Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

finals > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

UGIB?

A

Bleeding from upper GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of UGIB?

A
  • peptic ulcers - gastro/duodenal
  • MW tear
  • oesophageal varices
  • stomach cancer
  • oesophagitis / GORD
  • AV malformation / aorto-enteric fistula
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

UGIB Px

A
  • haematemesis
  • coffee ground vomit
  • melaena
  • shock
  • abdo pain - ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

UGIB Ix?

A

Bloods
Haemoglobin (FBC)
Urea (U&Es)
Coagulation (INR and FBC for platelets)
Liver disease (LFTs)
Crossmatch 2 units of blood
Group and Save
VBG

Oesophago-gastro-duodenoscopy (OGD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

UGIB risk assessment tools?

A

Glasgow-Blatchford Score
>0 - high risk for GI bleed
- considers bloods, obs, symptoms and comorbidities

Rockall score post endoscopy
- considers age, shock, co-morbidities, endoscopic signs of acute bleeding and endoscopic diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

UGIB MX?

A

unstable?
1. ABCDE - 2 large bore cannulas, O2, fluids and consider transfusion
2. stop anticoagulants / NSAIDs + reverse anticoagulation, eg vit K, PCC
3. keep nil by mouth and send for urgent endoscopic Dx

If variceal? give terlipression plus ABx
if non variceal? clipping or thermal coagulation or band ligation

Unsuccessful? consider surgery
NB can use Sengstaken-Blakemore tube with variceal bleed until surgery can be performed
NB PPI post endoscopy for PUD

Stable?
1. endoscopy within 24 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

peptic ulcer disease?

A

ulcer in mucosa of stomach / duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PUD causes

A

disruption of mucosa: NSAIDs + H pylori

Overproduction of acid: stress
- alcohol, caffeine, smoking, spicy foods
- Zollinger-Ellison syndrome

Bleeding risk increased with
- NSAIDs, aspirin, anticoags, steroids, SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PUD Px?

A
  • epigastric discomfort / pain - gastric worsens pain, duodenal pain improves on eating, then worsens in 2-3hrs
  • wt loss
  • N+V
  • dyspepsia - beware ALARMS - anaemia, loss of weight, anorexia, recent onset sx, melaena, haematemesis, dysphagia
  • UGIB - haematemesis, coffee ground vomit, melaena, low Hb
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PUD pain: gastric vs duodenal ulcer

A

gastric worsens pain
duodenal pain improves on eating, then worsens in 2-3hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PUD Ix?

A
  • FBC
  • OGD

H pylori Ix
- urea breath test
- stool antigen test
- rapid urease test - CLO test
- serological IgG test

  • biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PUD and H pylori Mx

A
  • Stop NSAIDs / causes
  • PPIs - lansoprazole / omeprazole
  • H2 receptor antagonist - ranitidine / cimetidine
  • rpt OGD in 4-8wks to check healing

H pylori Mx
- PPI - lansoprazole
- 2 abx - amoxicillin + clari / met (clari + met if pen allergic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Complications of PUD?

A
  • bleeding
  • perforation
  • acute pancreatitis
  • scarring, strictures -> gastric outlet obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

GORD?

A

Flow of acid from stomach through LOS into oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

GORD causes?

A
  • Greasy and spicy foods
  • Coffee and tea
  • Alcohol
  • Non-steroidal anti-inflammatory drugs
  • Stress
  • Smoking
  • Obesity
  • Hiatus hernia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

GORD Px?

A
  • dyspepsia
  • retrosternal / epigastric pain
  • bloating
  • nocturnal cough
  • hoarse voice
  • eased with burping
  • food / acid brash
  • water brash
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

GORD red flags - need 2ww for OGD

A
  • Dysphagia (at any age)
  • > 55
  • Weight loss
  • Upper abdo pain
  • Reflux
  • Tx-resistant
  • N+V
  • Upper abdo mass
  • Low Hb
  • Raised platelets

ALARMS
- anaemia
- loss of weight
- anorexia
- recent onset sx
- masses / melaena / haematemesis
- swallowing difficulty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

GORD Ix?

A
  • OGD
  • barium swallow
  • H pylori Ix
  • 24hr oesophageal pH monitoring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

GORD Mx

A
  • reduce tea, coffee, alcohol / wt loss / stop smoking / smaller meals
  • antacids - Gaviscon, rennie
  • PPIs - omeprazole, lansoprazole
  • H2 antagonist - ranitidine, famotidine
  • laparoscopic fundoplication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Complications of GORD?

A

Barrett’s oesophagus
- lower oesophageal epithelium changes from stratified squamous to simple columnar - premalignant for adenocarcinoma
- Mx - endoscopic monitoring, PPI, ablation / resection

Peptic stricture
- narrowing
- Px - intermittent dysphagia, worsening
- Mx - endoscopic dilatation, long term PPI

MW tear
Iron deficiency
Ulcers
oesophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

UC?

A

Relapsing / remitting inflammatory disorder of colonic mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pathophysiology of UC?

A

inappropriate immune response against colonic flora

C – Continuous inflammation
L – Limited to the colon and rectum
O – Only superficial mucosa affected
S – Smoking may be protective (ulcerative colitis is less common in smokers)
E – Excrete blood and mucus
U – Use aminosalicylates
P – Primary sclerosing cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

UC Px?

A
  • Insidious / intermittent sx
  • Bloody diarrhoea
  • Urgency
  • Tenesmus
  • Abdo pain
  • Fatigue, weight loss
  • Blood / mucus in stools
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what conditions are associated with inflammatory bowel disease?

