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Gastrointestinal Flashcards

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1
Q

What is the description of dysphagia?

A

Difficulty in swallowing

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2
Q

What are some of the causes of dysphagia?

A

Mechanical block:

  • Malignant stricture (i.e. cancer of the pharynx, oesophagus and stomach)
  • Benign strictures
  • Pharyngeal pouch
  • External pressures (e.g. lung cancer, mediastinal lymph nodes)

Motility disorders:

  • Achalasia
  • Diffuse oesophageal spasm

Other:

  • Globus
  • Oesophagitis
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3
Q

What is the description of diffuse oesophageal spasm?

A

A condition characterised by uncoordinated contractions of the oesophagus

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4
Q

What are some signs and symptoms of diffuse oesophageal spasm?

A

Intermittent dysphagia

Atypical chest pain (similar to that of angina)

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5
Q

How do you diagnose diffuse oesophageal spasm?

A

Barium swallow - “Corkscrew” appearance

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6
Q

What is the treatment of diffuse oesophageal spasm?

A

Proton pump inhibitors
Calcium channel blockers
Anti-anxiety medication

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7
Q

What is the description of achalasia?

A

Coordinated peristalsis is lost and the lower oesophageal sphincter fails to relax.

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8
Q

What are some signs and symptoms of achalasia?

A

Dysphasia
Regurgitation of food
Weight loss

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9
Q

How do you diagnose achalasia?

A

Barium contrast swallow show dilated tapering oesophagus

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10
Q

What is the treatment of achalasia?

A

Endoscopic balloon dilatation

Then PPIs

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11
Q

What is the description of a benign oesophageal stricture?

A

A narrowing of the oesophagus

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12
Q

What is the causes of a benign oesophageal stricture?

A

GORD
Corrosives
Radiotherapy

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13
Q

What are some symptoms of a benign oesophageal structure?

A 
Difficult or painful swallowing
Weight loss
Regurgitation of food or liquids
Sensation of something stuck in the chest after you eat
Frequent burping or hiccups
Heartburn
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14
Q

How do you diagnose a benign oesophageal stricture?

A

Barium swallow

Endoscopy

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15
Q

What is the treatment of a benign oesophageal stricture?

A

Endoscopic balloon dilatation

Oesophageal stent

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16
Q

What is the description of a duodenal ulcer?

A

Ulcer in the duodenum.

4 times more common than a stomach ulcer.

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17
Q

What are some symptoms of a duodenal ulcer?

A

Epigastric pain (relieved with eating or antacids)
Reduced weight
Epigastric tenderness

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18
Q

How do you diagnose a duodenal ulcer?

A

Upper GI endoscopy

Test for H. pylori

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19
Q

What is the treatment for a duodenal ulcer?

A

Antibiotic treatment for H. Pylori
OR
Proton pump inhibitors

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20
Q

What is the description of a gastric ulcer?

A

An ulcer in the stomach.

Most likely in the elderly, on the lesser curve.

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21
Q

What are some risk factors for peptic ulcer disease?

A

H. pylori
NSAIDs
Smoking
Stress

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22
Q

What are some symptoms of a gastric ulcer?

A

Burning stomach pain
Heartburn
Nausea

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23
Q

How do you diagnose a gastric ulcer?

A

Upper GI endoscopy to rule out malignancy

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24
Q

What is the treatment of a gastric ulcer?

