GI Flashcards
1
Q
Which two diseases have a toxin with less than 6hour incubation time and cause diarrhoea, nausea and vomitting
A
S. aureus and bacillus cereus
2
Q
Diarrhoea, nausea and vomitting from food handler. From dairy products, salads, ham, poultry
A
Staphylococcus aureus
3
Q
Diarrhoea, nausea and vomitting from reheated rice
A
Bacillus cereus
4
Q
Which two diseases have a toxin with 8-16h incubation time and causes abdominal cramps and watery diarrhoea
A
Clostridium perfingens and bacillus cereus
5
Q
Abdominal cramps and watery diarrhoea from beef and chicken and gravies
A
Clostridium perfringens
6
Q
Abdominal cramps and watery diarrhoea from reheated rice
A
Bacillus cereus
7
Q
Which toxins have a 16-72hour incubation and caue abdominal cramps and watery diarrhoea
A
Vibrio parahaemolyticus
8
Q
Abdominal cramps and watery diarrhoea from spring summer shellfish
A
Vibrio parahaemolyticus
9
Q
Tissue invasion of which microorganisms causes fever, abdominal cramps an diarrhoea which can be bloody, 16-72hr incubation
A
Salmonella spp, campylobacter jejuni, shigella spp
10
Q
Fever, abdominal cramps and diarrhoea which can be bloody, from poultry eggs beef dairy
A
Salmonella spp
11
Q
Fever, abdominal cramps and diarrhoea which can be bloody from poultry other meat, milk, water
A
Campylobacter jejuni
12
Q
What is the most common cause of gastroenteritis
A
Campylobacter jejuni
13
Q
Fever, abdominal cramps and diarrhoea which can be bloody from egg, salad and lettuce
A
Shigella spp
14
Q
What is the person to person spread of shigella spp
A
Low
15
Q
Toxin production in the gut with 72-120hr incubation time causing bloody diarrhoea without fever
A
E. coli 0157
16
Q
Bloody diarrhoea without fever from ground beef, apples, milk
A
E. coli 0157
17
Q
Which microorganism causes shiga toxin and renal failure
A
E coli 0157
18
Q
Which microorganism causes toxin production and tissue invasion 16-48hr incubation time. Fever and abdominal cramps without diarrhoea
A
Yersinia enterocolitica
19
Q
Fever and abdominal cramps without diarrhoea from pork and milk
A
Yersinia enterocolitica
20
Q
Fever and abdominal cramps without diarrhoea with an acute abdomen
A
Yersinia enterocolitica
21
Q
Causes of diarrhoea
A
Bacterial, viral, parasitic, nosocomial, Hepatobilliary infections, travellers, whipples disease and H pylori infection. Malaria and sepsis can also cause.
22
Q
What does nosocomial mean
A
A disease originating in hospital
23
Q
What are the three categories of causes of intestinal obstruction
A
Intraluminal obstruction, intramural disease and extraluminal obstruction
24
Q
Name four causes of intraluminal obstruction
A
Tumour, diaphragm disease, meconium ileus and gallstone ileus
25
Name three causes of intramural disease
Inflammatory, tumours and neural
26
Name two inflammatory causes of intramural disease
Crohns disease and diverticulitis
27
Name a neural cause of intramural disease
Hirschpung's disease
28
What does intramural mean
Within the walls of the intestine
29
Name three causes of extraluminal obstruction
Adhesions, volvulus and tumour
30
Name a tumour cause of extraluminal obstruction
Peritoneal deposits
31
What bowel sounds can you hear when there is intestinal obstruction
High tinkling
32
What is a lymphoma
Malignant tumour of lymphoid cells
33
How do NSAIDs cause intestinal obstructoin
Recurrant ulceration causes fibrosis and fibrous diaphargm formation, with a narrow lumen
34
What is gallstone ileus
A large gall stone inflames the gall bladder then erodes through into the small bowel
35
What is meconium
A baby's first poo
36
What is meconium ileus
Seen in CF, meconium adheres to intestinal wall and causes obstruction
37
Where does inflammatory bowel obstruction most commonly occur
Terminal ileum, inflammation causes fibrosis and bowel constricts down
38
What is diverticular disease and where does it occur
Outpouchings of mucosa in the sigmoid colon
39
What diet is associated with diverticular disease
Low fibre
40
How do diverticular form
Low fibre, so increased pressure in the lumen as contraction is reduced. Mucosa is pushed between holes in the muscularis. If they rupture, faecal material enters peritoneum.
