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MBChB > Gastro > Flashcards

Gastro Flashcards

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1
Q

What is the presentation of an upper GI bleed?

A

Haematemesis
Coffee ground vomiting
Malaena

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2
Q

What are some causes of upper GI bleed?

A

Peptic ulcer (acid, H.pylori, NSAIDs)
Gastritis
Oesophagitis
Varices

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3
Q

Describe the resuscitation required for a patient with upper GI bleed

A 
Pulse + HR - haemodynamically unstable if SBP <100mmHg or HR >100bpm
IV access - fluids and blood (if needed)
Bloods - FBCs, U&amp;Es (urea)
Lie flat
Give O2
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4
Q

What scoring systems can be used to assess how high risk a patient with a GI bleed is? How does this determine clinical management?

A

Rockall and Glasgow Blatchford

High risk = emergency endoscopy
Moderate risk = admit and endoscopy next day
Low risk = out-patient management

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5
Q

If a patient has a bleed due to an ulcer, what should they receive after their bleed?

A

IV PPI for 72 hours

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6
Q

If a patient has a GI bleed, how does this affect Aspirin, NSAIDs, Clopidogrel, Warfarin and DOACs?

A

Aspirin - continue low dose once haemostasis achieved with PPI

NSAIDs - discontinue

Clopidogrel etc - discuss with cardiologist

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7
Q

When should a patient with a GI bleed be given blood?

A

Once Hb is <7-8g/dl

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8
Q

When should a patient with a GI bleed be transfused platelets?

A

Actively bleeding and platelet count <50 x 10^9/L

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9
Q

When should FFP be given to a patient with a GI bleed?

A

INR >1.5

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10
Q

How can oesophageal varies be treated?

A

Endoscopic banding
TIPs
Beta-blockers

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11
Q

How should a patient with oesophageal varies be resuscitated?

A

Restore circulating volume
Transfuse once Hb <7g/dl
Consider airway protection

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12
Q

What drugs should be given in A&E to a patient with oesophageal varies bleed?

A 
Abx
Terlipressin (vasopressin) - constricts the portal vessels
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13
Q

What is the criteria for the diagnosis of acute pancreatitis?

A

2/3 of the following:

  1. Pain in keeping with pancreatitis - pain in central abdomen, radiates to back
  2. Amylase 3x the upper limit of normal (>300)
  3. Characteristic CT appearance
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14
Q

Define mild pancreatitis

A

Absence of organ failure/local/systemic complications

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15
Q

Define moderately-severe pancreatitis

A

Transient organ failure or presence of local/systemic complications in the absence of organ failure

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16
Q

Define severe pancreatitis

A

Persistent organ failure

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17
Q

What are some causes of pancreatitis?

A 
Gallstones - most common
Ethanol 
Trauma
Drugs
Hyperlipidaemia
Mumps
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18
Q

Describe the initial management of pancreatitis

A 
ABCs
Fluid
O2 
Organ support 
Abx - debatable
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19
Q

Why might an NG tube be needed in managing pancreatitis?

A

Acute pancreatitis is a hyper metabolic state
Patient needs calories
May need NG tube

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20
Q

What investigations are needed in managing acute pancreatitis?

A

US to assess for gallstones
MRCP to assess for CBD stones
CT if diagnostic doubt/concerns about complications
Monitor LFTs

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21
Q

What differential diagnoses are there for symptoms relating to acute pancreatitis?

A

Pancreatitis
Perforated DU
Ischaemic bowel

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22
Q

What are the phases of acute pancreatitis?

A

Early phase: systemic disturbance from host response to local pancreatic injury

Late phase: local and septic complications

(Death can occur in either phase)

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23
Q

Describe the management of acute pancreatitis

A 
Treat cause:
ERCP 
Lap Chole
Alcohol addiction advice
Stop meds responsible - often biologics
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24
Q

What is the sequalae associated with pancreatitis?

