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Flashcards in ALIM Deck (102):
1

what are the symptoms of GORD?

- heartburn
- regurgitation
- belching
- chronic cough

2

what is the first line investigation for GORD?

low dose PPI challenge

3

when would you do an endoscopy for GORD?

Patient is over 55 with alarm symptoms

4

what is grade A in the LA classification for oesophagitis used in GORD?

The mucosal breaks are confined to the mucosal folds, each no longer than 5mm

5

what is grade B in the LA classification for oesophagitis used in GORD?

at least one mucosal break longer than 5mm confined to the mucosal folds but not continuous between two folds

6

what is grade C in the LA classification for oesophagitis used in GORD?

mucosal breaks that are continuous between the tops of mucosal folds but not circumferential

7

what is grade D in the LA classification for oesophagitis used in GORD?

Grade D: extensive mucosal breaks engaging at least 75% oesophageal circumference.

8

what lifestyle changes should be advised in a patient with GORD?

Weight loss
smoking cessatation
small and regular meals
less hot drinks
reduce caffeine
less alcohol
less spicy food
don't eat at least 3 hours before going to bed

9

what is the treatment chart for GORD?

1. lifestyle advice
2. OTC antiacids
3. PPI such as omeprezale
4. double PPI dose and make twice daily
5. H2 receptor antagonist

10

what are the difference in effects of magnesium vs aluminium antacids?

Magnesium; tend to cause diarrhoea
Aluminium; tend to cause constipation

11

what are risk factors for GORD?

- obesity
- hiatus hernia
- pregnancy
- delayed gastric motility
- H.pylori

12

what drugs are a risk factor for gord?

anticholinergic agents
calcium channel blockers
nitrates

13

what are the two types of hiatus hernia?

80% sliding
15% paraoesophageal/ rolling

14

what type of hiatus hernia is more likely to cause gord?

sliding as the sphincter is no longer in tact

15

what is a sliding hiatus hernia?

The gastrooesophageal junction and part of the stomach slide up together into the chest

16

what is a rolling hiatus hernia?

The stomach squeezes through the hiatus landing next to the oesophagus in the chest

17

what is dyspepsia?

A term to describe a number of GI symptoms including heart burn, pain, nausea, belching.

18

how should you investigate dyspepsia?

endoscopy for patients over 55 or those with alarm symptoms

H pylori stool antigen test

19

what is the tissue change seen in Barrett's oesophagus?

Squamous epithelium is replaced with metaplastic columnar mucosa

20

What is the management for low grade dysplasia in Barrett's oesophagus?

repeat biopsy within 6 months. and give high dose PPI's.

21

what is the management for high grade dysplasia in Barrett's oesophagus?

High dose PPI's are started and repeat biopsy in 3 months.

22

what is achalasia?

Impaired LOS relaxation causing foods and liquids to fail to reach the stomach

23

what is dysphagia?

Difficulty or painful swallowing often due to improper LOS function and aperistalsis

24

what are clinical features of peptic ulcers?

recurrent burning epigastric pain that is worse at night and when hungry

nausea

anorexia

back pain if posterior penetrating

25

how can you tell apart gastric and duodenal ulcers on clinical history?

Gastric: worse on eating

Duodenal: eating will relieve pain.The pain will be worse at night and vomiting is uncommon

26

what are the risk factors for peptic ulcer formation?

- H.pylori
- NSAIDS
- steroids
- zollinger Ellison
- smoking
- alcohol

27

why is H.pylori a risk factor for ulcer formation?

Secretes urease causing ammonia production weakening the mucosal barrier

28

why are NSAIDS a risk factor for ulcer formation?

inhibits COX meaning less PGE2 and PGI2

29

what is a cushings ulcer?

Intracranial disease causing increase in vagal stimulation leading to ulceration from increased acid secretion

30

A curling ulcer?

A type of duodenal ulcer due to trauma to the body such as burns

31

what possible tests are there to diagnose H.pylori?

- serological antibody test
- C urea breath test
- stool antigen test
- biopsy urease test
- CLO
-histology staining

32

how does the serological test for H pylori diagnosis work?

Detects IgG antibodies. Useful in diagnosis but not eradication

33

what is the C- urea breath test for H.pylori?

