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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
Q

What is the next stage up from SIRS?

A

Sepsis

(SIRS with a presumed or confirmed infectious process

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26
Q

What is the next step up from sepsis?

A

Septic shock

Sepsis plus signs of at least one acute organ dysfunction

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27
Q

Where do hospital acquired E.coli infections come from?

A

Catheter

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28
Q

Give some examples of coliforms

A

E.coli

Klebsiella

Enterobacter sp.

29
Q

Give some examples of strict anaerobes

A

Clostridium sp
Bacteroides
Anaerobic cocci

30
Q

What is the empiric policy for initial mangement of intra-abdominal infections?

A

Amoxicillin (if penicillin allergic, IV vancomycin)

Gentamicin

Metronidazole

ALL IV

31
Q

What antibiotic is used to treat coliforms?

A

Gentamicin

32
Q

What antibiotic is used treat anaerobic bacteria?

A

Metronidazole

33
Q

What antibiotic is used to treat enterococcus sp.?

A

Amoxicillin

34
Q

What is the treatment of intra-abdominal sepsis?

A

Gentamicin, amoxicillin and metronidazole

cotrimoxazole if penicillin allergic

35
Q

What is used as prophylaxis for GI/hepatobiliary surgery?

A

Gentamicin and metronidazole

36
Q

How long can gentamicin be used for without micro approval?

A

72hrs

37
Q

What is sepsis 6?

A 
High flow oxygen
IV fluids
Blood cultures
IV antibiotics
Measure lactate and FBC
Measure urine output
38
Q

Why is urinary output measured in sepsis 6?

A

Good measurement of kidney perfusion

39
Q

Why do gallstones form?

A

Abnormal bile composition

Bile stasis

Infection

Excess cholesterol

Excess bilirubin

40
Q

What are the risk factors for the development of gallstones?

A 
>40
Female
High fat diet
Obese
Pregnant
Hyperlipidaemia
Bile salt loss (e.g. Crohn's)
Diabetes
etc
41
Q

Does the biliary system have commensal bacteria?

A

No, it’s sterile normally

42
Q

How are gallstones diagnosed?

A

Ultrasound
CT
MRCP/ERCP

43
Q

What is the treatment for acute cholecystitis?

A

IV antibiotics and IV fluids

Nil by mouth

Ultrasound to diagnose

URGENT CHOLECYSTECTOMY

44
Q

How are stones removed from the common bile duct?

A

ERCP

45
Q

How is cholangiocarcinoma staged?

A

Duplex ultrasound

46
Q

What are the parts of the pancreas?

A 
Uncinate process
Head
Neck
Body
Tail
47
Q

What are the functions of the pancreas?

A

Exocrine function: acinar cells secrete pancreatic enzymes

Endocrine function: Islets of Langerhans secrete hormones into the blood

48
Q

What cells secrete insulin?

A

Beta cells

49
Q

What cells secrete glucagon?

A

Alpha cells

50
Q

What ells secrete somatostatin?

A

Delta cells

51
Q

What are the secretions of the pancreas mediated by?

A

Vagus nerve

Gastrin levels

52
Q

What do acinar cells secrete?

A

Protease
Pancreatic lipase
Pancreatic amylase
And other cells

53
Q

What are the 4 stages of pancreatitis?

A

Hypovolaemic shock/Hypocalcaemia

Retroperitoneal haemorrhage

Pancreatic necrosis

Abscess formation

54
Q

What are Cullen’s sign, Grey Turner’s sign and erythema abigne all signs of?

A

Pancreatitis

55
Q

What initial investigations should be performed on a patient with suspected pancreatitis?

A

IV access
Bloods
Arterial blood gases

Ultrasound

56
Q

What is the glasgow criteria used to assess and what does a glasgow score of more than 3 indicate?

A

Pancreatitis

Severe

57
Q

What is a pancreatic pseudocyst?

A

Complication of acute and chronic pancreatitis

Cyst in pancreas

58
Q

What is the treatment for a pancreatic pseudocyst?

A

Nothing

Endoscopic drainage

Radiological drainage

Surgical drainage

59
Q

What investigations do you do on a patient with suspected pancreatic cancer?

A

Ultrasound

Triple phase CT

MRI

MRCP

60
Q

What hepatitis can come from poor hygiene and overcrowding?

A

Hep A

61
Q

What hep virus is only found with the hep B virus?

A

Hep D

62
Q

What hep B antigen is present in all infectious individuals?

A

HBsAg

63
Q

What hep B antigen is usually present in highly infectious individuals?

A

HBeAg

64
Q

What hepatitis virus has no vaccination available?

A

Hep C

65
Q

When do you treat hepatitis?

A

Before complications

Evidence of inflammation

66
Q

When is interferon alpha raised?

A

During a viral infection

67
Q

What is the treatment for hepatitis B?

A

Most used: Entecavir or tenofovir

Or peginterferon alone(try in HBsAg and HBeAg pos patients)

68
Q

What antiviral is active against all genotypes used in combination with other drugs?

A

Sofosbuvir

GI (22 decks)

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