Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medical Finals 2020 > Gastroenterology and Hepatobiliary > Flashcards

Gastroenterology and Hepatobiliary Flashcards

You may prefer our related Brainscape-certified flashcards:
USMLE® Step 1 flashcards
1
Q

What test do you do in order to investigate potential PBC or PBS?

A

Magnetic resonance - cholangiopancreatography (MRCP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the associated condition for Primary Sclerosing Cholangitis?

A

Ulcerative colitits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the key differentiating features of Crohn’s in comparison to Ulcerative Colitits?

A

Crohn’s - transmural, granulomas (cobblestone mucosa), skip lesions, discontinuous lesions, strictures)

Ulcerative Colitis - submucosa, crypts, continuous inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is your drug of choice to manage Crohn’s?

A

Methotrexate or infliximab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you treat UC flares?

A

Prednisolone

Usually on azathioprine
- 5-aminosalycylic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does a lack of abdominal breathing potentially indicate?

A

Peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What diet is helpful for IBS treatment?

A

FODMAP diet - Fermentable Oligo-di-monosaccharides and polyols

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What histological feature is seen in coeliac disease?

A

Villous atrophy
Flat mucosa
Marked crypt hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some associated conditions in coeliac disease?

A

Dermatitis herpetiformis (vesicular, pruritic skin eruption)
Autoimmune disorders (T1DM)
IBS
Autoimmune thyroid disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How might coeliac disease present?

A 
Malnutrition, failure to grow
Weight loss
GI symptoms: persistent vomiting/nausea/diarrhoea
Abdominal pain, cramping, distension
Unexplained iron deficiency anaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

A gentleman with a heavy drinking habit presents with mild jaundice and a palpable painless gallbladder. What is the most likely diagnosis?

A

Malignancy of gallbladder or pancreas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Courvoisier’s sign?

A

Painless enlarged gallbladder and mild jaundice = NOT gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a classical presentation of pancreatic cancer?

A

Painless jaundice

Non-specific - weight loss, anorexia, epigastric pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the procedure for surgical resection of the pancreas head?

A

Whipple’s resection (pancreaticoduodenectomy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is used to determine liver cirrhosis severity?

A 
Bilirubin
Albumin
PT
Encephalopathy
Ascites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the most common part of the colon affected by ischaemic colitis?

A

Splenic flexure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some common features of ischaemic colitis?

A 
Abdominal pain (acute mesenteric ischaemia) - sudden onset, severe, out of keeping with physical exams
Rectal bleeding
Diarrhoea
Fever
Raised WCC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the difference between acute mesenteric ischaemia and ischaemic colitis?

A

Mesenteric ischaemia - affects the small bowel, often embolic cause, hx of AF, urgent surgery required
Ischaemic colitis - transient compromise to blood flow - inflammation, ulceration and haemorrhages occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some classic features of a carcinoid tumour?

A

Flushing, sweating, diarrhoea, bronchoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What test is diagnostic for c difficile?

A

C difficile toxin

First line therapy is PO metronidazole for 10-14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does achalasia increase your risk for?

A

Squamous Cell Carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is Barrett’s Oesophagus?

A

Dysplasia of squamous cells in oesophagus to columnar epithelium.
Risk factor in adenocarcinoma
Treat with PPI + endoscopic surveillance

If dysplasia then consider ablation or resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are some causes of acute pancreatitis?

A 
I GET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps/Malignancy
Autoimmune
Scorpion stings
Hyperlipidaemia, Hypercalcaemia, Hypothermia
ERCP
Drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is a common but non-liver feature of Wilson’s Disease?

A

Neuropsychiatric symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is Wilson’s Disease?

A 
Autosomal recessive
Copper deposition in the tissues
Hepatitis, cirrhosis
Basal ganglia degeneration, speech, behavioral and psychiatric problems
Chorea, dementia, asterixis
Kayser-Fleischer rings (red in eyes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How do you diagnose and manage Wilson’s Disease?

A

Low serum caeruloplasmin, Low serum copper, increased urine copper
Penicillamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is a sign on biopsy of laxative abuse?

A

Melanosis coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is Budd-Chiari Syndrome and when can it occur?

A

Hepatic vein thrombosis

Seen in underlying haematological disease (polycythaemia, thrombophilia, pregnancy, COCP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is diagnostic of Budd-Chiari syndrome?

