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Long Case > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Presentation chronic liver disease

A 
Swelling of feet/abdomen
Fatigue, nausea
Jaundice, pruritis
Bruising
Haematemis
Confusion
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2
Q

Risk factors chronic liver disease

A

Alcohol
Hepatitis/jaundice
Drugs
Diabetes, cardiac failure

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3
Q

Causes of chronic liver disease

A

FIGCAT
Fatty liver
Infectious
Genetic (haemochromotosis, alpha-1-antitrypsin deficiency)
Congestion (RHF)
Autoimmune (primary biliary cirrhosis or primary sclerosing cholangitis)
Toxins

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4
Q

Complications of chronic liver disease

A 
Portal hypertension
Hepatitic encephalopathy
Coagulopathy
Hepatocellular carcinoma
Spontaneous bacterial peritonitis
Hepatorenal syndrome
Ascites
Hypoglycaemia
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5
Q

Bloods for chronic liver disease

A 
FBC, CRP, urea, ammonia
Coags
Lfts
Full liver screen: viral serology, autoantibodies, serum copper, ferritin
Alpha-1 antitrypsin
Alpha fetoprotein
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6
Q

investigations for chronic liver disease

A 
Bloods
Abdo USS +- portal vein doppler
Fibroscanning
MRCP
Ascitic tap
Liver biopsy
Paracetamol levels
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7
Q

Criteria for child-pugh score

A 
Encephalopathy
Ascites
Bilirubin
Albumin
Prothrombin time
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8
Q

Pharmacological treatment for chronic liver disease

A 
Depends on underlying cause:
Hep B: interferon
Hep C: ribavirin
Autoimmune hepatitis: steroids
Fatty: weight loss, statins
Nutritional support
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9
Q

How to treat ascites

A 
Bed rest and fluid restrict
Low salt diet
Spironolcatone
Frusemide
Therapeutic paracentesis
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10
Q

How to treat varices

A

Prophylactic treatment with beta blockers or variceal band ligation

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11
Q

Encephalopathy treatment

A 
Enemas to rid gut of blood
Low protein diet
Lactulose or antibiotics like metronidazole
Mannitol
Lorazepam for seizures
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12
Q

End line liver treatment

A

TIPS (transjugular intrahepatic portosystemic shunt) which connects portal vein to hepatic vein
Liver transplant

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13
Q

Screening in liver disease

A

USS +/- alpha fetoprotein every 6 months for HCC

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14
Q

Indications for liver transplant

A

Advanced cirrhosis caused by; alcohol, hepatitis, primary biliary cirrhosis, wilson’s, A1-antitrypsin, primary sclerosing cholangitis, HCC

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15
Q

Contraindications for liver transplant

A 
Extra hepatic malignancy
Multiple hepatic tumours
Severe cardioresp disease
Sepsis
HIV
Non compliance with medications
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16
Q

Kings college criteria for liver transplant

A 
Non-paracetamol induced
PT 100s/INR >6
or 3/5 of 
not hepatitis
Age <10 or >40
>1 week from first jaundice to encephalopathy
PT >50s/INR >3.5
Bilirubin >0.3mmol/L
Paracetamol induced
pH <7.3 or INR >6
Cr >300
Grade 3 or 4 encephalopathy
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17
Q

which drugs are needed for immunosuppression in liver transplant?

A

Ciclosporin and tacrolimus or

Tacrolimus and azathioprine or mycophenolate and prednisone

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18
Q

Complications of liver transplant

A

Rejection
Sepsis
1 year 80% success

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19
Q

How does the presentation of colon cancer change with position?

A

Left: PR bleeding/ altered bowel habit/ tenesmus/ mass on PR
Right: Weight loss/anaemia
Either: abdominal mass, haemorrhage, perforation, fistula

20
Q

Riak Factors colon cancer

A 
Polyps
Family History
IBD
Previous cancer
Smoking
Diet
Alcohol
21
Q

Investigations colon cancer

A 
FBC (microcytic anemia)
LFT
CEA
Faecal occult blood (if screening)
Colonoscopy
Liver USS
If polyposis in family refer for genetic testing once every 15 years
22
Q

Management of colon cancer

A

Hemicolectomy, sigmoid colectomy, anterior resection, hartmann’s procedure
Stenting (palliative)
Radiotherapy and chemotherapy

23
Q

Key things to ask in dyspepsia history

A 
When symptoms occur
NSAID use
Progressive
Previous ulcer/reflux
Dysphagia
Maleana
Losing weight
24
Q

Investigations for dyspepsia

A 
FBC
Urease breath test and stool antigen (H.pylori) 
Gastroscopy with biopsy
CXR
Barium swallow
24hr esophageal pH monitoring-GERD
25
Q

Differential diagnosis for dyspepsia

A 
GORD
Gastritis
Gastric cancer
Pancreatitis/pancreatic cancer
Ulcer
Chronic mesenteric ischaemia
26
Q

How do we kill H pylori

A

Triple therapy with omeprazole, clarithromycin and metronidazole

27
Q

Management of dyspepsia

A

H pylori eradication
Stop NSAIDS and steroids
PPIs/H2 antagonists
Ulcers should be biopsied to ensure not cancer

28
Q

Presenting symptoms of IBD

A 
Diarrhoea
Blood
Mucous
Abdo pain
Urgency/tenesmus
29
Q

Complications of UC

A 
Toxic megacolon
Strictures/fistulae
Carcinoma of colon
Primary sclerosing cholangitis
Cirrhosis
Erythema nodosum
30
Q

Complications of Crohn’s

A

Fissures/fistulas/abscesses
Obstruction
Carcinoma of colon and small bowel
Gallstones

31
Q

Investigations for IBD

A 
FBC
ESR, CRP
U and E
LFTs
Testing p-ANCA and ASCA
Stool sample-fecal calprotectin
AXR
Sigmoidoscopy
Biopsy
CT
32
Q

Treatment ladder for UC

A

mesalazine/sulfazine
prednisolone (oral or rectal)
azothioprine/cyclosporin/infliximab
proctocolectomy

33
Q

Treatment ladder to Crohn’s

A 
prednisolone
IV/rectal hydrocortisone
Metronidazole
Azathioprine/infliximab
Surgery-limited resection
34
Q

Presentation of haemochromatosis

A 
Tiredness
Arthralgia
Grey-skin
Hepatomegaly
cardiomyopathy
Diabetes
pituitary dysfunction
35
Q

Investigations haemochromatosis

A 
Raised LFT, raised sFerritin
Transferrin sat 
HFE genotype
XRAY
Liver MRI
Biopsy
36
Q

Management of haemochromatosis

A

venesection

Monitor

37
Q

What causes haemochromatosis

A

Defect in activation of hepcidin normally triggered by iron excess

38
Q

Investigations for coeliac disease?

A

Anti-tTG

Duodenal biopsy

39
Q

Complications of coeliac disease?

A

Anaemia, lactose intolerance, T cell lymphoma, GI malignancies, myopathies

40
Q

Difference between cushing’s syndrome and cushings disease

A

Syndrome: any other cause of high cortisol
Disease: ACTH secreting pituitary

41
Q

Difference between Boorhave’s syndrome and Mallory weiss?

A

Boorhave’s: perforation of the esophagus

Mallory weiss: damage to the mucus membrane of the gastroesophageal junction

42
Q

How do AST and ALT change in alcohol?

A

AST/ALT ratio of greater than 2 indicates alcoholic liver disease

43
Q

Which score is used to assess pre endoscopy for bleeding risk?

A

Rockall score

44
Q

Acute management of upper GI bleedig

A 
ABCDE
Nil by mouth
Obtain IV access
Give normal saline
Check hb, LFTS, clotting factors
If Hb low, transfuse (dont over transfuse because of risk of bleeding)
Give omeprazole and IV antibiotics and  ocreotide 
 plus terlipressin post op (if varices)
Calculate rockall score
Call endoscopist
45
Q

Causes of hypoglycemia

A 
Exogenous
Pituitary insufficiency
Liver failure
Addison's
Islet cell tumours
Naughty-alcohol
46
Q

How to tell if this lump is the spleen?

A

Can’t get over it
Splenic notch
Dull to percussion
Comes down on inspiration

Long Case (11 decks)

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