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Phase 3b > Gastro-Intestinal > Flashcards

Gastro-Intestinal Flashcards

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1
Q

Define acute pancreatitis

A

Acute inflammation of the pancreas

Exocrine enzymes are released that cause autodigestion of the organ

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2
Q

Causes of acute pancreatitis

A 
iGET SMASHED
Idiopathic
Gallstones
Ethanol (Alcohol)
Trauma
Steroids
Mumps
Autoimmune disease
Scorpion Sting
Hypercalcaemia/hyperlipidaemia
ERCP
Drugs (thiazides, azathioprine, valporate)

Neoplasms
Pregnancy

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3
Q

Symptoms of acute pancreatitis

A

Sudden onset abdominal pain (epigastric)
Vomiting
Pain radiates to the back
Leaning forward relieves the pain

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4
Q

Signs of acute pancreatitis

A 
Fever
Jaundice
Tachycardia
Cullen's sign - umbilical bruising
Grey Turner's sign - flank bruising
Ascites
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5
Q

Investigations for acute pancreatitis

A 
Serum amylase 3x higher than normal
Serum lipase
FBC 
U&E's
CRP
X-ray
CT scan
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6
Q

What scoring system measures the severity of acute pancreatitis

A

Glasgow prognostic score

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7
Q

What is the glasgow prognostic score

A

PANCREAS

PaO2 <60
Age >55
Neutrophils >15
Calcium <2
uRea >16
Enzymes (LDH>600 or AST/ALT >200)
Albumin <32
Suger (glucose >10)
<2 = mild
2 = moderate
>2 = severe
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8
Q

Management for acute pancreatitis

A

IV fluids
Analgesia

Endoscopic drainage of large pseudocysts
Antibiotics if infection causing pancreatic necrosis
Surgery to remove infected pancreatic necrosis

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9
Q

Early complications of acute pancreatitis

A 
Shock
ARDS
Renal failure
DIC
Sepsis
Low calcium
Increased glucose
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10
Q

Late complications of acute pancreatitis

A 
Pancreatic necrosis
Infected necrosis
Pseudocyst
Pancreatic abscess
Chronic pancreatitis
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11
Q

Causes of small bowel obstruction

A

Adhesions
Hernias
Malignancy

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12
Q

Causes of large bowel obstruction

A 
Adhesions
Hernias
Colon cancer
Constipation
Volvulus
Neoplasm
Intussusception
Gallstone ileus
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13
Q

Symptoms of bowel obstruction

A

Vomiting - occurs earlier in small bowel obstruction
Nausea
Anorexia
Abdominal distension - pain is higher in small bowel obstruction
Constipation

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14
Q

Investigations for bowel obstruction

A

Abdominal x-ray - small bowel has valvulae conniventes and haustra. no gas in large bowel. dilated bowel loops centrally

CT scan

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15
Q

Management for bowel obstruction

A 
NG tube and suction
IV fluids
Analgesia
Antibiotics e.g. metronidazole
Antiemetics
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16
Q

Define volvulus

A

When the bowel twists on its mesentery, which can produce severe, rapid, strangulated obstruction

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17
Q

What are the two main types of volvulus

A

Sigmoid - counter-clockwise twisting

Caecal - clockwise twisting

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18
Q

Complications of volvulus

A

Obstruction
Ischaemia
Perforation

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19
Q

What would you see on abdominal x-ray for a volvulus

A

Coffee bean sign

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20
Q

Treatment for a volvulus

A 
Laparotomy - Hartmann's procedure (sigmoid)
Right hemicolectomy (caecal)
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21
Q

Most common type of colorectal cancer

A

Adenocarcinoma

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22
Q

Risk factors for colorectal cancer

A 
Age
Smoking
Alcohol
Family history
Diet (low fibre, red meat)
Previous cancer
Inflammatory bowel disease (Crohn's and UC)
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23
Q

Symptoms for colorectal cancer

A

Left sided = Bleeding/mucus PR
Altered bowel habit. Tenesmus. Mass PR

Right sided = Weight loss. Low haemoglobin - iron deficiency anaemia. Abdominal pain.