A
  • Erythema nodosum (tender, red nodules on the shins caused by inflammation of the subcutaneous fat)
  • Pyoderma gangrenosum (rapidly enlarging, painful skin ulcers)
  • Enteropathic arthritis (a type of inflammatory arthritis)
  • Primary sclerosing cholangitis (particularly with ulcerative colitis)
  • Red eye conditions (e.g., episcleritis, scleritis and anterior uveitis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

UC Ix?

A
  • FBC, CRP, U/E, LFT, TFTs
  • Stool MC+S
  • faecal calprotectin
  • colonoscopy + biopsy
  • CT / MRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

UC Mx?

A
  • aim to induce / maintain remission

Inducing Remission
Mild to moderate disease
* 1st line: aminosalicylate (e.g. mesalazine oral or rectal)
* 2nd line : corticosteroids (e.g. prednisolone)

Severe disease
* 1st line : IV corticosteroids (e.g. hydrocortisone)
* 2nd line : IV ciclosporin

Maintaining Remission
Aminosalicylate (e.g. mesalazine oral or rectal)
Azathioprine
Mercaptopurine

  • Surgery - colectomy, tx strictures/fistulas/abscess
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

UC Cx

A
  • colonic cancer
  • toxic dilatation of colon
  • perforation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Crohn’s

A

Chronic inflammatory disease characterised by transmural granulomatous inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Crohn’s pathophysiology?

A
  • any part of gut affected
  • most commonly terminal ileum - site of B12 absorption
  • strictures / fistulas
  • transmural inflammation, goblet cells, granulomas, skip lesions, cobblestone appearance
    RFs
    smoking, NSAIDs, FHx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Crohns presentation?

A
  • Abdo pain
  • Diarrhoea
  • Weight loss
  • Fatigue, fever, malaise, anorexia
  • Inflammatory associations as above
  • Clubbing
  • Mouth ulcers
  • Blood / mucus less common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Crohn’s Ix?

A
  • Bloods - FBC, CRP, U/E, LFT, TFT, B12/folate
  • stool MC+S
  • faecal calprotectin
  • colonoscopy + biopsy
  • CT / MRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Crohn’s Mx/

A

Induce remission
- oral prednisolone / IV hydrocortisone
- mesalazine
- azathioprine / mercaptopurine / methotrexate / infliximab / adalimumab

Maintain remission
- azathioprine / mercaptopurine
- methotrexate

Surgery
- resect distal ileum, tx strictures / fistulas / abscesses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

coeliac disease

A
  • autoimmune inflammatory condition triggered by eating gluten
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

coeliac pathophysiology?

A
  • anti-TTG / anti-EMA ABs created in response to gluten - target epithelial cells in SI
  • jejunum particularly affected
  • crypt hypertrophy + villous atrophy -> malabsorption

Associations
- autoimmune thyroid disease
- T1DM
- dermatitis herpetiformis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Coeliac Px?

A
  • asym
  • failure to thrive (children)
  • diarrhoea
  • bloating
  • fatigue
  • wt loss
  • mouth ulcers
  • dermatitis herpetiformis - itchy, blistering skin rash - on abdo
  • anaemia
  • neuro sx - peripheral neuropathy, ataxia, epilepsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Coeliac Ix?

A
  • Bloods - FBC, ferritin, haematinics, LFTs, anti-TTG, total IgA
  • endoscopy, biopsy (traditionally duodenum, but also jejunum)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Coeliac Mx?

A
  • Bloods - FBC, ferritin, haematinics, LFTs, anti-TTG, total IgA
  • endoscopy, biopsy (traditionally duodenum, but also jejunum)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

IBS

A

Mixed group of abdo sx with no organic cause (functional)
- IBS-C/D/M - constipation/diarrhoea/mixed

  • disorder in brain-gut axis - abnormal smooth muscle activity
  • various causes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

IBS Px

A
  • Abdo pain
  • Diarrhoea
  • Constipation
  • Change in bowel habit
  • Bloating
  • Worse after eating
  • Improved by opening bowels
  • Passing mucus
  • Sx >6mo for d
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

IBS - red flags to exclude!

A
  • Rectal bleeding / blood in stool
  • Weight loss
  • FHx bowel / ovarian cancer
  • > 60yo
  • Nocturnal sx
  • Anaemi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

IBS Ix

A
  • Bloods - FBC, CRP/ESR, anti-TTG, CA125 (ovarian ca)
  • faecal calprotectin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

IBS Mx

A
  • fluids, fibre, limit caffeine/fatty foods, FODMAP, exercise
  • diarrhoea - loperamide
  • constipation - ispaghula husk / linaclotide
  • anti-spasmodics - mebeverine, buscopan, peppermint oil
  • low dose amitriptyline, SSRIs, CBT/hypnotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Alcoholic liver disease (ALD)

A
  • liver disease from alcohol consumption

fatty liver -> alcoholic hepatitis -> alcoholic steatosis -> cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

ALD Patho

A

Fatty liver
- cells swollen with fat from alcohol metabolism, reversible

Alcoholic hepatitis
- inflammation, fatty change, leukocyte infiltration, necrosis, mallory bodies

Liver cirrhosis
- fibrosis, irreversibl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

ALD Px?

A

Fatty liver
- asym
- N+V, diarrhoea
- hepatomegaly

Hepatitis
- jaundice, ascites, abdo pain, fever, hepatomegaly
- sx of chronic disease

Cirrhosis
- chronic disease - ascites, bruising, Dupuytren’s etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

ALD Ix?

