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GASTROINTESTINAL > Week 7 > Flashcards

Week 7 Flashcards

1
Q

What percentage of liver disease in Scotland is alcohol related?

A

80%

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2
Q

What are the recommendations for weekly alcohol intake?

A

Men and women shouldn’t have more than 14 units of alcohol per week and this should be spread over 3 or more days and drinkers should limit the amount they have on single occasions.

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3
Q

What are some of the clinical signs of alcoholic liver disease?

A 
Portal hypertension 
Jaundice 
Ascites 
Encephalopathy 
Cirrhosis 
Hepatomegaly 
Fever 
Malaise 
Sepsis 
Deranged LFTs
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4
Q

What is ‘Childs - Turcotte - Pugh’?

A

A scoring system/ model for end stage liver disease which indicates COMPENSATION or DECOMPENSATION

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5
Q

What is ‘Maddney’s Discriminant Function?’

A

A model which predicts PROGNOSIS in alcoholic hepatitis

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6
Q

What is the ‘Glasgow Alcoholic Hepatitis Score’?

A

A model which predicts MORTALITY in alcoholic hepatitis patients

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7
Q

Which drug can be beneficial in for short-term prevention of mortality in alcoholic hepatitis but is not useful for medium/ long-term outcomes?

A

Prednisolone

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8
Q

What is the most common liver tumour in the absence of liver disease?

A

Haemangioma

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9
Q

List benign liver tumours

A

Haemangioma
Hepatic adenoma
Focal nodular hyperplasia
Liver cysts

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10
Q

List malignant liver tumours

A

Hepatocellular carcinoma
Cholangiocarcinoma
Hepatoblastoma
Fibro-lamellar carcinoma

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11
Q

Focal nodular hyperplasia tumours are benign tumours of the liver. What are they composed of?

A

They are nodules of normal liver tissue and contain all the liver ultrastructure (sinusoids e.t.c)

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12
Q

Hepatic adenomas are benign liver tumours. What are they composed of?

A

They are nodules purely composed of hepatocyte - they do not contain all the liver ultrastructure

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13
Q

Which has a higher risk of malignant degeneration and bleeding ; Focal nodular hyperplasia tumours or hepatic adenomas?

A

Hepatic adenomas

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14
Q

What are some of the benign liver cysts?

A

Simple cysts
Hydatid cysts
Liver abscesses

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15
Q

How is polycystic liver disease managed?

A

Somatostatin analogues (for symptom relief)
Defenestration/ aspiration
Liver transplantation

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16
Q

How are liver abscesses managed?

A

Antibiotics
Aspiration/ drainage
Resection

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17
Q

What is the most common primary liver cancer?

A

Hepatocellular carcinoma (HCC)

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18
Q

What are the risk factors for hepatocellular carcinoma?

A

CIRRHOSIS

  • Hep B
  • Hep C
  • Alcohol
  • Aflatoxins
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19
Q

What are the clinical features of HCC?

A

Weight loss
RUQ pain
RUQ mass
Liver bruit

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20
Q

What sites can primary liver tumours metastasise to?

A 
The rest of the liver 
Portal vein 
Lymph nodes 
Lung 
Bone 
Brain
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21
Q

What tests are used for the diagnosis of HCC?

A 
Elevated AFP 
Ultrasound 
CT 
MRI 
Biopsy
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22
Q

How is HCC managed/ treated?

A 
Liver transplantation 
Resection (small tumours with preserved liver function) 
Local ablation 
Chemoembolisation 
Systemic therapies
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23
Q

Fibro- Lamellar carcinoma is a malignant liver tumour which is not associated with cirrhosis. How would this be diagnosed? What typical signs does it show on investigation?

A

Normal AFP

CT shows stellate scar and persistent enhancement of the radial septa

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24
Q

What are the common site for secondary metastases TO the liver?

A 
Colon 
Breast
Lung 
Stomach 
Pancreas 
Melanoma
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25
Q

Describe the appearance of urine and stools in the 3 different forms of jaundice

A

Prehepatic - Normal urine and stools
(Intra)Hepatic - Dark Urine + normal/ pale stools
Posthepatic - Dark urine and pale stools

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26
Q

What extra things should be asked about in a history of a patient who might have jaundice?

A 
Travel history 
Drugs 
Sexual history 
Blood transfusions 
Tattoos 
PMH of jaundice
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27
Q

What are the useful tests that can be done for a patient with suspected jaundice?

A 
U&Es 
FBC 
LFTs 
CRP 
Virology 
Ultrasound
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28
Q

Describe what is meant by prehepatic jaundice

A

Excess haemolytic - too much bilirubin is produced e.g haemolytic anaemia

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29
Q

Describe what is meant by intrahepatic jaundice

A

Hepatocytes are dead/ injured and therefore can’t conjugate and excrete bilirubin/ bile

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30
Q

What are some of the causes of intrahepatic jaundice?

