conditions Flashcards
(423 cards)
1
Q
what post operative care should be given for a liver transplant
A
12-48 hour ICU care
prophylactic antibiotics
anti rejection drugs - steroids , azathioprine, cyclosporine
2
Q
what are risk factors for developing primary biliary cholangitis
A
family history many UTIs smoking other autoimmune diseases female , 50
3
Q
what is the prevalence of IBS
A
10-20% - age of onset <40 years
4
Q
what diagnostic test confirms cirrhosis
A
liver biopsy
can also ultrasound, MRI, ascitic tap
5
Q
what is malnutrition
A
state of nutrition in which a deficiency or excess of energy, protein, and other nutrients causes measurable adverse effects on tissue/ body form/ function and clinical outcome
(failure to meet nutritional requirements of individual)
6
Q
what is the initial management for acute pancreatitis
A
analgesia, Iv fluids, oxygen
blood transfusion if low Hb
nasogastric tube for nutrition
treat underlying cause
7
Q
what is the operative treatment for gall stones
A
laparoscopic cholecystectomy (can do open/ mini )
8
Q
what are the main symptoms of IBS
A
abdominal pain abdominal bloating - mucus in stools altered bowel habit flatulence/ belching weight loss
9
Q
how is oesophageal carcinoma diagnosed
A
biopsy via endoscopy
10
Q
what is helicobacter pylori
A
genius of spiral flagellated gram negative bacteria, found in the stomach within the mucosal layer
almost always present in gastric/ duodenal ulceration
11
Q
what advice is given to manage the pancreatic function in chronic pancreatitis
A
low fat/ protein
pancreatic enzyme supplement s
insulin
12
Q
what is ascites
A
accumulations fluid in the peritoneal cavity
13
Q
what is tested in the 2007 Scottish bowel screening program
A
from age 50-74 - FOBT every 2 years
colonoscopy if positive
14
Q
who is entitled to a liver transplant
A
CLD with poor QOL
hepatocellular carcinoma
acute liver fialure
genetic diseases
15
Q
what are some small bowel causes of a lower GI bleed (only 5%)
A
Meckel’s diverticulum, angiodysplasia, ulceration, aorta-entero fistulation (following AAA repair)
16
Q
what is the palliative care of jaundice
A
endoscopic stent
opiates, radiotherapy, coeliac plexus block
17
Q
what is cyclical vomiting syndrome
A
2-3 episodes a day, 2-3 times a month for 2-3 years - need hospitalisation for rehydration
18
Q
what are oesophageal causes of an upper GI bleed
A
oesophageal varices, mallory weiss tear, malignancy
19
Q
what drug is given to stop nausea/ vomiting
A
anti- emetic
20
Q
what are complications of gastritis
A
bleeding, perforation, malignancy, reduced gastric outflow, obstruction due to scarring (Stenosis)
21
Q
how may a heptacellualr carcinoma present
A
fever, malaise, weight loss, anorexia
RUQ pain/ abdominal pain
decompensated liver function
jaundice/ hepatomegaly
22
Q
what are the commonest causes of diarrhoea
A
gastroenteritis travelling IBS IBD colorectal cancer laxative abuse antibiotic use
23
Q
what are contraindications of liver transplant
A
active extraheptaic malignancy active substance/ alcohol abuse active infection outside hepatobiliary tree sever cardio/ respiratory disease psychosocial factors
24
Q
how may you investigate a small bowel cause of a lower GI bleed
A
CT angiogram
capsule endoscopy
MEckel’s scan (scintigraphy)
25
what is the epidemiology of pancreatic cancer - sex, age, histology
M> F
peak at 60-80
majority adenocarcinoma
26
what does a diffuse oesophageal spasm appear like on a barium swallow
corkscrew
27
why is a colonoscopy gold standard for investigating colorectal cancer
allows tissue biopsies to be taken
28
how may acute pancreatitis present
severe abdominal pain - radiate to back
shock - collapse, tachycardia, pyrexia, oliguria
pleural and ascitic effusions
jaundice
29
what may be the cause of ascites if the serum ascites albumin gradient (SAAG) is <1.1 g/ dl
malignancy
Tb
pancreatic / biliary cause
serositis - inflammation of a serous membrane
30
how would you investigate a suspected peptic ulcer
upper GI endoscopy
| H pylori test
31
what is a gastric dielafoy
submucosal arteriole vessel erodes through mucosa and bleeds. common in gastric fundus but very rare.
32
what are symptoms of radiation proctitis
```
innefective staining to empty bowels
urgency
rectal pain
diarrhoea
discharges blood/ mucous
```
33
which organ does oesophageal cancer commonly metastasise to
liver, brain, bone, lungs
34
what is primary sclerosing cholangitis characterised by
inflammation, fibrosis and strictures of the intra AND extra hepatic bile ducts
male dominant
35
what scores is used to class NAFLD and how does it work
NAFLD score - 3 or more categories
| age >45, diabetes, BMI >30, AST: ALT ratio, platelet count <150, albumin <34
36
what is cholangiocarcinoma
cancer of the biliary tree
| most are slow growing, are distal extra hepatic or per-hilar
37
what is the gold standard investigation for coeliac disease
distal duodenal biopsy
38
why is there accurate localisation of somatic abdominal pain
receptors in parietal peritoneum have afferent nerves that run with segmental nerves
39
how would may spontaneous bacterial peritonitis present
abdominal pain, fever , rights, nausea
ascites - sepsis/ tachycardia
renal impairment
40
What are inflammatory indicators in the blood
high ESR, CRP and platelet count
high WCC
low HB and albumin
41
what is odynophagia
pain on swallowing
42
what is spontaneous bacterial peritonitis
infection within the abdominal cavity without an obvious cause, leading to ascites
common in liver biases (portal hypertension) and nephrotic syndrome
43
what is dyspepsia
difficulty swallowing foods and liquids
44
what percentage of cholagniocarcinomas are inoperable
70% - of those that are 76% reoccur
45
is ulcerative colitis or crohns disease more common
ulcerative colitis
46
what is NAFLD and its entities
increased fat in hepatocytes visualised on USS that can't be attributed to other causes
3 entities - steatosis, non alcoholic steatohepatitis (NASH), fibrosis
47
what motility disorders can cause dysphagia
achalasia
diffuse oesophageal spasm
systemic - sclerosis, MS
neuro - bulbar palsy, parkinsons, myasthenia gravis, MND
48
define ulcerative colitis
CONTINOUS inflammation that starts at the rectum and moves proximally but only effects the colon
49
how is a variceal haemorrhage managed
endoscopy + band ligation/ telipressin
blood transfusion as required
sengstaken- blakemore tube for uncontrolled bleeding
50
what does oesophageal manometry measure
muscle contraction of peristalsis as patient swallows
51
what investigations may you do to investigate causes of dysphagia
barium swallow
oesophageal ph and manometry
chest xray
endoscopy / biopsy if suspected malignancy
52
what are common causes of upper GI bleeding
```
peptic ulcer
inflammation - oesophagitis, gastritis, duodenitis
abnormal clotting
malignancy
angiodsyplasia
(oesophageal/ gastric causes also)
```
53
what is a peptic ulcer
breach in the mucosa of the GI tract caused by the actions of gastric acid and pepsin
54
what 3 scores are used to asses priority for a liver transplant
childs pugh - A <7, B 7-9, C>9
MELD
UKELD
55
why may you do a CXR and AXR in acute pancreatitis
look for effusions (pancreatic ascites)
| very high amylase level
56
what is jaundice
yellowing of the skin, sclera and mucosa, caused by excess circulating bilirubin
57
what things may cause a cholangiocarcinoma
PSC, biliary cysts, hepatitis, ulcerative colitis, diabetes
58
what is a sengstaken blakemore tube
trans jugular intra-hepatic portosystemic shunt
59
what is the most common presentation of colorectal cancer
rectal bleeding
| diarrhoea
60
what is diverticular disease
protrusion of the inner mucosal lining through the outer muscular layer forming a pouch
75% self limiting
61
what is the ROME III guideline for diagnosis of IBS
recurret abdominal pain/ discomfort for > 3 days of the month in the past 3 months, associated with 2 of;
relief by defecation
change in stool frequency / form
62
what are complications of a pancreatectomy
```
pancreatic duct stenosis
cyst/ pseudocysts
biliary tract obstruction
splenic vein thrombosis
duodenal stenosis
```
63
what is the acute management of an upper GI bleed
```
Protect airway/ give O2
IV fluids
urinary catheter
blood transfusion if Hb drop <70g/L
monitor - pulse, BP, CXR/ ECG.
