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Phase 2 > Gastrointestinal system Questions > Flashcards

Gastrointestinal system Questions Flashcards

1
Q

What is choledocolithiasis?

A
  • stone in common bile duct
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2
Q

What is cholangitis?

A

inflammation of the billiary tree epithelium

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3
Q

What conditions is Cholangitis associated with?

A

1) obstruction by gallstones
2) benign stricture
3) malignancy
4) infection
5) IBD

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4
Q

What is Psoas sign and how is it illicited?

A
  • RLQ pain elicited on passive extension of right hip

- > due to retrocaecal appendix

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5
Q

What is the obturator sign?

A
  • RLQ pain on passive internal rotation of the R hip with the hip and knee flexed
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6
Q

What skin manifestations are associated with IBD?

A
  • pyoderma gangrenosum
  • erythema nodosum
  • clubbing
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7
Q

What are the extra intestinal manifestations of Crohns disease?

A
  • *Joints**
  • enteropathic arthritis
  • clubbing
  • *Eyes**
  • uveitis
  • *Liver/bile ducts**
  • Cholelithiasis
  • *Oral mucosa**
  • ulcers
  • *Skin**
  • erythema nodosum
  • pyoderma gangrenosum
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8
Q

What are 6 causes of bilateral parotid gland enlargement?

A
  1. mumps
  2. sarcoidosis or lymphoma
  3. Sjogren syndrome
  4. alcohol associated parotiditis
  5. malnutrition
  6. severe dehydration -> renal failure
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9
Q

what are 3 conditions that cuase unilateral parotid enlargement?

A
  1. mixed parotid tumour
  2. tumour infiltration
  3. duct blockage by salivary calculaus
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10
Q

What are the descriptors you should give for any intraabdominal mass found on examination?

A
  1. Site
  2. tenderness
  3. Size and Shape
  4. Surface -> regular or irregular
  5. Edge -> regular or irregular
  6. consistency -> hard or soft
  7. mobility -> mobile or adhered
  8. pulsatile or not
  9. can you get above mass or not?
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11
Q

What are 5 differential diagnosis in massive hepatomegaly?

A
  1. metastasis
  2. alcoholic liver disease with fatty infiltrates
  3. myeloproliferative disease
  4. Right heart failure
  5. Hepatocellluar cancer
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12
Q

What are 5 differentials for a moderately enlarged liver?

A
  1. haemochromatosis
  2. Chronic leukemia or lymphoma
  3. Fatty liver disease
  4. infiltrations eg amyoid
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13
Q

What are causes of a mildly enlarged liver?

A
  1. hepatitis
  2. biliary obstruction
  3. hyatid disease
  4. HIV
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14
Q

what is the pathophysiology of Cirrhosis?

A
  1. 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
  2. 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.
  3. 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
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15
Q

What AST: ALT ratio is indicative of alcoholic liver disease?

A

> 1 eg 2:1

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16
Q

What does severly elevated ALP indicated?

A

cholestatic disease -> primary sclerosing cholangitis or primary billiary cirrhosis

17
Q

What are the LFTs that indicate cause of cirrhosis is due to alcohol?

A
  • AST:ALT ration bove 1

- very highly elevated GGT

18
Q

Why are platelets reduced in liver disease?

A
  • increased hepatic and splenic sequestration due to megaly and portal hypertension
  • decreased thrombopoietin produced by liver
19
Q

What are signs of cirrhosis on liver US?

A
  1. Nodular surface
  2. atrophy of right lobe
  3. loss of structural homogenity
  4. portal hypertension
20
Q

What are the components of the child-pugh score? (EABAP)

A
  1. Encephalopathy
  2. Ascites
  3. Bilirubin
  4. Albumin
  5. prothrombin/INR
21
Q

What is the difference between compnesated and decompensated cirrhosis?

A
  1. Compensated
    • biochemical, radiological and histological findings are consistent with cirrhosis
    • Liver synthetic function is preserved and no evidence of complications
  2. Decompensated
    • evidence of complications and reduced liver synthetic function
    • Jaundice, coagulopathy/haemorrhage, weight loss, ascites, encephalopathy
22
Q

What are non-pharmacological interventions to treat liver cirrhosis?

A
  • avoiding hepatotoxic substances
  • routine vaccinations → Heps etc
  • balanced diet and adequate caloric intake
  • Sodium restriction for oedema
23
Q

What are pharmacological interventions for cirrhosis?

A
  • non-selective beta blockers → lower portal pressure to manage portal hypertension
  • spironolactone and furosemide → fluid overload
24
Q

Surgical interventions for Cirrhosis

A
  1. liver transplant → only curative option for decompensated → MELD score for waiting list triage
  2. paracentesis → removal of ascitic fluid
  3. Transjugular intrahepatic portosystemic shunt (TIPS) → creates a shunt to lower portal pressure and manage complications of portal HTN
25
Q

what are 7 complications of liver cirrhosis?

A
  1. variceal haemorrhage
  2. ascites
  3. spontaneous bacterial peritonitis
  4. hepatic encephalopathy
  5. hepatocellular carcinoma
  6. hepatorenal syndrome
  7. hepatopulmonary syndrome
26
Q

Describe the pathophys and presenting symptoms of hepatic encephalopathy? and brief treatment

A
  1. fluctuations in mental status and cognitive function
  2. 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

  1. lactulose → acidifies gut → converts ammonia to ammonium be absorbed.
  2. Rifaximin → Abx that kills ammonia producing bacteria
27
Q

What investigations to order for Jaundice?

A
  1. FBC
  2. Coags
  3. LFTs
  4. UEC
  5. CRP
  6. Abdo US
  7. is ascites, ascitic tap.

Phase 2 (10 decks)

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