A

ultrasound with Doppler flow studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the symptoms of Budd-Chiari Syndrome?

A

Abdominal pain (sudden onset, severe)
Ascites
Tender hepatomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the best test to determine liver cirrhosis?

A

Transient elastography (fibroscan)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the most common features of IBS?

A

Feeling of incomplete stool evacuation
Back pain
Lethargy
Nausea

Consider diagnosis in abdominal pain, bloating or change in bowel habit for at least 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is a common cause of diarrhoea post-travelling?

A

E-coli causes travellers diarrhoea, commonly with nausea and abdominal cramps.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are some risk factors for Barrett’s oeseophagus?

A

GORD
Male
Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What cardiac abnormalities are associated with carcinoid syndrome?

A

Pulmonary stenosis and tricupsid insufficiency

It affects the right side of the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How do you treat carcinoid syndrome?

A

Octreotide - somatostatin analogue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is Gilbert’s Syndrome?

A 
Benign
Inability to conjugate bilirubin
Autosomal recessive
Occurs during illness, fasting, stress, lack of sleep, dehydration, alcohol excess
Reassure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is Primary Biliary Cholangitis?

A 
Autoimmune (F>M)
Interlobular bile duck inflammation
Progressive cholestasis and cirrhosis
Itching, hepatosplenomegaly
IgM, anti-mitochondrial antibodies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are causes of liver cirrhosis?

A

Alcohol
NAFLD
Viral Hep B and Hep C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the management for a liver abscess?

A

Drainage and antibiotics (amox + cipro + metro)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the gold standard investigation for oesophageal cancer?

A

Endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

When are gallstones treated?

A

Symptomatic patients - done with surgery (laparoscopic cholecystectomy) or ERCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are some classic differentiating features between Crohn’s and UC?

A

UC - continuous disease of IC valve to rectum, no inflammation beyond submucosa, crypt abscesses
Bloody diarrhoea more common, pseudopolyps

Crohn’s - skip lesions, mouth to anus, inflammation all levels, goblet cells, granulomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Which type of jaundice presents as dark urine and pale stools?

A

Obstructive jaundice (cholestasis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What deficiency is coeliac disease associated with?

A

Iron, folate and B12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Give some differential diagnosis of abdominal pain.

A 
Biliary cholic, cholecystitis
Cholangitis
Pancreatitis (often painless)
Hepatitis
Appendicitis
Renal colic
Gynae - ectopic, PCOS, fibrinoids, endometriosis
Splenic trauma
Peptic ulcer disease
AAA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are the five ‘F’s of abdominal distension?

A 
Fat
Fluid
Faeces
Foetus
Flatus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the nine regions of the abdomen?

A 
Hypochondriac - R and L
Epigastric
Lumbar - R and L
Umbilical
Iliac region R and L
Hypogastric
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are causes of GORD?

A 
NSAIDs
Pregnancy
Obesity
Smoking
Alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is dyspepsia?

A

Reflux and epigastric pain due to indigestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is dysphagia?

A

Problems swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How is GORD managed?

A

Lifestyle changes
PPI - 30mg omeprazole or lansoprazole
H2RA: ranitidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are some side effects of PPIs?

A

SE: bone demineralisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How is h. pylori treated?

A

PPI/H2RA

x2 antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is a common cause of an ulcer?

A

H. pylori
NSAIDs
Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Are they any differences between a gastric ulcer and a duodenal ulcer other than site?

A

Gastric/Peptic - less common, bleeding and haematemesis

Duodenal - more common, malaena

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is the name of the test for the bacteria that causes ulcers?

A

13C breath test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are potential differentials for an upper GI bleed?

A 
Gastric ulcer
Oesophageal varices
Liver disease
Mallory-Weiss tear
Malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What drug can you give to treat oesophageal varices?

A

Propranolol hydrochloride

If haemorrhaging can give terlipressin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What are the two MAIN causes of pancreatitis?

A

Gallstones

Alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are two typical signs of pancreatitis?

A

Grey-Turner’s Sign - discolouration in the flanks, a result of blood leaking into subcut tissues
Cullen’s Sign - grey discolouration around umbilicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is the abbreviated Glasgow scale used for?

A

Pancreatitis severity assessment

APACHE II used too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

How do you treat pancreatitis?

