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Phase II Medicine Block > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What are the symptoms of chronic liver disease?

A 
Abdominal pain and swelling
Itchy skin
Loss of appetite
Fatigue
Nausea and vomiting
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2
Q

What are the 2 scores used for an upper GI bleed?

A

Rockall score - predicts the risk of death and rebleeding from an upper GI bleed
Blatchford score - predicts the need for intervention e.g. endoscopy or blood transfusion, useful in deciding if a patient needs to be admitted into hospital or not

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3
Q

In someone with an upper GI bleed, why do you want to know if they have any history of liver disease.

A

In someone with chronic liver disease who has an upper GI bleed, you assume the cause is a variceal bleed until proven otherwise.

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4
Q

What is the most important step in managing a patient with an upper GI bleed?

A

Deciding the likelihood that variceal bleeding may be the cause as opposed to non-variceal bleeding

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5
Q

What is the definitive treatment for a variceal upper GI bleed?

A

Mechanical obstruction to the flow of blood through the varices, either by endoscopic banding, Linton or Sengstaken tube or TIPSS (trans-jugular intrahepatic porto-systemic shunt)

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6
Q

What investigations would you do for acute pancreatitis?

A

Serum amylase
Serum lipase (more specific than serum lipase as lots of things can cause raised amylase)
ABG

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7
Q

What is acute pancreatitis?

A

Condition where the pancreas becomes inflamed within a short period of time, often caused by gallstones or drinking too much alcohol, symptoms include: abdominal pain, nausea and vomiting, fever, diarrhoea

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8
Q

What is chronic pancreatitis?

A

Condition where the pancreas has become permanently damaged from inflammation over many years.

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9
Q

What is ascending cholangitis?

A

Infection and inflammation of the biliary tree where bacteria ascends up the ducts, most commonly caused by obstruction, patients present with RUQ pain, fever and jaundice.

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10
Q

What is cholecystitis?

A

Inflammation of the gall bladder, usually occurs when drainage from the gall bladder is blocked e.g. A gallstone, can cause severe abdominal pain. Infection can develop due to stasis of bile.

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11
Q

What is Barrett’s oesophagus?

A

A complication of GORD where there is metaplasia of the stratified squamous epithelium of the oesophagus and it converts to simple columnar epithelium of the stomach.

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12
Q

What is toxic megacolon?

A

A condition where massive dilatation of the large intestine develops very quickly over a few days, it can be a complication of IBD, if it’s left untreated then perforation of the colon, sepsis or shock can occur.

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13
Q

What is spontaneous bacterial peritonitis?

A

Infection of ascitic fluid, diagnosis is made by examination of ascitic fluid by an ascitic tap.

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14
Q

Name some signs of chronic liver disease.

A 
Jaundice
Peripheral oedema
Ascites
Fetor hepaticus (pear drop breath)
Raised JVP
Hepatomegaly (or small liver in later disease)
Splenomegaly
Dark urine and pale stool
Leuconychia
Dupuytren's contracture
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15
Q

What are the symptoms of acute liver failure?

A 
RUQ pain
Nausea and vomiting
Malaise
Confusion
Drowsiness
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16
Q

Name some signs of acute liver failure.

A 
Jaundice
Abdominal swelling
Hepatic encephalopathy
Fetor hepaticus
Liver flap
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17
Q

What is acute-on-chronic liver failure?

A

A syndrome in cirrhosis characterised by acute decompensation and organ failure, it has a high mortality rate.

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18
Q

What are the 3 diagnostic criteria for acute liver failure?

A

Increase in Pt of 4-6 seconds
Hepatic encephalopathy
In patients without pre-existing cirrhosis and with an illness duration <6months

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19
Q

Name a clinical sign that is specific to alcoholic liver disease.

A

Parotid gland enlargement.

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20
Q

What type of anaemia can alcoholism lead to?

A

Macrocytic anaemia (due to vitamin deficiencies)

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21
Q

What is leuconychia and what causes it?

A

White spots on the nails, caused by hypoalbuminaemia

22
Q

What is koilonychia and what causes it?

A

Spooning of the nails, caused by iron deficiency anaemia

23
Q

If a patient has deranged clotting and drowsiness, what do you immediately think of?

