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Yr1 > GI > Flashcards

GI Flashcards

1
Q

What does the liver do?

A
  • Glucose and fat metabolism
  • Detoxification and excretion
  • Protein synthesis
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2
Q

What is acute liver injury?

A
  • Damage to and loss of cells

- Cell death via necrosis or apoptosis

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3
Q

What is chronic liver injury?

A
  • Low grade and over years of injury. Response with scar tissue and cirrhosis
  • Eventually leads to fibrosis
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4
Q

What can cause acute liver injury?

A
  • Viral hepatits
  • Drugs
  • Alcohol
  • Vascular
  • Obstruction
  • Congestion
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5
Q

What can cause chronic liver injury?

A
  • Alcohol
  • Viral (B,C)
  • Autoimmune
  • Metabolic
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6
Q

How does acute liver injury present?

A
  • Malaise
  • Nausea
  • Anorexia
  • Jaundice
  • rarer: confusion, bleeding
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7
Q

How does chronic liver injury present?

A
  • Ascites (swollen stomach)
  • wasting (loss of body mass)
  • bruising
  • itching
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8
Q

What is jaundice?

A
  • raised serum bilirubin
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9
Q

What are risk factors for gallstones?

A
  • Female
  • Obesity
  • Fertile
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10
Q

How do you manage bile duct stones?

A
  • ERCP with removal or crushing

- Surgery (for large stones)

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11
Q

Which drugs cause drug-induced liver injury?

A
  • Antibiotics (augmentin, flucloxacillin, erythromycin)
  • CNS drugs
  • multiple drugs
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12
Q

What is leuconychia?

A

White nails/ milk spots

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13
Q

What are the causes of ascites?

A
  • Chronic liver disease (most cases)
  • Neoplasia
  • Pancreatitis
  • Cardiac causes
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14
Q

How would you manage ascites?

A
  • Fluid and salt restriction
  • Diuretics e.g. spironolactone
  • Large-vol paracentesis + albumin
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15
Q

What are the causes of portal hypertension?

A
  • Cirrhosis
  • Fibrosis
  • Portal vein thrombosis
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16
Q

What does portal hypertension lead to?

A
  • Varices (oesophageal or gastric)

- Splenomegaly

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17
Q

What is spontaneous bacterial peritonitis?

A
  • Commonest serious infection in cirrhosis

- based on neutrophils in ascitic fluid

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18
Q

How would you investigate chronic liver disease?

A
  • Viral serology
  • Immunology
  • Biochemistry
  • USS/CT/MRI
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19
Q

What is autoimmune hepatits?

A

liver inflammation that occurs when your body’s immune system turns against liver cells

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20
Q

What is primary biliary cholangitis (PBC)?

A
  • chronic disease

- immune damage is directed towards the small bile ducts

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21
Q

How does PBC present?

A
  • Asymptomatic
  • Itching
  • Fatigue
  • dry eyes
  • joint pain
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22
Q

How do you treat a cholestatic itch?

A
  • UDCA - antihistamines
  • cholestyramine
  • rifampicin (can occasionally damage liver)
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23
Q

What are the risk factors for non-alcoholic fatty liver?

A
  • Obesity
  • Diabetes
  • Hyperlipidaemia
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24
Q

What are the infectious causes of chronic hepatitis?

A
  • Hep B
  • Hep C
  • Hep E
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25
Q

What are the risk factors for hepatitis A?

A
  • travel
  • household/sexual contact
  • injecting drug use
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26
Q

Describe hepatitis A.

A
  • Usually symptomatic in adults
  • Not a chronic disease
  • Once had it, will not have it again
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27
Q

How do you manage hepatitis A?

A
  • Supportive
  • Monitor liver function
  • Prevention with a vaccine
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28
Q

How does hepatitis E present.

A
  • 95%+ cases are asymptomatic
  • self-limiting acute hepatitis
  • risk of chronic infection in immunosuppressed patients
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29
Q

How do you manage patients with hepatitis E?

A
  • Acute infection = supportive. Consider ribavirin

- Chronic infection = reverse immunosuppression

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30
Q

How is Hep B transmitted?

A
  • Mother-to-child
  • Sexual
  • iatrogenic
  • injecting drug use
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31
Q

How do you manage acute hep B?

A
  • Supportive
  • Monitor liver function
  • Vaccine
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32
Q

Describe pegylated interferon-alpha 2a.

