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9. gi system > Phase II - GI > Flashcards

Phase II - GI Flashcards

1
Q

Give 4 functions of the liver.

A
  1. Glucose and fat metabolism.
  2. Detoxification and excretion.
  3. Protein synthesis e.g. albumin, clotting factors.
  4. Defence against infection.
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2
Q

Name 3 things that liver function tests measure.

A
  1. Serum bilirubin.
  2. Serum albumin.
  3. Pro-thrombin time.
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3
Q

Name an enzyme that increases in the serum in cholestatic liver disease (duct and obstructive disease).

A

Alkaline phosphatase.

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4
Q

What enzymes increase in the serum in hepatocellular liver disease?

A

Transaminases e.g. AST and ALT.

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5
Q

Name two hepatocellular enzymes.

A

Transaminases e.g. AST and ALT.

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6
Q

Name a cholestatic enzyme.

A

Alkaline phosphatase.

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7
Q

What enzyme is responsible for ‘mopping up’ reactive intermediates of paracetamol and so prevents toxicity and liver failure?

A

Glutathione transferase.

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8
Q

What are the potential consequences of hepatocyte regeneration in someone with liver cirrhosis?

A

Neoplasia and therefore HCC. Hepatocyte regeneration is liable to errors.

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9
Q

Give 3 causes of iron overload.

A
  1. Genetic disorders e.g. haemochromatosis.
  2. Multiple blood transfusions.
  3. Haemolysis.
  4. Alcoholic liver disease.
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10
Q

What protein is responsible for controlling iron absorption?

A

Hepcidin.

Levels of this protein are decreased in haemochromatosis.

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11
Q

What can cause peritonitis?

A
  1. Bacterial infection due to a perforated organ; spontaneous bacterial peritonitis; infection secondary to peritoneal dialysis.
  2. Non-infective causes e.g. bile leak; blood from ruptured ectopic pregnancy.
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12
Q

Name a cause of pelvic inflammatory disease.

A

A complication of chlamydial infection.

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13
Q

Give 4 reasons why liver patients are vulnerable to infection.

A
  1. They have impaired reticulo-endothelial function.
  2. Reduced opsonic activity.
  3. Leukocyte function is reduced.
  4. Permeable gut wall.
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14
Q

Describe the progression from normal epithelium to colorectal cancer.

A
  1. Normal epithelium.
  2. Adenoma.
  3. Colorectal adenocarcinoma.
  4. Metastatic colorectal adenocarcinoma.
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15
Q

Give 4 groups at risk of diarrhoeal infection.

A
  1. Food handlers.
  2. Health care workers.
  3. Children who attend nursery.
  4. Persons of doubtful personal hygiene.
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16
Q

What is the criteria for dyspepsia?

A

> 1 of the following:

  • Postprandial fullness.
  • Early satiation.
  • Epigastric pain/burning.
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17
Q

Give 5 causes of dyspepsia.

A
  1. Excess acid.
  2. Prolonged NSAIDS.
  3. Large volume meals.
  4. Obesity.
  5. Smoking/alcohol.
  6. Pregnancy.
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18
Q

Give 5 red flag symptoms that you might detect when taking a history from someone with dyspepsia.

A
  1. Unexplained weight loss.
  2. Anaemia.
  3. Dysphagia.
  4. Upper abdominal mass.
  5. Persistent vomiting.
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19
Q

What investigations might you do in someone with dyspepsia?

A
  1. Endoscopy.
  2. Gastroscopy.
  3. Barium swallow.
  4. Capsule endoscopy.
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20
Q

What is the management for dyspepsia if the red flag criteria has been met?

A
  1. Suspend NSAID use and review medication.
  2. Endoscopy.
  3. Refer malignancy to specialist.
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21
Q

What is the management for dyspepsia without red flag symptoms?

A
  1. Review medication.
  2. Lifestyle advice.
  3. Full dose PPI for 1 month.
  4. Test and treat h.pylori infection.
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22
Q

What kind of lifestyle advice might you give to someone with dyspepsia?

A
  1. Lose weight.
  2. Stop smoking.
  3. Cut down alcohol.
  4. Dietary modification.
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23
Q

Give a potential consequence of anterior ulcer haemorrhage.

A

Acute peritonitis.

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24
Q

Give a potential consequence of posterior ulcer haemorrhage.

A

Pancreatitis.

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25
Q

What would be raised in the blood tests taken from someone with primary biliary cirrhosis?

A
  1. Raised IgM.
  2. Raised ALP.
  3. Positive AMA.
26
Q

What 4 features would you expect to see in the blood test results taken from someone who has overdosed on paracetamol.

A
  1. Metabolic acidosis.
  2. Prolonged pro-thrombin time (due to coagulability).
  3. Raised creatinine (renal failure).
  4. Raised ALT.
27
Q

Name 4 fat soluble vitamins.

A

A, D, E and K.

28
Q

Why might someone with primary biliary cirrhosis experience itching as a symptom?

A

Because there is a build up of bilirubin.

29
Q

Are most liver cancers primary or secondary?

