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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
What are the infective causes of cirrhosis?
Viral - hepatitis B, C, D Burcellosis Syphilis Schistosomiasis/leptospirosis
26
What are the autoimmune causes of cirrhosis?
Primary biliary cirrhosis | Primary sclerosins cholangitis.
27
What are the inherited causes of cirrhosis?
``` Haemochromatosis Wilson's disease Alpha-1 antitrypsin deficiency Hereditary Haemorrhagic Telangectasia Cystic fibrosis Glycogen storage disease ```
28
What are the non-specific constitutional symptoms of cirrhosis?
``` Fatigue Weakness Weight loss Recurrent infections Decreased libido Diarrhoea ```
29
What are the symptoms of decompensated cirrhosis?
``` Abdominal distension Peripheral oedema Haematemesis/malena Confusion Pruritis Jaundice Shortness of breath Syncope ```
30
What are the signs of liver disease?
``` 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
What are the predisposing factors to liver decompensation?
``` Infection Upper GI bleed Constipation Drugs Medical procedures Hypoxia Hypotension Hypoglycaemia Electrolyte disturbance ```
32
Which imaging tests can investigate liver disease?
Ultrasound liver Fibroscan CT MRI
33
Which invasive tests can give information on the liver?
Endoscopy Biopsy Paracentesis
34
In which conditions would you see a transudate on an ascitic tap?
Portaly hypertension Nephrotic syndrome Malnutrition Cardiac failure
35
In which situations would you see an exudate on an ascitic tap?
Hepatic or peritoenal malignancy | Pancreatitis
36
What are the non-cirrhotic causes of portal hypertension?
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
What is the management of cirrhosis?
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
What is the presentation of alcohol withdrawal?
Agitation Autonomic features Confusion Seizures
39
What is the management of alcohol withdrawal?
Pabrinex 2 x paris I & II Benzodiazepines Glasgow modified alcohol withdrawal score
40
What is the management of ascites?
Salt restriction Diuretics - spironolactone, furosemide Large volume paracentesis & albumin Transjugular intrahepatic portosystemic shunt
41
How would spontaneous bacterial peritonitis be diagnosed on an ascitic tap?
Ascitic fluid polymorphonuclear count >500cells/mm (intermediate risk 250-500)
42
What is the management of varices?
Surveillance Non-selective beta-blockers Transjugular intrahepatic portosystemic shunt
43
What is the management of a variceal haemorrhage?
``` Intravascular volume support. Aim of keeping Hb 70-80. Terlipressing/octreotide Antibiotic prophylaxis Endoscopy Sengstaken Tube ```
44
What is the management of hepatocellular carcinoma?
Monitor with US/alpha FP Treatment options depends on stage and degree of liver dysfunction. Transplant/surgical resection/RFA/ethanol injection/transarterial chemoembolisation
45
What is the management of encephalopathy?
Correct precipitating causes. Lactulose +/- NG May require HDU/ITU CT head
46
What is type 1 hepatorenal syndrome?
Rapidly progressive renal failure | Managed with albumin infusion, terlipressin, antibiotics, liver transplant
47
What is type 2 hepatorenal syndrome?
Slowly progressive renal failure associated with refractory ascites
48
What are the indications for liver transplantation in chronic liver disease?
``` Complications no longer responsive to treatment Child's C Hepatopulmonary syndrome Porto-pulmonary hypertension Hepatorenal syndrome ```

Phase 4 (12 decks)

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