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YEAR 3: Conditions Knowledge > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is achalasia?

A

Absent or uncoordinated oesophageal muscular action with a failure of relaxation of the lower oesophageal sphincter

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2
Q

Recall the pathophysiology of achalasia

A

Breakdown of ganglion cells in mesenteric plexus

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3
Q

Recall the symptoms of achalasia

A

Intermittent dysphagia
Regurgitation at night
CP and heart burn

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4
Q

What is a common complication of achalasia to be wary of?

A

Aspiration pneumonia

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5
Q

What specialist investigation should be done for achalasia?

A

Barium swallow

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6
Q

Recall 3 causes of acute cholangitis

A

Biliary colic
Biliary stenosis
Cholangiocarcinoma

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7
Q

What is Charcot’s triad?

A

The triad used to describe symptoms of acute cholangitis

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8
Q

Recall Charcot’s triad and Reynold’s pentad

A

Triad: RUQ pain, jaundice, fever with rigors

Pentad = + confusion + septic shock

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9
Q

Describe the blood results of someone with acute cholangitis

A

High WCC
Raised CRP and ESR
LFTs similar to those you would expect in jaundice

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10
Q

If biliary stones are non-calcified, which investigation should be done?

A

MRCP

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11
Q

What is the first-line in management of acute cholangitis?

A

Broad-spectrum ABx

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12
Q

Why is the mortality of acute cholangitis high?

A

Can cause liver failure

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13
Q

Recall the names of each state of liver damage

A

Steatosis (fatty liver)
Hepatitis
Cirrhosis

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14
Q

Describe the liver in hepatitis

A

Necrotic with regions of fatty inflammation

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15
Q

Recall the mnemonic for and the signs of alcoholic hepatitis

A 
Particularly Excessive Gin Drinking Can Make Hepatic Fatty Tissue Start Necrotising
Palmar Eryhtema
Gynaecomastia
Dupuytren's Contracture
Malnutrition
Hepatomegaly
Facial Telangiectasia
Spider Naevi
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16
Q

Recall the mnemonic for and the symptoms of severe acute alcoholic hepatitis

A 
BEAST
Bruising
Encephalopathy
Ascites
Splenomegaly
Tachycardia
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17
Q

Recall 2 things of note in the FBC of someone with alcoholic hepatitis

A

High WCC

Macrocytic anaemia

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18
Q

What will be low in the LFTs of someone with alcoholic hepatitis?

A

Albumin

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19
Q

What is the most common cause of anal fissure?

A

Hard faeces

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20
Q

What is an anal fissure?

A

Tear in SQUAMOUS lining of lower anal canal

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21
Q

Recall some symptoms of anal fissure

A

Pain
Blood in stool
Pruritis ani

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22
Q

Recall the management of anal fissure

A

Conservative: high fibre diet, laxatives and hydration
Mecial: lidocaine, GTN (relaxes internal sphincter)
Surgical: lateral sphincterectomy (caution: often causes incontinence)

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23
Q

Summarise the pathophysiology of appendicitis

A
  1. Gut lumen obstruction
  2. Bacteria have opportunity to invade appendix
  3. Results in oedema, ischaemic necrosis and perforation
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24
Q

