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Gastroenterology > Secondary care notes > Flashcards

Secondary care notes Flashcards

1
Q

What is a colloid fluid?

A

contains large molecules that cannot cross endothelium

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2
Q

What is a crystalloid fluid?

A

contains electrolytes that can cross endothelium

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3
Q

Name some crystalloid fluids

A

Hartmann’s
saline
dextrose

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4
Q

What fluid can’t you add stuff to?

A

Hartmann’s

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5
Q

What is prescribing 5% glucose essentially doing?

A

prescribing water

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6
Q

Indications for prescribing fluids

A

resuscitation
replacement of losses
routine maintenance
redistribution

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7
Q

How do you resuscitate a shocked patient?

A

500ml bolus of Hartmann’s/saline over 15mins
can repeat 4 times (2L)

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8
Q

How are routine maintenance fluid prescriptions calculated?

A

calculate daily fluid and electrolyte requirements

fluid 25-30ml/kg/day
sodium 1-1.5 mmol/kg/day
potassium 1mmol/kg/day
glucose 50-100g/day

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9
Q

What is a high output stoma?

A

> 1L/day

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10
Q

Which CXR can you comment on heart size on?

A

PA

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11
Q

Causes of pneumoperitoneum

A

perforated peptic ulcer
perforated diverticular disease

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12
Q

What is Rigler’s sign?

A

air on both sides of bowel wall

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13
Q

Causes of small bowel obstruction

A

adhesions
hernias
gallstone ileus
faecolith
bezoars

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14
Q

Sigmoid volvulus sign on AXR

A

coffee bean sign

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15
Q

Sigmoid volvulus treatment

A

flexible sigmoidoscopy
untwist + deflate

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16
Q

Caecal volvulus treatment

A

right hemicolectomy

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17
Q

Cause of dilated small bowel, dilated large bowel, drains and surgical clips in situ on CXR

A

post op ileus

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18
Q

Large bowel obstruction causes

A

colorectal cancer
diverticular disease - strictures

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19
Q

What does double contrast fluoroscopy mean?

A

air and contrast given

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20
Q

Apple core sign on fluoroscopy

A

colorectal cancer

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21
Q

Leadpipe colon sign cause and meaning

A

no bowel markings - smooth
ulcerative colitis

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22
Q

Is there air in the large and small intestines?

A

large bowel has air in it
small bowel does not

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23
Q

Define hernia

A

abnormal protrusion of a cavity’s contents through a defect in a wall

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24
Q

Why are platelets often low in cirrhosis?

A

due to portal hypertension causing splenomegaly

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25
Q

Causes of hepatic LFTs

A

fatty liver (alcohol-related, NAFLD)
viral hepatitis
autoimmune hepatitis
drug-induced liver injury

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26
Q

Causes of cholestatic LFTs

A

PBC
PSC
biliary obstruction (stones, stricture, Ca pancreas, cholangiocarcinoma)
hepatic congestion
drug-induced liver injury

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27
Q

What does an AST:ALT ratio of 2:1 suggest?

A

alcoholic liver disease

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28
Q

What are some commercial serum fibrosis marker tests?

A

ELF test

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29
Q

What is AST/ALT >1 diagnostic of?

A

cirrhosis
(AST/ALT>0.8 more sensitive in NAFLD)

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30
Q

What is the other name for fibro scan?

A

transient elastography

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31
Q

What factors can affect transient elastography scores?

A

disease aetiology
obesity
recent heavy meal
recent alcohol binge
operator experience
probe size

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32
Q

Why do we need liver biopsy in NAFLD?

A

confirm diagnosis
confirm advanced fibrosis
diagnose NASH
exclude other cofactors

33
Q

Which bilirubin will be high in Gilbert’s?

A

unconjugated

34
Q

What would an isolated raised ALP raise suspicion of?

A

bone disease - ?low vit D

35
Q

Autoantibody present in autoimmune hepatitis

A

anti-smooth muscle

36
Q

What immunoglobulin is raised in autoimmune hepatitis?

A

IgG

37
Q

What is the best scan for imaging the pancreas?

A

CT

38
Q

Are CT scans good for gallstones?

A

no
cholesterol stones will not show

39
Q

What is the best scan to visualise CBD stones?

A

MRI/MRCP

40
Q

How does PSC look on MRCP?

