Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gastroenterology > GI Conditions pt 2 > Flashcards

GI Conditions pt 2 Flashcards

1
Q

What is the secondary prophylaxis for variceal bleeding?

A

Non-selective B-blockade
Rpt endoscopic banding ligation
Transjugular intrahepatic porto-systemic shunt for varices resistant to banding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Management of Acute variceal bleeding

A 
Resusc + transfuse if anaemia
Correct clotting abnormalities w/
-	Vit K
-	FFP
-	Platelet transfusions
IVI terlipressin and somatostatin analogues alternatives
Endoscopic banding
Minnesota tube if bleeding uncontrolled
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pathogenesis of oesophageal varices

A

Progressive liver fibrosis + regeneration of nodules = contractile elements in liver’s vascular bed
 Portal HT
 Splanchnic vasodilation
 Increased CO
 Salt and Water retention
 Hyperdynamic circulation/increased portal flow
 Formation of collaterals between portal and systemic systems
 Gastro-oesophageal varices is >10mmHg
 >12mmHg variceal bleeding
 Death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name 6 kinds of liver failure

A

Acute hep failure
Acute-on-chronic: decompensation of chr liver disease
Fulminant hep failure: massive necrosis of liver cells
- Hyperacute: encephalopathy within 7d of onset of jaundice
- Acute: 8-28d
- Subacute: 5-25w

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Causes of Liver failure

A

Infections
Drugs
Toxins: mushroom, alcohol
Vascular: veno-occlusive disease, Budd-Chiari syndrome
Other: primary biliary cirrhosis, alpha-antitrypsin deficiency, Wilson’s disease, malignancy
Fatty liver of preg - HELLP syndrome (Haemolysis, elevated liver enzymes + low platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Signs of Liver failure

A 
Jaundice
Hepatic encephalopathy
Fetor hepaticus
Asterixis/flap
Constructional apraxia (cannot copy a 5 pointed star)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Specific tests for Liver failure

A 
Blood: Clotting, glucose, paracetamol level, hep, CMV, EBV serology
Ferritin
Alpha1- antritrypsin
Caeruloplasmin
Autoantibodies

Microbiology: blood culture, urine culture, ascites tap for MC+S, neutrophils

Radiology: Abdo US, Doppler flow studies of portal vein

Neurophysiology: EEG, evoked potentials

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What do you have to beware of in the management of liver failure

A

Sepsis, hypogly
GI bleeds/varices
Encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Management of liver failure

A

20 degree head-up tilt in ITU – protect with intubation + NG tube
Urinary and Central venous catheters to help assess fluid status
Monitor T, resp, pulse, BP, pupils, urine output, wt – FBC, U+E, LFT INR daily
10% glucose IV, blood glucose every 1-4h
Treat the cause
- Malnourished: thiamine + folate
- Seizures with lorazepam
- Haemofiltration / haemodialysis
- Avoid sedatics
- PPI against stress ulceration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How would you treat the complications to Liver failure

  • Cerebral oedema
  • Ascites
  • Bleeding
  • Blind Rx of infection
  • Low blood glucose
  • encephalopathy
A
  • Mannitol
  • Restrict fluid, low salt diet, wt daily, diuretics
  • Ceftriaxone
  • 50mL 50% glucose IV
  • Avoid sedatives, lactulose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name the Fourgrades of hepatic encephalopathy

A

I: altered mood behavior, sleep disturbance, dyspraxia, poor arithmetic, no liver flap
II: increased drowsiness, confusion, slurred speech +/- liver flap, personality change
III: incoherent, restless, liver flap, stupor but not coma
IV: coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

There are two types of Hepatorenal syndrome

A

I: rapid progressive deterioration
Rx: terlipressin
2: steady deteriorating -6mo
Rx: liver transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hereditary haemochromatosis signs and symp

  • Early
  • Late
A
  • Tiredness, athralgia, less erections

- Slate-grey skin pigmentation, Hepatomegaly, cirrhosis, Dilated cardiomyopathy, osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Specific tests for haemochromatosis

A 
LFT (inc)
Serum ferritin (inc)
Transferrin saturation >45%
Glucose: ?DM
HFE genotype
Imaging: chondrocalcinosis, Liver MRI for Fe overload, ECG / ECHO for cardiomyopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management for haemochromatosis