A

Hepatitis
Cirrhosis
Drugs
Pregnancy

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31
Q

Describe what is meant by post hepatic jaundice

A

There is obstruction of drainage of bile - it can’t get into the small intestine

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32
Q

What other terms are used to describe post hepatic jaundice?

A

Extrahepatic jaundice

Obstructive jaundice

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33
Q

Define jaundice

A

Yellowing of the skin and sclera of the eyes due to increased bilirubin levels. = ‘Clinically apparent hyperbilirubinaemia’

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34
Q

Describe the typical LFT patterns of the different types of jaundice, focusing on bilirubin, ALT/AST and Alkaline phosphatase

A

Prehepatic - Increased bilirubin, Normal ALT/AST and ALP
Intrahepatic - Increased bilirubin, Very high ALT/AST, elevated ALP
Posthepatic - Increased bilirubin, Elevated ALT/AST, Very high ALP

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35
Q

What kind of LFTs will non-alcoholic fatty liver disease show?

A

Hepatic LFTs - increased ALT and AST

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36
Q

What kind of LFTs will viral hepatitis show?

A

Hepatic LFTs - increased ALT and AST

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37
Q

What kind of LFTs and other test results are associated with autoimmune hepatitis?

A

Hepatic LFTs - Increased ALT and AST
Increased PT
Increased IgG
Anti-smooth muscle antibodies

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38
Q

What kind of LFTs/ other results are associated with PBC?

A

Cholestatic LFTs - Increased ALP, Bilirubin and ALT

Increased IgM

39
Q

Which things should be tested for in haemochromatosis?

A
  • Serum iron

- Ferritin/ Transferrin saturations

40
Q

Which things should be tested for in Wilson’s disease?

A
  • Serum and urine copper

- Serum caeruloplasmin

41
Q

What is meant by cardiac cirrhosis?

A

Liver cirrhosis secondary to high right sided heart pressure (incompetent tricuspid valve, congenital, rheumatic fever, constructive pericarditis)

42
Q

What are the two classes of portal hypertension?

A

Prehepatic (blockage of the portal vein before the liver e.g portal vein thrombosis)
Intrahepatic (distortion of liver architecture e.g Budd Chiari)

43
Q

What are some of the causes of post hepatic jaundice?

A

Gallstones
Carcinoma at the head of the pancreas
PSC
Strictures of the common bile duct

44
Q

What is meant by colonisation, infection, bacteraemia and sepsis?

A

Colonisation - bug present but not necessarily an inflammatory response
Infection - Inflammation in response to a bug
Bacteraemia - Bug in the blood
Sepsis - Inflammatory systemic response to infection

45
Q

Define sepsis and septic shock

A

Sepsis - life threatening organ dysfunction cause by a host response to infection
Septic shock is a subset of sepsis in which there is circulatory and metabolic dysfunction and a higher risk of mortality

46
Q

List some of the causes of peritonitis

A

Perforated tumour
Perforated ulcer
Ruptured appendix
Pancreatitis

47
Q

What criteria is used to determine whether a patient has sepsis?

A

The SIRS criteria

48
Q

What 3 things are needed to diagnose septic shock?

A

Signs of sepsis + SIRS score + organ failure

49
Q

What are coliforms?

A

Gram negative rod-like bacteria found normally in the GI tract
E.g E.coli

50
Q

Name 3 bugs which can be found in the mouth

A

Strep viridians
Neisseria
Candida

51
Q

What antibiotic treatment is given for intra-abdominal infections?

A

AMOXICILLIN
GENTAMICIN
METRONIDAZOLE

52
Q

If a patient is allergic to penicillin, what can they be given instead of amoxicillin?

A

Vancomyin

53
Q

Why can abscesses sometimes not be treated with antibiotics?

A

They have a low blood supply meaning antibiotics can’t always reach them

54
Q

What is the clinical presentation of septic shock?

A

Lactate above normal levels
Hypotension
Confusion
Cold and clammy

55
Q

What is included within the SEPSIS 6?

A 
High glow oxygen 
IV fluids 
Take blood cultures
IV antibiotics 
Measure lactate and FBC 
Monitor hourly urine output
56
Q

What are the categories of gall stones, which is the most common and what colour are they?

A

Mixed (most common)
Cholesterol (yellow)
Pigment (black)

57
Q

What are some of the risk factors for gallstones?

A 
Caucasian 
>40 yrs old 
High fat diet / obesity 
Hyperlipidaemia 
Pregnancy
58
Q

What tests are used to diagnose gallstones?

A

Ultrasound
CT
MRCP/ERCP
EUS

59
Q

How are uncomplicated gallstones managed (e.g occasionally cause biliary colic after a heavy meal)

A

Lifestyle modifications and painkillers

60
Q

How is acute cholecystitis managed?

A 
IV antibiotics 
IV fluids 
Ultrasound 
Cholecystectomy 
ERCP
61
Q

How can gallstones cause acute pancreatitis?

A

By blocking the sphincter of oddi there can be back-flow of bile up into the pancreas

62
Q

How can gallstones cause gallstone ileus?