Either = Abdominal mass. Perforation. Haemorrhage. Fistula.

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24
Q

Investigations for colorectal cancer

A 
FBC - microcytic anaemia
Faecal occult blood
Colonoscopy - Gold standard
CT colonoscopy
CT scan - staging
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25
What staging system is used to grade colorectal cancer
Duke's classification Being replaced by TNM now
26
Treatment for colorectal cancer
Surgery - Right/Left hemicolectomy, sigmoid colectomy, anterior resection, abdominoperineal resection Radiotherapy Chemotherapy
27
Complications for colorectal cancer
``` Bleeding/infection/pain Damage to nerves. bladder, ureter or bowel Requirement for a stoma Hernia Adhesions DVT/PE ```
28
Where are the majority of pancreatic cancers (adenocarcinomas) located?
The head of the pancreas
29
Risk factors for pancreatic cancer
``` Smoking Alcohol Carcinogens Diabetes mellitus Chronic pancreatitis ```
30
Symptoms for pancreatic cancer
``` Painless obstructive jaundice Epigastric pain Weight loss Pale stools (due to lack of bile) Steatorrhoea (greasy stools) Dark urine Palpable epigastric mass ```
31
What is Courvoisier's Law?
Painless jaundice + non-tender palpable gallbladder = pancreatic cancer until proven/not gallstones
32
What tumour marker is raised in pancreatic cancer
CA19-9
33
Investigations for pancreatic cancer
CA19-9 tumour marker CT scan Endoscopic ultrasound with biopsy ERCP
34
Treatment for pancreatic cancer
Whipple's procedure (removing head of pancreas, gallbladder, duodenum and pylorus) Chemotherapy
35
Associations with stomach cancer
``` Pernicious anaemia Blood group A H.pylori Atrophic gastritis Adenomatous polyps Smoking Diet (high nitrate, high salt) ```
36
Symptoms of stomach cancer
``` Dyspepsia Weight loss Vomiting Dysphagia Anaemia ```
37
Signs of stomach cancer
``` Epigastric mass Hepatomegaly Jaundice Ascites Large left supraclavicular (Virchow's) node Acanthosis nigricans ```
38
Investigations for stomach cancer
Gastroscopy + multiple ulcer edge biopsies | CT/MRI scan
39
Treatment for stomach cancer
Partial gastrectomy for distal tumours Total gastrectomy for proximal Combined chemotherapy
40
Risk factors for oesophageal cancer
``` Diet Alcohol Smoking Achalasia Obesity Reflux oesophagitis Barrett's oesophagus ```
41
What are the two types of oesophageal cancer
``` Squamous cell (proximal) Adenocarcinoma (distal) ```
42
Symptoms of oesophageal cancer
Dysphagia Weight loss Retrosternal chest pain
43
Signs from upper 1/3rd of oesophagus
Hoarseness | Cough
44
Investigations for oesophageal cancer
Oesophagoscopy with biopsy | TNM staging
45
Treatment for oesophageal cancer
Poor survival rates Radical curative oesophagectomy Chemotherapy - cisplatin
46
What is the foregut and its blood supply
Stomach + part of the duodenum, biliary system, liver, pancreas Blood supply = Celiac artery
47
What is the midgut and its blood supply
Duodenum to 1st half of the transverse colon Blood supply = Superior mesenteric artery
48
What is the hindgut and its blood supply
2nd half of the transverse colon to rectum Blood supply = interior mesenteric artery
49
What is acute mesenteric ischaemia
Almost always affects the small bowel and may follow SUPERIOR MESENTERIC ARTERY THROMBOSIS OR EMBOLISM Caused by blood clots blocking blood supply in mesenteric vessels
50
Risk factors for acute mesenteric ischaemia
Old age Atrial fibrillation Atherosclerosis Coagulation disorders
51
Symptoms for acute mesenteric ischaemia
Severe abdominal pain Rapid hypovolaemia -> shock Peritonitis
52
Investigations for acute mesenteric ischaemia
