Gastroenterology Flashcards
Score to assess alcohol withdrawal?
CIWA scale
Criteria for assess liver transplant feasibility?
King’s College Criteria
Looks at pH, PT, bilirubing, creatinine, hep viruses.
Depends on aetiology of liver failure (i.e. paracetamol overdose or not)
Organisms that can cause cholangitis?
OPPORTUNISTIC VIRUSES
CMV
Candida
TB
cryptosporidium
LFTs - ALT & AST found in…
Hepatocytes
LFTs - gGT & ALP found in…
Cholangiocytes
LFTs - INR, why?
INR is a measure of prothrombin ACTIVATIN (i.e. a ration) 12 -14 seconds
Albumin and Bilirubin, what do these say?
Albumin - synthetic function of the liver
Bili - most useful in assessing if someone is getting better?
Causes of acute liver failure?
PARACETAMOL (90%) Viral Autoimmune Pregnancy Cancer Wilson's (copper accumulation) Budd-Chiari Syndrome
Schistosomiasis can cause portal HTN
just know this…
What is achalasia?
Absent oesophogeal mesenteric plexus resulting in no peristalsis, dysphasia and regurgitation
What is the most common side effet of bisphosphenates?
Irritation, inflammation and ulceration of the oesophagus
What clinical picture can a pancreatic mass (carcinoma) give you?
Weight loss Obstructive jaundice (increased bili, ALP, GGT) Abdo discomfort
What investigation does dypepsia in someone over 55 warrant?
Urgent endoscopy
In managing dyspepsia, what are the ALARMS symptoms?
A - anaemia L - Loss of Weight A - anorexia R - recent onset of progressive symptoms M - melaena/haematemisis S - swallowing difficulty
How do you manage suspected H. pylori?
If red flag symptoms present then empirical treatment (triple therapy omeprazole, amoxicillin and clarithromycin)
If none, then test with fecal antigen test
What causes peripheral oedema in liver failure?
Low levels of serum albumin due to faltering synthetic function of the liver
How long should a person not have eaten solid food for before you consider TPN?
7 days without eating food
How does an anal fissure cause constipation?
Profound fear of passing stools
What are the complications of Crohn’s disease?
Small bowel obstruction Fistulae Osteoperosis Bowel cancer Stones
Joints - arthritis
Skin - pyoderma gangrinosum and errythema nodosu
Eyes - uveitis
Liver - Primary Sclerosis Cholangitis (PSC) -> cirrhosis
Oral Ulcers
What is tenesmus?
Sensation of incomplete passing of stools - indicates possible rectal Ca
What is the clinical picture in someone who is suffering from a bleeding ulcer?
Hypotension, melaena, long term steroid use
What should happen if a patient requires a procedure/operation but they are acutely confused and mentally disorientated that they cannot provide consent?
A doctor can sign the consent form as a proxy therefore allow the procedure to happen.
How do oesophogeal varices result in a patient with CLD?
CLD results in portal HTN and dilated collaterol veins, this leads to oesophogeal varices which can bleed and cause compliactions
Before an operation, which drug can be used to discourage bleeding? How does it work?
Vasopressin - bleeding reduced via narrowing of blood vessels to small intestine.
What is the Child-Pugh score used for?
Grading cirrhosis and the risk of variceal bleeding.
Uses:
Bilirubin, albumin, PT
grades of ascites and encephalopathy
What investigation should you order in a patient who is struggling to swallow, regurgitating food and is losing weight?
Barium swallow
What is the sepsis 6?
Give broad spec antibiotics Give fluids Monitor UO (catheter) Serum lactate and Hb Blood cultures High flow oxygen
What is the therapy given to eradicate H. pylori?
Triple therapy: amoxicillin +clarithrmycin + omeprazole
What is an oculogyric crisis?
A dystonic reaction of D2 receptor blockage. Notably rolling backwards of eyeballs.
Caused by neuroleptics (metoclopramide, domperidone, halloperidol, levodopa, carbamazepine)