A
  • Used for hep B treatment
  • Immunomodulatory
  • weekly subcut. injection
  • side effects and needs monitoring
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33
Q

What are directly acting antivirals (DAAs)?

A
  • A treatment for hep C
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34
Q

What is the definition of diarrhoea?

A
  • 3 or more loose/liquid stools within 24 hours
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35
Q

Name some causes for diarrhoea.

A
  • Intraluminal infection
  • systemic infections e.g. sepsis
  • cancer
  • IBD
  • IBS/ malabsorption
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36
Q

If the diarrhoea is chronic, what are the likely causes?

A
  • Parasites

- non-infectious

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37
Q

What characteristics of stool should you look out for?

A
  • Floating = higher fat content (malabsorption)
  • Blood/mucus = inflammatory/cancer
  • Watery = infection
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38
Q

What investigations are done with diarrhoea?

A
  • Stool tests

- Blood tests

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39
Q

What are some bacterial causes of watery diarrhoea?

A
  • Cholera
  • E. Coli
  • Staph. aureus
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40
Q

What are some bacterial causes of bloody/mucus diarrhoea?

A
  • Shigella
  • E. coli
  • Salmonella
  • C. difficile
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41
Q

What are some parasitic causes of watery diarrhoea?

A
  • Giardia

- Cryptosporidium (Swimming pools)

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42
Q

Describe symptoms of diarrhoea caused by Giardia.

A
  • offensive diarrhoea
  • chronic
  • bloating
  • flatulence
  • nurseries/old age facilities
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43
Q

What are most cases of diarrhoea caused by?

A
  • Viruses e.g. rota or noro
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44
Q

What is Traveller’s Diarrhoea?

A
  • Occurs within 2 weeks of arrival in a new country

- 3 or more unformed stool in 24 hours PLUS: abdo pain, cramps, nausea, vomiting

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45
Q

What causes travellers diarrhoea?

A
  • Enterotoxigenic e. coli
  • campylobacter
  • shigella
  • viral
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46
Q

Describe Enterotoxigenic E.coli (ETEC).

A
  • Leading bacterial cause of diarrhoea in children

- Travellers diarrhoea

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47
Q

What are the symptoms of cholera?

A
  • Watery “rice water” diarrhoea
  • Vomiting
  • rapid dehydration
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48
Q

What is the treatment for cholera?

A
  • Doxycycline

- Fluids

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49
Q

What are the issues with C. difficile?

A
  • Gram positive spore-forming bacteria

- Mostly asymptomatic but become an issue if normal gut flora is altered

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50
Q

What do you treat C. difficile with?

A
  • Metronidazole

- Oral vancomycin

51
Q

What are the red flats associated with diarrhoea?

A
  • dehydration
  • electrolyte imbalance
  • renal failure
52
Q

What is peptic ulcer disease?

A
  • Break in the inner lining of the stomach

- H. pylori

53
Q

What are the symptoms of peptic ulcer disease?

A
  • Acquisition mostly asymptomatic
  • Ongoing symptoms = dyspepsia, epigastric pain
  • nausea, vomiting, fever
54
Q

How would you diagnose for an H. pylori infection?

A
  • stool antigen test
  • breath test
  • blood test
55
Q

What is the treatment for an H. pylori infection?

A
  • Clarithromycin
  • Amoxicillin
  • PPI e.g. omeprazole
  • CAP
56
Q

What is acute cholangitis?

A
  • Obstruction of common bile duct which leads to stasis of bile
  • Bacteria invades so gets infected
57
Q

What are the symptoms of acute cholangitis?

A
  • Charcot’s triad =
  • Jaundice
  • RUQ pain
  • Fever
58
Q

What is the differentials for colicky RUQ pain?

A
  • If biliary colic, only RUQ pain

- If cholecystitis, RUQ pain and fever

59
Q

What is the treatment for biliary sepsis/acute cholangitis?

A
  • IV anti-biotics e.g. coamoxiclav
  • ERCP
  • Fluids
60
Q

What is enteric fever?

A
  • Like typhoid fever

- Salmonella, a bacterial infection that go through the body

61
Q

What are the symptoms of enteric fever?

A
  • RLQ pain
  • High fever
  • relative bradycardia
  • headache/ myalgia
  • rose spots
  • green diarrhoea
62
Q

How would you diagnose enteric fever?

A
  • Blood culture

- Bone marrow aspiration

63
Q

What is substance misuse?

