Gastrointestinal (GEER) Flashcards
(109 cards)
1
Q
What are the 4 common causes of liver cirrhosis?
A
Alcohol-related liver disease
Non-alcoholic fatty liver disease (NAFLD)
Hepatitis B
Hepatitis C
2
Q
What Autoantibodies relevant to liver disease.
(Name 4)
A
1.Antinuclear antibodies (ANA)
2.Smooth muscle antibodies (SMA)
3.Antimitochondrial antibodies (AMA)
4.Antibodies to liver kidney microsome type-1 (LKM-1)
3
Q
A patient is struggling with Alcohol Withdrawal. What should be prescribed?
A
Benzodiazepine (based on symptom score)
+Prophylaxis:
IM Pabrinex (High dose B vitamins)
4
Q
What vitamin deficiency is common among Alcoholics?
A
Vitamin B1 deficiency (Thiamine)
5
Q
What 2 disorders are due to Thiamine deficiency?
A
Wernicke’s encephalopathy and Korsakoff syndrome.
6
Q
What are the features of Wernicke’s Encephalopathy?
A
-Confusion
-Oculomotor
-Ataxia
7
Q
What are the features of Korsakoff syndrome?
A
-Memory impairment
-Behavioural changes
8
Q
What is the prognosis for Wernicke’s Encephalopathy?
A
Medical emergency with a high mortality rate.
9
Q
What is the medical emergency for Korsakoff Syndrome?
A
Often Irreversible and means patients will require full time institutional care.
10
Q
What is the management for Alcohol Related Liver Disease?
A
Clinical:
-Thiamine vitamins
-Corticosteroids for severe Hepatitis
11
Q
What is the pathophysiology of Non-Alcoholic Fatty Liver Disease?
A
Excessive fat (Triglycerides in the liver cells interfering with the functioning of the liver cells.
12
Q
How prevalent is Non-Alcoholic Fatty liver disease?
A
25% of Adults have it
13
Q
What can Non-alcoholic fatty liver disease (NAFLD) progress to?
A
Hepatitis (inflammation of the liver)
Liver Cirrhosis
14
Q
What are the risk factors for Non-alcoholic fatty liver disease (NAFLD)?
(Name 7)
A
1.Middle age onwards
2.Obesity
3.Poor diet and low activity levels
4.Type 2 diabetes
5.High cholesterol
6.High blood pressure
7.Smoking
15
Q
A patient presents with fatigue and right upper quadrant pain/dullness. They have Hypertension and are Obese. What investigations would you like to do?
A
Prime Suspect: Non Alcoholic Fatty Liver disease
-First line: Liver function test (ALT)
-Liver ultrasound (is stenosis or fibrosis present?)
-Enhanced Liver Fibrosis blood test
-Liver Biopsy : Gold standard test for diagnosis
16
Q
Describe a typical presentation of Non-Alcoholic Fatty Liver disease?
A
-Usually Obese with Hypertension
-Fatigue
-Right upper quadrant pain/dullness
17
Q
A patient with Non-Alcoholic Fatty Liver Disease has their Liver Profile back. What would you expect?
A
Raised ALP
18
Q
What results would you expect from an Enhanced Liver Fibrosis Blood test for a patient with advanced Non-Alcoholic Fatty Liver Disease?
A
10.51 or above = Advanced Fibrosis
Under 10.51 = Unlikely to be advanced fibrosis
19
Q
What is the management for Non-Alcoholic Fatty Liver Disease ?
A
Lifestyle -stop drinking smoking, weight loss, exercise etc
20
Q
What Hepatitis is a RNA virus and what is a DNA virus?
A
RNA: A,C,D,E
DNA: B
21
Q
What is the mode of transmission for Hepatitis ABCDE?
A
A: Faecal Oral
B: Blood/Bodily fluids
C:Blood
D:Always with Hep B
E: Faecal Oral
22
Q
What does a Hepatic picture on a Liver Function Test mean?
A
High Transaminases (AST and ALT)
-Bilirubin may also be high
23
Q
What antibodies confirm a Hep A diagnosis?
A
IgM
24
Q
What are the key viral markers for Hep B?
A
-Surface Antigen : HBsAg
-E Antigen: HBeAg
-Core Antibodies : HBcAb
-Surface antibody: HBsAb
-Hep B DNA
25
A patient's blood test has come back with HBcAB antibodies. What does this suggest?
Hepatitis B: Implies past or current infection
26
A patient's blood test has come back with HBsAg antibodies. What does this suggest?
Hep B: Active Infection
27
A patient's blood test has come back with HBeAg antibodies. What does this suggest?
Hep B: Viral replication and therefore HIGH infectivity
28
A patient's blood test has come back with HBsAb antibodies. What does this suggest?
