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General Medicine > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is the cause of nutmeg liver?

A

Right heart failure

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2
Q

What is the clinical and lab criteria required to diagnose alcoholic hepatitis? Either clinical or lab is required for diagnosis

A

Clinical: Person drinking >= 6 months, known liver disease, can’t be abstinent in last 60 days before jaundice
LAB: AST:ALT 2:1, AST & ALT < 400

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3
Q

What symptoms does alcoholic hepatitis have?

A

Epigastric pain, fever, neutrophilia, rapid onset jaundice, occasionally encephalopathy

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4
Q

Mx of Alcoholic hepatitis?

A

AWS -> manage with benzos (Diazepam or oxazepam - Better in liver dysnfunction)
Thiamine before glucose -> hydrate and electrolytes
ATODS Referral
Council on long term abstinence = liver regeneration
MELD score >18 = start prednisolone
Give prednisolone if encephalopathy present

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5
Q

What demographic of patient gets NAFLD?

A

T2DM and metabolic syndrome pts

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6
Q

What is the basic pathology of NAFLD?

A

Insulin resistance -> Decrease sensitivity to lipoprotein lipase -> increase Free fatty acids in circulation -> stores in liver -> steatosis

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7
Q

What are the clinical features of NAFLD?

A

RUQ pain, fever, N&V

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8
Q

NAFLD Ix?

A

FBC, BSL/HbA1c, Lipids, LFTs, fibroscan for cirrhosis

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9
Q

What is the mx of NAFLD?

A

Manage CVS risk factors - SNAP + Weight loss
If absolute CVD Risk factor >15% -> lipid and BP lowering meds

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10
Q

How many paracetamol tablets are deadly?

A

> 20

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11
Q

Explain the paracetamol nomogram and how it is used in treatment?

A

Levels rise until 4 hours
After 4 hours, take levels and see where on nomogram. Below line do not treat, above line treat with N-acetylcystine

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12
Q

Alpha 1 AT deficiency can cause symptomatic disease / liver cirrhosis at any age. What is the definitive management?

A

Liver transplant

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13
Q

What are the risk factors for haemachromatosis?

A

Family Hx, Alcoholics, Celtic

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14
Q

What is the basic pathology of haemachromatosis?

A

HFE gene mutation -> decreased hepcidin -> Increased iron absorption -> tissue deposition

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15
Q

What is wilson’s disease, clinical features, Ix and MX?

A

Lack of copper excretion in bile -> copper accumulation
CF: KF rings, blue lunulae, liver failure, neuropsych sx, jaundice
IX: Decreased ceruloplasmin concentration, high 24 hour urinary copper excretion
MX: Lifelong zinc, refer to specialist

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16
Q

Autoimmune Hepatitis affects middle aged women. What tests do you perform to confirm this and what is the management?

A

ASMA, ANA, Elevated IgG
Mx: Prednisolone + referral to specialist

17
Q

What are some clinical features of PBC and management?

A

Joint pain, pruritis, jaundice, xanthelasma

Ursodeoxycholic Acid

18
Q

What are the PBC investigations?

A

AMA, LFTs. Fibroscan for cirrhosis

19
Q

Who gets PBC?

A

Old women (50s) and associated with sjogren’s syndrome (dry eyes and mouth due to gland distruction)

20
Q

Who gets PSC?

A

Young male, associated with Ulcerative Collitis

21
Q

What is the investigations and management for PSC?

A

ix: pANCA, MRCP
Mx: Ursodeoxycholic Acid

22
Q

What are your differentials for viral hepatitis?

A

EBV, HIV, CMV, HSV

23
Q

Hepatitis A&E are forcal oral transmitted. What is the incubation period and risk factors?

A

<6 Weeks
RF: Travelling, poor hygiene, Shellfish for Hep A

24
Q

How is Hepatitis B,C,D spread? What are the risk factors?

A

Blood, Birth, Banging

RF: Transfusions, tattoos, Taking drugs, Toothbrush, DeTention, Taboo (MSM), healTh care workers

25
Q

What are the clinical features of all acute hepatitis?

A

Fatigue
Lethargy
Jaundice
RUQ pain
N&V
Fever
Myalgia
Arthralgia

26
Q

Which hepatitis is more common / more commonly causes cirrhosis?

A

Hep C more likely to cause cirrhosis, however hep B more common

27
Q

Why is vertical Hep B transmission bad?

A

90% chance of cirrhosis

28
Q

How do you diagnose Hep A?

A

IgM and anti HAV Ab

29
Q

How do you diagnose Hep B?

A

Check HBsAg -> positive = current infection
Check Anti-HBs -> Positive = vaccinated or resolved infection
Check Anti-HBc -> Positive = resolved infection, negative = vaccinated
Acute = IgM, Chronic = IgG

30
Q

How do you test for hep C?

A

Anti-HCV Ab = Acute
HCV RNA test (PCR) = Chronic

31
Q

How do you diagnose Hep E?

A

HEV RNA & Anti-HEV Ab (IgM & IgG)

General Medicine (10 decks)

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