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GI Flashcards

1
Q

how is liver failure recognised?

A

coagulopathy (INR > 1.5)

encephalopathy

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2
Q

what are the 2 types of liver failure

A

acute - sudden, healthy liver

chronic - background of cirrhosis

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3
Q

how is acute liver failure classified?

A
  • hyperacute liver failure (within 7 days) - paracetamol overdose
  • acute liver failure (within 8-21 days)
  • subacute liver failure (within 4-26 weeks)
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4
Q

what is fulminant hepatic failure

A
  • clinical syndrome
  • result of massive necrosis of liver cells
  • leads to severe liver function impairment
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5
Q

risk factors for hepatic failure

A

Hepatitis Infection

Mental Health Conditions (Suicide Risk)

Alcohol Abuse

Sex Worker

IVDU

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6
Q

differentials for liver failure

A

Chronic Liver Disease

Hepatitis

Hepatocellular Carcinoma

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7
Q

causes of hepatic failure

A
  • infection - hep B and C
  • drugs - paracetamol overdose, isoniazid (abx)
  • Toxins
  • Vascular conditions
  • Specific conditions - alcohol abuse, fatty liver disease, primary biliary cholangitis, autoimmune hep, Wilson’s, alpha 1 anti-trypsin
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8
Q

what are the signs of chronic liver disease

A 
leukonychia 
palmar erythema 
clubbing  
jaundice 
gynaecomastia 
spider naevi
splenomegaly 
hepatomegaly 
caput medusa 
pedal oedema
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9
Q

signs of hepatic failure

A 
hepatic encephalopathy - this is needed to be classified as liver failure 
pear drop breath
asterixis/liver flap
constructional apraxia
jaundice
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10
Q

what are the signs of hepatic encephalopathy

A

confusion, altered GCS (see below)
asterix: ‘liver flap’
constructional apraxia: inability to draw a 5-pointed star

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11
Q

what bloods tests are needed for hepatic failure?

A 
FBC - anaemia (GI bleed) and infection 
U&Es
LFTs (deranged) 
coagulation - raised PT
iron studies - high ferritin and transferin (haemochromatosis)
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12
Q

what antibodies will be high in autoimmune hep

A

IgG

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13
Q

what special tests would be requested for someone with suspected liver failure

A 
ammonia 
CXR
paracetamol 
viral serology 
ascitic tap
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14
Q

how to manage coagulopathy in hepatic failure (GI bleed)

A

vitamin K
FFP
blood
endoscopy

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15
Q

how to manage hepatic encephalopathy in hepatic failure

A
  • lactulose (traps ammonia in colon)
  • rifaximin (abx that kills nitrogen forming bacteria in gut)
  • avoid drugs that constipate
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16
Q

how to manage ascites?

A
  • fluid restriction
  • low salt diet
  • diuretics
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17
Q

what can you give to someone who has overdosed on paracetamol

A

N-acetylcysteine

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18
Q

what is hepatorenal syndrome and how is it treated

A

failure of liver leads to failure of kidneys (renal vasoconstriction)

kidneys become ischaemic and fail

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19
Q

what is an upper GI bleed

A

GI blood loss proximal to ligament of Treitz

oesophagus, stomach, duodenum

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20
Q

how would someone with upper GI bleed present

A
  • Hematemesis
  • ‘Coffee Ground’ Vomit (oxidation of blood by stomach acid)
  • Melena (Black, tarry stools)
  • tachycardic
  • signs of shock, hypovolaemia
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21
Q

causes of upper GI bleeding

A 
oesophagitis 
oesophageal varices 
oesophageal perforation 
Mallory-Weiss syndrome 
Booerhave's syndrome - alcoholics
gastritis 
peptic ulcer 
duodenal ulcer 
gastric cancer
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22
Q

investigations for upper gi bleed

A

Blatchford score

bloods - urea (raised due to blood meal), anaemia (FBC), coagulation screen

endoscopy (once stabilised)

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23
Q

management of unstable patient with upper GI bleed

A

airway - high flow O2
2 large bore IV cannula -FBCm U&Es, LFTs, clotting, crossmatch (hypovolaemia, anaemia)
IV fluids

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24
Q

what is a lower GI bleed

A

GI bleed below the ligament of Trietz

bleeding from small intestine, large intestine, rectum, anus

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25
Q

causes of lower GI bleed

A 
angiodysplasia of colon 
haemorrhoids
*diverticular disease 
UC 
Crohn's (if colitis too but unlikely)
colorectal cancer
26
Q

clinical presentation of lower GI bleed

A

Haematochezia (fresh blood in stools, this may or may not be mixed with stool)

rarely melaena (as no digestive enzymes in colon)

haemorrhoid bleeding - paper and pan

27
Q

investigations for lower GI bleed

A

bloods - FBC and WCC (anaemia and infection)

PR exam

colonoscopy

28
Q

management of lower GI bleed

A

if severe bloody diarrhoea assume UC

treat with hydrocortisone

29
Q

what is a hernia

A

Abnormal protrusion of abdominal contents through a weakness or defect along the abdominal wall. They can be acquired or congenital. The most common is inguinal.

30
Q

what causes congenital hernias?

A

failure of process vaginalis to close after testicular descent

causes a indirect inguinal hernia

31
Q

what causes acquired hernias

A

loss of mechanical integrity of abdo wall

due to a genetically weak abdo wall or damage to abdo muscles during surgery

32
Q

types of hernia

A

reducible = contents of hernia freely return into the abdominal cavity

incarcerated = oedema and swelling of tissue, causes pain, non reducible, interruption to passage of contents -> obstruction

strangulated = progressive reduction in arterial flow to contents, erythema, ischemia, tissue necrosis

33
Q

classification of hernias

A

Anterior hernia

  • epigastric
  • umbilical
  • splegelian
  • incisional
  • parastomal

Groin hernia

  • inguinal
  • femoral
34
Q

what are the 2 types of inguinal hernia?

A

direct - bowel pushes directly forward through posterior wall of inguinal canal

indirect - bowel passes through deep inguinal ring (can enter scrotum)

35
Q

differences between direct and indirect inguinal hernias

A

direct - acquired, medial to epigastric vessels, common in old men

indirect - congenital, lateral to epigastric, born with it

36
Q

where does a femoral hernia travel below and who is it more common in?

A

under inguinal ligament

common in females

37
Q

which hernias have the highest risk of strangulation?

A

femoral

congenital inguinal hernia

38
Q

how does umbilical hernia happen and what are the causes

A

through linea alba

born with it or increase in intra abdo pressure

39
Q

how does an incisional hernia occur

A

through scar tissue of past surgical incision due to poor wound healing

40
Q

what type of stoma does a parastomal hernia occur most common in

A

colostomy

41
Q

which side does a hernia most commonly occur on?

A

right

42
Q

what is the relationship between the pubic tubercle and inguinal and femoral hernias

A

inguinal hernias are above pubic tubercle (superomedial)

femoral hernias are below (inferolateral)

43
Q

what are colorectal cancers?

A

malignancies arising from the beginning of the colon, caecum, through to the rectum

does not include anus or small bowel

44
Q

what is the purpose of a loop colostomy

A

protect distal anastomoses after recent surgery - allows time for anastomoses to heal and become stronger before allowing faeces to travel through and leak

proximal loop colostomy are common

only temporary - can be reversed

45
Q

risk factors for colorectal cancer

A 
family hx 
hereditary syndromes - lynch and FAP
IBD 
diet 
alcohol 
smoking 
DM
46
Q

what is another name for lynch syndrome and what other cancer is it associated with

A

hereditary non polyposis colorectal carcinoma

endometrial

47
Q

what is the clinical presentation for colorectal cancer

A

Common

  • abdo mass (late sign)
  • haematochezia - blood on stool
  • constitutional sx

Right sided = often bleed → anaemia

  • microcytic anaemia - fatigue, weight loss, pallor
  • abdo pain

Left sided = obstruction

  • bleeding and mucus on PR
  • change in bowel habits - constipation
  • tenesmus
  • palpable mass on PR
48
Q

who is the colorectal screening programme offered to

A

56-74

invited to test every 2 years

49
Q

investigations for suspected CR cancer

A
  • Bloods - FBC (microcytic anaemia), serum iron, transferrin saturation, TIBC, LFTs, clotting, CEA
  • FIT test
  • colonoscopy* with biopsy (for CR cancer)
    • just colonoscopy for polyps
  • CT pneumocolon
  • barium enema
  • CT abdo pelvis scan for staging (TNM)
  • MRI liver
50
Q

where do most colorectal cancers metastasise to?

where does rectal cancer metastasise to?

A

liver

lungs

51
Q

what is diverticular disease

A

surgical problem which consists of herniation of the colonic mucosa through the muscular wall of the colon, usually in the sigmoid colon

It is known as diverticular disease if the patient experiences specific sx due to the presence of diverticula (diverticulosis).

52
Q

what is the difference between diverticulum, diverticulosis, diverticulitis?

A
  • Diverticulum - outpouching of colonic mucosa that has herniated through the muscularis propria and has come to lie in the subserosal fat outside the bowel wall
  • Diverticulosis - a common disorder characterised by the presence of multiple outpouchings of the bowel wall (usually sigmoid colon), usually asymptomatic
  • Diverticulitis - infection or inflammation of a diverticulum, presents acutely
53
Q

risk factors for diverticular disease

A
  • > 50
  • FHx
  • Low-fibre diet → raised intraluminal pressure
  • Obesity
  • Sedentary lifestyle
  • Smoking
  • NSAIDs
54
Q

clinical presentation of diverticulosis

A

painless rectal bleeding

asymptomatic

55
Q

clinical presentation of diverticular disease

A

altered bowel habit - constipation, diarrhoea
bloating
rectal bleeding
lower abdo pain

56
Q

clinical presentation of diverticulitis

A
  • L iliac fossa pain and tenderness (guarding)
  • Fever (with raised WBC and CRP)
  • Tachycardia
  • Reduced bowel sounds
  • Diarrhoea
  • N&V
  • Rectal bleeding
  • Palpable abdominal mass
  • Localised peritonitis
57
Q

what happens in diverticulitis

A

caused when faecal matter impacts and obstructs the neck of the diverticulum (muscularis propria) → irritation and damage to the mucosa → body mounts an acute inflammatory response

58
Q

investigations for diverticular disease

A

urinanalysis

bloods - FBC, faecal occult blood, U&Es, CRP

imaging CT and endoscopy

59
Q

investigations for acute diverticulitis

A

bloods - FBC, CRP

imaging - CXR (erect) for perforation, CT

60
Q

management of diverticular disease

A

avoid NSAIDs and codeine (give para)

offer antispasmodic

61
Q

management for acute diverticulitis

A

IV abx - co-amox
liquid diet
analgesia
hartmann’s procedure - if perforated

Revision (20 decks)

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