Gastroenterology and Hepatology Flashcards

Question

describe Crohn's disease and its risk factors

Answer 1

transmural granulomatous inflammation commonly affects terminal ileum and proximal colon NOD2/CARD15 mutation smoking NSAIDs

Answer 2

``` granulomas containing multinucleate giant cells transmural inflammation neutrophil infiltrates skip lesion wall thickening discrete deep ulcers cobblestone mucosa ```

Answer 3

``` diarrhoea urgency abdominal pain weight loss fever PR blood malaise ``` ``` anal/perianal/oral lesions skin tags fissure fistula anal disease adhesions strictures perforation fatty liver renal stones malnutrition ```

Answer 4

``` small bowel obstruction toxic dilatation abscess formation fistula rectal haemorrhage colonic carcinoma B12 deficiency iron deficiency anaemia venous thromboembolism ```

Answer 5

reducing course prednisolone (mild) hospital admission, NBM, IVF, hydrocortisone 100mg IV 6hrly (severe) antibiotics daily bloods and axr after improvement start oral prednisolone if no improvement consider infliximab/adalimumab perianal disease - local surgery with seton insertion

Answer 6

PENTASA reduces recurrent disease post-op azathioprine methotrexate TNF alpha inhibitors

Answer 7

squamous tumours - mid thoracic portion | adenocarcinomas - lower oesophagus or on a background of barrett's oesophagus

Answer 8

``` smoking alcohol barrett's oesophagus chronic reflux obesity Chinese/russian ethnicity achalasia tylosis ```

Answer 9

``` asymptomatic dyspepsia progressive dysphagia vomiting weight loss ```

Answer 10

surgery oesophageal stenting radical radiotherapy chemotherapy

Answer 11

``` Japanese hypo/achlorydia male high salts and nitrates gastric polyps ```

Answer 12

``` dyspepsia epigastric pain anorexia early satiety iron deficiency anaemia haematemesis melaena ```

Answer 13

``` male FHx IBD (especially ulcerative colitis) familial polyposis coli diet low in fibre, fruit and vegetables diet high in red meat and fat obesity cholecystectomy ```

Answer 14

iron deficiency anaemia abdominal pain abdominal mass

Answer 15

blood per rectum altered bowel habit abdominal mass

Answer 16

tenesmus obstruction blood per rectum

Answer 17

adjuvant chemotherapy and radiotherapy serial monitoring of CEA marker to detect recurrence isolated hepatic metastases of a single liver lobe can be resected

Answer 18

``` abdominal pain radiating through to the back obstructive jaundice weight loss pruritus double duct sign at ERCP small bowel obstruction CA19-9 ``` increased risk in diabetes and smokers

Answer 19

``` africa, asia and japan hepatitis B and C cirrhosis long-term OCP use aflatoxin ```

Answer 20

resection transplant chemo/ethanol injection not tumour/embolisation (palliative)

Answer 21

obstructive jaundice PSC liver fluke infection choledochal cyst caroli's disease transplant resection

Answer 22

OCP >5 years anabolic steroids asymptomatic intraperitoneal bleeding RUQ pain

Answer 23

``` coeliac Crohn's diverticulitis IBS IBD thyroid disorders antibiotics laxatives cancers nerve damage (stroke) spinal cord injury ```

Answer 24

``` faecal calprotectin stool O&S barium enema sigmoidoscopy serum iron, B12, folate, albumin AXR colonoscopy & biopsy CT small bowel ```

Answer 25

5% over 3-6 months

Answer 26

exercise/dieting bariatric surgery anorexia nervosa/eating disorder

Answer 27

hyperthyroidism increased exercise (marathon runner) malabsorption (pancreatic, bowel) DM

Answer 28

malignancy GI disease psychological endocrine

Answer 29

nocturnal symptoms progressive symptoms FHx

Answer 30

increased BMR negative nitrogen balance increased gluconeogenesis increased production of acute phase proteins

Answer 31

``` increased glucose demand glycogen stores rapidly used increased gluconeogenesis protein oxidation muscle loss increasingly negative nitrogen balance less oral intake ```

Answer 32