A
  • Bloods - FBC, LFT (raised ALT/AST, raised GGT, later raised ALP, raised bilirubin in cirrhosis, low albumin), coag, U/E
  • liver USS - fatty changes / cirrhosis
  • transient elastography (Fibroscan)
  • CT / MRI
  • liver biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

ALD Mx?

A
  • stop drinking
  • CBT / motivational interviewing
  • tx cx - eg thiamine, detox
  • prednisolone
  • liver transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Non alcoholic fatty liver (NAFLD?)

A
  • excessive fat in liver

Patho
- steatosis - fat liver
- Non-alcoholic steatohepatitis (NASH) - fat with inflammation
- fibrosis/cirrhosis later on

RFs
- older, obesity, poor diet, sedentary, T2DM, high cholesterol, HTN, smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

NAFLD Px?

A
  • asymptomatic
  • hepatomegaly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

NAFLD Ix

A
  • bloods - LFTs, enhanced liver fibrosis (ELF) test
  • USS - increased echogenicity
  • NAFLD fibrosis score
  • FIB-4 score
  • Fibroscan
  • liver biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

NAFLD Mx?

A
  • diet, weight, stop smoking
  • specialist mx - vit E, pioglitazone, bariatric surgery, liver transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

acute liver failure?

A
  • acute deterioration in liver function

Patho
- hepatic encephalopathy
- coagulopathy
- ascites
- jaundice

Causes
- paracetamol OD
- alcohol
- viral hepatitis
- acute fatty liver of pregnancy
- HCC, Wilson’s, A1AT deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

acute liver failure Px

A
  • jaundice
  • coagulopathy - bleeding, bruising
  • hypoalbuminaemia - ascites
  • hepatic encephalopathy - confusion, coma, asterixis, drowsiness, slurred speech, behaviour change, apraxia
  • renal failure
  • fever, vomiting
  • fetor hepaticus
  • maybe sx of chronic disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

acute liver failure Ix

A
  • Bloods - inc LFTs, PTT, albumin, coag, FBC, U/E, culture, viral serology
  • USS, CT/MRI, CT head
  • avoid liver biopsy if coagulation derranged
  • EEG - encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

acute liver failure Mx

A
  • tx cause
  • liver transplan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

liver cirrhosis

A
  • fibrosis of liver from chronic inflammation
  • collagen deposition + scarring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

causes of liver cirrhosis?

A
  • Alcohol liver disease
  • NAFLD
  • Hep B/C
  • Autoimmune hepatitis
  • Primary biliary cirrhosis
  • Haemochromatosis, Wilson’s, A1AT deficiency
  • CF
  • Drugs - amiodarone, methotrexate, sodium valproate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

liver cirrhosis Px?

A
  • leukonychia
  • finger clubbing
  • palmar erythema
  • Dupuytren’s contracture
  • spider naevi >5
  • xanthelasma
  • loss of body hair
  • jaundice
  • HSM
  • bruising
  • ankle swelling, oedema, ascites
  • caput medusae
  • cachexia
  • gynaecomastia, testicular atrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Liver cirrhosis Ix?

A
  • bloods - LFTs, coag, FBC, U/E, AFP (HCC)
  • NILS
  • US liver
  • enhanced liver fibrosis test
  • fibroscan
  • CT / MRI
  • liver biopsy
  • Model for End-Stage liver disease (MELD) score
  • Child Pugh score
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

liver cirrhosis Mx?

A
  • tx cause
  • monitor cx - 6mo US/AFP, 3yrly OGD
  • ascites - fluid restrict, spironolactone, furosemide, paracentesis
  • liver transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

liver cirrhosis Cx?

A
  • malnutrition
  • varices
  • portal HTN
  • ascites
  • SBP
  • hepatorenal syndrome
  • hepatic encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

portal HTN?

A
  • high pressure in hepatic portal vein from liver cirrhosis, increased resistance
  • leads to ascites, splenomegaly, varices, caput medusae, collateral vessel formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

portal HTN causes?

A

Pre-hepatic
- portal vein thrombosis

intra-hepatic
- cirrhosis
- schistosomiasis
- sarcoidosis

Post-hepatic
- RHF
- constrictive pericarditis
- IVC obstruction
- Budd-Chiari syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Portal HTN Px?

A
  • Splenomegaly
  • Caput medusae
  • Ascites
  • Sx of liver disease / other cx
  • Sx of varices
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Portal HTN Ix?

A
  • for liver disease - bloods, biopsy, CT/MRI etc
  • Abdo US / doppler US
  • hepatic venous pressure gradient
  • vascular imaging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

portal HTN Mx?

A
  • tx cause, liver transplant
  • BBs / nitrates
  • TIPS
  • salt restriction, diuretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

ascites?

A

free fluid in peritoneal cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

causes of ascites?

A

Inflammation
- peritonitis
- infection, TB
- abdo cancer, ovarian
- intra-abdo surgery

Low protein
- hypoalbuminaemia
- nephrotic syndrome
- malnutrition

Low flow
- cirrhosis, portal HTN
- Budd Chiari syndrome
- Cardiac failure
- constrictive pericarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

How to classify ascites?