41
Which bowel tumour is the most common and what does it do
Gastrointestinal stroma stumours are tumours of the bowel pacemaker cells
42
What is Hirschprung's disease
Developmental, section of bowel without ganglion so doesnt move and it obstructs. Causes dilation and obstruction of all proximal bowel loops.
43
Which factor predisposes to bowel adhesions
Abdominal surgery
44
What is a volvulus
Where the sigmoid colon twists on it's long mesentery causing obstruction and cutting off blood supply
45
Which cancer can easily spread to the peritoneal cavity
Ovarian
46
Is the peritoneum good for cancer and why?
Yes very good, moist, smooth mucosa and good blood supply
47
What percentage of faeces is water and what percentage solid
75%, 25%
48
Where does the gut start and end
Mouth to anus
49
Define intestinal obstruction
Blockage to the lumen of the gut
50
What is intesussuption
Telescoping, one hollow structure into its distal hollow structure
51
What is atresia
Absence of opening or failure of development of hollow structure
52
What is a volvus
A twist/rotation of a segment of bowel
53
What is a paralytic obstruction
A pseudo obstruction
54
What are the four pathologies of obstruction
Simple, closed loop, strangulation or intussusception
55
What can an incompetent ileocaecal valve cause
Faeculant vomiting
56
What can cause proximal dilation of the small bowel
Increased secretions or swallowed air
57
What can cause proximal dilation of the large bowel
Bacterial fermentation
58
What is the consequence of untreated obstruction
Ischaemia, necrosis and perforation
59
What is a simple obstruction
Where the bowel is blocked somewhere
60
What is closed loop obstruction
Where a twist has blocked the bowel at one point
61
What is a strangulation obstruction
Where the blood supply is at risk
62
Will the colon dilate proximal or distal to the obstruction
Proximal
63
Will the small intestine dilate proximal or distal to the obstruction
Distal
64
If the ileocaecal valve is competent where does large bowel obstruction normally occur
The caecum
65
What is a common cause of small bowel obstruction in the developing world
Hernia
66
What are common causes of small bowel obstruction in children
Appendicitis and intesussuption
67
Are bowel obstructions mainly large bowel or small bowel
Small bowel (75%)
68
What is the most common cause of large bowel obstruction in US/.Europe
90% colorectal malignancy
69
What is the most common cause of large bowel obstruction in African countries
50% volvulus
70
What is the most common developmental cause of large bowel obstruction
Imperforate anus or Hirschpungs disease
71
Define hernia
Abnormal protrusion of viscus through normal or abnormal defects of body cavity
72
Do smaller or larger hernias carry a bigger risk
Small, more likely to cause strangulation
73
Where can colonic volvuli occur
Sigmoid (76%) and Caecum (22%)
74
What causes intussusception
Imbalance in the longitudinal forces along the intestinal wall due to a mass acting as a lead point or disorganised pattern of peristalsis.
75
What is obstipation
Absolute constipation
76
How would you describe the pain in intestinal obstruction
Colicky and poorly localised
77
What is the vomiting and constipation like in small bowel obstruction
Early vomiting and late constipation
78
What is the vomiting and constipation like in large bowel obstruction
Late vomiting and early constipation
79
Obstruction of which part of the bowel causes more distension
The more distal the obstruction the greater the distension
80
What is tenesmus
Increasing difficulty to open bowels
81
Stretching of which layer of the bowel causes severe pain
Muscularis propria
82
How is pain relief given in intestinal obstruction
IV as wont absorb orally, avoid opiates because slow bowel
83
Why is NGT used
To relieve proximal pressure to the obstruction by decompressing
84
How big do bowels have to be on XRay to be classified as obstructed
369 rule. Small 3cm, Large 6cm, sigmoid/caecal 9cm.
