GI & Liver Flashcards
Name some of the metabolic conditions that can cause chronic liver disease?
Haemochromatosis
Wilson’s Disease
Alpha A antitripsin deficiency
Budd-Chiari syndrome
What is the treatment for Budd-Chiari syndrome?
Anticoagulation, transjugular intrahepatic portosystemic shunt
What are the symptoms of an H. Pylori infection?
Abdominal pain with gnawing or burning sensation Pain worse with an empty stomach Poor appetite Weight Loss Heartburn Indigestion (dyspepsia) Belching Nausea Vomiting Blood in Stool
What is the difference between a stricture and a fistula?
Stricture: Abnormal narrowing of a body passage, tube or canal
Fistula - Abnormal connection between two hollow spaces
What can H. Pylori cause pathologically?
Live in the mucous layer of the stomach and secrete chemicals that damage the endothelium and cause acute inflammation and ulceration. Intestinal metaplasia can occur - ulceration can lead to haemorrhages which can be fatal. Ulcers can erode through the muscular layer and cause peritonitis which can be fatal.
What is found in the blood of somebody with coeliac disease?
IgA Tissue Transglutaminase
Give some symptoms of chronic liver disease?
Ascites, Oedema, Haematemesis, Malaise, Anorexia, Wasting, Easy Bruising, Itching, Hepatomegaly, Abnormal LFTs
Which cancers are more likely in an individual with gluten sensitive enteropathy?
Intestinal T Cell Lymphoma, Small Bowel and Oesophageal Cancer
What could a transudative ascites fluid indicate?
CHF, Cirrhosis, Pulmonary Embolism, Nephrotic Syndrome, Peritoneal Dialysis, Myxedema, SVC syndrome
Which bacteria comes from reheated rice often?
Bacillus Cereus
How does peritonitis present?
Colicky central abdominal pain, billous vomiting, “heartburn” followed by sharp pain that hurts in the shoulders. Worse on coughing.
A 35-year-old woman presented to her general practitioner complaining of a stomach ache and copious amounts of watery diarrhoea.
After carrying out relevant tests, the general practitioner prescribed her omeprazole which caused all her symptoms to resolve.
What was the likely diagnosis?
Zollinger-Ellison Syndrome
Which genes are linked to coeliac disease?
HLA DQ2 and DQ8.
What is Short Gut Syndrome?
Less Water Absorption due to section of bowel missing or being removed.
If a patient has paracetamol poisoning, what is the antidote?
N Acetyl Cysteine (NAC)
What colour will the urine and stools be in hepatic jaundice?
Urine dark, stools normal?
How does travellers diarrhoea present?
3 or more unformed stools per day and at least one of:
- abdominal pain/cramps
- nausea/vomiting/dyssentry
Occurs within 2 weeks of arrival in a new country - most often within 3 days
Most often caused by bacteria
Give some symptoms of acute liver disease?
Malaise, Nausea, Anorexia, Jaundice
Rare: Confusion, Bleeding, Liver pain, hypoglycaemia
What are the biggest risk factors for Hepatocellular Carcinoma?
Hepatitis B and C
Haemochromatosis
Males
Risk from Cirrhosis, Alcohol and Autoimmune disease but not as much
How is E. Coli treated?
Fluids and Electrolytes - try to avoid antibiotics but if necessary use rifaximin
What can you use to treat gastritis and ulceration?
H2 Receptor Antagonst - Ranitadine
Proton Pump Inhibitor - Lanzoprazole
What is measured for in Liver Function tests (7)?
Bilirubin, Alkaline Phosphatase (ALP), Aspartate Transaminase (AST), Alanine Transaminase (ALT), Gamma-glutamyl transpeptidase (GGT), Albumin, Prothrombin time (PT)
Describe the levels of serum bilirubin in pre hepatic, hepatic and post-hepatic jaundice? What causes this physiologically?
Pre Hepatic: Elevated UNCONJUGATED bilirubin - due to excessive amount presented to the liver due to hemolysis
Hepatic: Both conjugated and unconjugated bilirubin can be raised due to damaged liver
Post Hepatic: Elevated conjugated bilirubin in serum due to impaired excretion and mechanical obstruction to bile flow
What colour will the urine and stools be in pre hepatic jaundice?
