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Pathology > GI > Flashcards

GI Flashcards

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
Q

list some causes of portal hypertension

A 
sarcoidosis
cirrhosis
primary bilary cholangitis
RH failure
constrictive pericarditis
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26
Q

what is Budd-Chiari syndrome

A

occlusion of hepatic vein> obstruction of venous outflow of liver because unknown, hypercoagubility, thrombophilia or sarcomas, hepatocellular carcinoma

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27
Q

what is Charcot’s triad?

A

RUQ pain
Fever
Jaundice
Suggest ascending cholangitis

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28
Q

what’s ERCP?

A

Endoscopic reterograde cholangiopancreatography which is used to image asc cholangitis and to remove gallstones

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29
Q

what’s cef and met?

A

cefotaxime and metronidazole, used commonly in surgery e.g. for asc cholangitis

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30
Q

what condition might cause someone to have grey skin?

A

Wilson’s disease, it is hereditary haemochromatosis which leads to bronze skin-counterintuitive

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31
Q

what are the symptoms of hereditary haemochomatosis

A 
arthalgia
hepatomegaly
cardiomyopathy
diabetes mellitus
hypogonadism
skin pigmentation
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32
Q

what condition involving destruction of the bile ducts leads to increased risk of hepatocellular carcinoma?

A

primary biliary cholangitis (only in the liver-sclerosing is outside too so it’s not PSC)

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33
Q

what are the symptoms of Korsakoff’s?

A 
opthalmoplegia
confusion
ataxia
confabulation
cannot make new memories-anterograde amnesia
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34
Q

who is at risk of the blood borne B-D hepatitis?

A

IVDU
healthcare workers
sex workers

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35
Q

apart from both being RNA viruses, faeco-orally spread and acute, what do A and E share?

A

short incubation period of 2-6 weeks rather than 1-6 months

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36
Q

what is the treatment for hepatitis C?

A 
pegylated interferon
protease inhibitor (Ribavarin)
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37
Q

what will the ascitic tap yield in a patient with cirrhosis?

A

transudate

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38
Q

what could pancreatitis cause?

A

exudate ascities

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39
Q

what are the symptoms of ascites?

A 
abdominal distension
fullness in flanks
shifting dullness
(respiratory distress)
(pleural effusion and peripheral oedema)
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40
Q

how does renal failure come about in liver disease?

A

systemic vasodilation>RAA, noradrenaline and ADH>renal vasoconstriction. It means that diuretics should be stopped to increase the blood pressure.

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41
Q

what are the symptoms of spontaneous bacterial peritonitis?

A

there aren’t really any, just deterioration of a patient with ascites

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42
Q

what bacteria usually causes spontaneous bacterial peritonitis

A

E. coli

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43
Q

what scan should be used for pancreatitis?

A

CT

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44
Q

what is multiple organ dysfunction syndrome?

A

systemic inflammatory response syndrome (no proven infection) with loss of homeostatic mechanisms

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45
Q

what is chronic pancreatitis?

A

where there’s decreased bicarbonate secretion, this leads to activation of pancreatic enzymes and then necrosis with irreversible fibrosis

46
Q

what is another name for coeliac disease

A

gluten sensitive enteropathy

47
Q

what kind of anaemia does coeliac disease cause?

A

microcytic iron deficiency

48
Q

what parts of the small intestine does coeliac disease affect?

A

duodenum and jejunum

49
Q

give some causes of bowel obstruction

A 
cancer
volvulus
inflammation due to Crohn's or diverticular disease
Hirschsprung's
adhesions
diaphragm disease
50
Q

what is the most common cause of SBO?

A

adhesions
Crohn’s
malignancy
apendicitis (paediatric)

51
Q

what is the most common cause of LBO?

A

colorectal malignancy

52
Q

when will vomit be faeculent in LBO?

A

when the ileocaecal valve is incompetent

53
Q

cancer on which side of the bowel is more likely to give obstructive symptoms

A

left, these are the most common too

54
Q

how do ileus and obstruction differ?

A

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
Q

where do indirect inguinal hernias occur through

A

deep inguinal ring

56
Q

what kind of tumour is colorectal cancer?

A

adenocarcinoma

57
Q

what staging is used for colorectal cancer?

A

Duke’s

58
Q

how is IBS defined

A

with the Rome criteria-also used for dyspepsia and many other functional bowel disorders

59
Q

what differentiates IBS from cancer

A

nocturnal sympotms

60
Q

what drugs can you give to IBS patients?

A

antispasmodics: buscopan
laxatives
loperamide-even though it is an opiate
tricyclic antidepressants and SSRIs

61
Q

what kind of fibre should IBS patients increase

A

insoluble, it absorbs water and bulks up the faeces, cereals, wholewheat, lentils, fruit. NOT sweet potato, oats, beans

62
Q

what antibodies are raised in coeliac disease?