A
  • Relates to the harmful use of any substance for non-medical purposes or effect
64
Q

What is alcohol withdrawal?

A
  • tremulousness / shaking
  • Activation syndrome
  • Seizures
  • Hallucinations
65
Q

What is fetal alcohol syndrome (FAS)?

A
  • pre and post-natal growth retardation
  • CNS abnormalities
  • Craniofacial abnormalities
66
Q

What are the treatments for alcohol dependence?

A
  • Medical
  • acamprosate calcium
  • disulfiram
  • nalmefene
  • psychosocial = therapy
67
Q

What screening tools are used in alcohol dependence?

A
  • FAST
  • AUDIT
  • CAGE
68
Q

Where can intestinal obstruction occur?

A
  • Lumen
  • Wall
  • Something pressing outside of the bowel
69
Q

What can obstruction in the lumen of the gut be?

A
  • Tumour
  • Diaphragm disease
  • Meconium
  • Gallstone ileus
70
Q

With a tumour in the lumen of the gut, where is most likely to produce an obstruction?

A
  • Left side of colon
71
Q

What is diverticular disease?

A
  • Small bulges that form in the wall of the colon
  • Mainly occurs in older people
  • Generally in the sigmoid colon
72
Q

What happens to the colon in diverticular disease?

A
  • Increased pressure in the lumen of the bowel
  • Mucosal increased pressure
  • Causes deformation
  • Eventually leads to an out-pouch, through the muscularis
73
Q

What is Hirschprung’s Disease?

A
  • congenital disorder of the colon in which ganglion cells are absent
  • Causes constipation
  • Grossly-distended abdomen so people die quite young
74
Q

What are examples of extraluminal obstructions?

A
  • Adhesions
  • Volvulus
  • Tumour
75
Q

What is an example of small bowel mechanical obstruction?

A
  • proximal dilatation
  • increased secretions and distension
  • untreated obstruction leads
76
Q

What are the symptoms of intestinal obstruction?

A
  • anorexia
  • nausea
  • vomiting
  • distension
  • abdominal pain
  • altered bowel habits
77
Q

How does intestinal obstruction present in patients?

A
  • Vomiting
  • Will be forceful and content = bilious/faeculent
  • abdominal pain (SOCRATES)
  • distension/swelling
78
Q

How does small bowel obstruction present in patients?

A
  • Vomiting
  • Pain
  • Constipation
  • Distension
  • Tenderness
79
Q

What would the abdomen look like with a patient with small bowel obstruction?

A
  • distension
  • visible peristalsis
  • obvious lump at site of obstruction
80
Q

What are the causes of SBO in adults, and in children?

A
  • Adults = adhesions, hernia, crohns, malignancy

- Children = appendicitis, volvulus, atresia

81
Q

What is a hernia?

A
  • Abnormal protrusion of viscus through normal/abnormal defects of body cavity
82
Q

Where can hernias present?

A
  • Indirect inguinal (opening of inguinal canal)
  • Femoral
  • Direct inguinal (opening)
  • Epigastric
  • Incisional
83
Q

What is adhesive obstruction?

A
  • 60% of SBO

- Secondary to previous abdominal surgery

84
Q

What is intesussuption?

A
  • Telescoping of intestine into one another
85
Q

How does a large bowel obstruction (LBO) present?

A
  • Malignancy
  • Abdominal discomfort and pain
  • Bloating/ nausea
  • Altered bowel habit
  • Volvulus - suddenly and painful
86
Q

What are the causes of LBO?

A
  • Age and race dependent - US/Europe high

- Paediatric - anatomical development goes wrong

87
Q

What is volvulus?

A
  • loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction.
88
Q

What is paralytic ileus?

A
  • Failure of peristalsis with no mechanical obstruction
89
Q

What are the signs of paralytic ileus?

A
  • painless distension
  • vomiting absent
  • minimal bowel sounds
90
Q

Describe colorectal cancer.

A
  • Mainly occurs in older people

- Incidence rates higher in Australia, N. America and W. Europe

91
Q

What is hereditary nonpolyposis colorectal cancer (HNPCC)?

A
  • Inherited autosomal dominant

- There is a risk of further cancers

92
Q

What can cause diarrhoea?

A
  • Infective causes

- Non-infective causes e.g. neoplasma, inflammatory, irritable bowel, hormonal etc

93
Q

What type of bacteria is cholera?

A
  • Gram-negative vibrio
94
Q

What type of bacteria is E. coli?

A
  • Gram negative bacillus
95
Q

What is norovirus?

A
  • mainly occurs in winter
  • causes vomiting
  • can cause diarrhoea, nausea, cramps, headache, fever, chills
  • lasts 1-3 days
96
Q

What is C. difficile associated with?

A
  • Antibiotic use, broad-spec antibiotics
97
Q

How is C. difficile spread?

A
  • faeco-oral route directly or through spores in the environment
98
Q

How can you prevent C. difficile?

A
  • alcohol rub will NOT destroy the pores
  • hand-washing using soap will remove microorganisms from the hands
  • SIGHT (gloves/apron and test stool for toxin)
99
Q

How would you investigate C. difficile?

A
  • test stool samples

- tissue samples at sigmoidoscopy

100
Q

What is diarrhoeal disease in children?

A
  • Frequent loose or watery stools
  • significant fluid loss can occur in children
  • range of causative organisms
101
Q

What is meningococcal infection?

A
  • Can present as meningitis or septicaemia
  • Casued by Neisseria meningitidis
  • infection NOT easily spread, but via direct contact
102
Q

What is gastritis?

A
  • Inflammation of the lining of the stomach
103
Q

What are the symptoms of gastritis?

A
  • indigestion
  • burning stomach pain
  • nausea/ vomiting
  • full after eating
104
Q

How would you diagnose gastritis?

A
  • Stool test
  • check for H. pylori infection
  • Endoscopy
105
Q

What is the differential diagnosis for gastritis?

A
  • H. pylori bacterial infection
  • Excessive use of cocaine or alcohol
  • regularly taking NSAIDS
  • stress
106
Q

What is the treatment for gastritis?

A
  • antacids
  • H2 blockers = ranitidine
  • PPIs = omeprazole
107
Q

What is H. pylori gastritis?

A
  • can cause recurring bouts of indigestion
  • common in elderly
  • generally lifelong, unless treated with eradication therapy
108
Q

What are the symptoms of oesophageal cancer?

A
  • difficulty swallowing
  • persistent indigestion
  • loss of appetite and weight loss
109
Q

What are the causes of oesophageal cancer?

A
  • persistent GORD
  • smoking
  • excessive alcohol
  • obesity
110
Q

What is the treatment for oesophageal cancer?

A
  • surgery to remove affected section

- chemotherapy

111
Q

What are the symptoms of gastric cancer?

A
  • persistent indigestion
  • trapped wind
  • bloating
  • persistent stomach pain
  • advanced symptoms = blood/black poo
112
Q

What can increase your likelihood of developing gastric cancer?

A
  • male
  • 55+
  • smoking
  • low fibre diet
113
Q

What is peritonitis?

A

Inflammation of the peritoneum

114
Q

What can cause inflammation of the peritoneum? (6)

A
  • Inflammed organ e.g. appendix
  • Air (ulcer, leak or stab wound)
  • Pus
  • Faeces (colon perforation)
  • Luminal contents
  • Blood
115
Q

What are the common causes of peritonitis and where is pain felt?

A
  • Gastritis (CUQ)
  • Cholecytitis (RUQ)
  • Pancreatitis (Epigastric)
  • Appendicitis (RLQ)
  • Diverticulitis (LLQ)
116
Q

How do you diagnose peritonitis?

A
  • MRI

- CT scan

117
Q

How do you treat peritonitis?

A
  • Laproscopy
  • Treat problem (patch hole/remove organ or cause)
  • Wash out infection
118
Q

What is ascites?

A
  • Collection of fluid in the peritoneal cavity - detectable or chronic
119
Q

How is ascites classified?

A
  • Stage 1 = mild
  • Stage 2 = easily detectable
  • Stage 3 = obvious, but not tense
  • Stage 4 = tense ascites
120
Q

What are the causes of ascites?

A
  • cirrhosis (75%)
  • malignancy
  • heart failure
  • TB
  • pancreatitis
121
Q

How would a patient with ascites present?

A
  • Abdominal distension
  • Nausea, loss of appetite
  • Constipation
  • Jaundice (if cause is liver)
122
Q

How would you diagnose ascites?

A
  • Analysis of ascitic fluid
  • Naked eye assessment
  • X-ray or ultrasound
123
Q

How would you treat ascites?

A
  • Treat underlying cause (95% portal hypertension)

- Shunts (portosystemic shunts for liver cirrhosis)

Yr1 (13 decks)

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