GI Presentation And Condtions Flashcards
What is the most common cause of acute pancreatitis?
Gallstones
What is the classic triad of symptoms in acute pancreatitis?
Severe abdominal pain, elevated serum amylase/lipase, nausea/vomiting
What is the treatment for acute pancreatitis?
NPO, IV fluids, pain management, possible ERCP
What is the most common cause of chronic pancreatitis?
Alcohol abuse
What is the classic triad of symptoms in chronic pancreatitis?
Chronic abdominal pain, malabsorption, diabetes
What imaging modality is used to diagnose gallstones?
Abdominal ultrasound
What is the treatment for gallstones?
Cholecystectomy
What is the most common cause of upper GI bleeding?
Peptic ulcer disease
What is the most common cause of lower GI bleeding?
Diverticulosis
What is the treatment for peptic ulcer disease?
PPIs, H2 blockers, antibiotics for H. pylori
What is the most common cause of esophagitis?
GERD
What is the treatment for GERD?
PPIs, lifestyle modifications
What is the most common cause of lower GI obstruction?
Colorectal cancer
What is the treatment for colorectal cancer?
Surgery, chemotherapy, radiation
What is the most common cause of acute mesenteric ischemia?
Embolism
What is the treatment for acute mesenteric ischemia?
Surgical revascularization
What is the most common cause of chronic mesenteric ischemia?
Atherosclerosis
What is the treatment for chronic mesenteric ischemia?
Angioplasty, stenting, surgical revascularization
What is the most common cause of bowel obstruction in children?
Intussusception
What is the treatment for intussusception?
Air contrast enema, surgery if necessary
What is hepatic encephalopathy?
A condition that may occur in liver disease, associated with excess absorption of ammonia and glutamine from protein breakdown in the gut
The exact aetiology is not fully understood.
In which liver conditions can hepatic encephalopathy be observed?
Acute liver failure and chronic liver disease
It is recognized that liver cirrhosis can lead to subtle symptoms before overt signs appear.
What is ‘minimal’ or ‘covert’ hepatic encephalopathy?
Subtle symptoms such as mild cognitive impairment in patients with liver cirrhosis
These symptoms become more recognizable as the condition progresses.
What is a potential precipitating factor for hepatic encephalopathy related to medical procedures?
Transjugular intrahepatic portosystemic shunting (TIPSS)
TIPSS may precipitate or worsen encephalopathy.
List some clinical features of hepatic encephalopathy.
- Confusion
- Altered GCS
- Asterixis
- Constructional apraxia
- Triphasic slow waves on EEG
- Raised ammonia level
Asterixis is also known as ‘liver flap’ and is characterized by arrhythmic negative myoclonus.
What is the grading system for hepatic encephalopathy?
- Grade I: Irritability
- Grade II: Confusion, inappropriate behaviour
- Grade III: Incoherent, restless
- Grade IV: Coma
Each grade reflects the increasing severity of symptoms.
What are some common precipitating factors for hepatic encephalopathy?
- Infection (e.g., spontaneous bacterial peritonitis)
- GI bleed
- Post TIPSS
- Constipation
- Drugs (e.g., sedatives, diuretics)
- Hypokalaemia
- Renal failure
- Increased dietary protein
Increased dietary protein is considered uncommon as a precipitating factor.
What is the first-line treatment recommended by NICE for hepatic encephalopathy?
Lactulose
Rifaximin may be added for secondary prophylaxis.
How does lactulose help in managing hepatic encephalopathy?
It promotes the excretion of ammonia and increases its metabolism by gut bacteria
This mechanism helps reduce ammonia levels in the body.
What is the role of rifaximin in the management of hepatic encephalopathy?
It modulates gut flora, resulting in decreased ammonia production
Rifaximin is used for secondary prophylaxis.
What are other treatment options for hepatic encephalopathy beyond lactulose and rifaximin?
- Embolisation of portosystemic shunts
- Liver transplantation in selected patients
These options may be considered based on individual patient circumstances.
What is disulfiram also known as?
Antabuse
Disulfiram is used in the treatment of alcohol dependence.
What does disulfiram inhibit?
Acetaldehyde dehydrogenase
This inhibition leads to the buildup of acetaldehyde.
What are the symptoms caused by the buildup of acetaldehyde after alcohol consumption while on disulfiram?
Facial flushing, nausea, vomiting
The reaction can be life-threatening.
For how long do the effects of disulfiram last?
Seven days
Disulfiram is taken once daily.
What is acamprosate also known as?
Campral
Acamprosate is used in preventing alcohol relapse.
How many times a day is acamprosate taken?
Three times a day
It is effective when combined with psychological support.
What type of medication is acamprosate described as?
‘Anti-craving’ medication
Its underlying mechanism of action remains unclear.
What is buprenorphine classified as?
Mixed opioid agonist/antagonist
It is an alternative to methadone.
What form is buprenorphine typically given in?
Sublingual tablet
Patients often report it as less sedating.
What is chlordiazepoxide used for?
Alcohol detoxification
It is a benzodiazepine used during reducing regimes.
What is diazepam typically used as?
Anxiolytic
It is also used in alcohol detoxification.
What is dihydrocodeine primarily used for?
Analgesia
It is not typically used to treat addiction.
What condition is gabapentin used to treat?
Neuropathic pain
Gabapentin is not typically used to treat addiction.
What type of receptor agonist is methadone?
Opioid mu receptor agonist
It is the most common drug for opiate replacement therapy.
What is naltrexone used for?
Relapse prevention in opioid-dependent patients
Naltrexone is an opioid receptor antagonist.
What type of receptor antagonist is ondansetron?
5-HT3 receptor antagonist
It is used as an anti-emetic during detoxification.