Recall one peculiar sign of appendicitis

A

Tongue-furring

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25
Recall the 3 special signs that can be elicited in appendicitis
Rovsing's: pushing down on LIF increases pain in RIF Psoas: pain on hip extension Cope: plain on flexion and internal rotation of hip
26
What is the test performed to confirm a diagnosis of appendicitis?
US/CT
27
What is the aetiology of autoimmune hepatitis?
Unknown
28
Recall 3 features of a blood test that are abnormal in autoimmune hepatitis
Hyperglobulinaemia (ANA, ASMA, Anti-LKM) Same LFTs as alcoholic hepatitis (low albumin, high everything else) WCC is LOW (unlike alcoholic hepatitis)
29
Recall the immunoglobulins present in type 1 and type 2 autoimmune hepatitis
Type 1: ANA, ASMA, Anti-SLA, AAA | Type 2: ALKM-1, ALC-1
30
Recall the aetiology of Barrett's oesophagus
1. Prolonged exposure of squamous epithelium to acid from GORD 2. Mucosal inflammation and erosion 3. Transformation into columnar epithelium (METAPLASTIC CHANGE)
31
What is the main sinister consequence of Barrett's oesophagus?
Can lead to adenocarcinoma
32
What is water-brash and what is it a common symptom of?
Sour taste when swallowing: GORD, barrett's oesophagus
33
What investigations need to be done to confirm a diagnosis of Barrett's oesophagus?
OGD and biopsy
34
Recall the management of low-grade dysplasia in Barrett's oesophagus
Endoscopic surveillance
35
Recall the management of high-grade dysplasia in Barrett's oesophagus
For fit and well pt: mucosal resection | Otherwise: mucosal ablation
36
What causes the waves of pain in biliary colic?
Contraction of biliary tree around stone
37
Where may biliary colic pain radiate to and why?
Right scapula: due to diaphragmatic irritation
38
Recall 2 findings on ultrasound that indicate biliary colic
1. Dilation of common bile duct | 2. Hypertrophy of gallbladder wall
39
Recall 2 uses of ERCP in biliary colic
1. Diagnostic | 2. Therapeutic - can be sued to remove small stones
40
Recall the surgical management of biliary colic
Laparoscopic cholecystectomy
41
What is cholecystitis
The INFLAMMATION of the gallbladder that is caused by biliary stones
42
What is the composition of most gallbladder stones?
Mixed: cholesterol, calcium bilirubinate, protein and phosphate
43
What is Murphy's sign used to diagnose?
Cholecystitis?
44
What is Murphy's sign?
Ask patient to exhale then inhale deeply as you push your hand up under their rib cage on the RHS - causes lots of pain and they catch their breath
45
Recall the expected LFT abnormalities in cholecystitis
High ALP and GGT
46
Describe the histopathology of the liver in cirrhosis
Normal liver architecture replaced by diffuse fibrosis, nodules of regenerating hepatocytes present
47
Which types of hepatitis can lead to cirrhosis?
B and C
48
Define decompensated cirrhosis
Cirrhosis that is complicated by jaundice, encephalopathy, GI bleeding and ascites
49
Systematically recall the symptoms of liver cirrhosis
Systemic effects: anorexia, fatigue Due to loss of synthetic function: easy bruising, ankle oedema Due to loss of detox function: jaundice. amenorrhoea, personality change Due to portal hypertension: haematemesis, melaena, abdominal swelling
50
Recall ALL the signs of liver cirrhosis
``` Easy bruising Gynaecomastia Dupuytren's contracture Spider Naevi Leukoonychia Asterixis Ascites Jaundice Clubbing Facial telangiectasia Caput medusae Scratch marks Palmar erythema Splenomegaly Hepatomegaly ```
51
What does an FBC show in liver cirrhosis and why?
Low platelets and haemaglobin This is due to hypersplenism Hypersplenism is a result of portal hypertension
52
What conditions can an elevated serum AFP be used to diganose?
Elevated: liver cirrhosis | Super-high: hepatocellular carcinoma
53
What is the use of an ascitic tap in liver cirrhosis?
Do MCS | If neutrophils are >250, is spontaneous bacterial peritonitis
54
Using what system is liver cirrhosis graded?
Child-pugh
55
Recall the histopathological appearance of the gut in coeliac disease