``` increased proteolysis and increased protein synthesis -> increased free amino acid pool -> increased acute phase protein ```

Answer 33

the equilibrium between protein intake and losses

Answer 34

``` general muscle wasting from famine reduced oral intake malabsorption increased catabolism ```

Answer 35

``` reported recent weight loss food diary behavioural patterns BMI biochemical markers MUST assessment ```

Answer 36

intact GI tract ability to absorb nutrients adequate diet

Answer 37

``` polyuria polydipsia genital thrush unexplained weight loss (mostly T1DM) visual blurring lethargy ```

Answer 38

glucose cannot get into the cells due to a lack of insulin and so the body breaks down fat and muscle to use for energy the glucose remains in the blood and the kidneys excrete it, causing frequent urination and weight loss due to dehydration and loss of calories

Answer 39

``` diarrhoea weight loss increased appetite sweating heat intolerance palpitations tremor irritability oligomenorrhoea ```

Answer 40

``` tachycardia goitre warm moist skin tremor lid lag and retraction thin hair palmar erythema ```

Answer 41

``` exopthalmos ophthalmoplegia oedematous swellings above lateral malleolus clubbing painful finger and toe swelling periosteal reaction in limb bones ```

Answer 42

``` TSH suppressed increased T3 and T4 mild normocytic anaemia mild neutropenia increased ESR, Ca, LFT thyroid autoantibodies isotope scan eye exam ```

Answer 43

circulating IgG autoantibodies binding to and activating G-protein-coupled TSH receptors, causing smooth thyroid enlargement and increased hormone production

Answer 44

``` Grave's disease toxic multi nodular goitre toxic adenoma ectopic thyroid tissue iodine excess levothyroxine excess contrast media ```

Answer 45

beta blockers (symptomatic) titration Carbimazole 20-40mg/24hr for 4 weeks Carbimazole and thyroxine simultaneously (block & replace) radioiodine (contraindicated in pregnancy and worsens eye disease) thyroidectomy (risk of recurrent laryngeal nerve damage and hypoparathyroidism)

Answer 46

agranulocytosis | must stop if suspected infection

Answer 47

``` HF (thyrotoxic cardiomyopathy) angina AF osteoporosis ophthalmopathy gynaecomastia thyroid storm ```

Answer 48

``` diarrhoea weight loss steatorrhoea bloating lethargy anaemia (B12, folate, iron) bleeding disorders (low vitamin K) oedema (low protein) metabolic bone disease (low vitamin D) neuropathy ```

Answer 49

T cell mediated protamine intolerance causes villous atrophy and malabsorption HLA DQ2

Answer 50

``` diarrhoea weight loss anaemia bloating abdominal pain mouth ulcers steatorrhoea ``` GI T-cell lymphoma malignancy osteoporosis neuropathy

Answer 51

``` epigastric pain that radiates to the back relieved by sitting forward steatorrhoea weight loss bloating brittle diabetes ``` alcohol cystic fibrosis haemochromatosis duct obstruction

Answer 52

``` analgesia lipase fat soluble vitamins insulin surgery ``` pseudocyst diabetes biliary obstruction pancreatic cancer

Answer 53

``` diarrhoea urgency PR bleeding weight loss aphthous ulcers perianal abscess/fistulae/strictures clubbing skin/joint/eye involvement ```

Answer 54

DMARDs immunosuppression surgery in severe cases ``` SBO toxic dilatation abscess fistulae colon cancer rectal haemorrhage PSC ```

Answer 55

``` nausea vomiting change in bowel habit melena dysphagia odynophagia abdominal pain jaundice masses/raised lymph nodes ```

Answer 56

must be considered in feeding with inadequate oral intake for >5 days surges in insulin large intracellular shifts in potassium, phosphate and magnesium resulting in low plasma levels

Answer 57

``` cardiac instability/arrhythmias seizures delirium parasthesia myopathy haemolysis paralysis oedema respiratory and cardiac failure ```