A

Eradicate H. pylori

PPIs

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25
What is the description of gastritis?
An inflammation of the lining of the stomach.
26
What are some symptoms of gastritis?
Epigastric pain Nausea Vomiting
27
How do you diagnose gastritis?
Upper GI endoscopy, only if suspicious features arise
28
What is the treatment of gastritis?
PPIs
29
What is the description of gastro-oesophageal reflux disease (GORD)?
Reflux of the acid of the stomach up to the oesophagus.
30
What are some causes of GORD?
Oesophageal sphincter hypotension Hiatus hernia Obesity Oesophageal dysmotility
31
What are some symptoms of GORD?
Oesophageal: - Heartburn - Belching - Dysphagia - Waterbrash (mouth fills with saliva) Extra-oesophageal: - Nocturnal asthma - Chronic cough
32
What are some potential complications of GORD?
Oesophagitis Barrett's oesophagus Oesophageal cancer
33
How do you diagnose GORD?
Endoscopy if dysphasia is a symptom | 24h pH monitoring of the oesophagus if endoscopy is normal
34
What is the treatment of GORD?
Lifestyle - Weight loss, smoking cessation, small regular meals, reduce alcohol consumption Drugs - Antacids or alginates. Can add a PPI Surgery - Only consider in severe GORD when drugs are not working
35
What is the description of a Mallory-Weiss tear?
A tear in the oesophagus near the gastro-oesophageal junction.
36
What are some symptoms of a Mallory-Weiss tear?
``` Haematemesis/ coffee-ground vomit Malaena Shortness of breath Diarrhoea Abdominal or chest pain that can radiate to the back ```
37
What are some of the causes of a Mallory-Weiss tear?
Violent coughing or vomiting Hiatal hernia Childbirth
38
How do you diagnose a Mallory-Weiss tear?
Presentation of symptoms Check stool for blood/melaena Endoscopy
39
What is the treatment of a Mallory-Weiss tear?
Most Mallory-Weiss tears will resolve on their own | Rarely, a clip will be places endoscopically to close the tear
40
What is the description of oesophageal varices?
Abnormal, enlarged veins in the oesophagus that can often tear and bleed.
41
What is the cause of oesophageal varices?
Blood flow to the liver is compromised by cirrhosis or a blockage, so angiogenesis takes place.
42
What are some symptoms of oesophageal varices?
Vomiting large amounts of blood Melaena Pre-syncope Syncope in severe cases Also signs of liver disease: Jaundice Ascites
43
How do you diagnose oesophageal varices?
Endoscopy | Doppler ultrasound to detect presence of liver disease
44
What is the treatment of oesophageal varices?
``` Beta-blockers to reduce portal hypertension Variceal banding (using elastic bands to "tie off" the oesophageal varices) Balloon tamponade (inflating a ballon to put pressure on the bleeding temporarily - usually 24h) ```
45
What is the description of oesophagitis?
Inflammation of the epithelial lining of the oesophagus
46
What are some causes of oesophagitis?
GORD | Ingestion of chemicals
47
What are some symptoms of oesophagitis?
``` Heartburn Bloating Belching Dysphasia Persistent cough at night ```
48
How do you diagnose oesophagitis?
Presentation of symptoms Endoscopy Barium swallow
49
What are some potential complications of oesophagitis?
Barrett's oesophagus | Cancer
50
What is the treatment for oesophagitis?
Drugs - Antacids or alginates. Can add a PPI
51
What is the description of Barrett's oesophagus?
The change of stratified squamous epithelium in the oesophagus to simple columnar epithelium with the presence of goblet cells .
52
What is the cause of Barrett's oesophagus?
Chronic GORD or oesophagitis Risk factors include: - Being male - Being overweight/obese - Smoking
53
What is Barrett's oesophagus associated with a higher risk for?
Oesophageal cancer
54
What are some symptoms of Barrett's oesophagus?
Dysphagia Chest pain Heartburn
55
How do you diagnose Barrett's oesophagus?
Presentation of symptoms Endoscopy Biopsy will be diagnostic
56
What is the treatment for Barrett's oesophagus?
Lifestyle - Weight loss, smoking cessation, small regular meals, reduce alcohol consumption Drugs - Antacids or alginates. Can add a PPI Monitoring - Regular endoscopies to monitor disease If dysplasia is found: - Cryotherapy - Surgery
57
What is the description of diverticulitis?
Inflammation of the diverticula (out-pouches in the colon).
58
What is the cause of diverticulitis?
Diverticula usually develop when naturally weak places in the colon give way under pressure. Diverticulitis occurs when diverticula tear, resulting in inflammation or infection or both.
59
What are some symptoms of diverticulitis?
``` Pain, which may be constant and persist for several days in the LLQ Nausea and vomiting Fever Abdominal tenderness Constipation or diarrhoea ```
60
How do you diagnose diverticulitis?
FBC and U&E => to check for signs of infection. Stool culture => rule out infection in patients with diarrhoea LFTs => to rule our liver-related causes CT scan => diagnostic
61
What is the treatment for diverticulitis?
IV antibiotics Pain relief Potential surgery - bowel resection may be necessary
62
What is the description for Meckel's diverticulum?
A congenital diverticulum, left over from the umbilical cord.
63
What are some symptoms of Meckel's diverticulum?
``` Gastrointestinal bleeding Abdominal pain and cramping Tenderness near the belly button Obstruction of the bowels Diverticulitis ```
64
What causes Meckel's diverticulum?
The vitilline duct is not fully absorbed in the 7th week of foetal development.
65
How is Meckel's diverticulum diagnosed?
Presentation of symptoms Colonoscopy Wireless capsule endoscopy
66
What is the treatment for Meckel's diverticulum?
Surgery - resection of part of bowel and anastomoses
67
What is the description of Peutz-Jeghers syndrome?
A disorder characterised by the development of hamartomatous polyps.
68
