liver Flashcards
1
Q
hepatic encephalopathy
A
- caused by increased ammonia in the ciculation
- acute liver failure or decomp of chronic
- mx - lactulose increases secretion of ammonia
2
Q
C. diff diarrhea
A
- caused by Clindamycin/ciprofloxacin / PPI
- diagnosis is made by C.diff antigen in stool
- mx - metronidazole and 2nd line is vanc
3
Q
non symptomatic gall stones
A
no mx necessary
4
Q
UC
A
- bloody diarrhea and pain in the llq
- Primary schlerosing cholangtis and ‘back pain’ - Sacroillitis
- high risk of colorectal cancer
- continous/inflammation in submucosa/crypt abscess and depletion of goblet cells
- endoscopy - pseudopolyps
- enema - loss of haustrations and lead pipe colon
5
Q
Mx barrets
A
- symptomatic but no metaplasia - endoscopic surveillance with biospy and high dose ppi
- metaplasia - endoscopic surveillance very 3-5 years
- dysplasia - mucosal resection/radiofreq ablation
6
Q
urea breath test
A
- also used to check for h.pylori eradication
- no antibiotics for 4 weeks and no PPI for 2 weeks
7
Q
wilson’s disease
A
- excess copper - AR thus problem with ceruloplasmin which is the transport protein that free copper binds to
- low ceruloplasmin/low serum copper/ increased 24 hour copper secretion
- Kayser fleisher rings
- neurological and liver signs
8
Q
2 week referral for dyspepsia - endoscopy
A
- all patients with dysphagia
- upper abdo mass
- > 55 years with reflux/pain/dyspepsia
9
Q
dyspepsia without referral mx
A
- 1 month of PPI
or
- test and treat for H.pylori via urea breath test and triple therapy for 7 days
10
Q
UC flares
A
- mild - < 4 stool
- modertale 4 -6 stool within minimal systemic upset
- > 6 stool with fever/tachy/systemic upset
11
Q
goldstandard for GORD
A
24 hour ph monitoring
12
Q
Budd chiari syndrome
A
- background of procoagulation condition
- hepatic vein thrombosis
- abdo pain /ascites / tender hepatomegaly
- Ix - Ultrasound with doppler
13
Q
Vit C def
A
- asorbic acid def
- collagen synthesis -> bleedy tendency an poor wound healing
- facilitates iron absorbtion - iron deficiency
- gingivitis and lose teeth
14
Q
Crohn’s mx
A
Remission -
- oral/topical/IV glucocorticoids
- Aminosalycylate - Mesalazine
Maintain remission
- Azathiprine
- methotrexate
15
Q
HNPCC
A
- increased risk of colorectal cancer
- increased risk of bowel cancer
- increased risk of endometrial cancer
16
Q
UC mx - inducing remission
A
- topical aminosalicyclate (mesalazine) if beyond rectum or not improved start oral mesalazine
- oral corticosteroid
17
Q
UC mx - maintaining remission
A
- rectal aminosalicylateand/or oral aminosalicyclate
2. > 2 exacerbations a year = oal azathioprine
18
Q
PPI SE
A
- hyponatremia
- hypomagnesemia - muscle pain
- osteoporosis
- increased risk of C diff
19
Q
Ascites
A
- SAAG (serum/ascites albumin ratio) > 11 = due to portal hypertesion
- aldosterone antagonist - sprinolactone
- drainage
- prophylactic abx to reduce the risk of spontaneous bacterial perionitis
20
Q
Hep D
A
- co infection - hep B and hep D infection at the same time
2. superinfection - Hep B surface antigen positive patient subsequently develops hep D
21
Q
Coeliac’s
A
- check for TTG IGA antibodies and duodenal biopsy for diagnosis
- biopsy shows - villous atrophy/crypt hyperplasoa and increase in intraepithelial lymphocytes
- iron/folate and B12 def
22
Q
Peutz jeher’s syndrome
A
- autosomal dominal condition
- numerous harmartomous polyps in GI tract - no malignant potential
- pigmented freckles on lips, face, palms and soles
- intussception
23
Q
NALFD disease
A
- ultrasound - fatty changes on liver
- enhanced liver fibrosis blood test - check for advances levels of fibrosis
- mx - weight loss
