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Holibobs Revision of all Semester 1 (yr 2) diseases > GI > Flashcards

GI Flashcards

To learn the very basics

1
Q

ulcerative colitis is a type of what disease

A

IBD

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2
Q

is fatigue, weight loss, bleeding more likely in IBD or IBS? I know this is kinda a tough/subjective question really

A

well, bleeding from the rectum is more likely in UC

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3
Q

which IBD is related to primary sclerosing cholangitis

A

ulcerative colitis

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4
Q

what’s the pathology behind UC?

A

environment
genetics
gut microbiome

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5
Q

symptoms of UC

A

bleeding from rectum?
fatigue
weight loss

basically periods of exacerbation and remission, of recurring diarrhoea, perhaps with mucus or blood

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6
Q

affect of diet of UC

A

diet doesn’t cause, but can help e.g. smaller regular meals etc.

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7
Q

Is the small bowel affected in UC?

A

Just large

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8
Q

Does smoking help in UC or make worse

A

help

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9
Q

Sclerosing cholangitis is a risk factor for UC. What else is?

A

other inflammatory things like arthritis

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10
Q

Describe the inflammation in UC

A

superficial mucosal inflammation, that’s continuous.

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11
Q

How do we treat ulcerative colitis? (2)

A

amino salicylate aka 5-ASAs
corticosteroids

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12
Q

There are lots of differentials for UC. Including, checking electrolytes, and doing a FBC for platelets for inflammation, how do we check:
liver function?
it’s not coeliac disease?
for a specific marker for IBD?
the difference between crohns/Ulcerative colitis?

A

liver function test

coeliac antibodies

looking for faecal calprotectin

biopsy with colonoscopy and imaging to check for fistula’s and strictures etc.

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13
Q

which disease do we check for faecal calprotectin

A

IBD.

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14
Q

Pathology of liver cirrhosis

A

chronic inflammation and scarring of the liver, where fibrotic tissues replace functioning hepatocytes, and nodules of scar tissue can form

therefore blood flow affected and there is portal hypertension

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15
Q

Liver cirrhosis most commonly occurs in these 4 diseases?

A

hepatitis B and C
alcohol related liver disease
non-alcoholic fatty liver disease

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16
Q

Jaundice in liver cirrhosis is caused by what?

A

Raised bilirubin

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17
Q

What might happen to muscles in liver cirrhosis?

A

cachexia (wasting of body and muscles)

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18
Q

What are caput medusae- which may be a sign of cirrhotic liver?

A

Distended paraumbilical veins due to portal hypertension

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19
Q

Why does ascites occur with a cirrhotic liver?

A

With increased portal pressure, fluid moves to the peritoneal cavity

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20
Q

why might splenomegaly occur with a cirrhotic liver?

A

with increased portal pressure, fluid may back up in the spleen

21
Q

Why is cirrhotic liver bumpy?

A

nodules occur, where the living cells clump together as a kind of colony (with fibrotic tissue in between)

22
Q

which tremour is associated with liver disease?

A

Flapping tremor

23
Q

Easy bruising could be a sign of fibrosis in what organ?

A

liver

24
Q

why confusion in cirrhotic liver?

A

toxins build up in the blood

25
Q

VERY simply, what investigations into cirrhotic liver?

A

blood tests- can liver still function?
biopsy
scan

26
Q

top 5 symptoms of liver cirrhosis? INITIAL

A

spider naevi
fatigue
nausea
weight loss
appetite loss

27
Q

top 6 symptoms liver cirrhosis when more severe

A

itching
bruising
jaundice
vomiting blood
gynecomastia
ascites/oedema

28
Q

What scan would you likely go for initially in liver cirrhosis? What might it show?

A

ultrasound

enlarged portal vein with reduced flow
ascites
splenomegaly

29
Q

When would endoscopy be used when a patient has liver cirrhosis?
What about CT scan?

A

Endoscopy = to investigate oesophageal varices when portal hypertension is suspected.
Carcinoma or hepatosplenomegaly

30
Q

What’s the MELD score that NICE recommends?