What are some symptoms of Peutz-Jeghers syndrome?
``` Dark coloured spots around the mouth Bowel obstruction Abdominal pain Nausea GI bleeding ```
69
What is the cause of Peutz-Jeghers syndrome?
Mutation in the STK11 gene.
70
How do you diagnose Peutz-Jeghers syndrome?
Presentation of symptoms Check family history for history of polyps Genetic testing
71
What is the management of Peutz-Jeghers syndrome?
Colonoscopy for removal of polyps | Continue monitoring for possibility of cancer development
72
What is the description of Lynch syndrome?
An inherited condition which causes multiple polyps and increases risk of multiple cancers e.g. bowel, uterus, breast
73
What is the cause of Lynch syndrome?
MMR mutation
74
How do you diagnose Lynch syndrome?
Genetic screening
75
What is the management of Lynch syndrome?
Currently there are no treatments
76
What is the description of gastroenteritis?
A disease characterised by diarrhoea and vomiting due to enteric infection (with viruses, bacteria or parasites).
77
What are some symptoms of gastroenteritis?
``` Acute diarrhoea (3 or more episodes of water stool for less than 14 days) Blood in the stool Nausea and vomiting Abdominal pain Fever ```
78
What are the different types of diarrhoea?
Acute diarrhoea - 3 or more episodes of water stool for less than 14 days Dysentery - bloody diarrhoea Persistent - diarrhoea lasting > 14 days Traveller's diarrhoea - starting during or shortly after foreign travel Food poisoning - caused by consumption of food
79
What is the full description of Norovirus infection? | include symptoms, diagnosis and treatment in your answer
Causes gastroenteritis. Single-stranded RNA virus, which is highly infectious. Symptoms - diarrhoea, cramps, vomiting Diagnosis - stool sample reverse transcriptase PCR Treatment - usually self-limiting, anti-motility drugs
80
What is the full description of Rotavirus infection? | include symptoms, diagnosis and treatment in your answer
Causes gastroenteritis. Double-stranded RNA virus, commonest cause of gastroenteritis in children. Symptoms - watery diarrhoea, vomiting, fever Diagnosis - antigen in stool Treatment - supportive + routine vaccination
81
What is the full description of Campylobacter infection? | include symptoms, diagnosis and treatment in your answer
Commonest cause of food poisoning. Grave -ve spiral shaped rod. Symptoms - Bloody diarrhoea, abdominal pain, fever, headache Diagnosis - Stool culture Treatment - Supportive. Antibiotics only in invasive cases
82
What is the description of irritable bowel syndrome?
A mixed group of abdominal symptoms for which no cause can be found. Often triggered by factors such as stress or mental health issues.
83
What are some symptoms of irritable bowel syndrome?
- Abdominal pain, cramping or bloating that is typically relieved by passing a bowel movement - Excess gas - Diarrhoea or constipation - Mucus in the stool
84
How do you diagnose irritable bowel syndrome?
Patient must have abdominal pain associated with 2 others: - relief by defecation - altered stool form - altered bowel frequency (diarrhoea and constipation alternating) Then do FBC, CRP, Coeliac serology to confirm positive diagnosis
85
What is the treatment for irritable bowel syndrome?
Symptom control: - Constipation => Ensure adequate water and fibre intake, simple laxatives e.g. Imodium - Diarrhoea => Avoid sorbitol sweeteners, alcohol and caffeine. Avoid trigger foods. Add a bulking agent and loperamide - Colic/bloating => oral antispasmodics e.g. mebeverine
86
What is the prevalence of irritable bowel syndrome?
10-20% of people 2:1 female:male ratio People under 50
87
What is the description of anal fissure?
A tear in the mucosa of the anus
88
What are some symptoms of anal fissure?
- Pain (can be severe) during bowel movements - Bright red blood on stool or paper - A visible crack around the anus
89
What are some of the causes of anal fissures?
- Passing large or hard stools - Constipation or chronic diarrhoea - Anal intercourse (more common in gay men) - Anal cancer
90
How do you diagnose an anal fissure?
- PR exam tends to be enough | - Otherwise => Flexible sigmoidoscopy
91
What is the treatment for an anal fissure?
Medications: - Externally applied nitroglycerin (Rectiv), to help increase blood flow to the fissure and promote healing. May cause headache. - Topical anaesthetic creams such as lidocaine hydrochloride for pain relief. - Diltiazem can help relax the anal sphincter. Surgery: - For chronic anal fissures or severe symptoms, consider surgery
92
What is the description of rectal prolapse?
A condition where the rectum protrudes out of the anus
93
What are some symptoms of rectal prolapse?
- Feeling of a lump coming out of anus after bowel movement - Difficulty controlling bowel movements - Bright red blood or slimy mucus coming out of rectum - Discomfort or pain
94
What causes rectal prolapse?
- Chronic constipation | - Weakened pelvic floor muscles
95
How do you diagnose rectal prolapse?
- Presentation of symptoms - PR exam (usually diagnostic) - Barium enema - Colonoscopy may be needed
96
What is the description of ileus?
A temporary and often painful lack of peristalsis (or any movement) of the intestines.
97
What are some potential causes of ileus?
Post surgery | Opioid drugs, calcium channel blockers and anticholinergics may affect the intestines
98
What are some symptoms of ileus?
- Abdominal cramps and pain - Bloating - Nausea and vomiting - Constipation and inability to pass gas
99
How do you diagnose ileus?
- Presentation of symptoms - Medication history may suggest ileus - Abdominal exam => absent or excessive bowel sounds - AXR - CT scan - Ultrasound
100
What is the treatment for ileus?
Pain relief Dietary changes Surgery is an option if the above don't work.
101
What is the description of volvulus?
