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Year 3 Medicine > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

How can acute liver failure present?

A

Coagulopathy
Hepatic encephalopathy
Jaundice
Ascites

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2
Q

What are some causes of acute liver failure?

A

Alcoholic liver disease, fatty liver disease, autoimmune hepatitis
Infection: viral hepatitis, CMV
Drugs: paracetamol overdose, isoniazid
Vascular: Budd-Chiari syndromen

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3
Q

What investigations are done to investigate acute liver disease?

A

Bloods
Ascitic tap => MC&S
CXR
Doppler flow study of portal vein

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4
Q

What bloods are done in acute liver failure?

A

FBC - infection, GI bleed
U&Es - urea synthesised in liver, so can’t be used for measuring renal function in liver failure
LFT
Clotting - measures synthetic function of liver, raised PT/INR in liver failure
Hepatitis serology
Blood cultures

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5
Q

What is included in a liver screen?

A 
LFTs
Coagulation screen
Hepatitis serology 
Epstein Barr Virus 
Cytomegalovirus
Immunoglobulins 
Ferritin - haemochromatosis 
Serum copper - Wilson's disease
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6
Q

What LFT results would indicate hepatocellular injury?

A

Greater than 10 fold increase in ALT

Less than 3 fold increase in ALP

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7
Q

What LFT results would indicate cholestasis?

A

Greater than 3 fold increase in ALP, with a raised gamma GT

Less than 10 fold increase in ALT

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8
Q

What would a raised gamma GT indicate?

A

Alcohol use
Drugs such as phenytoin

ALP also raised => cholestasis (biliary epithelial damage/bile flow obstruction)

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9
Q

What would an isolated ALP rise indicate?

A

Present in bone therefore indicates bone pathology
Bone mets/primary bone cancer
Vit D deficiency
Recent fracture

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10
Q

What can cause an isolated rise in bilirubin?

A

Gilbert’s syndrome

Haemolysis

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11
Q

What do ALT/AST ratios indicate?

A

ALT > AST chronic liver disease

AST > ALT - cirrhosis, acute alcoholic hepatitis

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12
Q

What are complications of acute liver failure?

A 
Cerebral oedema
Ascites
Bleeding 
Hypoglycaemia 
Encephalopathy
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13
Q

How does encephalopathy develop in acute liver failure?

A

Build up of nitrogenous waste, cleared by astrocytes => production of glutamate
Osmotic imbalance => cerebral oedema

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14
Q

How is hepatic encephalopathy treated?

A

Avoid sedatives, correct electrolyte imbalances
Lactulose
Rifaximin => abx, reduces ammonia forming bacteria

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15
Q

What are symptoms of ulcerative colitis?

A 
Bloody diarrhoea 
Abdominal pain
Urgency 
Tenesmus 
Acute attacks: fever, malaise
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16
Q

What are extra-intestinal features of UC?

A 
Erythema nodosum
Episcleritis
Conjunctivitis
Ankylosing spondylitis, sacroilitis 
Primary sclerosing cholangitis
17
Q

What investigations are done for UC?

A

Bloods - FBC, U&Es, LFTs, CRP, iron studies
Stool culture
Faecal calprotectin
Flexible sigmoidoscopy with biopsies

18
Q

How is mild UC defined?

A 
<4 bowel movements pre day 
Small amount of PR bleed
HR <90 
Apyrexial 
No anaemia
19
Q

How is moderate UC defined?

A

4 - 6 bowel movements a day
No anaemia
Apyrexial

20
Q

How is severe UC defined?

A 
>6 bowel movements a day
Large amount of PR bleed
Pyrexial
Anaemic
HR >90
21
Q

What maintains remission in UC?

A

Mesalazine

22
Q

What is the management for severe UC?

A

Admit
IV fluids
IV hydrocortisone/PR prednisolone
VTE prophylaxis

Rescue therapy - ciclosporin, tacrolimus, surgery

23
Q

What are features of UC?

A

Continuous mucosal/sub-mucosal inflam, extends from rectum proximally
Crypt abscesses, pseudopolyps

24
Q

What are acute complications of UC?

A

Toxic megacolon => risk of perforation

Severe exacerbations

25
Q

What are chronic complications of UC?

A

Colorectal ca

Osteoporosis

26
Q

What are features of Crohn’s?

A

Transmural granulomatous inflammation, affecting any part of the GI tract. Can form fistulas
Has skip lesions

27
Q

What are symptoms of Crohn’s?

A

Non-bloody diarrhoea
Weight loss
Abdo pain

28
Q

What are signs of Crohn’s?

A

Abdo tenderness
Anal and peri-anal disease - fitsula, skin tag, abscess
Mouth ulcers

29
Q

What investigations are done for Crohn’s?

A

Bloods - FBC, U&E, LFT, INR, B12, folate
Stool culture, faecal calprotectin
Colonoscopy and biopsy
Capsule endoscopy - look for small bowel inflam

30
Q

What are complications of Crohn’s?

A 
Small bowel obstruction 
Toxic megacolon 
Abscess formation 
Fistula formation 
Colorectal ca 
Malnutrition
31
Q

What are some causes of upper GI bleeds?

A

Peptic ulcer
Oesophageal varices
Malignancy
Mallory-Weiss tear

32
Q

How can upper GI bleeds present?

A

Haematemesis, malaena

Features of shock

33
Q

What is the initial management for upper GI bleeds?

A 
A-E 
2 large bore cannulas 
Bloods - FBC, U&amp;E, LFT, clotting, crossmatch 
CXR, ECG, ABG 
Urgent OGD
34
Q

What bloods should be done in upper GI haemorrhage?

A 
FBC - anaemia, assess trend
Crossmatch blood
Clotting - assess for coagulopathy (liver failure)
LFTs
U&amp;Es
35
Q

What is the definitive management for a peptic ulcer bleed?

A

OGD => haemostasis
Clips, cautery or adrenaline
Give PPI afterwards
Treat for H pylori if +ve

36
Q

How should oesophageal varices be managed?

A

Terlipressin and prophylactic abx
Band ligation
TIPS procedure if band ligation doesn’t control

Prevention: beta blocker, propanolol

Year 3 Medicine (11 decks)

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