Answer 58

``` dysphagia weight loss haematemesis melena persistent vomiting iron deficiency anaemia epigastric mass ```

Answer 59

PPI full-dose for 4-8 weeks (lansoprazole 30mg OD) oesophageal stricture dilatation; remain on full-dose long-term therapy (lansoprazole 30mg OD) continuous/recurring symptoms - lowest dose PPI or H2RA therapy (ranitidine)

Answer 60

offer laparoscopic fundoplication for those who respond to PPI but do not want to continue long-term antacid and/or alginate therapy

Answer 61

delay in swallow initiation postnasal regurgitation when swallowing cough when swallowing repetitive swallowing required

Answer 62

``` CVA Parkinson's MS MND ALS MG pharyngeal pouch head and neck malignancies enlarged thyroid anticholinergics opiates ```

Answer 63

``` foreign body (acute) tumour peptic stricture oesophageal rings and webs eosinophilic oesophagitis chemical injury radiation infectious oesophagi's (herpes, candida) achalasia dysmotility disorders scleroderma mixed CT diseases ```

Answer 64

``` stricture oesophagitis cancer oesophageal rings, webs eosinophilic oesophagitis ```

Answer 65

scleroderma absent contractility achalasia distal oesophageal spasm

Answer 66

``` high dose PPI inject steroid and dilate stents self-dilatation surgery ```

Answer 67

food impaction >15 eosinophils per HPF lack of response to high dose PPI normal pH monitoring

Answer 68

topical steroids dilatation elimination diet (paeds)

Answer 69

botox balloon dilatation heller myotomy

Answer 70

sense of food sticking or passing abnormally through the oesophagus no oesophageal, mucosal or structural abnormality no GORD or EoE no major oesophageal motor disorders

Answer 71

high dose PPI | SSRI (fluoxetine) or TCA (amitriptyline)

Answer 72

``` dyspnoea lethargy chest pain tinnitus headache palpitations pallor tachycardia flow murmur ESM cardiac enlargement ankle swelling (CF) ```

Answer 73

``` haematological defect IDA sideroblastic; lead poisoning globin defect thalassaemia ```

Answer 74

blood loss bone marrow failure renal failure pregnancy (increased plasma volume)

Answer 75

vitamin B12 or folate deficiency anti-folate drugs (phenytoin, methotrexate) cytotoxic (hydroxycarbamide)

Answer 76

reticulocytosis alcohol or liver disease hypothyroidism myelodysplasia

Answer 77

``` reticulocytosis mild macrocytosis haptoglobin reduced increased bilirubin increased urobilinogen mild jaundice ```

Answer 78

endocrine, liver and cardiac damage

Answer 79

``` congenital acquired myelodysplastic/proliferative disease chemotherapy anti-TB drugs lead ``` remove cause pyridoxine transfusion for severe anaemia

Answer 80

unbalanced production of globin chains haemolytic while still in the bone marrow and removal by the spleen autosomal recessive inheritance

Answer 81

``` severe anaemia jaundice failure to thrive extra medullary erythropoiesis frontal bossing maxillary overgrowth hepatosplenomegaly haemochromatosis >10yrs ```

Answer 82

``` menorrhagia GI bleeding poor diet coeliac disease Crohn's disease ```

Answer 83

oral or IV iron

Answer 84

``` varices oesophago-gastro-duodenitis PUD/DU oesophageal or gastric cancer mallory-weiss tear mucosal tear angiodysplasia HHT large arteriole rupture in stomach or bowel warfarin thrombolytics epistaxis ```

Answer 85

``` diverticular disease rectal haemorrhoids camplyobacter shigella E. coli C. diff amoebic dysentery polyps UC Crohn's neoplasia gastric/upper bowel bleeding ischaemic colitis HHT angiodysplasia ```

Answer 86

``` tachycardia chronic liver disease melena PR hypotension/postural hypotension reduced urine output reduced GCS ```

Answer 87

``` PUD/DU mallory-weiss tear acute erosions/gastritis varices oesophagitis stomach/oesophageal cancer ```

Answer 88

