ulcerative colitis

A

Sulfasalazine, mesalazine, olsalazine

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62
Q

What surgical options are there in ulcerative colitis

A

Remove colon + rectum = Panproctocolectomy - patient left with a permanent ileostomy

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63
Q

Complications of surgery

A

Perforation
Massive haemorrhage
Toxic dilatation

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64
Q

Define Crohn’s disease

A

A chronic inflammatory GI disease characterised by transmural granulomatous inflammation.
Affect the entire GI tract (mouth to anus) - and especially the terminal ileum
Skip lesions
Smoking is a risk factor
NSAIDs may exacerbate disease

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65
Q

Symptoms of Crohn’s disease

A 
Diarrhoea/urgency - No blood or mucus
Abdominal pain
Weight loss/failure to thrive
Fever
Malaise
Anorexia
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66
Q

Signs of Crohn’s disease

A 
Aphthous ulcerations
Abdominal mass
Clubbing
Skin, joint and eye problems
Strictures
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67
Q

Complications of Crohn’s disease

A 
Small bowel obstruction
Toxic dilatation
Abscess formation
Fistulae
Perforation
Colon cancer
Fatty liver
Renal stones
Malnutrition
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68
Q

Investigations for Crohn’s disease

A 
FBC
ESR
CRP
U&amp;E's
LFT's
Stool MC&amp;S
Colonoscopy + rectal biopsy
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69
Q

What would colonoscopy in Crohn’s disease show

A

Increased goblet cells

Granulomas

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70
Q

How do you induce remission in Crohn’s disease

A

Oral prednisolone
IV hydrocortisone

If steroids fail then Mesalazine, Azathioprine, Mercaptopurine, Methotrexate, Infliximab, Adalimumab

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71
Q

How do you maintain remission in Crohn’s disease

A 
Azathioprine
Mercaptopurine
Methotrexate
Infliximab
Adalimumab
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72
Q

Symptoms of irritable bowel disease

A 
Diarrhoea
Constipation
Fluctuating bowel habit
Abdominal pain
Bloating
Worse after eating
Improved by opening bowels
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73
Q

Investigations for irritable bowel disease

A

Other pathology should be excluded:
Normal FBC, ESR, CRP
Faecal calprotectin negative
No anti-TTG antibodies

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74
Q

Management for irritable bowel disease

A

Adequate fluid intake
Limit caffeine and alcohol
Low FODMAP diet
Trial of probiotic supplements

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75
Q

Medications for irritable bowel disease

A 
Loperamide for diarrhoea
Laxatives for constipation
Antispasmodics for cramps
Tricyclic antidepressants
CBT
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76
Q

Define coeliac disease

A

Autoimmune condition where exposure to gluten causes an autoimmune reaction that causes inflammation in the small bowel.

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77
Q

Which antibodies are present in coeliac disease

A

Anti-tissue transglutaminase (Anti-TTG)

Anti-endomysial (anti-EMA)

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78
Q

Where specifically does coeliac disease affect

A

Small bowel - Jejunum

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79
Q

What are the genetic links in coeliac disease

A

HLA DQ2 and HLA DQ8

80
Q

Symptoms of coeliac disease

A 
Diarrhoea
Weight loss
Anaemia (iron/B12 deficiency)
Fatigue
Mouth ulcers (aphthous)
Failure to thrive in children
Abdominal pain
Dermatitis herpetiformis
81
Q

Investigations in coeliac disease

A

Low Hb, B12 and ferritin
Raised anti-TTG antibodies
Raised anti-endomysial antibodies
Duodenal endoscopy: Villous atrophy, crypt hypertrophy

82
Q

Associations of coeliac disease

A 
Type 1 diabetes
Thyroid disease
Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis
83
Q

Complications of coeliac disease

A 
Vitamin deficiency
Anaemia
Osteoporosis - 
Ulcerative jejunitis
Non-Hodgkin lymphoma
Enteropathy-associated T-cell lymphoma
84
Q

Treatment for coeliac disease

A

Lifelong gluten free diet

85
Q

Define acute cholecystitis

A

Stone obstruction causing inflammation of the gallbladder

86
Q

Risk factors for gallstones

A

Fat (high BMI)
Fair (caucasian)
Female
Forty - 40

87
Q

Symptoms of acute cholecystitis

A 
RUQ pain
Vomiting
Fever
Local peritonism
Murphy's sign - two fingers on RUQ, ask patient to breathe in = causes pain + feel gallbladder
88
Q