Twisting of part of the small or large intestine which may cut off blood supply to the bowel.
102
What are some of the potential causes of volvulus?
- Malrotation in infants | - Chronic constipation, an enlarged colon, abdominal adhesions and pregnancy in adults
103
What are some of the symptoms of volvulus?
- Abdominal pain and tenderness - Vomiting green bile - Nausea - Distended abdomen - Constipation
104
How do you diagnose volvulus?
- Presentation of symptoms - Abdominal exam - Barium x-rays - CT scan
105
What is the treatment for volvulus?
Urgent surgery
106
What are the different types of intestinal failure?
Type 1 - short-term, self-limiting and often perioperative in nature. Type 2 - more long term, in metabolically unstable patients. Requires parenteral nutrition and careful monitoring to prevent it from developing into type 3 IF. Can be reversed with surgery. Type 3 - Irreversible, chronic IF. Long term parenteral feeding is required (therefore Home Parenteral feeding).
107
What is the description of pseudo-obstruction?
A condition with symptoms that resemble those caused by an obstruction of the intestines, but no blockage exists. Instead, the symptoms are due to nerve or muscle problems that affect the movement of food, fluid, and air.
108
What are the causes of pseudo-obstruction?
- Abdominal or pelvic surgery - Lupus erythematous and Parkinson’s disease - Medications, such as opiates and antidepressants
109
What are some symptoms of pseudo-obstruction?
- Abdominal distension - Abdominal pain - Nausea and vomiting - Constipation - Diarrhoea
110
How do you diagnose a pseudo-obstruction?
- Presentation of symptoms - Abdominal examination - Abdominal X-ray - CT scan
111
What is the treatment of pseudo-obstruction?
- Enteral Nutrition - Medications such as laxatives - Surgery in severe cases
112
What is the description of ulcerative colitis?
A relapsing and remitting inflammatory disorder of the colonic mucosa.
113
What is the cause of ulcerative colitis?
Inappropriate immune response against colonic flora in genetically susceptible individuals.
114
What are some symptoms of ulcerative colitis?
- Episodic or chronic diarrhoea - Abdominal cramps - Tenesmus - Fever - Malaise
115
What are some signs of ulcerative colitis?
- Clubbing - Erythema nodosum - Pyoderma gangrenosum
116
How do you diagnose ulcerative colitis?
- Presentation of symptoms | - FBC, CRP, U&E, stool culture to eliminate gastroenteritis
117
What is the treatment for ulcerative colitis?
Mild UC - Mesalazine, given PR for distal disease and PO for extensive disease. Prednisolone 20mg as well. Moderate UC - 40mg of prednisolone that taper by 5mg over 7 weeks. Maintain with mesalazine. Severe UC - IV steroids, thromboembolism prophylaxis
118
What is the description of Crohn's disease?
A chronic inflammatory disease characterised by transmural granulomatous inflammation affecting any part of the gut from mouth to anus.
119
What is the cause of Crohn's disease?
Inappropriate immune response against colonic flora in genetically susceptible individuals.
120
What are some symptoms of Crohn's disease?
- Diarrhoea, which is bloody - Abdominal pain - Weight loss, failure to thrive - Fatigue, fever, malaise
121
What are some signs of Crohn's disease?
- Bowel ulceration - Abdominal tenderness - Peri-anal abscess/fistulae - Clubbing
122
How do you diagnose Crohn's disease?
- Presentation of symptoms - Abdominal and PR exams - FBC, CRP, U&E, stool culture - Colonoscopy and biopsy
123
What is the treatment of Crohn's disease?
Mild/moderate: Azathioprine, 40mg of prednisolone/day for 1 week, then taper by 5mg for 7 weeks. Severe: IV steroids, thromboembolism prophylaxis Perianal disease: oral antibiotics, immunosuppressant therapy, local surgery and seton insertion
124
What is the description of gastrointestinal malabsorption?
Malabsorption refers to decreased intestinal absorption of carbohydrate, protein, fat, minerals or vitamins.
125
What are some causes of gastrointestinal malabsorption?
- Coeliac disease - Chronic pancreatitis - Crohn's disease - Primary biliary cholangitis
126
What are some symptoms of gastrointestinal malabsorption?
- Diarrhoea - Reduced weight - Lethargy - Steatorrhoea - Bloating
127
How do you diagnose gastrointestinal malabsorption?
- FBC - Stool culture - Endoscopy and small bowel biopsy
128
What is the description of coeliac disease?
A common digestive condition where the small intestine becomes inflamed and unable to absorb nutrients due to the ingestion of gluten.
129
What is the cause of coeliac disease?
T-cell responses to gluten in the small bowel causes villous atrophy and malabsorption.
130
What are some symptoms of coeliac disease?
- Stinking stools - Diarrhoea - Abdominal pain - Bloating
131
How do you diagnose coeliac disease?
- Presentation of symptoms - Antibodies - Biopsy
132
What is the treatment of coeliac disease?
A gluten free diet
133
What is the full description of scurvy? | cause, signs, diagnosis, treatment
- Due to a lack of vitamin C - Signs: anorexia, gingivitis, bleeding from gums, muscle pain, oedema - Diagnosis: WBC, lowered ascorbic acid - Treatment: dietary education and ascorbic acid
134
What is the description of chronic pancreatitis?
Long term inflammation of the pancreas that alters its normal structure and function.
135
What are some causes of chronic pancreatitis?
- Alcohol - Smoking - Autoimmune - Sometimes can be familial
136
What are some symptoms of chronic pancreatitis?
- Epigastric pain, which can be relieved by sitting forward or hot water bottles on epigastrium. Pain may worsen when eating or drinking alcohol. - Nausea and vomiting - Steatorrhea
137
How do you diagnose chronic pancreatitis?
- Presentation of symptoms - Ultrasound (pancreatic calcifications confirm the diagnosis) - CT
138