A

Serum ascitic albumin gradient (SAAG) = serum albumin - ascitic fluid albumin

High SAAG >1.1g/dL - transudate
- Cirrhosis, portal HTN
- Acute liver failure
- Budd Chiari syndrome
- Portal vein thrombosis
- Cardiac failure
- Constrictive pericarditis

Low SAAG <1.1g/dL - exudate
- Malignancy
- Infection
- Pancreatitis
- Nephrotic syndrome
- Peritoneal TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

ascites Px?

A
  • Abdo swelling
  • Distention
  • Shifting dullness
  • Peripheral oedema
  • Weight gain
  • Abdo pain
  • Difficulty breathing
  • Sx of liver disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

ascites Ix?

A
  • abdo exam, shifting dullness
  • Bloods
  • USS / CT / MRI
  • Ascitic tap - SAAG, raised WCC, culture, cytology, amylase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

ascites mx?

A
  • tx cause
  • low Na diet, fluid restriction
  • oral spironolactone
  • add furosemide
  • paracentesis - ascitic tap / drain
  • human albumin solution
  • prophylactic abx - eg oral cipro
  • TIPS
  • liver transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Spontaneous bacterial peritonitis (SBP)?

A
  • infection of ascitic fluid (from liver cirrhosis)
  • commonly E coli / Klebsiella
74
Q

SBP Px

A
  • asymptomatic
  • ascites
  • abdo pain
  • fever
  • ileus
  • hypotension
  • guarding
  • abdo distention
75
Q

SBP Ix?

A
  • paracentesis - raised WCC
  • bloods - raised WCC
76
Q

SBP Mx?

A
  • broad spec abx - IV cefotaxime / met, maybe tazocin
77
Q

hepatorenal syndrome

A
  • impaired kidney function from changes in blood flow to kidneys - relating to cirrhosis / portal HTN

Mx
- Terlipressin
- albumin
- TIPS
- liver transplant

78
Q

hepatic encephalopathy

A
  • neurological dysfunction from build up of ammonia
  • grade I-IV
79
Q

hepatic encephalopathy Px?

A
  • irritable
  • confused, inappropriate behaviour
  • incoherent, restless
  • coma
  • asterixis, drowsiness, dyspraxia, slurred speech, apraxia (unable to draw 5-pointed star)
80
Q

hepatic encephalopathy Ix?

A
  • as for liver failure
  • EEG - triphasic slow waves
81
Q

hepatic encephalopathy Mx?

A
  • lactulose
  • rifaximin (neomycin / met alternatives)
  • tx liver disease
82
Q

viral hepatitis

A
  • inflammation of liver
  • <6mo acute, >6mo chronic
83
Q

Causes of hepatitis?

A

Viral
- Hep A, E, C, B/D
- Herpes viruses – EBV, CMV, VZV

Non-viral
- Leptospirosis
- Toxoplasmosis
- Coxiella
- TB

Non-infective
- Drugs / toxins
- NAFLD / NASH
- Pregnancy
- Autoimmune
- Hereditary metabolic causes

84
Q

viral hepatitis Px?

A
  • Abdo pain
  • Fatigue
  • Flu-like illness
  • Jaundice
  • Pruritis
  • Myalgia
  • N+V
  • Acute liver failure - bleeding, ascites, encephalopathy
  • If chronic, signs of cirrhosis / chronic liver disease
85
Q

viral hepatitis Ix?

A
  • LFTs - hepatitis picture - high AST/ALT, greater than ALP, high bilirubin
86
Q

hepatitis A?

A
  • RNA virus, faeco-oral transmission
  • 2-6wk incubation
  • usually self-limiting
  • Vaccine to prevent
87
Q

hepatitis A Px?

A
  • pre-icteric - 1wk before jaundice - abdo pain, fever, anorexia, arthralgia, N+V
  • icteric - jaundice
  • HSM, RUQ pain
88
Q

hepatits A Ix?

A
  • Bloods - LFTs, FBC
  • HAV ABs - IgM / IgG
89
Q

hepatitis A Mx?

A
  • supportive - fluids, antiemetics
  • vaccine to prevent / for contacts
90
Q

hepatitis E?

A
  • RNA virus, similar to hep A
  • faeco-oral transmission, 2-9wk transmission

Px
- as hep A
- >95% asym
- maybe neuro sx

Ix
- LFTs
- viral serology

Mx
- supportive
- ribavirin
- hygiene / sanitation to prevent

91
Q

hepatitis B?

A
  • DNA virus
  • blood-borne, bodily fluid transmission, vertical transmission
  • 1-6mo incubation
  • 5% develop chronic hep B - risk of HCC, cirrhosis, liver failure - virus DNA integrates into cell nucleus
92
Q

Hep B Px?

A
  • can be asymptomatic
  • jaundice
  • dark urine
  • hepatosplenomegaly
93
Q

hep B Ix?

A
  • serology
  • LFTs
  • screen for other viral infections - HIV, hep A, C, D
94
Q

hep B serology?

A

HBsAg - surface antigen - active infection

Anti-HBs / HBsAb - surface antibody - vaccination or past/current infection - immune response

Anti-HBc / HBcAb - core antibodies - past/current infection - in response to core antigen - IgM / IgG

HBeAg - envelope antigen - marker of viral replication / infectivity

Anti-HBe / HBeAb - antibodies to envelope antigen - if positive with negative HBeAg -> replication phase has passed, chronic infection is inactive

HBV DNA - hep B virus DNA - direct count of viral load

95
Q

Hep B screening?

A
  • test for anti-HBc (previous infection) and HBsAg (active infection)
  • if positive, test for HBeAg and HBV DNA for infectivity
96
Q

hep B serology interpretation?

