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1
Q

give some symptoms of acute liver failure

A 
nausea
malaise
anorexia
hepatomegaly
jaundice, confusion, bleeding and hypoglycaemia are rare
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2
Q

what are some symptoms specific to chronic liver failure?

A

ascites
clotting disorder
jaundice
pruritis
spider naevus
endocrine problems (gynaecomastia/impotence/amenorrhoea)
fluid overload (due to systemic vasodilation)
signs: hepatic flap, Dupuytren’s contracture, disorentation, oedema, clubbing, palmar erythema

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3
Q

what hepatitis viruses can cause chronic liver disease?

A

B (D) and C

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4
Q

what is cholangitis and how does it present?

A

infection of the biliary tree, caused by bile duct stones. It presents with RUQ pain, fever and jaundice. It can lead to pancreatitis.

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5
Q

what is cholecystitis

A

inflammation of the gallbladder caused by gallbladder stones, patients usually have a history of biliary colic and palpable gallbladder, jaundice is unlikely. Think CYST, fluid filled sac so it’s the gallbladder rather than the biliary tree.

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6
Q

why are liver disease patients likely to get infections?

A

impaired reticuloendothelial system

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7
Q

give some signs that a liver failure patient may be deteriorating

A 
hyponatraemia
constipation
infection
spontaneous bacterial peritonitis
kidney failure
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8
Q

what 3 things lead to ascites?

A

fluid retention
low albumin levels
portal hypertension

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9
Q

list some causes of hepatic encephalopathy

A 
hypokalaemia
GI bleed
infection
sedatives
analgesics
constipation
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10
Q

what do you give a patient with hepatic encephalopathy

A

lactulose, it decreases ammonia absorption from the gut

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11
Q

what is paracentesis

A

taking fluid from the abdominal cavity, may sample it to see if they have bacterial peritonitis (culture and ^WCC)

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12
Q

what is fulimant hepatic failure?

A

when decompensation starts within 12 weeks of onset of disease, the liver can’t regenerate or repair

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13
Q

what decreases risk of bleeding from varicies

A

beta blockers, if bleeding need endoscopy and somatostatin

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14
Q

why do you test INR rather than LFTs to test liver function?

A

patients with chronic liver disease may have normal LFTs. INR=prothrombin time

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15
Q

signs that suggest decompensation

A

coagulopathy
jaundice
ascites
encephalopathy

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16
Q

which hepatitis viruses are blood borne?

A

B, D and C. A and E are faeco-oral

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17
Q

how is hepatitis C infection treated?

A

it is usually chronic, can be cured with antivirals, protease inhibitors and pegylated IFN

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18
Q

which hepatitis viruses have a vaccine?

A

A, B, E

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19
Q

what are AST and ALT?

A

serum aspartate=AST
alanine aminotransferases=ALT
if increased, they suggest hepatocellular damage

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20
Q

what will be elevated in primary biliary cholangitis?

A

anti-mitochondrial antibody
anti-nuclear cytoplasmic antibody
IgM

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21
Q

apart from liver disease, what may cause hypoalbuminaemia?

A

malnutrition
urinary protein loss
sepsis

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22
Q

what is ALP?

A

alkaline phosphatase, it is in liver membranes, bone, intestine, placenta. Raised in intrahepatic and extra hepatic cholestatic disease, cirrhosis and liver metastases

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23
Q

what on the hands indicates chronic liver disease?

A

palmar erythema, Dupuytren’s contracture is more a sign of alcohol consumption

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24
Q

what is NASH

A

non alcoholic steatohepatitis, a type of non alcoholic fatty liver disease, it can complicate to cirrhosis