urgent endoscopy
```
64
how is hepatic encephalopathy graded
1- mild confusion
| 4 - coma
65
what is the treatment of sever ulcerative colitis
Iv hydration
IV + rectal steroids
thromboembolism prophylaxis
(mortality 3% first attack, 23% 2nd attack)
66
what may be the cause of ascites if the serum ascites albumin gradient (SAAG) is >1.1 g/ dl
```
portal hypertension
chronic heart failure, pericarditis
budd chiarri (occluded hepatic vein)
liver mets
hypothyroid
```
67
how would you investigate someone with achalasia
barium swallow
oesophageal manometry (high P in LOS at rest)
xray
endoscopy
68
are melon and hematemesis presentation of upper GI or lower GI disease
upper GI
69
what may be the cause of vomiting if it is preceded by a loud gurgling
GI obstruction
70
what is the non operative treatment for gall stones
dissolution - medical drink
| lithotripsy - shock waves to break up stones into urine
71
what imaging can be done in primary sclerosing cholangitis to reveal anatomy
ERCP and MRCP
72
what is coeliac disease
condition in which the small intestine sails to absorb and digest food - sensitive to gliadin fraction of gluten
73
what are complications of hepatitis C
glomerulonephritis
| autoimmune hepatitis
74
what are the risk factors for fatty liver disease
obesity , diabetes, hypercholesterolaemia, hypertension
| affect 25-40% of population
75
what causes Ulcerative colitis
inappropriate immune response against colonic flora in genetically susceptible individual
76
what is the commonest cause of liver cancer (90%) and what is its background
hepatocellular carcinoma
background of cirrhosis, hep B, hep C
autoimmune hepatitis, NAFLD
77
what is the 1st line therapy for induction of remission of IBD
aminosalicyclates (5ASA)
| asacol, i-cool, mesren, salofak - stick to one brand
78
what is oesophageal cancer associated with
male, barrets oesophagus, smoking, alcohol, iron deficiency, anaemia
79
what are risk factors for GORD
pregnancy, obesity
smoking, alcohol, men, caucasian
drugs lowering LOS pressure - tricyclics, anticholinergics, nitrates
80
What may cause a hepatic encephalopathy (increase NH3 levels)
infection
constipation - urea broken down
drugs
GI bleed - oesophageal varices - protein breakdown in blood
81
what are the most common causes of cirrhosis
alcohol
chronic hepatitis B/C
NAFLD/ NASH
portal hypertension ,budd chiari
82
what are condequences to the body of an altered liver function
decreased plasma protein/ clotting factor synthesis
| altered drug metabolism
83
what are joint manifestations of IBD
sacrolitis
monoarticular arthritis
ankylosing spondylitis
large joint arthritis
84
what bloods would you ask for in acute pancreatitis
```
amylase/ lipase
FBC, U&E
LFT
Ca
glucose
```
85
what are some hepatic causes of jaundice
hepatitis
hepatocyte damage
defective uptake/ conjugation / excretion
86
in which part of the pancreas are cancers most likely to occur
head - 60%
body - 25%
tail - 15%
87
what is the diet treatment for IBS
limit caffeine , alcohol, sweetener
trial for lactose/ gluten exclusion
FODMAP diet
88
what is shock
circulatory collapse resulting in inadequate tissue oxygen delivery leading to global hypo perfusion and tissue hypoxia
89
what environmental factors increase risk of colorectal cancer
```
diet - low fibre, processed meat
alcohol
smoking
obesity
diabetes
```
90
How would you investigate for hep B
HBsAg - surface antigen defines carrier status
HbeAg
if IgM acute infection, if IgG chronic infection
91
what are complications of ulcerative colitis
```
toxic dilation (risk of perofration)
colonic cancer - give surveillance colonoscopy
```
92
what are complications of crohns disease
```
small vowel ulceration
abscess formation
fistulae
colon cancer
toxic dialtion
```
93
what is the mortality rate for GI bleeds
7%
94
what is visceral abdominal pain associated with
systemic upset - very unwell, nausea, poor localisation
95
what are liver manifestations of IBD
fatty change
gall stones
sclerosis cholangitis - disease of the bile ducts with multiple strictures
96
how is gastric cancer treated
subtotal gastrectomy
| total gastrectomy with Roux en Y construction
97
how often are cirrhosis patients screened for hepatocellular carcinoma
6 months
98
what is the 'test and treat' for H pylori
urea breath test
| PPI + 2 antibiotics (e.g. lansoprazole, clarithromycin, amoxicillin)
99
when is a prophylactic protocolectomy offered to people with FAP
16-25 years
100
what are unacceptable complications of IBD medical therapy
diabetes, psychosis, severe osteoporosis
101
what is chronic pancreatitis
continuing inflammatory disease of the pancreas characterised by irreversible glandular destruction leading to chronic pain / impairment of function
102
what if faecal calprotectin
white cell protein only present in bowel (<50 normal)
103
how may hepatocellular carcinoma be treated
hepatic resection (lobe grows back)
liver transplant
hormonal - tamoxifen
104
if someone <55 presents with dyspepsia what test should you give them
H pylori - urea breath test
| peptic ulcer is most common cause
105
what psychological problems can present with GI symptoms
stress, anxiety, depression, somatisation, eating disorders
106
what predisposes the gastro-oesophageal reflux of stomach contents (acid/ bile)
dysfunction of lower oesophageal sphincter
107
what blood test results are elevated in primary biliary cholangitis
IgM
ALP
GGT and AST: ALT
108
is visceral abdominal pain well localised
no - general to forget, midgut, hindgut (nerves run with vessels)
109
what criteria is used to predict the severity of pancreatitis within 48 hours and what does it consider
Glasgow criteria - severe >3
| glucose, WCC, Urea, AST/ALT, LDH, albumin, calcium, PaO2
110
what is the difference between nausea and vomiting
nausea - feeling of going to be sick
| vomit - expel contents of stomach through mouth
111
what is the differential diagnosis of IBD
chronic diarrhoea (malnutrition/ malabsorption)
colitis - infective/ ischaemic
ileo-caecal TB - steroids make this worse
112
what biologics may be used to treat IBD
anti TNFa = infliximab (iv), adulimumab (sc)
a4b7 intern blockers = vedolizumab
IL12/23 blockers
113
describe Dukes staging of colorectal cancer
A - tumour confined to mucosa (11%)
B - tumour through mucosa to muscle layer (35%)
C - involvement of lymph nodes (26%)
D - metastatic spread (29%)
114
what are eye manifestations of IBD
uveitis
conjunctivitis
episcleritis
115
what causes Barretts oesophagus