``` Raised blood lactate Raised haemoglobin Raised WCC X-ray = 'gasless' CT angiogram ```
53
Treatment for acute mesenteric ischaemia
Fluid resuscitation + antibiotics Thrombolysis Surgical intervention - dead bowel removal Poor prognosis
54
Complications of acute mesenteric ischaemia
Gangrene | Perforation
55
Define ulcerative colitis
Relapsing and remitting inflammatory disorder of the colonic mucosa Limited to just the colon and rectum Continuous inflammation Smoking is protective
56
Symptoms of ulcerative colitis
``` Diarrhoea + blood/mucus Abdominal pain Weight loss Fever Anorexia Malaise ```
57
Signs of ulcerative colitis
``` Clubbing Oral ulcers Erythema nodosum Conjunctivitis Epscleritis Sacroillitis Ankylosing spondylitis Primary sclerosing cholangitis Fatty liver Amyloidosis ```
58
Investigations for ulcerative colitis
``` FBC - anaemia ESR CRP - inflammation U&E's Stool MC&S Faecal calprotectin - released by inflammed intestines Endoscopy + biopsy = diagnostic ```
59
What would show on endoscopy in ulcerative colitis
Crypt abscesses | Depletion of goblet cells
60
How do you induce remission in ulcerative colitis
Mild = Sulfasalazine or Mesalazine Prednisolone Severe = IV Hydrocortisone, IV ciclosporin
61
How do you maintain remission in ulcerative colitis
Sulfasalazine, mesalazine, olsalazine
62
What surgical options are there in ulcerative colitis
Remove colon + rectum = Panproctocolectomy - patient left with a permanent ileostomy
63
Complications of surgery
Perforation Massive haemorrhage Toxic dilatation
64
Define Crohn's disease
A chronic inflammatory GI disease characterised by transmural granulomatous inflammation. Affect the entire GI tract (mouth to anus) - and especially the terminal ileum Skip lesions Smoking is a risk factor NSAIDs may exacerbate disease
65
Symptoms of Crohn's disease
``` Diarrhoea/urgency - No blood or mucus Abdominal pain Weight loss/failure to thrive Fever Malaise Anorexia ```
66
Signs of Crohn's disease
``` Aphthous ulcerations Abdominal mass Clubbing Skin, joint and eye problems Strictures ```
67
Complications of Crohn's disease
``` Small bowel obstruction Toxic dilatation Abscess formation Fistulae Perforation Colon cancer Fatty liver Renal stones Malnutrition ```
68
Investigations for Crohn's disease
``` FBC ESR CRP U&E's LFT's Stool MC&S Colonoscopy + rectal biopsy ```
69
What would colonoscopy in Crohn's disease show
Increased goblet cells | Granulomas
70
How do you induce remission in Crohn's disease
Oral prednisolone IV hydrocortisone If steroids fail then Mesalazine, Azathioprine, Mercaptopurine, Methotrexate, Infliximab, Adalimumab
71
How do you maintain remission in Crohn's disease
``` Azathioprine Mercaptopurine Methotrexate Infliximab Adalimumab ```
72
Symptoms of irritable bowel disease
``` Diarrhoea Constipation Fluctuating bowel habit Abdominal pain Bloating Worse after eating Improved by opening bowels ```
73
Investigations for irritable bowel disease
Other pathology should be excluded: Normal FBC, ESR, CRP Faecal calprotectin negative No anti-TTG antibodies
74
Management for irritable bowel disease
Adequate fluid intake Limit caffeine and alcohol Low FODMAP diet Trial of probiotic supplements
75
Medications for irritable bowel disease
``` Loperamide for diarrhoea Laxatives for constipation Antispasmodics for cramps Tricyclic antidepressants CBT ```
76
Define coeliac disease
Autoimmune condition where exposure to gluten causes an autoimmune reaction that causes inflammation in the small bowel.
77
Which antibodies are present in coeliac disease
Anti-tissue transglutaminase (Anti-TTG) | Anti-endomysial (anti-EMA)
78
Where specifically does coeliac disease affect
