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FINALS > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Causes of increased ALP

A

Increased in bile duct obstruction

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2
Q

What is ALP and where is it distributed in the body

A

Alkaline Phosphatase

High levels in cell membranes of:
- Biliary tree
- intestine
- placenta
- bone
- renal tubular cells

“Plate of Liver and Kidney beans”

(N.B. low levels in liver)

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3
Q

Hepatitis picture of LFTs

A

High transaminases (AST / ALT) with proportionally less of a rise in ALP

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4
Q

Criteria for Acute Liver failure

A
  1. Increase in PT (by 4-6 seconds) - INR >1.5
  2. Development of hepatic encephalopathy
  3. WITHOUT pre-existing cirrhosis & illness for > 6 months
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5
Q

What is GGT

A

Gamma-glutamyl transpeptidase

Enzyme found around body but particularly in the liver (primarily biliary epithelium)

Increased in bile duct obstruction

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6
Q

Causes of metabolic alkalosis

A

Vomiting / aspiration
Diuretics
Hypokalaemia
Primary hyperaldosteronism (Conn’s syndrome)
Cushing’s syndrome

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7
Q

Biochem disturbance from prolonged vomiting

A

Metabolic alkalosis + hypokalaemia

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8
Q

Why does vomiting cause hypokalaemia and metabolic acidosis?

A

Large amounts of hydrochloric acid are lost –> loss of H+ ions and fluid

Fluid loss –> activation of the renin-angiotensin-aldosterone system (RAAS) due to reduced renal perfusion –> increased aldosterone secretion.

Aldosterone promotes the reabsorption of Na+ in exchange for H+ and K+ in the kidneys.

In general, where Na+ goes, water follows, meaning the blood volume is increased, however, more potassium and H+ are lost, leading to hypokalaemic metabolic alkalosis

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9
Q

Prolonged diarrhoea ABG

A

hypokalaemia
hypovolaemic shock
metabolic acidosis (due to the loss of bicarbonate ions from the gut)

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10
Q

What is Primary sclerosing cholangitis?

A

biliary disease of unknown aetiology characterised by inflammation and fibrosis of intra and extra-hepatic bile ducts

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11
Q

What condition is primary sclerosing cholangitis associated with ?

A

Ulcerative colitis

8% of people with UC have PSC
80% of people with PSC have UC

(also Crohns and HIV but a lot less common)

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12
Q

What is primary sclerosing cholangitis?

A

intrahepatic or extrahepatic ducts become strictured and fibrotic

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13
Q

Hepatic consequence of primary sclerosing cholangitis

A

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

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14
Q

Presentation of Primary sclerosing cholangitis

A

Jaundice
Chronic right upper quadrant pain
Pruritus
Fatigue
Hepatomegaly
Signs of cirrhosis if they have developed this

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15
Q

LFTs “cholestatic picture”

A

ALP = most derranged LFT and may be the only abnormality at first

May be a rise in bilirubin as strictures become more severe and prevents bilirubin from being excreted through the bile duct

Other LFTs (i.e. transaminases: ALT and AST) can also be deranged, particularly as the disease progresses to hepatitis.

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16
Q

Role of autoantibodies in primary sclerosing cholangitis

A

Not helpful in diagnosis (Not specific/sensitive)

Can indicate where there is autoimmune element –> may respond to immunosuppression

  • p-ANCA - in up to 94%
  • Antinuclear antibodies (ANA) - in up to 77%
  • Anticardiolipin antibodies (aCL) in up to 63%
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17
Q

What is an MRCP and what is it used for?

A

MRI of Liver, bile ducts and pancreas

Diagnosis of:
- PSC
-

18
Q

Fat soluble vitamins

A

Vitamins A, D, E, and K

(Amelia Doesnt Even Know)

19
Q

Management of primary sclerosing cholangitis

A
  1. Only definitive = liver transplant
  2. ERCP - stents to open strictures
  3. Ursodeoxycholic acid - may slow progression of disease
  4. Colestyramine - bile acid sequestrate in that it binds to bile acids to prevent absorption in the gut and can help with pruritus due to raised bile acids
20
Q

Where foes ECRP scope pass through from GI tract –> biliary system

A

sphincter of Oddi and into the ampulla of Vater

21
Q

“Beads on a string” appearance of bile ducts

A

Primary sclerosing cholangitis

22
Q

What is Primary Biliary Cirrhosis?