chronic inflammation and damage from GORD or corrosive oesophagitis
116
what are the 4 F risk factors for gall stones
female, fertile (middle age) , fair, fat
117
what is the 5yr survival of colorectal cancer (by dukes classification )
A - 83%
B - 64%
C- 38%
D- 3%
118
what are gastric causes or an upper GI bleed
gastric varices, malignancy, dieulafoy, angiodysplasia
119
What is the MUST screening for undernutrition
1. BMI
2. unintentional weight loss
3. eaten in 5 days
score >2 risk of malnutrition
120
what is the gold standard investigation for gall stones
USS
121
how may a peptic ulcer present
asymptomatic
weight loss
epigastric pain - relieved by antacids
122
what is the difference in prognosis of chronic pancreatitis for people who do and son stop drinking
stop - 80% 10 yr
| continue - 50% 10 yr
123
what are side effects of 5-ASA
rash, haemolysis, hepatitis, pancreatitis
| worsening of colitis
124
what is the difference between a sliding and para- oesophageal hiatus hernia
sliding - fundus moves through oesophageal hiatus to chest, LOS becomes less competent
para-oesophageal - bit of the fundus slides up through the hiatus to the chest but junction still remains in the abdomen
125
what is ischaemic colitis and how does it normally presetn
disruption in blood supply to the colon (normally descending/ sigmoid)
crampy abdominal pain, bloody diarrhoea, >60
126
what are the routes to spread infection in primary peritonitis
perforation of the GI/ binary tract
female genital tract
Penetration of abdominal wall - knife etc
Haeamatogenous spread (blood)
127
why is it important to ask someone with dyspepsia if they had difficulty swallowing foods form the start
yes - motility disorder e.g achalasia/ pharyngeal cause
| no - solids then liquids - could be a stricture
128
what is the differential diagnosis of jaundice (and what is the difference)
carotenemia - sclera aren't discoloured
129
how may hepatic encephalopathy present
drowsiness/ confusion
changes in personality
coma
130
what conditions is coeliac disease associated with
DM 1
autoimmune thyroid, hepatitis, PBC,
downs syndrome
131
what surgical problems may be referred for colorectal surgery
```
colorectal cancer
UC/ chrohns
diverticualr disease
abnormal function - incontinence, constipation, IBD
congenital
```
132
how is hepatitis A spread
faecal - orla route
| shellfish
133
what classes of drugs can be given to alleviate GORD
alginates - gaviscon
antacids - magnesium trisillicate
H2RA - ranitidine
PPI - omeprazole, lansopazole
134
what percentage of hep C patients develop silent chronic infections
85%
| 25% get cirrhosis in 20 years
135
how may crohns dies present
diarrhoea
increased frequency
abdominal pain
systemic - malaise, weight loss, anorexia, nausea, fever
136
why must you repeat an endoscopy after treating a gastric ulcer
can lie over a gastric cancer
137
who is most likely to get primary biliary cholangitis
female 90-95%
| peak at 50 years
138
how would you describe a high risk lesion for colorectal cancer
size, number, degree of dysplasia, villous architecture
139
what are complication of GORD
ulceration, oesphagitis, parrets oesophagus
stricture narrowing/ fibrosis
carcinoma
140
how is refeeding syndrome treated
slow correction of fluid depletion, thaiamine
| feeding at 5-10 kcal/ kg/ 24 hours
141
what are indications for surgical resection of the bowel
```
colorectal cancer
benign polyps
diverticular disease
IBD not responding to medical treatment
perforation
ischaemic bowel
```
142
what are signs of chronic liver disease
```
spider naevi, gynaecomastia
palmar erythema
loss pf pubic/ axillary hair
jaundice
ascites
encephalopathy
```
143
what is autoimmune hepatitis
an inflammatory liver disease of unknown cause, characterised by abnormal T cell function and autoantibodies directed against hepatocyte surface antigens
144
what drugs affect oesophageal motility
nitrates, anticholinergics, Ca blockers
145
what are some autoimmune causes of cirrhosis
autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis
146
how does hepatitis A present
fever, malaise, anorexia, nausua, arthralgia then moves to jaundice, hepatomegaly and splenomegaly
most common in 5-14 year olds
147
what is the management for acute abdomen
ABC
surgery
pain relief
restore circulating volume, ensure tissue perforation/ oxygenation, treat sepsis, decompose gut
148
what is the differential diagnosis for GORD
```
oesophagitis
peptic ulcer
non ulcer dyspepsia
oesophageal spasms
malignancy
cardiac disease
```
149
what is constipation
increased transit time or pelvic dysfunction
| Bowel passage may occur infrequently, be painful or faeces hard and small
150
what are the main symptoms of cholestasis
pruritus, pale stools, dark urine, pain , jaundice
151
how is hepatitis B spread
blood, sexual, mother to child, IV drug abuse
152
what is acute pancreatitis
an acute inflammatory process of the pancreas with variable involvement of other regional tissue or remote organ systems (serum amylase x4)
153
how is gastric cancer diagnosed
endoscopy and biopsy
154
what is the gold standard treatment for achalasia
endoscopic balloon dilatation of LOS
| also hellers cardiomyotomy - surgical division on muscel fibres in LOS
155
what is shock staged 1-4 on
```
volume/ % of blood lost
RR - tachypnoea
HR - tachycardia
BP - hypotension
pulse pressure
conscious level - anxious/ confused
urine output - oliguria
```
156
what anatomical abnormality commonly leads to GORD
hiatus hernia
157
how would you investigate IBD
bloods - FBC, ESR, SRP, platelet, LFT, culture, U&E
stool tests
AXR - shadows, mucosal thickening, dilatation
Lower GI endoscopy (stable) + biopsy (crohns)
158
what is the value of circulating bilirubin for a patient to become jaundice
> 34umol/ L - normal 17
159
how may primary biliary cholangitis present
often asymptomatic
| fatigue, pruritus, diarrhoea, jaundice
160
which tests can be done to investigate the pancreas exocrine function
Lundh, pancreolauryl
161
what is the treatment for ascites
diuretics , spironolactone
| or large volume paracentesis
162
what are skin manifestations of IBD
pyoderma gangrenosum
| erythema nodosum
163
what behaviours may be seen in anorexia nervosa
```
self starvation
self induced vomiting
compulsive exercise
laxative use
diet pills
herbal medicines
overexposure to the cold
```
164
what is the cardinal feature of achalasia
failure of LOS to relax after swallowing leading to distal obstruction of oesophagus and absent peristaltic contractions
165
how would you investigate a liver tumour