Quick and reliable
Ingest C13 urea then measure carbon dioxide levels.

sensitivity affected if taken PPIs/ antibiotics

34

what is the stool antigen test for H.pylori?

monoclonal antibodies are used for qualititative detection of H.pylori antigen.
Useful for both diagnosis and eradication

Patients should be off PPI's but can continue H2 antags

35

what is the invasive biopsy urease test for H.pylori?

antral biopsies are added to urease and phenol red. if there is H.pylori colour change from yellow to red

cant be on antibiotics or PPI's

36

what cancer is h.pylori infection associated with?

- gastric adenocarcinoma (distal)
- B cell MALT lymphoma

37

what is often included in an eradication regime for H pylori?

Two antibiotics with a PPI

38

what antibiotics can be used in a H.Pylori eradication regime?

Metronidazole
clarithromycin
amoxicillin
tetracycline

39

what is the medical management of a peptic ulcer?

- if the patient is on an NSAID stop taking it
- give a PPI

40

at what bilirubin level is jaundice detectable?

3mg/Dl

41

why is there jaundice in pre-hepatic causes?

An excess amount of bilirubin is presented to the liver due to increased haemolysis

42

what levels will be in the serum of someone with pre-hepatic jaundice?

Elevated unconjugated bilirubin

43

why is there jaundic in hepatic causes?

Due to impaired uptake, faulty conjugation or abnormal secretion of bilirubin by the liver cell

44

what levels will be high in someone with hepatic cause of jaundice?

Both conjugated and unconjugated

45

what is a cause of pre-hepatic jaundice?

Haemolysis

46

what are some causes of hepatic jaundice?

Viral hepatitis
Cirrhosis
Drugs
Cholangitis
Pregnancy
Cholestasis

47

why is there jaundice in post hepatic causes?

Impaired excretion of conjugated billirubin due to mechanical obstruction

48

what levels are high in the serum of someone with jaundice due to a post hepatic cause?

Conjugated billirubin

49

what are some causes of post hepatic jaundice?

- common duct stones
- carcinoma
- biliary sstricture
- sclerosing cholangitis
- pancreatic pseudocyst

50

how is the urine, stool and skin change in pre- hepatic jaundice?

Normal urine and stool
No pruritis

51

how is the urine, stool and skin change in hepatic jaundice?

Dark urine, normal stool and no pruritis

52

how is the urine, stool and skin change in post hepatic jaundice?

Dark urine, acholic pale poop, pruritis

53

what oher clinical signs can be seen in haemolyic (pre hepatic jaundice)?

- anaemia
- jaundice
- splenomegaly
- leg ulcers

54

why is there high levels of unconjugated billirubin in gilberts syndrome?

A mutation means reduced levels of UDP glucuronosyl transferase activity. This normally conjugates billirubin

55

what investigations would you do in someone with jaundice?

- viral markers
- USS
- liver biochemistry

56

when is AST raised?

acute phase of cellular necrosis

57

what is disadvantage of suing AST for liver damage?

Non organ specific

58

what is a raised ALP associated with?

biliary obstruction with cholestasis

59

what liver function tests are associated with a cholestatic pattern?

billirubin, ALP, GGT

60

what LFT's are associated with an inflammatory pattern?

ALT

61

what is the main route of transmission of Hep A?

Faecal Oral route

62

what is the main route of transmission of Hep B?

Blood products
Sexual intercourse
Vertical transmission

63

what is the main transmission of Hep C?

Blood products
Saliva

64

what is the main route of transmission of hep D?

Blood products mainly

65

what is the main route of transmission of hep E?

faeco-oral
Large water borne outbreaks

66

what are complications of chronic hepatitis B or C infection?

- hepatocellular caricnoma
- liver cirrhosis
- liver fibrosis

67

what are indications for Hep B vaccination?

- healthcare personnel
- haemophilia patients
- CKD
-dialysis
- long term travellers
- MSM
- bisexual men
- more than 1 sexual partner
- sex worker
- IVDU
- diabetics

68

Why does the increased NADH in alcohol liver disease lead to increased damage?

Due to lactate and malate build up

69

why does increased NADH in alcohol liver disease lead to an increase in lactate?

