Oxford Clinical Medicine Qn Flashcards
What is this condition: Liver failure with a history of repeated falls and strange responses
Hepatic encephalopathy
What is the underlying problem in hepatic encephalopathy?
There is a disturbance in brain functioning due to nitrogenous substances derived from the gut that are allowed to build up by a failing liver.
What is the first-line treatment of hepatic encephalopathy?
Lactulose 45mL PO
- a non-absorbable disaccharide for bowel cleansing
Which medication is used as a prevention of variceal haemorrhage? What does it do to prevent this?
Propranolol.
It reduces cardiac output and vasoconstricts.
What is the first-line treatment for ascites?
Spironolactone 100MG, along with salt restriction
Which autoantibody is the hallmark of Primary Biliary Cirrhosis?
Anti-mitochondrial antibodies
How is Primary Biliary Cirrhosis often diagnosed?
Often diagnosed after finding a raised Alkaline Phosphatase ALP level in routine LFT
What is suspected when there is hypotension, melaena and a history of long-term steroid use?
The long-term steroid use increases the risk of a gastric ulcer.
What is another condition that will come into mind when a patient presents with nausea and dizziness, and a history of long-term steroid use?
Addison’s disease (or gastric ulcer perforation if patient also presents with melaena).
What is Angiodysplasia?
Angiodysplasia is a small vascular malformation of the gut, a common cause of unexplained GI bleeding and anaemia.
What will be the presentation of someone with Diverticulitis?
Fresh red blood that is sudden
What is the Child-Pugh grading for?
The Child-Pugh grading is used to assess the risk of variceal bleeding in cirrhosis.
It can also be used to predict mortality and quantify the need for liver transplantation.
What are the factors taken into account wit the Child-Pugh grading?
Bilirubin level, Albumin Prothrombin time Presence of ascites Presence of encephalopathy
What investigation is done for patients suspected of motility disorder?
A) Barium swallow
B) Endoscopic ultrasound scan
C) Oesophagogastroduodenoscopy (OGD)
A. Barium swallow
The contrast material is seen to pass slowly through a distally tapering oesophagus into the stomach.
When are both the endoscopic ultrasound scan and OGD used together? How do they work together?
An OGD can be used to rule out a tumour at the gastro-oesophageal junction and an endoscopic ultrasound scan for further visualisation if a tumour is detected.