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25
list some causes of portal hypertension
``` sarcoidosis cirrhosis primary bilary cholangitis RH failure constrictive pericarditis ```
26
what is Budd-Chiari syndrome
occlusion of hepatic vein> obstruction of venous outflow of liver because unknown, hypercoagubility, thrombophilia or sarcomas, hepatocellular carcinoma
27
what is Charcot's triad?
RUQ pain Fever Jaundice Suggest ascending cholangitis
28
what's ERCP?
Endoscopic reterograde cholangiopancreatography which is used to image asc cholangitis and to remove gallstones
29
what's cef and met?
cefotaxime and metronidazole, used commonly in surgery e.g. for asc cholangitis
30
what condition might cause someone to have grey skin?
Wilson's disease, it is hereditary haemochromatosis which leads to bronze skin-counterintuitive
31
what are the symptoms of hereditary haemochomatosis
``` arthalgia hepatomegaly cardiomyopathy diabetes mellitus hypogonadism skin pigmentation ```
32
what condition involving destruction of the bile ducts leads to increased risk of hepatocellular carcinoma?
primary biliary cholangitis (only in the liver-sclerosing is outside too so it's not PSC)
33
what are the symptoms of Korsakoff's?
``` opthalmoplegia confusion ataxia confabulation cannot make new memories-anterograde amnesia ```
34
who is at risk of the blood borne B-D hepatitis?
IVDU healthcare workers sex workers
35
apart from both being RNA viruses, faeco-orally spread and acute, what do A and E share?
short incubation period of 2-6 weeks rather than 1-6 months
36
what is the treatment for hepatitis C?
``` pegylated interferon protease inhibitor (Ribavarin) ```
37
what will the ascitic tap yield in a patient with cirrhosis?
transudate
38
what could pancreatitis cause?
exudate ascities
39
what are the symptoms of ascites?
``` abdominal distension fullness in flanks shifting dullness (respiratory distress) (pleural effusion and peripheral oedema) ```
40
how does renal failure come about in liver disease?
systemic vasodilation>RAA, noradrenaline and ADH>renal vasoconstriction. It means that diuretics should be stopped to increase the blood pressure.
41
what are the symptoms of spontaneous bacterial peritonitis?
there aren't really any, just deterioration of a patient with ascites
42
what bacteria usually causes spontaneous bacterial peritonitis
E. coli
43
what scan should be used for pancreatitis?
CT
44
what is multiple organ dysfunction syndrome?
systemic inflammatory response syndrome (no proven infection) with loss of homeostatic mechanisms
45
what is chronic pancreatitis?
where there's decreased bicarbonate secretion, this leads to activation of pancreatic enzymes and then necrosis with irreversible fibrosis
46
what is another name for coeliac disease
gluten sensitive enteropathy
47
what kind of anaemia does coeliac disease cause?
microcytic iron deficiency
48
what parts of the small intestine does coeliac disease affect?
duodenum and jejunum
49
give some causes of bowel obstruction
``` cancer volvulus inflammation due to Crohn's or diverticular disease Hirschsprung's adhesions diaphragm disease ```
50
what is the most common cause of SBO?
adhesions Crohn's malignancy apendicitis (paediatric)
51
what is the most common cause of LBO?
colorectal malignancy
52
when will vomit be faeculent in LBO?
when the ileocaecal valve is incompetent
53
cancer on which side of the bowel is more likely to give obstructive symptoms
left, these are the most common too
54
how do ileus and obstruction differ?
ileus has more mild pain, obstruction is more severe with anorexia, nausea, vomiting ileus silent abdomen, obstruction gurgling, high pitched sounds, tenderness and rushing
55
where do indirect inguinal hernias occur through
deep inguinal ring
56
what kind of tumour is colorectal cancer?
adenocarcinoma
57
what staging is used for colorectal cancer?
Duke's
58
how is IBS defined
with the Rome criteria-also used for dyspepsia and many other functional bowel disorders
59
what differentiates IBS from cancer
nocturnal sympotms
60
what drugs can you give to IBS patients?
antispasmodics: buscopan laxatives loperamide-even though it is an opiate tricyclic antidepressants and SSRIs
61
what kind of fibre should IBS patients increase
insoluble, it absorbs water and bulks up the faeces, cereals, wholewheat, lentils, fruit. NOT sweet potato, oats, beans
62
what antibodies are raised in coeliac disease?
anti-endomysial antibodies | anti-tissue transglutamase antibodies
63
how is H. pylori infection treated
