Gastrointestinal system Questions Flashcards
What is choledocolithiasis?
- stone in common bile duct
What is cholangitis?
inflammation of the billiary tree epithelium
What conditions is Cholangitis associated with?
1) obstruction by gallstones
2) benign stricture
3) malignancy
4) infection
5) IBD
What is Psoas sign and how is it illicited?
- RLQ pain elicited on passive extension of right hip
- > due to retrocaecal appendix
What is the obturator sign?
- RLQ pain on passive internal rotation of the R hip with the hip and knee flexed
What skin manifestations are associated with IBD?
- pyoderma gangrenosum
- erythema nodosum
- clubbing
What are the extra intestinal manifestations of Crohns disease?
- *Joints**
- enteropathic arthritis
- clubbing
- *Eyes**
- uveitis
- *Liver/bile ducts**
- Cholelithiasis
- *Oral mucosa**
- ulcers
- *Skin**
- erythema nodosum
- pyoderma gangrenosum
What are 6 causes of bilateral parotid gland enlargement?
- mumps
- sarcoidosis or lymphoma
- Sjogren syndrome
- alcohol associated parotiditis
- malnutrition
- severe dehydration -> renal failure
what are 3 conditions that cuase unilateral parotid enlargement?
- mixed parotid tumour
- tumour infiltration
- duct blockage by salivary calculaus
What are the descriptors you should give for any intraabdominal mass found on examination?
- Site
- tenderness
- Size and Shape
- Surface -> regular or irregular
- Edge -> regular or irregular
- consistency -> hard or soft
- mobility -> mobile or adhered
- pulsatile or not
- can you get above mass or not?
What are 5 differential diagnosis in massive hepatomegaly?
- metastasis
- alcoholic liver disease with fatty infiltrates
- myeloproliferative disease
- Right heart failure
- Hepatocellluar cancer
What are 5 differentials for a moderately enlarged liver?
- haemochromatosis
- Chronic leukemia or lymphoma
- Fatty liver disease
- infiltrations eg amyoid
What are causes of a mildly enlarged liver?
- hepatitis
- biliary obstruction
- hyatid disease
- HIV
what is the pathophysiology of Cirrhosis?
- degeneration and necrosis of hepatocytes
- activated kupffer cells destroy hepatocytes → activate stellate cells and promote inflammation
- inflammatory cytokines → cause hepatocyte apoptosis and hepatic stellate cell activation → produces excess collagen and fibrosis - fibrotic tissue and regenerative nodules replace liver parenchyma
- the excess collagen and connective tissue thicken the walls and vessels within the liver → compression of hepatic sinusoids and venules → increase in portal vein hydrostatic pressure → intrasinusoidal hypertension → decrease in functional sinusoids. - Loss of liver function
- sinusoids become capillarised → due to the fibrosis and excess formation of connective scar tissue from the stellate cells
- this impairs substrate exchange → loss of normal liver function of exocrine and metabolic functions
What AST: ALT ratio is indicative of alcoholic liver disease?
> 1 eg 2:1
What does severly elevated ALP indicated?
cholestatic disease -> primary sclerosing cholangitis or primary billiary cirrhosis
What are the LFTs that indicate cause of cirrhosis is due to alcohol?
- AST:ALT ration bove 1
- very highly elevated GGT
Why are platelets reduced in liver disease?
- increased hepatic and splenic sequestration due to megaly and portal hypertension
- decreased thrombopoietin produced by liver
What are signs of cirrhosis on liver US?
- Nodular surface
- atrophy of right lobe
- loss of structural homogenity
- portal hypertension
What are the components of the child-pugh score? (EABAP)
- Encephalopathy
- Ascites
- Bilirubin
- Albumin
- prothrombin/INR
What is the difference between compnesated and decompensated cirrhosis?
- Compensated
- biochemical, radiological and histological findings are consistent with cirrhosis
- Liver synthetic function is preserved and no evidence of complications
- Decompensated
- evidence of complications and reduced liver synthetic function
- Jaundice, coagulopathy/haemorrhage, weight loss, ascites, encephalopathy
What are non-pharmacological interventions to treat liver cirrhosis?
- avoiding hepatotoxic substances
- routine vaccinations → Heps etc
- balanced diet and adequate caloric intake
- Sodium restriction for oedema
What are pharmacological interventions for cirrhosis?
- non-selective beta blockers → lower portal pressure to manage portal hypertension
- spironolactone and furosemide → fluid overload
Surgical interventions for Cirrhosis
- liver transplant → only curative option for decompensated → MELD score for waiting list triage
- paracentesis → removal of ascitic fluid
- Transjugular intrahepatic portosystemic shunt (TIPS) → creates a shunt to lower portal pressure and manage complications of portal HTN
what are 7 complications of liver cirrhosis?
- variceal haemorrhage
- ascites
- spontaneous bacterial peritonitis
- hepatic encephalopathy
- hepatocellular carcinoma
- hepatorenal syndrome
- hepatopulmonary syndrome
Describe the pathophys and presenting symptoms of hepatic encephalopathy? and brief treatment
- fluctuations in mental status and cognitive function
- due to accumulation of ammonia (due to decrease in liver metabolic function) → crosses BBB → formation of glutamine → astrocyte swelling → cerebral oedema and raised ICP
Treatment
- lactulose → acidifies gut → converts ammonia to ammonium be absorbed.
- Rifaximin → Abx that kills ammonia producing bacteria
What investigations to order for Jaundice?
- FBC
- Coags
- LFTs
- UEC
- CRP
- Abdo US
- is ascites, ascitic tap.
