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stuff to remember > Gi revision session > Flashcards

Gi revision session Flashcards

1
Q

what is PEG feeding used for

A

long term

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2
Q

what is NG feeding for

A

short term

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3
Q

what is pabernex

A

a vitamin D complex given to those with a thiamine deficiency, but not caused by alcohol

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4
Q

what can be given to people in withdrawel of alcohol

A

benzodiazapam

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5
Q

buzz word for sigmoid volvulus

A

coffee bean sign on xray

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6
Q

what can small bowel obstruction be caused by

A

previous surgery, scar tissue

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7
Q

buzz word for pernicious anaemia

A

swollen, smooth red apple looking tongue

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8
Q

what is a polyp

A

A polyp is a protrusion above an epithelial surface. It is a tumour (a swelling)

pedunculated and sessile can be easily resected

adenoma is the most common type, you should remove it and send to lab

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9
Q

what is adenoma of the colon

A

Benign tumours, Not invasive, do not metastasise. But they may evolve into cancers (dysplastic). should ALL be removed

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10
Q

examples of inherited carcinomas

A

HNPCC (right sided tumours) FAP (throughout colon)

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11
Q

what is gastrin

A

Stimulates H+ (acid) secretion by parietal cells in the stomach

Trophic (growth) effects on the mucosa of the small intestine, colon, and stomach

Inhibits the actions of Secretin and GIP

Inhibited by H+

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12
Q

what is CCK

A

Contraction of the gallbladder with simultaneous relaxation of the sphincter of Oddi

Inhibits gastric emptying

Stimulates secretion of pancreatic enzymes: lipases, amylase, and proteases

Secretion of bicarbonate from the pancreas

Trophic effects on the exocrine pancreas and gallbladder

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13
Q

what is secretin

A

Inhibits gastrin, H+ secretion, and growth of stomach mucosa

Stimulates biliary secretion of bicarbonate and fluid

Secretion of bicarbonate from the pancreas

Trophic effect on the exocrine pancreas

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14
Q

what is GIP

A

Stimulation of insulin secretion

Induces satiety

In large doses, decreases gastric acid secretion

In large doses, decreases the motor activity of the stomach and therefore slows gastric emptying when the upper small intestine is already full of food products.

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15
Q

what is GLP-1

A

Decreases gastric emptying
Induces satiety
Increases sensitivity of pancreatic beta-cells to glucose.

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16
Q

what is motilin

A

Increases gastrointestinal motility by stimulating the “migrating motility” or “myoelectric complex” that moves through the fasting stomach and small intestines every 90 minutes. This cyclical release and action get inhibited by the ingestion of food.

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17
Q

types of viral hepatitis

A

A, B, C, E

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18
Q

Hep A

A

ACUTE.

Faecal-oral. associated w poor sanitation. rare in UK. most common in children/young adults.

High ALT/AST
resolves spontaneously

19
Q

Hep B

A

ACUTE and CHRONIC. incubation 1-6 months. DNA virus

blood borne and sexually transmitted. can be passed on vertically. PWIDs, children of infected, gay men are at highest risk

95% will clear spontaneously. only small amount need treatment

20
Q

Hep C

A

CHRONIC. blood borne. RNA virus

PWIDs, bad tattoos or surgeries can cause it. most patients are asymptomatic until they get liver disease. 20% develop cirrhosis within 20 years

treatment, 8-12 weeks combo treatment

21
Q

Hep E

A

ACUTE. faecal-oral. incubation 15-60 days

self limiting disease. can rarely cause chronic in immunocompromised. only 5% symptomatic

22
Q

Diagnosis of viral Hepatitis

A

HBsAg (surface antigen)
Screen for evidence of infection

HBeAg (e antigen)
Indicates high viral replication / infectivity

Anti-HBs (surface antibody)
In infection usually seen with loss of HBsAg (indicating clearance of infection)
In vaccinated patients shows immunity

Anti-HBe (e antibody)
Indicates clearance of eAg / reduced viral replication

Anti-HBc (core antibody)
Only seen in previously infected patients (not in vaccinated patients)

HBV DNA PCR
Used to assess level of viraemia

23
Q

what does HBsAg (surface antigen) show

A

shows evidence of active infection

24
Q

what does HBeAg (e antigen) show

A

shows the level of viral replication

25
Q

what does Anti-HBs (surface antibody) show

A

In infection usually seen with loss of HBsAg (indicating clearance of infection)

In vaccinated patients shows immunity

26
Q

what does Anti-HBe (e antibody) show

A

Indicates clearance of eAg / reduced viral replication

27
Q

what does Anti-Hbc (core antibody) show

A

Only seen in previously infected patients (not in vaccinated patients)

28
Q

presence of IgM vs IgG in Hep infection

A

is IgG is present then they have chronic infection. if IgM then acute infection

29
Q

liver enzymes

A

Alanine aminotransferase (ALT)
Aspartate aminotransferase (AST)
Alkaline phosphatase (ALP)
Gamma glutamyl transferase (GGT)

30
Q

liver function tests

A

Bilirubin
Albumin
Prothrombin time (PT)

31
Q

causes of elevated ALT

A

ALT 50-200
Likely causes: NAFLD, chronic viral hepatitis
Other possibilities: autoimmune hepatitis, hereditary haemochromatosis, Wilson’s disease, ⍺1 anti-trypsin deficiency

ALT in the 1000’s
Likely causes: viral hepatitis, shocked liver, paracetamol overdose, autoimmune hepatitis, Budd-Chiari

ALT > 3000
Likely drug/ischaemia (paracetamol)

32
Q

important points about ALT and AST

A

ALT can be elevated in HCV and fatty liver when AST normal

AST:ALT in alcoholic liver disease 2:1

ALT rarely > 3x ULN in alcoholic hepatitis

ALT also increased in acute biliary obstruction and precedes ↑ALP

33
Q

what is unconjugated bilirubin

A

a breakdown product of Rd blood cells. Rbcs spleen; bound to albumin for delivery to liver

34
Q

conjugated bilirubin

A

Bilirubin conjugated in liver with glucuronic acid. Conjugated bilirubin is not absorbed but bile is deconjugated in small bowel and colon.

35
Q

causes of increased conjugated bilirubin

A

biliary pathology, hepatitis, cirrhosis, drug toxin, TPN

36
Q

causes of increased unconjugated bilirubin

A

haemolysis, gilberts syndrome (the stress one)

37
Q

what is albumin

A

its synthesised in the liver. it transports insoluble bilirubin, hormones and fatty acids.

decreases in late stage liver disease. can also decrease with malnutrition, malabsorption

38
Q

prothrombin time (PT)

A

increased PT is related to a decrease in clotting factors. which can be found in chronic liver disease, acute liver injury or hepatocellular necrosis (toxins or viral hep)

39
Q

when is ALP increased

A

primary biliary cholangitis, pregnancy. bone disease.

40
Q

what is GGT

A

excreted in bile. it increases in alcoholic liver disease but levels drop 2-5 weeks after not drinking. anticonvulsants can also increase GGT

41
Q

should ALT or AST normally be higher

A

ALT is physiologically higher. in alcoholic liver disease the AST:ALT ratio can jump to 2:1

42
Q

what liver enzymes increase with obstruction

A

ALP and gamma-GT

43
Q

platelets and cirrhosis

A

platelet count usually drops with cirrhosis

stuff to remember (10 decks)

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