biopsy - histological diagnosis
imaging - US/ CT
bloods - FBC, hepatitis serology, LFTs, clotting, alpha- fetoprotein
166
what is the best diagnostic test for a hiatus hernia
barium swallow
167
what are complications of colorectal surgery
```
anaesthetic related
small bowel obstruction
wound hernia
bleeding
sepsis
VTE
```
168
how may achalasia present
progressive dysphagia (liquids -> solids)
chest pain - substernal cramps
regurgitation
weight loss
169
what is a liver tumour marker
alpha - feto protein (serology test)
170
what may be done to stage gastric cancer
CT chest and abdomen
171
what are the main constituents of gallstones
50-80% cholesterol
| calcium, carbonate, palmitae, phosphate, bilirubin
172
how may you investigate cholagniocarcinoma
USS
ERCP
CT at level of obstruction
bloods - increased bilirubin/ ALP
173
what are cardinal features of intestinal obstruction
pain, constipation, vomiting, distension
| borborygmi - gurgling due to gas
174
describe the heartburn related to GORD
burning, retrsternal discomfort, related to meals, lying down, stooping, straining, relieved by antacids
175
what is a mallory weiss tear
linear tear at the oesophageal - gastric junction followed by protracted vomiting and retching (alcoholics)
90% heal themselves
176
what is the treatment for haemorrhoids
Milligan morgan open haemorrhoidectomy - very painful
| banding (tight band around base cuts of blood supply and they fall off)
177
what are complications of liver failure
```
sepsis
hypoglycaemia
GI bleeds/ varices
encephalopathy
cerebral oedema - mannitol
```
178
what is the prognosis of gastric cancer
very poor - 5 year <20 %
179
what is required before a colonoscopy
bowel prep
180
what is the prognosis of a liver transplant
1 year - 80%
| 5 year - 60-90%
181
what are signs of alcohol withdrawal
raised pulse, low BP
tremor, fits
confusion, hallucinations
182
why is an IgA test not reliable in coeliac disease
3% of coelaics don't make IgA
| HLA status - 97% are HLA DQ2/ DQ8
183
what steroids may be used to treat IBD
prednisolone - 40mg optimal dose
| budesonide - ileal/ ascending colon only, 1st pass metabolism
184
What may be the cause of vomiting if it relieves pain
peptic ulcer
185
when is an osmotic laxative good for treating
hepatic encephalopathy
| produces osmotic diarrhoea, discouraging the growth of ammonia producing organisms
186
what is stool frequency like in IBS
constipation alternating with diarrhoea
187
what is the pyramid medical management of IBD
```
5ASA
steroids
immunosuppresants
biologics
surgery
```
188
define irritable bowel syndrome
mixed group of abdominal symptoms for which no organic cause can be found
189
what stool tests would you do to investigate IBD
MC&S, CDT - exclude campylobacter, C difficile, salmonella, shigella, Ecoli
faecal calprotectin
190
why is referring after long periods of starvation potentialy dangerous
major fluid and electrolyte shift - K, Ca, S, Mg, insulin
191
what liver enzyme is liekly to be high in an alcoholic
GGT
| AAT:ALT >2
192
what are pre - hepatic causes of jaundice (un- conjugated bilirubin)
Heamolysis - increased quantity of bilirubin
| Impaired transport/ liver uptake/ conjugation
193
how may you investigate a jaundice patient to find the cause
most important - abdominal ultrasound - shows site of obstruction
liver screening test
urine - if bilirubin is present it is pre- hepatic
LFT
anemia
liver biopsy if ultrasound normal
194
describe the pain presentation of IBS
```
abdominal
altered by bowel action
variable - vague/ sharp/ burning
occasionally radiates to back
rarely happens at night
```
195
what is the accepted definition of constipation
passage <2 bowel motions/ week, often passed with difficulty, straining, or pain and a sense of incomplete evacuation
196
what are complications of primary biliary cholangitis
osteoporosis
malabsorption of fat soluble vitamins
hepatocellular carcinoma
197
what is classed as a sever attack of ulcerative colitis
> 6 stools a day +
| fever, tachycardia, high ESR/ CRP/ platelet, low albumin anaemic
198
what is the treatment for Dukes B/C colorectal caner
chemotherapy
199
what is angiodysplasia
abnormal collection of small blood vessels found in the mucosa of the GI tract, from the degeneration of previousy healthy blood vessels
200
what is achalasia characterised by
disorder of the oesophagus characterised by uncoordinated or abscent contracts of oesophageal smooth muscel and incomplete relaxation of LOS, leading to difficulty swallowing
201
how are oesophageal and gastric varices treated
glue injection
| IV terlipreesin - vacoconstricter of splanchnic blood supply (reduces portal pressure)
202
how may oesophageal carcinoma present (usually late)
```
progressive dysphagia
odynophagia
hematemesis
weight loss - anorexia
cough
vocal cord paralysis
chest pain (heartburn)
```
203
what % of Barretts oesophagus turn into oesophageal adenocarcinoma
6%
204
how may a cholangiocarcinoma present
```
obstructive jaundice (painless)
itching
fever, mailaise, weight loss
abdominal pain
peak at 80 years
```
205
what metabolic associations are there with NAFLD
diabetes mellitus, obesity, hypertension, dyslipidaemia
206
how may you investigate a colonic cause of a lower GI bleed
flexible sigmoidoscopy
| full colonoscopy
207
what liver failure patients have the worst prognosis
```
age >40
garde 3-4 encephalopathy
albumin <30 g/L
raised INR >1.5
drug induced
```
208
what blood investigations may be done for liver failure
```
FBC
U and E
LFT
clotting - raised INR
glucose
paracetamol level
```
209
why may a liver transplant be needed to treat a patient with hep D
very resistant to treatment as patients normally have sever chronic hepatitis
210
how may gastric cancer present
weight loss, nausea/vomiting
early satiety
iron deficiency anaemia
Gi bleeding
211
what are the parameters for an upper and lower GI bleed
upper - oesophagus, stomach, duodenum proximal to ligament trietz
lower - distal duodenum to rectum
212
what is the most used stimulant laxative
senna
213
how is barretts oesophagus treated
endoscopic mucosal resection
| radio frequency ablation - current strips away mucosal layer allowing squamos cells to regrow
214
what are the risk factors for developing NAFLD
```
age
obesity
ethnicity (hispanics)
diabetes
genetic factors
```
215
what is the different diagnosis for dysphagia that is intermittent or constant
intermittent - oesophageal spasm
| constant - malignant stricture
216
a patient presents with dysphagia - what is your differential ?
