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Clinical lists GI > Gastro > Flashcards

Gastro Flashcards

1
Q

Signs of Portal hypertension?

A

Splenomegaly Ascites

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2
Q

Causes of portal hypertension?

A

Liver cirrhosis and anything that causes this.

Other

  • Presinusoidal
    • portal vein compression e.g lymphoma, carcinoma
  • Intrahepatic
    • Sarcoid
    • Lymphoma
    • Leukaemia infiltrates
  • Post sinusoidal
    • Budd chiari - either idiopathic or due to myeloprolifertaive disease or cancer, or OCP, PNH
    • Constrictive pericarditis
    • Right heart failure
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3
Q

Causes of hepatic decompensation?

A

Alcoholic binge

Hepatoma

Infection - SBP or any other

Sedatives

Metabolic - hypoglycaemia, hypokaelameia or alkalosis

Bleed

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4
Q

Gastro causes of clubbing?

A

Cirrhosis - 1/3

IBD

Coeliac’s Disease

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5
Q

Alcohol signs?

A

Dupuytron’s contraction

Parotomegaly

Midline cerebellar - ataxic gait, no heel toe walk, nystgamus, past pointing, dysdidokinesis, legs more than arms

Cardiomyopathy

Wernicke’s opthalmoplegia

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6
Q

Causes of massive hepatomegaly (5)?

A
  1. NASH
  2. Myeloprolifertaive disease
  3. Right heart failure
  4. HCC
  5. Metastasis
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7
Q

Causes of hepatomegaly ?

A
  • Malignancy
    • HCC
    • Mets
  • Haematological
    • CLL
    • Lymphoma
    • Myeloprolifertaive
  • Chronic Liver disease
    • NAFLD
    • Alcoholic liver with fatty infiltration
  • Vascular
    • Right heart failure
    • Ischaemia
  • Infiltrative
    • Sarcoid
    • Amyloid
    • Haemochromatosis
  • Infection
    • HIV
    • EBV
    • CMV
    • Hyatid cyst
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8
Q

Causes of tender hepatomegaly?

A

Vascular - Right heart failure, Budd Chiari

Acute Hepatits - Alcoholic or viral

Malignancy - HCC, Mets,

Infiltrative - Sarcoid, Amyloid

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9
Q

Causes of hepatosplenomegaly ?

A

Chronic liver disease plus portal hypertension

  • NAFLD
  • Alcohol
  • HCC complicating underlying cirrhosis of any cause

Haematological

  • Myeloprolifertaive disease
  • Lymphoproliferative

Infection

  • EBV/CMV - tender
  • HIV
  • Malaria

Infiltrative

  • Amyloidosis
  • Sarcoidosis
  • CT - SLE, Sjogrens
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10
Q

Causes of high SAAG? >11

A

Cirrhosis from any cause

Alcoholic hepaitits

Fuminant Hepatic failure

Liver mets

CCF

Constrictive pericarditits

Budd chiari

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11
Q

Causes of low SAAG < 11?

A

Peritoneal mets

TB

Pancreatits ascites

Neprhotic syndrome

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12
Q

General signs of chronic liver disease?

A

Spider naevi

Gynaecomastia

Loss of hair

Clubbing

Leuconychia

Palmar eyrthema

Testicular atrophy

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13
Q

Signs of hepatic decompensation?

A

Jaundice

Signs of portal hypertension - Splenomegaly, venous hum, caput medusae

Ascites

Asterixis

Purpura

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14
Q

Causes of ascites?

A

Chronic Liver disease + portal hypertension

Malignancy with peritoneal mets

Right ventricular failure, portal vein thrombosis

Nephrotic syndrome

Rare -Meig’s syndrome (benign ovarian tumour, pleural effusion and ascites), serositis in familial mediterranean fever

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15
Q

Parotid enlargement?

A

Alcohol

Mumps

Sjogren’s

Sarcoid

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16
Q

Moderate spleenomegaly ?

A

Chronic liver disease with portal hypertension

Myeloproliferative disease

Leukaemia/Lymphoma - CLL

Infection - EBV/CMV, malaria

Infiltrative - Sarcoid, amyloid

CT - Felty, SLE

Thalassaemia

17
Q

Causes of massive splenomegaly ?

A

Myeloproliferative

  • Myelofibrosis
  • CML

Primary splenic lymphoma

Hairy cell leukaemia

Malaria

18
Q

Investigating massive splenomegaly ?

A
  • CBE - pancytopenia, or neutrophilia
  • Blood film - tear drop
  • Lymphocyte surface markers/Flow cytometry/Immunophenotyping
  • Mutational analysis - BCR-ABL, JAK - 2, Calreticulin
  • Any endemic travel - thin and thick films

Imaging

  • Ultrasound for cross-sectional analysis
  • Espcially if tenderness for splenic infarct in rapidly expanding spleen

Special test

  • Bone marrow aspirate - dry tap in myelofibrosis
19
Q

Hepato Splenomegaly + nodes?

