GI Flashcards
To learn the very basics
ulcerative colitis is a type of what disease
IBD
is fatigue, weight loss, bleeding more likely in IBD or IBS? I know this is kinda a tough/subjective question really
well, bleeding from the rectum is more likely in UC
which IBD is related to primary sclerosing cholangitis
ulcerative colitis
what’s the pathology behind UC?
environment
genetics
gut microbiome
symptoms of UC
bleeding from rectum?
fatigue
weight loss
basically periods of exacerbation and remission, of recurring diarrhoea, perhaps with mucus or blood
affect of diet of UC
diet doesn’t cause, but can help e.g. smaller regular meals etc.
Is the small bowel affected in UC?
Just large
Does smoking help in UC or make worse
help
Sclerosing cholangitis is a risk factor for UC. What else is?
other inflammatory things like arthritis
Describe the inflammation in UC
superficial mucosal inflammation, that’s continuous.
How do we treat ulcerative colitis? (2)
amino salicylate aka 5-ASAs
corticosteroids
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?
liver function test
coeliac antibodies
looking for faecal calprotectin
biopsy with colonoscopy and imaging to check for fistula’s and strictures etc.
which disease do we check for faecal calprotectin
IBD.
Pathology of liver cirrhosis
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
Liver cirrhosis most commonly occurs in these 4 diseases?
hepatitis B and C
alcohol related liver disease
non-alcoholic fatty liver disease
Jaundice in liver cirrhosis is caused by what?
Raised bilirubin
What might happen to muscles in liver cirrhosis?
cachexia (wasting of body and muscles)
What are caput medusae- which may be a sign of cirrhotic liver?
Distended paraumbilical veins due to portal hypertension
Why does ascites occur with a cirrhotic liver?
With increased portal pressure, fluid moves to the peritoneal cavity
why might splenomegaly occur with a cirrhotic liver?
with increased portal pressure, fluid may back up in the spleen
Why is cirrhotic liver bumpy?
nodules occur, where the living cells clump together as a kind of colony (with fibrotic tissue in between)
which tremour is associated with liver disease?
Flapping tremor
Easy bruising could be a sign of fibrosis in what organ?
liver
why confusion in cirrhotic liver?
toxins build up in the blood
VERY simply, what investigations into cirrhotic liver?
blood tests- can liver still function?
biopsy
scan
top 5 symptoms of liver cirrhosis? INITIAL
spider naevi
fatigue
nausea
weight loss
appetite loss
top 6 symptoms liver cirrhosis when more severe
itching
bruising
jaundice
vomiting blood
gynecomastia
ascites/oedema
What scan would you likely go for initially in liver cirrhosis? What might it show?
ultrasound
enlarged portal vein with reduced flow
ascites
splenomegaly
When would endoscopy be used when a patient has liver cirrhosis?
What about CT scan?
Endoscopy = to investigate oesophageal varices when portal hypertension is suspected.
Carcinoma or hepatosplenomegaly
What’s the MELD score that NICE recommends?
Model for end stage liver disease, that scores a patient every 6 months, that considers bilirubin, creatinine, sodium, and whether they require dialysis.
what are the 3 principles of management of a patient when they have liver cirrhosis?
treat underlying cause
monitoring/managing complications
liver transplant
4 examples of treating the underlying cause in liver cirrhosis?
stop drinking alcohol
lifestyle changes for non-alcohol fatty liver disease
anti-viral drugs for hepatitis C
immunosuppressants for autoimmune hepatitis
3 ways we monitor for complications in liver cirrhosis?
MELD score every 6 months
US to check for carcinoma
Endoscopy every 3 years to look for oesophageal varices
We have a liver transplant when there are (4) symptoms of decompensated liver disease. This can be remembered with a mnemonic. Name them:
AHOY
ascites
hepatic encephalopathy
oesophageal varices bleeding
yellow for jaundice
Potential complication of ascites?
spontaneous bacterial peritonitis
Why does cirrhosis lead to malnutrition? (and loss of appetite. leading to reduced intake?)
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.
Back pressure in the portal system causes swollen and tortuous vessels at which two sites
Distal oesophagus (oesophageal varices)
Anterior abdominal wall (caput medusae)
Prophylaxis for oesophageal varices?
1st in prophylaxis = non selective beta blockers such as propranolol and variceal band ligation
First thing for bleeding esophageal varices- which is a life threatening emergency?
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
Alcohol related liver disease: pathology (3 stages)
- build up of fat in the liver- reversible with abstinence
- Alcoholic hepatitis- inflammation over long time, or binge drinking. If mild, can be reversible with permanent abstinence.
- Cirrhosis. Irreversible. Functional liver tissue replaced with scar tissue.
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?
everything is raised, especially the AST:ALT ratio being more than 1.5. And especially raised Gamma GT.
BUT
there is reduced albumin.
Alcohol related liver disease: symptoms
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.
Alcohol related liver disease: treatment
CAGE questions to screen for harmful alcohol abuse?
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?
symptoms of alcohol withdrawal?
6-12 hours = tremor, sweating, headache and anxiety
12-24 = hallucinations
24-48 = seizures
24-72 = delirium tremens
symptoms of delirium tremens?
acute confusion
severe agitation
ataxia
delusions and hallucinations
tremor
tachycardia
hypertension
hyperthermia
arrhythmias
pathology of delirium tremens?
Alcohol is a depressant.
So it stimulates GABA, and inhibits glutamate neurotransmitters (excitatory).
So when no alcohol, opposite way in the extreme. Not good.
How to manage alcohol withdrawal?
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.