Hep B: vaccination or past or current infection
29
How would you access the viral load of a patient with Hep B?
Hepatitis B virus DNA (HBV DNA) blood test
30
What is the management for a patient with Hep B?
-Screen for other viral infections
-Referral to Gastroenterology, Hepatology or Infectious Diseases
-Avoid Alcohol
-Reduce transmission
-Antiviral medications to slow progression : Entecavir
31
Name some Antiviral treatments for treating Chronic Hep B?
-Entecavir
-Tenofovir
-Lamivudine
-Adefovir
-Telbivudine
32
A patient presents with Abdominal pain, fatigue and flu like virus. Additional clinical observations include Pruritus, Significant Jaundice, Dark Urine and Pale Stools. They have just returned from Africa. What would you most likely advice?
-No management treatments
-Recover can take several weeks to months
-AVOID Acetaminophen and Paracetamol
33
A patient is diagnosed with Hep C. What is the management?
Direct-Acting Antiviral tablets :
=Ribavirin
34
A woman is diagnosed with Hep C and is prescribed Ribavirin. What advise is required?
-Can cause Birth defects
-DO NOT GET PREGNANT
-IF PREGNANT, DO NOT HAVE SEX WITH MALE TAKING RIBAVIRIN
35
What are the 2 main side effects of Ribavirin?
Fatigue and Headaches
36
What is Type 1 Autoimmune Hepatitis?
Affect women in their late 40s or 50s presents around Menopause. Less acute than type 2.
Rare cause of chronic hepatitis (inflammation in the liver). It appears to occur due to a combination of genetic and environmental factors.
37
What is Type 2 Autoimmune Hepatitis?
Affects Children or Young People (mainly girls)
Rare cause of chronic hepatitis (inflammation in the liver). It appears to occur due to a combination of genetic and environmental factors.
38
What are the Autoantibodies in type 2 autoimmune hepatitis?
Anti-liver kidney microsomes-1 (anti-LKM1)
Anti-liver cytosol antigen type 1 (anti-LC1)
39
How to treat autoimmune hepatitis?
Prednisolone (high dose steroids)
Azathioprine (immunosuppressants)
40
What is the pathophysiology of Haemochromatosis?
Autosomal Recessive causing iron overload.
41
Describe presentation of Hemochromatosis.
Chronic tiredness
Joint pain
Pigmentation (bronze skin)
Testicular atrophy
Erectile dysfunction
Amenorrhoea (absence of periods in women)
Cognitive symptoms (memory and mood disturbance)
Hepatomegaly
42
How to diagnose Haemochromatosis?
-Raised Serum Ferritin
-High Transferrin Saturation
-Genetic testing for HFE gene mutations
-Liver Biopsy with Perl's stain (assess the conc of iron in the liver)
OR MRI to avoid Biospy
43
A 19 year old patient presents with Liver Cirrhosis with no drinking or smoking history. Additionally, displays a tremor and is depressed. What initial screening test would you like to do?
Serum Caeruloplasmin
-Suggestive of Wilson's Disease
44
What is the pathophysiology of Wilson's Disease?
Autosomal Recessive causing excessive accumulation of copper in body tissues
45
What are the typical features of presentation of a patient with Wilson's Disease?
First presentation: Liver Cirrhosis
+Kayser-Fleisher Rings (Green brown circles round the iris)
+Haemolytic Anaemia
Advanced Disease:
Neurological and Psychiatric: Tremor, Dysarthria, Dystonia (abnormal muscle tone), Bradykinesia, Abnormal behaviour, Depression etc
46
What investigations for Wilson's Disease?
-Serum Caeruloplasmin
-24hr Urine Copper Assay
-Liver Biopsy
-Slit lamp exam (look for Kayser-Fleischer rings)
-MRI
47
A patient's Serum Caeruloplasmin results are back. What results would you expect from a patient with Wilson's disease?
Low
48
If a Serum Caeruloplasmin is raised, what would that indicate?
Elevated in cancer or inflammatory conditions
49
Name 6 complications of Haemochromatosis.
-Secondary diabetes
-Liver cirrhosis
-Endocrine and sexual problems
-Cardiomyopathy
-Hepatocellular carcinoma
-Hypothyroidism
-Chondrocalcinosis (calcium pyrophosphate deposits in joints) causes arthritis
49
A patient's 24hr urine copper assay is back and is high. What does this indicate?
Wilson's Disease
49
What is the management for Hemochromatosis.
-Venesection - regular removal of blood to remove excess iron
-Monitor Serum ferritin
50
What is the treatment for Wilson's Disease?
-Penicillamine
-Trientine
51
A patient has Alpha-1 Antitrypsin Deficiency. Their Liver Biopsy has got back- what would you expect?
Periodic acid-Schiff positive staining globules in hepatocytes, resistant to diastase treatment.
52
What is the management forAlpha-1 Antitrypsin Deficiency?
-Stop smoking
-Symptomatic treatment :Same as COPD
-Monitor for complications
-May need Liver transplant
53
How would you diagnose Alpha-1 Antitrypsin Deficiency?
-Low serum alpha-1 antitrypsin (the screening test)
-Genetic testing
-->Will also want to access lung damage (CXR, CT thorax and Pulmonary Function tests)
54
What is the genetic mode of inheritance of Alpha-1 antitrypsin deficiency ?
Autosomal Co-dominant
(SERPINA1 gene)
55
What is the pathophysiology Alpha-1 Antitrypsin Deficiency?
Due to mutation of gene responsible for coding the protease inhibitor Alpha-1 Antitrypsin, elastin in the lungs is not protected from the enzyme Neutrophil elastase that digests elastin in the lungs.
Alpha-1 Antitrypsin Deficiency is made in the liver and sometimes the deficiency means that instead there is a production and build up of abnormal mutant versions of the protein that are toxic to the liver.
56
What is the presentation for Alpha-1 Antitrypsin Deficiency?
-Causes Bronchiectasis and Emphysema
(smoking makes this much worse)
-Liver cirrhosis
57
A middle-aged white woman presents with itching, a positive Anti-Mitochondrial Antibodies and a raised alkaline phosphatase. What is the most likely diagnosis?
Primary Biliary Cholangitis.
58
What are the two most specific blood test results to diagnosing Primary Biliary Cholangitis?
-Anti-Mitochondrial Antibodies
-Alkaline Phosphatase
59
What is the treatment for Primary Biliary Cholangitis?
Ursodeoxycholic Acid
=(protects the cholangiocytes from inflammation and damage)
60
What treatment would you give a patient with Primary Biliary Cholangitis and Pruritus ?
Colestyramine
61
What is the pathophysiology of Primary Biliary Cholangitis?
Autoimmune conditions that attacks the small bile ducts leading to obstruction of bile flow called Cholestasis. The back pressure of bile leads to Liver Fibrosis, Cirrhosis and Failure. The lack of Bile acids also interupt the digestion of fats in the GI tract causing abdominal symptoms and malabsorption of fat.
62
What does Primary Biliary Cholangitis cause?
-Obstructive Jaundice
-Liver Disease
63
What is the typical presentation of Primary Biliary Cholangitis?
-White woman 40-60yrs
-Fatigue
-Pruritus (itching)
-Gastrointestinal symptoms and abdominal pain
-Jaundice
-Pale, greasy stools
-Dark urine
64
What 3 clinical examination observations would you expect with a patient Primary Biliary Cholangitis?
-Xanthoma
-Excoriations (scratches on skin from itching)
-Hepatomegaly
65
What other disease is associated strongly with Primary Sclerosing Cholangitis?
Ulcerative Colitis
(70% of cases associated with this)
66
What is the pathophysiology of Primary Sclerosing Cholangitis?
Stricture of the biliary ducts causing backflow of bile
67
What are the key risk factors for Primary Sclerosing Cholangitis?
-Male
-30-40 yrs
-Ulcerative Colitis
-Family History
68
What is a common presentation of a patient with Primary Sclerosing Cholangitis?
-Abdominal pain in the right upper quadrant
-Pruritus (itching)
-Fatigue
-Jaundice
-Hepatomegaly
-Splenomegaly
69
What is the chosen diagnostic imaging for Primary Sclerosing Cholangitis?
Magnetic Resonance Cholangiopancreatography (MRCP)
70
A patient has suspected Primary Sclerosing Cholangitis. Why would you want to perform a Colonoscopy?
To assess for Ulcerative Colitis
71
A patient has Primary Sclerosing Cholangitis and Pruritus. What should be prescribed?
Colestyramine
72
What is the management for Primary Sclerosing Cholangitis?
No management BUT procedures for treating dominant strictures or advanced disease.
1.Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
2.Stents
3.Liver transplant (in advanced disease)
73
A patient has suspected Primary Sclerosing Cholangitis with raised IgG4. What is the treatment?
Steroids
74
What is the main type of liver cancer called?
Hepatocellular carcinoma
75
What is the main lifestyle choice that affects Liver cancer?
Alcohol
76
What is the screening for Liver Cancer and who is offered it?
i)Liver Ultrasound and Alpha Fetoprotein
ii)Patients with Liver Cirrhosis offered every 6mnths
77
What is the presentation of a patient with Liver Cancer?
Weight loss
Abdominal pain
Anorexia
Nausea and vomiting
Jaundice
Pruritus
Upper abdominal mass on palpation
78
What are the initial investigations for Liver cancer?
-Alpha-fetoprotein (tumour marker for hepatocellular carcinoma)
-Liver ultrasound is the first-line imaging investigation
79
A patient presents with painless jaundice. What are the red flag diagnosis that you are thinking of?
Cholangiocarcinoma AND Cancer of the head of the Pancreas
80
What is Cholangiocarcinomas?
Type of cancer that originates in the bile ducts. The majority are adenocarcinomas.
81
What are the symptoms of Obstructive jaundice?
Pale stools, Dark urine and generalised itching
82
What is the tumour marker for Cholangiocarcinoma?
CA19-9
83
What is management for Hepatocellular Carcinoma?
-Surgery in early disease e.g Resection
-Liver transplant if tumour isolated to the liver
84
What factors can exacerbate symptoms of GORD?
-Greasy/Spicy Foods
-Coffee/Tea
-Alcohol
-NSAIDs
-Stress
-Smoking
-Obesity
-Hiatus Hernia
85
What does Dyspepsia mean?
Symptoms of Indigestion:
Heartburn. Acid regurgitation, Retrosternal/Epigastric pain, Bloating, Nocturnal cough, Hoarse voice
86
A patient presents with Dysphagia. What do you do?
=Difficulty swallowing
--> Red flag 2 week referral for Urgent Direct-Access Endoscopy
87
What red flag GI symptoms qualify for an urgent 2 week referral for investigations of cancer?
(Name 10)
-Dysphagia
-Aged over 55
-Weight Loss
-Upper Abdominal pain
-Reflux
-Treatment-Resistant Dyspepsia
-Nausea and vomiting
-Upper abdominal mass on palpation
-Low Haemoglobin
-Raised platelet count
88
A patient presents with Melaena, what should be done?
Admission to hospital and Urgent Endoscopy
89
What is a Hiatus Hernia?
Herniation of the stomach up through the diaphragm
90
What does H.Pylori cause?
Gastritis, ulcers and increases risk of stomach cancer
91
What type of bacteria is H.Pylori?
Gram-negative aerobic bacteria
92
What are investigations for H.Pylori?
Stool antigen test
Urea breath test using radiolabelled carbon 13
H. pylori antibody test (blood)
Rapid urease test performed during endoscopy (also known as the CLO test)
93
How to treat Barrett's Oesophagus?
-Endoscopic monitoring for progression to adenocarcinoma
-Proton pump inhibitors
-Endoscopic ablation (e.g., radiofrequency ablation)- to destroy columnar epithelial cells
94
What is Focal Nodular Hyperplasia and who is more at risk?
Benign Liver tumour made of fibrotic tissue found incidentally and no malignant potential.
-Related to those on the Contraceptive Pill.
94
What is Barrett's Oesophagus?
Premalignant condition
=Metaplasia (change in type of cell)
95
A patient has been admitted due to Melaena due to a peptic ulcer bleed. What medications could have caused this?
-Aspirin
-DOACs - Rivaroxaban, Dabigatran, Apixaban, Edoxaban
-Steroids
-SSRI antidepressants - Fluoxetine, Cipramil, Paroxetine
96
Name some SSR antidepressants.
-Fluoxetine
-Cipramil
-Paroxetine
97
What does Haemodynamic Instability mean?
Significant blood loss causing low blood pressure, tachycardia and signs of shock.
98
What are Oesophageal varices and what associated with?
Liver Cirrhosis and Portal Hypertension
99
What symptoms is Stomach Cancer associated with?
Weight loss, Epigastric pain, Treatment resistant dyspepsia, low haemoglobin and a raised platelet count
100
What would you expect from blood urea levels in an Upper GI bleed?
High
101
How would you manage an Upper GI bleed?
MEDICAL EMERGENCY
-Bloods
-Large bore cannula
-Transfusions
-Endoscopy
-Anticoagulants and NSAIDs
102
A patient with an Upper GI bleed regularly takes Warafin. What additional step is required in their management?
Prothrombin Complex Concentrate
103
A patient has Oesophageal Varices. What medications will they require?
-Terlipressin
-Broad spectrum antibiotics
104
A patient has had an Upper GI bleed with no Varices. What current medication must they be told to stop until their Endoscopy?
PPI- Omeprazole
105
What are the differentiating symptomatic features that separates Chron's Disease from IBS?
(Remember mneumonic)
NESTS
No blood or mucus
Entire GI affected (mouth to anus)
Skip lesions
Terminal ileum is most affects and Transmural Inflammation
Smoking is a risk factor
106
What is the long term treatment for varices?
Prophylaxsis
=Non-selective Beta Blockers
e.g Propranolol and Nodalol
