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Phase 4 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is the aetiology of gastric ulcer disease?

A 
H. pylori
NSAIDs
Smoking
Alcohol
Steroids
Stress
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2
Q

What are the complications of gastric ulcers?

A

Bleeding
Perforation
Pyloric stenosis

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3
Q

What are the risk factors for GORD?

A 
Obesity
Lax OG junction
Medications
Lifestyle: smoking/caffeine/alcohol
Hiatus hernia
Familial
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4
Q

How would you investigate GORD?

A 
Bloods
Chest x-ray
OGD and biopsies
Barium swallow
Oesophageal manometry and pH studies
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5
Q

What are the complications of GORD?

A

Inflammatory strictures
Dysphagia
Hoarseness/cough/chest infections
Barretts oesophagus

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6
Q

What is the treatment for GORD?

A 
Lifestyle advice
Medical:
PPI (e.g. omeprazole)
H2 antagonists e.g. ranitidine
Gaviscon
Prokinetics e.g. domperidone/metoclopramide
Surgical:
Botox on OGD
Nissan fundoplication
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7
Q

What is the epidemiology of Barrett’s oesophagus?

A

M>F

Ages 50-70

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8
Q

What are the risk factors for Barrett’s oesophagus?

A

Chronic acid reflux
Smoking
High BMI

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9
Q

What is the pathophysiology of Barrett’s oesophagus?

A

Intestinal metaplasia. Normal squamous epithelium replaced with columnar intestinal epithelium.

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10
Q

What is the management of non ulcer dyspepsia?

A 
Lifestyle advice:
Stop smoking
Lose weight
Reduce alcohol intake
Avoid triggering foods
Raise head of bed at night.
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11
Q

What does the Glasgow Blatchford score test?

A

Those at high risk of dying from GI bleeds.

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12
Q

What does the Rockall score test?

A

Post endoscopy risk of bleeding.

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13
Q

Which Glasgow-Blatchford score result would indicate required intervention?

A

6 or more.

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14
Q

What is a Mallory Weiss tear?

A

A tear in the mucosa at gastro-oesophageal junction.

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15
Q

What are the risk factors for a Mallory-Weiss tear?

A

Retching/vomiting

Large volumes of alcohol

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16
Q

What are the roles of the liver?

A 
Amino acid and protein synthesis
Storage: iron, copper, vitamins
Blood protein synthesis
immunologically active cells
Drug and toxin metabolism
Decomposition of RBC
Food digestion
Bilirubin metabolism
Cholesterol metabolism
Decomposition of RBC
Degrades hormones
Ammonia breakdown (urea cycle)
Glyconeogenesis and glycogenesis.
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17
Q

What is chronic liver disease?

A

Disease of the liver which has lasted > 6 months. It consists of a wide range of liver pathologies which include inflammation (chronic hepatitis), liver cirrhosis and hepatocellular carcinoma.

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18
Q

What happens in cirrhosis?

A

Late stage of progressive hepatic fibrosis.
Distortion of hepatic architecture and formation of regenerative nodules.
Disturbance of blood flow through liver.
Irreversible.
Reduced life expectancy.

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19
Q

What is compensated liver disease?

A

Preservation of hepatic synthetic function.

Biochemical, radiological or histological findings consistent with the pathological process of cirrhosis.

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20
Q

What is decompensated liver disease?

A

Complications of liver dysfunction.
Reduced hepatic synthetic function.
Portal hypertension.
Ascites, varices, encephalopathy, jaundice.

21
Q

What are the complications of cirrhosis?

A

Hepatic failure

Portal hypertension

22
Q

What are the complications of hepatic failure?

A

Hepatic cellular carcinoma.
Jaundice
Hepatorenal syndrome
Hepatopulmonary

23
Q

What are the complications of portal hypertension?

A

Ascites
Variceal haemorrhage
Portosystemic encephalopathy

24
Q

What are the causes of cirrhosis?

A 
Alcohol
Obesity
Infective
Autoimmune
Inherited
Medications
25
Q

What are the infective causes of cirrhosis?

A

Viral - hepatitis B, C, D
Burcellosis
Syphilis
Schistosomiasis/leptospirosis

26
Q

What are the autoimmune causes of cirrhosis?

A

Primary biliary cirrhosis

Primary sclerosins cholangitis.

27
Q

What are the inherited causes of cirrhosis?

