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GASTRO - RIA > Pancreas & alcohol > Flashcards

Pancreas & alcohol Flashcards

1
Q

3 most common causes of acute pancreatitis

A
  • alcohol
  • gall stones
  • post ERCP
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2
Q

typical symptoms presentation of acute pancreatitis

A

Sudden onset mid epigastric/LUQ abdo pain, radiating to back

N&V

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3
Q

pathophysiology of acute pancreatitis

A

Inflammation of the pancreas, pancreatic enzymes (amylase&lipase) attack the pancreatic tissue causing epigastric pain radiating to the back

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4
Q

score used to assess severity of acute pancreatitis

A

Glasgow score

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5
Q

PANCREAS pneumonic for Glasgow score

A 
P - PaO2 
A - Age > 55 years
N - Neutrophils (WCC >15) 
C - Calcium < 2 
R - Urea > 16 
E - Enzymes (LDH > 600 or AST/ALT > 200) 
A - Albumin <32
S - Glucose >10
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6
Q

complications of acute pancreatitis (4)

A
  • Pancreatic necrosis
  • Infection in necrosis areas
  • Pseudocytes
  • Chronic pancreatitis
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7
Q

Management of acute pancreatitis

A

1) fluid resuscitation
2) pain relief & antiemetic
- careful monitoring
Consider ERCP
- endoscopic drainage of large pseudocysts
- ABx IF evidence of infected pancreatic necrosis
- surgery to remove infected pancreatic necrosis

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8
Q

what to suspect if Charcot’s triad is present

A

cholangitis

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9
Q

what is Charcots triad

A
  • jaundice
  • fever & rigors
  • RUQ pain
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10
Q

2 important diagnoses to rule out in ACUTE ABDOMEN

A
  • Perforation

- Bowel obstruction

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11
Q

2 scores to use to assess risk of bleeding BEFORE & AFTER endoscopy

A

Before: Glasgow blatchford
After: Rockall

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12
Q

Resuscitation for acute upper GI bleed

A
  • ABC, wide bore IV access
  • platelet transfusion
  • fresh frozen plasma
  • prothrombin complex concentrate (if pt actively bleeding or taking warfarin)
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13
Q

what procedure should all patients with severe upper GI bleed have within 24 hours

A

Endoscopy

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14
Q

Management of NON variceal bleed

A

Give PPI if endoscopy shows non variceal bleeding or stigmata of recent haemorrhage

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15
Q

management of variceal bleeding (3)

A

Terlipressin & prophylactic abx before endoscopy

Band ligation for oesophageal varices & injections of N-butyl-2-cyanoacrylate

TIPS

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16
Q

what is TIPS and when should it be offered

A

Transjugular intrahepatic portocystemic shunt

offered after giving terlipressin & band ligation of varices

17
Q

mechanism of terlipressin

A

synthetic vasopressin analogue. causes vasoconstriction of vessels in splanchnic circulation –> reducing portal pressure

18
Q

adverse effects of terlipressin

A
  • low cardiac output
  • AF
  • MI
  • HF
  • GI upset
  • low sodium
19
Q

3 steps of progression of alcohol affecting liver

A

1) Alcohol related fatty liver
2) Alcoholic hepatitis
3) Cirrhosis

20
Q

what is recommended alcohol consumption

A

no more than 14 units in a week, should be spread evenly over 3 days or more
& no more than 5 units a day

21
Q

screening tool for harmful alcohol use:

A

CAGE questionairre

22
Q

what is CAGE questionairre

A

C - Ever thought you should cut down your alcohol intake

A - Do you get annoyed at others commenting on your drinking

G - Do you ever feel guilty about your drinking

E - Ever drink in the morning to help your hangover/nerves

23
Q

signs of liver disease

A
  • jaundice
  • hepatomegaly
  • spider naevi
  • ascites
  • capat medusae
  • asterixis
  • palmar erythema
  • gynaecomastia
  • bruising
24
Q

markers for reduced synthetic function of the liver

A

low albumin

elevated prothrombin time

25
Q

when do alcohol withdrawal symptoms begin to occur and what are these

A

6-12 hours

tremor, sweating, headache, craving, anxiety

26
Q

at what time frame of alcohol withdrawal do hallucinations and seizures occur

A

12-24 hours: hallucinations

24-48 hours: seizures

27
Q

what time frame does ‘delirium tremens’ tend to occur at

A

24-72 hours after abstaining from alcohol consumption

28
Q

mechanism of action of alcohol withdrawal causing delerium tremens

A

Alcohol Stimulates GABA receptors & inhibits glutamate receptors. therefore in chronic alcoholics the GABA system is upregulated & Glutamate receptors are downregulated

in alcohol withdrawal, GABA under functions & glutamate overfunctions –> causing extreme excitability of the brain with excess adrenergic activity

29
Q

presentation of delerium tremens

A
  • acute confusion
  • severe agitation
  • delusions/hallucinations
  • tremor
  • tachycardia
  • HTN
  • ataxia
  • arrhythmia
30
Q

management of alcohol withdrawal

A

chlordiazepoxide (Librium)

31
Q

3 features of wernicke’s encephalopathy

A
  • confusion
  • ataxia
  • occulomotor disturbances
32
Q

what can wernicke’s encephalopathy progress into

A 
Korsakoff syndrome 
(memory impairment &amp; behavioural changes)
33
Q

management of wernickes encephalopathy

A

Thiamine (Vit B1)

GASTRO - RIA (10 decks)

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