peptic ulcer/ non ulcer dyspepsia
Oesophagitis/ gastritis/ duodenitis
GORD
gastric malignancy
217
what is the treatment for gastritis
lifestyle - smoking and lcohol
H pylori eradication (PPI + 2 antibiotics)
drugs to reduce acid - PPIs, H2RA
218
what is the main treatment for NAFLD
lifestyle
diet , exercise, weight reduction
no alcohol
control risk factors
219
what are complications of pancreatitis
```
abscess
fluid collection
pseudocsyst (fluid collection without a lining)
pancreatic necrosis
biliary obstruction
chronic - cancer, cirrhosis
```
220
what is a variceal haemorrhage
back flow of blood due to portal hypertension
| - oesophageal, gastric, rectal, skin (caput medusa)
221
what is oesophageal squamous cell carcinoma associated with
achalasia, strictures, fistulas (trachea - pneumonia)
222
which type of IBD is more likely to have goblet cell depletion and crypt abscesses
Ulcerative colitis
223
what are signs of pancreatic cancer
```
painless obstructive jaundice
thrombophlebitis migrans
hepatomegaly/ splenomegaly
abdominal mass
supraclavicular lymphadenopathy
```
224
what are surgical indications of crohns
failure of medical management
relief for obstructive symptoms
management of fistula/ anal conditions
anal crohns - tempora stoma to allow chance to heal
225
which drugs, used to treat osteoporosis, are corrosive to the oesophagus
bisphosphonates
226
what contrast imaging can be used to investigate the bowel
barium enema
227
what investigations may be used to stage oesophageal cancer
CT
endoscopic ultrasound
PET scan for mets
228
what is Meckel's diverticulum
sac/ puch formed at weak points in the walls of the GI tract due to a congenital abnormality in the ileum with gastric remnant mucosa
Meckel's scan - nuclear scintigraphy
229
at what BMI can physical impairment and severe consequences occur
physical impairment - <18
| sever consequences - <16
230
what are advantages of laparoscopic surgery
less scarring
less pain
faster recovery
shorter hospital stay
231
what drug is give to help with pruritus (PBC, PSC)
colestyramine
232
what are key questions to ask someone with dysphagia
difficulty swallowing solids and liquids form the start?
difficult to initiate swallowing? (bulbar palsy)
Odynophagia?
intermittent or constant?
does neck bulge or gurgle on swallowing? (pharyngeal pouch)
associated features - weight loss
233
what gene is mutated in 95% of pancreatic cancers
KRAS2
234
how would you confirm Barretts oesophagus
appearance on endoscopy must be confirmed by biopsy
235
what is the blatchford score
pre endoscopy score
> 6 - need investigation
(blood urea, haemoglobin, systolic BP. hepatic disease, cardiac failure)
236
how is the pain described in chronic pancreatitis
epigastric pain - radiate to back
relieve by sitting forward or hot water bottles
exacerbated by food and alcohol
237
what are risk factors for developing a peptic ulcer
- h. pylori - produces urease/ ammonia that buffer gastric acid to increase production
- NSAID use - reduced mucus and bicarbonate excretion
- alcohol excess/ smoking
- impaired coagulation (anticoagulants/ antiplatelets)
238
where does crohns disease commonly affect
small intestine - 30%
ileo- coeacal - 40% - appendicitis
colon/ rectum - 30%
239
what is the main cause of acute <2 weeks diarrhoea
gastroenteritis
240
what imaging may you use for pancreatitis and why
ERCP
USS - gallstones, pancreatic oedema
CT scan (4-10 days) necrosis, abscess
241
what is crohns disease
patchy disease anywhere form mouth to anus, which may skip lesions leaving unaffected bowel between areas of active disease
242
what are the main 2 diseases that make up inflammatory bowel disease
crohns disease
| ulcerative colitis
243
what investigatiion can be done to look at the portal and hepatic vein (budd-chiari)
doppler flow studies
244
what is HNPCC
autosmal dominant condition causing DNA micro satellite instability / frequent mutations
early onset - 40s
245
what is Courvoisers sign in a jaundice patient
palpable gall bladder - obstruction beyond cystic duct (normal malignant)
246
what are the 3 most common causes of small intestine malabsorption
coeliac disease
crohns disease
chronic pancreatitis
247
what infection is strongly associated with gastric cancer
H pylori
248
If someone has any of the ALARM features, what should you do?
refer for an endoscopy
249
what may cause and intestinal obstruction
hernias, adhesions, tumours, strictures, anatomical abnromality
250
what are complications of portal hypertension
ascites
spenomegaly
oesophageal varices
caput medusa
251
describe the CAGE alcohol screening
```
2 or more of;
feel need to CUT down
have you been ANNOYED by being told to stop drinking
ever felt GUILTY
ever had an EYE opener
```
252
what is the rockall score
upper GI bleed - risk of mortality and risk of further bleeding
(age, shock, co-morbidity, diagnosis, recent haemorrhage)
253
what is the NICE guideline for diagnosing IBS
abdominal pain relieved by defeacation or associated with altered stool form/ frequency plus 2 of;
- altered stool passage
- abdominal bloating
- symptoms made worse by food
- passage of mucus
254
what is the clinical course of hepatitis A
presents after 2/3 weeks with fever --> jaundice and settles in 2-3 months (usually self limiting)
255
what are complications of a colonscopy
perforation, bleeding
256
how is autoimmune hepatitis diagnosed
liver biopsy
| elevated IgG 1, 2, 3 +ve autoantibodies
257
how does gall stone most commonly present
asymptomatic - found accidentally on scans
258
what is constructional apraxia (sign of liver failure)
can't copy 5 pointed star
259
what result should you get for foecal calprotectin in IBS
negative
260
what may cause oesophagitis
```
reflux oesophagitis - regurgitate acid and peptic juice
alcohol
infection
hiatus hernia
bisphosphonates - corrosive
```
261
what is dyspepsia
indigestion - non specific group of symptoms related to the upper GI tract
262
who is GORD due to para- oesophageal hiatus hernia common in
obese >50
| treat with lifestyle management
263
what are signs of a decompensated liver function
ascites, vatical haemmorhage, hepatic encephalopathy, jaundice
264
what is the surgical treatment of oesophageal cancer
oesophagectomy (stomach as conduit)
must be localised and <70
10% mortality - long post op recovery and require nutritional support
265
how dosecondary peritionitis occur
rupture of perforation of an abdominal organ
266
when and what immunosuppressants may be used in IBD
maintenance of remission/ steroid sparing
| azathioprine, methotrexate, ciclosporin
267
what are haemorrhoids
enlargement of the normal spongy blood filled cushions in the wall of the anus
