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Gastrointestinal Flashcards

1
Q

Management of acute liver failure

A 
30º tilt - to minimise ICP elevation
Intubation
NGT
Urinary cathether/CVC
Analgesia
Sedation
10% dextrose - for hypoglycaemia
Dialysis - for renal failure
Treatment of underlying cause
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2
Q

Features of Korsakoff’s syndrome

A

Anterograde/retrograde amnesia
Aphasia, apraxia, agnosia
Confabulation
Lack of insight

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3
Q

Causes of cirrhosis

A

HANDWAVE:

  • Haemochromatosis
  • Autoimmune - autoimmune hepatitis, PBC, PSC
  • Non-alcoholic steatohepatitis (NASH)
  • Drugs - amoxicillin, flucloxacillin, amiodarone, methotrexate
  • Wilson’s disease
  • Alpha-1 antitrypsin disease
  • Viral hepatitis - hepatitis B, hepatitis C
  • Ethanol
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4
Q

Pathology of cirrhotic nodules

A

Fibrous bands subdivide liver parenchyma into regenerative nodules - micro/macro/mixed

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5
Q

Serum albumin ascites gradient (SAAG)

A

SAAG = serum albumin - ascitic fluid albumin

> 11 g/L - transudate

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6
Q

Causes of liver decompensation

A

DIGROCK:

  • Dehydration
  • Infection (SBP)
  • GI bleeding
  • Renal failure
  • Opioids
  • Constipation
  • Killing liver by other means (benzodiazepines, hypoxia, surgery, hyponatraemia, hypokalaemia)
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7
Q

Management of ascites

A

Fluid/salt restriction
Paracentesis
Transjugular intrahepatic portosystemic shunt (TIPS)

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8
Q

Management of hepatic encephalopathy

A

Laculose

Rifaximin

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9
Q

Most common pathogens in SBP

A

Gram-negative bacteria (E. coli, Klebsiella)

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10
Q

Management of SBP

A

Ceftriaxone/cefotaxime (IV)

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11
Q

Management of hepatorenal syndrome

A

Albumin

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12
Q

Child-Pugh score

A

ABCDE:

  • Albumin
  • Total bilirubin
  • Clotting time (PT)
  • Distended abdomen (ascites)
  • Hepatic encephalopathy
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13
Q

Extraintestinal features of coeliac disease

A 
Anaemia
Bleeding diathesis (vitamin K deficiency)
Osteoporosis
Neurological features (hypocalcaemia)
Hormonal disorders
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14
Q

Pathological process in gastritis

A

Metaplasia

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15
Q

Management of Crohn’s disease

A

Induction:

  • Prednisolone
  • Anti-TNF (infliximab)
  • Immunomodulatory agents (azathioprine, mercaptopurine, methotrexate)

Maintenance:

  • Anti-TNF
  • Immunomodulatory agents
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16
Q

Management of ulcerative colitis

A

Induction:

  • Mesalazine + 5-ASA
  • Corticosteroids

Maintenance:

  • Mesalazine + 5-ASA
  • Immunomodulatory agents
17
Q

Management of primary biliary cirrhosis

A

Ursodeoxycholic acid

18
Q

Management of GORD

A

Lifestyle modification:

  • Limit trigger foods
  • Eat smaller meals
  • Avoid eating/drinking 2-3 hrs before bed/exercise
  • Stop smoking
  • Lose weight

Medications:

  • PPI (esomeprazole, omeprazole, pantoprazole)
  • H2 receptor antagonist (ranitidine)
  • Antacid (Mylanta)

Surgery:
-Nissen fundoplication (upper stomach wrapped around LOS)

19
Q

Complications of GORD

A
  • Reflux oesophagitis
  • Oesophageal stricture
  • Barrett’s oesophagus (requires monitoring)
  • Oesophageal adenocarcinoma
20
Q

Avoid antibiotics in which gastroenteritis pathogen and why?

A

EHEC - may cause HUS

21
Q

H. pylori triple therapy

A

PPI - esomeprazole/omeprazole
Amoxicillin (or metronidazole)
Clarithromycin

22
Q

Location and epithelium of external vs. internal haemorrhoids

A

External: distal to dentate line; anoderm (specialised squamous epithelium)
Internal: proximal to dentate line; transitional epithelium

23
Q

Grades of haemorrhoids

A

1 - no prolapse
2 - prolapse upon bearing down with spontaneous reduction
3 - prolapse upon bearing down requiring spontaneous reduction
4 - irreducible prolapse

24
Q

PBC vs. PSC antibodies

A

PBC: AMA, ANA
PSC: ANA, pANCA, anti-SMA

25
Q

Transmission of viral hepatitis

A

A - faecal-oral
B - sexual contact, vertical transmission (and other blood contact)
C - IVDU (and other blood contact)

26
Q

Interpretation of HBV serology – HBsAg, anti-HBs, anti-HBc

A

HBsAg - active infection (acute or chronic)
Anti-HBs - immune (due to vaccination or infection)
Anti-HBc - active or previous infection

27
Q

Dukes’ classification

A

A - no penetration of muscularis propria
B - invasion of muscularis propria
C - lymph node involvement
D - distant metastasis

28
Q

TNM staging of colorectal cancer

A 
Definitions:
♣T:
•	is – confined to mucosa
•	1 – invasion of submucosa
•	2 – invasion of muscularis propria
•	3 – invasion of subserosa or beyond
•	4 – invasion of adjacent organs or visceral peritoneum 
♣N:
•	1 – 1-3 lymph nodes
•	2 – 4+ lymph nodes
♣M:
•	1 – distant metastasis 
Stages:
♣0 – Tis, N0, M0
♣I – T1/2, N0, M0
♣IIA – T3, N0, M0
♣IIB – T4, N0, M0
♣IIIA – T1/2, N1, M0
♣IIIB – T3/4, N1, M0
♣IIIC – any T, N2, M0
♣IV – any T, any N, M1
29
Q

Most common cause of hepatocellular carcinoma

A

Chronic viral hepatitis

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