Investigations for acute cholecystitis

A

Increased WCC

Ultrasound scan

89
Q

Treatment for acute cholecystitis

A

Fluids
Antibiotics e.g. Cefuroxime
Laparoscopic cholecystectomy

90
Q

Define biliary colic

A

Gallstones are symptomatic with cystic duct obstruction

91
Q

Symptoms of biliary colic

A

RUQ pain

NO fever/NO increased WCC

92
Q

Treatment for biliary colic

A

Analgesia

Laparoscopic cholecystectomy

93
Q

Define acute cholangitis

A

Infection biliary obstruction

94
Q

Symptoms of acute cholangitis

A

RUQ pain
Jaundice
Fever

= CHARCOTS TRIAD

95
Q

What makes up Charcot’s triad

A

RUQ pain
Jaundice
Fever

96
Q

Treatment for acute cholangitis

A

Antibiotics - cefuroxime and metronidazole

97
Q

Define gallstone ileus

A

A stone erodes through the gallbladder into the duodenum

98
Q

Symptoms of chronic pancreatitis

A 
Epigastric pain that 'bores' through to back
Relieved by sitting forward
Bloating
Steatorrhoea
Weight loss
Brittle diabetes
99
Q

Causes of chronic pancreatitis

A 
Alcohol
Cystic fibrosis
Haemochromatosis
Pancreatic duct obstruction (stones/tumour)
Increase PTH
Congenital
100
Q

Investigations for chronic pancreatitis

A

Ultrasound + CT scan

MRCP + ERCP (risks acute attack)

101
Q

Treatment for chronic pancreatitis

A

Analgesia
Lipase
No alcohol
Surgery - pancreatectomy

102
Q

Complications of chronic pancreatitis

A 
Pseudocyst
Diabetes
Biliary obstruction
Local arterial aneurysm
Splenic vein thrombosis
Pancreatic carcinoma
103
Q

Symptoms of appendicitis

A

Abdominal pain: Central then moves -> RIF
Anorexia
Nausea and vomiting
Constipation

104
Q

Signs of appendicitis

A 
Tachycardia
Fever
Cough hurts
Guarding in RIF
Rebound tenderness + percussion tenderness
Rovsing's sign - palpation of LIF causes pain in the RIF
Psoas sign
Cope sign
105
Q

What is Rovsing’s sign and what condition is it seen in?

A

Palpation of the LIF causes pain in the RIF

Seen in APPENDICITIS

106
Q

Investigations in appendicitis

A

FBC - raised CRP
Increased WCC
CT scan
Ultrasound scan

107
Q

Differential diagnoses for appendicitis

A 
Ectopic pregnancy
Ovarian cyst
UTI
Mesenteric adenitis - abdominal pain, lymphadenopathy
Meckel's diverticulum - malformation distal ileum
Cystitis
Cholecystitis
Crohn's disease
108
Q

Treatment for appendicitis

A

Prompt appendicectomy

Antibiotics - Metronidazole + cefuroxime

109
Q

Complications of appendicectomy

A

Bleeding
Infection
Pain
DVT/PE

110
Q

Define diverticula

A

Pouches in bowel wall

111
Q

Define diverticulosis

A

Presence of diverticula without symptoms

112
Q

Define diverticulitis

A

Inflammation of diverticula

113
Q

Risk factors for diverticulosis

A

Lack of dietary fibre + obesity = risk factors
Diagnosed incidentally on colonoscopy

High fibre diet and weight loss advised

114
Q

Symptoms in diverticulitis

A

LIF pain and tenderness
Fever
Diarrhoea
PR blood/mucus

115
Q

Management for diverticulitis

A

Analgesia
IV fluids
Antibiotics

116
Q

Complications for diverticulitis

A 
Perforation
Haemorrhage
Fistula
Abscess
Ileus/obstruction
117
Q

Define Meckel’s diverticulum

A

Remnant of the vitellointestinal duct and contains gastric and pancreatic tissue

Rule of 2’s:
Occurs in 2% of the population
2 feet from the ileocaecal valve
2 inches long

