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Year 1 > GI 3 > Flashcards

GI 3 Flashcards

1
Q

The 5 common risk factors for developing gallstone disease (5 F’s)

A

Fat, Female, Fertile, Forty, and Fair

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2
Q

How would cholelithiasis (gallstones) commonly present?

A

RUQ/Epigastric Pain (Biliary Colic)

Pain may be induced by a fatty meal

Usually lasts from 30-90 minutes, although can last for hours

Should go away when gallbladder stops contracting

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3
Q

What is Biliary Colic?

A

impaction of a gallstone in the cystic duct can cause pain known as ‘biliary colic.’

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4
Q

How would Acute Cholecystitis present?

A

Abdominal Pain, worse in RUQ
Fevers, Nausea
Right shoulder tip pain (radiating to right shoulder)
PMH of gallstones and/or episodes of biliary colic
Murphy’s Sign Positive

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5
Q

The two specific LATE signs to look out for on examination of a patient with suspected Acute Pancreatitis are:

A

Cullen’s sign (periumbilical bruising)

Grey Turner’s sign (Bruising on flanks)

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6
Q

Clinical Presentation of Acute Pancreatitis

A

Abdominal pain, radiates to the back but may be relieved by sitting forward

Systemically unwell, hypovolemic, +/- temperature

Possible Cullen’s sign (periumbilical bruising) and Grey Turner’s sign (Bruising on flanks) [Late signs]

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7
Q

The single best test for diagnosing Cholelithiasis (Gallstones)

A

Ultrasound

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8
Q

Name the four lobes of the liver

A

Right, Left, Caudate and Quadrate

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9
Q

Where is the liver located?

A

Mainly in the RUQ below the diaphragm, but some of left lobe in LUQ.

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10
Q

Briefly describe the livers blood supply/drainage

A

Nutrient rich blood drains from the GIT and into the liver via the portal vein. Oxygen rich blood is supplied to the liver by the hepatic artery. Both blood supplies mix when inside the liver. Blood is drained from the liver into the hepatic vein, which will drain into the inferior vena cava and back to the heart.

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11
Q

What components make up the ‘triad’ within the liver lobules?

A

Portal Vein, Hepatic Artery and Bile Duct

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12
Q

Name some of the risk factors for developing cirrhosis of the liver

A

Chronic excessive alcohol intake
Chronic hepatitis B/C infection
Non-alcoholic Steatohepatitis (NASH)
Autoimmuneliver disease/hepatitis

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13
Q

What is Non-Alcoholic Fatty Liver Disease?

A

Term for a range of conditions caused by a build-up of fat in the liver.

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14
Q

Briefly describe the stages of Non-Alcoholic Fatty Liver Disease

A

Simple fatty liver (steatosis), Harmless build-up of fat in the liver

Non-alcoholic steatohepatitis (NASH): A more serious form of NAFLD, where the liver has become inflamed.

Fibrosis: Persistent inflammationcauses scar tissue formation - liver still able to function normally.

Cirrhosis: Most severe stage of NAFLD, occurring afteryears of inflammation. Damage is permanent and canlead toliver failure andliver cancer

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15
Q

When suspecting Acute Pancreatitis or when trying to rule out a Pancreatic cause, what is a key blood test that can be used?

A

Lipase/Amylase blood test. Released by the pancreas when damaged. Lipase thought to be more specific as there is a salivary amylase.

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16
Q

When using the Lipase/Amylase blood test, how much above the normal range is considered to be a strong indicator of pancreatitis?

A

3 times the upper range of normal is considered to be a strong indicator of pancreatitis

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17
Q

Key investigatory imaging used when suspecting pancreatic cancer?

A

Abdominal CT

18
Q

Symptoms that would make you suspect pancreatic cancer

A 
Epigastric/Back pain.
Jaundice
Itching
Dark urine
Pale/fatty stools
Weight loss/Reduced appetite
Abdominal swelling
Nausea and vomiting +/- Haematemesis
19
Q

The key lymphadenopathy that is seen in cases of gastrointestinal related cancers and its location?

A

Virchow’s node (VEER-CO’s), found within the left supraclavicular region.

20
Q

What two risk factors contribute to increasing the likelihood of developing liver cirrhosis if the individual already have Non-alcoholic steatohepatitis (NASH)?

A

Obesity (BMI >30) and Diabetes

21
Q

What is Non-alcoholic Steatohepatitis (NASH)?

