GI

Question 1

What are the characteristics of HepB:

How many become chronic

Who gets treated?

What are the serological tests?

Answer 1

5% chronic

Treat if signs of liver disease

Question 2

What are the characteristics of HepC:

How many become chronic

Who gets treated?

Answer 2

70% become chronic

Everyone tends to get treated and success depends on genotype

Question 3

Tazocin:

What is it?

When is it used?

How is it used?

Adverse reactions?

Answer 3

• Mixture of Piperacillin sodium (PENICILLIN)/Tazobactam sodium (B LACTAMASE INHIBITOR)
• Broad spectrum antibiotic used for pneumonia or abdo infections
• It is given IV
• Diarrhoea is most common

Question 4

Chlordiazepoxide hydrochloride:

When is it used?

Answer 4

Acute alcohol withdrawal syndrome* - Acts as a GABA agonist

*Delirium tremens (confusion, hypertension, tremors, sweating) seizures and agitation due to hyper arousal of CNS due to downregulation of GABA activity.

Question 5

What is the GDH toxin?

Answer 5

Produced by C.Diff.

Is also produced by other bacteria so not enough for diagnosis

Question 6

What is Courvesiers law?

Answer 6

Jaundice plus non painful cholecystitis = ?Pancreatic Ca

If it is non enlarged but is painful then probably gall stones

Question 7

What can cause hepatic Bruits?

Answer 7

HCC

ALD

Question 8

When is a fecal calprotectin used?

What can cause a positive result?

Answer 8

It is a test using the faeces and it distinguishes between a functional and inflammatory process.

Causes of raised levels:

IBD

Infection

Cancer

NSAIDS and tissue damage

Question 9

NB - IBD WEEKS

Question 10

What can cause PR bleeding?

Answer 10

• IBD
• Fissure
• Polyps
• Rectal carcinoma
• Haemorrhoids
• Fistula
• Gasteroentiritis
• Diverticuli causing weakened and subsequent bursting of vessels

Question 11

What is hepatorenal syndrome and what is used to treat it?

Answer 11

Renal failure as a result of liver disease

Splanchic vasodilation causes renal vasoconstriction

Tx - Telepressin - causes vasoconstriction of splanchic vessels

Question 12

What are the signs of Hypoalbuminemia?

What causes it

Answer 12

Signs -

• Leukonychia
• oedema

Causes -

• Liver failure
• Renal failure (nephrotic syndrome)

Question 13

What is hepatic encephalopathy?

What is the pathophysiology?

What is the treatment?

Answer 13

Liver failure causes condusion and coma due to a build up ammonia in the blood causes cerebral swelling via bacterial production of glutamine.

Tx - Lactulose to suppress toxic substances in blood from gut bacteria

Question 14

What commonly causes DIC?

What blood results do you get?

Answer 14

E.coli septicaemia

Clotting and bleeding together

Bloods:

• Increase APTT, INR, PT, bleeding time
• Decreased fibrinogen
• Increased FDP
• Schistocytes

Question 15

What is gilberts disease?

Answer 15

Increase in unconjugated bilirubin and subsequent transient jaundice in times of stress or illness

Question 16

LIVER ICM DECK

ANAEMIA DECK

Question 17

What are the ECG changes for hyperkalaemia?

Answer 17

1. Peaked T waves
2. Small P waves
3. Wide QRS

Question 18

What are the three stages of hyperkalamia management?

Answer 18

1. Stabilise myocardium if ECG changes - 10ml calcium gluconate IV 3-5 min. Can repeat 5 mins later
2. Shift potassium intracellularly - Insulin and glucose. Nebulised salbutamol
3. Remove K from body - Calcium resonium to bind it in gut

NB - may need to treat hypoglycaemia

Question 19

What are the symptoms and signs of anaemia?

Answer 19

Symptoms

• SOB
• Tiredness
• Palpitations/Angina
• Dyspnoea
• Headache
• Tinnitus

Signs

• Conjuctival pallor
• Leuconychia
• Glossitis in (IDA atrophic, bald and shiny with pallow or B12 deficiency)
• Angular stomatitis (IDA IDA or B12 deficiency)

Question 20

What are the three catagories of anaemia and what are the blood results?

Answer 20

Microcytic (High MCV)

• Low Hb, low MCV, Low ferritin, High TIBC

Normocytic (Normal MCV)

• Low Hb, Normal MCV, Low TIBC, Low Ferritin

Macrocytic (Low MCV)

• Low Hb, High MCV,

Question 21

What terms do you use to describe the anaemia?

Answer 21

Anaemia - Low Hb

Macro/Normo/Microcytic - Size of MCV

Macro/Normo/Microchromic - MCH

Question 22

What are the common causes of microcytic anaemia?

Answer 22

IDA

Thallasemia

Lead poisoning

Sideroblastic

Anaemia of chronic disease (also normocytic)

Question 23

What are the common causes of iron deficiency?

Answer 23

Menorrhagia

GI bleed eg cancer

No absorption eg coeliac

Question 24

What can cause normocytic anaemia?

Answer 24

Blood loss

Anaemia of chronic disease (also microcytic)

Sickle Cell

Haemolytic

Hypothyroidism

Question 25

What are the causes of macrocytic anaemia?

Answer 25

Megaloblastic - Low B12 or folate

Non megaloblastic - Alcohol, hypothyroid (also normo)

Question 26

Why do you get peripheral neuropathy with macrocytic anaemia?

Answer 26

Loss of myelin

Question 27

What are the causes of b12/folate deficieny?

Answer 27

Coeliac

IBD

Poor diet (folate = green, b12 = meat and poultry)

Question 28

What can cause relative polycythaemia i.e low plasma volume?

Answer 28

Acute dehydration

Chronic - obesity, smoking, alcohol

Question 29

What can cause absolute polycythaemia

Answer 29

Increased EPO

Chronic hypoxia eg Altitude. COPD

Question 30

What cause cause B12 to rise?

Answer 30

Any inflammatory reaction

Question 31

What causes both normo and mirocytic anaemia?

Answer 31

Anaemia of chronic diesease

Question 32

What causes both macro and normocytic anaemia?

Answer 32

Hypothyroid

Question 33

What do you treat B12 and folate deficiency?

Answer 33

B12 injections first to stop

subacute combined degeneration of the spinal cord (dorsal columns and corticospinal)

Question 34

What is Kussmaul breathing?

Answer 34

Shallow and rapid and then deep and laboured breathing associated with metabolic acidosis