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Finals > Gastro (Medicine) > Flashcards

Gastro (Medicine) Flashcards

1
Q

What could cause acute liver failure?

A 
paracetamol OD
alcohol 
hepatitis (A&B)
acute fatty liver of pregnancy
Wilson's
Malignancy
Budd-Chiari
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2
Q

How would acute liver failure present? Including investigation results

A 
Jaundice
Prolonged PT
Hypoalbuminaemia 
Renal failure (hepatorenal syndrome)
Encephalopathy - flap and constructional apraxia
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3
Q

What tests would be most useful in looking for acute liver failure and why?

A

PT and albumin

LFTs don’t necessarily reflect the synthetic function of the liver

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4
Q

What is the pathophysiology of hepatic encephalopathy?

A

There is excess ammonia and glutamine absorption from protein breakdown in the gut

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5
Q

What could precipitate hepatic encephalopathy?

A

Infection
Hypokalaemia
GI bleed
Sedative drugs

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6
Q

How would hepatic encephalopathy present? (Grades)

A 
All grades: liver flap and constructive apraxia
1 - irritable
2 - confused
3 - incoherent 
4 - coma
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7
Q

How would you manage hepatic encephalopathy? What do these drugs do?

A

Lactulose: increased excretion
Rifaximin: reduced production

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8
Q

What are the most common causes of chronic liver failure?

A

Alcohol

Hepatitis

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9
Q

What are the signs and symptoms of chronic liver failure?

A

Clubbing, leukonychia, palmar erythema, asterixis (flap)

Spider nevi, gynaecomastia, caput medusae

Hepatomegaly, ascites

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10
Q

What could you find on examination of someone with portal hypertension?

A

Caput medusae
Oesophageal varices
haemorrhoids (painless)

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11
Q

Describe the pathophysiology of palmar erythema and leukonychia

A

palmar erythema: reduced breakdown of sex hormones

leukonychia: hypoalbuminaemia

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12
Q

What screening would you want to carry out in someone with cirrhosis

A

Upper endoscopy on diagnosis: varices?

6 monthly USS and a-feto-protein: cancer?

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13
Q

What investigation would you use to screen for cirrhosis

A

Transient elastography

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14
Q

What investigations would suggest alcoholic liver disease?

A

Raised gamma-GT

AST:ALT ratio >2

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15
Q

How is alcoholic liver disease managed?

A

Steroids (often prednisolone)

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16
Q

How would you assess the severity of alcoholic liver disease?

A

Maddrey’s discriminant function

It looks at PT and bilirubin

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17
Q

What drugs would cause a hepatocellular liver disease and which would cause a cholestatic?

A

Hepatocellular:
paracetemol, alcohol, TB drugs, psychotics, statins

Cholestatic:
COCP, antibiotics eg co-amox, sulphonylurea

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18
Q

What is thought to be the mechanism behind non-alcoholic fatty liver disease? Therefore what are the risk factors/causes?

A

Insulin resistance

Obesity, T2DM, hyperlipidaemia
Also sudden weight loss/starvation

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19
Q

What blood results do you get in non-alcoholic fatty liver disease?

A

ALT > AST

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20
Q

How is non-alcoholic liver disease managed?

A

Weight loss

+/- drugs like metformin

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21
Q

What is the model for end stage liver disease (MELD) and what factors determine a patients score?

A

It predicts survival in end stage liver disease

INR, creatinine and bilirubin

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22
Q

How would autoimmune hepatitis present? Including investigation results

A

As acute liver failure: fever, jaundice
As chronic liver failure
Amenorrhoea (very common)
ANA or SMA or LKM1 antibodies and raised IgG

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23
Q

How is autoimmune hepatitis treated?

A

Steroids +/- other immunosuppressants

Liver transplant

24
Q

What is the pathophysiology of a raised serum-ascites albumin gradient (SAAG)?

A

certain disease cause a raised hydrostatic pressure in the circulation = fluid leaves circulation and enters peritoneum (ascites) = circulation is now more concentrated = raised serum albumin compared to ascites.

25
Q

What would cause ascites with a raised SAAG?

A

PORTAL HYPERTENTION
Liver disease: alcohol, cirrhosis, metastasis
Budd-Chiari
Right heart failure and constrictive pericarditis

26
Q

What would causes ascites with a normal SAAG?

A

Hypoalbuminaemia: Nephrotic syndrome, Kwashiokor
Pancreatitis
Bowel obstruction
Peritoneal cancer

27
Q

How is ascites managed?

A

Reduce dietary sodium
Fluid restrict (if sodium is <125)
Spironolactone +/- loop
Drainage with paracentesis

28
Q

What is a complication of paracentesis? What can this lead to? How is it managed?

A

paracentesis induced circulatory failure
leads to: recurrence of ascites, hepatorenal syndrome and dilutional hyponatraemia
management: give prophylactic albumin cover

29
Q

Causes of hepatomegaly?