nomally caused form straining - not painful
268
what are coeliacs allergic to
gliadin fraction of gluten - found in wheat rye and barley but not rice, maize or oats
269
what drug can cause an anal ulceration
nicorandil (stop and ulcers heal)
270
what percentage of GI bleeds occur in already hospitalised patients
26%
271
what may cause blood diarrhoea
campylobacter/ e.coli
IBD
colorectal cancer
colonic polyps
272
what are haemorrhoids
enlarged vascular cushions around the anal canal - associated with straining, constipation or low fibre diet
273
when does crohns disease peak
20- 40 M=F
| >60 - F>M
274
what is the treatment of an anal fissure
vasodilator - topical NO, GTN paste, stool softener
| surgical - internal spincterotomy (cut muscle of anal sphincter)
275
what is steatorrhea characterised by (fat malabsorption)
increased gas, oily/ floating stools, offensive smell
| consider pancreatic insufficiency or biliary obstruction
276
what is gastritis and how may it present
inflammation of the lining (mucosa) of the stomach
| presents epigastric pain and vomiting
277
what is the prognosis for a patients with alcoholic hepatitis if they stop or continue drinking
continue - 50% at 1 year
| stop - 90% at 1 year
278
how may peritonitis present
diffuse abdominal pain, fever, swelling
279
which type of peptic ulcer is most common
duodenal over gastric
280
what is the diagnostic test for hepatitis C
antibody against HCV
| HCV- PCR confirms ongoing infection
281
what is a cutaneous manifestation of coeliac disease
dermatitis herpetiformis - blistering and intensely itchy, on scalp, shoulders, elbows and knees
282
in primary biliary cholangitits, what happens to the interlobular bile ducts
interlobular bile ducts are damaged by chronic granulomatous inflammation causing progressive cholestasis, fibrosis, cirrhosis and portal hypertension
283
what imaging can be done to investigate colorectal cancer
barium enema
CT colonography (3D colonoscopy) - can't tolerate bowel prep
CT abdome, pelvis
PET scan
284
what are complications of a liver transplant
acute rejection
sepsis (esp. gram -ve)
hepatic artery thrombosis
disease recurrence
285
what 2 scores are used to assess the risk of an upper GI bleed
rockall score
| Blatchford score
286
what symptoms will be seen with choledolithiasis (gall stones in bile duct)
obstructive jaundice - painful, dark urine, pale stool, pruritus, steatorrhoea
287
how is angiodysplasia treated
endoscopic coagulation with ;
embolisation on angiography
argon plasma coagulation
288
what is the criteria for pancreatic surgery
tumour <3 cm , no mets
good respiratory / cardiac function - CXR, ECG, respiratory function tests
psychological scoring system
289
where do squamous cell oesophageal carcinomas occur
proximal and middle 1/3
290
what staging is used for colorectal cancer
```
Dukes classification (A- D)
TNM
```
291
how is coeliac disease treated
lifelong gluten free diet
292
how may primary sclerosing cholangitis present
pruritis and fatigue
| if advanced - jaundice, cirrhosis, hepatic failure
293
what does vomiting in the morning suggest
pregnancy - do test
294
what causes the oesophageal tissue to become resistant to acid/ bile in GORD (erosive)
increased relaxation of LOS --> delayed oesophageal emptying --> decreased acid clearance --> mucosa exposed to acid/ pepsin/ bile
295
what modes are used to screen for colorectal cancer
foecal occult blood test (FOBT)
foecal immunochemical test (FIT)
flexible sigmoidoscopy (2/3 occur in left bowel)
296
what is a whipples procedure
anastomoses of duodenum, pancreas and stomach
297
what mechanical blocks can cause dysphagia
malignant stricture (pharyngeal, oesophageal, gastric)
extrinsic pressure - lung cancer, lymph nodes, goitre
pharyngeal pouch
298
what are pathological types of pancreatic cancer
75% adenocarcinoma (duct cell mutinous)
carcinosarcoma
cystadenocarcinoma
acinar cell
299
what is the most common histological diagnosis of colorectal cancer
adenocarcinoma
| 75% tubular, 10% villous, 15% tubulovillous
300
how is pancreatic cancer pain relieved
sitting forward
301
what is the symptomatic treatment for dyspepsia
PPIs, H2R antagonist, lifestyle factors
302
what is an anal fissure
break or rent of the mucosa of the anal canal, which commonly presents with anal pain during and immediately following defecation and the passage of bright red fresh blood (more common in young)
303
what drugs can be used to treat alcohol dependence
Acamprosate - anxiety/ craving
| Disulifiram - unpleasant side effects to any alcohol
304
why is nutrition vital in alcoholic hepatitis
100% are malnourished, 33% severe
305
what is familial adematous polyposis (FAP)
autosomal dominant mutation causing >100 adenomas throughout colon with a high risk of malignant change in early adulthood (<40)
50% by 15 , 95% by 35
306
how may you want to investigate diarrhoea
```
FBC , ESR, CRP (anaemia/ infection)
U& E - low K in sever diarrhoea
coeliac serology
foecal calco-rotino - IBS/ IBD
lower GI endoscopy
examination - dehydration, low skin turgor, long capillary refil
```
307
what are consequences of malnutrition
```
impaired immune response
reduced muscle strength
impaired wound healing
impaired recovery from illness
more GP appointments
```
308
where are the commonest liver tumours metastases from
breast, bronchus, GI tract
309
what are disadvantages of laparoscopic surgery
longer operation time
can't have had previous abdominal surgery
must be consented for open surgery
310
what are colonic causes of a lower GI bleed
diverticular disease, haemorrhoids, polyps, ischamic colitis, IBD, radiation proctitis
311
how may ulcerative colitis present
diarrhoea - episodic or chronic
abdominal pain - cramps
increased bowel frequency
systemic - weight loss, fear, malaise, anorexia
312
what can cause pancreatitis
| I GET SMASHED O
```
idiopathic (10%)
gall stones - raised duct pressure
ethanol (alcohol)
trauma
steroids
malignancy/ mumps and other infections
autoimmune
scorpion bite
hyperlipidaemia/ hyper Ca (metabolic)
ERCP
drugs
obstruction of duct - sphincter of oddi dysfunction/ duodenal obstruction
```
313
what is bilirubin and its metabolism
breakdown product of haemoglobin - conjugated with glucuronic acid by hepatocytes, secreted into bile and passes out into the gut
314
what are magenta stools
red/ purple stools - typically from right colon or distal small bowel
315
if someone with colorectal cancer has iron deficiency anaemia, where is the malignancy most likely to be
right sided
316
what is the difference between water brash and acid brash (GORD)