Small bowel - Jejunum
79
What are the genetic links in coeliac disease
HLA DQ2 and HLA DQ8
80
Symptoms of coeliac disease
``` Diarrhoea Weight loss Anaemia (iron/B12 deficiency) Fatigue Mouth ulcers (aphthous) Failure to thrive in children Abdominal pain Dermatitis herpetiformis ```
81
Investigations in coeliac disease
Low Hb, B12 and ferritin Raised anti-TTG antibodies Raised anti-endomysial antibodies Duodenal endoscopy: Villous atrophy, crypt hypertrophy
82
Associations of coeliac disease
``` Type 1 diabetes Thyroid disease Autoimmune hepatitis Primary biliary cirrhosis Primary sclerosing cholangitis ```
83
Complications of coeliac disease
``` Vitamin deficiency Anaemia Osteoporosis - Ulcerative jejunitis Non-Hodgkin lymphoma Enteropathy-associated T-cell lymphoma ```
84
Treatment for coeliac disease
Lifelong gluten free diet
85
Define acute cholecystitis
Stone obstruction causing inflammation of the gallbladder
86
Risk factors for gallstones
Fat (high BMI) Fair (caucasian) Female Forty - 40
87
Symptoms of acute cholecystitis
``` RUQ pain Vomiting Fever Local peritonism Murphy's sign - two fingers on RUQ, ask patient to breathe in = causes pain + feel gallbladder ```
88
Investigations for acute cholecystitis
Increased WCC | Ultrasound scan
89
Treatment for acute cholecystitis
Fluids Antibiotics e.g. Cefuroxime Laparoscopic cholecystectomy
90
Define biliary colic
Gallstones are symptomatic with cystic duct obstruction
91
Symptoms of biliary colic
RUQ pain NO fever/NO increased WCC
92
Treatment for biliary colic
Analgesia | Laparoscopic cholecystectomy
93
Define acute cholangitis
Infection biliary obstruction
94
Symptoms of acute cholangitis
RUQ pain Jaundice Fever = CHARCOTS TRIAD
95
What makes up Charcot's triad
RUQ pain Jaundice Fever
96
Treatment for acute cholangitis
Antibiotics - cefuroxime and metronidazole
97
Define gallstone ileus
A stone erodes through the gallbladder into the duodenum
98
Symptoms of chronic pancreatitis
``` Epigastric pain that 'bores' through to back Relieved by sitting forward Bloating Steatorrhoea Weight loss Brittle diabetes ```
99
Causes of chronic pancreatitis
``` Alcohol Cystic fibrosis Haemochromatosis Pancreatic duct obstruction (stones/tumour) Increase PTH Congenital ```
100
Investigations for chronic pancreatitis
Ultrasound + CT scan | MRCP + ERCP (risks acute attack)
101
Treatment for chronic pancreatitis
Analgesia Lipase No alcohol Surgery - pancreatectomy
102
Complications of chronic pancreatitis
``` Pseudocyst Diabetes Biliary obstruction Local arterial aneurysm Splenic vein thrombosis Pancreatic carcinoma ```
103
Symptoms of appendicitis
Abdominal pain: Central then moves -> RIF Anorexia Nausea and vomiting Constipation
104
Signs of appendicitis
``` Tachycardia Fever Cough hurts Guarding in RIF Rebound tenderness + percussion tenderness Rovsing's sign - palpation of LIF causes pain in the RIF Psoas sign Cope sign ```
105
What is Rovsing's sign and what condition is it seen in?
Palpation of the LIF causes pain in the RIF Seen in APPENDICITIS
106
Investigations in appendicitis
FBC - raised CRP Increased WCC CT scan Ultrasound scan
107
Differential diagnoses for appendicitis
``` Ectopic pregnancy Ovarian cyst UTI Mesenteric adenitis - abdominal pain, lymphadenopathy Meckel's diverticulum - malformation distal ileum Cystitis Cholecystitis Crohn's disease ```
108
Treatment for appendicitis
Prompt appendicectomy | Antibiotics - Metronidazole + cefuroxime
109
Complications of appendicectomy
Bleeding Infection Pain DVT/PE
110
Define diverticula
Pouches in bowel wall
111
Define diverticulosis
Presence of diverticula without symptoms