85
How do you differentiate between small and large bowel on XRay
Large bowel's haustral fols do not go all the way across the lumen and tend to be peripheral
86
How does intussusception appear on CT scan
Target shape
87
How does sigmoid volvolus appear on CT scan
Coffee bean sign
88
Whats the name of the mucosal folds in the small intestine
Valvulae conniventes
89
Which sections of the large intestine arent fixed and are on a mesentery
Transverse and sigmoid
90
Which types of obstruction require surgery
Strangulation and large bowel obstruction
91
What is the immediate treatment for intestinal obstruction
Drip and Suck: IV fluids and NGT
92
Which scan is used most commonly in GI
CT
93
Define malabsorption
Reduced or defective absorption of various nutrients in the small bowel
94
What provides the immune function of the small intestine
Lymphocytes in the tips of the villi
95
How does CF cause malabsorption
Pancreas fills with mucid secretions causing defective bile secretion and defective intraluminal digestion
96
Where are bile salts reabsorbed
Terminal ileum
97
Coeliac disease (gluten sensitive enteropathy) histologically
Short villi, much larger crypts as working much harder. Villous atrophy, crypt hypertrophy. Many more intravillous lymphocytes
98
What is the mechanism of gluten sensitive enteropathy
Lymphocytes with abnormal HLA, react to gliadin and cause and abnormal immune response. T cells subsequently target villi
99
Name four causes of malabsorption by insufficient absorptive area
Gluten sensitive enteropathy, Crohns, Parasites (giardia lamblia) and small intestine resection
100
What are the 6 categories of malabsorption causes
Insufficient intake, defective intraluminal digestion, insufficient absorptive area, lack of digestive enzymes, defective epithelial transport and lymphatic obstruction
101
What is a cause of malabsorption through lack of digestive enzymes
Disaccharide deficiency leads to lactose build up
102
What is a cause of malabsorption through defective epithelial transport
AB protein lipoeamia means lipoproteins cant be moved
103
What is a cause of malabsorption through lymphatic obstruction
Lymphatic oedema
104
Who mainly gets colorectal cancer and what does this show?
The elderly therefore mainly environmental cause
105
What is an adenoma
Group of cells showing dysplasia, a polyp
106
What is a genetic cause of colorectal adenocarcinoma
Familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer (FAP and HNPCC)
107
What is familial adenomatous polyposis
Thousands of polyps (therefore high risk of cancer forming). Removing of colon is treatment.
108
What causes familial adenomatous polyposis
APC protein binds and removes beta cartenin, in familial adenomatous there is a mutant gene and therefore beta cartenin builds up and causes proliferation
109
What happens in BRCA
The DNA repair protein is absent so you get accumulation of cross linking and genetic damage
110
Why should you identify the genetic link in colorectal cancer
To identify further cancers in index patient and relatives and also possible implications for therapy
111
Malignant neoplasm of the colon must be a
Adenocarcinoma
112
What is the resection coding system
R0-tumour completely excised R1-microscopic involvement at margin R2-macroscopic involvement at margin
113
What does CRM mean in GI tumours
Circumferential resection margin, if +ve risk of local recurrence is 85%. If negative means total resection and recurrence rate 10%
114
Name two staging systems for lower GI tumours
Dukes and TIN
115
What is a Dukes A tumour
Not through the wall
116
What is Dukes B tumour
Through the wall but not into lymph nodes
117
What is Dukes C tumour
Through the wall and in nearby lymph nodes
118
What is Dukes D tumour
Through the wall and to higher lymph nodes
119
What is the treatment for adenoma
endoscopic resection
120
What is the treatment for adenocarcinoma
Surgical resection
121
What is the treatment for metastatic colorectal adenocarcinoma
Chemotherapy and palliative care (unless a small bit of liver resection cures)
122
What can be used to prevent adenoma formation
NSAIDs - low dose aspirin
123