What is the treatment for chronic pancreatitis?
Drugs - Give analgesics for pain Diet - no alcohol, low fat diet Surgery - for unremitting pain
139
What are some potential complications of chronic pancreatitis?
- Pseudocyst - Diabetes - Biliary obstruction
140
What is the description of pancreatic carcinoma?
Cancer can present in 3 parts of the pancreas; the head, the body and the tail.
141
What is the presentation of pancreatic carcinoma?
Head of the pancreas - Painless jaundice Body and tail - epigastric pain and jaundice Patients also present with: - Weight loss - Acute pancreatitis
142
What are some signs of pancreatic carcinoma?
- Jaundice - Palpable epigastric mass - Hepatomegaly - Splenomegaly
143
What is the epidemiology of pancreatic carcinoma?
- 3% of all malignancies - More common in males - >70 years old - 95% of patients have mutations in the KRAS2 gene
144
How do you diagnose pancreatic carcinoma?
- Blood tests - show cholestatic jaundice - Ultrasound and CT can show a pancreatic mass - Biopsy
145
What is the treatment of pancreatic carcinoma?
- 20% of pancreatic carcinomas are suitable for radical surgery (pancreatoduodenectomy - Whipple procedure) - Most patients also get adjuvant chemotherapy
146
What is the prognosis of pancreatic carcinoma?
Mean survival < 6 months 5 year survival < 3 % 5 year survival after Whipple - 5-14%
147
What is the description of carcinoid tumours?
A group of tumours capable of producing 5HT.
148
Where do carcinoid tumours occur?
Common sites include the appendix, ileum, rectum, ovaries and testes
149
What are some symptoms of carcinoid tumours?
GI tumours can cause: - Appendicitis - Intussusception - Intestinal obstruction
150
What is carcinoid syndrome and some of its symptoms?
Paraneoplastic syndrome Occurs in 5% of patients with carcinoid tumours Symptoms include: - Bronchoconstriction - Flushing - Diarrhoea - Congestive cardiac failure
151
How do you diagnose a carcinoid tumour?
- CXR and CT to locate tumours | - increased 24h urine 5HIAA (5HT metabolite)
152
What is the treatment for carcinoid tumours?
- Resection is the only cure for carcinoid tumours
153
What is the treatment for carcinoid syndrome?
- Octreotide => blocks the release of tumour mediators and counters peripheral effects
154
What is the description of jaundice?
The yellowing of skin, sclera and mucosa due to increased plasma bilirubin
155
How is jaundice classified?
In two ways: a) By the site of the problem i.e. pre-hepatic, hepatocellular, cholestatic b) By the type of circulating bilirubin i.e. conjugated or unconjugated.
156
What is the description of unconjugated hyperbilirubinaemia?
As unconjugated bilirubin is water-insoluble, it does not enter urine.
157
What are some of the potential causes of unconjugated hyperbilirubinaemia?
- Overproduction e.g. Haemolysis - Impaired hepatic uptake e.g. Drugs - Impaired conjugation e.g. Gilbert's syndrome - Physiological neonatal jaundice
158
What is the description of conjugated hyperbilirubinaemia?
Conjugated bilirubin is water-soluble, so it enters urine and makes it dark. Less conjugated bilirubin enters the intestine and makes stool pale.
159
What causes jaundice when the patient has normal urine and normal stool?
Pre-hepatic cause
160
What is the cause of jaundice when the patient has dark urine and normal stool?
Hepatic cause
161
What is the cause of jaundice when the patient has dark urine and pale stool?
Cholestatic cause/ obstructive cause
162
What are some pre-hepatic causes of jaundice?
- Haemolysis - Malaria - Sickle-cell anaemia - Thalassemia
163
What are some hepatic causes of jaundice?
- Liver cirrhosis - Viral hepatitis - Liver cancer - Alcoholic hepatitis - Primary biliary cirrhosis
164
What are some cholestatic causes of jaundice?
- Cholelithiasis (gall stones) - Pancreatic carcinoma - Pancreatitis - Cholangiocarcinoma
165
How do you diagnose the type of jaundice a patient is presenting with?
- Blood tests - look for haemolysis - Urine analysis - only conjugated jaundice presents with bilirubin in the urine - Ask patient about IV drug use, blood transfusions, tattoos, sexual activity, travelling abroad, alcohol use etc.
166
Which raised LFT's show hepatic pathology?
AST and ALT - if AST > ALT, then it indicates acute liver disease or cirrhosis - if ALT > AST, then it indicated chronic liver disease
167
Which raised LFT's show cholestatic pathology?
ALP and GGT - A more than 3-fold increase in ALP suggests cholestasis - A raised GGT is indicative of biliary epithelial damage and bile flow obstruction
168
What does an isolated raised ALP indicate?
- Bony metastases / primary bone tumours (e.g. sarcoma) - Vitamin D deficiency - Recent bone fractures
169
What does an isolated decreased albumin indicate?
- Cirrhosis | - Inflammation affecting the liver
170
What does an isolated raised bilirubin indicate?
Pre-hepatic cause of jaundice i.e. haemolysis or Gilbert's syndrome
171
What can an increased prothrombin time indicate?
Hepatic pathology
172
What is the description of liver failure?
Loss of function to the liver. This may be recognised by the development of coagulopathy or encephalopathy. It may occur acutely or chronically.
173
What are some of the causes of liver failure?
- Infections e.g. viral hepatitis and yellow fever - Drugs e.g. paracetamol overdose and isoniazid - Toxins e.g. mushrooms - Vascular - Other e.g. alcohol, fatty liver disease
174
What are some signs of liver failure?
- Jaundice - Hepatic encephalopathy - Liver flap - Fetor hepaticus (smells like pear drops) - Ascites
175
How do you diagnose liver failure?
FBC, LFTs, U&E, clotting, urine culture, abdominal ultrasound etc.
176
What is the management of liver failure?
- Treat the cause if known - Treat any seizures with phenytoin - If malnourished, give dietary supplements - Haemofiltration or haemodialysis - Treat ascites with diuretics - Avoid drugs with hepatic metabolism
177
What is the description of cirrhosis?
Loss of normal hepatic architecture with fibrosis and nodular regeneration. It implies irreversible liver damage.
178
What are some of the causes of cirrhosis?
- Chronic alcohol abuse - HBV or HCV infection - Haemochromatosis
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What are some signs of cirrhosis?
- Leuconychia - Clubbing - Palmar erythema - Spider navei - Xanthelasma - Gynecomastia
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How do you diagnose cirrhosis?
- FBC and LFTs - Liver ultrasound and duplex - MRI - Ascitic tap - Liver biopsy (diagnostic)
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What is the management of cirrhosis?
- Good nutrition - No alcohol and avoid NSAIDs, opiates and sedatives - Liver transplantation is the only effective treatment for cirrhosis
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What is the prognosis of cirrhosis?
5 year survival is about 50%
183
What is the description of viral hepatitis A?
An RNA virus with a faecal-oral spread (or shellfish) and an incubation period of 2-6 weeks. Most infections usually occur in childhood.
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What are some symptoms of viral hepatitis A?
- Fever - Malaise - Anorexia - Nausea - Arthralgia (pain in a joint) Then: - Jaundice - Hepatosplenomegaly - Adenopathy
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How do you diagnose viral hepatitis A?
- AST and ALT rise for 22-40 days after exposure and return to normal after 5-20 weeks - IgM rises from day 25 and means recent infection - IgG is detectable for life
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What is the treatment of viral hepatitis A?
- Supportive care, as disease is usually self-limiting and not chronic - Avoid alcohol - Active immunisation is important => with inactivated viral protein, 1 dose gives immunity for 1 year (20 years if further booster is given at 6-12 months.
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What is the description of viral hepatitis B?
A DNA virus with spread through blood products, IV drug users and sexual and direct contact. It has an incubation period of 1-6 months.
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What are some of the risk factors for viral hepatitis B?
- Being an IV drug user - Sexual partners/ carers of IV drug users - Health workers - Haemophiliacs - Men who have sex with men - Haemodialysis - Sex workers - Babies of affected mothers
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What are some of the symptoms of viral hepatitis B?
- Fever - Malaise - Anorexia - Nausea - Arthralgia (pain in a joint) - Urticaria (hives) - Jaundice - Hepatosplenomegaly
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How do you diagnose viral hepatitis B?
- HBsAg - present 1-6 months after exposure - HBsAg - persisting for >6 months defines carrier status - HBeAg - present 1.5- 3 months after acute illness (implies high infectivity) - Antibodies to HBcAg imply past infection - Antibodies to HBsAg alone imply vaccination
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What is the vaccination for viral hepatitis B?
- Passive immunisation may be given to non-immune contacts after high-risk exposure - Use hepatitis B vaccine 1ml into deltoid and repeat at 1&6 months
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What are some potential complications of viral hepatitis B?
- Hepatic failure - Cirrhosis - Cholangiocarcinoma
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What is the treatment for viral hepatitis B?
- Avoid alcohol - Immunise sexual contacts - Any patients with chronic liver inflammation or cirrhosis refer for antivirals: * PEG interferon alfa-2a for 48 weeks or better tolerated * Long-term nucleotide analogues e.g. tenofovir, entecavir
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What is the description of viral hepatitis C?
An RNA flavivirus with spread through blood, transfusions, IV drug abuse and sexual contact. The incubation period is 2 weeks to 3 months (after which its considered chronic).
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What are the symptoms of a viral hepatitis C infection?
- Early infection is often asymptomatic - 85% develop silence chronic infection - 25% will get cirrhosis in 20 years of which 4% get hepatocellular cancer
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Who is at higher risk for progression of a viral hepatitis C infection?
- Male - Older - Higher viral load - Use of alcohol - HIV - Hepatitis B virus
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How do you diagnose a viral hepatitis C infection?
- LFTs - Anti-HVC antibodies confirms exposure - HVC-PCR confirms ongoing infection - Liver biopsy
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What is the treatment for a viral hepatitis C infection?
- Quit alcohol | - Ledipasvir & sofosbuvir
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What is the full description of a viral hepatitis D infection? (description, complications, diagnosis, treatment)
- An incomplete RNA virus (need hep B virus for its completion). - Hep B vaccination prevents Hep D infection. - Complications: can cause liver failure or cirrhosis - Diagnosis: Anti-HDV antibody (only ask for it if HBsAg positive) - Treatment: Interferon alfa has limited success so liver transplantation may be needed
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What is the full description of a viral hepatitis E infection? (description, epidemiology, diagnosis, treatment)
- RNA virus, incubation period of 2-10 weeks - Common in Indochina, and commoner than Hep A in the UK - Mortality high in pregnancy - Vaccine is available in China (not Europe) - Diagnosis: Serology - Treatment: Ribavirin