A

Chronic, progressive, autoimmune condition leading to destruction of intrahepatic ducts

The first parts to be affected are the intralobar ducts, also known as the Canals of Hering. This causes obstruction of the outflow of bile, which is called cholestasis. The back-pressure of the bile obstruction and the overall disease process ultimately leads to fibrosis, cirrhosis and liver failure.

23
Q

Which conditon is autoimmune out of PBC and PSC ?

A

Primary Biliary Cirrhosis

24
Q

Conditions associated with Primary Biliary Cirrhosis?

A

Coeliac disease
Thyroiditis
Middle aged women
Rheumatoid conditions (e.g. systemic sclerosis, Sjogrens and rheumatoid arthritis)

25
Q

Autoantibodies associated with primary biliary cirrhosis?

A

Anti-mitochondrial antibodies
- most specific to PBC, part of the diagnostic criteria)

Anti-nuclear antibodies (35% of patients)

26
Q

Ursodeoxycholic acid role

A

used in the management and treatment of cholestatic liver disease

27
Q

Treatment of primary biliary cirrhosis

A

Ursodeoxycholic acid (better response to this compared to PSC)
Colestyramine - symptomatic management of itching
Immunosuppresants (some patients)

28
Q

What is aminosalicylates (e.g. mesalazine) used for?

A

To control inflammation in GI tract

Used in Ulcerative colitis
I) Inducing remission in mild to moderate disease
II) Maintaining remission

29
Q

Treatment of Severe flare of UC

A

Admit + IV hydrocortisone

30
Q

Treatment of flare of Crohns

A

Steroids (e.g. oral prednisolone or IV hydrocortisone)

If steroids don’t help, consider immunosuppression:
Azathioprine
Methotrexate

31
Q

Effect of smoking on IBD ?

A

Crohns - smoking increases risk

UC - smoking decreases risk

31
Q

Effect of smoking on IBD ?

A

Crohns - smoking increases risk

UC - smoking decreases risk

32
Q

Severe disease criteria IBD

A

if >= 6 bowel movments per day PLUS at least 1 feature of systemic upset

Other features:
Blood in stool clearly visible
Pyrexia
HR >90 bpm
Anaemia
ESR >30
(Trulove & Witts’ criteria)

33
Q

Which IBD has tenesmus

A

UC

34
Q

Rome IV criteria for IBS

A

Recurrent abdo pain at least one day/week over the past three months (with symptom onset at least six months ago)

and two of the following:
1. It is related to defecation and/or
2. it is associated with a change in stool frequency, and/or
3. It is associated with a change in stool appearance.

35
Q

What is Charcot’s triad?

A

Suggestive of ascending cholangitis (bacterial infection of the biliary tree - typically E.Coli)

  1. Fever
  2. Jaundice
  3. Right upper quadrant pain
36
Q

What is Reynold’s pentad?

A

Suggestive of severe ascending cholangitis

= Charcot’s triad + hypotension and confusion
SO
1. Fever
2. Jaundice
3. Right upper quadrant pain
4. Hypotension
5. Confusion

37
Q

Management of ascending cholangitis

A
  1. IV antibiotics
  2. ERCP after 24-48 hours to relieve any obstruction
38
Q

Key differentiating features between chronic liver disease and acute failure

A

In acute but not chronic
- Prothombin time raised
- Very high bilirubin
- presence of encephalopathy

39
Q

Causes of acute liver failure

A

Paracetamol overdose
Alcohol
Viral hepatitis (A & B)
Acute fatty liver of pregnancy

40
Q

Pancreatitis scoring system

A

P - PaO2 <8kPa

A - Age >55-years-old

N - Neutrophilia: WCC >15x10(9)/L

C - Calcium <2 mmol/L

R - Renal function: Urea >16 mmol/L

E - Enzymes: LDH >600iu/L; AST >200iu/L

A - Albumin <32g/L (serum)

S - Sugar: blood glucose >10 mmol/L

FINALS (19 decks)

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