A

anti-endomysial antibodies

anti-tissue transglutamase antibodies

63
Q

how is H. pylori infection treated

A

triple therapy of amoxicillin, clarithromycin and lansoprazole

64
Q

give an example of a PPI and a Histamine 2 receptor antagonist

A

lansoprazole

famotidine

65
Q

what are the histological changes in coeliac disease?

A

villus atrophy

crypt hyperplasia

66
Q

give some complications of ulcerative colitis

A 
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
Q

give differentials of jaundice

A

pre hepatic: haemolysis, malaria, sickle cell
hepatic: primary biliary cholangitis, cirrhosis, Gilbert’s
post hepatic (occlusion) gallstones (in bile duct), pancreatic cancer, pancreatitis

68
Q

what is Whipple’s procedure?

A

removal of parts of the pancreas

69
Q

what kind of innervation does the visceral peritoneum have?

A

autonomic, the parietal has somatic

autonomic means poorly localised pain

70
Q

how can you test for H. pylori?

A

c-urea breath test

culture from biopsy from endoscope

71
Q

C. diff treatment?

A

oral vancomycin or metronidazole

72
Q

what GI diseases cause pernicious anaemia rather than iron deficiency?

A

Crohn’s

coeliac

73
Q

what might pseudomembranous colitis complicate into?

A

toxic megacolon

74
Q

how does typhoid fever present?

A 
cough
headache
pyrexia
bradycardia
CNS signs
constipation
75
Q

types of Salmonella

A

enterica
typhi
paratyphi

76
Q

H2RA

A

ranitidine

77
Q

what is dyspepsia?

A

indigestion, epigastric discomfort

78
Q

what is used to assess pancreatitis severity?

A

Glasgow score

79
Q

investigations in pancreatitis

A

endoscopy

serum amylase will be elevated

80
Q

skin coeliac disease

A

dermatitis herpetiformis

81
Q

skin in ulcerative colitis

A

erythema nodosum

82
Q

what blood test can differentiate between UC and Crohn’s?

A

pANCA is sometimes positive in UC

83
Q

first line treatment for Crohn’s?

A

stop smoking

84
Q

UC DMARD

Crohn’s resmission

A

UC-sulfasalazine

Crohn’s-azathioprine

85
Q

cardinal symptoms of obstruction

A

n and v
obstipation
abdominal distention
abdominal pain

86
Q

sign of obstruction

A

tinkling bowel sounds

87
Q

causes of non mechanical ileus

A

post op
pneumonia
electrolytes
because of failure of peristalsis

88
Q

bloody diarrhoea, which organisms?

A

E. coli
Salmonella enterica
Shigella sonnei

89
Q

causes of malabsorption

A 
coeliac disease
pancreatitis/CF
bariatric surgery
lactose intolereance
lymphoma/TB>obstruction
tropical sprue
90
Q

what antibodies will be positive in coeliac disease?

A

anti endomysial
anti transglutaminase
anti gliadin

91
Q

what is achalasia?

A

lower oesophageal stricture relaxation and oesophagus cannot move. No difference between solids and liquids, treated with antispasmodics, nitrates, CCBs and bot A toxin.

92
Q

what can anal fistula be caused by?

A 
abscess
Crohn's
TB
diverticular disease
rectal carcinoma
93
Q

how are anal haemorrhoids looked for?

A

protoscopy

94
Q

how are haemorrhoids treated

A

mostly self limiting but increase fluid and fibre
laxative
topical analgesic

95
Q

where will you find onion skin fibrosis?

A

primary sclerosing cholangitis

96
Q

which of PBC and PSC has a greater response to immunosuppression?

A

PSC

97
Q

causes of malabsorption

A

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
Q

symptoms of pancratic cancer in head

A

painless obstructive jaundice

99
Q

symptoms of pancreatic cancer in body or tail

A

epigastric pain that radiates to the back, relieved by sitting forward

100
Q

risk factors of small bowel cancer

A

Crohn’s
coelaic
familial adenomatous polyposis

101
Q

risk factors of volvulus

A

elderly, comorbid, constipated, bedridden

102
Q

symptoms of volvulus

A

sudden onset abdominal pain, distension and obstipation

103
Q

how is volvulus treated

A

insertion of tube, sigmoidoscopy

104
Q

H2 receptor antagonists

A

ranitidine

105
Q

coeliac disease antibodies

A

IgA tissue transglutimase

IgA anti endomysial

106
Q

symptoms of carcinoid syndrome?

A

flushing
wheezing
diarrhoea
abdominal pain

107
Q

what is leukoplakia?

A

white patches on the inside of the mouth asso with smoking and alcohol, may lead to ca

108
Q

what is bisocodyl used for?

A

constipation

109
Q

main causes of liver cirrhosis

A

alcohol XS

diabetes

110
Q

alcohol effects

A 
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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