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Zero to Finals Medicine > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What are the stages of Alcoholic Liver Disease?

A

Alcohol related fatty liver - resolves in 2 weeks

Alcoholic hepatitis - Reversible

Cirrohis - ireversabile

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2
Q

What are the CAGE questions?

A

Cut down?
annoyed when people mention your drinking?
Guilt?
Early morning

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3
Q

What is the alcohol assesment score questionaire?

A

AUDIT 10 questions

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4
Q

Signs of liver disease?

A

Jaundice
hepatomegaly
spider naevi
Palmar erythema
gynaecomastia
ascities
caput medusa

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5
Q

What blood results would you find in alcohol misuse?

A

rasied MCV on FBC
raised ALT and AST
Especially raised gamma-GT

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6
Q

What investgations can you do for Acoholic liver disease?

A

ultrasound “fibroscan”
Liver biopsy
CT

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7
Q

How do you treat acute alcohol withdrawl?

A

Diazepam and pabrinex

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8
Q

What is pabrinex?

A

B vitamins. Thimaine is a B vitamin

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9
Q

What are the four most common causes of liver disease?

A

Alcoholic liver disease
Non alcholoic fatty liver disease
Hep B
Hep C

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10
Q

What tells you about the synthetic function of the liver?

A

Poor synthetic function will show in low albumin and a long prothrombin time

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11
Q

What should you check for in patients with cirrohsis?

A

alpha-fetoprotein for hepatocellular carcinoma

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12
Q

What is alpha-fetoprotien a marker of?

A

hepatocellular carcinoma

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13
Q

What is the follow up for people with eosphageal varices?

A

If liver cirhosis then ultrasound every 6 months

for varices endoscopy every 3 years

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14
Q

What score do you do for a liver transplant?

A

MELD score

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15
Q

What is the 5 year survival with liver cirrohsis?

A

50%

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16
Q

What is the best diet for someone with liver cirrohsis?

A

High protein high calorie low salt

eat every 3 hours

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17
Q

What are the treatment options for stable oesopagheal varices?

A

Banding
propanolol

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18
Q

What is the treatment of bleeding oesphageal varices?

A

Call anasthetics and general surgery

Terlipressin
correct coagulopathy with fresh frozen plasma and vitamin K

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19
Q

What causes ascities?

A

increased portal pressure leads to fluid leaking out of the cappliaries in the liver and bowel. Thus reduced flow into the kidneys causes aldosterone release and fluid retention

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20
Q

What is the treatment for ascites?

A

Low sodium diet
anti-aldosterone diurectic like spironolactone
paracentesis

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21
Q

What is spironolactone?

A

anti-aldosterone diuretic

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22
Q

What is the big risk in someone with ascities?

A

Spontaneous Bacterial Peritonitis - Needs treated with ascitic culture and IV ABX

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23
Q

What is hepatorenal syndrome?

A

nackered liver causes renal hypotension and renal failure- life threatening without liver transplant

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24
Q

What is hepatic encephalopathy?

A

Amonia poisioning which causes confusion and reduced consciousness

Treat by clearing out gut bio with laxatives and abx

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25
Q

how common is NAFLD

A

possibly 1/3 of adults

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26
Q

What are the stages of NAFLD?

A

NAFLD
Non alcoholoic steatoheptatitis NASH
Fibrosis
Cirrhosis

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27
Q

What are the risk factors for NAFLD?

A

Same as cardiac and diabetes risk

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28
Q

What should you do to investigate new abnormal LFTs?

A

Hep B and C serology
check autoantibodies (autoimmune hepatitis, primary sclerosis, primary sclerosing cholangitis)
Alpha 1 anti-trypsin leves
ferretin and transferrin for hereditary haemochromatosis

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29
Q

How do you ivestigate for NAFLD?

A

Do a NAFLD fibrosis score

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30
Q

What are the symptoms of hepatitis?

A

abdominal pain
fatigue
puritis
muscle and joint aches
nausea and vomiting
jaundice

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31
Q

How is hep B transmitted?

A

blood or bodily fluids

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32
Q

What is the prognosis of Hep B?

A

Most recover in 2 months

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33
Q

Is there a vaccine for Hep B or Hep C?

A

There is a vaccine for hep B only

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34
Q

What is the prognosis for Hep C?

A

25% - Fight it off
75% - Chronic infection

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35
Q

How do you test for hep C?

A

Hep C antibody screening test
then
Hep C RNA test for viral load

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36
Q

How do you manage hep C?

A

confirm diagnosis
Notify Public Health
refer to gastro or infectious diseases
stop smoking and alcohol

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37
Q

How is hep C treated?

A

direct anti virals tailord to the specific virus - cure in 12 weeks

38
Q

What are the two demographics for autoimmune hepatitis ?

A

menopausal woman

teenager with acute hepatitis

39
Q

what ivestigations could you do for autoimmune hepatitis?

A

raised ALT and AST and igG

Liver biopsy to confirm

40
Q

How do you treat autoimmune hepatitis?

A

Steroids - pernisolone

41
Q

How is haemochromatosis inherited?

A

autosomal ressesive

42
Q

How does haemachromatosis present?

A

40 year old
Fatigue
Joint pain
Hair loss
bronze colouration

43
Q

How do you investigate for haemachromatosis?

A

Check serum ferritin and transferrin

then genetic testing

44
Q

What are the complications of heamachromatosis?

A

Liver damage
endocrine disorders
cardiomyopathy?

45
Q

How do you treat haemachromatosis?

A

Weeky venesection

46
Q

What is alpha 1 antirypsin deficiency?