Urine normal, stools normal
What are the maximum diameters for the small bowel, large bowel and caecum
3, 6, 9 Rule
3cm for Small Bowel
6 cm for Large Bowel
9cm for Caecum
An elderly gentleman was found to have an incidental asymptomatic midline abdominal mass.
Which characteristic on examination would most support a diagnosis of an abdominal aortic aneurysm (AAA)?
An AAA is characteristically expansile, and pulsatility alone is not sufficient to make a diagnosis, as it is common for pulsations to be transmitted by viscera overlying the aorta.
A 22-year-old university student was found lying on the floor outside a nightclub on Saturday night.
His friend had indicated that he had drunk 10 pints of beer that night and then started retching. About one hour later he noticed that he was vomiting up blood.
What is the diagnosis?
Mallory-Weiss Tear
What can cause malabsorption?
Insufficient dietary intake Defective intraluminal digestion insufficient absorptive area Lack of digestive enzymes Defective epithelial transport Lymphatic obstruction
Which indications would suggest that a drug reaction was severe?
Late presentation
Acidosis (PH <7.3)
Prothrombin time more than 70 seconds
Serum Creatinine more than or equal to 300 micromol/l
Which bacteria is often ingested through ground beef, apples, milk?
E. Coli
What is the best treatment for Non Alcoholic Fatty Liver Disease?
Weight Loss - the more the better
What could a exudative ascites fluid indicate?
Infections, Cancer, Connective Tissue Disease, Pancreatitis, Chylothorax, Drug Reaction
What is Hirschprung’s Disease? What complication of this can cause ascites?
Developmental Disorder: Segment of bowel without ganglion cells, so it doesn’t move - causes Ganglion cells to get stuck. Achalasia - failure of smooth muscle fibres to relax, can cause the rectal sphincter to remain closed and fail to open when needed.
How is hepatocellular carcinoma treated?
Chemotherapy does not work - limited treatment, transplantation, resection or local ablative techniques. Sorafenib has been shown to prolong life.
How are exudate and transudate differentiated?
Transudate has a high serum to ascites albumin gradient it is transudate (<0.5 ratio). If low serum to ascites albumin gradient it is exudate (>0.5 ratio).
Which hormones can increase bowel movement?
Thyroxine: Thryotoxicosis
Adrenaline: Neurotransmitter
Serotonin: Increases bowel motility
A patient presents with slate grey skin and signs of chronic liver disease. What is the diagnosis and how do you treat it?
Hereditary Haemochromatosis - inherited disorder of iron metabolism - iron is deposited in joints, liver, heart, pancreas, pituitary, adrenals and skin. Periodic phlebotomies by venesection is required to reduce iron levels.
What are some of the common causes of peritonitis?
Appendicitis, Perforated ulcers, diverticulitis, nonvascular small bowel perforation, gangrenous cholecystitis, ischaemic small bowel injuries, acute necrotizing pacreatitis, postoperative complications
Which markers will be raised in primary biliary cholangitis?
Anti-mitochondrial antibodies
Give 4 causes of hepatitis?
Viral
Drug Induced - allergic reaction
Immune Conditions
Alcohol
How is ascites managed?
Fluid and Salt Restriction
Diuretics: Spironolactone and or Furosemide
If there is a large volume paracentesis is required (draining)
Transjugular intrahepatic portosystemic shunt may be required
What are adhesions?
Two parts of the bowel adhering together with a fibrous band (nearly always due to previous surgery)
How is Crohns Disease treated pharmacologically?
Oral 5-ASA (e.g. Mesalazine) Steroids (Oral Prednisolone) Liquid Enteral Nutrition Thiopurine Drugs (Azathioprine/mercaptopurine) Metronidazole Methotrexate Anti TNF Antibodies
How are Crohn’s Disease and Ulcerative Colitis differentiated?