triple therapy of amoxicillin, clarithromycin and lansoprazole
64
give an example of a PPI and a Histamine 2 receptor antagonist
lansoprazole | famotidine
65
what are the histological changes in coeliac disease?
villus atrophy | crypt hyperplasia
66
give some complications of ulcerative colitis
``` skin pigmentation erythema nodusum uveitis fatty change of liver, cirrhosis, hepatitis cholangitis electrolyte disturbance blood loss>anaemia toxic dilatation colorectal cancer arthritis ankylosing spondlylitis ```
67
give differentials of jaundice
pre hepatic: haemolysis, malaria, sickle cell hepatic: primary biliary cholangitis, cirrhosis, Gilbert's post hepatic (occlusion) gallstones (in bile duct), pancreatic cancer, pancreatitis
68
what is Whipple's procedure?
removal of parts of the pancreas
69
what kind of innervation does the visceral peritoneum have?
autonomic, the parietal has somatic | autonomic means poorly localised pain
70
how can you test for H. pylori?
c-urea breath test | culture from biopsy from endoscope
71
C. diff treatment?
oral vancomycin or metronidazole
72
what GI diseases cause pernicious anaemia rather than iron deficiency?
Crohn's | coeliac
73
what might pseudomembranous colitis complicate into?
toxic megacolon
74
how does typhoid fever present?
``` cough headache pyrexia bradycardia CNS signs constipation ```
75
types of Salmonella
enterica typhi paratyphi
76
H2RA
ranitidine
77
what is dyspepsia?
indigestion, epigastric discomfort
78
what is used to assess pancreatitis severity?
Glasgow score
79
investigations in pancreatitis
endoscopy | serum amylase will be elevated
80
skin coeliac disease
dermatitis herpetiformis
81
skin in ulcerative colitis
erythema nodosum
82
what blood test can differentiate between UC and Crohn's?
pANCA is sometimes positive in UC
83
first line treatment for Crohn's?
stop smoking
84
UC DMARD | Crohn's resmission
UC-sulfasalazine | Crohn's-azathioprine
85
cardinal symptoms of obstruction
n and v obstipation abdominal distention abdominal pain
86
sign of obstruction
tinkling bowel sounds
87
causes of non mechanical ileus
post op pneumonia electrolytes because of failure of peristalsis
88
bloody diarrhoea, which organisms?
E. coli Salmonella enterica Shigella sonnei
89
causes of malabsorption
``` coeliac disease pancreatitis/CF bariatric surgery lactose intolereance lymphoma/TB>obstruction tropical sprue ```
90
what antibodies will be positive in coeliac disease?
anti endomysial anti transglutaminase anti gliadin
91
what is achalasia?
lower oesophageal stricture relaxation and oesophagus cannot move. No difference between solids and liquids, treated with antispasmodics, nitrates, CCBs and bot A toxin.
92
what can anal fistula be caused by?
``` abscess Crohn's TB diverticular disease rectal carcinoma ```
93
how are anal haemorrhoids looked for?
protoscopy
94
how are haemorrhoids treated
mostly self limiting but increase fluid and fibre laxative topical analgesic
95
where will you find onion skin fibrosis?
primary sclerosing cholangitis
96
which of PBC and PSC has a greater response to immunosuppression?
PSC
97
causes of malabsorption
insufficient intake? defective intraluminal digestion from pancreatitis, CF defective bile secretion from gallstones, biliary obstruction insufficient absorptive area from coeliac disease, Giardia lamblia and bariatric surgery lymphatic obstruction from lymphoma or TB
98
symptoms of pancratic cancer in head
painless obstructive jaundice
99
symptoms of pancreatic cancer in body or tail
epigastric pain that radiates to the back, relieved by sitting forward
100
risk factors of small bowel cancer
Crohn's coelaic familial adenomatous polyposis
101
risk factors of volvulus
elderly, comorbid, constipated, bedridden
102
symptoms of volvulus
sudden onset abdominal pain, distension and obstipation
103
how is volvulus treated
insertion of tube, sigmoidoscopy
104
H2 receptor antagonists
ranitidine
105
coeliac disease antibodies
IgA tissue transglutimase | IgA anti endomysial
106
symptoms of carcinoid syndrome?
flushing wheezing diarrhoea abdominal pain
107
what is leukoplakia?
white patches on the inside of the mouth asso with smoking and alcohol, may lead to ca
108
what is bisocodyl used for?
constipation
109
main causes of liver cirrhosis
alcohol XS | diabetes
110
alcohol effects
``` cognitive decline, dementia (B12, thiamine) eyes-optic neuropathy aspiration pneumonia alcoholic myopathy gastritis cirrhosis proximal muscle wasting neuropathy testicular atrophy ```

Pathology (21 decks)

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