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Pathology and final year > Gastro > Flashcards

Gastro Flashcards

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1
Q

RFs for NAFLD

A

Obesity
diabetes
dyslipidaemia
rapid weight loss
total parentral nutrition

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2
Q

describe the progression of NAFLD

A

hepatic fat accumulation without inflammation
–> steatohepatitis,
–> fibrosis,
–>cirrhosis
–> end-stage liver disease.

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3
Q

diagnostic factors of NAFLD

A

dont drink much ETOH
RFs
deranged LFTs
truncal obesity
hepatosplenomegaly
RUQ pain

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4
Q

medications associated with hepatic steatosis

A

tamoxifen, corticosteroids, diltiazem, nifedipine, methotrexate, valproate, griseofulvin, intravenous tetracycline, amiodarone, and antiretroviral therapy for HIV.

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5
Q

AST and ALT in NAFLD

A

both elevated but usually no higher than 300IU/L

AST:ALT ratio usually <1 (which differs from alcoholic LD where ratio is >2)

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6
Q

Investigations for liver conditions

A

Bloods:
FBC- Hb for anemia
U&Es- Uraemia
LFTs + billirubin
lipids
clotting screen
serum albumin
autoimmune Ab screen
Iron studies
Hep B and C

Imaging:
Liver USS/ fibroscan
Abdo MRI

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7
Q

possible signs in a patient for liver disease

A

General:
jaundice
abdo distension
unwell looking
bruising/ petechiae
Bronzed appearance- haemochromatosis

Hands/nails:
Leukonychia and mherkles lines- hypoalbuminaemia
Asterixis- uraemia
dupyutrens contracture- chronic liver disease
clubbing- chronic stable liver disease
palmar erythema

Neck:
raised JVP- right sided heart failure secondary to hepatic congestion

face:
Conjunctival pallor- anaemia
Kayserfleisher rings- Wilsons
corneal arcus- hyperlipidaemia
yellowing of sclera- uraemia, billirubinaemia
Xanthelasma- hyperlipidaemia
angular stomatitis- anaemia

chest:
spider naevi
gynaecomastia

abdo:
Ascites
caput madusae
bruising
hepato/splenomegaly

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8
Q

differentials for NAFLD

A

alcoholic liver disease
autoimmune hepatitis
viral hepatitis

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9
Q

Management of NAFLD

A

Diet and exercise
consider pioglitazone
vitamin E
liver transplant

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10
Q

complications of cirrhosis

A

Ascites
Portal hypertension- splenomegaly, hepatopulmonary syndrome
oesophageal varices
uraemic encephalopathy
Hepatocellular carcinoma
hepatorenal syndrome

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11
Q

signs of chronic stable liver disease

A

Palmar erythema (high oestrogen)
dupyutrens contrcture
clubbing

gynaecomastia (male- failure of liver to break down oestradiol)
spider naevi

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12
Q

signs of portal hypertension

A

SAVE

Splenomegaly
Ascites
Varices
Encephalopathy

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13
Q

pressure in portal venous system

A

5-10mmHg

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14
Q

mechanism of hepatic encephalopathy

A

toxic metabolites such as ammonia/ urea not cleared by the liver
can cross BBB

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15
Q

Mechanism of oesophageal varices

A

portosystemic shunts are made to minimise portal hypertension at 3 points where the potal system meets the systemic system (oesphagus, anus and round ligament)

causes varices which are very fragile and easly rupture casuing massive upper GI bleeding

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16
Q

mechanism of caput medusae

A

round ligament (originally umbilicus at birth and closed off) rechannels blood from portal vein to abdominal veins which dilate

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17
Q

mechanism of splenomegaly in chronic liver disease

A

portal hypertension causes blood to back up into the spleen leading to congestive splenomagaly

–> anaemia, thrombocytopenia and thrombocytopenia as these cells get congested in spleen