``` age shock (BP, HR, co-morbidities) final diagnosis evidence of recent haemorrhage active bleeding visible vessel adhered clot ```

Answer 89

``` variceal banding Sengstaken-Blakemore tube beta blockers broad spectrum antibiotics IV terlipressin repeat endoscopic banding TIPSS ```

Answer 90

``` pale and cold extremities sweating pulse volume bruises mouth and nose bleeding abdominal tenderness +/- peritonism masses signs of chronic liver disease blood, melon, palpable mass, haemorrhoids (PR) ```

Answer 91

``` diverticular bleeds angiodysplasia colorectal cancer ischaemic colitis Meckel's diverticulum infectious colitis IBD haemorrhoids radiation proctitis aorta-enteric fistula ```

Answer 92

surgical resection colonoscopic haemostasis radiological embolisation may be upper GI

Answer 93

``` resuscitate and stabilise IV fluids group and crossmatch ABG and bloods correct clotting factors oxygen if hypoxic IV PPI urgent endoscopy inform surgeons incase need for surgery/embolisation ```

Answer 94

``` reduced intake increased demand (pregnancy, haemolytic, malignancy) coeliac Crohn's phenytoin methotrexate trimethoprim ```

Answer 95

``` decreased meat, fish and dairy intake decreased intrinsic factor pernicious anaemia post-gastrectomy ileal resection bacterial overgrow congenital metabolic errors ```

Answer 96

``` anaemia pallor and mild jaundice glossitis parasthesia peripheral neuropathy depression dementia optic atrophy subacute combined degeneration of the cord ```

Answer 97

most common cause of macrocytic anaemia autoimmune attack against gastric parietal cells that secrete intrinsic factor and acid = achlorhydria and lack of gastric intrinsic factor secretion >40yrs associated with thyroid disease, vitiligo and addison's

Answer 98

presence of intrinsic factor and parietal cell antibodies in serum lifelong quarterly hydroxocobalamin B12 injections

Answer 99

an acute mental disturbance characterised by confused thinking and disrupted attention usually accompanied by disordered speech and hallucinations usually develops over 1-2 days

Answer 100

heightened arousal, restless, agitated and aggressive

Answer 101

withdrawn, quiet and sleepy | can be more difficult to recognise

Answer 102

``` disordered thinking euphoric, fearful, depressed, or angry language impaired delusions reversal of sleep/awake cycle inattention disorientated memory deficits ```

Answer 103

``` >65yrs dementia severe illness surgery infection impaired hearing/vision poly pharmacy (including alcohol) dislocation to an unfamiliar environment sleep deprivation immbolisation CNS damage previous CVA ```

Answer 104

head injury + warfarin focal neurology reduced GCS high NEWS score

Answer 105

``` reduce distress encourage family to sit with patient moderately lit quiet room improve orientation to time and place verbal de-escalation hearing aids and glasses avoid physical restraints ``` ``` haloperidol lorazepam (alternative in Parkinson's or QTC prolongation) ```

Answer 106

rapid onset, focal neurological deficit due to a vascular lesion lasting >24hrs infarction due to ischaemia (80%) or intracerebral haemorrhage (20%)

Answer 107

``` smoking hypertension diabetes high lipids FHx AF cardiac valve disease peripheral vascular disease Hx ethnicity OCP ```

Answer 108

``` facial drop weakness in arms or legs dysarthria/dysphagia sudden loss/blurring of vision dizziness confusion balance and co-ordination problems sudden/severe headache loss of consciousness ```

Answer 109

``` hemiplegia (contralateral) homonymous hemianopia (contralateral) higher cortical dysfunction ```

Answer 110

contralateral motor/sensory loss in the legs>arms | face is spared

Answer 111

contralateral motor/sensory loss in face and arms>legs contralateral homonymous hemianopia cognitive changes

Answer 112

contralateral homonymous hemianopia with macula sparing

Answer 113

patient aware and cognitively intact but completely paralysed except for the eye muscles ventral pons infarction (basilar artery) central pontine myelinolysis rapid correction of hyponatraemia

Answer 114