Which cancers are classified as upper GI tract cancers
Oesophageal and stomach cancer
124
What marks the junction between the stomach and oesophageal
Diaphragm
125
What is the epithelium of the oesophageus
Squamous epithelium, resists food
126
What is the epithelium of the stomach
Glandular
127
Which epithelium change occurs in Barretts oesophagus
Squamous to glandular epithelium
128
What is metaplasia
Change in differentiation of a cell from one fully-differentiated type to a different fully-differentiated type
129
Why are oesophageal cells susceptible to death and ulceration
As they dont have much mucin
130
Which epithelium change occurs in vagina during puberty
Cervix invades into the vagina and due to vaginal pH becomes squamous
131
Which population has a high prevalence of squamous cell carcinoma and why
The chinese due to heavy smoking and drinking
132
Which population has a high prevalence of adenocarcinoma and why
Europe due to obesity causing acid reflux
133
Why do eastern europe and eastern asia have higher rates of gastric cancer
Pickled and smoked foods
134
Which microorganism predisposes to gastric cancer
Helicobacter pylori as causes metaplasia
135
Which three factors can cause metaplasia of the gastric mucosa
Smoked/pickled diet, H. pylori, pernicious anaemia
136
What is responsible for the progression of metaplastic oesophagus to neoplastic
GO reflux and other factors
137
What is responsible for the progression of metaplastic gastric mucosa to neoplastic
Genetic change
138
What are all gastric cancers classified as
Adenocarcinoma
139
What is shallow gastric carcinoma
Early gastric cancer
140
What is linitis plastic
Leather bottle stomach. Where cancer cells cause a fibrotic reaction causing widespread stiffness
141
What is used for screening of upper GI cancer
Barium and endoscopy
142
How is oesophagitis and hiatal hernia assessed
Endocopy
143
How is oesophagitis treated
Endoscopic dilatation and long term proton pump inhibitor therapy
144
What protects the gastric cells from damage
Mucin provides buffering
145
Name factors which can cause disruption of mucin buffering
Mucosal ischaemia, ITU, shock, septicaemia, burns
146
What is the treatment for gastric ulcers
Increase blood pressure and volume and reduce the amount of acid
147
How can you increase blood pressure and volume
Fluids and ionotropes
148
How can you reduce the amount of stomach acid
H2 blocker or PPI
149
Which microorganism can PPIs increase the risk of further down the gut
C difficile
150
Name causes of ulceration
Stress, helicobacter, aspirin, bile reflux and high concentrations of alcohol
151
How does aspirin cause ulceration
Causes mucosal ischaemia as it moves into mucosa and inhibits prostaglandin production through COX2. Enteric coated tablets avoid this
152
How does helicobacter pylori cause ulceration
Exists in an ecological niche within the mucin layer, secretes chemicals which cause acute inflammation via neutrophil polymorphs
153
Will an ulcerated artery present earlier in the stomach or duodenum
Stomach, it will be vomitted out whereas if in the duodenum it would take days before excreted as black stools
154
What will happen if an ulcer goes through connecctive tissue
Peritonitis
155
What will happen if a gastric ulcer erodes through the posterior wall
It will cause pancreatitis
156
Name chronic idiopathic inflammatory bowel diseases
Crohns disease and ulcerative colitis
157
Name inflammatory bowel diseases other than Crohns and UC
Diverticulitis, ischaemic colitis, infective colitis (bacterial or protozoal)
158
What is a complication of Crohns which isnt to do with the bowel
Amyloidosis
159
What are potential bowel complications of crohns disease
Malabsorption, obstruction, perforation, fistula formation, anal, neoplasia
160
What are the unique features of crohns
Only affects the colon and mainly the sigmoid and rectum, only mucosal layer, distinct cut off a wide ranging consequences
161
What are some systems affected by UC
Colon, joints, eyes, liver, skin
162
What is ascites
Abnormal accumulation of fluid within the peritoneal cavity
163
What are capus medusi and whats it a sign of