A
  1. Lymphoproliferative - ALL, CLL, Walderstrom’s, NHL
  2. Infection - EBV/CMV
  3. CT - Felty’s
20
Q

Investigating non-massive splenomegaly?

A

Bloods

  • CBE - pancytopenia, or neutrophilia
  • Blood film - tear drop, Blast
  • Lymphocyte surface markers/Flow cytometry/Immunophenotyping
  • Mutational analysis - BCR-ABL, JAK - 2, Calreticulin
  • Any endemic travel - thin and thick films

Imaging

  • Ultrasound for cross-sectional analysis
  • Espcially if tenderness for splenic infarct in rapidly expanding spleen

Special test

  • Bone marrow aspirate - dry tap in myelofibrosis
  • ? Lymph node biopsy
21
Q

Investigation of heaptosplenomegaly + nodes?

A

Bloods

  • CBE - pancytopenia, or neutrophilia
  • Blood film - smudge cells, blasts
  • Lymphocyte surface markers/Flow cytometry/Immunophenotyping
  • Complications - LDH, Urate

Imaging

  • CT neck, abdo, pelvis - adenopathy to stage above or below diaphragm

Special test

  • Lymph Node biopsy
  • If marrow invasion suspected - bone marrow biopsy for aspirate and trephine
22
Q

Investigation of Hepatomegaly with CLD ?

A

Bloods

  • Synthetic function
    • Bili, INR, Albumin - Childs Pugh
    • Na + Cr - Meld ?
  • Pattern of liver ezyme dernagement - esp ratio AST;ALT, GGT
  • Complications
    • Macrocytosis
    • Thrombocytopenia
    • Biochemistry - Na, Cr
  • Assess for cause
    • Hepatits C and B
    • Iron studies - ferritin and transferrin saturation
    • EBV
    • CMV
    • Autoimmune - Antinuclear antibody, Anti - Liver kidney microsomal, anti - Smooth muscle, Anti-mitochondrial antibody
    • Ceruloplasmin
    • Alpha -1 Anti-trypsin

Imaging

  • Ultrasound - features of HCC, portal hypertension,
23
Q

Investigation for hepatomegaly without signs of CLD?

A

History

  • Chronicity

Bloods

  • Synthetic function
    • Bili, INR, Albumin - Childs Pugh
    • Na + Cr - Meld ?
  • Pattern of liver ezyme dernagement - esp ratio AST;ALT, GGT, cholestasis in RHF

Imaging

  • Ultrasound - features of HCC, portal hypertension, mets, cysts

Assess for cause if U/S was normal

  • HbA1c
  • Iron studies - ferritin and transferrin saturation
  • Autoimmune - ANA, Anti - LKM, anti - SM, AMA,
  • Ceruloplasmin
  • Alpha -1 Anti-trypsin
  • HIV

In an acute presentation

  • Q fever serology
  • Hepatits B
  • Hepatitis C
  • EBV
  • CMV
24
Q

Hepatomegaly + Ascites + with CLD ?

A
  • Alcohol
  • NAFLD
  • HCC
  • Chronic budd chiari
  • Haemochromatosis
25
Q

Hepatomegaly + Ascites + No CLD?

A
  • Alcoholic hepatitis

Malignancy

  • HCC
  • Mets with peritoneal deposits
  • Lymphoma + chylous ascites

Vascular

  • Budd chiari
  • Right heart failure
  • Portal vein thrombosis
26
Q

Investigation of hepatic decompensation ?

A
  • Synthetic function
    • bil, alb, INR
  • Paracentesis
    • SAAG - transudate vs exudate

Cause of decompensation

  • Recent GI bleed - Hb drop, elevated urea, PR exam
  • Electrolyte abnormalities which could precipitate this
  • Evidence of recent alcoholic hepatitis - ALT;AST, GGT, Macrocytosis
  • Paracentesis - SBP
  • Full sepsit screen
  • Ultrasound to exclude HCC
27
Q

Associations PCKD?

A

Polycystic Kidney disease

  • Hypertension
  • CKD

Extra-renal complications

  • Hepatic cystic disease
  • Pancreatic cysts
  • Ovarian cysts
  • Mitral valve prolapse
  • Cerebral Aneurysms and SAH
28
Q

Investigation of PCKD?

A

Proceed - Urinalysis - infection, haemorrhage

Blood pressure

CBE

  • Anaemia secondary CRF
  • WCC - infected cyst

Biochemistry

  • Creatinine, eGFR, Urea
  • K

Imaging

  • Confirm findings
  • Evidence of hepatic involvement

Urine mc and s

Genetics - ADPCKD

Clinical lists GI (7 decks)

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