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PHASE 2A > GI AND LIVER > Flashcards

GI AND LIVER Flashcards

1
Q

What is Charot’s triad linked to and what is it?

A

It is linked to ascending cholangitis and primary sclerosing cholangitis and is made of:
Fever
Upper right quadrant pain
Jaudice (Dark urine and pale stools)

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2
Q

Which infections cause ascending cholangitis?

A

E.coli or Kelbsiella also enterococcus (group D strep) although it is usually due to gallstones blockage

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3
Q

What is primary sclerosing cholangitis?

A

Chronic inflammation and fibrosis of the bile ducts (Linked to ulcerative colitis

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4
Q

What is diverticulosis and diverticulitis?

A

Diverticulosis: Presence of diverticula (Mucosa that has ppouched through the muscular wall)
Diverticulitis: Inflammation from when faeces obstructs the neck

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5
Q

What are risk factors of GORD?

A

Smoking, alcohol, pregnancy, big meals, hernia and obesity

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6
Q

When is heartburn must often felt when you have GORD?

A

When lying down and just after eating.

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7
Q

What investigatiosn do you do for GORD?

A

Endoscopy to check red flags

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8
Q

What treatment do you give for GORD?

A

Life style changes, Antacids (Magnesium carbonate), h2 receptor blockers (Ranitidine) and PPIs (omeprazole)

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9
Q

When do you experience pain with stomach ulcers?

A

While eating

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10
Q

What can cause ulcers?

A

H.pylori and NSAIDs

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11
Q

How would someone with an ulcer describe the pain?

A

Burning

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12
Q

How would you test for H.pylori?

A

C13 Urea breath test, stool sample test, blood antibody test

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13
Q

How do we treat H.pylori?

A

Omeprazole, metronidazole and clarithromycin

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14
Q

How do we treat ulcers if no H.pylori?

A

Stop NSAIDs, PPI (Lansoprazole) and H2 blocker (Rantidine)

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15
Q

What is EIEC?

A

Enteroinvasive E.coli that causes bloody diarrhoea

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16
Q

What is EPEC?

A

Enteropathogenic E.coli

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17
Q

What is EAEC?

A

Enteroaggregative which causes Traveller’s diarrhoea and produces EAST toxin

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18
Q

What are varices?

A

Dilated veins between the systemic and portal vein system leading to haemorrhage

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19
Q

What can cause varices?

A

Chronic liver disease

Oesophageal- Portal hypertension

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20
Q

How do we treat varices?

A

EMERGENCY

Banding, beta blockers, treat underlying, liver transplant

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21
Q

What are causes of gastritis?

A

H.pylori, alcohol and NSAIDs

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22
Q

What is gastritis?

A

Inflammation of the mucosa

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23
Q

What on gluten causes coeliac disease?

A

Alpha Giladin

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24
Q

What gene is linked to Coeliac disease?

A

HLA DQ2 AND HLA DQ 8

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25
Q

What are the signs and symptoms of coeliac disease?

A

Abdominal pain and bloating, steatorrhoea, diarrhoea, weight loss, anaemia, failure to thrive

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26
Q

What antibody do you find in coeliac disease?

A

Anti-transglutamase (type of IgA)

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27
Q

What are the investigations for coeliac disease?

A

Anti-transglutamase, if positive do a duodenal biopsy (villous atrophy and crypt hyperplasia)

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28
Q

Where does Crohns effect?

A

The entire GI tract

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29
Q

Where does ulcerative collitis effect?

A

The terminal ileum

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30
Q

What symptoms does UC cause?

A

Cramp/colicky abdo pain and diarrhoea with blood and mucus

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31
Q

What is the macroscopic apprearances of chrons?

A

Skip lesions

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32
Q

What is the macroscopic appearance of UC?

A

Continuous involvement in the colon only

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33
Q

What are the microscopic signs of chrons?

A

Inflammation in all the layer and granulomas

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34
Q

What are the microscopic signs of UC?

A

Mucosal only inflammation and no signs of granulomas

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35
Q

What helps remember Chron’s?

A

GALS-
Granuloma
All Layers
Skip lesions

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36
Q

What investigations should be done for inflammatory bowel disease?

A

Bloods- low HB but high WCC, ESR and CRP
A colonoscopy biopsy differentiates between the 2
A x ray shows the involvement extent

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37
Q

What is the treatment for Crohns?

A

Mild- Prednisolone

Severe- IV hydrocortisone

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38
Q

What is preventive treatment for Crohns?

A

5-ASA analogues (mezalazine), corticosteroids (prednisolone) and surgery

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39
Q

What is the treatment for ulcerative colitis?

A

Mild- 5-ASA analogues (mesalazine) and steroids
Moderate- steroids
Severe- IV hydrocortisone, ciclosporin (immunosuppresant) and surgery

40
Q

In the UK what is the most common cause of diarrhoea?

A

Rotavirus

41
Q

What can cause hernias?

A

Muscle weakness, chronic cough, trauma damage, heavy weight lifting, pregnancy and constipation

42
Q

What is incarceration of a hernia?

A

Where the contents of the hernial sac are stuck inside by adhesions.

43
Q

What are the 5 types of hernias?

A 
1- Hiatal (stomach-oesophageal hiatus of diaphragm)
2-Inguinal (most common)
3-Femoral
4-Incisional (after surgery)
5-Umbilical (<6 will correct itself)
44
Q

What are the causes of acute pancreatitis?

A

GET SMASHED
Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune
Scorpion sting
Hyperlipideamia
ERCP
Drugs
45
Q

What are the signs of acute pancreatitis?

A

Cullen’s- periumbilical brusing

Grey Turner’s- flank bruising

46
Q

What does acute pancreatitis present with?

A

Epigastric or central abdo pain radiating to the back
Pain relived by sitting forwards
Nausea and vomitting, jaundice

47
Q

What are the investigations for acute pancreatitis?

A

See 3x higher serum amylase
sensitive lipase levels
A contrast CT or MRI confirms the diagnosis

48
Q

What is the management of acute pancreatitis?

A

Fluids, analgesia, o2 and potentially surgery

49
Q

What causes chronic pancreatitis most commonly?

A

Alcohol and presents with steatorrhoea

50
Q

How do we test for chronic pancreatitis?

A

USS/ abdominal X ray for pancreatic calcification

51
Q

What is the treatment for chronic pancreatitis?

A

Lifestyle, analgesia, pancreatic enzyme supplements

52
Q

Who is appendicitis rare in?

A

The very young and the very old

10-20 most common

53
Q

What are the signs of appendicitis?

A

Patient guards so prefers to have their legs bent
Vomiting
Diarrhoea
loss of appetite,

54
Q

What can appendicitis lead to?

A

Peritonitis if the obstruction bursts, releasing the infected and faecal matter

55
Q

What is Barrett’s metaplasia?

A

Linked to oesophageal cancer and a change from squamous to columnar.

56
Q

What investigations are done for osphageal cancer?

A

Biopsy and endoscopy along with a CT scan for staging

57
Q

What is familial adenomatous polyposis?

A

1000s of adenocarcinoma in the large bowl caused by genetic factors

58
Q

What is the screening for cholorectal cancer?

A

Biannual faecal occult blood tests for people 60-69 years old

59
Q

What is a Mallory Weiss tear?

A

Haematemesis (throwing up blood) from a tear in the mucosa of the oesophagus

60
Q

What can cause a Mallory Weiss tear?

A

Prolonged vomiting (bulimia), chronic cough or alcohol excess

61
Q

How do we find a Mallory Weiss tear?

A

Endoscopy

62
Q

Sign and symptoms of peritonitis?

A

Pain, fever, vomiting, rebound tenderness, SILENT ABDOMEN, patient avoids moving

63
Q

What does a peritonitis ERECT chest X-ray show?

A

Air under the diaphragm

64
Q

What score is used for a Mallory Weiss tear?

A

The Rockall score

65
Q

Does vomiting appear earlier in large or small bowel obstruction?

A

Small bowel

66
Q

Does constipation appear earlier in large or small bowel obstruction?

A

Large bowel

67
Q

What is a sign of mechanical obstruction?

A

Tinkling bowel sounds

68
Q

What are the causes of mechanical obstruction?

A 
Abdominal adhesion's from surgery
Strangulated hernia
Malignancy
Volvus
Intussusception (telescoping)
69
Q

How do we treat a mechanical obstruction?

A

Fluids, surgery, intestinal compression.

70
Q

What is ascites?

A

Fluid build up in the peritoneal cavity

71
Q

How do treat ascites?

A

Treat cause, limit sodium intake, diuretics, surgical shunts

72
Q

What is haemorrhoids?

A

Plies from traumatised passage of hard stools in preganancy

73
Q

What does the liver do?

A

Produce albumin
Regulate oestrogen
Produce clotting factors Regulate bilirubin
Protect against infection using kupffer cells
Store glycogen

74
Q

What bug causes liver abscesses?

A

Entamoeba histolytica

75
Q

What is the treatment of liver abscesses?

A

Metronidazole and drainage

76
Q

Which hepatitis are spread via blood?

A

B,C and D

77
Q

Which hepatitis is DNA?

A

B

78
Q

How do we detect hepatitis?

A

Serology for antibodies and antigens

79
Q

Which forms of hepatitis have vaccines?

A

A and B

80
Q

What is the treatment for chronic hepatitis B?

A

Pegylated interferon alpha 2a

81
Q

What is the treatment for chronic hepatits C?

A

Velpatasvir/sofobuvir

82
Q

How do we manage drug induced liver injury (i.e. Paracetamol overdose)?

A

N-acetyl-cysteine or activated charcol

83
Q

What is the presentation of liver failure?

A

Confusion, drowsy, disorientated, jaundice, can present with sepsis

84
Q

What is liver cirrhosis?

A

Irreversible liver damage from fibrosis and abnormal nodules

85
Q

What is the classification system for cirrhosis?

A

Child-pugh or MELD

86
Q

What investigations do we do for liver cirrhosis?

A

A liver biopsy or TRANSIENT ELASTOGRAPHY for alcohol VS. Hep C virus

87
Q

How do we monitor liver cirrhosis?

A

Screen for HCC with alpha-fetoprotein every 6 months

88
Q

What are complications of cirrhosis?

A

Hepatic failure, odema, coagulopathy, ascites

89
Q

How does alcoholic liver disease occur?

A

Less oxidation of fat mean that is accumulates in hepatocytes. ROS is produced more with alcohol and this can damage hepatocytes

90
Q

What do we see raised in alcoholic liver disease?

A

Gamma glutamyl transpeptidase
Aspartate transaminase
Alanine transaminase

91
Q

What is wilson’s disease?

A

Excess copper in liver. Causes kayser-fleischer rings and neurological signs.
Do serum caeruloplasmin and give penicillamine and reduce copper

92
Q

What is Haemochromatosis?

A

Genetic excess iron everywhere causing bronze diabetes and heart issues.
Managemant- Desferrioxamine

93
Q

What is the epi for gallstones?

A

Fat, female, forty and fertile

94
Q

What turns Charot’s into Reynold’s pentad

A

Hypotension and confusion

95
Q

What relives IBS?

A

Pooing and passing wind

96
Q

What is primary bilary cholangitis?

A

Granlomatous inflammation destroying the bile duct.
Young female
Only in live

PHASE 2A (14 decks)

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