A

Hepatic encephalopathy (with acute liver failure)

24
Q

What is hepatorenal syndrome?

A

A complication of severe liver damage, it’s when the kidneys stop functioning, causing toxins to build up in the body and progression to renal failure

25
Q

What is biliary sepsis?

A

Sepsis resulting from infection in the gall bladder, caused by stasis of bile due to gall stone obstruction.

26
Q

What is Charcot’s triad and what causes it?

A

Combination of jaundice, fever and RUQ abdominal pain, it is characteristic of cholangitis.

27
Q

Name some causes of acute pancreatitis.

A 
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hyperlipidaemia, hypercalcaemia
ERCP, emboli
Drugs
28
Q

What is the typical pain presentation with chronic pancreatitis?

A

Epigastric pain radiating to the back

29
Q

What is faecal calprotectin? What does a raised level indicate?

A

A substance that is released into the intestines in excess when there is inflammation, raised levels can indicate inflammatory bone disease e.g. Crohn’s or UC.

30
Q

Name 3 liver conditions that are can be caused by alcohol damage.

A

Fatty liver (reversible)
Alcoholic hepatitis
Cirrhosis (irreversible)

31
Q

What colours would you expect urine and stools to be in each type of jaundice?

A

Pre-hepatic: no change in colour of stools or urine
Hepatic: dark urine but normal stools
Post-hepatic: dark urine and pale, floaty stools that are hard to flush

32
Q

What is the imaging of choice in a patient presenting with jaundice and RUQ pain? What are its benefits?

A

Liver USS
Helps to identify potential cause of pain
Will not expose the patient to radiation

33
Q

What is the treatment for hepatitis B?

A

There is no treatment, you just have to hope the virus will clear from the body - in 1 in 10 cases the virus can remain long-term and become chronic hepatitis.

34
Q

For which 2 types of viral hepatitis do vaccines exist.

A

Hepatitis A & B

35
Q

Why are PT and INR raised with liver failure?

A

Clotting factors are produced by the liver, therefore when the liver’s synthetic function is reduced, there will be a delay in clotting.

36
Q

Why are albumin levels reduced in chronic liver disease?

A

Albumin is produced by the liver therefore its levels are reduced when the synthetic function of the liver is reduced.

37
Q

What emergency would you suspect if a patient with known liver disease started vomiting blood?

A

Oesophageal varices

38
Q

Name some triggers for hepatic encephalopathy in a patient with chronic liver disease.

A 
Infection
GI bleeding
Drugs
Alcohol binge
Constipation
Surgery
39
Q

The treatment for hepatic encephalopathy depends on its cause, however there are certain medications that can be given to reduce the risk of recurring episodes. Name some…

A

Lactulose
Neomycin
Rifaximin

40
Q

Where does bilirubin come from?

A

Breakdown product of haem, which is contained in RBC.

41
Q

What does Courvoisier’s Law state in relation to the gallbladder?

A

If a palpable gallbladder is seen with painless jaundice then the cause is not gallstones.

42
Q

What is the first line treatment in prevention of variceal bleeding?

A

Beta blockers

43
Q

What is achalasia?

A

Condition where the muscular ring at the lower oesophageal sphincter closes off and fails to open up during swallowing, can lead to backup of food within oesophagus, dilation of oesophagus and difficulty swallowing.

44
Q

Why does biliary colic sometimes radiate to the interscapular region?

A

Referred pain from diaphragmatic irritation.

45
Q

What drug is used in the treatment of alcohol withdrawal?

A

Chlordiazepoxide.

46
Q

What is delirium tremens?

A

The most severe form of alcohol withdrawal, characterised by altered mental status and sympathetic overdrive that can lead to cardiovascular collapse.

47
Q

What drug can be used in the prophylaxis of bleeding from oesophageal varices?

A

A non-selective beta blocker such as propranolol.

48
Q

What actually causes hepatic encephalopathy?

A

Increased concentrations of ammonia that cross the blood brain barrier, leading to confusion.

49
Q

What investigations are done for coeliac disease?

A 
Tissue transglutaminase (usually raised but not diagnostic)
OGD with duodenal biopsy
50
Q

What rash might be seen with coeliac disease?

A

Dermatitis herpetiformis

Phase II Medicine Block (13 decks)

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