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GI > Week 7 > Flashcards

Week 7 Flashcards

1
Q

What is the limit of alcohol for men and woman per week?

A

14 units spread evenly over 3 days

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2
Q

In non cirrhotic patients, what is the most common solid liver tumour?

A

Haemangioma

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3
Q

Is a haemangioma benign or malignant?

A

Benign

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4
Q

What is the main component of a hepatic adenoma?

A

Normal hepatocytes

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5
Q

What increases the risk of a female developing hepatic adenoma?

A

Oral contraception

Androgenic steroids

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6
Q

What is the treatment for a hydatid cyst?

A

Surgery

Albendazole

Percutaneous drainage

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7
Q

What is polycystic liver disease?

A

Embryonic ductal plate malformation of the intrahepatic biliary tree

Nymerouscysts throughout liverparenchyma

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8
Q

What are the 3 types of polycystic liver disease?

A

Von Meyenburg Complexes

Polycustic Liver Disease

Autosomal dominant polycystic kidney disease

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9
Q

What are Von Meyenburg Complexes?

A

Microhamartomas

Benign cystic nodules throughout the liver

Cystic bile duct malformations originating from the peripheral biliary tree

Remnants develop intosmallhepatic cysts and usually remain silent

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10
Q

What is the treatment of polycystic liver disease?

A

Symptom control

Halt of cyst growth

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11
Q

What are the clinical features of liver abscesses?

A

High fever

Leukocytosis

Abdominal pain

Complex liver lesion

History: abdominal or biliary infection; dental procedure etc

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12
Q

What is the management of a liver abscess?

A

Initial empiric broad spectrum antibiotics

Aspiration/drainage percutaneously

Echocardiogram

Operation if no clinical improvement

4 weeks antibiotic therapy with repeat imaging

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13
Q

If a patient has an elevated alpha feto protien and weight loss, what do they have?

A

Hepatocellular carcinoma

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14
Q

Is systemic chemotherapy an option for the treatment of hepatocellular carcinoma?

A

No

TACE is though
transarterial chemoembolization

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15
Q

What is a systemic therapy for hepatocellular carcinoma?

A

Sorafenib

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16
Q

What type of patients does fibro-lamellar carcinoma present in?

A

Young patients (5-35)

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17
Q

What does colonisation mean?

A

The presence of a microbe in the human body without an inflammatory response

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18
Q

What does infection mean?

A

Inflammation due to a microbe

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19
Q

What is bacteraemia?

A

The presence of viable bacteria in the blood

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20
Q

What is sepsis?

A

The systemic inflammatory response to infection

Life-threatening organ dysfunction caused by a dysregulated host response to infection

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21
Q

What is septic shock?

A

A subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a high risk of mortality

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22
Q

What can cause peritonitis?

A

Perforated duodenal ulcer, appendix, diverticulum, tumour

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23
Q

What is the qSOFA score?

A

Severity of infection

RR>22bpm

sBP<100mmHg

Altered GCS>2

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24
Q

What is the SIRS criteria?

A

Body temp of > 38 or < 36

Heart rate of > 90bpm

RR >20/min or PaCO2<32mmHg/4.3kPa

White blood cell count > 12000 or less than 4000

WHEN 2 OR MORE CRITERIA ARE PRESENT

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25
What is the next stage up from SIRS?
Sepsis (SIRS with a presumed or confirmed infectious process
26
What is the next step up from sepsis?
Septic shock Sepsis plus signs of at least one acute organ dysfunction
27
Where do hospital acquired E.coli infections come from?
Catheter
28
Give some examples of coliforms
E.coli Klebsiella Enterobacter sp.
29
Give some examples of strict anaerobes
Clostridium sp Bacteroides Anaerobic cocci
30
What is the empiric policy for initial mangement of intra-abdominal infections?
Amoxicillin (if penicillin allergic, IV vancomycin) Gentamicin Metronidazole ALL IV
31
What antibiotic is used to treat coliforms?
Gentamicin
32
What antibiotic is used treat anaerobic bacteria?
Metronidazole
33
What antibiotic is used to treat enterococcus sp.?
Amoxicillin
34
What is the treatment of intra-abdominal sepsis?
Gentamicin, amoxicillin and metronidazole | cotrimoxazole if penicillin allergic
35
What is used as prophylaxis for GI/hepatobiliary surgery?
Gentamicin and metronidazole
36
How long can gentamicin be used for without micro approval?
72hrs
37
What is sepsis 6?
``` High flow oxygen IV fluids Blood cultures IV antibiotics Measure lactate and FBC Measure urine output ```
38
Why is urinary output measured in sepsis 6?
Good measurement of kidney perfusion
39
Why do gallstones form?
Abnormal bile composition Bile stasis Infection Excess cholesterol Excess bilirubin
40
What are the risk factors for the development of gallstones?
``` >40 Female High fat diet Obese Pregnant Hyperlipidaemia Bile salt loss (e.g. Crohn's) Diabetes etc ```
41
Does the biliary system have commensal bacteria?
No, it's sterile normally
42
How are gallstones diagnosed?
Ultrasound CT MRCP/ERCP
43
What is the treatment for acute cholecystitis?
IV antibiotics and IV fluids Nil by mouth Ultrasound to diagnose URGENT CHOLECYSTECTOMY
44
How are stones removed from the common bile duct?
ERCP
45
How is cholangiocarcinoma staged?
Duplex ultrasound
46
What are the parts of the pancreas?
``` Uncinate process Head Neck Body Tail ```
47
What are the functions of the pancreas?
Exocrine function: acinar cells secrete pancreatic enzymes Endocrine function: Islets of Langerhans secrete hormones into the blood
48
What cells secrete insulin?
Beta cells
49
What cells secrete glucagon?
Alpha cells
50
What ells secrete somatostatin?
Delta cells
51
What are the secretions of the pancreas mediated by?
Vagus nerve Gastrin levels
52
What do acinar cells secrete?
Protease Pancreatic lipase Pancreatic amylase And other cells
53
What are the 4 stages of pancreatitis?
Hypovolaemic shock/Hypocalcaemia Retroperitoneal haemorrhage Pancreatic necrosis Abscess formation
54
What are Cullen's sign, Grey Turner's sign and erythema abigne all signs of?
Pancreatitis
55
What initial investigations should be performed on a patient with suspected pancreatitis?
IV access Bloods Arterial blood gases Ultrasound
56
What is the glasgow criteria used to assess and what does a glasgow score of more than 3 indicate?
Pancreatitis Severe
57
What is a pancreatic pseudocyst?
Complication of acute and chronic pancreatitis Cyst in pancreas
58
What is the treatment for a pancreatic pseudocyst?
Nothing Endoscopic drainage Radiological drainage Surgical drainage
59
What investigations do you do on a patient with suspected pancreatic cancer?
Ultrasound Triple phase CT MRI MRCP
60
What hepatitis can come from poor hygiene and overcrowding?
Hep A
61
What hep virus is only found with the hep B virus?
Hep D
62
What hep B antigen is present in all infectious individuals?
HBsAg
63
What hep B antigen is usually present in highly infectious individuals?
HBeAg
64
What hepatitis virus has no vaccination available?
Hep C
65
When do you treat hepatitis?
Before complications | Evidence of inflammation
66
When is interferon alpha raised?
During a viral infection
67
What is the treatment for hepatitis B?
Most used: Entecavir or tenofovir Or peginterferon alone(try in HBsAg and HBeAg pos patients)
68
What antiviral is active against all genotypes used in combination with other drugs?
Sofosbuvir

GI (22 decks)

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