112
Define diverticulitis
Inflammation of diverticula
113
Risk factors for diverticulosis
Lack of dietary fibre + obesity = risk factors Diagnosed incidentally on colonoscopy High fibre diet and weight loss advised
114
Symptoms in diverticulitis
LIF pain and tenderness Fever Diarrhoea PR blood/mucus
115
Management for diverticulitis
Analgesia IV fluids Antibiotics
116
Complications for diverticulitis
``` Perforation Haemorrhage Fistula Abscess Ileus/obstruction ```
117
Define Meckel's diverticulum
Remnant of the vitellointestinal duct and contains gastric and pancreatic tissue Rule of 2's: Occurs in 2% of the population 2 feet from the ileocaecal valve 2 inches long
118
Symptoms of Meckel's diverticulum
Abdominal pain Rectal bleeding Intestinal obstruction
119
Management for Meckel's diverticulum
Removal - laparotomy
120
Define Achalasia
Failure of oesophageal peristalsis and of relaxation of lower oesophageal sphincter (LOS) due to degeneration of the myenteric plexus
121
Symptoms of Achalasia
Dysphagia of BOTH liquids and solids Heartburn Regurgitation - cough, aspiration pneumonia Weight loss
122
Investigations for Achalasia
Oesophageal manometry Chest X-ray - wide mediastinum Barium swallow - dilated tapered oesophagus. 'Bird's beak' appearance
123
Treatment for Achalasia
Endoscopic balloon dilatation Heller cardiomyotomy Botulinum toxin injection
124
Causes of gastritis
``` Alcohol NSAIDs H.pylori GORD Atrophic gastritis Crohn's disease Sarcoidosis CMV Zollinger-Ellison Menetrier's disease ```
125
Symptoms of gastritis
Epigastric pain Vomiting Haematemsis
126
Investigations for gastritis
Endoscopy + biopsy
127
Prevention for gastritis
Give PPI gastroprotection with NSAIDs
128
Treatment for gastritis
Ranitidine or PPI
129
H.pylori eradication treatment
PPI + clarithromycin + amoxicillin | PPI + clarithromycin + metronidazole (if penicillin allergy)
130
Define tropical sprue
Malabsorption found in tropical regions - far and middle east, carribean
131
Causes of tropical sprue
Giardia, cryptosporidium, isoproi belli,microsporidia
132
Symptoms of tropical sprue
``` Diarrhoea Fever Malaise Weight loss Anorexia Steatorrhoea ```
133
Investigations for tropical sprue
Endoscopy + biopsy = incomplete villous atrophy
134
Management for tropical sprue
Fluid replacement Antibiotics - tetracycline Nutritional support - folic acid - B12
135
Causes of an Upper GI bleed
``` Mallory-Weiss tear Peptic ulcer Oesophageal varices Malignancy Gastritis Drugs (NSAIDs, aspirin, steroids, anticoagulants) Oesophagitis Angiodysplasia ```
136
Presentation of an Upper GI bleed
``` Haematemesis Melaena Coffee ground vomit Epigastric pain Dyspepsia Jaundice -> Ascites - liver disease with oesophageal varices ```
137
What scoring system is used in suspected upper GI bleeds on initial presentation?
Glasgow-Blatchford score
138
What scoring system is used for patients that have had an endoscopy to calculate their risk of rebleeding and overall mortality
Rockall score
139
Management of an upper GI bleed
``` ABCDE IV cannulae 2 large bore Bloods - FBC, U&E's, Clotting, Crossmatch, LFT's IV fluids Transfuse Stop drugs (NSAIDs, anticoagulants) ```
140
Triad of Plummer-Vinson syndrome
Dysphagia Glossitis Iron-deficiency anaemia
141
Investigations for Plummer-Vinson syndrome
Barium swallow - detect oesophageal webs | Endoscopy
142
Differential diagnosis for Plummer-Vinson syndrome
Oesophageal cancer Achalasia GORD
143
Treatment for Plummer-Vinson syndrome
Iron supplementation | Dilatation of the webs
144
Define hereditary haemochromatosis