118
Q

Symptoms of Meckel’s diverticulum

A

Abdominal pain
Rectal bleeding
Intestinal obstruction

119
Q

Management for Meckel’s diverticulum

A

Removal - laparotomy

120
Q

Define Achalasia

A

Failure of oesophageal peristalsis and of relaxation of lower oesophageal sphincter (LOS) due to degeneration of the myenteric plexus

121
Q

Symptoms of Achalasia

A

Dysphagia of BOTH liquids and solids
Heartburn
Regurgitation - cough, aspiration pneumonia
Weight loss

122
Q

Investigations for Achalasia

A

Oesophageal manometry
Chest X-ray - wide mediastinum
Barium swallow - dilated tapered oesophagus. ‘Bird’s beak’ appearance

123
Q

Treatment for Achalasia

A

Endoscopic balloon dilatation
Heller cardiomyotomy
Botulinum toxin injection

124
Q

Causes of gastritis

A 
Alcohol
NSAIDs
H.pylori
GORD
Atrophic gastritis
Crohn's disease
Sarcoidosis
CMV
Zollinger-Ellison
Menetrier's disease
125
Q

Symptoms of gastritis

A

Epigastric pain
Vomiting
Haematemsis

126
Q

Investigations for gastritis

A

Endoscopy + biopsy

127
Q

Prevention for gastritis

A

Give PPI gastroprotection with NSAIDs

128
Q

Treatment for gastritis

A

Ranitidine or PPI

129
Q

H.pylori eradication treatment

A

PPI + clarithromycin + amoxicillin

PPI + clarithromycin + metronidazole (if penicillin allergy)

130
Q

Define tropical sprue

A

Malabsorption found in tropical regions - far and middle east, carribean

131
Q

Causes of tropical sprue

A

Giardia, cryptosporidium, isoproi belli,microsporidia

132
Q

Symptoms of tropical sprue

A 
Diarrhoea
Fever
Malaise
Weight loss
Anorexia
Steatorrhoea
133
Q

Investigations for tropical sprue

A

Endoscopy + biopsy = incomplete villous atrophy

134
Q

Management for tropical sprue

A

Fluid replacement
Antibiotics - tetracycline
Nutritional support - folic acid - B12

135
Q

Causes of an Upper GI bleed

A 
Mallory-Weiss tear
Peptic ulcer
Oesophageal varices
Malignancy
Gastritis
Drugs (NSAIDs, aspirin, steroids, anticoagulants)
Oesophagitis
Angiodysplasia
136
Q

Presentation of an Upper GI bleed

A 
Haematemesis
Melaena
Coffee ground vomit
Epigastric pain
Dyspepsia
Jaundice -> Ascites - liver disease with oesophageal varices
137
Q

What scoring system is used in suspected upper GI bleeds on initial presentation?

A

Glasgow-Blatchford score

138
Q

What scoring system is used for patients that have had an endoscopy to calculate their risk of rebleeding and overall mortality

A

Rockall score

139
Q

Management of an upper GI bleed

A 
ABCDE
IV cannulae 2 large bore
Bloods - FBC, U&amp;E's, Clotting, Crossmatch, LFT's
IV fluids
Transfuse
Stop drugs (NSAIDs, anticoagulants)
140
Q

Triad of Plummer-Vinson syndrome

A

Dysphagia
Glossitis
Iron-deficiency anaemia

141
Q

Investigations for Plummer-Vinson syndrome

A

Barium swallow - detect oesophageal webs

Endoscopy

142
Q

Differential diagnosis for Plummer-Vinson syndrome

A

Oesophageal cancer
Achalasia
GORD

143
Q

Treatment for Plummer-Vinson syndrome

A

Iron supplementation

Dilatation of the webs

144
Q

Define hereditary haemochromatosis

A

An inherited disorder of iron metabolism in which an increase in intestinal iron absorption leads to iron deposition in joints, liver, pancreas, pituitary, adrenals and skin

145
Q

What inheritance pattern does hereditary haemochromatosis have

A

Autosomal recessive

146
Q

Symptoms in hereditary haemochromatosis

A 
Chronic tiredness
Joint pain (2nd + 3rd MCP joints)
Erectile dysfunction
Bronze/slate-grey pigmentation
Hair loss
Amenorrhoea
Cirrhosis
Osteoporosis
Memory and mood disturbance
147
Q