A

Active infection
HBsAg+, HBeAg+, anti-HBc IgM+, HBV DNA+

Chronic infection (active)
HBsAg+, HBeAg+, anti-HBc IgG+, HBV DNA+ (high)

Chronic infection (inactive, carrier)
HBsAg+, anti-HBe+, anti-HBc IgG+, HBV DNA+ (low)

Immunity (after acute infection)
HBsAb+, anti-HBe+, anti-HBc IgG+

Immunity (after vaccine)
HBsAb+

97
Q

hep B Mx?

A
  • vaccine to prevent
  • contact tracing
  • antivirals - pegylated interferon-alpha, tenofovir
  • liver transplant if liver failure
98
Q

hep B Cx?

A
  • chronic hepatitis
  • liver failure
  • HCC
99
Q

hepatitis D?

A
  • incomplete RNA virus, needs hep B to manifest
  • blood-borne

Px
- as hep B

Ix
- as HBV
- hep D ABs, HDV RNA (PCR)

Mx
- pegylated interferon alpha

100
Q

hepatitis C?

A
  • RNA virus
  • blood-borne, bodily fluids
  • 70% develop chronic infection -> cirrhosis, liver failure, HCC, rheum issues, cryoglobulinaemia
    Px
  • most acute infections asym
  • flu-like sx
  • jaundice
    Ix
  • LFTs
  • POCTs
  • hep C AB
  • hep C RNA testing
    Mx
  • pegylated interferon alpha / ribavirin
  • supportive
  • no vaccine
    Cx
  • HCC, cirrhosis, liver failure
101
Q

autoimmune hepatitis?

A
  • chronic autoimmune inflammatory liver disease

Type 1
- 80%, F in late 40/50s
- ANA, anti-actin, anti-SLA/LP

Type 2
- children
- anti-LMK1, anti-LC1

Type 3
- adults middle aged
- soluble liver kidney Ag

102
Q

autoimmune hepatitis Px?

A
  • liver disease - hepatitis, HSM, ascites, encephalopathy, abdo pain, jaundice
  • fever, malaise, urticarial rash, polyarthritis, pleurisy, pulm infiltration, glomerulonephritis
  • amenorrhoea
103
Q

autoimmune hepatitis Ix?

A
  • Bloods - LFTs, IgG, auto-ABs
  • liver biopsy
104
Q

autoimmune hepatitis Mx?

A
  • immunosuppressants - pred, azathioprine
  • liver transplant
105
Q

hereditary haemochromatosis (HHC)

A
  • autosomal recessive - increased intestinal iron absorption
  • iron deposits in liver, joints, heart, pancreas, pituitary, adrenals -> fibrosis, liver cirrhosis
106
Q

HHC Px?

A
  • fatigue, arthralgia, hypogonadism (erectile dysfunction, testicular atrophy, amenorrhoea)
  • chronic liver disease, hepatomegaly, HF, arrhythmias, osteoporosis, DM, memory/mood disturbance
  • bronze skin pigmentation
107
Q

HHC Ix?

A
  • iron study - raised ferritin, transferrin, serum iron, low TIBC
  • LFTs
  • genetic testing
  • MRI
  • liver biopsy
  • ECG / ECHO
108
Q

HHC Mx?

A
  • low dietary iron
  • venesection
  • desferrioxamine
  • liver transplant
  • tx cx - eg DM, testosterone
109
Q

Wilson’s disease?

A
  • autosomal recessive - excess copper accumulation in body
  • error in copper metabolism - not bound to caeruloplasmin - deposited in liver, basal ganglia, cornea, kidneys, bones
110
Q

Wilson’s Px?

A
  • Liver - acute / chronic hepatitis, cirrhosis
  • Neuro - tremor, dysarthria, dystonia, Parkinsonism
  • Psych - abnormal behaviour, depression, cognitive impairment, psychosis
  • Kaiser-Fleischer rings
  • osteopenia
  • renal tubular acidosis
  • haemolytic anaemia
111
Q

Wilson’s Ix?

A
  • Bloods - low serum caeruloplasmin, low total serum copper, low Hb, negative Coombs
  • 24hr urine copper assay
  • liver biopsy
  • Slit-lamp
  • MRI brain
  • genetic testing
112
Q

Wilson’s Mx?

A
  • penicillamine / trientine
  • zinc salts
  • liver transplan
113
Q

A1AT deficiency?

A
  • genetic condition - low alpha-1 antitrypsin
  • no inhibition of neutrophil elastase -> attacks connective tissue in lungs
  • abnormal variant of A1AT builds up in hepatocytes -> inflammation, fibrosis
114
Q

A1AT deficiency Px?

A

Lungs - adults, resp sx, SOB etc
Liver - children, hepatitis, cirrhosis, jaundice

115
Q

A1AT deficiency Ix?

A
  • low serum A1AT
  • genetic testing
  • CXR, HRCT, pulm function tests
  • liver biopsy
116
Q

A1AT deficiency Mx?

A
  • stop smoking
  • Mx of COPD
  • lung volume reduction surgery
  • liver / lung transplant
117
Q

primary biliary cholangitis?

A
  • autoimmune granulomatous inflammation of small bile ducts in liver
  • obstructive jaundice + liver disease
  • anti-mitochondrial ABs (AMA)
118
Q

primary biliary cholangitis Px?