Prominent veins running away from the umbilicus. Can be seen in ascites
164
What are the three causes of ascites
Impaired blood outflow, leaky membrane and decreased oncotic pressure
165
What is exudate
High protein fluid
166
What is transudate
Low protein fluid
167
What is the mechanism of transudate ascites
Outflow problem eg portal HTN, decreased oncotic pressure and high serum to ascites albumin gradient
168
What are the causes of transudate ascites
Cirrhosis, cardiac failure and Budd-Chiari syndrome
169
What is Budd Chiari syndrome
Post hepatic venous thrombosis
170
What is the treatment of transudate ascites
Underlying cause, fluids, low salt diet, drainage
171
What is the mechanism of exudate ascites
Membrane more porous, altered oncotic pressure. low serum to ascites albumin gradient
172
What are the causes of exudate ascites
Cancer, sepsis, TB, nephrotic syndrome
173
Which ascites is more serious
Exudate- extremely bad
174
What does abdominal pain relieved by defecation suggest
IBS
175
In which part of the colon is cancer more common
Distal
176
In which part of the colon does cancer have a worse prognosis
Proximal
177
What is Dukes A classification of bowel cancer
Invading through the bowel wall but not inot the muscularis propria
178
What is the Dukes B classification of bowel cancer
Through the wall of the bowel but hasnt yet invade lymph
179
What is the Dukes C classification of bowel cancer
It has invaded through the bowel wall and into the lymph vessels
180
What is the Dukes D classification of bowel cancer
It has invaded through the bowel, into the lymph system and has also metastasised
181
Define peritonitis
Inflammation of the peritoneum
182
What are possible causes of peritonitis
Blood, GI content (faeces and bile), air and bacterial infection
183
How can you identify a blocked bowel on XRay
You will see a fluid level
184
What are the clinical signs of intestinal obstruction
Colicky central abdominal pain and bilious vomiting
185
Why might you see air under diaphragm on XRay
Due to perforation, air in peritoneum
186
Where will the pain be felt for gastric ulcer
Epigastric pain
187
Which structure allows the movement of intraabdominal collections and spread of infections
Paracolic gutters
188
Which nerves are responsible for dull pain
Visceral
189
Which nerves are responsible for sharp pain
Somatic
190
Where is the problem when epigastric pain
Stomach to duodenum
191
Where is the problem when umbilical pain
Duodenum till left colon
192
Where is the problem when pubic pain
Left colon onwards
193
Sudden onset low abdominal pain, peritonism, tachycardia, hypotension. 23 yo woman
Ectopic pregnancy
194
What is shock
Inadequate delivery of oxygen to tissues or organs
195
Which screen is used to estimate survival in peritonitis
P-POSSUM
196
Why is there increased physiological frailty with increasing age
There is increased use of the physiological reserve
197
What is haematemesis
Vomitting of blood
198
What are varices
Veins which are distended, lengthened and tortuous
199
What is tachycardia
Increased pulse rate, above 100bpm
200
What would die of first if you didn't have a liver
Hypoglycaemia, the liver is the only producer of glucose
201
What are the consequences of cirrhosis
Both scarring and disorganisation
202
What are the functions of the liver
Glucose and fat metabolism, detoxification and excretion, protein synthesis and defended against infection
203
What type of epithelium lines the portal tract
Cuboidal
204
What are the three possible outcomes of acute livery injury
Recovery and liver failure
205
What are the three possible consequences of chronic liver injury
Recovery, cirrhosis and liver failure
206
Which cells are associated with necrosis
Neutrophils
207
What is the histological appearance of necrotic liver cells
Dense eisonophilic cytoplasm and pyknotic nucleus
208
What is pyknosis
Condensation of chromatin
209
Causes of acute liver injury
Viral (A,B,EBV), drug, alcohol, vascular, obstruction, congestion
210
Causes of chronic liver injury
Alcohol, viral (B,C), autoimmune, metabolic (iron, copper)
211
Which hepatitis types cause acute liver injury
A and B
212
Which hepatitis types cause chronic liver injury