``` ensure patent airway NBM until swallowing assessed don't over hydrate monitoring (glucose 4-11, BP <185/110) urgent CT/MRI thrombolysis with tPA clot retrieval if large vessel occluded antiplatelets refer to stroke unit DVT prophylaxis surgery carotid endarterectomy ```

Answer 115

start statin after 48hr aspirin/clopidogrel 300mg 2weeks after then reduce dose warfarin for cardiac thromboembolism 2 weeks post-stroke

Answer 116

sudden onset focal neurology lasting <24hr due to temporary occlusion of part of the cerebral circulation

Answer 117

atherothromboembolism from carotids cardioembolism (post-MI, AF, valve disease) hyper viscosity (polycythaemia, myeloma)

Answer 118

carotid bruits murmur AF HTN

Answer 119

aspirin or clopidogrel 300mg OD 2 weeks then 75mg after BP, lipids, smoking, DM, exercise, diet control ABCD2 score (assess risk) score >4, refer within 24hrs score <4, refer within 7 days

Answer 120

age >60 BP >140/90 clinical features (unilateral weakness, speech disturbance without weakness) duration of symptoms (>1hr, 10-59 minutes) diabetes

Answer 121

``` headache vomiting seizures reduced vision papilloedema ```

Answer 122

headache +/- mastoid pain focal neuro seizures papilloedema

Answer 123

cerebellar signs | lower CN palsies

Answer 124

5th and 6th CN palsies

Answer 125

``` spread from facial pustules or folliculitis headache chemosis eyelid oedema proptosis painful ophthalmoplegia fever ```

Answer 126

venous infarcts with stroke-like focal symptoms | evolve over days

Answer 127

``` pregnancy/puerperium OCP head injury dehydration intra/extracranial malignancy thrombophilia ```

Answer 128

LMWH -> warfarin (INR 2-3) | fibrinolytics (streptokinase)

Answer 129

extends from the cranio-cervical junction at the top of C1 to the conus medullaris opposite the bottom of L1

Answer 130

the principle descending motor pathway is the corticospinal tract that crosses in the midbrain the two principal ascending sensory pathways are the dorsal columns (carry vibration and joint position sense ) and spinothalamic tracts (carries pain and temperature)

Answer 131

due to trauma or severe inflammation complete loss of all modalities distal to the transection including motor, sensory and sphincter function

Answer 132

brown-sequard syndrome due to trauma, glioma, MS loss of motor function and dorsal column sensation ipsilateral to the hemisection contralateral loss of pain and temperature

Answer 133

due to syringomyelia, intramedullary tumour, trauma, central necrosis syringomyelia - cervical and thoracic region leading to dissociated sensory loss (preserved dorsal column function) and LMN weakness, atrophy and fasciculations

Answer 134

back pain lower limb; weakness, numbness, sensory changes, reflex loss ``` metastases in spine abscess haematoma disc prolapse intrinsic cord tumour ```

Answer 135

``` treat the cause dexamethasone 8mg IV BD radiotherapy chemotherapy surgical drainage of abscess and antibiotics decompressive laminectomy ```

Answer 136

mixed UMN/LMN weakness early constipation and retention back pain sacral sensory disturbance

Answer 137

``` saddle anaesthesia back pain radicular pain down legs bilaterally flaccid, areflexic lower limb weakness incontinence/faeces/urine retention poor anal tone ```

Answer 138

usually asymptomatic neck stiffness +/- crepitus stabbing/dull arm pain (brachialgia) upper limb motor and sensory disturbances according to compression levels (often C7) myelopathy with quadraparesis and sphincter dysfunction

Answer 139

``` stiff collar analgesia transforaminal steroid injection decompression laminectomy or laminoplasty ```

Answer 140

``` most commonly compression by L4/5, L5/S1 discs severe pain on sneezing/coughing lumbago sciatica limited spinal flexion pain on straight-leg raise ```

Answer 141