Subtotal villous atrophy | Crypt hyperplasia
56
What is the major cause of signs in coeliac disease?
Malnutrition
57
What sort of anaemia presents in coeliac disease?
Iron-deficiency
58
What is the key serological finding in coeliac disease?
Anti-gliadin
59
Summarise the defining characteristics of Crohn's disease
1. Granulomatous inflammation (so involves macrophages) 2. Can be anywhere in length of gut 3. May cause erosion into the deep mucosa
60
What stool symptoms are common in Crohn's disease?
Diarrhoea and steatorrhoea
61
What external signs of crohn's disease may be seen upon examination of the anus?
Perineal skin tags | Fistulae
62
Recall some extra-articular manifestations of Crohn's diease
Finger clubbing Mouth ulcers Uveitis Erythema nodosum
63
Which elements of the FBC are elevated in Crohn's disease?
WCC | Platelets
64
Describe the ESR and CRP in Crohn's disease
ESR high | CRP may be normal or high
65
How can you distinguish infective colitis from Crohn's disease?
Stool MC&S
66
Describe the management of an acute flair up of Crohn's disease
Corticosteroids 5-ASA analogues (mesalazine) Analgesia
67
Describe the long-term management of chronic Crohn's disease
Mesalazine/olsalazine | Anti-TNF/immunosuppression
68
Recall some common complications of Crohn's disease
``` Strictures Perforation of bowel Fistulae Haemorrhage GI cancers ```
69
What are diverticulae?
Outpoachings of colonic mucosae/submucosae through a weakness in the muscular layer
70
Define diverticular disease
Diverticulitis PLUS COMPLICATIONS (haemorrhage, infection, fistulae)
71
Recall the aetiology of diverticulae formation
Low fibre diet --> higher intraluminal pressure required to expel stool Higher pressure --> herniation of mucosa
72
Where do diverticulae most commonly appear?
At sites of nutritional artery penetration
73
What is the main complication of diverticulae?
They get obstructed with faeces leading to bacterial overgrowth and peritonitis
74
What are the Hinchley criteria used for? | Recall them
Staging of diverticular disease 1a: Phlegmon 1b: Localised abscesses 3: Purulent peritonitis 4: Faecal peritonitis
75
Where is right-sided diverticulitis most common?
Asia
76
What symptoms can be caused by fistulae?
Pneumaturia | Faecaluria
77
What is the diagnostic test used for diverticulae?
Barium enema | Do not use in acute setting in case of perforation
78
What is the management for diverticulitis?
Bowel rest IV antibiotics Rehydration
79
What does time of onset in gastroenteritis indicate about aetiology?
Toxins = early onset (1-24 hours) | Bacteria/viruses/protozoa have a later onset (12+ hours)
80
Recall and justify the blood tests that should be done for gastroenteritis
FBC Blood culture (bactaraemia?) U&Es (dehydrated?)
81
Where are the most common sites of gastrointestinal perforation?
Colon | Gastroduodenal
82
What are the most likely causes of colon perforation?
Cancer Diverticulitis Appendicitis
83
What is the most likely cause of gastroduodenal perforation?
Perforated ulcer
84
Describe the signs of GI perforation
Quite non-specific but they will be very unwell | Signs of shock, dehydration and pyrexia
85
What would a CXR show in GI perforation?
Air under diaphragm
86
Recall the surgical management of GI perforation
Peritoneal lavage For large bowel perforation: resection For small bowel perforation: close with omental patch
87
Recall 3 things that aggravate heartburn in GORD
Lying supine Large meals Alcohol
88
If someone has GORD and begins to experience dysphagia, what does this indicate?
Stricture has formed
89
Differentiate internal and external haemorrhoids
Internal: above dentate line, arising from superior haemorrhoidal plexus External: below dentate line
90
Recall and define each degree of haemorrhoid classification
1st degree: no prolapse 2nd degree: prolapses on defaecation and resolves spontaneously 3rd degree: prolapses on defaecation and needs to be resolved manually 4th degree: Prolapse which cannot be reduced
91
Describe how haemorrhoidal blood appears in stool
Does not mix with stool
92
