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Ask Doctor Clarke 2018 > GI > Flashcards

GI Flashcards

1
Q

Pathophysiology of alcoholic liver disease

A
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2
Q

Location of hepatic damage vs autoimmune

A

Alcohol- centrilobar, around the portal vein

autoimmune- peri-portal- around portal tracts

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3
Q

Signs of chronic liver disease

A

clubbing- associated with primary biliary sclerosis

palmar erythema

Dupuytren’s

spider naevi

gynacomastia

testicular atrophy

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4
Q

What is feminisation?

A
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5
Q

Signs of liver cell failure

A

jaundice

leuconychia

Bruising

ascites

encephalopathy

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6
Q

Pathophysiology of ascites

A

dysregulation of RAAS

increased hydrostatic

decreased oncotic

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7
Q

Signs of portal hypertension

A

varicies

ascites

splenomegaly

caput medusa- veins flowing down below umbilicus

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8
Q

IVC Obstruction vs Caput medusae

A

in IVC Obstruction blood flows up below the umbilicus, to bypass the IVC. In caput medusae, they flow down.

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9
Q

Causes of ascites

A

cirrhosisHypoalbuminaemic states

peritoneal secondaries

constrictive pericarditis

severe biventricular failure

hepatic Vein thrombosis

TB

ovarian tumours

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10
Q

Features of encephalopathy

A

falpping tremour- asterixis

confusion, irritability

constructional apraxia e.g. difficulty drawing 5 point star

coma

convulsions

fetor hepaticus

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11
Q

Severity of encephalopathy grading

A
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12
Q

Signs of shock

A

I SHOCKS

Increased RR- early sign

Sinus tachycardia

Hypotension

Oliguria

Cold

Klammy

Slow cap. Refill

plus confusion, cyanosis, acidosis

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13
Q

How does systemic inflammatory response cause hypotension?

A
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14
Q

Signs of peritonitis

A

TRAPPED

Tenderness

Reflex guarding

Absent bowel sounds

Pyrexia

Percussion pain

Extremely unwell

Distant-local sign - e.g. Rovsing’s sign

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15
Q

Causes of acute pancreatitis

A

I GET SMASHED

I: idiopathic

G: gallstones

E: ethanol (alcohol)

T: trauma

S: steroids

M: mumps (and other infections) / malignancy

A: autoimmune

S: scorpion stings/spider bites

H: hyperlipidaemia/hypercalcaemia/hyperparathyroidism (metabolic disorders)

E: ERCP

D: drugs

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16
Q

Acute Pancreatitis management

A

IV fluids, pain control, NG tube if vomiting

80% improve in 3 days

20% have more severe- nasogastric tube, IV antibiotics, ITU

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17
Q

What is ARDS?

A

’shock lung’

pulmonary oedema

due to leaking pulmonary capillaries due to cytokines storm

first organ to fail in multi-organ failure

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18
Q

Scoring of Acute Pancreatitis

A

P - PaO2 <8kPa

A - Age >55-years-old

N - Neutrophilia: WCC >15x10(9)/L

C - Calcium <2 mmol/L

R - Renal function: Urea >16 mmol/L

E - Enzymes: LDH >600iu/L; AST >200iu/L

A - Albumin <32g/L (serum)

S - Sugar: blood glucose >10 mmol/L

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19
Q

qSOFA score

A

Hypotension <100

techypnoea >22

altered mental state (GCS <15)

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20
Q

Sepsis six

A

BUFALO

blood cultures

Urine output

Fluids

antibiotics

lactate

oxygen

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21
Q

Symptoms of intestinal obstruction

A
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22
Q

Causes of intestinal obstruction

A
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23
Q

Small bowel vs large bowel on xray

A
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24
Q

Risks in AP resection

A

Parasacral plexus lies between sacrum and rectum

parasympathetic fibres are easily damaged

risk of erectile impotence in men, vaginal lubrication and anorgasmia in women

risk reduced by total mesorectal excision

25
Q

Complications of a stoma

A

FOUL SHITS

fluid loss

odour

ulceration of skin

leakage

stenosis

herniation

Ischaemia

terminal ileum loss- failure to absorb bile salts and B12

sexual and psychological problems

26
Q

Causes of haematemesis

A

peptic Ulcer disease

varices

oesophagitis

gastritis

mallory-weiss

malignancy

AVMs

27
Q

H.pylori eradication

A

7 days tripple therapy

PPI (omeprazole), amoxicillin, carithromycin/ metronidazole

28
Q

Blood tests in haematemesis

A

FBC- Anaemia/ thrombocytopenia

U&E- prerenal failure, risk of rebleed

clotting- INR

LFTs- Liver disease

Group & save/ cross match - 4-6 units if active bleeding

29
Q

Why give Terri-resin in active bleeding varicies

A

constricts splanchnic bessels, restricting portal inflow

30
Q

Glasgow blatchford score

A

The Blatchford score is calculated prior to endoscopy and is based on simple clinical and laboratory parameters. Its principal use is to identify low-risk patients’ who do not require any intervention (blood transfusion, endoscopic therapy, surgery). Approximately 20% of patients’ presenting with upper GI haemorrhage have a Blatchford score of zero. Such patients’ can largely be managed safely in the community, as the mortality in this group is ni