``` rest analgesia mobilisation/physiotherapy transforaminal steroid injection diseconomy or laminectomy may be considered with continuing pain or muscle weakness ```

Answer 142

``` spinal claudication aching or heavy buttock and lower limbs pain on walking parathesia/numbness pain eased by leaning forward pain on spine extension ```

Answer 143

NSAIDs epidural steroid injection canal decompression surgery

Answer 144

``` symmetrical dysaesthesiae loss of posterior column sensory modalities spastic para or quaraparaesis brisk knee jerks absent ankle jerks extensor plantas ``` ``` B12 deficiency (treatment is parenteral B12 replacement) seen alongside pernicious anaemia, severe malnutrition, nitrous oxide abuse ```

Answer 145

transit short-lasting sensation at the back of the neck, lower back after neck flexion electric-like, tingling, buzzing disappears on normal posture MS spondylosis vitamin B12 adulation myelopathy

Answer 146

acute inflammatory demyelinating polyneuropathy post infectious (campylobacter, EBV, zoster) symmetrical ascending weakness antibodies attack nerves can advance quickly and causes paralysis can affect respiratory muscles IV immunoglobulins

Answer 147

``` antibiotics with IV acyclovir if CNS infection suspected respiratory support haemodynamic support fluid and electrolyte balance VTE prophylaxis acid-base balance ```

Answer 148

bile duct branch of the hepatic artery branch of the portal vein

Answer 149

``` hepatocyte damage alcohol viral hepatitis paracetamol ischaemia ```

Answer 150

``` cholestasis biliary disease primary biliary cholangitis drugs fatty liver ```

Answer 151

<2-3 months paracetamol alcohol viral hepatitis

Answer 152

>6 months progression to fibrosis ``` caused by fatty liver disease alcohol viral hepatitis autoimmune liver disease metabolic ```

Answer 153

prehepatic - haemolysis, thalassemia, haemoglobinpoathies, Gilbert's syndrome hepatic - viral hepatitis, drugs, cirrhosis, tumours post hepatic - gallstones, cancer of bile duct, pancreatic carcinoma, lymph node enlargement in portal vein

Answer 154

``` jaundice hepatic encephalopathy coagulopathy portal hypertension liver cancer ```

Answer 155

RUQ pain weight loss decompensated disease AFP predominately in patients with cirrhosis single lesion or diffuse growth

Answer 156

``` resection transplant (CLT/LDLT) RF/PEI TACE sorafenib supportive care ```

Answer 157

``` jaundice ascites hepatomegaly cirrhosis caput medusae gynaecomastica palmar erythema spider naevi bruising leukonychia asterixis finger clubbing fetor hepaticus xanthelasma parotid enlargement xanthoma hepatic flap ```

Answer 158

AST ALT GGT ALP

Answer 159

bilirubin albumin PT

Answer 160

``` infection (hepatotropic viruses) alcohol autoimmune disease paracetamol statins anaesthetics haemochromatosis Wilson's disease vascular insult ```

Answer 161

fatty liver disease

Answer 162

biliary obstruction (stones, slide, strictures) primary and secondary biliary cholangitis primary sclerosing cholangitis ischaemia heart failure fibrosis

Answer 163

``` agitation hallucination orientation sweating tremor ```

Answer 164

portal hypertension -> reduced albumin -> reduced oncotic pressure -> transudation of fluid reduced aldosterone metabolism ->RAAS activation -> reduced renal blood flow -> salt and water retention

Answer 165

alcohol withdrawal IV thiamine (pabrinex) twin vials 3x daily oral/IV benzodiazepines determine mortality using GAHS and Maddrey's discriminant function (corticosteroids if >32)

Answer 166

prediction of mortality in patients with severe alcoholic hepatitis who have been treated with corticosteroids ``` age renal insufficiency albumin PT bilirubin evolution of bilirubin at day 7 ```

