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GI > TOP OF GI TABLE / Interprtation LFT > Flashcards

TOP OF GI TABLE / Interprtation LFT Flashcards

1
Q

When do you do endoscopy

A 
ALARMS
- Anorexia
- Loss of weight unintentionally 
- Anaemia
- Recent onset / refractory dyspepsia 
- Melena / haematemesis / persistent vomit
- Swallowing difficulty (dysphagia) = urgent 
>55
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2
Q

Other reasons

A 
Mass
Nocturnal 
>55 + new onset dyspepsia 
>55 + weight loss + raised platelet +-
- Abdo pain
- Refux / Dyspepsia
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3
Q

What are indications for colonoscopy

A 
Rectal bleeding
Iron deficiency anaemia
Persistent diarrhoea / change in bowel habit >6 weeks 
Positive qFIT
IBD suspicion
COlon caner surveillance
>50 + IBS symptoms as rare
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4
Q

Who gets 2 week cancer referral + qFIT

GUIDANCE

A

> 40 + unexplained abdominal pain + weight loss
50 + unexplained rectal bleed
60 + change in bowel or iron deficiency / any anaemia
qFIT shows blood

Consider if rectal / abdominal mass

Consider if <50 with rectal bleed

  • abdo pain
  • change in bowel
  • weight loss
  • iron anaemia

Offer qFIT if no rectal bleed / do not meet criteria and <50

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5
Q

When are aminotransferases raised

A

Tissue injury
ALT more specific
AST more specific to alcohol
Will be normal in obstruction

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6
Q

When is alk phosphatase raised

A

Obstruction of liver / cholestatic picture

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7
Q

When can it be raised physiologically

A

Growing child
Pregnancy
Healing fracture

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8
Q

When can it be raised pathologically

A 
Paget's
Osteomalacia
Boen mets
Hyperparathyroid
Renal failure
Lymphoma
Infiltratin - sarcoid
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9
Q

When is GGT raised

A 
Alcohol 
If ALP also raised suggest cholestatic 
But also raised 
NSAID 
Malignancy / tumour
Rifampicin
Carbmazepine
COPD / renal / post MI
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10
Q

How do all interact

A

Tissue can affect pipes so can all be raised

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11
Q

What are tests for hepatic function

A 
Serum albumin - produced in liver
Serum bilirubin - high in cholestasis
PT / INR - as liver producing clotting 
Platelet count
Lactate 
Glucose as gluconeogensis in liver 
Ammonia
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12
Q

Why is platelets affected

A

Cirrhosis leads to splenomegaly which decreases platelet

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13
Q

What should you consider if predominate hepatocellular injury

A

Medication?
Alcohol history
USS for fatty liver / mets
Viral serology - A, B, C, D, EBV, CMV

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14
Q

What is typical of alcoholic picture

A 
Raised GGT
Macrocytosis 
Raised ALP 
AST > ALT
Low platelet
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15
Q

What do you do if tissue injury suggestive on LFT but asymptomatic and tests -ve

A 
Lifestyle - weight / alcohol / DM / lipids
Stop hepatotoxic drug
Repeat test after 1-2 months 
Do USS +- abdo CT 
Consider biopsy
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16
Q

Raised ALP but normal LFT

A

Suspect bone mets

17
Q

Albumin and relation to malnutrition

A

Albumin = test of liver function as producer there
Low albumin likely due to acute illness
If CRP is high / no illness then consider malnutrition

18
Q

Lactate and liver

A

Liver metabolises lactate into glucose so high in liver failure

19
Q

Glucose and liver

A

Glucose low and high lactate suggests acute liver failure as responsible of gluconeogenesis

20
Q

Ammonia and liver

A

Marker of hepatic encephalopathy

21
Q

GI Question

A 
Appetite
Dysphagia
Dyspepsia 
N+V - blood / bile
Abdo pain 
Bowels 
PR bleed 
Jaundice
22
Q

What systemic screen

A 
Weight loss
Energy 
Eye problem
Skin rash
Joint
23
Q

What does bilious vomit suggest

A

Obstruction in Lowe GI

24
Q

What is included in LFT

A 
ALP
ALT
TOtal protein
Albumin
Total bilirubin
25
Q

What do you. add on

A

AST / GGT - alcohol

PT - different tube

26
Q

If abnormal LFT what next

A 
History 
- Any regular meds or acute Rx e.. Ax 
- Illicit drug use / herbal
- Viral risk
- FH autoimmune
- Comorbid e.g. CCF or DM 
Examination 
Non-invasive screen
27
Q

Non invasive screen

A 
LFT inc creatinine / platelet / INR 
Virology 
- Hep B,C,E
- E only if acute 
- EBV, CMV, HIV, Yellow fever if indicated 
Biochemistry 
- TSH
- Lipids + glucose 
- Serum copper -  for Wilson disease if young 
- Ferritin and transferrin -Haemochromatosis
- A1-anti-trypsin 
Immunology
- AMA, SMA, Anti-TTG
28
Q

What else is standard imaging

A

USS

29
Q

Further

A

Fibroscan
- DM / NAFLD / hepatitis / alcohol / CLD
Biopsy

30
Q

What typically causes an isolated ALT rise

A

Ischaemic hepatitis e.g. after hypobolaemia
Paracetamol / toxins
Viral hepatitis

GI (29 decks)

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