acid brash - acid or bile regurgitation
| water brash - excessive salivation
317
what are common presentations of anorectal disease
pain - sharp or dull
haemorrhage - black or red
dysfunction - constipation or diarrhoea
altered frequency - night , caught short
318
what are the risk factors for developing gastritis
```
alcohol
NSAIDs
H pylori
hiatus hernia
Granulomas - crohns, sarcoidosis
```
319
how may a primary liver tumour present
```
very rare
fever, fatigue, weight loss, anorexia, RUQ pain/ mass
jaundice is late
hepatomegaly
decompensated liver function
```
320
what are symptoms of pancreatic cancer
upper abdominal pain - radiate to back
| weight loss, anorexia, nausea, fatigue
321
how is hepatic encephalopathy treated
underlying cuase
laxatives to clear out bowel
reduce protein/ salt intake
antibiotics
322
how would you treat spontaneous bacterial peritonitis
Iv antibitoics
| drain ascites fluid
323
what are the symptoms of diffuse oesophageal spasm
intermittent dysphagia and severs episodic chest pain (may be confused with ACS)
324
what is oesophageal adenocarcinoma associated with
Barretts oesophagus / GORD
325
what is a common history for a fistula in ano
abscess in rectum - never healed/ burst creates hole
| crohns disease - between adjacent loops of bowel or bladder/ vagina/ skin
326
which enlarged node suggests an intrabdominal malignacny
VIrchows - (dysphagia)
327
what does chronic liver failure result from
massive necrosis of liver cells leads to severe impairment of function
328
what criteria is used to diagnosis HNPCC
amsterdam / bethesda
| genetic testing
329
what may be a differential diagnosis for hepatic encephalopathy
infection
hypoglycaemia
intra- cranial bleed form fall
delirium
330
how is autoimmune hepatitis treated
immunosuppressant - prednisone or long term azathioprine
331
how would you treat hepatitis B
pegylated interferon alpha
| oral antiviral drugs
332
what percentage of colorectal cancers have a familial risk
10 %
5% inheritable conditions - HNPCC/ FAP
(85% sporadic)
333
what are some acquired anorectal disorders
```
haemorrhoids
fissure
abscess (drain)
fistula - in - ano
ulceration
cancer
```
334
what are signs of liver disease on the body
```
spider nave
xanthelasma
loss of body hair
gynaecomastia
ascites
hepatomegaly/ splenomegaly
```
335
what clues in history may lead to jaundice
```
alcohol
IV drug use
anaemia
risk factors for liver disease
family history
blood transfusion
```
336
what are risk factors for developing pancreatic cancer
smoking/ alcohol
chronic pancreatitis
type II diabetes
hereditary FAP
337
what are the risk factors for gastroenteritis
travel, diet change, contact with D&V, on PPI,
338
what is the common pain for appendicitis
midgut colic --> local right flank
339
what is radiation proctitis
previous history of radiotherapy causes inflammation of the rectum
340
which classification system is used for IBD and how does it distinguish the two types
Montreal
crohns - age, location, behaviour
uc - extent and severity
341
how can gastric cancer spread
direct - surrounding structures
lymphatic
blood - liver
transcoelomic spread - within peritoneal cavity, can lead to rapid dissemination of tumour cells
342
Why can hepatitis D only be present with hepatitis B
needs HBsAg to activate core
343
if there is faecal calprotectin in the stool what does this indication (>200)
inflammation
344
what are 2 common benign tumours of the liver
haemangiomas
| adenomas
345
how is hep E transmitted
pigs
| highest mortality in pregnancy
346
how does a fatty liver appear on ultrasound
area of brightness
347
what surgery is done to treat ulcerative colitis
sub total colectomy with rectal preservation and an ileostomy
348
if someone presents with epigastric pain, what should you ask if it relates to
hunger, specific foods, time of day, aggravating, intermittent or constant
349
what are causes of ascites
```
infections
cirrhoiss
portal hypertension
heart failure
cancers in abdomen - liver and ovarian
```
350
what should you suspect if a patient has odynophagia
ulceration - malignancy, oesophagi's, viral infection, poor steroid inhaler technique
351
what is the presentation of hepatitis B
fever, mailasia, anorexia, nausea
| incubation period of 1-6 months
352
what LFT would you expect to see in cirrhosis
raised bilirubin, AST, ALT, ALP , GGT
353
what is the lifestyle treatment for GORD
diet, exercise, stop smoking, small regular meals
| avoid hot drinks and alcohol, eating 3 hours before bed
354
what is a functional GI disorder and what diseases does the term include
diseases with no detectable pathology but have symptoms related to function
oesophageal spasm, non-ulcer dyspepsia , IBS, slow transit constipation, biliary dyskinesia
355
what are risk factors for developing oesophageal adenocarcinoma
obesity, male, middle age, causcasian
356
what is the difference between IBS-C and IBS- D
c- muscualr contractions are stronger and more frequency (triggers include walking and eating)
d - muscular contractions are reduced with reduced response to tiggers
357
which drug can cause a GI bleed
NSAIDs
| also anti coagulants / antiplatelets
358
what drug can be used in sever cases of IBS
linaclotide - for bloating and constipation
359
why does pre- hepatic jaundice give normal coloured urine
unconjugated bilirubin is insoluble so doesn't enter urine
360
what are common causes of constipation
```
poor diet/ fluid intake
IBS
colorectal cancer (+ rectal bleeding)
stricture/ gi obstruction (+ active bowel sounds)
hypothyroid (+ mennorhagia)
opiates
neuromuscular conditions - slow transit
chronic laxitive abuse
```
361
what is the medical term for a black stool
melena
362
what are the age guidelines of how frequently an IBD patient should have a colonoscopy
8-20 years - 3 years
3-40 years - 2 years
40+ - annual
363
what is the most common liver disorder in western industrialised countries
Non alcoholic fatty liver disease (NAFLD) - 20%
364
what is the name of the disease caused by tropheryma whippelii that leads to small intestine malabsorption
```
whipples disease
(skin, brain, joint, cardiac manifestation)
```
365
what is the difference between mild and sever pancreatitis
mild - minimal organ dysfunction and uneventful recovery
| sever - organ failure or local complication (15% mortality)
366
what organs are affected in anorectal cancer
skin AND adenocarcinoma of bowel
367
what percentage of pancreatic caners are inoperable
<10 % - advanced disease + metastases
368
what does heartburn feel like
retrosternal pain with acid reflux
369
in blood tests for chronic pancreatitis , what would you expect to be raised and low?