A
  • autoimmune granulomatous inflammation of small bile ducts in liver
  • obstructive jaundice + liver disease
  • anti-mitochondrial ABs (AMA)
119
Q

primary biliary cholangitis Ix?

A
  • LFTs - raised ALP
  • Auto-ABs - AMA, also ANA
  • raised IgM
  • US liver / biliary tract / MRCP
  • Liver biopsy
120
Q

primary biliary cholangitis Mx?

A
  • LFTs - raised ALP
  • Auto-ABs - AMA, also ANA
  • raised IgM
  • US liver / biliary tract / MRCP
  • Liver biopsy
121
Q

primary biliary cholangitis complications?

A
  • Liver cirrhosis, portal HTN, HCC
  • Renal tubular acidosis
  • Hypothyroidism / thyroid disease
  • Fat malabsorption, ADEK deficiency
  • Osteoporosis
  • Hyperlipidaemia
  • Sjogren’s syndrome, systemic sclerosis, RA
122
Q

primary sclerosing cholangitis?

A
  • inflammation / sclerosis of intra/extrahepatic bile ducts - obstruct bile flow - liver inflammation / cirrhosis
  • UC association
123
Q

primary sclerosing cholangitis Px?

A
  • asym
  • RUQ pain, pruritis, fatigue, jaundice, HSM, sx of cirrhosis
124
Q

primary sclerosing cholangitis Mx?

A
  • ERCP - stent strictures
  • liver transplant
  • colestyramine
  • vit ADEK
125
Q

primary sclerosing cholangitis Ix?

A
  • LFTs - raised ALP
  • Auto-ABs (less helpful) - p-ANCA, ANA, anti-SMA
  • MRCP
  • colonoscopy (UC)
  • liver biopsy
126
Q

primary sclerosing cholangitis complications?

A
  • Cirrhosis
  • Cholangiocarcinoma - develops in 10-20%
  • Acute bacterial cholangitis
  • ADEK deficiency
  • Osteoporosis
127
Q

hepatocellular carcinoma (HCC)

A
  • primary liver cancer
  • secondary more common
  • mets to lymph nodes, bones, lungs, brain
128
Q

HCC risk factors?

A
  • liver cirrhosis - from NAFLD, ALD, hep B/C, PSC
  • pts with liver cirrhosis - screen for HCC - 6monthly USS, AFP
129
Q

HCC Px?

A
  • asym - presents late
  • liver cirrhosis / failure
  • wt loss
  • abdo pain
  • anorexia
  • N+V
  • jaundice
  • pruritis
  • upper abdo mass
130
Q

HCC Ix?

A
  • AFP - raised
  • Liver USS
  • CT / MRI
  • biopsy
131
Q

HCC Mx?

A
  • surgical resection
  • liver transplant
  • radiofrequency / microwave ablation
  • transarterial chemoembolisation
  • radiotherapy
  • targeted drugs - kinase inhibitors, MAbs
132
Q

describe 3 types of benign liver tumour?

A

Haemangioma
- most common benign liver tumour
- US / CT / MRI
- no tx

Hepatic adenoma
- common - cOCP, anabolic steroids, pregnancy association
- abdo pain, intraperitoneal bleeding
- surgical resection if sx

Focal nodular hyperplasia
- benign liver tumour of fibrotic tissue, related to oestrogen, OCP
- asym
- no tx / monitorin

133
Q

Zollinger-Ellison syndrome

A
  • duodenal / pancreatic tumour secretes excess gastrin -> stimulates acid secretion in stomach -> dyspepsia, diarrhoea, peptic ulcers

Dx
- fasting gastrin levels / secretin stimulation test

Gastrinomas associated with MEN 1

134
Q

achalasia?

A
  • failure of oesophageal peristalsis and impaired relaxation of LOS
  • due to degeneration of ganglia from Auerbach’s plexus
135
Q

achalasia Px?

A
  • dysphagia - both solids + liquids
  • variation in sx severity
  • dyspepsia
  • regurg of foods -> cough, asp pneumonia
  • malignant change (in small no)
136
Q

achalasia Ix?

A
  • oesophageal manometry
  • barium swallow
  • CXR
  • CT / OGD
137
Q

achalasia Mx?

A
  • balloon dilatation
  • surgery - Heller cardiomyotomy
  • botox injection into sphincter
  • nitrates, CCBs
138
Q

alcoholic ketoacidosis

A
  • non-diabetic euglycaemic ketoacidosis
  • binge drinkers -> malnourished, starved
  • metabolic acidosis, elevated anion gap, elevated serum ketones, normal/low glucose

Mx
- IV fluids, thiamine

139
Q

angiodysplasia?

A
  • vascular deformity of GI tract

Px
- iron-deficiency anaemia
- GI bleed

Ix
- colonoscopy
- mesenteric angiography

Mx
- endoscopic cautery
- TXA
- oestrogens

140
Q

Budd-chiari syndrome?

A
  • blockage of hepatic vein, obstructing liver outflow
  • primary - thrombosis
  • secondary - external - eg tumour
    Causes
  • polycythaemia
  • thrombophilia
  • pregnancy
  • cOCP
    Px
  • abdo pain, sudden onset, severe
  • ascites, abdo distension
  • tender hepatomegaly
  • liver failure sx
    Ix
  • deranged LFTs, coag
  • USS, doppler flow studies
  • CT / MRI
    Mx
  • tx cause
  • anticoagulate - warfarin / DOAC
  • shunt - TIPS
  • liver transplant if failure
141
Q

Gilbert’s syndrome?

