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Zero to Finals Medicine > Gastroenterology > Flashcards

Gastroenterology Flashcards

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1
Q

What are the stages of Alcoholic Liver Disease?

A

Alcohol related fatty liver - resolves in 2 weeks

Alcoholic hepatitis - Reversible

Cirrohis - ireversabile

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2
Q

What are the CAGE questions?

A

Cut down?
annoyed when people mention your drinking?
Guilt?
Early morning

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3
Q

What is the alcohol assesment score questionaire?

A

AUDIT 10 questions

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4
Q

Signs of liver disease?

A

Jaundice
hepatomegaly
spider naevi
Palmar erythema
gynaecomastia
ascities
caput medusa

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5
Q

What blood results would you find in alcohol misuse?

A

rasied MCV on FBC
raised ALT and AST
Especially raised gamma-GT

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6
Q

What investgations can you do for Acoholic liver disease?

A

ultrasound “fibroscan”
Liver biopsy
CT

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7
Q

How do you treat acute alcohol withdrawl?

A

Diazepam and pabrinex

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8
Q

What is pabrinex?

A

B vitamins. Thimaine is a B vitamin

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9
Q

What are the four most common causes of liver disease?

A

Alcoholic liver disease
Non alcholoic fatty liver disease
Hep B
Hep C

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10
Q

What tells you about the synthetic function of the liver?

A

Poor synthetic function will show in low albumin and a long prothrombin time

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11
Q

What should you check for in patients with cirrohsis?

A

alpha-fetoprotein for hepatocellular carcinoma

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12
Q

What is alpha-fetoprotien a marker of?

A

hepatocellular carcinoma

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13
Q

What is the follow up for people with eosphageal varices?

A

If liver cirhosis then ultrasound every 6 months

for varices endoscopy every 3 years

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14
Q

What score do you do for a liver transplant?

A

MELD score

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15
Q

What is the 5 year survival with liver cirrohsis?

A

50%

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16
Q

What is the best diet for someone with liver cirrohsis?

A

High protein high calorie low salt

eat every 3 hours

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17
Q

What are the treatment options for stable oesopagheal varices?

A

Banding
propanolol

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18
Q

What is the treatment of bleeding oesphageal varices?

A

Call anasthetics and general surgery

Terlipressin
correct coagulopathy with fresh frozen plasma and vitamin K

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19
Q

What causes ascities?

A

increased portal pressure leads to fluid leaking out of the cappliaries in the liver and bowel. Thus reduced flow into the kidneys causes aldosterone release and fluid retention

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20
Q

What is the treatment for ascites?

A

Low sodium diet
anti-aldosterone diurectic like spironolactone
paracentesis

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21
Q

What is spironolactone?

A

anti-aldosterone diuretic

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22
Q

What is the big risk in someone with ascities?

A

Spontaneous Bacterial Peritonitis - Needs treated with ascitic culture and IV ABX

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23
Q

What is hepatorenal syndrome?

A

nackered liver causes renal hypotension and renal failure- life threatening without liver transplant

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24
Q

What is hepatic encephalopathy?