A

Model for end stage liver disease, that scores a patient every 6 months, that considers bilirubin, creatinine, sodium, and whether they require dialysis.

31
Q

what are the 3 principles of management of a patient when they have liver cirrhosis?

A

treat underlying cause
monitoring/managing complications
liver transplant

32
Q

4 examples of treating the underlying cause in liver cirrhosis?

A

stop drinking alcohol

lifestyle changes for non-alcohol fatty liver disease

anti-viral drugs for hepatitis C

immunosuppressants for autoimmune hepatitis

33
Q

3 ways we monitor for complications in liver cirrhosis?

A

MELD score every 6 months
US to check for carcinoma
Endoscopy every 3 years to look for oesophageal varices

34
Q

We have a liver transplant when there are (4) symptoms of decompensated liver disease. This can be remembered with a mnemonic. Name them:

A

AHOY
ascites
hepatic encephalopathy
oesophageal varices bleeding
yellow for jaundice

35
Q

Potential complication of ascites?

A

spontaneous bacterial peritonitis

36
Q

Why does cirrhosis lead to malnutrition? (and loss of appetite. leading to reduced intake?)

A

Cirrhosis affects protein metabolism in the liver, reduces the amount of protein the liver produces, and disrupts the ability of the liver to store glucose.

37
Q

Back pressure in the portal system causes swollen and tortuous vessels at which two sites

A

Distal oesophagus (oesophageal varices)
Anterior abdominal wall (caput medusae)

38
Q

Prophylaxis for oesophageal varices?

A

1st in prophylaxis = non selective beta blockers such as propranolol and variceal band ligation

39
Q

First thing for bleeding esophageal varices- which is a life threatening emergency?

A

Immediate senior help

consider blood transfusion by activating major haemorrhage protocol

vasopressin (ADH) analogues like terlipressin and somatostatin for vasoconstriction

and prophylactic broad spectrum antibiotics

urgent endoscopy with variceal band ligation

40
Q

Alcohol related liver disease: pathology (3 stages)

A
  1. build up of fat in the liver- reversible with abstinence
  2. Alcoholic hepatitis- inflammation over long time, or binge drinking. If mild, can be reversible with permanent abstinence.
  3. Cirrhosis. Irreversible. Functional liver tissue replaced with scar tissue.
41
Q

Alcohol related liver disease: investigations. We do blood tests, ultrasound scan, endoscopy for oesophageal varices, and then a liver biopsy. What am i looking for in the blood tests?

A

everything is raised, especially the AST:ALT ratio being more than 1.5. And especially raised Gamma GT.
BUT
there is reduced albumin.

42
Q

Alcohol related liver disease: symptoms

A

when there is excessive alcohol consumption, you’ll know it. They’ll smell of alcohol, slurred speech and blood shot eyes, tremor and telangiectasia on the face.

43
Q

Alcohol related liver disease: treatment

A
44
Q

CAGE questions to screen for harmful alcohol abuse?

A

C = cut down. Do you ever think you should cut down?
A = annoyed. Do you ever get annoyed at others commenting on your drinking?
G = guilty. Do you ever feel guilty about drinking?
E = eye opener. Do you ever drink in the morning to help your hangover or nerves?

45
Q

symptoms of alcohol withdrawal?

A

6-12 hours = tremor, sweating, headache and anxiety
12-24 = hallucinations
24-48 = seizures
24-72 = delirium tremens

46
Q

symptoms of delirium tremens?

A

acute confusion
severe agitation
ataxia
delusions and hallucinations
tremor
tachycardia
hypertension
hyperthermia
arrhythmias

47
Q

pathology of delirium tremens?

A

Alcohol is a depressant.
So it stimulates GABA, and inhibits glutamate neurotransmitters (excitatory).

So when no alcohol, opposite way in the extreme. Not good.

48
Q

How to manage alcohol withdrawal?

A

give a benzodiazepine (such as chlordiazepoxide). Given orally and reduced over a week.

Give B vitamins (pabrinex) IV, followed by long term oral thiamine. This is used to prevent wernicke- korsakoff syndrome.

Holibobs Revision of all Semester 1 (yr 2) diseases (5 decks)

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