A
  • autosomal recessive condition of defective bilirubin conjugation (glucuronyl transferase deficiency)
    Px
  • jaundice - eg when ill, exercising, fasting
  • no stool / urine change
    Ix
  • high bilirubin - after fasting / IV nicotinic acid
    Mx
  • none
142
Q

ischaemic hepatitis?

A
  • autosomal recessive condition of defective bilirubin conjugation (glucuronyl transferase deficiency)
    Px
  • jaundice - eg when ill, exercising, fasting
  • no stool / urine change
    Ix
  • high bilirubin - after fasting / IV nicotinic acid
    Mx
  • none
143
Q

clostridium difficile?

A
  • G+ rod, anaerobic
  • develops when normal gut flora suppressed by broad spec abx
  • exotoxin damages intestine (epithelial/inflammatory cells) -> colitis
  • faeco-oral transmission
144
Q

c diff causes?

A
  • clindamycin
  • cephalosporins
  • co-amox
  • carbapenems
  • ciprofloxacin
  • PPIs
145
Q

c diff presentation?

A
  • diarrhoea
  • abdo pain
  • nausea
  • dehydration
  • fever if severe
146
Q

c. diff Ix?

A
  • stool sample - C diff Ag / A/B toxins
  • FBC - raised WCC
  • C diff Ag - serum
147
Q

c diff Mx?

A

First episode
- oral vancomycin
- oral fidaxomicin
- oral vanc +/- IV met

Recurrent
- <12wks of sx resolution - oral fidaxomicin
- >12wks - oral vancomycin / fidaxomicin

Life-threatening
- oral vancomycin + IV met
- surgery
- bezlotoxumab
- faecal microbiota transplant

148
Q

c diff complications?

A
  • pseudomembranous colitis - yellow/white plaques
  • toxic megacolon
  • bowel perforation
  • sepsis
149
Q

gastroenteritis

A

inflammation / infection of gastrointestinal tract
Diarrhoea - >3 loose/watery motions/d, chronic >14d

Causes
- travellers diarrhoea
- acute food poisoning
- Viruses - rotavirus, norovirus, adenovirus
- Bacterial

150
Q

gastroenteritis –> E. coli

A
  • Travellers, watery stools, abdo cramps, nausea
  • E coli -157 - Shiga toxin -> HUS
  • Abx increase HUS risk - avoid in E coli GE
  • self limiting
151
Q

gastroenteritis –> giardiasis

A
  • Prolonged, non-bloody diarrhoea
  • Microscopic parasite, faeco-oral transmission
  • metronidazole
152
Q

gastroenteritis - cholera

A

Profuse watery diarrhoea, severe dehydration, wt loss, not common in travellers
- doxycycline/ ciprofloxacin

153
Q

gastroenteritis - shigella

A
  • Bloody diarrhoea, vomiting, abdo pain
  • Faeces / contaminated food/drink
  • Shiga toxin -> HUS
  • ciprofloxacin / azithromycin
154
Q

gastroenteritis - staph aureus

A
  • Severe vomiting - short incubation period
  • Caused by enterotoxin from bacteria
  • self limiting
155
Q

gastroenteritis - campylobacter

A
  • Flu-like prodrome, crampy abdo pain, fever, diarrhoea +/- blood, GBS cx
  • Most common cause travellers diarrhoea
  • Untreated water, unpasteurised milk, poultry
  • clarithromycin / azithro / cipro
156
Q

gastroenteritis - bacillus cereus

A
  • Vomiting in 6hrs (eg rice) / watery diarrhoea after 6hrs
  • self limiting or vancomycin
157
Q

gastroenteritis amoebiasis

A
  • Gradual onset bloody diarrhoea, abdo pain, tenderness
  • metronidazole + diloxanide furoate
158
Q

gastroenteritis - salmonella

A
  • Sudden onset abdo pain, diarrhoea +/- blood, nausea, vomiting, sometimes constipation
  • Food contamination / raw eggs / chicken
  • treat with ABx if severe e.g. cipro
159
Q

gastroenteritis incubation periods?

A
  • Sudden onset abdo pain, diarrhoea +/- blood, nausea, vomiting, sometimes constipation
  • Food contamination / raw eggs / chicken
160
Q

gastroenteritis presentation?

A
  • Nausea
  • Vomiting
  • Diarrhoea
  • Abdo pain
  • Fever
  • Blood in stools
  • Dehydration
161
Q

diarrhoea Ddx

A

Acute
- GE
- Diverticulitis
- Abx therapy
- Overflow incontinence – constipation

Chronic
- IBS
- IBD
- Colorectal cancer
- Coeliac disease

Other conditions
- Thyrotoxicosis
- Laxative abuse
- appendicitis

162
Q

gastroenteritis Ix

A
  • Stool sample - MC+S
  • monitor dehydration
163
Q

gastroenteritis Mx?

A
  • hydrate
  • oral rehydration salts - dioralyte
  • IV fluids
  • avoid loperamide / antiemetics
  • off school/work for 48hrs after sx
  • abx - if bloody diarrhoea, immunocompromised, typhoid, elderly, severe sx
164
Q

complications of gastroenteritis?

A
  • Lactose intolerance
  • IBS
  • ReA
  • GBS
  • HUS
165
Q

constipation?

A
  • Defecation that is unsatisfactory - can be infrequent, difficult passage (straining / discomfort), incomplete defecation
  • Chronic >3mo
166
Q

causes of constipation?

