Case 6 - Upper GI and Hepatitis Flashcards

Question

Causes of coughing blood (haemoptysis)

Answer 1

``` oesophagus irritation nosebleeds swallowing blood tear in the oesophagus due to chronic coughing or vomiting swallowing a foreign object stomach ulcers gastritis, or stomach inflammation NSAIDS side effects Pancreatitis cirrhosis oesophageal cancer erosion of the stomach lining pancreatic cancer ```

Answer 2

gabapentin

Answer 3

Loperamide

Answer 4

Dicyclomine

Answer 5

Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health Intense fear of gaining weight or becoming fat, even when significantly underweight Disturbance about body weight or shape, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of current low body weight

Answer 6

Recurrent episodes of binge eating: An episode of binge eating is characterized by both of the following: Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating). Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise: The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for three months. Self-evaluation is unduly influenced by body shape and weight. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Answer 7

An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following: Significant weight loss (or failure to achieve expected weight gain or faltering growth in children). Significant nutritional deficiency. Dependence on enteral feeding or oral nutritional supplements. Marked interference with psychosocial functioning.

Answer 8

Recurrent episodes of binge eating: An episode of binge eating is characterized by both of the following: Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). The binge eating episodes are associated with three (or more) of the following: Eating much more rapidly than normal. Eating until feeling uncomfortably full. Eating large amounts of food when not feeling physically hungry. Eating alone because of feeling embarrassed by how much one is eating. Feeling disgusted with oneself, depressed, or very guilty afterward. Marked distress regarding binge eating is present. The binge eating occurs, on average, at least once a week for 3 months.

Answer 9

H.Pylori test Endoscopy Trial medication

Answer 10

a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary symptoms of active disease are abdominal pain and diarrhoea mixed with blood. Weight loss, fever, and anaemia may also occur. Often, symptoms come on slowly and can range from mild to severe. It is typically diagnosed with a colonoscopy and biopsies.

Answer 11

Aminosalicylates - reduce inflammation Corticosteroids - stronger drug to reduce inflammation Immunosuppressants Ciclosporin (immunosuppressant used to treat flare up intravenously) Ileostomy

Answer 12

Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract from the mouth to the anus. While the causes of Crohn's disease are unknown, it is believed to be due to a combination of environmental, immune, and bacterial factors in genetically susceptible individuals. Smokers are 2x more likely to get Crohn’s.

Answer 13

Steroids - reduce inflammation Liquid diet Immunosuppressants Ileostomy

Answer 14

Diverticula are small bulges or pockets that can develop in the lining of the intestine as you get older. If the diverticula become inflamed or infected, causing more severe symptoms, it's called diverticulitis. Symptoms of diverticular disease include: tummy pain, usually in your lower left side, that tends to come and go and gets worse during or shortly after eating (emptying your bowels or passing wind eases it) constipation, diarrhoea, or both occasionally, blood in your poo

Answer 15

Antibiotics Fluid diet High fibre diet Colectomy

Answer 16

Excessive amount of bilirubin is presented to the liver due to excessive haemolysis There's an elevated unconjugated bilirubin in LFTs

Answer 17

Impaired cellular uptake, defective conjugation or abnormal secretion of bilirubin by liver cells Both conjugated and unconjugated bilirubin levels may be raised

Answer 18

Impaired excretion due to obstruction of the bile duct Raised conjugated bilirubin in LFTs

Answer 19

- malaria, a blood infection caused by a parasite - sickle cell anemia, a genetic condition in which red blood cells become crescent-shaped rather than the typical disc shape - spherocytosis, a genetic condition of the red blood cell membrane that causes them to be sphere-shaped rather than disc-shaped - thalassemia, a genetic condition that causes your body to make an irregular type of hemoglobin that limits the number of healthy red blood cells in your bloodstream

Answer 20

- liver cirrhosis, which means that liver tissues are scarred by long-term exposure to infections or toxic substances, such as high levels of alcohol - viral hepatitis, an inflammation of the liver caused by one of several viruses that can get into your body through infected food, water, blood, stool, or sexual contact - primary biliary cirrhosis, which happens when bile ducts are damaged and can’t process bile, causing it to build up in your liver and damage liver tissue alcoholic hepatitis, in which your liver tissues are scarred by the heavy, long-term drinking of alcohol - leptospirosis, is a bacterial infection that can be spread by infected animals or infected animal urine or feces - liver cancer, in which cancerous cells develop and multiply within liver tissues

Answer 21