Answer 167

``` if infection, treat with antibiotics prednisolone 40mg daily x7 days at day 7 assess using Lille score <0.45 continue for 28 days (responder) >0.56 stop (non-responder) alcohol abstinence nutrition ```

Answer 168

dietary restriction of sodium (80-120mmol/day or 4.6-6.9g) anti-mineralocorticoid drugs furosemide (no response to anti-mineralocorticoids or hyperkalaemia develops) torasemide (weak response to furosemide)

Answer 169

presents in older ages | pain in the left iliac fossa

Answer 170

blood flows from the portal triad to the central vein in the branches of the portal vein and hepatic artery bile flows from the centre to the portal triad in the bile duct surrounded by hepatocytes

Answer 171

``` digestion; bile production coagulation metabolism immune function storage of vitamins, minerals and glucose ```

Answer 172

AST/ALT GGT (+MCV, IgA, ferritin) approx 2-300

Answer 173

viral hepatitis drugs; paracetamol ischaemia

Answer 174

``` cholestasis biliary disease; deranged LFTs and pain 90% gallstones primary biliary cholangitis drugs fatty liver ```

Answer 175

assess liver stiffness non-invasive quick safe

Answer 176

liver dysfunction; jaundice, hepatic encephalopathy, coagulopathy portal hypertension liver cancer

Answer 177

``` shows the estimated 1 and 2 year survival of cirrhosis encephalopathy ascites bilirubin albumin PT; seconds prolonged, INR ```

Answer 178

``` increased hepatic vascular resistance increased portal blood inflow formation of portosystemic collaterals 20-60% mortality pressure = resistance (liver) x blood flow ```

Answer 179

6 monthly USS AFP; rises with exacerbation of underlying disease

Answer 180

elevated in response to liver parenchymal injury

Answer 181

found in cells lining bile ducts and elevated in cholestatic diseases

Answer 182

symptoms; pain, urine colour, stool colour, itch risk factors; alcohol, viral hepatitis, drugs, FHx past medical history; NAFLD, pancreatitis, gallstones, malignancy

Answer 183

``` U&E blood glucose coagulation screen liver screening panel CXR USS diagnostic peritoneal tap OGD ```

Answer 184

``` hepatitis screen; acute viruses, viruses leading to chronic disease autoimmune coeliac IgG ferritin & % saturation copper & caeruloplasmin A1-anti trypsin levels ```

Answer 185

``` age WCC urea PT ratio or INR bilirubin ```

Answer 186

a disease specific prognostic score of alcoholic hepatitis 4.6 x bilirubin + (patients PT - control PT) >32; 30-50% mortality in 1 month

Answer 187

alcohol abstinence ascites management nutrition

Answer 188

viral hepatitis (B, C, CMV) yellow fever leptospirosis

Answer 189

paracetamol overdose halothane isonazid

Answer 190

Budd Chiari syndrome | veno-occlusive disease

Answer 191

``` AFLD NAFLD PBC haemochromatosis autoimmune hepatitis alpha-1 antitrypsin deficiency Wilsons disease HELLP fatty liver of pregnancy malignancy ```

Answer 192

``` jauncide asymptomatic hepatic encephalopathy fetor hepaticus asterixis/flap constructional apraxia ascites ```

Answer 193

``` leukonychia malnourishment IVDU finger clubbing palmar erythema hyperdynamic circulation Dupuytren’s spider naevi xanthelasma gynaecomastica atrophic testes reduced body hair parotid swelling hepatomegaly shrunken liver lethargy bruising thin skin ```

Answer 194

splenomegaly caput medusa oesophageal varices ascites

Answer 195

band varices prophylactic beta blockers TIPPS procedure

Answer 196

``` portal hypertension upper GI haemorrhage ascites spontaneous bacterial peritonitis hepatic encephalopathy hepatopulmonary syndrome hepatorenal syndrome ```

Answer 197

``` essential monitoring treat the underlying cause nutrition (thiamine and folate) cholestryamine reduced alcohol intake ``` be mindful of sepsis, GI bleeds/varices, hypoglycaemia, encephalopathy

Answer 198

``` NSAIDs bisphosphonates calcium antagonists nitrates theophylline corticosteroids ```