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When do patient who suffer from alcoholism start to experience withdrawal symptoms?
10-72 hours after last drink
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What are some of the signs and symptoms of alcohol withdrawal?
- Increased pulse - Decreased BP - Tremor - Confusion - Fits - Hallucinations
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What is the relapse rate for alcoholism?
About 50%
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What is the description of fatty liver disease?
A condition in which fat levels build up in the liver. There's two types; alcoholic fatty liver disease and non-alcoholic fatty liver disease.
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What is the description of non-alcoholic fatty liver disease?
A type of fatty liver disease that is not associated with heavy alcohol use. There are two types; simply fatty liver (no inflammation, no liver damage) and non-alcoholic steatohepatitis (NASH) (inflammation and liver damage).
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What are some risk factors for non-alcoholic fatty liver disease?
- Type 2 diabetes, pre-diabetes - Obesity - Middle-aged or older - Hypertension - Hyperlipidaemia and hypercholesterolaemia - Hep C exposure - Too rapid weight loss
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What are some of the symptoms of fatty liver disease?
Usually silent with barely any symptoms
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How do you diagnose fatty liver disease?
- LFTs - Ultrasound - CT - Liver biopsy
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What is the treatment for fatty liver disease?
Control risk factors - including obesity - weight loss can help Avoid alcohol consumption Vitamin E may improve histology of fibrosis
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What is the description of alcoholic hepatitis?
Inflammation of the liver caused by heavy consumption of alcohol.
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What are some symptoms of alcoholic hepatitis?
- Jaundice - Loss of appetite - Nausea and vomiting - Fever, low grade - Abdominal tenderness - Fatigue and weakness
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What are some potential complications of alcoholic hepatitis?
- Varices - Ascites - Hepatic encephalopathy - Cirrhosis - Kidney failure
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How do you diagnose alcoholic hepatitis?
- LFTs - FBC - Ultrasound or CT - Liver biopsy
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What is the treatment of alcoholic hepatitis?
- Quit alcohol consumption - Corticosteroids for inflammation - Liver transplant may be an option
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What is the description of primary biliary cholangitis?
Bile ducts are damaged by chronic autoimmune granulomatous inflammation.
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What is the cause of primary biliary cholangitis?
- Unknown environmental triggers (pollutants, xenobiotics) | - Possible genetic predisposition
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What are some of the signs and symptoms of primary biliary cholangitis?
- Lethargy - Pruritus - Jaundice - Xanthelasma - Hepatosplenomegaly
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What are some of the potential complications of primary biliary cholangitis?
- Cirrhosis | - Osteoporosis
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How do you diagnose primary biliary cholangitis?
- Blood => increased ALP, GGT and mildly increased ALT and AST. - Ultrasound - Biopsy (not usually needed)
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What is the treatment for primary biliary cholangitis?
- Treat symptoms - Monitor LFTs - Consider high-dose ursodeoxycholic acid (UDCA) - Liver transplantation
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What is the description of primary sclerosing cholangitis?
Progressive cholestasis (inability for bile to flow from the bile duct to the duodenum) with bile duct inflammation and strictures.
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What are some of the symptoms of primary sclerosing cholangitis?
- Pruritus - Fatigue - Ascending cholangitis - Cirrhosis - Hepatic failure Also causes increased risk of bile duct, gall bladder, liver and colon cancer.
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How do you diagnose primary sclerosing cholangitis?
- LFTs => Increased ALP and then increased bilirubin - ERCP or MRCP - Livery biopsy shows a fibrous, obliterative cholangitis
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What is the treatment for primary sclerosing cholangitis?
- Liver transplantation is the mainstay for end-stage disease - Ursodeoxycholic acid may improve LFT - Colestyramine for prutirus
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What is the description for autoimmune hepatitis?
Autoimmune liver inflammation. Characterised by abnormal T-cell function and autoantibodies directed against hepatocyte surface antigens.
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What are some of the symptoms of autoimmune hepatitis?
- Fatigue - Abdominal discomfort - Jaundice - Hepatomegaly - Spider naevi - Rashes - Joint pain
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How do you diagnose autoimmune hepatitis?
- LFTs (bilirubin, AST, ALT and ALP all usually increased) - Liver biopsy - MRCP Sometimes diagnosis is a challenge as there is overlap with other conditions.
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What is the treatment for autoimmune hepatitis?
- Immunosuppressant therapy with prednisolone | - Liver transplantation