A

Faecal impaction
Functional / primary
Organic / secondary
- drugs - opioids, anticholinergics, calcium salts, iron salts, CCBs
- medical - bowel obstruction, IBS, cancer, diverticular disease, dehydration, hypothyroid, neuromuscular, anorexia, pregnancy

167
Q

constipation Px?

A
  • Not opening bowels
  • Infrequent
  • Hard stools
  • Maybe droppings
  • Overflow incontinence
168
Q

constipation assessment

A
  • normal bowel habit
  • abdo / rectal / urinary sx
  • abdo exam, PR
  • bloods - FBC, U/E, LFTs, Ca, TFTs
  • specialist - sigmoidoscopy / colonoscopy, CT colon, AXR
169
Q

constipation red flags?

A
  • Persistent unexplained change in bowel habits
  • Palpable mass in RLQ / pelvis
  • Persistent PR bleed w/o anal sx
  • Narrowing of stool calibre
  • FHx colon cancer / IBD
  • Unexplained weight loss, iron deficiency anaemia, fever, nocturnal sx
  • Severe, persistent constipation
170
Q

constipation management?

A

red flags - gastro / surgery referral
- continence service / dietician
- increase fibre, fluids, activity

General mx
1st - ispaghula husk
2nd - macrogols +/- senna/bisacodyl
3rd - prucalopride / linaclotide

171
Q

management of faecal impaction?

A

1st - macrogols +/- senna/bisacodyl
2nd - suppositories - bisacodyl +/- glycerol
3rd - micro-enema - docusate sodium / sodium citrate
4th - retention enema - sodium phosphate enema / arachis oil enema

172
Q

management of opioid induced constipation?

A

1st - senna/bisacodyl +/- macrogols (also prophylaxis)
2nd - docusate sodium / sodium picosulfate
3rd - methylnaltrexone SC / naloxegol tabs

173
Q

management of ibs associated constipation

A

antispasmodic - mebeverine / peppermint oil

174
Q

constipation complications?

A
  • overflow diarrhoea
  • acute urinary retention
  • haemorrhoids
175
Q

paracetamol overdose?

A
  • peak conc at 4hrs
  • inactivated by liver conjugation, then renally excreted
  • in OD, normal pathway saturated, so metabolised by alt pathway - toxic NAPQI produced - normally deactivated by glutathione - but stores of this depleted - NAPQI builds up -> necrosis in liver/kidney
176
Q

types of paracetamol OD?

A

Acute ingestion
- taken within <1hr
- >150mg/kg can be fatal

Staggered
- over >1hr

Unknown time
- tx as staggered

Delayed presentation
- start tx empirically whilst awaiting tx

Unintentional
- no self-harm intention
- >4g/24hrs

177
Q

paracetamol OD Px?

A

<24hrs
- May be asymptomatic
- N+V, abdo pain

> 24hrs-72hrs
- RUQ pain, jaundice, acute liver failure
- Hepatic encephalopathy, confusion
- Hypoglycaemia
- Coagulopathy, bruising
- Asterixis
- Oliguria, renal failure ~72hrs
- Lactic acidosis
- Coma

178
Q

paracetamol OD Ix?

A

Bloods
- FBC, U/E, LFTs (ALT most important), bone profile, gas, BM, coag, phosph
- paracetamol levels >4hrs post-ingestion - use nomogram
- salicylate levels

Assess
- dose ingested, time since last dose, weight, pregnancy, suicide risk

Indications for hospital admission
- Symptomatic
- >75mg/kg over <1hr
- >75mg/kg, time uncertain
- Staggered OD
- >4g/24hrs
- Self-harm

179
Q

paracetamol OD Mx?

A
  • activated charcoal <1hr post-ingestion
  • N-acetylcysteine (NAC) - beware anaphylactoid reaction
  • liver transplant
  • liaison psychiatry
180
Q

NAC indications?

A
  • plasma paracetamol conc above tx line 4-15hrs post-ingestion
  • staggered OD
  • presenting 8-24hrs post-ingestion of >150mg/kg dose
  • presenting >24hrs - jaundiced / hepatic tenderness / ALT deranged
181
Q

Paracetamol OD Mx timeline - very long flashcard!

A

<1hr post-ingestion
- Activated charcoal

<8hrs post-ingestion
- Take paracetamol level >4hrs after last ingestion
- Plot level on nomogram
- Start NAC if - plasma conc levels greater than nomogram line / evidence of hepatic injury / results not available within 8hrs ingestion

8-24hrs post-ingestion
- Take urgent paracetamol level on admission
- Start NAC immediately if >150mg/kg ingested
- Plot plasma level on nomogram
- If below line, asymptomatic, normal bloods – can stop NAC

> 24hrs post-ingestion
- Take urgent paracetamol level on admission
- Start NAC immediately if jaundiced / hepatic tenderness
- Tx with NAC if ALT raised / INR >1.3 / paracetamol level still detected
- No NAC if asym, normal bloods, no paracetamol detected

Staggered OD
- Start NAC immediately
- Take paracetamol level >4hrs after last ingestion
- Stop NAC if – >4hrs after last ingestion AND paracetamol <10mg/L, ALT normal, no signs hepatic damage
- Continue NAC if – sx of hepatic damage, paracetamol >10 / raised ALR / INR >1.3

182
Q

what happens to urea after a UGIB?

A

Acid and digestive enzymes break down blood in the upper GI tract. One of the breakdown products is urea, which is then absorbed in the intestines, causing a rise in blood urea

finals (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions