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UKMLA Prep > Gastrointestinal including liver > Flashcards

Gastrointestinal including liver Flashcards

Conditions and presentation

1
Q

Acute pancreatitis symptoms

A
  • stabbing-like, epigastric pain radiating to the back.
  • foetal position is usally taken
  • associated with vomiting
  • assoicated with alcohol consumption
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2
Q

Clinical signs of pancreatitis

A
  • hypovolaemia
  • fever
  • Non-specific guarding
  • Grey-Turner’s sign (bruising along the flanks)
  • Cullen’s sign, characterized by bruising around the peri-umbilical area
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3
Q

Pancreatitis investigations

A
  • FBC,urea and electrolytes
  • LFTs
  • Lipase and amylase
  • US
  • MRCP
  • ERCP
  • CT pancreas
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4
Q

Pancrease Mnemonic

A

PaO2 < 8kPa (60mmHg)
Age > 55 years
Neutrophils - WBC >15 x109/l
Calcium < 2mmol/l
Renal function - Urea > 16mmol/l
Enzymes - AST/ALT > 200 iu/L or LDH > 600 iu/L
Albumin < 32g/l
Sugar - Glucose >10mmol/L

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5
Q

Managment of pancreatitis

A
  • Aggressive fluid resuscitation with crystalloids to maintain urine output > 30 mL/hour.
  • Catheterisation.
  • Analgesia: Strong opioids are often necessary.
  • Anti-emetics.
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6
Q

complications of pancreatitis

A
  • Peripancreatic Fluid Collection
  • Pdeudocyst
  • pancreatic abcess
  • pancreatic necrosis
  • haemorrhage
  • ARDS
  • Hypovolemic
  • DM
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7
Q

Porphyria

A

pectrum of disorders arising from abnormalities in the haem synthesis pathway, which result from either structural or functional alterations in the enzymes involved.

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8
Q

Porphyria symptoms

A

Abdominal pain
Nausea
Confusion
Hypertension
Seizures

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9
Q

Signs and symptoms of Porphyria

A
  • Urine may appear red/purple
  • Urinary porphobilinogen levels (keep away from light)
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10
Q

Managment of Porphyria

A

supportive

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11
Q

6-12 hours after withdrawal symptoms of alcohol

A
  • Insomnia
  • Tremors
  • Anxiety
  • Agitation
  • Nausea and vomiting
  • Sweating
  • Palpitations
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12
Q

12-24 hours post-drink

A

hallucinations

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13
Q

72-hours post drink

A

Delusions
Confusion
Seizures
Tachycardia
Hypertension
Hyperthermia

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14
Q

alcohol withdrawal investigations

A
  • AUDIT and SADQ questionnaires to assess the severity of alcohol misuse.
  • Blood tests to assess liver function and electrolyte balance.
  • Neuroimaging may be considered in cases of persistent confusion or seizures.
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15
Q

INDICATIONS FOR INPATIENT WITHDRAWAL TREATMENT

A
  • Patients drinking >30 units per day
  • Scoring over 30 on the SADQ score
  • High risk of alcohol withdrawal seizures (previous alcohol withdrawal seizures or delirium tremens, or history of epilepsy)
  • Concurrent withdrawal from benzodiazepines
  • Significant medical or psychiatric comorbidity
  • Vulnerable patients
  • Patients under 18
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16
Q

Managment of alcohol withdrawal

A
  • chlordiazepoxide
  • Pabrinex
  • intravenous lorazepam or oral lorazepam
17
Q

Cyclizine

A
  • H1 receptor antagonist
  • Vestibular disturbances
18
Q

Domperidone, metoclopramide

A
  • D2 receptor antagonist
  • Post-operative nausea, motion sickness
19
Q

Ondansetron

A
  • 5HT3 receptor antagonist
  • Acute gastroenteritis, post-operative nausea, radiotherapy- or chemotherapy-induced
20
Q

Hyoscine hydrobromide

A
  • Anti-muscarinics
  • Vestibular disturbances, palliative care
21
Q

When to avoid Metoclopramide

A
  • bowel obstruction
22
Q

When to avoid Haloperidol

A

Parkinson’s disease and prolonged QT interval.

23
Q

Prochlorperazine and clorpromazine avoid using when

A
  • Parkinson’s disease symptoms
  • young women as causes dystonia
24
Q

Cyclizine avoidance when?

A

acute porphyurias

25
Q

Zollinger Ellison syndrome

A
  • Tumour that sits in the pancreas or the duodenum.
  • Uncontrolled release of gastrin from a gastrinoma,
  • development of multiple ulcerations in the stomach and duodenum.
26
Q

Zollinger Ellison signs and syptoms

A
  • Abdominal pain, particularly in the epigastric region
  • Diarrhoea
  • Ulceration of the duodenum, which can often lead to gastrointestinal bleeding
  • Non-responsiveness to simple Proton Pump Inhibitors (PPIs)
27
Q

Zollinger Ellison investigations

A
  • screening for elevated gastrin levels.
  • secretin stimulation test
  • Somatostatin receptor scintigraphy is the preferred imaging modality, as conventional
  • CT scans may often miss the tumour.
    Endoscopy is also performed to identify duodenal ulcers.
28
Q

Zollinger Ellison syndrome managment

A
  • surgical resection
  • PPIs
  • chemotherapy and somatostatin analogues may be considered.
29
Q

Ascites

A

abnormal accumulation of fluid within the peritoneal cavity.

30
Q

Symptoms of ascities

A
  • Abdominal distension
  • Abdominal discomfort or pain
  • Dyspnea
  • Reduced mobility
  • Anorexia and early satiety due to pressure on the stomach
  • Tense abdomen
  • Shifting dullness

UKMLA Prep (38 decks)

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