A 
Haemochromatosis
Wilson's disease
Alpha-1 antitrypsin deficiency
Hereditary Haemorrhagic Telangectasia
Cystic fibrosis
Glycogen storage disease
28
Q

What are the non-specific constitutional symptoms of cirrhosis?

A 
Fatigue
Weakness
Weight loss
Recurrent infections
Decreased libido
Diarrhoea
29
Q

What are the symptoms of decompensated cirrhosis?

A 
Abdominal distension
Peripheral oedema
Haematemesis/malena
Confusion
Pruritis
Jaundice
Shortness of breath
Syncope
30
Q

What are the signs of liver disease?

A 
Leukonychia
Palmar erythema
Spider angiomata
Bruising
Dupuytren's contracture
Finger clubbing
Telangiectasia
rhinophyma
Parotid gland swelling
Xanthelasma
Seborrhoeic dermatitis
Gynaecomastia
Breast atrophy in women
Caput medusae
31
Q

What are the predisposing factors to liver decompensation?

A 
Infection 
Upper GI bleed
Constipation
Drugs
Medical procedures
Hypoxia
Hypotension
Hypoglycaemia
Electrolyte disturbance
32
Q

Which imaging tests can investigate liver disease?

A

Ultrasound liver
Fibroscan
CT
MRI

33
Q

Which invasive tests can give information on the liver?

A

Endoscopy
Biopsy
Paracentesis

34
Q

In which conditions would you see a transudate on an ascitic tap?

A

Portaly hypertension
Nephrotic syndrome
Malnutrition
Cardiac failure

35
Q

In which situations would you see an exudate on an ascitic tap?

A

Hepatic or peritoenal malignancy

Pancreatitis

36
Q

What are the non-cirrhotic causes of portal hypertension?

A

Budd-Chiari, portal and splenic vein thrombosis, IVC obstruction
Schistosomiasis, sarcoidosis
Nodular regenerative hyperplasia
Hepatoportal sclerosis
Vitamin A intoxication, arsenic and vinyl chloride toxicity

37
Q

What is the management of cirrhosis?

A

Treat underlying cause +/- screening
Manage alcohol withdrawal if present
avoid superimposed injury (alcohol, NSAIDs, high dose paracetamol, immunisations)
Manage complications: Regular ultrasounds and fibroscans, reduce salt intake, beta-blockers, high suspicion for infection.
Liver transplant

38
Q

What is the presentation of alcohol withdrawal?

A

Agitation
Autonomic features
Confusion
Seizures

39
Q

What is the management of alcohol withdrawal?

A

Pabrinex 2 x paris I & II
Benzodiazepines
Glasgow modified alcohol withdrawal score

40
Q

What is the management of ascites?

A

Salt restriction
Diuretics - spironolactone, furosemide
Large volume paracentesis & albumin
Transjugular intrahepatic portosystemic shunt

41
Q

How would spontaneous bacterial peritonitis be diagnosed on an ascitic tap?

A

Ascitic fluid polymorphonuclear count >500cells/mm (intermediate risk 250-500)

42
Q

What is the management of varices?

A

Surveillance
Non-selective beta-blockers
Transjugular intrahepatic portosystemic shunt

43
Q

What is the management of a variceal haemorrhage?

A 
Intravascular volume support. Aim of keeping Hb 70-80. 
Terlipressing/octreotide
Antibiotic prophylaxis
Endoscopy
Sengstaken Tube
44
Q

What is the management of hepatocellular carcinoma?

A

Monitor with US/alpha FP
Treatment options depends on stage and degree of liver dysfunction.
Transplant/surgical resection/RFA/ethanol injection/transarterial chemoembolisation

45
Q

What is the management of encephalopathy?

A

Correct precipitating causes.
Lactulose +/- NG
May require HDU/ITU
CT head

46
Q

What is type 1 hepatorenal syndrome?

A

Rapidly progressive renal failure

Managed with albumin infusion, terlipressin, antibiotics, liver transplant

47
Q

What is type 2 hepatorenal syndrome?

A

Slowly progressive renal failure associated with refractory ascites

48
Q

What are the indications for liver transplantation in chronic liver disease?

A 
Complications no longer responsive to treatment
Child's C
Hepatopulmonary syndrome
Porto-pulmonary hypertension
Hepatorenal syndrome

Phase 4 (12 decks)

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