A

multiple narrowings (strictures) in biliary tree with dilatation behind it

41
Q

What is ERCP used for?

A

therapeutic, not diagnostic
removal of CBD stones
decompression of biliary obstruction

42
Q

What is the most sensitive test for gallstones?

A

endoscopic ultrasound

43
Q

What is the most sensitive test for early chronic pancreatitis and small pancreatic tumours?

A

endoscopic ultrasound

44
Q

Painless obstructive jaundice and weight loss?

A

pancreatic cancer/cholangiocarcinoma

45
Q

Origin of cystic artery

A

right hepatic artery (in 80% of people)

46
Q

What artery supplies the gallbladder?

A

cystic artery

47
Q

Cholelithiasis meaning

A

stones in gallbladder

48
Q

Choledocholithiasis meaning

A

stones in CBD

49
Q

Biliary microlithiasis meaning

A

gallstones<3mm diameter

50
Q

What cells secrete CCK?

A

I cells of duodenum

51
Q

What drains a gallbladder empyema?

A

cholecystostomy

52
Q

What activates pancreatic enzymes?

A

trypsin

53
Q

What causes a high GGT but no obstructive jaundice?

A

alcohol

54
Q

Radiographic sign of head of pancreas cancer

A

double duct sign
dilatation of the common bile duct and pancreatic duct

55
Q

What is Courvoisier’s Law?

A

if gallbladder is palpable in a jaundiced patient, it is unlikely to be due to gallstones, because stones would have given rise to chronic inflammation and subsequently fibrosis of gallbladder therefore, rendering it incapable of dilatation

56
Q

What are the normal maximum diameters of the small bowel, large bowel and caecum?

A

small bowel = 3cm
large bowel = 6cm
caecum = 9cm

57
Q

Signs of gallstone ileus

A

pneumobilia
gallstones
small bowel dilatation

58
Q

What is a cholecystoduodenal fistula?

A

tract between gallbladder and duodenum

59
Q

What is an enterotomy?

A

incision in small bowel

60
Q

What is Mirizzi syndrome?

A

common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder

61
Q

What is Bouveret syndrome?

A

a rare form of gallstone ileus secondary to an acquired fistula between the gallbladder and either the duodenum or stomach. Through the fistula, a gallstone may enter the enteric system and cause a gastric outlet obstruction

62
Q

How does gastric outlet obstruction present?

A

vomiting
hypochloric hypokaleemic
metabolic alkalosis

63
Q

Why is common bile duct hard to see on USS?

A

CBD enters duodenum posteriorly

64
Q

What do pancreas delta cells produce?

A

somatostatin

65
Q

What do pancreas alpha cells produce?

A

glucagon

66
Q

What do pancreas beta cells produce?

A

insulin

67
Q

Pancreatitis causes

A

alcohol
gallstones
idiopathic
drugs
autoimmune (IgG4)
scorpions
ERCP

68
Q

Can pancreatitis patients eat and drink?

A

yes

69
Q

What is a Hartmann’s operation?

A

a type of colectomy that removes part of the colon and sometimes rectum (proctosigmoidectomy). The remaining rectum is sealed, creating what is known as Hartmann’s pouch. The remaining colon is redirected to a colostomy. It can be reversed later

70
Q

What is a subtotal colectomy?

A

leaves small amount of rectum, all colon removed

71
Q

What surgery is done if there is a carcinoid tumour of the appendix?

A

right hemicolectomy

72
Q

What surgery is done as an emergency if there is a cancer in sigmoid colon causing an obstruction?

A

defunctioning ileostomy then plan the definitive surgery

73
Q

Describe stoma examination

A

look inside stoma bag
remove bag
look at surrounding skin
look at stoma stump
look for peristalsis
poke finger in with lube
look at finger
put a new bag on

74
Q

What does having a stoma bag that is much wider than the stump cause?

A

contact dermatitis

75
Q

When is NAC definitely given for paracetamol overdose?

A

after 8 hours

76
Q

If a paracetamol overdose was taken 4-8 hours ago, how do you decide on treatment?

A

paracetamol normogram
above line = treat with NAC

77
Q

What do you give if a paracetamol overdose was taken <1 hour ago?

A

activated charcoal

78
Q

What criteria can be used to decide if a liver transplant should be offered?

A

King’s college criteria
Child-Pugh

79
Q
A

Gastroenterology (43 decks)

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