A

Amonia poisioning which causes confusion and reduced consciousness

Treat by clearing out gut bio with laxatives and abx

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25
how common is NAFLD
possibly 1/3 of adults
26
What are the stages of NAFLD?
NAFLD Non alcoholoic steatoheptatitis NASH Fibrosis Cirrhosis
27
What are the risk factors for NAFLD?
Same as cardiac and diabetes risk
28
What should you do to investigate new abnormal LFTs?
Hep B and C serology check autoantibodies (autoimmune hepatitis, primary sclerosis, primary sclerosing cholangitis) Alpha 1 anti-trypsin leves ferretin and transferrin for hereditary haemochromatosis
29
How do you ivestigate for NAFLD?
Do a NAFLD fibrosis score
30
What are the symptoms of hepatitis?
abdominal pain fatigue puritis muscle and joint aches nausea and vomiting jaundice
31
How is hep B transmitted?
blood or bodily fluids
32
What is the prognosis of Hep B?
Most recover in 2 months
33
Is there a vaccine for Hep B or Hep C?
There is a vaccine for hep B only
34
What is the prognosis for Hep C?
25% - Fight it off 75% - Chronic infection
35
How do you test for hep C?
Hep C antibody screening test then Hep C RNA test for viral load
36
How do you manage hep C?
confirm diagnosis Notify Public Health refer to gastro or infectious diseases stop smoking and alcohol
37
How is hep C treated?
direct anti virals tailord to the specific virus - cure in 12 weeks
38
What are the two demographics for autoimmune hepatitis ?
menopausal woman teenager with acute hepatitis
39
what ivestigations could you do for autoimmune hepatitis?
raised ALT and AST and igG Liver biopsy to confirm
40
How do you treat autoimmune hepatitis?
Steroids - pernisolone
41
How is haemochromatosis inherited?
autosomal ressesive
42
How does haemachromatosis present?
40 year old Fatigue Joint pain Hair loss bronze colouration
43
How do you investigate for haemachromatosis?
Check serum ferritin and transferrin then genetic testing
44
What are the complications of heamachromatosis?
Liver damage endocrine disorders cardiomyopathy?
45
How do you treat haemachromatosis?
Weeky venesection
46
What is alpha 1 antirypsin deficiency?
inherited disease which causes lung disease (30yrs) and liver diease (50yrs)
47
What is the treatment for alpha 1 antitrypsin deficiency?
organ transplant symptomatic managment
48
What is primary biliary cirrhosis?
autoimmune attack on small bile ducts in liver
49
How does primary billiary cirrhosis present?
Jaundice Pale and greasy stools fatigue puritis xanthoma and xanthelasma
50
What is raised alkaline phosphate a marker of?
marker of billary obstruciton
51
What does anti-mitochondrial antibodies cause?
Primary biliary cirrohsis
52
How is primary bilary cirrohsis diagonesd?
Liver biopsy
53
How is primary biliary cirrhosis treated?
Ursodeoxycholic acid it reduces intestinal absoprtion of cholestrol
54
What is Primary sclerosing cholangitis?
sclerosis of intra and extra hepatic bile ducts leading to liver disease
55
What liver disease is associated with ulcerative colitis?
Primary sclerosing cholangitis
56
Who gets primary sclerosing cholangitis?
Male 30 UC
57
How does primary sclerosing cholangitis present?
Jaundince URQP puritis fatigue
58
What is a cholestatic picture on lft?
Really high alkaline phosphate compared to the other markers
59
How is primary sclerosing cholangitis investigated?
MRCP
60
How do you treat primary scleorisng cholangitis?
Endoscopic retrograde cholangio-pancretography to insert stents liver transplant
61
What are the two types of liver cancer?
hepatocellular carcinoma 80% cholangiocarcinoma 20%
62
What is the main risk factor for liver cancer?
liver cirrohsis
63
What are the tumour markers you should check for in liver cancer?
Alpha-fetoprotein for hepatocellular cancer CA19-9 for cholangiocarcinoma
64
How is hepatocellular cancer treated?
not a good prognosis does not respond to chemo or radio liver transplant if isolated or surgery
65
How is cholangiocarcinoma treated?
resection ERCP basically uncurable
66
What is focal nodular hyperplasia?
Benign liver tumour, asymptomatic and no malignant potential
67
What are the red flags for 2 week ref
Dysphagia Weight loss nausea and vomiting
68
When should someone with GORD get an endoscopy?
Red flag symptom or treatment resistant dyspepsia
69
What lifestyle advice can you give for GORD?
Reduce tea, coffee and alcohol weightloss smoking smaller meals lay upright
70
What medical treatments do you use for GORD?
omeprazole and lanzoprazole
71
What should you caution peope about when prescribing omeprazole?
start high then slowly reduce to maintance long term risk of oesteoporosis
72
What can you use instead of PPI for Gord?
Ranitidine
73
What test should you do for all people with dyspepsia ?
Stool antigen test for h.pylori
74
What are the testing methods for helicobacter pylori?
Only works if 2 weeks off of PPI Stool antigen test Rapid Urease test during endoscopy
75
How do you treat helicobacter pylori infection?
triple therapy PPI amoxicilin clarithromycin
76
What is the lifetime risk of adenocarcinoma with barrets oesophagus ?
3-5% lifetime risk
77
How do you differentiate between gastric and duodenal ulcers?
Eating makes gastric ulcers pain worse and duodenal ulcers pain better
78
How are peptic ulcers investigated?
oesophageal endoscopy with biopsy
79
What are the complications of peptic ulcers?
Bleeding perforation scarring and strictures
80
What are the causes of an upper gi blled?
oesophageal varices peptic ulcers mallory-weiss tear cancer
81
How does upper gi bleed present?
haematemesis coffee ground vomit (digested blood) Malena
82
What bloods should you take in upper gi bleed
FBC UREA coagulation LFT cross match 2 units of blood
83
What is group and save and what is cross match?
group and save checks patients blood group and saves a sample for crossmatch later crossmatch finds blood tests it and keeps it ready in the fridge for use
84
What should you give for transfusion in upper gi bleed?
Blood Platelets fresh frozen plasma prothrombin in warfarinsed
85
What can you test for in inflammatory bowel disease?
Feacal calprotectin
86
How is Crohn's treated?
induce remission with steroids then maintain with Azathioprine
87
How is Ulcerative collitis treated?
mesalazine or steroids then mesalazine or azathioprine
88
What tests should you do to investigate irritable bowel syndrome?
Bloods Faecal calprotectin for inflammatory bowel anti ttg antibodies for coeliac
89
What symptoms are suggestive of irritable bowel syndrome?
abdominal pain which is improved by pooing or is associated with change in bowel habit plus 2 of: abnormal stool mucus bloating worse after eating
90
How do you treat irritable bowel syndrome?
regular small meals low caffine and alcohol probiotic for 4 weeks Loperamide for diarrhoea buscopan for cramps laxitives
91
What are the two auto-antibodies in coeliac disease?
Anti-TTG Anti-EMA
92

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