Bits

Question 1

What are some extra intestinal conditions related to activity of colitis

Answer 1

• Erythema nodosum
• Pyoderma gangrenosum
• Aphthous ulcers
• Episcleritis
• Anterior uveitis
• Acute arthropathy

Question 2

What are the radiographic features of gallstone ileus?

Answer 2

Rigler triad

• small bowel obstruction
• gas within the biliary tree
• Gall stone - usually within right iliac fossa

Question 3

What are the examination findings of hepatic cirrhosis

Answer 3

• Finger clubbing
• Dupuytren’s
• Palmar erythema
• Gynaecomastia
• Testicular atrophy

Question 4

What is the definition of ascites? What is SAAG?

Answer 4

Abnormal build-up of fluid in peritoneal space ≥25ml

High SAAG ≥ 1.1.mg/dL

• Hydrostatic pressure imbalance
  
  • Portal Hypertension (>10mmHg)
    
    • Cirrhosis (80%
    • Heart Failure
    • Budd-Chiari
    • Portal vein thrombosis
• Albumin high in serum, low in ascitic fluid

Low SAAG <1.1. mg/dL

• Oncotic pressure imbalance (peritoneum has become more permeable to albumin)
  
  • Infection
  • Peritoneal malignancy - often mets
  • Pancreatitis
  • Nephrotic syndrome

Question 5

What are some complications of ascites

Answer 5

Sudden bacterial peritonitis

Hepatorenal syndrome

Question 6

What are the radiographic features of ascites

Answer 6

Increased density of paracolic regions

Loss of psoas muscle margins

Question 7

What tests are performed on ascitic fluid

Answer 7

Routine

• Culture and sensitivity
• Cytology
• Total Protein count
• Albumin concentration
• Cell count

Specific

• Glucose - ?malignancy
• Amylase -?Pancreatic ascites
• Bilirubin - ?perforated viscus
• Triglyceride - ?Chylous ascites

Question 8

how do you define decompensated cirrhosis?

Answer 8

• ascites
• variceal haemorrhage
• Hepatic encephalopathy

Question 9

What is the scoring system used to grade liver dysfunction

Answer 9

Child Pugh

• It considers five variables;
  
  • the severity of ascites
  • the severity of encephalopathy
  • serum bilirubin
  • serum albumin
  • clotting time.

Question 10

What are the CI to NG tube insertion

Answer 10

• severe facial trauma
• altered anatomy
• abnormal clotting results
• varices
• oesophageal pouch
• skull fracture

Question 11

What are the main indications for NG tube insertion

Answer 11

• Removal of gastric contents (or to relieve gastric distension)
• • For feeding
• • Administration of medication

Question 12

What are the criteria for liver transplant in non-paracetamol liver failure?

Answer 12

King’s college hospital

• Prothrombin time > 100s
• OR any three of
  
  • Drug-induced liver failure
  • Age under 10 or over 40 years
  • 1 week from 1st jaundice to encephalopathy
  • Prothrombin time >50s
  • Bilirubin ≥300µmol/L.

Question 13

What is the tumour marker CA 19-9 representative of

Answer 13

Cholangiocarcinoma

• RF: UC

Also raised in pancreatic and gastric cancer

Question 14

What tumour causes raised AFP

Answer 14

Hepatocellular carinoma and non-seminomatous germ cell tumours

Question 15

What does infection in a closed space do

Answer 15

• any infection in a closed space causes swinging fever