A

inherited disease which causes lung disease (30yrs) and liver diease (50yrs)

47
Q

What is the treatment for alpha 1 antitrypsin deficiency?

A

organ transplant
symptomatic managment

48
Q

What is primary biliary cirrhosis?

A

autoimmune attack on small bile ducts in liver

49
Q

How does primary billiary cirrhosis present?

A

Jaundice
Pale and greasy stools
fatigue
puritis
xanthoma and xanthelasma

50
Q

What is raised alkaline phosphate a marker of?

A

marker of billary obstruciton

51
Q

What does anti-mitochondrial antibodies cause?

A

Primary biliary cirrohsis

52
Q

How is primary bilary cirrohsis diagonesd?

A

Liver biopsy

53
Q

How is primary biliary cirrhosis treated?

A

Ursodeoxycholic acid

it reduces intestinal absoprtion of cholestrol

54
Q

What is Primary sclerosing cholangitis?

A

sclerosis of intra and extra hepatic bile ducts leading to liver disease

55
Q

What liver disease is associated with ulcerative colitis?

A

Primary sclerosing cholangitis

56
Q

Who gets primary sclerosing cholangitis?

A

Male 30 UC

57
Q

How does primary sclerosing cholangitis present?

A

Jaundince
URQP
puritis
fatigue

58
Q

What is a cholestatic picture on lft?

A

Really high alkaline phosphate compared to the other markers

59
Q

How is primary sclerosing cholangitis investigated?

A

MRCP

60
Q

How do you treat primary scleorisng cholangitis?

A

Endoscopic retrograde cholangio-pancretography to insert stents

liver transplant

61
Q

What are the two types of liver cancer?

A

hepatocellular carcinoma 80%
cholangiocarcinoma 20%

62
Q

What is the main risk factor for liver cancer?

A

liver cirrohsis

63
Q

What are the tumour markers you should check for in liver cancer?

A

Alpha-fetoprotein for hepatocellular cancer

CA19-9 for cholangiocarcinoma

64
Q

How is hepatocellular cancer treated?

A

not a good prognosis
does not respond to chemo or radio

liver transplant if isolated or surgery

65
Q

How is cholangiocarcinoma treated?

A

resection
ERCP
basically uncurable

66
Q

What is focal nodular hyperplasia?

A

Benign liver tumour, asymptomatic and no malignant potential

67
Q

What are the red flags for 2 week ref

A

Dysphagia
Weight loss
nausea and vomiting

68
Q

When should someone with GORD get an endoscopy?

A

Red flag symptom or treatment resistant dyspepsia

69
Q

What lifestyle advice can you give for GORD?

A

Reduce tea, coffee and alcohol
weightloss
smoking
smaller meals
lay upright

70
Q

What medical treatments do you use for GORD?

A

omeprazole and lanzoprazole

71
Q

What should you caution peope about when prescribing omeprazole?

A

start high then slowly reduce to maintance

long term risk of oesteoporosis

72
Q

What can you use instead of PPI for Gord?

A

Ranitidine

73
Q

What test should you do for all people with dyspepsia ?

A

Stool antigen test for h.pylori

74
Q

What are the testing methods for helicobacter pylori?

A

Only works if 2 weeks off of PPI

Stool antigen test
Rapid Urease test during endoscopy

75
Q

How do you treat helicobacter pylori infection?

A

triple therapy
PPI
amoxicilin
clarithromycin

76
Q

What is the lifetime risk of adenocarcinoma with barrets oesophagus ?

A

3-5% lifetime risk

77
Q

How do you differentiate between gastric and duodenal ulcers?

A

Eating makes gastric ulcers pain worse and duodenal ulcers pain better

78
Q

How are peptic ulcers investigated?

A

oesophageal endoscopy with biopsy

79
Q

What are the complications of peptic ulcers?

A

Bleeding
perforation
scarring and strictures

80
Q

What are the causes of an upper gi blled?

A

oesophageal varices
peptic ulcers
mallory-weiss tear
cancer

81
Q

How does upper gi bleed present?

A

haematemesis
coffee ground vomit (digested blood)
Malena

82
Q

What bloods should you take in upper gi bleed

A

FBC
UREA
coagulation
LFT
cross match 2 units of blood

83
Q

What is group and save and what is cross match?

A

group and save checks patients blood group and saves a sample for crossmatch later

crossmatch finds blood tests it and keeps it ready in the fridge for use

84
Q

What should you give for transfusion in upper gi bleed?

A

Blood
Platelets
fresh frozen plasma

prothrombin in warfarinsed

85
Q

What can you test for in inflammatory bowel disease?

A

Feacal calprotectin

86
Q

How is Crohn’s treated?

A

induce remission with steroids

then maintain with Azathioprine

87
Q

How is Ulcerative collitis treated?

A

mesalazine or steroids

then
mesalazine or azathioprine

88
Q

What tests should you do to investigate irritable bowel syndrome?

A

Bloods
Faecal calprotectin for inflammatory bowel
anti ttg antibodies for coeliac

89
Q

What symptoms are suggestive of irritable bowel syndrome?

A

abdominal pain which is improved by pooing or is associated with change in bowel habit

plus 2 of:
abnormal stool
mucus
bloating
worse after eating

90
Q

How do you treat irritable bowel syndrome?

A

regular small meals
low caffine and alcohol
probiotic for 4 weeks

Loperamide for diarrhoea
buscopan for cramps
laxitives

91
Q

What are the two auto-antibodies in coeliac disease?

A

Anti-TTG
Anti-EMA

92
Q
A

Zero to Finals Medicine (10 decks)

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