31
Q

Rockall score

A

It is important to identify those patients who are at risk of ongoing bleeding and death.
The Rockall scoring system is used for risk categorisation based on simple clinical parameters. Rockall scores can be calculated both before and after endoscopy, but the post endoscopy Rockall score provides a more accurate risk assessment. It provides independent risk factors which have been shown to accurately predict the risk of rebleeding and mortality.³

With increasing age, there is an increased risk of death: ³

Mortality in those aged below 40 is negligible

Mortality increases to 30% in those aged over 90

Patients’ who have evidence of active bleeding and signs of shock have an 80% risk of death

Those with a non-bleeding visible vessel at endoscopy have a 50% chance of re-bleeding

32
Q

Signs of a variceal rebleed

A

Tachycardia

decreased BP

decreased CVP

Decreased urine output

haematemesis

malena

33
Q

Abdominal signs of chronic liver disease

A

Hepatomegaly/ small liver in late

ascites

splenomegaly

caput medusae

34
Q

Blood tests to assess liver synthetic function

A

Albumin

INR

35
Q

Liver function tests

A

AST/ALT- hepatocellular damage

ALP/gGT intra/extrahepatic

36
Q

How is the severity of liver failure calculated?

A
37
Q

Complications of liver cirrhosis

A
38
Q

Grading of hepatic encephalopathy

A
39
Q

Complications of gallstones

A

Biliary colic

cholecystitis

empyema

obstructive jaundice

cholangitis

gallbladder perforation

gallstone ileus

40
Q

Complications of cholecystectomy

A

Death <1/1000

bile duct injury

bile leakage

jaundice due to retained ductal stoned

general surgical complications

41
Q

Causes of bloody diarrhoea

A

UC

colorectal Ca

polyps

ischaemic colitis

pseudomembranous colitis

infective

42
Q

Extraintestinal manifestations of IBD

A
43
Q

What class of drug is used to maintain remission of UC?

A

aminosalicylates- active ingredient is 5ASA

mesalazine, sulfasalazine

44
Q

Severity of UC attack scoring

A
45
Q

Complications of UC

A

perforqrion

bleeding

malnutrition

toxic dilation of the colon

PSC

colon cancer risk increased

46
Q

Causes of erythema nodosum

A

sarcoid

sterptococcal infection

TB

IBD

drugs- sulphonamides, OCP

47
Q

Features of both UC and Crohns

A

young age

chronic

innapropriate activation of mucosal immune system

abdo pain and diarrhoea

may cause total colitis—> toxic mega colon

associated with extraintestinal manifestations e.g. iritis, arthritis, erythema nodosum, pyoderma gangrenosum

50
Q

Features of Crohn’s disease

A

peak incidence in 20s (30s in UC)

transmural Disease with patchy distribution and non-caseating granulomas

mouth to anus

more likely to present with weight loss, ill health, Anaemia of chronic disease

51
Q

Site of disease in Crohns

A

skip lesions

terninal ileum involvement —> malabsorption due to loss of bile salts

rectum commonly spared

strictures, typically in terminal ileum

peri-anal disease is common

52
Q

Types of ulceration in Crohns disease

A

superficial- mucosal only- apthous

deep- mucosa and submucosa- fissures leading to cobblestone mucosa

transmural- full thickness, down to muscle layer, rose thorn ulcers

53
Q

Features of Crohns

A

CAMPERS

Clubbing / Cobblestone

Apthous ulcers

Mass in RIF/ Malabsorption

Peri-anal Disease- skin tags, fistula, abscess

Erythema nodosum

Rosethorn ulcers/ Rectal sparing

Skip lesions/ Strictures

54
Q

Features of UC

A

peak incidence 30s

diarrhoea, blood mucus

superficial mucosal ulceration

inflammatory cells extending into lumen of colonic glands ‘crypt abscesses’

pseudopolyps

Confined to colon (backwash ileitis)

recutm nearly always involved

risk of colonic carcinoma

55
Q

IBD differentials

A

infection

pseudomembranous colitis

iscaemic colitis

radiation colitis

56
Q

Severity grading of UC

A

mild- <4 stools per day, systemically well

moderate- >4 stools per day, systemically unwell

severe- >6 stools per day or systemically unwell

systemically unwell- tachycardia, fever, Anaemia, hypoalbuminaemia

57
Q

borders of the inguinal canal

A

floor- inguinal ligament

roof- internal oblique

anterior- external oblique

posterior- transversalis

58
Q

complications of hernias

A

incarceration, strangulation, obstruction

59
Q

what is a Richter’s hernia?

A

only part of the bowel herniates –> strangulation without herniation

commoner in femoral hernias

60
Q

mid inguinal point vs mid-point of the inguinal ligament

A

mid-inguinal point–> pubic symphysis to ASIS–> femoral pulse

mid point of the inguinal ligament–> pubic tubercle to ASIS–> deep inguinal ring

61
Q
A

Ask Doctor Clarke 2018 (12 decks)

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