A

Secondary - they have metastasised to the liver from the GI tract, breast and bronchus.

30
Q

Where have most secondary liver cancers arisen from?

A
  1. The Gi tract.
  2. Breast.
  3. Bronchus.
31
Q

Describe the aetiology of HCC.

A

Most HCC is in patients with cirrhosis. This is often due to HBV/HCV and alcohol.

32
Q

Give 5 symptoms of HCC.

A
  1. Weight loss.
  2. Anorexia.
  3. Fever.
  4. Malaise.
  5. Ascites.
33
Q

What investigations might you do on someone who you suspect has HCC?

A
  1. Bloods: serum AFP may be raised.
  2. US or CT to identify lesions.
  3. MRI.
  4. Biopsy if diagnostic doubt.
34
Q

Describe the treatment for HCC.

A
  1. Surgical resection of solitary tumours.
  2. Liver transplant.
  3. Percutaneous ablation.
35
Q

How long after infection with hepatitis B virus is HBsAg present in the serum for?

A

HBsAg will be present in the serum from 6 weeks - 3 months after infection.

36
Q

How long after infection with hepatitis B virus is anti-HBV core (IgM) present in the serum for?

A

Anti-HBV core (IgM) slowly rises from 6 weeks after infection and its serum level peaks at about 4 months.

37
Q

Name 3 diseases that lead to heamolytic anaemia and so a raised unconjugated bilirubin and pre-hepatic jaundice.

A

Causes of haemolytic anaemia:

  1. Sickle cell disease.
  2. Hereditary spherocytosis/elliptocytosis.
  3. GP6D deficiency.
  4. Hypersplenism.
38
Q

How would you know if an individual had been vaccinated against hepatitis B?

A

They would have anti-HBVs IgG in their serum.

39
Q

What type of anaemia do you associate with alcoholic liver disease?

A

Macrocytic anaemia.

40
Q

Name a protozoa that can cause amoebic liver abscess?

A

Entemoeba histolytica.

41
Q

What are the symptoms of entemoeba histolytica?

A
  • RUQ pain.
  • Bloody diarrhoea.
  • Fever and malaise.

Often the patient has a history of foreign/rural travel.

42
Q

What is the treatment for entemoeba histolytica?

A

Metronidazole.

43
Q

What is the treatment for mild/moderate UC?

A

Mesalazine.

44
Q

A 4-year-old girl presents with diarrhoea and is hypotensive. What is the physiological reason that fluid moves from the interstitium to the vascular compartment in this case?

A

Reduced hydrostatic pressure.

Fluid will move from the interstitium into the plasma if there is an increase in osmotic pressure or a decrease in hydrostatic pressure. As this patient is hypotensive it is more likely to be the latter.

45
Q

What drug would you give to someone that has overdosed on paracetamol?

A

IV N-Acetyl-Cysteine.

46
Q

Where is folate absorbed?

A

In the jejunum.

47
Q

Where is vitamin B12 absorbed?

A

In the terminal ileum.

48
Q

Where is iron absorbed?

A

In the duodenum.

49
Q

Give 5 histological features of a malignant neoplasm.

A
  1. High mitotic activity.
  2. Rapid growth.
  3. Border irregularity.
  4. Necrosis.
  5. Poor resemblance to normal tissues.
50
Q

What hormone is responsible for the production of gastric acid?

A

Gastrin.

51
Q

A patient’s oedema is caused solely by their liver disease. State one possible pathophysiological mechanism for their oedema.

A

Hypoalbuminaemia.

52
Q

List two stool tests a GP might request to help differentiate between the different causes of diarrhoea.

A
  1. Stool culture.

2. Faecal calprotectin.

53
Q

What investigations might you do in someone with inflammatory bowel disease?

A
  1. Bloods - FBC, ESR, CRP.
  2. Faecal calprotectin - shows inflammation but is not specific for IBD.
  3. Flexible sigmoidoscopy.
  4. Colonoscopy.
54
Q

What 2 products does haem break down in to?

A

Haem -> Fe2+ and biliverdin.

55
Q

What enzyme converts biliverdin to unconjugated bilirubin?

A

Biliverdin reductase.

56
Q

What is the function of glucuronosyltransferase?

A

It transfers glucuronic acid to unconjugated bilirubin to form conjugated bilirubin.

57
Q

What protein does unconjugated bilirubin bind to and why?

A

Albumin.

It isn’t H2O soluble therefore it binds to albumin so it can travel in the blood to the liver.

58
Q

What does conjugated bilirubin form?

A

Urobilinogen.

59
Q

What is responsible for the conversion of conjugated bilirubin into urobilinogen?

A

Intestinal bacteria.

60
Q

What can urobilinogen form?

A
  1. It can go back to the liver via the enterohepatic system.
  2. It can go to the kidneys forming urinary urobilin.
  3. It can form stercobilin which is excreted in the faeces.
61
Q

Give 3 causes of duct obstruction.

A
  1. Gallstones.
  2. Stricture (narrowing) e.g. malignant, inflammatory.
  3. Carcinoma.
  4. Blocked stent.

9. gi system (15 decks)

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