Crohns Disease: Inflammation anywhere in the digestive system mouth to anus - UC only rectum to sigmoid colon
Crohns Patchy inflammation, UC is continuous
Crohns goes through full thickness of bowel wall, UC is only to mucosa level
UC can have complications all over the body: blood loss, liver damage, skin probllems, arthritis, uveitis
Crohns - can form strictures, loose granulomas, fistula formation
How Do Small Bowel Obstructions present?
Vomiting (Projectile, Faeculent)
Pain (Colicky to constant)
Constipation
Distension
Describe the Dukes staging of Bowel cancer?
A - No deeper than submucosa
B1 - Not through bowel wall
B2 - Through Bowel Wall
C1 - Not through bowel wall, lymph node metastases
C2 - Through bowel wall, lymph node metastases
D - Distant Metastases
Which genetic deficiency can lead to liver disease and emphysema?
Alpha 1 Antitripsin Deficiency
Which drugs commonly cause liver injury?
Antibiotics (Augmentin, Flucloxacillin,TB drugs)
CNS Drugs (Chlorpromazine, carbamazepine, valproate)
Immunosuppressants (Diclofenac)
Paracetamol
What happens to the intestine in gluten sensitive enteropathy?
Villous Atrophy and Crypt Hyperplasia
What is Barretts Oesophagus?
Barrett’s oesophagus refers to an abnormal change (metaplasia) in the cells of the lower portion of the oesophagus. It is characterised by the replacement of the normal stratified squamous epithelium lining of the oesophagus by simple columnar epithelium with goblet cells (which are usually found lower in the gastrointestinal tract).
A patient presents with severe upper abdominal pain, nausea and vomiting. Serum amylase is above the lab cut-off concentration - what is the diagnosis?
Acute Pancreatitis
How does alcohol induced liver injury present?
Spider Naevi Ascites - due to chronic liver disease, portal vein thrombosis, hepatoma, TB Neoplasia Pancreatitis Portal Hypertension
What colour will the urine and stools be in post hepatic jaundice? Will there be any other symptoms?
Urine Dark, Pale stools, Itchy skin
Which markers will be raised in autoimmune hepatitis?
Anti-nuclear antibodies (ANA)
Anti-smooth muscle antibodies
Anti-soluble liver antigen
Anti-liver kidney microsomal antibodies
What is a volvulus?
Sigmoid colon is less fixed and can twist on its mesentery, obstructing itself
A 74-year-old man has a five day history of constipation, vomiting, and colicky abdominal pain. He has been passing no faeces or flatus at all and refuses to eat.
On examination, he is apyrexial, heart rate is 82 bpm, blood pressure is 118/76 mmHg, and respiratory rate is 16. He has a non-tender, distended abdomen, with high-pitched, tinkling bowel sounds.
What is the most likely diagnosis?
Intestinal Obstruction
What are the three most common autoimmune diseases of the liver and biliary tract?
Autoimmune Hepatitis
Primary Biliary Cholangitis
Primary Sclerosing Cholangitis
What is Budd-Chiari Syndrome?
The condition is caused by occlusion of the hepatic veins that drain the liver. It presents with the classical triad of abdominal pain, ascites, and liver enlargement. The formation of a blood clot within the hepatic veins can lead to Budd–Chiari syndrome.
Reductions in hepatic venous outflow:
- From Right Atrium
- To Small Hepatic Venules
- Including Inferior Vena Cava
Results from thrombosis of one or more hepatic veins:
- Increases sinusoidal pressure / congestion
- Portal hypertension
- Reduced portal vein flow
- Hepatomegaly, ascites
Name a pharmacological treatment for alcohol withrawal.
Lorazepam
How is gluten sensitive enteropathy diagnosed?
Distal duodenal biopsy (obtained endoscopically) - histological changes show increase in intraepithelial lymphocytes, crypt hyperplasia and chronic inflammatory cells in lamina propria as well as villous atrophy.
What is the antidote for a heroin overdose?
Naloxone IV
What general treatment can be used to treat adverse drug reactions?
Activated Charcoal orally 50g
ABC
Administer High flow oxygen
Whole Bowel Irrigation may be required
After treating an adverse drug reaction, how is the potential liver damage measured?
INR and Prothrombin time
What may be found in the blood plasma of somebody that has overdosed on aspirin?
High plasma salicylate concentration
