GI + HPB Flashcards by prion alpha

name some common drugs that undergo extensive FPM

aspirin
levodopa
lidocaine
morphine
propranalol
salbutamol

How well did you know this?

Not at all

Perfectly

name 3 ways in which liver impairment can affect drug metabolism

1) drug accumulation due to less metabolic activity
2) decreased active drug availability due to decreased active-metabolite
3) increase in free active drug due to hypoalbunaemia

How well did you know this?

Not at all

Perfectly

phenytoin is not a hepatotoxic drug - T or F

How well did you know this?

Not at all

Perfectly

it is safe to give anti TB drugs in liver failure - T or F

How well did you know this?

Not at all

Perfectly

what is extraction ratio?

the % of drug in the blood that is removed each time it goes through the liver.

How well did you know this?

Not at all

Perfectly

how does extraction ratio affect drug doses in liver failure

in oral medication

if high extraction ratio - must reduce both loading dose and maintenance dose

if low extraction ratio - reduce maintenance dose, but keep loading dose same

in IV medication

keep loading dose the same, but reduce maintenance dose

How well did you know this?

Not at all

Perfectly

how to investigate suspected c diff

c diff stool test

flexi sig

How well did you know this?

Not at all

Perfectly

management of C diff

14 days metronidazole, if not vancomycin

How well did you know this?

Not at all

Perfectly

differentials diarrhea

gastroenteritis
c diff
pancreatitis
alcoholic gastritis
IBD
ischaemic bowel

How well did you know this?

Not at all

Perfectly

further investigations of diarrhea if suspecting cancer

flexi sig
faecal calprotectin
faecal elastase
CT abdomen

How well did you know this?

Not at all

Perfectly

causes of secondary constipation

opiates, iron, CCB
neurological damage
dietary
mechanical obstruction - cancer, stricture, painful anus
metabolic 
endocrine

How well did you know this?

Not at all

Perfectly

what are metabolic causes of constipation

high or low calcium
low potassium
low mg

How well did you know this?

Not at all

Perfectly

2 endocrine causes of constipation

hypothyroidism

diabetes

How well did you know this?

Not at all

Perfectly

when to investigate further in constipation

if over 40 years old or

iron def anaemia, associate red flag symptoms

How well did you know this?

Not at all

Perfectly

4 types of laxatives

bulk forming - ispaghula husk
osmotic - macrogol
stimulant - senna
stool softeners - docusate

How well did you know this?

Not at all

Perfectly

how to go about management constipation

1st line - ispaghula husk
2nd line - macrogol
if not then add stimulant

How well did you know this?

Not at all

Perfectly

how to manage opioid induced constipation?

osmotic and stimulant laxative

How well did you know this?

Not at all

Perfectly

what must patient be encouraged to do when given bulk forming laxative?

drink water

How well did you know this?

Not at all

Perfectly

what is a common contraindication of laxatives

intestinal obstruction

How well did you know this?

Not at all

Perfectly

what blatchford score is indicative of further investigation needed

> 0

How well did you know this?

Not at all

Perfectly

what is dyspepsia

loose term describing symptoms of

epigastric pain (heartburn)
nausea, vomiting
bloating, fullness

what are some redflags in dyspepsia

weight loss
upper GI bleed
vomiting
anorexia
dysphagia
haematemesis

causes of peptic ulcer disease

h pylori
nsaid use
stress
long term steroid use
smoking
alcohol

symptoms of PUD

dyspepsia
epigastric pain
gastric bleeding
weight loss
anaemia

how can upper GI bleeding present

haematemesis | malaena

what 2 scoring systems used in pud/gastric bleeding

blatchford and rockall

differential diagnoses of PUD

``` ulcer pancreatitis gastric cancer reflux gall stones MI ```

how to manage PUD?

if under 55 test and treat - if clinical assessment suggests, do H pylori test, and if positive, treat if over 55 - do endoscopy

how is h pylori tested for

urea breath test stool antigen testing HP antibody serum test endoscopic biopsy tests

how is PUD managed if under 55, +veHP and on NSAIDs, incld monitoring

give 2 months of PPI first, then eradication therapy 7 days PPI + amox + clarithro/metro repeat endoscopy 6-8 weeks later

how is PUD managed if under 55, +ve HP, and not on NSAIDs, incld monitoring

eradication therapy, retest for HP after

how to manage if HP -ve?

4-8 weeks of PPI

what should be done if someone has PUD but needs to take NSAID?

give PPI also, consider switching to COX2 if low CDVS risk

how is alcohol metabolised in the liver?

ethanol ---(ethanol dehydrogenase)--> acetyldehyde ---(aldehyde dehydrogenase)---> acetic acid

what causes fatty acid accumulation in ALD?

increased ethanol metabolism causes depletion of NAD+ and increase in NADH, this causes decrease in fatty acid oxidation and increased hepatic fatty acid synthesis. fatty acids then esterified into glyceride

how does ALD cause damage to hepatocytes

increase in NADH causes necrosis of hepatic acinus, causing release of TNF-alpha and free radicals

what role does inflammation play in ALD

release of cytokines cause inflammation, neutrophil infiltration and cirrhosis

what are the stages of ALD

steatosis alcohol steatohepatitis alcohol cirrhosis

hepatic steatosis from alcohol is reversible - T or F

T, with abstinence

symptoms of ALD

can be asymptomatic, otherwise signs of liver damage incl. jaundice, RUQ pain, vomiting/nausea, hepatomegaly, ascites, fatigue, complications of cirrhosis

what are compliations of liver cirrhosis

jaundice, ascites, portal hypertension, bleeding varices, SBP, encephalopathy

biochemical marker picture in ALD

raised bili, ast, alt, alk phos, PT, low albumin

specific investigations in ALD

ultrasound CT biopsy

management of ALD

alcohol cessation - managed thiamine steroids liver transplant

what is NAFLD associated with

metabolic syndrome

what is metabolic syndrome

``` hypertension insulin resistance central obesity hyperlipidaemia nafld ```

what is nafld

fatty liver causing inflammation, fibrosis and cirrhosis

what does nafld increase the risk of

cirrhosis, hcc, liver failure

what are symptoms of nafld

often asymptomatic, picked up incidentally

what are signs of nafld

abnormal lfts hepatomegaly ultrasound showing fatty liver

how is nafld diagnosed

raised alt/ggt imaging evidence of steatosis raised alt and evidence of metabolic syndrome with no other possible causes of liver disease (alcohol, viral, autoimmune etc)

how is nalfd managed

lifestyle, exercise, diet, weight loss, alcohol cessation, treat metabolic syndrome