Which investigations must be done when haemorrhoids are suspected and why?
DRE Flexible sigmoidoscopy Need to exclude any other causes of blood in stool that are more sinister
93
Recall the management of haemorrhoids
Conservative: high fibre diet. laxatives, topical analgesic Minor surgery: injection scleropathy (induces fibrosis of dilated veins) and banding (causes haemorrhoid to fall off in a few days) Surgical: reserved for symptomatic 3rd/4th degree haemorrhoids
94
Which abdominal contents are protuding into the inguinal region in an inguinal hernia?
Peritoneum
95
Recall which type of inguinal hernia arises medial and lateral to the key blood vessel, and what that vessel is
Vessel = inferior epigastric vessels Direct: medial Indirect: lateral
96
Where is the weakness in direct inguinal hernias?
Transversalis fascia
97
Where do direct inguinal hernias protrude?
Hasselbach's triangle
98
Recall the borders of Hasselbach's triangle
Inferior epigastric artery Lateral border of rectus Inguinal ligament
99
Where do indirect inguinal hernias protrude?
Deep inguinal ring
100
Which type of hernias can be reduced on cough impulse?
Indirect
101
What would make an inguinal hernia and emergency?
If it were obstructed or strangulated
102
What symptoms are produced by a hiatus hernia?
Symptoms of GORD (but usually asymptomatic)
103
What may be seen on CXR in hiatus hernia?
Gastric air bubble above diaphragm
104
What is the surgical management of hiatus hernia?
Nissen fundoplication
105
Recall the symptoms of infectious colitis
Diarrhoea Blood in stools Lower abdominal pain
106
Define intestinal ischaemia
Obstruction of a mesenteric vessel
107
In what ways might a mesenteric vessel be obstructed?
Thrombus or embolus
108
Recall 3 symptoms of intestinal ischaemia
1. Severe colicky pain 2. Vomiting 3. Rectal bleeding
109
Recall 3 signs of intestinal ischaemia
1. Abdominal tenderness 2. Abdominal distention 3. Palpable mass which is ischaemic bowel
110
What would an ABG show in intestinal ischaemia?
Lactic acidosis
111
Where is the bowel most susceptible to ischaemia?
Watershed zone - this is near the splenic flexure, between the SMA and IMA supplies
112
How is intestinal obstruction classified?
Extramural, intramural and intraluminal
113
Recall a cause of extramural intestinal obstruction
Hernia/ volvulus
114
Recall a cause of intramural intestinal obstruction
Tumours/ Inflammatory strictures
115
Recall a cause of intraluminal intestinal obstruction
Foreign body
116
Recall the 3 key symptoms of intestinal obstruction
Severe colic Frequent vomiting Absolute constipation
117
Recall the 3 necessary investigations for intestinal obstruction
AXR Water-soluble enema Barium swallow
118
How is vomiting managed in intestinal obstruction?
Gastric aspiration
119
What is the surgical management option for intestinal obstruction?
Emergency laparotomy
120
Define IBS
Recurrent abdominal pain and discomfort for >6 months, associated with 2 or more out of: - altered stool passage - bloating - passage of mucous - symptoms being worse post-prandially
121
Recall one important thing to exclude in a IBS diagnosis and how you would exclude it
H Pylori | Urease breath test
122
Define liver abscess
Liver infection resulting in a walled-off collection of pus
123
Define liver cyst
Liver infection resulting in a walled-off collection of cyst fluid
124
What is a pyogenic liver abscess?
A liver cyst that produces pus caused by bacterial infection
125
What is the most common cause of pyogenic liver abscess?
Biliary tract disease
126
What is the most common cause of liver abscess in the Western world vs worldwide?
Western world: bacterial | Worldwide: Entamoeba histolytica
127
Recall the management of both pyogenic and amoebic liver abscesses
Pyogenic: needle aspiration Amoebic: metronidazole + amoebacide
128
What symptoms do liver abscesses produce?
Systemic: fever, night sweats, anorexia | Liver symptoms: RUQ pain, jaundice, diarrhoea
129
What lung sign may be present alongside a liver abscess?
Right-sided reactive pleural effusion
130