- gallstones, hard calcium deposits in the gallbladder that can block bile ducts - pancreatic cancer, the development and spread of cancer cells in the pancreas, an organ that helps produce digestive substances - bile duct cancer, the development and spread of cancer cells in your bile ducts - pancreatitis, an inflammation or infection of your pancreas - biliary atresia, a genetic condition in which you have narrow or missing bile ducts

Answer 22

Hepatocellular damage

Answer 23

Indirect marker for cholestasis

Answer 24

Bony metastases or primary bone tumours (e.g. sarcoma) Vitamin D deficiency Recent bone fractures Renal osteodystrophy

Answer 25

cholestasis

Answer 26

biliary epithelial damage and bile flow obstruction

Answer 27

Gilbert's syndrome | Haemolysis

Answer 28

Liver disease resulting in a decreased production of albumin (e.g. cirrhosis). Inflammation triggering an acute phase response which temporarily decreases the liver’s production of albumin. Excessive loss of albumin due to protein-losing enteropathies or nephrotic syndrome

Answer 29

Chronic liver disease

Answer 30

Acute alcoholic hepatitis | Cirrhosis

Answer 31

It is usually long term or severe liver damage if synthetic function is impaired

Answer 32

Contaminated food and water ``` feeling tired and generally unwell joint and muscle pain a raised temperature loss of appetite feeling or being sick pain in the upper right part of your tummy a headache, sore throat and cough constipation or diarrhoea a raised, itchy rash (hives) pale faeces dark urine ``` treatment = self care, symptoms management

Answer 33

There is a vaccine for Hep A but it is not commonly given. People usually advised to have the hepatitis A vaccine include: close contacts of someone with hepatitis A people planning to travel to or live in parts of the world where hepatitis A is widespread, particularly if sanitation and food hygiene are expected to be poor people with any type of long-term liver disease men who have sex with other men people who inject illegal drugs people who may be exposed to hepatitis A through their job – this includes sewage workers, people who work for organisations where levels of personal hygiene may be poor, such as a homeless shelter, and people working with monkeys, apes and gorillas

Answer 34

Anti-HAV IgM Indicates recent infection Anti-HAV IgG Indicates past infection or immunisation

Answer 35

Blood and bodily fluids ``` tiredness general aches and pains high temperature a general sense of feeling unwell loss of appetite feeling and being sick diarrhoea tummy pain yellowing of the skin and eyes (jaundice) dark urine and pale, grey-coloured poo ``` treatment = acute infection usually does not need treatment, just symptom management chronic infection - peginterferon alfa 2-a. This stimulates the immune system to attack the hepatitis B virus and regain control over it. Antivirals.

Answer 36

Routinely given to all babies as of recent change to vaccine schedule Also should be given to: people who inject drugs or have a partner who injects drugs people who change their sexual partners frequently men who have sex with men babies born to infected mothers close family or sexual partners of someone with hepatitis B anyone who receives regular blood transfusions or blood products, and their carers people with any form of chronic liver disease people with chronic kidney disease people travelling to high-risk countries male and female sex workers people whose work puts them at risk of contact with blood or body fluids, such as nurses, prison staff, doctors, dentists and laboratory staff prisoners families adopting or fostering children from high-risk countries

Answer 37

Anti-HBcAg IgM indicates acute infection Surface antibody (anti-HBsAg IgG): Indicates viral clearance Post vaccination Persistent HBsAg or presence of HBeAg (part of viral core) - indicated chronic infection

Answer 38

Blood and bodily fluids ``` a high temperature of 38C (100.4F) or above tiredness loss of appetite tummy (abdominal) pains feeling and being sick jaundice ``` treatment: - acute - body can usually attempt to fight on its own - chronic: simeprevir sofosbuvir a combination of ledipasvir and sofosbuvir a combination of ombitasvir, paritaprevir and ritonavir, taken with or without dasabuvir a combination of sofosbuvir and velpatasvir a combination of sofosbuvir, velpatasvir and voxilaprevir a combination of glecaprevir and pibrentasvir ribavarin

Answer 39

There is no vaccine for Hep C

Answer 40

HCV RNA present = acute infection IgG antibodies and HCV RNA = chronic infection

Answer 41

Blood and bodily fluids Can only be co-infected alongside HBV Symptoms and treatment same as B

Answer 42

No vaccine for Hep D, however if vaccinated against Hep B that will offer adequate protection

Answer 43

Acute infection of HDV detected with Anti-HDV IgM

Answer 44

Contaminated food and water ``` muscle and joint pain a high temperature feeling and being sick feeling unusually tired all the time a general sense of feeling unwell loss of appetite tummy pain dark urine pale, grey-coloured poo itchy skin yellowing of the eyes and skin (jaundice) ``` treatment: not usually serious in most people but can be dangerous for people with compromised immune systems

Answer 45

There is no vaccine available for Hep E

Answer 46

Anti-HEV IgM Indicates recent infection Anti-HEV IgG Indicates past infection or immunisation

Answer 47

left and right hepatic duct | common hepatic duct

Answer 48

cystic duct | common bile duct

Answer 49

common hepatopancreatic duct

Answer 50

it's almost completely taken up again in the distal ileum and finally returned to the liver with portal blood in a process termed enterohepatic circulation

Case 6 - Upper GI and Hepatitis Flashcards

(74 cards)