Investigations in hereditary haemochromatosis

A 
Increased serum ferritin
Increased transferrin saturation
Genetic testing
Liver biopsy - Perl's stain
CT abdomen
MRI
148
Q

Management for hereditary haemochromatosis

A

Venesection (removal of blood to decrease total iron)
Monitor serum ferritin
Avoid alcohol

149
Q

Complications for hereditary haemochromatosis

A 
Type 1 diabetes mellitus
Liver cirrhosis
Hypogonadism
Cardiomyopathy
Hepatomegaly
150
Q

Define Wilson’s disease

A

Excessive accumulation of copper in the body and tissues

151
Q

What inheritance pattern is Wilson’s disease?

A

Autosomal recessive disorder of a gene on chromosome 13

152
Q

Symptoms of Wilson’s disease

A

Liver disease - Hepatitis, Cirrhosis

CNS signs - Tremor, Dysarthria, Dysphagia, Dystonia,
Dyskinesia, Parkinsonism

Depression
Kayser-Fleischer rings in cornea-brown circles
Haemolysis

153
Q

Investigations in Wilson’s disease

A

Low serum caeruloplasmin (high in cancer/inflammation)
Liver biopsy
24 hour urine copper assay is high
Slit lamp examination - Kayser-Fleischer rings
Low serum copper

154
Q

Treatment for Wilson’s disease

A

Diet - avoid foods with high copper content
Penicillamine
Trientene

155
Q

Define alpha1-antitrypsin deficiency

A

An inherited deficiency of a protease inhibitor called alpha 1 antitrypsin

Leads to excess of protease enzymes that attack the liver and lung tissue and cause liver cirrhosis and lung disease

156
Q

What enzyme does alpha1-antitrypsin inhibit?

A

Elastase - this enzyme digests connective tissue

157
Q

What inheritance pattern does alpha1-antitrypsin deficiency follow

A

Autosomal recessive

158
Q

Symptoms of alpha1-antitrypsin deficiency

A

Liver and lungs affected

Liver cirrhosis
Cholestatic jaundice
Emphysema - dyspnoea

159
Q

Investigations for alpha1-antitrypsin deficiency

A

Low serum alpha1-antitrypsin levels
Liver biopsy - cirrhosis
Genetic testing

160
Q

Management for alpha1-antitrypsin deficiency

A

Stop smoking

Liver transplantation

161
Q

Define sclerosis

A

Stiffening and hardening of the bile ducts

162
Q

Define cholangitis

A

Inflammation of the bile ducts

163
Q

Define primary sclerosing cholangitis

A

Where the intrahepatic or extrahepatic ducts become strictured and fibrotic. This causes an obstruction to the flow of bile out of the liver and into the intestines

Chronic bile obstruction eventually leads to liver inflammation (hepatitis) fibrosis and cirrhosis

164
Q

Risk factors for primary sclerosing cholangitis

A

Male
Aged 30-40
Ulcerative collitis - 70% of cases have UC
Family history

165
Q

Symptoms of primary sclerosing cholangitis

A 
Jaundice
Chronic right upper quadrant pain
Pruritis
Fatigue
Hepatomegaly
166
Q

Investigations for primary sclerosing cholangitis

A 
MRCP - Gold standard
MRI of liver, bile ducts, pancreas
LFT's - alkaline phosphatase derranged, billirubin raised
Autoantibodies - p-ANCA
ANA
aCL
167
Q

Associations and complications of primary sclerosing cholangitis

A 
Acute bacterial cholangitis
Cholangiocarcinoma
Colorectal cancer
Cirrhosis and liver failure
Biliary strictures
168
Q

Management for primary sclerosing cholangitis

A

Liver transplant
Ursodeoxycholic acid
Colestyramine
ERCP - dilatation and stent

169
Q

Define primary biliary cirrhosis

A

Where the immune system attacks the small bile ducts within the liver
The first part to be affected is the intralobar ducts, also known as the canals of Hering. This causes obstruction of the outflow of bile, which is called cholestasis

Bile obstruction causes fibrosis, cirrhosis and liver failure

170
Q

What does a build up of bile acids cause?