What is the main complication of liver abscess to be aware of?
Rupture and dissemination causing septic shock/ acute cholangitis/ peritonitis
131
How is liver failure classified?
Based on time interval between onset of jaundice and hepatic encephalopathy Hyperacute: <7 days Acute: 1-4 weeks Subacute: 4-12 weeks
132
What is the main cause of acute liver failure in the UK?
Paracetamol OD
133
What is the pathophysiology of jaundice in liver failure?
Decrease secretion of conjugated bilirubin
134
What is the pathophysiology of encephalopathy in liver failure?
Decresed clrnce of nitrogenous products such as ammonia --> brain
135
What would the LFTs show in liver failure?
Low albumin, high everything else
136
What is the main use of an ascitic tap in liver failure?
To identify spontaneous bacterial peritonitis - indicated by neutrophil count of >250mm^3
137
Recall the medical management of liver failure if it is caused by paracetamol overdose
N-acetylcysteine
138
What is the medical management of hepatic encephalopathy?
Lactulose enema to reduce blood ammonia
139
How is coagulopathy treated in liver failure?
IV Vitamin K | FFP
140
What are the 2 main complications of liver failure to be aware of?
Cerebral oedema | Renal failure
141
What is the cause of a mallory-weiss tear?
Straining to vomit
142
Recall a *sign* of mallory weis tear
melaena
143
What is the main investigation that needs to be done in suspected mallory-weis tear?
OGD
144
Recall the management of mallory weiss tear
80% self-resolve | 20% may need surgical repair if bleeding does not stop
145
Differentiate fatty liver from NASH
Fatty liver = fat accumulation in the liver | Non-alcoholic steatohepatitis = fat plus inflammation and scarring
146
What are the symptoms of NASH?
Nearly always asymptomtic
147
In what way would liver tests be deranged in NASH?
Elevated AST and ALT
148
Recall the mnemonic for and the causes of acute pancreatitis
GET SMASHED Gallstones Ethanol Trauma ``` Steroids Mumps Autoimmune Scorpion venom Hypercalcaemia ERCP Drugs ```
149
Recall 3 drugs that may cause acute pancreatitis
Thiazides Valporate Azothioprine
150
Where does the epigastric pain resulting from acute pancreatitis radiate to?
The back
151
What can relieve the pain of acute pancreatitis?
Sitting forward
152
Recall 2 signs that are specific to acute pancreatitis
Grey-Turner's (flank bruising) | Cullen's (periumbiliCal bruising)
153
Recall 4 things that would be elevated on a blood test in acute pancreatitis
WCC CRP Amylase Glucose
154
What happens to serum calcium in acute pancreatitis and why?
Hypocalcaemia | Calcium binds to digested lipids from pancreas
155
What are the 2 main scoring systems used to assess the severity of acute pancreatitis?
1. Modified Glasgow scale combined with CRP | 2. APACHE-II score
156
What is the main cause of acute pancreatitis for men and women in the UK?
Men: alcohol Women: gallstones
157
Define chronic pancreatitis
Irreversible parenchymal atrophy and fibrosis
158
What is the primary cause of chronic pancreatitis?
Alochol
159
Describe the amylase level in chronic pancreatitis
Usually normal
160
What is the first line of management in chronic pancretitis?
A good dose of conservative management with lots of lifestyle advice and support to make changes
161
What treatment for chronic pancreatitis can be offered endoscopically?
Extraction of stones Dilation of strictures Sphincterectomy
162
As well as gastric acid, what must the gastric lining be exposed to in order for a peptic ulcer to form?
Pepsin
163
What are the 2 strongest correlated risk factors for peptic ulcer disease?
H pylori | NSAID use
164
How can the history differentiate between gastric and duodenal ulcers?
Gastric: pain worst post-prandially Duodenal: pain worst several hours post-prandially
165
What may be seen on an FBC that is abnormal in peptic ulcer disease?
Anaemia
166
What is the medical management of H pylori?
Triple therapy for 1-2 weeks: PPI Clarithromycin Amoxicillin OR metronidazole
167
Define perineal abscess
Pus collection in perineal region
168
Define perineal fistula
Chronically infected tract connecting between perineal skin and anal canal
169
What is the cause of a perineal abscess or fistula?
Bacterial infection
170
Recall the symptoms of perineal abscess/fistula
Throbbing pain | Intermittent discharge
171
What is Goodsall's law?
Law used to locate internal opening of a fistula based on where the external opening is: If anterior to anal canal it runs radially and directly into the anal canal If posterior to the anal canal, or >3cm away from rectum, it takes a curved path
172
What is the most useful form of imaging to investigate a perineal fistula?
MRI
173
What is the first line management of a perineal abscess?
Open drainage
174
Differentiate the management of high and low perineal fistulae
High: SETON inserted to allow drainage (as fistulotomy would cause incontinence) Low: fistulotomy
175
What are the 3 different types of peritonitis?
Localised Primary generalised Secondary generalised
176
Recall 4 types of localised peritonitis
Appendicitis Cholecystitis Diverticulitis Salpingitis
177
Differentiate between primary and secondary generalised peritonitis
Primary: rare, usually seen in adolescent females = bacterial infection without obvious cause Secondary: bacterial translocation from localised focus for example a peptic ulcer rupture causing spillage of bowel contents
178
What is the standard medical treatment for SBP
Quinolone antibiotics (eg ciprofloxacin)
179
What is the surgical management of generalised peritonitis?
Laparotomy to remove necrotised tissue
180
Define pilonidal sinus
Abnormal epithelium-lined track, filled with hair, that opens onto skin surface, most commonly at the natal cleft
181
What is the pathophysiology of pilonidal sinus?
Shed hair penetrates the skin causing an inflammatory reaction
182
What is the management of pilonidal sinus
Incision and drainage
183
Define portal hypertension
High pressure within the hepatic portal vein
184
What pressure in the hepatic portal vein is clinically significant?
>10mmHg
185
Recall 2 possible pre-hepatic causes of portal hypertension
Thrombosis of splenic/ portal vein | Extrinsic compression
186
Recall 3 possible hepatic causes of portal hypertension
Cirrhosis Chronic hepatitis Schistosomiasis
187
Recall 3 possible post-hepatic causes of portal hypertension
Blockage of hepatic vasculature Right heart failure Constrictive pericarditis
188
Give some examples of complications of portal hypertension
Ascites Maleana Haematemesis Hepatic encephalopathy
189
Recall 2 signs that specifically indicate portal hypertension
Splenomegaly | Caput medusae
190
Why might a doppler ultrasound be helpful in portal hypertension
Can assess direction of blood flow
191
Where might a shunt be positioned to treat portal hypertension?
Between HPV and hepatic vein
192
Name the 2 autoimmune cholestatic liver diseases
Primary biliary cirrhosis | Primary sclerosing cholangitis
193
Differentiate which elements of the liver are damaged by PBC and PSC
PBC: small interlobular ducts PSC: intralobular and extrahepatic ducts
194
Differentiate the immunoglobulins implicated in PBC and PSC
PBC: AMA, IgM PSC: pANCA, AMSA, ANA
195
Recall a complication of both PBC and PSC
PBC: hypercholesterolaemia PSC: stricture formation
196
Describe the symptoms of primary biliary cirrhosis
Insidious onset: fatigue, weight loss and fat-soluble vitamin deficiencies
197
Describe the symptoms of primary sclerosing cholangitis
Often those of IBD, as it often follows UC/Crohn's
198
What is the key LFT result that indicates PBC/PSC?
High ALP and GGT
199
In which type of autoimmune cholestatic liver disease may anti-mitochondrial antibodies be present?
Primary biliary cirrhosis
200
How is a diagnosis of PBC/PSC confirmed?
Liver biopsy
201
What is the aetiology of rectal prolapse?
Straining
202
What might make a rectal prolapse an emergency?
If it is irreducible or strangulated
203
What is the main investigation to do for rectal prolapse?
Protosigmoidoscopy
204
Recall an immunoglobulin that is associated with ulcerative colitis?
pANCA
205