A

A fistula can form between the gall bladder and the duodenum - if a stone escapes into the S.I it can cause blockage in the distal ileum and cause intermittent colic

63
Q

How is Hep A transmitted? Are there carrier states/ is it a chronic infection?

A

Faecal-oral spread
(poor hygiene and overcrowding)
- No carrier state

64
Q

What investigation result can indicate acute Hepatitis A?

A

Hepatitis A IgM

65
Q

Hep E is clinically very like Hep A, but how does it differ?

A

Hep E can cause *chronic infection

66
Q

Where in the world is Hep E most common?

A

In the tropics

67
Q

Hepatitis D can only be found alongside another form of viral hepatitis, which other Hep is this?

A

Hep B

- infection with Hep D exacerbates Hep B infection

68
Q

How is Hepatitis B transmitted? Does it involve a chronic/ carrier state?

A

Sex
Vertical transmission
Blood
*It can involve carriers/chronic infection

69
Q

What groups of people are at highest risk of contracting Hep B?

A

People born in areas of high prevalence
Multiple sexual partners
People who inject drugs
Children of infected mothers

70
Q

What test results indicate infectious, low infectivity and chronic infection with Hep B?

A

HBsAG+ = infectious
- For more than 6 months = chronic
Anti-HBe = low infectivity

71
Q

What is present in the blood of all patients infected with the hepatitis B virus?

A

HBsAg

72
Q

What is the most common cause of acute viral hepatitis in Tayside?

A

Hepatitis E

73
Q

How is Hep C transmitted?

A

It is less easily transmitted than Hep B (less infectious) but can be transmitted by similar ways (sex, blood)

74
Q

Which is the rarest form of viral hepatitis?

A

Hep D

75
Q

How many months define chronic infection with viral hepatitis?

A

6 months

76
Q

What is the typical time span from infection with viral hepatitis to development of cirrhosis?

A

Typically >20 years

77
Q

Name antivirals used for Hepatitis C

- What are some of the side effects?

A

Interferon Alfa and Ribavirin
Side effects of IA;
(LOTS)
Flu like symptoms, Autoimmune disease e.g SLE and pyschosis)

78
Q

What is meant by Sustained virological Response / SVR in Hepatitis C therapy?

A

Loss of HCV RNA in blood, sustained for 6 months after the end of treatment

79
Q

Name some of the newer antivirals for HCV therapy

A

Simeprevir, Ledipasvir

80
Q

Describe the embryological development of the pancreatic duct?

A

The main pancreatic duct comes from the ventral bud

81
Q

Describe the two main functions of the pancreas, what cells make up these and what the cells secrete

A

Exocrine - Acinar cells - Enzymes

Endocrine - Islets of Langerhan- Hormones

82
Q

Within the Islets of Langheran, there are Alpha, Beta, Delta and F cells. What do these secrete?

A

Alpha - Glucagon
Beta - Insulin
Delta - Somatostatins (inhibit the release of gastric hormones)
F cells - Pancreatic polypeptides

83
Q

How much pancreatic fluid is produced per day?

A

1 - 1.5 L

84
Q

What are the causes of acute pancreatitis?

I GET SMASHED

A 
IDIOPATHIC 
GALLSTONES 
ETHANOL (alcohol)
STEROIDS 
MUMPS 
AUTOIMUNE 
STINGS/ SCORPIONS
HYPERCALCAEMIA/HYPERLIPIDAEMIA ERCP 
DRUGS (E.g azathioprine)
85
Q

What are the *MOST COMMON causes of acute pancreatitis?

A

Gallstones and alcohol

86
Q

What signs visible on examination might pancreatitis present with?

A

Cullen’s sign
Grey Turner’s sign
Guarding

87
Q

Which scoring systems can be used for pancreatitis?

A

Glasgow Criteria

Ranson’s Criteria

88
Q

What are some of the possible complications of pancreatitis?

A 
Pseudocysts 
Abscesses 
Necrosis 
Ascites 
Pleural effusion 
Pulmonary oedema
89
Q

What are some of the possible causes of chronic pancreatitis?

A 
Alcohol and smoking 
Genetics - (CF and Pancreas Divisum)
Gallstones 
ERCP 
Drugs
90
Q

What does ‘creons’ do in the management of chronic pancreatitis?

A

Replaces pancreatic enzymes

91
Q

What are some of the complications of chronic pancreatitis?

A
  • Splenic vein thrombosis
  • Pseudoaneurysm over the splenic vein
  • Duodenal/ bile duct obstruction
  • Exocrine dysfunction
92
Q

What is the most common pancreatic cancer?

A

Exocrine tumours (adenocarcinomas)

93
Q

Describe the production of hormones and enzymes from the different parts of the pancreas, with reference to the specific cells

A

EXOCRINE - acing cells - enzymes

ENDOCRINE - Islets of Langerhan

  • A cells - Glucagon
  • B cells - Insulin
  • D cells - Somatostatin
  • F cells - Pancreatic polypeptide

GASTROINTESTINAL (13 decks)

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