A

IV fluids, O2
Antibiotics
Monitor urine output
Analgesia for pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is the difference between primary and secondary peritonitis?

A

Primary - spontaneous bacterial peritonitis (occurs in compromised immune systems)
Secondary - occurs due to underlying pathology (pancreatitis, surgery, bowel perforation, appendicitis, ectopic, bowel infarct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Abdominal pain that improves when a hand is laid on it may indicate…

A

Peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is Rovsing’s sign?

A

When pressing on the left iliac fossa, pain may be felt on the right iliac fossa.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is paralytic ileus?

A

Cessation of peristaltic waves in the gut, occur as a result of abdominal distension

68
Q

What is the most common cause of infective diarrhoea?

A

E.coli

0157

69
Q

What infective cause is bloody diarrhoea associated with?

A

Shigella

70
Q

What is rice water diarrhoea associated with?

A

Cholera

71
Q

What antibiotics are associated with clostridium difficile?

A

Clindamycin
Ciprofloxacin
Co-amoxiclav
Cephalosporins

72
Q

How do you treat c. difficile?

A

Metronidazole, PO vanc or rifampicin.

Stop current antibiotics

73
Q

Give 5 investigations you can do in pancreatitis and their expected result?

A 
Amylase - raised
WCC - raised
Lactate - raised
CRP - raised
Abdominal CT - loss of fat, pancreatic oedema
74
Q

Give 4 investigative tests you can do in peritonitits and their expected result?

A 
WCC - raised
Platelets - raised
CRP - raised
bHCG - negative, rule out pregnancy
Ascitic tap - organisms growing
ECG - normal, rule out cardiac causes
75
Q

What 3 primary histological features will you see in Crohn’s disease?

A

Skip lesions
Transmural inflammation (all layers of the bowel wall)
Granulomas
Discontinuous inflammation

76
Q

What 2 primary histological features will you see in Ulcerative Colitis?

A

Mucosal inflammation only

Continuous inflammation

77
Q

Which inflammatory bowel disease affects the whole of the GI tract?

A

Crohn’s

UC only affects the colon

78
Q

Give 5 extra-intestinal features of ulcerative colitis?

A 
Uveatis
Mouth ulcers (orofacial granulomatosis)
Erythema nodosum (red lumps)
Arthritis
Ankylosing spondylitis
79
Q

Fecal calprotectin is used for which disease?

A

IBD

80
Q

What are classic symptoms of IBS?

A

Abdominal pain
Bloating
Lethargy, nausea, back ache
Change in bowel habit, often symptoms improve with defecation, change in tool frequency

81
Q

What is involved in the management of IBS?

A

Education
Change in diet (avoid insoluble fibres, eat fruit, fluids, avoid caffeine)
Pharmacological - antispasmodics (mebeverine, buscopan), laxatives
CBT, psycholoical

82
Q

What are the 5 pathophysiologies involves in malnutrition?

A 
Defective intraluminal digestion
Insufficienct absorptive area
Lack of digestive enzymes
Defective epithelial transport
Lymphatic obstruction
83
Q

What antibodies are involved in a coeliac screen?

A

Anti-tissue transglutaminase (tTG)
Anti-endomysial antibody (EMA)
Immunoglobulins

Jejunal biopsy

84
Q

How might coeliac disease present?

A 
Bloating
Abdominal pain
Diarrhoea, steatorrhoea
Weight loss, malabsorption
Rash (dermatitis herpetiformis)
85
Q

What classification is used to stage coeliac disease?

A

Marsh Classification

86
Q

How is coeliac disease treated?

A

Gluten-free diet

87
Q

What is diverticular disease and what is the difference between diverticular disease and diverticulitis?

A

The presence of outpouchings in the gut wall

Diverticulitis - infection of these outpouchings - causes pain, inflammation and requires antibiotics

88
Q

Does ascites occur with gallstones?

A

No

89
Q

What is hepatorenal syndrome and how is it managed?

A

Vasoactive mediators cause splanchnic vasodilation which reduces systemic vascular resistance causing underfilling of the kidneys (decreased pressure causes water retention and renal vasoconstriction)
Treat with terlipressin

90
Q

What drug can be used to prevent bleeding in oesophageal varices?

A

Beta blocker

91
Q

What is a sign that patients are at risk of refeeding syndrome?