A 
Complete resolution with/without organ dysfunction
Necrosis with/without infection 
Fluid collection:
Peripancreatic fluid collection
Pseudocyst
Pancreatic fistula
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25
Describe pancreatic necrosis
Detected by serial CT If ongoing sepsis and presence of gas in pancreas - intervention needed: Percutaneous necrosectomy Radiological draining Complications: bleeding/erosion to surrounding structures
26
Describe pancreatic pseudocyst
May settle without intervention (take up to 12 weeks) | If symptomatic drain
27
Describe pancreatic fistula
May require parenteral feeding Endoscopic treatment Salvage distal pancreatomy
28
What are the longterm consequences of acute pancreatitis?
May be diabetic May require creon pancreatic enzyme supplements Significant impact on QoL If gallstones - lap chole
29
Other than liver disease, what could cause a raised ALT and a normal GGT?
Bone
30
If AST is raised, what could be a cause of this (other than liver)?
Muscle
31
If there is an isolated increase in bilirubin, what does this suggest?
Haemolysis
32
What investigations should be performed in acute liver disease?
US Acute viral Hep - specific IgG increase is very suggestive of acute hepatitis Autoimmune disease - ANA, SMA, LKM Paracetamol levels
33
What investigations should be performed in chronic liver disease?
``` US Chronic viral hep (HBV, HCV) Autoimmune - AMA in PBC (increased IgM) Metabolic: Ferritin - haemochromatosis Caeruloplasmin - Wilson's disease ```
34
What are the most common causes of liver disease?
Fatty liver Chronic hepatitis - chronic Hep C Autoimmune liver disease Haemochromatosis
35
What are the common causes of fatty liver disease?
Alcoholic Liver Disease | Non-alcoholic Fatty Liver Disease
36
What are the most common autoimmune liver disease?
Primary biliary cholangitis | Autoimmune hepatitis
37
What are the microscopic features of FLD?
Microvascular stenosis Steatohepatitis Pericellular fibrosis
38
What AST/ALT ratio is seen in ALD?
High AST/ALT ratio >1.5 (AST > ALT)
39
What AST/ALT ratio is seen in NAFLD?
Low AST/ALT ratio <0.8 (ALT > AST)
40
What are the essential features of alcoholic hepatitis?
``` Excess alcohol within 2 months Bilirubin >80umol/L for <2 months Exclusion of other liver disease Treatment of sepsis/GI bleed AST/ALT ratio >1.5 (AST <500) ```
41
What are the characteristic features of alcoholic hepatitis?
Hepatomegaly ± fever ±leucocytosis ± hepatic bruit
42
What are the parameters of the Glasgow Alcoholic Hepatitis Score (GAHS)?
``` Age WCC Urea PT ratio Bilirubin ```
43
What is the non-invasive technique which can be used to assess the degree of liver fibrosis?
Fibroscan The firmer the liver, the greater the degree of fibrosis and the higher the score F4 = cirrhosis
44
What are the blood based assessments of liver fibrosis?
APBI FIB-4 NAFLD fibrosis score
45
Describe some of the physical features of chronic liver disease
Stigmata: spider naevi, foetar (sweet biscuit smelling breath), encephalopathy Prolonged PT, hypoalbuminaemia
46
Describe some of the features of portal hypertension
Caput medusa | Hypersplenism - thrombocytopenia, pancytopenia
47
What scoring system can be used to assess the severity of liver disease?
Childs-Turcotte-Pugh Score
48
What parameters are used in the Childs-Turcotte-Pugh Score?
``` Encephalopathy Ascites Bilirubin Albumin PT prolongation ```
49
What is the scoring system of the Childs-Turcotte-Pugh Score?
Grade A: 5-6 = mild Grade B: 7-9 = moderate Grade C: 10-15 = severe
50
What is the criteria for Spontaneous Bacterial Peritonitis?
Cell count of ascites: | >500 WBC/cm3 or >250 neutrophils/cm3
51
If lymphocytes are present in the ascites, what does this suggest?
TB | Peritoneal carcinomatosis
52
What is SAAG?
Serum ascites albumin gradient | Serum albumin - ascitic albumin
53
If SAAG >11g/l, what is it indicative of?
Portal hypertension
54
If SAAG <11g/l, what is it indicative of?
Infection etc
55
Describe the management of ascites
``` Low NaCl diet Diuretics Paracentesis TIPS Liver transplant ```
56
What diuretics can be used in the management of ascites?
Spironolactone | Frusemide
57
What side effects are associated with Spironolactone?
Gynaecomastia Hyperkalaemia Hyponatraemia Impotence
58
What side effects are associated with Frusemide?
Hyponatraemia
59
When a patient has ascites, what needs to be regularly assessed?
Renal Function | Electrolytes
60
What are common precipitating factors of hepatic encephalopathy?
``` GI bleeding Infections Constipation Electrolye disturbance Excessive dietary protein ```
61
As a doctor, what can you do to prevent making hepatic encephalopathy worse?
Avoid regular sedation Caution with opiates Avoid hyponatraemia Aim for multiple bowel movements per day

MBChB (14 decks)

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