An inherited disorder of iron metabolism in which an increase in intestinal iron absorption leads to iron deposition in joints, liver, pancreas, pituitary, adrenals and skin
145
What inheritance pattern does hereditary haemochromatosis have
Autosomal recessive
146
Symptoms in hereditary haemochromatosis
``` Chronic tiredness Joint pain (2nd + 3rd MCP joints) Erectile dysfunction Bronze/slate-grey pigmentation Hair loss Amenorrhoea Cirrhosis Osteoporosis Memory and mood disturbance ```
147
Investigations in hereditary haemochromatosis
``` Increased serum ferritin Increased transferrin saturation Genetic testing Liver biopsy - Perl's stain CT abdomen MRI ```
148
Management for hereditary haemochromatosis
Venesection (removal of blood to decrease total iron) Monitor serum ferritin Avoid alcohol
149
Complications for hereditary haemochromatosis
``` Type 1 diabetes mellitus Liver cirrhosis Hypogonadism Cardiomyopathy Hepatomegaly ```
150
Define Wilson's disease
Excessive accumulation of copper in the body and tissues
151
What inheritance pattern is Wilson's disease?
Autosomal recessive disorder of a gene on chromosome 13
152
Symptoms of Wilson's disease
Liver disease - Hepatitis, Cirrhosis CNS signs - Tremor, Dysarthria, Dysphagia, Dystonia, Dyskinesia, Parkinsonism Depression Kayser-Fleischer rings in cornea-brown circles Haemolysis
153
Investigations in Wilson's disease
Low serum caeruloplasmin (high in cancer/inflammation) Liver biopsy 24 hour urine copper assay is high Slit lamp examination - Kayser-Fleischer rings Low serum copper
154
Treatment for Wilson's disease
Diet - avoid foods with high copper content Penicillamine Trientene
155
Define alpha1-antitrypsin deficiency
An inherited deficiency of a protease inhibitor called alpha 1 antitrypsin Leads to excess of protease enzymes that attack the liver and lung tissue and cause liver cirrhosis and lung disease
156
What enzyme does alpha1-antitrypsin inhibit?
Elastase - this enzyme digests connective tissue
157
What inheritance pattern does alpha1-antitrypsin deficiency follow
Autosomal recessive
158
Symptoms of alpha1-antitrypsin deficiency
Liver and lungs affected Liver cirrhosis Cholestatic jaundice Emphysema - dyspnoea
159
Investigations for alpha1-antitrypsin deficiency
Low serum alpha1-antitrypsin levels Liver biopsy - cirrhosis Genetic testing
160
Management for alpha1-antitrypsin deficiency
Stop smoking | Liver transplantation
161
Define sclerosis
Stiffening and hardening of the bile ducts
162
Define cholangitis
Inflammation of the bile ducts
163
Define primary sclerosing cholangitis
Where the intrahepatic or extrahepatic ducts become strictured and fibrotic. This causes an obstruction to the flow of bile out of the liver and into the intestines Chronic bile obstruction eventually leads to liver inflammation (hepatitis) fibrosis and cirrhosis
164
Risk factors for primary sclerosing cholangitis
Male Aged 30-40 Ulcerative collitis - 70% of cases have UC Family history
165
Symptoms of primary sclerosing cholangitis
``` Jaundice Chronic right upper quadrant pain Pruritis Fatigue Hepatomegaly ```
166
Investigations for primary sclerosing cholangitis
``` MRCP - Gold standard MRI of liver, bile ducts, pancreas LFT's - alkaline phosphatase derranged, billirubin raised Autoantibodies - p-ANCA ANA aCL ```
167
Associations and complications of primary sclerosing cholangitis
``` Acute bacterial cholangitis Cholangiocarcinoma Colorectal cancer Cirrhosis and liver failure Biliary strictures ```
168
Management for primary sclerosing cholangitis
Liver transplant Ursodeoxycholic acid Colestyramine ERCP - dilatation and stent
169
Define primary biliary cirrhosis