A

Venesect
Vitamin prep containing no irone
Diet: low-Fe diet may help, tea, coffee, red wine with meals

Monitor lft, glucose/diabetes, HbA1c (may be low due to venesection)
Screen: serum ferritin, genotype (C282Y), LFT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Indications for liver transplant in chronic liver disease

A

Advanced cirrhosis secondary to
- Hep b, c, autoimmune

  • Alcoholic liver disease
  • Primary biliary cirrhosis
  • Primary sclerosing cholangitis
  • Alpha1 antitrypsin deficiency
  • Wilson’s disease
  • Hepatocellular ca
17
Q

Contraindications for liver transplant

A 
Extrahepatic malignancy
Multiple tumours
Severe cardioresp disease
Systemic sepsis
HIV infection
Non-compliance with drug therapy
18
Q

What is deficient in alpha-1antitrypsin A1AT deficiency

A

A1at affecting the lung (emphysema) and liver (cirrhosis and hepatocellular ca, HCC)
Erpinopathy: serine protease inhibitors which controls inflammatory cascades
Associated with HCC, asthma, pancreatitis, gallstones, Wegener’s

19
Q

Specific tests for alpha-1antitrypsin

A 
Serum alpha1-antitrypsin
Genotyping
Liver biopsy: periodic acid Schiff +ve, diastase-resistant globules
Phenotyping
CT: to measure lung density
20
Q

Management for alpha-1 antitrypsin deficiency

A

Supportive for emphysema and liver disease
Quit smoking
Giving IV a1at from human plasma
Liver transplantation in decompensated cirrhosis

21
Q

Signs of autoimmune hepatitis

A 
Fever
Malaise
Urticarial rash
Polyarthritis
Pleurisy
Pulmonary infiltration
Glomerulonephritis
Amenorrhoea
22
Q

Specific Tests for autoimmune hep

A 
Serum bilirubin (inc)
AST (inc)
ALT (inc)
Alk phos (inc)
Hypergammaglobulinaemia
FBC: anaemia, WCC dec, platelets dec = hypersplenism
Liver bipsy
MRCP: exclude PSC
23
Q

How do u classify autoimmune hepatitis

A

I: <40yo, ASMA +ve, ANA +ve, high IgG,
Good response to immunosuppress
II: European kids, progress to cirrhosis, LKM1 antibodies +ve, ASMA -ve, ANA-ve
III: ASMA -ve, ANA, -ve, high IgG, SLA or liver pancrease antigen

24
Q

Management of autoimmune hep

A

Immunosuppressant therapy: Prednisolone 30mg/d x1mo – stop at 2y, Azathioprine for steroid sparing agent
Liver transplant: decompensated cirrhosis

25
Q

What is associated with autoimmune hepatitis

A 
Haplotype: HLA A1, B8, DR3
D: diabetes mellitus
A: autoimmune haemolysis
P: pernicious anaemia
G: glomerulonephritis
U: ulcerative colitis
A: autoimmune thyroiditis
P: Primary Sclerosing Cholangitis
26
Q

Typical presentation for non-alcoholic fatty liver disease (NAFLD)

A

Alcohol
Middle aged
Obese
Male

27
Q

Risk factors for non-alcoholic fatty liver disease (NAFLD)

A

Parenteral feeding
Jejuno-ileal bypass

Dm
Dyslipidaemia
Wilson’s disease

Drugs: ex: amiodarone, methotrexate, tetracycline

28
Q

Follow up for non-alcoholic fatty liver disease (NAFLD)

A

LFT

Glucose

29
Q

Signs of Wilson’s disease

A

Liver disease: hepatitis, cirrhosis, fulminant liver failure
CNS signs: tremor, dysarthria, dysphagia, dyskinesias, dystonias, purposeless stereotyped movements, dementia, parkinsonism, micrographia, ataxia/clumsiness
Mood: depression mania, labile emotions
Cognition: low memory and quick to anger, slow to solve problems
Kayser-Fleischer rings
Haemolysis, blue lunulae, arthritis, hypermobile joints, grey skin

30
Q

Specific tests for Wilson’s disease

A 
Urine: 24h copper secretion is high
LFTs High
Serum Copper
Serum caeruloplasmin decreased
Molecular genetic testing
Slit lamp exam: KF rings
Liver biopsy
MRI: degeneration of basal ganglia

Gastroenterology (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions