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Long Case > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

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1
Q

Presentation chronic liver disease

A 
Swelling of feet/abdomen
Fatigue, nausea
Jaundice, pruritis
Bruising
Haematemis
Confusion
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2
Q

Risk factors chronic liver disease

A

Alcohol
Hepatitis/jaundice
Drugs
Diabetes, cardiac failure

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3
Q

Causes of chronic liver disease

A

FIGCAT
Fatty liver
Infectious
Genetic (haemochromotosis, alpha-1-antitrypsin deficiency)
Congestion (RHF)
Autoimmune (primary biliary cirrhosis or primary sclerosing cholangitis)
Toxins

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4
Q

Complications of chronic liver disease

A 
Portal hypertension
Hepatitic encephalopathy
Coagulopathy
Hepatocellular carcinoma
Spontaneous bacterial peritonitis
Hepatorenal syndrome
Ascites
Hypoglycaemia
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5
Q

Bloods for chronic liver disease

A 
FBC, CRP, urea, ammonia
Coags
Lfts
Full liver screen: viral serology, autoantibodies, serum copper, ferritin
Alpha-1 antitrypsin
Alpha fetoprotein
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6
Q

investigations for chronic liver disease

A 
Bloods
Abdo USS +- portal vein doppler
Fibroscanning
MRCP
Ascitic tap
Liver biopsy
Paracetamol levels
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7
Q

Criteria for child-pugh score

A 
Encephalopathy
Ascites
Bilirubin
Albumin
Prothrombin time
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8
Q

Pharmacological treatment for chronic liver disease

A 
Depends on underlying cause:
Hep B: interferon
Hep C: ribavirin
Autoimmune hepatitis: steroids
Fatty: weight loss, statins
Nutritional support
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9
Q

How to treat ascites

A 
Bed rest and fluid restrict
Low salt diet
Spironolcatone
Frusemide
Therapeutic paracentesis
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10
Q

How to treat varices

A

Prophylactic treatment with beta blockers or variceal band ligation

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11
Q

Encephalopathy treatment

A 
Enemas to rid gut of blood
Low protein diet
Lactulose or antibiotics like metronidazole
Mannitol
Lorazepam for seizures
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12
Q

End line liver treatment

A

TIPS (transjugular intrahepatic portosystemic shunt) which connects portal vein to hepatic vein
Liver transplant

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13
Q

Screening in liver disease

A

USS +/- alpha fetoprotein every 6 months for HCC

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14
Q

Indications for liver transplant

A

Advanced cirrhosis caused by; alcohol, hepatitis, primary biliary cirrhosis, wilson’s, A1-antitrypsin, primary sclerosing cholangitis, HCC

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15
Q

Contraindications for liver transplant

A 
Extra hepatic malignancy
Multiple hepatic tumours
Severe cardioresp disease
Sepsis
HIV
Non compliance with medications
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16
Q

Kings college criteria for liver transplant

A 
Non-paracetamol induced
PT 100s/INR >6
or 3/5 of 
not hepatitis
Age <10 or >40
>1 week from first jaundice to encephalopathy
PT >50s/INR >3.5
Bilirubin >0.3mmol/L
Paracetamol induced
pH <7.3 or INR >6
Cr >300
Grade 3 or 4 encephalopathy
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17
Q

which drugs are needed for immunosuppression in liver transplant?

A

Ciclosporin and tacrolimus or

Tacrolimus and azathioprine or mycophenolate and prednisone

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18
Q

Complications of liver transplant

A

Rejection
Sepsis
1 year 80% success

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19
Q

How does the presentation of colon cancer change with position?

Study These Flashcards
A

Left: PR bleeding/ altered bowel habit/ tenesmus/ mass on PR
Right: Weight loss/anaemia
Either: abdominal mass, haemorrhage, perforation, fistula

20
Q

Riak Factors colon cancer

Study These Flashcards
A 
Polyps
Family History
IBD
Previous cancer
Smoking
Diet
Alcohol
21
Q

Investigations colon cancer

Study These Flashcards
A 
FBC (microcytic anemia)
LFT
CEA
Faecal occult blood (if screening)
Colonoscopy
Liver USS
If polyposis in family refer for genetic testing once every 15 years
22
Q

Management of colon cancer

Study These Flashcards
A

Hemicolectomy, sigmoid colectomy, anterior resection, hartmann’s procedure
Stenting (palliative)
Radiotherapy and chemotherapy

23
Q

Key things to ask in dyspepsia history

Study These Flashcards
A 
When symptoms occur
NSAID use
Progressive
Previous ulcer/reflux
Dysphagia
Maleana
Losing weight
24
Q

Investigations for dyspepsia

Study These Flashcards
A 
FBC
Urease breath test and stool antigen (H.pylori) 
Gastroscopy with biopsy
CXR
Barium swallow
24hr esophageal pH monitoring-GERD
25
Differential diagnosis for dyspepsia
``` GORD Gastritis Gastric cancer Pancreatitis/pancreatic cancer Ulcer Chronic mesenteric ischaemia ```
26
How do we kill H pylori
Triple therapy with omeprazole, clarithromycin and metronidazole
27
Management of dyspepsia
H pylori eradication Stop NSAIDS and steroids PPIs/H2 antagonists Ulcers should be biopsied to ensure not cancer
28
Presenting symptoms of IBD
``` Diarrhoea Blood Mucous Abdo pain Urgency/tenesmus ```
29
Complications of UC
``` Toxic megacolon Strictures/fistulae Carcinoma of colon Primary sclerosing cholangitis Cirrhosis Erythema nodosum ```
30
Complications of Crohn's
Fissures/fistulas/abscesses Obstruction Carcinoma of colon and small bowel Gallstones
31
Investigations for IBD
``` FBC ESR, CRP U and E LFTs Testing p-ANCA and ASCA Stool sample-fecal calprotectin AXR Sigmoidoscopy Biopsy CT ```
32
Treatment ladder for UC
mesalazine/sulfazine prednisolone (oral or rectal) azothioprine/cyclosporin/infliximab proctocolectomy
33
Treatment ladder to Crohn's
``` prednisolone IV/rectal hydrocortisone Metronidazole Azathioprine/infliximab Surgery-limited resection ```
34
Presentation of haemochromatosis
``` Tiredness Arthralgia Grey-skin Hepatomegaly cardiomyopathy Diabetes pituitary dysfunction ```
35
Investigations haemochromatosis
``` Raised LFT, raised sFerritin Transferrin sat HFE genotype XRAY Liver MRI Biopsy ```
36
Management of haemochromatosis
venesection | Monitor
37
What causes haemochromatosis
Defect in activation of hepcidin normally triggered by iron excess
38
Investigations for coeliac disease?
Anti-tTG | Duodenal biopsy
39
Complications of coeliac disease?
Anaemia, lactose intolerance, T cell lymphoma, GI malignancies, myopathies
40
Difference between cushing's syndrome and cushings disease
Syndrome: any other cause of high cortisol Disease: ACTH secreting pituitary
41
Difference between Boorhave's syndrome and Mallory weiss?
Boorhave's: perforation of the esophagus | Mallory weiss: damage to the mucus membrane of the gastroesophageal junction
42
How do AST and ALT change in alcohol?
AST/ALT ratio of greater than 2 indicates alcoholic liver disease
43
Which score is used to assess pre endoscopy for bleeding risk?
Rockall score
44
Acute management of upper GI bleedig
``` ABCDE Nil by mouth Obtain IV access Give normal saline Check hb, LFTS, clotting factors If Hb low, transfuse (dont over transfuse because of risk of bleeding) Give omeprazole and IV antibiotics and ocreotide plus terlipressin post op (if varices) Calculate rockall score Call endoscopist ```
45
Causes of hypoglycemia
``` Exogenous Pituitary insufficiency Liver failure Addison's Islet cell tumours Naughty-alcohol ```
46
How to tell if this lump is the spleen?
Can't get over it Splenic notch Dull to percussion Comes down on inspiration

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