A

A more serious form of Non-Alcoholic Fatty Liver Disease (NAFLD), where the liver has become inflamed.

22
Q

What GI-related condition is a common cause of pancreatitis?

A

Gallstones

23
Q

Why can gallstones cause pancreatitis?

A

Gallstones can block the common bile duct, stopping pancreatic enzymes from traveling to the small intestine and forcing them back into the pancreas, where they start to degrade the pancreas.

24
Q

Name the functional unit of the liver? Approximately how many are there?

A

Liver Lobules. Approximately 50,000-100,000

25
Q

What is the most common type of viral hepatitis in the UK?

A

Hepatitis C

26
Q

Name the two aminotransferase intracellular enzymes used in a LFT

A

Aspartate aminotransferance (AST) and Alanine aminotransferase (ALT).

27
Q

Which aminotransferase intracellular enzyme is more specific to the liver?

A

Alanine aminotransferase (ALT). [All About the Liver]

28
Q

Levels of what protein that is made by the liver is decreased in liver disease?

A

Albumin

29
Q

What is Albumin and what does it do?

A

The most abundant protein, made by the liver. Functions as a carrier protein and also maintains the oncotic pressure within the blood (fluid in the bloodstream so it doesn’t leak into other tissues).

30
Q

A decrease in oncotic pressure due to liver dysfunction and therefore low albumin levels allows fluid to leak out from the interstitial spaces into the peritoneal cavity, producing what condition/symptom?

A

Ascites

31
Q

What techniques is used to assess for the presence of ascites? How do you do it?

A

Assessment of shifting dullness. Percuss from umbilical region to left flank (away from you).

Ask PT to turn onto their right side to face you, and repercuss the same location after 30 seconds.

If dullness is now resonant, shifting dullness
present, indication ascites.

32
Q 
What are (6) clinical indicators that a patient may need
fluid resuscitation?
A 
Systolic BP <100mmHg
HR > 90bpm
CRT >2s or peripheries cold to touch
Respiratory rate >20 breaths per min
NEWS ≥5
33
Q

According to NICE Guidance, what are the first 2 steps of fluid resuscitation?

A

(1) Identify cause of deficit and respond.

(2) Give a fluid bolus of 500ml of crystalloid over less than 15 minutes.

34
Q

When carrying out fluid resuscitation, after giving the first 500ml bolus of crystalloid over less than 15 minutes, what should you do next?

A

Reassess using the ABCDE approach - Does the patient still need fluid resuscitation?

35
Q

When carrying out fluid resuscitation, after reassessment of the patient, if the patient still demonstrates evidence of ongoing hypovolaemia, how much further fluid is given and what is the maximum amount of fluid that can be given before you should seek expert help?

A

A further fluid bolus of 250–500 ml of crystalloid. A maximum of 2000ml/2L

36
Q

What is the protocol for carrying out observations on patients that are undergoing a blood transfusion? (before, during and after)

A

Baseline observations 1 hour before

Observations should be checked around 15 minutes after the start of transfusion

Observations no more than 60 minutes after the end of the transfusion

37
Q

What is a Group and Screen/Group and Save blood test?

A

Pre-transfusion blood sample is tested to determine the ABO and RhD groups. The plasma is screened for the presence of red cell alloantibodies capable of causing transfusion reactions.

38
Q

Which regards to the Group and Screen/Group and Save blood test, how many times does the current guidance recommend carrying out this test? Why?

A

Current guidelines recommend that a second sample should be requested for confirmation of the ABO group. To prevent reactions.

39
Q

Briefly describe the ABO system…

A

There are four main blood groups: A, B, AB and O.

Individuals have antibodies to the A or B antigens which are NOT on their own RBCs.

When the Rhesus Antigen is present on the RBC surface, they are termed Rhesus positive.

40
Q

The arterial supply of the spleen comes from which artery? Where does this artery branch from?

A

The arterial supply of the spleen comes from the splenic artery.

This artery emerges from the celiac trunk which is a branch of the abdominal aorta.

41
Q

What are the (3) functions of the spleen?

A

(1) Provides an environment in which lymphocytes proliferate and mature
(2) Recycles old and damaged RBCs.
(3) Immune surveillance - constantly filtering the blood in order to detect the presence of microorganisms

42
Q

The name of the ligament that separates the right and left lobes of the liver?

A

The Round ligament (Remnant of the left umbilical vein)

Year 1 (16 decks)

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