B and C
213
What are two manifestations of liver failure
Varices and hepatoma
214
What are hepatoma
Hepatocellular carcinoma, the most common malignancy of the liver. Hep B and C greatly increase the risk
215
What are varices
Varicose veins are veins that are distended, lengthened and tortuous
216
Why does cirrhotic liver have an increased risk of turning into cancer
There is an increased rate of regeneration
217
If someone presenets with liver pain what does this suggest
Obstruction or malignancy
218
What are the common presentations of acute liver injury
Malaise, nausea, anorexia and jaundice
219
What are the common presentations of chronic liver injury
Ascites, oedema, haematemesis, malaise, anorexia, wasting, easy bruising, itching, hepatomegaly, abnormal LFTs
220
Why is the liver twice as likely to get ischaemic disease
As it has a dual blood supply
221
Metabolic causes of chronic liver injury
Iron overload, haemochromatosis, copper overload
222
When do you get liver pain
When the liver expands into the capsule. The liver doesnt have nerves but the capsule does
223
What is the most common presentation of liver injury
Abnormal liver tests
224
When will there be disease but normal LFTs
Compensatory cirrhosis
225
Which serum liver enzymes are cholestatic
Alkaline phophatase and gamma-GT
226
Which serum liver enzymes are hepatocellular
Transaminases (AST and ALT)
227
What are two causes of yellow skin
Jaundice and carotenosis
228
How would you differentiate between carotenosis and jaundice
Carotenosis does not affect the eyes
229
What does raised serum unconjugated bilirubin suggest
Prehepatic problem (Gilbert's or haemolysis)
230
What does raised serum conjugated bilirubin suggest
Cholestatic problem
231
What is a hepatic cause of raised serum conjugated bilirubin
Liver disease
232
What is a post hepatic cause of raised serum conjugated bilirubin
Bile duct obstruction
233
Dark stools, pale urine, itching and abnormal liver tests are suggestive of which type of jaundice
Cholestatic (hepatic and post hepatic)
234
Which enzyme converts non conjugated bilirubin to conjugated
Glucorinotransferase
235
What are the four causes of hepatitis
Viral, drug, immune and alcohol
236
Name four causes of liver disease
hepatitis, ischaemia, neoplasm and congestion (CCF)
237
What is mirizzis syndrome
Compression of the bile duct from the outside
238
Name two ways gall stones cause obstruction
Bile duct and mirizzi
239
Name three types of obstructive stricture
Malignant, ischaemic and inflammatory
240
Name three causes of hepatic obstruction
Gallstone, stricture and blocked stent
241
What do MRCP and ERCP liver scans stand for
Magnetic resonance cholangiogram and endoscopic reterograde cholangiogram
242
How is paracetamol induced liver failure treated
NAC
243
What is leukonychia
White nails
244
What are three main risk factors for gall stones
Fat, female, fertile
245
What are some additional risk factors for gall stones
Liver disease, ileal disease, TFN, clofibrate
246
Gall bladder gallstone presentation
Biliary pain, cholecysitis, maybe obstructive jaundice
247
Bile duct gallstone presentation
Biliary pain, obstructive jaundice, pancreatitis, cholangitis
248
What is cholangitis
Inflammation of the bile duct system
249
Management of gall bladder gallstones
laproscopic cholecystecomy or bile acid dissolution therapy
250
Management of bile duct gallstones
ERCP sphincterectomy and removal, crushing and stent placement. Surgery for large stones
251
What can be used for the removal aspect of bile duct gallstones
Basket or balloon
252
What can be used for the crushing aspect of bile duct gallstones
Mechanical or laser
253
What do raised ALT and AST suggest
hepatitis or liver injury, not obstruction
254
Do atenolol and beta blockers cause liver injury
NO
255
What enzyme levels will be present in hepatocellular DILI
Raised ALT and ALT/Alk ratio
256
What enzyme levels will be present in cholestatic DILI
Raised Alk and low ALT/Alk ratio
257
What enzyme levels will be present in mixed DILI
Ratio between 2 and 5
258
What is used to treat paracetamol induced fulminant hepatic failure
N acetyl cysteine (NAC) and supportive therapy
