liver/GI Flashcards
what is hepatitis?
inflammation of liver
what are the roles of the liver?
glucose & fat metabolism
detoxification & excretion (bilirubin, ammonia etc)
protein synthesis
infection defence
which are the 2 blood supplies to the liver?
hepatic artery and portal vein
what can cause chronic liver damage?
viruses (hep B, C)
alcohol
autoimmune
metabolic (iron copper excess)
what does a raised eosinophil count in a patient with diarrhoea, often point towards?
parasite
what commonly causes travellers diarrhoea?
enterotoxigenic E.coli
which antibiotics increase the risk of c.diff diarrhoea?
clindamycin, cephalosporins, coamoxiclav
what causes cholangitis?
stasis of bile usually due to lodged gallstones (also cancer and parasite)
what makes up charcots triad?
RUQ pain, fever, jaundice
what are the symptoms of cholangitis?
Charcots triad- RUQ pain, fever, jaundice
what is ascites?
abnormal accumulation of fluid in peritoneal cavity (10-15ml+)
what is exudate?
high protein fluid leaked from blood vessels
what is transudate?
low protein fluid leaked from blood vessels
what is coeliac disease?
inflammation of upper small bowel caused by gluten (specifically gliadin)
what are common symptoms of coeliac?
abdominal pain steatorrhea bloating weight loss diarrhoea anaemia
what investigations can be carried out in coeliac disease?
FBC- anaemia and infection electrolytes- malabs LFT *autoantibodies- tTG, endomysin, gliadin endoscopy and biopsy
what would you expect to find on an endoscopy/biopsy of a patient with coeliac who is eating gluten?
villus atrophy
crypt hyperplasia
high white cell
which part of the gut is affected by ulcerative colitis?
continuous spread from rectum
which part of the gut is affected by Crohns?
all but most commonly terminal ileum and proximal colon
what is the macroscopic appearance of crohns?
patchy skip lesions
thickened and narrowed
cobblestoned appearance
what is the macroscopic appearance of ulcerative colitis?
continuous inflammation of mucosa
ulcerations
pseudopolyps
what is the microscopic appearance of ulcerative colitis?
superficial layer inflammation- mucosa only
depleted goblet cells
crypt abscesses
what is the microscopic appearance of crohns?
transmural inflammation
granulomas
lymphoid hyperplasia
where is the common site of pain in both uc and crohns?
uc- left lower quadrant
crohns- right ileac fossa
what blood test may distinguish crohns and uc?
pANCA
what is the treatment for mild ulcerative colitis?
5ASA’s e.g.oral/rectal sulphalazine or mesalazine
what treatment can be used with or instead of 5ASA’s in ulcerative colitis?
corticosteroids e.g. prednisolone
why is it important that corticosteroids aren’t used long-term?
side effects e.g. osteoporosis and cataracts
what are some short term effects of steroid use?
insomnia
acne
mood changes
weight gain
in more severe ulcerative colitis what types of drugs can be given?
immunosupressants and biologic medication
what are two examples of drugs given in a severe flare up of ulcerative colitis?
infliximab (biologic)
ciclosporin (immune sup)
what is the intervention used to treat severe ulcerative colitis which is unresponsive to medication?
colectomy (prevents disease reoccurring)
what is the lifestyle advice given to someone with crohns disease?
stop smoking!
what is the drug given to patients with mild/moderate crohns?
steroids e.g. prednisolone
which 3 types of drug can be used to treat crohns?
steroids
immunosupressants
biologic medication
what is an example of an immune suppressant used on crohns treatment?
methotrexate
what is an example of a biologic medicine used in the treatment of crohns?
infliximab
what intervention can be used to treat unresponsive crohns?
resection of the bowel (not permanent cure)
what are 5ASA’s?
aminosalicylates which reduce inflammation e.g. mesalazine sulphalazine
what is GORD?
gastro oesophageal reflux disease
what are the symptoms of GORD?
heartburn
belching
regurgitation
cough/horse voice
what is the lifestyle advice given to someone with GORD?
weight loss
smoking cessation
small meals
avoid: spicy, citrus, fizzy
what drugs can be given to someone with GORD?
PPI e.g. lansoprazole
alginic acid e.g. Gaviscon
antacid e.g. calcium carbonate
H2 antagonist e.g. cimetidine
what are the potential complications of long term GORD?
Barrats oesophagus
stricture
what is barrets oesophagus?
long term acid damage to the oesophagus causing metaplasia of epithelium from squamous to collumnar
why is barrats oesophagus serious?
it is a precursor of oesophageal adenocarcinoma
what is an oesophageal stricture?
long term inflammation resulting in narrowing due to chronic fibrosis
what is a peptic ulcer?
break in the epithelium that penetrates the muscularis mucosa of the stomach or duodenum
what are the causes of peptic ulcer?
H pylori
NSAIDS
what do G cells of the stomach produce?
gastrin
what do D cells of the stomach produce?
somatostatin
what do enterochromaffin like cells of the stomach produce?
histamine
which substances promote HCl production in the stomach?
histamine, gastrin, Acetyl choline
which substance inhibits HCl production in the stomach?
somatostatin
a peptic ulcer in the lesser curvature of the stomach poses a threat to which blood vessel?
left gastric artery
a duodenal ulcer in the posterior duodenum poses a threat to which blood vessel?
gastroduodenal artery
what are the potential complications of PUD?
perforation
peritonitis
haemorrhage
obstruction
how can a Hpylori induced stomach ulcer be diagnosed?
breath test (urea) stool sample
what pharmacological interventions can be used for PUD?
stop NSAIDS
PPI e.g. lansoprazole
antibiotics for H pylori e.g. amoxicillin or tetracycline
H2 antagonists e.g. cimetidine