A

Itching, greasy stools

171
Q

What does a build up of bilirubin cause?

A

Jaundice, pale stools

172
Q

What does raised cholesterol cause?

A

Xanthelasma

173
Q

Symptoms of primary biliary cirrhosis

A 
Fatigue
Pruritis
GI disturbance and abdominal pain
Jaundice
Pale stools
Xanthoma and xanthelasma
Ascites
Splenomegaly
Spider naevi
174
Q

Investigations for primary biliary cirrhosis

A 
LFT's - raised alkaline phosphatase
Autoantibodies = anti-mitochondrial antibodies, anti-nuclear antibodies
ESR raised
IgM raised
Liver biopsy
175
Q

Treatment for primary biliary cirrhosis

A

Ursodeoxycholic acid
Colestyramine
Liver transplant
Immunosuppression

176
Q

Complications of primary biliary cirrhosis

A 
Advanced liver cirrhosis
Portal hypertension
Pruritis
Fatigue
Steatorrhoea
Distal renal tubular acidosis
Hypothyroidism
Osteoporosis
Hepatocellular carcinoma
177
Q

What is the main type of liver cancer?

A

Hepatocellular carcinoma (80%)

178
Q

What are the other types of liver cancer?

A

Cholangiocarcinoma (20%)

179
Q

Risk factors for liver cancer

A

Liver cirrhosis due to: Viral Hepatitis B and C
Alcohol,
Non-alcoholic fatty liver disease
Cholangiocarcinoma is associated with primary sclerosing cholangitis

180
Q

Symptoms of liver cancer

A 
Weight loss
Abdominal pain
Anorexia
Nausea and vomiting
Jaundice
Pruritis
Cholangiocarcinoma presents with painless jaundice
181
Q

Investigations for liver cancer

A 
Alpha-fetoprotein 
CA19-9 
Liver ultrasound
CT/MRI scan
ERCP
182
Q

What is the tumour marker for hepatocellular carcinoma

A

Alpha-fetoprotein

183
Q

What is the tumour marker for cholangiocarcinoma

A

CA19-9

184
Q

Treatment for hepatocellular carcinoma

A

Resection in early disease
Liver transplant if isolated
Kinase inhibitors - sorafenib, regorafenib, lenvatinib

185
Q

Treatment for cholangiocarcinoma

A

Resection in early disease

ERCP

186
Q

What are the stages of non-alcoholic fatty liver disease

A
  1. Non-alcoholic fatty liver disease
  2. Non-alcoholic steatohepatitis
  3. Fibrosis
  4. Cirrhosis
187
Q

Risk factors for non-alcoholic fatty liver disease

A 
Obesity
Poor diet - low activity levels
Type 2 diabetes mellitus
High cholesterol
Smoking
Hypertension
188
Q

Investigations for non-alcoholic fatty liver disease

A

Liver ultrasound
Enhanced liver fibrosis (ELF) blood test - 1st line
NAFLD fibrosis score - 2nd line
Fibroscan

189
Q

Management for non-alcoholic fatty liver disease

A 
Weight loss
Exercise
Stop smoking
Control diabetes, BP, cholesterol
Avoid alcohol
190
Q

Define Boerhaave syndrome

A

Spontaneous perforation of the oesophagus that results from sudden increase in intraoesophageal pressure combined with negative intrathoracic pressure (e.g. severe straining or vomiting)

191
Q

Causes of Boerhaave syndrome

A 
Vomiting
Weightlifting
Straining
Seizures
Trauma
Childbirth

ALCOHOL

192
Q

Symptoms of Boerhaave syndrome

A

Vomiting
Lower thoracic pain/chest pain
Emphysema

193
Q

Investigations of Boerhaave syndrome

A

Chest x-ray: mediastinal emphysema. mediastina widening, pleural effusion
Contrast oesophagogram - CT

194
Q

Treatment for Boerhaave syndrome

A

Fluid replacement
Broad spectrum antibiotics
Oesophageal repair

195
Q

Differential diagnosis of Boerhaave syndrome

A

Aortic dissection
Acute pancreatitis
MI
Pneumothorax

196
Q

Complications for Boerhaave syndrome

A

Pleural effusion
Subcutaneous emphysema
ARDS
Empyema

Phase 3b (18 decks)

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