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18
Q

mechanism of ascites

A
  1. decreased oncotic pressure from hypoalbuminaemia causes water to leak out
  2. portal hypertension leads to NO release from endothelial cells which causes vasodilation. as a result RAAS is stimulated and more water and Na are retained –> fluid overload
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19
Q

causes of portal hypertension

A

prehepatic
- obstruction
eg. portal vein thrombosis

intrahepatic
- cirrhosis
- sarcoidosis
- schistosomiosis

post hepatic
- right sided heart failure
- constrictive pericarditis
- Budd-chiari syndrome (hepatic vein obstruction eg. thrombus in PCV or a tumor)

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20
Q

Management of decompensated liver disease

A

beta blockers may help portal HPTN

Rifaximin- targets GIT bacteria which will reduce ammonia production

lactulose- improvs ammonia clearance

Ascitic tap for WCC and MC&S to rule out SBP- if previously had give prophylactic ciprofloxacin

Ascites- 20% human albumin solution and diuretics (spironolactone/ frusemide) and drain

OGD to look for varices- band ligation if necessary

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21
Q

signs of decompensated liver disease

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A

Ascites
Jaundice
asterixis
encephalopathy
portal hypertension

22
Q

Main investigations for pt with suspected liver disease

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A

bloods:
FBC- may have anaemia, thrombocytopenia
CRP
U&Es- uraemia
LFTs
Renal function + Cr- hepatorenal syndrome
clotting profile- synthetic marker of liver function
serum albumin

serum hepatitis virology
Immunoglobulins- aSM, amitochondrial, aANCA
caeruloplasmin and Cu- wilsons
Iron studies- haemochromatosis

23
Q

extra hepatic manifestations of haemochromatosis

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A

arthritis
secondary T2DM and insulin resistance
infertility

24
Q

secondary causes of diabetes mellitus

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A

cystic fibrosis
pancreatitis
pancreatic cancer
haemochromatosis
phaochromocytoma
cushings