A

Hypophosphataemia

Low K+, Mg, thiamine deficiency

92
Q

How does a cholangiocarcinoma present?

A 
Jaundice
Weight loss
Pruritis
Persistent Biliary Symptoms
Affects up to 10% of PSC patients
93
Q

What prophylactic treatment is given after SBP?

A

Ciprofloxacin

94
Q

What is intussusception?

A

The telescoping on one piece of bowel into another

Commonest cause of obstruction

95
Q

What is a common location for intussusception?

A

Ileo-caecal junction

96
Q

What are your management options for intussusception?

A 
Contrast enema (both diagnostic and therapeutic)
Open/laparascopic reduction
97
Q

What is the biggest risk factor for oesophageal cancer?

A

Smoking (especially squamous cell carcinoma)

98
Q

What is the most common location of colorectal cancers?

Do proximal or distal cancers have a better prognosis?

A

Sigmoid colon and rectum

Proximal cancers have a worse prognosis as they present later

99
Q

What family history has an influence in incidence of colorectal cancers?

A

Hereditary non-polyposis colorectal cancer (HNCC)

Familial Adenomatous polyposis (FAP)

100
Q

What symptoms could someone with colon cancer present with?

A 
PR bleeding
Excess mucous
Narrowing obstruction
Constipation
Colicky abdominal pain
Abdominal distension
101
Q

What tumour marker is used in colon cancer?

A

CEA - not diagnostic

102
Q

What investigations are done in suspected colorectal cancer?

A

Colonscopy - gold standard (with biopsy)

Faecal occult blood - high specificity and low sensitivity

103
Q

What staging criteria is used in colorectal cancers?

A

Duke’s Staging Criteria

104
Q

What are the 4 stages of Duke’s Staging Criteria?

A

A - invasion into but not through the bowel wall
B - invasion through the bowel wall penetrating the muscle layer but not involving lymph nodes
C - lymph node involvement
D - lymph nodes with widespread metastases

105
Q

What is the tumour marker for pancreatic cancer?

A

Ca19-9

106
Q

What are risk factors in hepatocellular carcinoma?

A

Alcohol
Liver cirrhosis
Viral Hep C

107
Q

What is a good marker of hepatocellular carcinoma?

A

Alpha-feto protein

108
Q

What alternative to chemo can you give for hepatocellular carcinoma?

A

Sorafenib

Side effects - decreases platelets, increases BP, can’t give in PVD or ACS

109
Q

What is the most important electrolyte to be given in refeeding syndrome?

A

Phosphate

110
Q

What is included in a NILS?

A 
FBC
LFT
Clotting
Cholesterol
Blood Glucose
Hep B & C, Viral Screen (CMV, EBV, HIV)
Ferritin, Total Iron Binding Capacity
Alpha-1-Antitrypsin
Immunoglobulins
AFP
Serum copper, ceruloplasmin
111
Q

What are some extra-hepatic signs of liver disease?

A 
Dupuytren's contractures
Spider naevi
Spider angioma
Caput medusa (enlarged veins)
JVP rise
Splenomegaly
112
Q

What is the best indication of cholestatic injury?

A

Raised ALP and GGT

113
Q

What blood tests give the best result of liver function?

A

Albumin
Bilirubin
PTT

114
Q

What are some complications of a liver transplant?

A

Sepsis
Malignancy outside the liver
Shortage of donors
Rejection

115
Q

What is the score used to determine the severity of liver cirrhosis and what does it look at?

A 
Child-Pugh Score
Bilirubin
Albumin
INR
Ascites
Encephalopathy
116
Q

What are common causes of liver cirrhosis?

A

Alcohol
Viral hepatitis
NAFLD

117
Q

What symptoms do you get in liver cirrhosis?

A

Splenomegaly (liver actually shrinks due to scarring and fibrosis)
Jaundice
Pyrexia
Ascites (low albumin, portal hypertension, varices)
Systemic - malnutrition, coagulopathy, vit K deficiency, encephalopathy, hypoglycaemia)

118
Q

What are some causes of acute liver failure and how might it present?

A

Paracetamol overdose
Alcohol
Viral Hep

Jaundice
Coagulopathy (raised PT)
Low albumin
Hepatic encephalopathy (asterixis)
Renal failure is common
119
Q

How does vitamin C deficiency present?