raised - LFT, glucose, prothrombin time
| low - albumin, Ca, Mg, vitB12
370
when should you investigate constipation
weight loss, abdominal mass, anemia, post rectal bleeding
371
what are high risk features for a patient with rectal bleeding
persistant changes in bowel habit >6 weeks
persistent rectal bleeding without anal symptoms
right sided abdominal mass
palpable rectal mass
unexplained iron deficiency anaemia
372
what is the criteria for high risk of refeeding syndrome
1 or more of - BMI <16, weight loss >15%, no intake in > 10 days, low K, P, Mg
2 or more of - BMI <18.5, weight loss >10%, no intake in >5 days, drug/ alcohol abuse
373
what scores are used to asses alcohol history
CAGE
| FAST
374
what investigations can be used to see the anatomy of the pancreas
EUS, US, CT
| size, cysts, duct diameter, tumour
375
what occurs in Barretts oesophagus
intestinal metaplasia due to prolonged acid exposure in the distal oesophagus (stratified squamous --> simple columnar, mucus secreting, gastric epithelium)
376
what major surgery is given to those with cholangiocarcinoma
major hepatectomy + extra hepatic bile ducts + caudate lobe resection
(stenting biliary trees improves quality of life)
377
what are clinical signs of ascites
```
dullness in flanks / shifting dullness
spider navei
palmar erythema
abdominal ven distension
factor hepaticas (smell)
```
378
what is the differential diagnosis for duodenal ulcers
non ulcer dyspepsia
duodenal Chrohns
pancreatic caner
379
what is the treatment for Dukes A colorectal cancer/ polyps
endoscopic resection
380
what is the treatment for H pylori
1 week eradication therapy - PPI + 2 antibiotics
381
how is hepatitis A diagnosed (RNA virus)
rise in IgM antibodies or AST/ ALTs
382
what is the major haemorrhage protocol for a GI bleed
```
A
Breathing - O2 sats
C - Iv fluids, blood transfusion
D
Endoscope once stable
```
383
how may someone with a peptic ulcer present
dyspepsia (indigestion), weight loss, collapse, decreased urine output, melena/ hematemesis
384
how may alcoholic hepatitis present
fever, malaise, anorexia, diarrhoea and vomiting
| signs of decompensating liver
385
what is an alcoholic
someone whose problematic pattern of alcohol use leads to significant impairment or distress, manifested by multiple psychological, behavioural or physiological features
386
how is hepatitis C spread
blood transfusion, IV drug abuse, sexual contact
387
what drugs are hepatotoxic
```
paracetamol
methotrexate
isoniazid
oestrogen
salicyclates
```
388
what are side effects of azathioprine (immunosuppressant)
```
leukopenia
pancreatitis
hepatotoxity - blood monitoring
lymphoma/ skin cnacer
up to 285 intolerant
```
389
what is the difference between steatosis and steatohepatisi
steatosis - fat deposited in the liver
| steatohepatitis - fatty liver with inflammation
390
when does UC peak
20-40 , F>M
391
what are complications of hepatitis B
cirrhosis, ESLD, hepatocellular carcinoma, polyarteritis nodosa
392
what is the final treatement for GORD
anti- reflux surgery fundoplication (increases LOS pressure)
393
how is hepatitis C treated
IFN free combination of direct acting anti- viral drugs
394
what is the treatment for primary biliary cholangitis
symptomatic - pruritus, diarrhoea, osteoporosis
vitamin prophylaxis A D E K
UDCA - bile acid flushes out bile salts from liver
395
how do you decide when to investigate someone for colorectal cancer if they are >60 or >40
>60 - 1 symptoms
| >40 - more than 1 symptom
396
what is diarrhoea defined as
increased stool frequency and volume with decreased consistency
397
what is the mean survival of inoperable pancreatic cancer and 5yr survival
mean - <6 months
| 1% 5 year survival
398
what are signs of liver disease on the hands and nails
```
leukonychia - white spots (hypoalbuminaemia)
terrys nails - distal 1/3 reddened
clubbing
palmar erythema
dupuytrens contracture
```
399
what is hepatic encephalopathy
condition in which brain function is impaired by the presence of toxic substances (NH43), absorbed from the colon, which are normally removed/ detoxified by the liver
400
how should all patients with ascites be investigated
```
ultrasound
diagnostic paracentesis (needle aspiration ) for cell count, protein and albumin concentration (SAAG)
```
401
what symptoms may be seen in jaundice
biliary colic - RUQ pain, nausea/vomiting, self limiting in a few hours
dyspepsia symptoms
402
what are the alarm symptoms
```
A - anorexia (lack of appetite)
L- loss of weight (unintentional)
A - anaemia (iron deficiency)
R - recent onset (> 55 years or persistent without treatment)
M - maleana/ haematemesis or mass
S - swallowing problems (dysphagia)
```
403
in post hepatic/ obstructive jaundice / why is urine dark and stools pale
conjugated bilirubin is water soluble so makes urine dark but as less conjugated bilirubin enters the gut the faeces become pale
404
how may coeliac disease present
```
diarrhoea/ stetorhea
abdominal pain/ bloating
weight loss
anaemia - angular stomatitis
fatigue
dermatitis herpetiformis
```
405
when may someone with primary biliary cholangitis receive a transplant
end stage disease
| intractable pruritus
406
what are risk factors for developing cholangiocarcinoma
Primary scelrosing cholangiits
congenital cystic disease
hepatolithisasis
407
what is the overall 5 year survival for cirrhosis
~50%
408
which type of IMD is more likely to have fistulas and granulomas
Crohns
409
how may you investigate a anorectal cancer
digital rectal examination
410
what are varices (oesophageal/ gastric)
abnormally dilated collateral vessels secondary to portal hypertension that can lead to life threatening bleeding
411
what is the aetiology of IBD
mostly unknown
environmental - western?
genetically susceptible
412
how are peptic ulcers treated
endoscopy with endotherapy - adrenaline injection + mechanical clip
lifestyle
413
what factors are considered in the Childs Pugh scoring system for liver disease
```
bilirubin
albumin
prothrombin time
encephalopathy
ascites
```
414
what is the difference between acute erosive gastritis and chronic gastritis
acute erosive - caused by alcohol excess, NSAIDs, major surgery, burns
chronic - H pylori (smoking, chronic alcohol, binary reflux)
415
what imaging would you do to investigate a pancreatic cancer
abdominal ultrasound
endoscopic ultrasound - show mass, distended biliary tree, hepatic masses (biopsy)
CT
ERCP if jaundice
416
what is the 5 year survival for oesophageal cancer
<10%
417
what is Mirrizi's syndrome
obstructive jaundice secondary to compression of the common hepatic duct
418
what are high risk groups for colorectal cancer and how often are they given colonscopies
```
FAP - annual for 10-12 years
HNPCC- 2 years from 25
IBD - 10 years post diagnosis
family risk (high is 3 FDR< 50/ 3 FDR <60) - 5 years from 50
previous CRC - 5 yearly
```
419
what are some post hepatic/ obstructive causes of jaundice
gall bladder - obstruction/ blockage of ducts, gallstones, PBC, PSC
pancreatic cancer
420
what is cirrhosis
irreversibel liver damage - liver replaces damaged tissue with fibrous nodules (knobbly appearnace)
421
what liver enzymes are raised in alcoholic hepatitis
bilirubin, GGT, AlkP
422
what is the medical term for vomiting blood
haematemesis
423
what are complications of achalasia
aspiration pneumonia
| increased risk of squamous cell carcinoma