259
What is spider naevus
Swollen blood vessels beneath the skin. They have a central vessel and if you depress the lump the rash spreads
260
What is the most common cause of ascites
Chronic liver disease
261
Name causes of ascites
Chronic liver disease, neoplasia, pancreatitis and cardiac causes
262
What are two causes of portal hypertension
Systemic vasodilation (flow) and increased intrahepatic resistance
263
What is a TIPS
Transjugular intrahepatic portosystemic shunt, bypass from high pressure hepatic vein to low pressure portal vein
264
What is steatosis
Fat accumulating in hepatocytes from alcohol changing the metabolism
265
What is oliguria
Low urine output (<400-500mls a day)
266
What is haematemesis
Vomitting blood
267
Causes of portal hypertension
Cirrhosis, fibrosis and portal vein thrombosis
268
Pathology of portal hypertension
Increased hepatic resistance and increased splanchnic blood flow
269
Consequences of portal hypertension
Varices and splenomegaly
270
Which drugs shouldnt be given to those with liver failure as they cause renal failure
NSAIDs, diuretics, ACE inhibitors and aminoglycosides
271
Treatment for alcohol withdrawal
Lorazepam
272
Do people with liver disease tend to have a high or low blood pressure
Low
273
What is the most common cause of infection in liver patients
Spontaneous bacterial peritonitis
274
What is spontaneous bacterial peritonitis on gram stain
Gram negative bacilli
275
Why do liver patients have reduced opsonic activity
Reduced function of Kupffer cells
276
What is primary biliary cholangitis
Cirrhosis - name changed to reduce stigma
277
What is hepatic encephalopathy
Build up of nitrogenous waste in the brain due to liver failure
278
amenorrhoea meaning
absense of periods
279
Which analgesic is safest in those with liver failure
Paracetamol
280
How is malnutrition treated
Nasogastric feeding
281
How is variceal bleeding treated
Endoscopic banding, propanolol and telepressin
282
How is encephalopathy treated
Lactulose
283
How is ascites/oedema treated
salt/fluid restriction. Diuretics and paracentesis
284
How are infections treated
Antibiotics
285
Why do ferritin levels change
It is an acute phase protein so goes up when there is any inflammation
286
How is autoimmune hepatitis treated
Prednisolone +- azathioprine
287
Which system is used to stage primary biliary cirrhosis
Ludwig
288
What is ductopenia
Destruction of the bile duct
289
What are varices
Dilated blood vessels in the oesophagus or stomach
290
Which prognostic score is used in primary biliary cirrhosis
Mayo clinic
291
All autoimmune diseases are associated with which condition
Sjogrens, thyroiditis, scleroderma and RA
292
What is sjogrens
Women: dry secretions eg tears
293
Which mutation causes haemochromatosis
HFE gene C282Y on chromosome 6. It is autosomal recessive and shows variable penetrance
294
What is the mechanism of haemochromatosis
Uncontrolled intestinal iron absoprtion with deposition in the liver, heart and pancreas
295
How is haemochromatosis diagnosed
Suggested by raised ferritin and transferrin saturation, then confirmed by HFE genotyping and liver biopsy
296
Who is at highest risk of hepatocellular carcinoma
Those with fibrosis from a viral cause or haemochromatosis
297
Which groups get non alcoholic fatty liver disease
The obese and the diabetic
298
Which disease is the most common cause of mildly raised LFTs
Non alcoholic fatty liver disease
299
What does cryptogenic mean
Unknown cause
300
What happens to the fat levels as cirrhosis increases in NAFL
They drop
301
What is the best treatment of NAFL
Weight loss
302
What defect accounts for alpha 1 antitrypsin deficiency
Z allelle of the alpha 1 antitrypsin gene
303
How does alpha1 antitrypsin deficiency cause liver failure
Protein retention in the liver
304
How does alpha1 antitryspin deficiency cause emphysema
Low protein in the blood
305
Hepatic vein occlusion causes
Thrombosis, membrane obstruction and venocclusive disease
306
What is the presentation of hepatic vein occlusion
Abnormal liver tests, ascites, acute liver failure
307
What is the treatment for hepatic vein occlusion
Anticoagulation and TIPS