A

Right heart failure
Cirrhosis
Malignancy

30
Q

What is ischaemic hepatitis and what blood results would you expect?

A

Due to acute hypoperfusion eg after arrest
ALT is +++++
Can also get AKI picture on bloods

31
Q

How does Gilberts syndrome present? Signs and bloods

A

Jaundice in times of stress eg ill, drunk, dehydrated

unconjugated hyperbilirubinemia

32
Q

What is budd-chiari syndrome?

A

Hepatic vein thrombosis leading to:

  • Tender Hepatomegaly
  • Ascites - abdo distension
  • Abdominal pain - severe sudden onset
33
Q

What causes Budd-chiari syndrome?

A

Polycythaemia rubra vera

Thrombophilia’s - antithrombin III deficiency, protein C and S deficiency

COCP

Pregnancy

34
Q

How is Budd-Chiari investigated and managed?

A

Doppler US

Radiological - angioplasty or shunt
Surgery - shunt or liver transplant

35
Q

Which vessels are affected by portal hypertension to lead to varices, caput medusa and haemorrhoids?

A

Varices - Normally left gastric –> oesophageal vein

Caput medusa - normally para-umbilical –> small epigastric vein

Haemorrhoids - normally superior rectal –> inferior rectal

36
Q

What are the scoring systems for liver cirrhosis?

A 
MELD
Child-Pugh:
- bilirubin
- albumin
- PT
- ascites
- encephalopathy
37
Q

What is spontaneous bacterial peritonitis? How does it present?

A

Seen in patients with ascites secondary to liver cirrhosis

Present:

  • abdo pain
  • fever
  • ascites
38
Q

How is spontaneous bacterial peritonitis investigated and managed?

A

Ix - paracentesis - neut >250. Commonly E. Coli

Mx - IV Cefotaxime

39
Q

When is Abx prophylaxis given for spontaneous bacterial peritonitis?

A

Had an episode of spontaneous bacterial peritonitis

Fluid protein <15 and child-pugh score >9 or hepatorenal syndrome

Give oral ciprofloxacin or norfloxacin

40
Q

What blood result abnormalities are seen in alcoholic liver disease?

A

Macrocytic anaemia

Thrombocytopaenia

41
Q

State the ABG results seen in alcoholic ketoacidosis

A

metabolic acidosis with raised anion gap
raised ketones
normal to low glucose

42
Q

How is alcohol ketoacidosis managed?

A

saline and thiamine

43
Q

What antibodies are associated with the 3 types of autoimmune hepatitis?

A

Raised IgG in all

Type 1: ANA and SMA antibodies
Type 2 (children): LKM1 antibodies
Type 3: soluble liver kidney antigen

44
Q

How does autoimmune hepatitis present?

A

Often as chronic liver failure picture
Can present as acute hepatitis with fever and jaundice
Amenorrhoea

45
Q

How is autoimmune hepatitis managed?

A

steroids

46
Q

What blood test results indicate hepatorenal syndrome?

A

Huge rise in creatinine and decline in creatinine clearance within a space of 2 weeks

47
Q

What is the management of hepatorenal syndrome?

A 
Ideally liver transplant but most patients are too unwell for this
Vasopressin analogues (pathophysiology is thought to be splanchnic vasodilation leading to underperfused kideny)
48
Q

What are the risk factors for non-alcoholic fatty liver disease?

A

Anything that causes insulin resistance:

  • obesity
  • T2DM
  • hyperlipidaemia
  • starvation
49
Q

What LFTs are seen in non-alcoholic fatty liver disease?

What does the liver look like on USS?

A

ALT typically >AST

Echogenic on USS

50
Q

What is the management of non-alcoholic fatty liver disease?

A

weight loss

51
Q

Who is at risk of re-feeding syndrome?

A

Low BMI
++ unintentional weight loss
Severely reduced intake over past 5-10 days
Pre-existing electrolyte abnormalities

52
Q

What are the characteristic investigation findings of refeeding syndrome?

A

Low phosphate, K and Mg
Can get Torsades as a result of low Mg
Abnormal fluid balance

53
Q

What is Wilsons disease?

A

autosomal recessive disorder of abnormal copper deposition in tissues

54
Q

What are the features of Wilsons disease?

A

LIVER: hepatitis and cirrhosis

BRAIN: psych symptoms, speech difficulty, chorea, asterixis, dementia, parkinsonism

CORNEA: Kayser-Fleischer rings

NAILS: blue

55
Q

What blood test results indicate Wilsons disease?

A

Low serum caeruloplasmin
Low total serum copper (as it’s bound to caeruloplasmin)
Raised free non-bound copper

56
Q

What is the management of Wilsons disease?

A

Penicillamine

Finals (16 decks)

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