Where the immune system attacks the small bile ducts within the liver The first part to be affected is the intralobar ducts, also known as the canals of Hering. This causes obstruction of the outflow of bile, which is called cholestasis Bile obstruction causes fibrosis, cirrhosis and liver failure
170
What does a build up of bile acids cause?
Itching, greasy stools
171
What does a build up of bilirubin cause?
Jaundice, pale stools
172
What does raised cholesterol cause?
Xanthelasma
173
Symptoms of primary biliary cirrhosis
``` Fatigue Pruritis GI disturbance and abdominal pain Jaundice Pale stools Xanthoma and xanthelasma Ascites Splenomegaly Spider naevi ```
174
Investigations for primary biliary cirrhosis
``` LFT's - raised alkaline phosphatase Autoantibodies = anti-mitochondrial antibodies, anti-nuclear antibodies ESR raised IgM raised Liver biopsy ```
175
Treatment for primary biliary cirrhosis
Ursodeoxycholic acid Colestyramine Liver transplant Immunosuppression
176
Complications of primary biliary cirrhosis
``` Advanced liver cirrhosis Portal hypertension Pruritis Fatigue Steatorrhoea Distal renal tubular acidosis Hypothyroidism Osteoporosis Hepatocellular carcinoma ```
177
What is the main type of liver cancer?
Hepatocellular carcinoma (80%)
178
What are the other types of liver cancer?
Cholangiocarcinoma (20%)
179
Risk factors for liver cancer
Liver cirrhosis due to: Viral Hepatitis B and C Alcohol, Non-alcoholic fatty liver disease Cholangiocarcinoma is associated with primary sclerosing cholangitis
180
Symptoms of liver cancer
``` Weight loss Abdominal pain Anorexia Nausea and vomiting Jaundice Pruritis Cholangiocarcinoma presents with painless jaundice ```
181
Investigations for liver cancer
``` Alpha-fetoprotein CA19-9 Liver ultrasound CT/MRI scan ERCP ```
182
What is the tumour marker for hepatocellular carcinoma
Alpha-fetoprotein
183
What is the tumour marker for cholangiocarcinoma
CA19-9
184
Treatment for hepatocellular carcinoma
Resection in early disease Liver transplant if isolated Kinase inhibitors - sorafenib, regorafenib, lenvatinib
185
Treatment for cholangiocarcinoma
Resection in early disease | ERCP
186
What are the stages of non-alcoholic fatty liver disease
1. Non-alcoholic fatty liver disease 2. Non-alcoholic steatohepatitis 3. Fibrosis 4. Cirrhosis
187
Risk factors for non-alcoholic fatty liver disease
``` Obesity Poor diet - low activity levels Type 2 diabetes mellitus High cholesterol Smoking Hypertension ```
188
Investigations for non-alcoholic fatty liver disease
Liver ultrasound Enhanced liver fibrosis (ELF) blood test - 1st line NAFLD fibrosis score - 2nd line Fibroscan
189
Management for non-alcoholic fatty liver disease
``` Weight loss Exercise Stop smoking Control diabetes, BP, cholesterol Avoid alcohol ```
190
Define Boerhaave syndrome
Spontaneous perforation of the oesophagus that results from sudden increase in intraoesophageal pressure combined with negative intrathoracic pressure (e.g. severe straining or vomiting)
191
Causes of Boerhaave syndrome
``` Vomiting Weightlifting Straining Seizures Trauma Childbirth ``` ALCOHOL
192
Symptoms of Boerhaave syndrome
Vomiting Lower thoracic pain/chest pain Emphysema
193
Investigations of Boerhaave syndrome
Chest x-ray: mediastinal emphysema. mediastina widening, pleural effusion Contrast oesophagogram - CT
194
Treatment for Boerhaave syndrome
Fluid replacement Broad spectrum antibiotics Oesophageal repair
195
Differential diagnosis of Boerhaave syndrome
Aortic dissection Acute pancreatitis MI Pneumothorax
196
Complications for Boerhaave syndrome
Pleural effusion Subcutaneous emphysema ARDS Empyema

Phase 3b (18 decks)

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