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Gastro + HPB Flashcards

(54 cards)

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1
Q

Triad of symptoms associated with ascending cholangitis

A

Fever
RUQ pain
Jaundice

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2
Q

Cullens sign

A

Periumbilical discolouration in acute pancreatitis

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3
Q

Grey-Turner’s sign

A

Flank discolouration in acute pancreatitis

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4
Q

Causes of unconjugated hyperbilirubinaemia

A

Haemolysis - sickle cell, G6PD deficiency, thalassaemia
Medications - Rifampicin, Sulphonamides
Impaired conjugation by the liver - hepatitis, cirrhosis, Wilsons, Gilberts

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5
Q

Intrahepatic/hepatocellular causes of conjugated hyperbilirubinaemia

A 
Hepatitis 
Cirrhosis
Primary biliary cirrhosis
TB
Sarcoidosis/amyloidosis
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6
Q

Extrahepatic/obstructive causes of conjugated hyperbilirubinaemia

A

Gallstones - cholecystitis, cholangitis
Pancreatic cancer
Primary sclerosing cholangitis
Pancreatitis

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7
Q

Colour of stool and urine in unconjugated hyperbilirubinaemia

A

Dark stools

Pale urine

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8
Q

Colour of stool and urine in conjugated hyperbilirubinaemia

A

Pale stools

Dark urine

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9
Q

Antibodies associated with PBC

A

Anti-mitochondrial

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10
Q

Antibodies associated with PSC

A

ANA and anti-smooth muscle

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11
Q

Typical presentation of Gilberts syndrome

A

Unconjugated hyperbilirubinaemia

Mild jaundice during times of stress

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12
Q

Blood test markers of haemolysis

A

Raised LDH
Raised unconjugated bilirubin
Low haptoglobin

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13
Q

Consequences of impaired liver function

A

Bleeding
Ammonia build up + hepatic encephalopathy
Ascites (low albumin)
Less bile - less fat soluble vitamin absorption
Raised estrogen
Impaired medication metabolism
Low vitamin D

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14
Q

Classification system for liver cirrhosis

A

Child-Pugh score

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15
Q

Blood results for Hep A - acute and chronic

A

Acute: IgM anti-HAV
Chronic: IgG anti-HAV

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16
Q

Blood results for HBV vaccination only

A

Antibody to HBV surface antigen only

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17
Q

Blood results for acute HBV infection

A

Surface antigen
IgM anti-core
HBV DNA

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18
Q

Blood results for chronic HBV infection

A

Surface antigen
IgG anti-core
HBV DNA

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19
Q

Which blood test can be used to screen for hepatocellular carcinoma

A

AFP (alpha fetoprotein)

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20
Q

Blood results for previous exposure to HCV

A

HCV antibody positive

RNA negative

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21
Q

Blood results for chronic HCV infection

A

HCV antibody positive

RNA positive

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22
Q

Blood results for HAV prior infection/acquired immunity

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A

IgG anti-HAV positive

23
Q

Blood results for acute HAV infection

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A

IgM anti-HAV positive

24
Q

Which viral hepatitis is particularly severe in pregnancy?

25
Causes of acute pancreatitis
Gallstones Alcohol Idiopathic High triglycerides, high calcium, ERCP, meds (steroids, azathioprine), mumps, trauma, autoimmune, CF
26
Clinical features of acute pancreatitis
Constant severe epigastric pain, radiates to back, worse after meals and lying down, improves leaning forward Nausea and vomiting Shock - tachycardia, hypotension, oliguria/anuria Jaundice if biliary Abdo tenderness, distention, guarding Cullens and Grey Turner's sign
27
Management of acute pancreatitis
``` Fluid resuscitation (third space losses) Analgesia - usually IV opioids Nil by mouth until pain subsides Abx if infected necrosis Consider ERCP ```
28
What test can you do to confirm that steatorrhoea is due to pancreatic lipase insufficiency
Fecal elastase (low)
29
What criteria can you use to diagnose IBS
Rome criteria
30
What parts of the bowel does Crohn's disease affect
Terminal ileum/ileocaecal region mainly but can be anywhere from mouth to anus but rectum is spared
31
Which classification system is used to grade severity of UC
Truelove and Witts
32
What parts of the bowel does UC affect
Ascending beginning in the rectum and spreading proximally. Rectum is always involved.
33
Which IBD is transmural and which is just mucosal + submucosal
``` Crohn's = transmural UC = mucosal + submucosal ```
34
Which biliary condition is strongly associated with UC
Primary sclerosing cholangitis
35
How can you test for H.pylori
Urea breath test | Biopsy from OGD (rapid urease test)
36
What is H.Pylori eradication therapy (triple and quadruple)
``` A PPI (usually twice normal dose) and two different antibiotics Omeprazole + 2 of amoxicillin/clarithromycin/metronidazole ``` Quadruple therapy adds Bismuth - raises pH so HP divides more so abx work better
37
Main underlying mechanism that causes GORD
Transient lower oesophageal sphincter relaxations
38
What is Barrett oesophagus
Squamous epithelium of the esophagus gets replaced by columnar epithelium of the stomach - due to chronic reflux damage
39
Which type of cancer affects the upper 1/3 of the oesophagus and which affects the lower 2/3
Adenocarcinoma upper 1/3 | Squamous cell carcinoma lower 2/3
40
Diarrhoea is considered chronic if it continues for how long?
>4 weeks
41
Common viral causes of diarrhoea
Norovirus Rotavirus CMV
42
Common bacterial causes of diarrhoea
``` Campylobacter Shigella Salmonella E.coli C.diff ```
43
Which bacterial cause of diarrhoea should you be wary of treating with antibiotics and why
E.Coli 0157 because it can increase the risk of HUS
44
Name a stimulant laxative
Senna
45
Name a stool softener laxative
Docusate
46
Name an osmotic laxative
Movicol Lactulose Mannitol
47
What are the two hereditary disorders that predispose to colorectal cancer
Familial adenomatous polyposis (FAP) | Hereditary non-polyposis colorectal cancer (HNPCC)
48
What is the inheritance pattern of FAP and HNPCC
Autosomal dominant
49
Describe the screening programme for colorectal cancer in the UK
Fecal occult blood test | 2 yearly from the age of 60/62
50
What type of cancer are most colorectal cancers
Adenocarcinoma
51
What part of the colon is most commonly affected by colorectal cancer
Rectosigmoid
52
What is the name of the staging classification system used for colorectal cancer
Dukes criteria
53
Which tumour marker is used to assess response to treatment of colorectal cancers
CEA (carcinoembryonic antigen)
54
How do you calculate units of alcohol
ml X % then divide by 1000

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