Which 2 ethnic groups are most likely to have ulcerative colitis?
Ashkenazi jews | Caucasians
206
Recall 4 extra-articular manifestations of IBD
Uveitis Erythema nodosum Scleritis Aphthous ulcers
207
How may stool appear in IBD?
Bloody or mucousy
208
As well as signs of IBD and its extra-articular manifestations, what signs may be present in UC patients?
Signs of IDA as they aren't absorbing iron
209
Describe the blood results in IBD
High CRP, ESR and WCC | Low FBC as anaemia
210
What blood test is done to differentiate IBS and IBD?
Faecal calprotectin
211
What investigations may be done to assess IBD severity?
Flexible sigmoidoscopy
212
What is the most useful medical management option for mild ulcerative colitis?
5-ASA analogues like mesalazine/olsalazine
213
What drugs may be added to 5-ASA analogues in more severe ulcerative colitis?
Immunosuppressants such as azothioprine/ steroids | Anti-TNF (infliximab)
214
In general, what class of immunoglobulin is produced in acute and chronic manifestations of hepatitis virus infection?
Acute: IgM Chronic: IgG
215
Which types of viral hepatitis always follow an acute course?
A and E
216
Recall the route of transmission of each type of hepatitis
A&E - faeco-oral B&D - sexual contact, bodily fluids, vertical C - parenteral (sexual/vertical)
217
Describe the symptoms of viral hepatitis A/E infection
Often subclinical May have prodromal malaise/ fever May have dark urine with pale stool (as is liver infection) NO STIGMATA of chronic liver disease
218
Recall the antibodies detectable on viral serology in the presence of viral hepatitis A/E infection?
Anti-HAV | Anti-HEV
219
Describe the course of viral hepatitis B/D infection
1-2 weeks of prodromal illness: malaise, anorexia, diarrhoea, nausea and vomiting, RUQ pain Jaundice develops Recovery period of 4-8 weeks
220
What immunoglobulin is detectable by viral serology in infection of viral hepatitis B/D?
HBcAg
221
Does hepatitis C tend to follow an acute or chronic course?
Chronic in 80%
222
Describe the pathophysiology of viral hepatitis infection?
The virus itself is not directly hepatotoxic - it is the immune response that lads to inflammatory damage
223
What are the symptoms of Hep C infection?
90% are asymptomatic
224
In what way are LFTs likely to be deranged in viral hepatitis?
Elevated AST and ALT
225
What are the 2 drugs of choice for treating chronic Hep C infection?
Interferon alpha | Ribavarin (anti-viral)
226
Define volvulus
Rotation of a loop of small bowel around the axis of its mesentery
227
Recall the relative proportion of cases of volvulus that affect each part of the large bowel
65% = sigmoid colon 30% = caecum In neonates affects MIDGUT = volvulus neonatorum
228
Recall the 2 key symptoms of volvulus
Severe colicky pain | Absolute constipation
229
Describe the signs that may be seen in a case of volvulus
Signs of bowel obstruction with abdominal distention and tenderness Tachycardia and pyrexia Signs of dehydration
230
Which 2 investigations are most useful in suspected volvulus?
XR | Water-soluble contrast enema
231
What is the inheritance pattern of Wilson's disease?
Autosomal recessive
232
Define Wilson's disease
Reduced biliary excretion of copper
233
Where does copper tend to accumulate in Wilson's disease?
In liver and brain, especially in the basal ganglia
234
Which gene is mutated in Wilson's disease?
Copper-transporting ATPase
235
How does excess copper cause damage to the liver in Wilson's disease?
Build-up of copper --> mitochondrial damage --> cell death --> copper released into plasma --> tissue deposition
236
Recall the symptoms of Wilson's disease
Liver: jaundice, encephalopathy, easy bruising Neurological: dysphagia, dyskinesia, dysphasia, dystonia
237
What is a specific sign that indicates Wilson's disease?
"Sunflower cateract" due to copper deposition in eye
238
Recall the management of Wilson's disease
Treat with copper chelators and oral zinc | Liver transplantation may be necessary

YEAR 3: Conditions Knowledge (17 decks)

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