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What is the description of Wilson's disease?
A rare, inherited autosomal recessive disorder of copper excretion with excess deposition in liver and CNS.
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What are some signs and symptoms of Wilson's disease in children?
Begin with liver disease: - Hepatitis - Cirrhosis - Liver failure
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What are some signs and symptoms of Wilson's disease in adults?
Begin with CNS disease: - Tremor - Dysphagia - Dyskinesia - Demetia
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What are some general signs and symptoms of Wilson's disease?
- Mood => depression, mania, personality change - Cognition => worse memory, slow to solve problems, decreased IQ - Kayser-Sleischer rings => Copper in iris - Haemolysis
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How do you diagnose Wilson's disease?
- Urine: 24h copper excretion is high - Increased LFTs - Serum copper: very high - Liver biopsy: increased hepatic copper
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What is the management of Wilson's disease?
- Diet: avoid foods with high copper content - Check water sources for copper - Drugs: lifelong penicillamine - If severe: liver transplantation Also screen siblings.
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What is the description of hereditary haemochromatosis?
An inherited disorder of iron metabolism in which increased intestinal iron absorption leads to iron deposition in joints, liver, heart, pancreas, adrenals and skin.
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What are some symptoms of hereditary haemochromatosis?
Early on: - Tiredness - Arthralgia Later: - Slate-Grey skin pigmentation - Signs of chronic liver disease - Hepatomegaly - Cirrhosis - Dilated cardiomyopathy
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How do you diagnose hereditary haemochromatosis?
- LFTs - increased - Increased ferritin - HFE genotyping - Liver and cardiac MRI - Fe overload - Liver biopsy
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What is the treatment of hereditary haemochromatosis?
- Venesect for life (consider desferrioxamine if intolerant of this) - Monitor LFTs - Diet: a well-balanced diet should be encouraged. Avoid alcohol, avoid uncooked seafood.
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What is the description of alpha-1-antitrypsin (A1AT) deficiency?
An inherited disorder affecting lung (emphysema) and liver (cirrhosis and HCC). A1AT is a glycoprotein made in the liver that controls inflammatory cascades. A1AT deficiency is the chief genetic cause of liver disease in children.
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What some of the symptoms of A1AT deficiency?
- Dyspnoea from emphysema - Cirrhosis - Cholestatic jaundice
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How do you diagnose A1AT deficiency?
- Serum alpha-1-antitrypsin levels low - Lung function testing => shows reduction in FEV1 with obstructive pattern - Liver biopsy - Phenotyping Can also make a pre-natal diagnosis which is possible by DNA analysis of chorionic villus samples.
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What is the treatment of A1AT deficiency?
- Smoking cessation - Prompt treatment/ preventative vaccinations for lung infections - Liver transplantation and lung transplantation may be needed
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What is the description of liver tumours?
Tumours of the liver. Usually they are metastases as primary hepatic tumours are much less common.
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What are some of the symptoms of liver tumours?
- Fever - Malaise - Anorexia - Weight loss - RUQ pain - Jaundice (usually late)
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What are some signs of liver tumours?
- Hepatomegaly - Cirrhosis - Jaundice - Ascites
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How do you diagnose liver tumours?
- Blood tests: FBC, clotting, LFTs, hepatitis serology - Imaging: Ultrasound, CT - Liver biopsy for histological diagnosis
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What is the full description of liver metastases?
- Typically signify advanced disease - Treatment and prognosis vary on type and extent of the primary tumour (but prognosis is typically < 6 months) - Chemotherapy may be effective (e.g. lymphomas) - Small, solitary metastases may be amenable to resection
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What is the full description of hepatocellular carcinoma?
- Primary hepatocyte neoplasia which accounts for 90% of primary liver cancers. - Symptoms: Fatigue, reduced appetite, RUQ pain, weight loss, jaundice, ascites. - Causes: Hepatitis B infection is the leading cause worldwide - Diagnosis: 3-phase CT, MRI, liver biopsy - Treatment: Resecting solitary tumours increased survival. Liver transplant
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What is the full description of cholangiocarcinoma?
- Billiary tree cancer - Causes: Flukes, primary sclerosing cholangitis, biliary cysts - Symptoms: Fever, abdominal pain, ascites, high bilirubin and high ALP - Pathology: Usually slow growing - Management: 70% inoperable at presentation - Prognosis: about 5 months
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What is the full description of benign liver tumours?
- Haemangiomas: commonest benign liver tumours. They are often an incidental finding on ultrasound or CT. They don't require treatment. Avoid biopsy - Adenomas: Common. Causes include anabolic steroids, oral contraceptive pill and pregnancy. Only treat if symptomatic, or >5cm.

Medical Conditions (3 decks)

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