A

Scurvy
Lethargy, arthralgia, easy bruising, bleeding gums
Common in low income backgrounds, elderly, alcoholics or in those with a poor diet.

120
Q

What is Rovsing positive mean?

A

Appendicitis - palpation in the LIF causes pain in the RIF

121
Q

What are early signs of haemochromatosis and what does the disease involve?

A

Fatigue, erectile dysfunction and arthralgia
Autosomal recessive
Disorder of iron absorption and metabolism resulting in accumulation

122
Q

How does Addison’s disease present acutely?

A

Abdominal pain, weight loss, nausea and vomiting

123
Q

What do you give in the secondary prophylaxis of hepatic encephalopathy?

A

Lactulose and rifaximin

124
Q

What test should be done before commencing azathioprine?

A

Thiopurine methyltransferase (TPMT) activity

125
Q

What is the first line medication to prescribe in IBS?

A

Loperamide

126
Q

What is the most common cause of EBP?

A

E.coli

127
Q

Give some causes of unconjugated jaundice?

A

Haemolysis
Gilbert’s Syndrome
Drugs

Liver enzymes normal
Stools normal or dark, urine normal

128
Q

What are some causes of conjugated jaundice?

A

Viral hepatitis
Alcohol and toxins - paracetamol
Haemachromatosis, alpha-1-antitrypsin deficiency, Budd-Chiari

Post-hepatic causes - gallstones, cholangitis

129
Q

What do Mallory bodies on biopsy suggest?

A

Alcoholic liver disease

130
Q

How might alcoholic liver disease present?

A

Malnutrition - ascites, thin arms/legs, iron deficiency anaemia
Liver problems - jaundice, ascites, hepatosplenomegaly
Face or skin involvement - spider naevi, easy bruising
Endocrine - gynaecomastia, testicular atrophy
Neuro - Wernicke-Korsakoff, peripheral myopathy, memory loss, encephalopathy, asterixis

131
Q

What are the five metabolic changes that occur in paracetamol overdose?

A 
Acute hepatitis
Hypoglycaemia
Metabolic acidosis
Coagulopathy
Renal failure
132
Q

What is your management drug of choice for paracetamol overdose?

A

N-acetyl-cysteine (NAC)

133
Q

Which viral hepatitis can cause chronic disease?

A

Hep B, C

134
Q

What antibodies do you see in autoimmune hepatitis?

A

ANA positive
Anti-smooth muscle antibody

There may be an association with other autoimmune diseases

135
Q

Steatohepatitis on biopsy indicates…?

A

Non-Alcoholic Fatty Liver Disease

Non-Alcoholic Steatohepatitis (NASH)

136
Q

What is hepatorenal syndrome?

A

Renal failure secondary to cirrhosis, portal hypertension or ascites. There is low renal output due to peripheral vasodilation
Decreased renal blood flow

137
Q

What are low and high platelets referred to as..?

A

Thrombocytopenia - low

Thrombocythaemia - high

138
Q

What kind of inheritance is haemochromatosis?

What is the pathology involved?

A

Autosomal recessive

Iron deposition and organ failure

139
Q

What two organs are involved with alpha-1-antitrypsin deficiency and what is the inheritance?

A

C14 genetic mutation

Lungs and Liver (chronic inflammation)

140
Q

What is a major risk factor in hepatic vein occlusion?

A

Thrombophilia - hypercoagulable state

Budd-Chiari Syndrome

141
Q

What are the main risk factors for gallstones?

A

Fat
Female
Fertile

142
Q

What are your management options for gallstones? Is there is a difference in management in symptomatic and asymptomatic?

A

Asymptomatic - don’t treat

Cholecystectomy
Stone dissolution
ERCP - sphincterotomy - for bile duct stones

143
Q

What is Charcot’s Triad and Reynold’s Pentad and in what do they occur?

A

Triad - fever, RUQ pain, jaundice
Pentad - hypotension, confusion + triad

Ascending Cholangitis

144
Q

What is the difference between ascending cholangitis and acute cholecystitis?

A

Cholecystitis - inflammation/infection of GALLBLADDER

Cholangitis - obstruction causing infection of whole biliary tree and potentially the liver and gallbladder

145
Q

Give 3 differences between PBC and PSC?