To use up the NADH pyruvate is converted to lactate.

70

why does increased NADH in alcohol liver disease lead to an increase in malate?

Using up the NADH by converting oxacoacetate to malate

71

why are patients with alcoholic liver disease at risk of hypoglycaemia?

They use up pyruvate and oxaloacetate to get rid of the NADH. This means less gluconeogenesis can take place

72

why can alcooholic liver disease lead to fatty liver?

- more ehtnaol means more acetate which is broken down to form malonyl CoA Which is a TG precursor

removal of NADH using DHAP leading to glycerol 3 phosphate formation

73

what two TG precursors are produced in alcoholic liver disease?

malonyl COA
Glycerol 3 phosphate

74

Why is thiamine deficiency an issue?

There are thiamine dependant enzymes;
1. transketolase
2. pyruvate dehydrogenase
3. alpha ketogluterate

75

In wernickes there is thiamine deficiency meaning pyruvate dehydrogenase can't work what does this cause?

A build up of lactate

76

what is the triad seen in wernickes?

Ataxia
Opthalmoplegia
Nystagmus

77

As well as thiamine deficiency what other defieincy is often seen in alcoholics?

vit B3

78

alcoholics can get vit B3 deficienncy how does this present?

Pallega
Redness and swelling of the mouth, tongue.
Skin rash
diarrhoea

79

what are the stages of alcoholic liver disease?

Fatty iver
Alcoholic hepatitis
Alcoholic cirrhosis

80

what is the pathology in alcoholic hepatitis?

Fatty change
infiltration of leucocytes and hepatocellular necrosis in zone 3
Mallory bodies
Giant mitochondria

81

In alcoholic hepatitis mallory bodies are visible what are these?

dense cytoplasmic inclusions suggesting damage

82

what are the clinical manifestations of fatty liver?

Often no symptoms
Can have nausea and vomiting

83

what drugs can cause acute hepatitis?

Alcohol
Rifampicin
Isoniziad
Methyldopa
Atenolol

84

what drugs can cause chronic hepatitis??

- methyldopa
- nitrofurantoin
- isoniazid
- fenofibrate

85

How does paracetomal cause acute hepatotoxicity?

Normally paracetomal is metabolised by glucoronidation and sulfation. Also a little by N hydroxylation forming toxic NAPQI. this is the conjugatied with glutathione to be non toxic

In OD gltathione is saturated and toxic NAPQI builds up

86

what does the west haven criteria assess?

Impaired mental status mainly for HE

87

What is your west haven criteria score based on?

impairment in consciousness
intellectual function
behaviour

88

what is grade 1 in the west haven criteria?

- trivial lack of awareness
shortened attention span
impaired addition

89

what is grade 2 on the west haven criteria?

ethargy
minimal disorientation in place/time
personality change
inappropriate behaviour

90

what is grade 3 in the west haven criteria?

- semi stupir but can respond to verbal stimuli
confusion
gross disorientation

91

what are the three main factors underlying the pathogenesis of ascites?

Low serum albumin
Portal nHypertension
Sodium and water retention

92

what are causes of straw coloured ascitic fluid?

malignancy
cirrhosis
TB
hepatic vein obstruction
chronic pancreatitis
constrictive pericarditis
nephrotic syndrome

93

what are causes of chylous coloured ascitic fluid?

obstruction of the main lymphatic duct
cirrhosis

94

what are causes of haemmorhagic ascites?

malignancy
ruptured ectopic pregnancy
abdo trauma
acute pancreatitis

95

where in the bowel does crohns affect?

Any part from the mouth to anus

96

where in the bowel does uc AFFECT?

Starts at the rectum and works up

97

in what pattern does crohns affect tissue?

Patchy and discontinious

98

In what pattern does uc affect tissue?

Continious

99

What layers does inflammation in crohns affect?

transmural

100

What layer of tissue is affected in UC?

just mucosal

101

what is the management of UC?

- Proctitis and proctosigmoiditis you give an aminosalicylate
- corticosteroids
- prednisolone

102

what is the management of crohns?

- monotherapy with prednisolone or hydrocortisone
- can add azathioprine/ mercaptopurine
- consider methotrexate