25
markers of synthetic liver function
albumin clotting platelets (liver makes thrombopoetin)
26
causes of acute liver failure
Hep A&E paracetamol OD TB antibiotics some tropical infections
27
criteria for hepato-renal syndrome
1. Chronic liver disease or acute liver disease with LIVER FAILURE. 2. Poor GFR 4. Absence of volume depletion 5. no nephrotoxic drugs. 6 Absence of shock 7. No evidence of kidney disease (ie proteinuria or haematuria) / Ultrasound shows no obstruction. 8. No improvement in creatinine after withdrawing diruetics or using 1.5 litre of fluid to replete.
28
types of hepato-renal syndrome
Type 1 is rapidly progessing over 2 weeks. Where as type 2 is more slowly progessing and sometimes a cause can be found such as SBP.
29
what are the 2 types of autoimmune hepatitis
Type 1: This is the most common type of autoimmune hepatitis. This type patients have ANTI-SMOOTH MUSCLE ANTIBODIES and ANTI-NUCLEAR antibodies. Type 2: this is rarer, and seen mainly in children, with anti-liver/kidney microsomal type 1 antibodies.
30
emphysema plus cirrhosis
alpha 1 antitrypsin deficiency
31
causes of ascites
3C's and an N Cirrhosis Cardiac failure Cancer Nephrotic synrome
32
what is the SAAG and what are different types/ casues
serum ascites albumin gradient serum albumin- ascites albumin exudative- SAAG <1.1g/dL casues (MINP): malignancy, infection (eg.TB), nephrotic syndrome, and pancreatitis transudative- SAAG >1.1g/dL Casues: Alcoholic hepatitis, Budd-chiari syndrome, cirrhosis, Kwashiorkor malnutrition Another way of differentiating between an exudate and a transudate is to assess the ascitic fluid’s lactate dehydrogenase (LDH) level: LDH <225 U/L = transudate LDH > 225U/ L = exudate
33
causes of chronic liver failure
hep B, C and D alcoholic liver disease Metabolic associated steatohepatitis/ NAFLD rare: Wilsons Haemochromatosis Autoimmune hepatitis alpha1 antitrypsin deficiency
34
complications of cirrhosis
hepatocellular carcinoma portal hypertension- rupture of oesophageal varices ascites and spontaneous bacterial peritonitis clotting dysfunction and bleeding uraemic encephalopathy- confusion, reduced GCS, seizure
35
what is creon
tablet of exogenous pancreatic enzymes
36
causes of pancreatitis
Idiopathic Gall stones ERCP Trauma Steroids Malignancy, mumps Autoimmune Scorpion venom Hhypercalcamia, hypertriglyceride Ethanol Drugs (sulfonamides, azathioprine, NSAIDs, diuretics)
37
Management of GORD
supportive - smaller meals - dont eat 2hrs before bed - avoid citrusy foods medical - gavisocn - PPIs surgical - fundoplication
38
what is the montreal classification of crohns
A- age of onset L- disease location B- disease behaviour A1: ≤16 years A2: 17-40 years A3: > 40 years L1: terminal ileum L2 : colon L3: ileocolon L4: upper gastrointestinal B1: Inflammatory B2: stricturing B3: penetrating
39
what is the montreal classification of UC
extent E1: ulcerative proctitis; involvement limited to rectum (rectosigmoid junction) E2: left sided ulcerative colitis: involvement limited to portion of colorectum distal to splenic flexure E3: extensive ulcerative colitis: involvement extends proximal to splenic flexure severity S0: ulcerative colitis in clinical remission; no symptoms of UC S1: mild UC ≤ 4 bloody stools daily, lack of fever, pulse <90 bpm, haemoglobin >105g/L, ESR < 30mm/hr S2: moderate ulcerative colitis: > 4-5 stools daily but with minimal signs of systemic toxicity S3: severe ulcerative colitis: ≥ 6 bloody stools daily, pulse > 90 bpm, temperatures > 37.5°C, haemoglobin < 105 g/L, ESR > 30 mm/hr
40
eosinophilia plus iron deficiency anaemia
think parasitic infection such as giardia or strongoloides
41
what would you give if someone with Cdiff diarrhoea was not responding to vancomycin?
oral fidaxomicin if fulament colitis suspected then refer to surgery
42
drugs that cause liver cirrhosis
Amiodarone methotrexate methyldopa
43
Drugs that cause cholestasis
clauvulanic acid penicillins oestrogens erythromycin chlorpromazine
44
Infective causes of bloody diarrhoea
E.coli Salmonella shigella campylobacter
45
causes of dysphagia
obstructive: - oesophageal/ gastric carcinoma - oesophageal web - oesophageal strictures - external compression: goitre, thymoma, lung cancer motility issue: - achalasia - stroke - MG - systemic sclerosis - MND - parkinsons
46
scoring systems used in upper GI bleed
Glasgow-Blachford score- calculated before a procedure to determine whether a patient will need to be admitted for medical intervention AIMS65 - used to calculate the risk of in-hospital mortality in patients with an upper GI bleed Rockall score- used after GI endoscopy to determine the percentage risk of rebleeding and mortality in patients with upper GI bleeding
47
differentials for dysphagia
Painful to swallow: - tonsilitis - oesphagitis Mechanical/ obstruction - oesophageal cancer - oesphageal web - oesophageal stricture - external compression (thymoma, goitre, lung Ca) - pharyngeal puch Motility disorder - achalasia - stroke - bulbar/pseudobulbar palsy
48
Ix for non neuro casues of dysphagia
REFERRAL UNDER 2WW to exclue oesphageal Ca OGD Barium swallow manometry
49
Differentials for dyspepsia
GORD Gastric/ duodenal ulcer - NSAIDs, steroids, H.pylori Upper GI Ca Achalasia oesophagitis (think HIV with candida) Functional
50
redflag features with new dyspepsia
ALARM Anaemia Loss of weight Anorexia +/- abdo pain Recent symptoms Meleana/ haematemesis
51
features of a pancreatic pseudocyst
Pseudocysts can be asymptomatic or present with signs of biliary obstruction (abdominal pain, jaundice) or gastric outlet obstruction (post-prandial vomiting) due to mass effect of an enlarging pseudocyst on adjacent structures. There is also the risk of secondary infection

Pathology and final year (21 decks)

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