A

Primary Biliary Cholangitis/Cirrhosis - AMA positive, intrahepatic bile ducts, granuloma and ductopenia, RA association

Primary Sclerosing Cholangitis - extrahepatic ducts, strictures, IBD (UC) link

146
Q

What symptoms do you experience in bile duct obstructions?

A

Fatigue
Pruritis
Jaundice

147
Q

Sudden onset dysphagia indicates?

A

Red flat

Requires urgent endoscopy regardless of age or other symptom

148
Q

Give some differentials for dysphagia?

A

Dysphagia = problems swallowing
Oesophageal cancer - associated weight loss, anorexia, vomiting, PMN smoking or alcohol, Barrett’s oesophagus
Oesophagitis - heartburn history, systemically well
Oesophageal candidiasis - HIV hx, steroid use is a risk factor
Achalasia - liquids and solids from the start, ‘bird’s beak’ sign, heartburn, risk of cough and aspiration pneumonia
Pharyngeal pouch - older men, posteromedial herniation, regurgitation, chronic cough, halitosis
Systemic Scerolsis
Myasthenia Gravis - extraocular muscle weakness
Globus hystericus - anxiety history, symptoms relieved by swallowing, usually painless

149
Q

Give 5 non-gastro-oesophageal causes of dysphagia?

A

Parkinson’s, MND, MS, MG
Systemic sclerosis
Post-stroke/CVA

150
Q

What is used in the management of severe acute alcoholic hepatitis?

A

Prednisolone

151
Q

What does a paracetamol overdose do to the liver and how long does it take liver failure to develop?

A

Toxic metabolite – build up of NAPQI, binds to liver cell membranes causing necrosis
It takes 72-96 hours, 3-4 days

152
Q

How do you calculate alcoholic units?

A

Units = Volume (L) x ABV%

153
Q

Which is worse after eating -peptic or duodenal ulcer?

A

Peptic ulcer worse after eating
Duodenal ulcer - improved by eating, worse with stress and at night, radiates to back. Bleeding from gastroduodenal artery (first 2/3 of duodenum)

154
Q

What is your first line test in primary sclerosing cholangitis?

A

USS
MR cholagiopancreatography

ULCERATIVE COLITIS LINK

155
Q

What do you see in biopsies to suggest carcinomas?

A

Hyperchromic
Pleomorphism
Nuclear enlargement

156
Q

What are signs of a paralytic ileus?

A

No bowel sounds
No passing of gas or faeces
Distended abdomen
No rebound tenderness or guarding

157
Q

What is your management of a paralytic ileus?

A

NG tube insertion

Nil by mouth

158
Q

What are some causes of a raised serum ferritin?

A

Alcohol
Obesity
Inflammation
Hemochromatosis

159
Q

What are some hand signs of liver disease?

A 
Duypetren's Contracture
Clubbing
Palmar erythma
Terry's nails
Asterixis
Spider naevi
160
Q

What are some features of autoimmune hepatitis?

A
  • signs of chronic liver disease
  • acute presentation with fever, jaundice
  • amenorrhoea is common
  • ANA/SMA antibodies
  • liver biopsy will show inflammation

Manage with steroids and immunosupressants

161
Q

Pain in the epigastrium and vomiting is most likely due to what?

A

Pancreatitis - EPIGASTRIUM

RUQ consider gallstones/cholecystitis

162
Q

When is a pancreaticoduodenectomy used?

A

Whipple’s Procedure

Pancreatic carcinoma with no metastases

163
Q

What is Rigler’s sign?

A

Double wall sign on AXR that suggests free air in the abdomen

164
Q

What might a raised ALP suggest?

A
  • biliary cirrhosis
  • pregnancy
  • Paget’s disease
  • hypercalcaemia
  • osteomalacia
  • bone metastases
165
Q

How might a chlangiocarcinoma present?

A

RUQ mass
malaise, weight loss
anorexia, n+v
RUQ pain

patients may present with obstructive jaundice (pale stools, dark urine, pruritis)

166
Q

What is the primary management for a cholangiocarcinoma?

A
  • surgical resection
    This is contraindicated if the patient has metastatic disease, malignant ascites, vascular invasion (at risk of major bleed)
167
Q

What is the most common cause of a liver abscess and your usual management?

A

Usual cause is e.coli (staph aureus in children)

  • Drainage and antibiotics
  • Amoxicillin + ciprofloxacin + metronidazole

Medical Finals 2020 (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions