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GI Flashcards

1
Q

how do you calculate BMI

and what is healthy?

A

kg/m^2

18.5-25

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2
Q

dysphagia - if difficulty swallowing solids AND liquids, what are the differentials?

A

MOTILITY
achalasia
diffuse oesoph spasm
CNS e.g. parkinsons

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3
Q

dysphagia - if difficulty swallowing solids 1st, THEN liquids, what are the differentials?

A

STRICTURE
CA - pharangeal, gastric, oesoph
external - lung CA, mediastinal lymph nodes
benign stricture

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4
Q

dysphagia - difficult to initiate swallowing action. Diagnosis

A

bulbar palsy

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5
Q

dysphagia Ix

A

bloods - U&E (dehydration), FBC (anaemia)
upper GI endoscopy +/- biopsy
(contrast swallow)

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6
Q

patient reports dysphagia, regurg, weight loss.
contrast swallow shows dilated tapering oesophagus, loss of coordinated peristalsis. Lower oesoph sphincter doesnt relax. Diagnosis

A

achalasia

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7
Q

patients reports dysphagia and chest pain. contrast swallow shows abnormal contractions. Diagnosis

A

diffuse oesophageal spasm

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8
Q

mx of achalasia

A

endoscopic balloon dilatation + PPIs

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9
Q

vomiting that relieves pain. Likely diagnosis?

A

peptic ulcer

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10
Q

severe vomiting ABG might show?

A

metabolic alkalosis due to loss of stomach acid

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11
Q

antiemetics that act at D2 receptor

A

metoclopramide
domperidone
haloperidol

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12
Q

H1 receptor antiemetic

A

cyclizine

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13
Q

5HT3 receptor antiemetic

A

ondansetron

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14
Q

Mx of h.pylori infection

A

lansoprazole + clarithromycin + amoxicillin or metro

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15
Q

complications of prolonged GORD

A 
oesophagitis
barretts / CA
benign oesophageal stricture
ulcers
iron def
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16
Q

causes of GORD

A 
oesophagal dysmotility (systemic sclerosis)
hiatus hernia
obesity
gastric acid hypersecretion
delayed gastric emptying
smoking, alcohol
pregnancy
drugs (anticholinergics, nitrates, tricyclics)
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17
Q

Signs and Sx of upper GI bleed

A

haematemesis
melaena
tachy, low BP

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18
Q

common causes of upper GI bleed

A 
CA
oesoph varices (liver disease/portal HTN)
peptic ulcer
NSAIDs/ anticoags
mallory-weiss tear
gastritis/ oesophagitis
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19
Q

acute Mx of upper GI bleed

A 
ABC
cannula, take bloods - FBC, U&E, crossmatch, clotting
fluids, transfuse
catheter
ABG
?clotting - vit K
emergency endoscopy/ surgery
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20
Q

causes of bloody diarrhoea

A

UC/crohns
colorectal CA
campylobacter/salmonella/shigella/E.coli
colon polyp

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21
Q

diarrhoea Ix

A

bloods - FBC, CRP, U+E (low K+ in severe), TFT, coeliac serology
stool culture
endoscopy

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22
Q

why avoid loperamide / codeine in colitis?

A

may precipitate toxic megacolon

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23
Q

tx of C.diff

A 
stop causative Abx if poss
metronidazole 400mg 10-14d in mild
vancomycin 125mg  in severe
AXR for toxic megacolon
faecal transplantation
spread prevention
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24
Q

constipation + menorrhagia could indicate what endocrine abnormality?

A

hypothyroidism

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25
constipation with abdo distension & active bowel sounds could indicate what?
bowel obstruction / stricture
26
describe the pathology and site of UC
relapsing and remitting inflammation of the colonic mucosa, not deeper, and never past ileocaecal valve, involves rectum and above/non patchy
27
sx of UC
``` diarrhoea, episodic OR chronic, with blood and mucus abdo cramps bowel frequency urgency fever anorexia weight loss malaise ```
28
examination signs of UC
``` clubbing episcleritis, conjunctivitis, erythema nodosum mouth ulcers arthritis ```
29
Ixs in UC
``` bloods: FBC, CRP, ESR blood culture stool MC+S, C diff toxin faecal calprotectin AXR lower GI endoscopy ```
30
AXR findings in UC
mucosal thickening | colonic dilatation: toxic megacolon
31
UC complications
toxic megacolon perf VTE colon CA
32
Mx of UC
``` mesalazine PO/PR (a 5-ASA) pred enema PO pred immunomodulation w/ azathioprine infliximab ``` ``` severe flare: IV fluids, IV hydrocort/methylpred, hydrocort enema, VTE prophylaxis, stool culture > ?Abx ``` rescue therapy: cyclosporin/ infliximab COLECTOMY
33
causes of erythema nodosum
``` UC/crohns sarcoid strep TB drugs ```
34
describe the imflammation of crohns
transmural granulomatous mouth to anus skip lesions [unaffected bowel in between]
35
crohns Sx
``` abdo pain diarrhoea anorexia malaise, fatigue fever weight loss/ failure to thrive ```
36
non GI signs and sx of crohns
clubbing arthritis erythema nodosum, pyoderma gangrenosum conjunctivitis/episcleritis/iritis
37
crohns complications
``` small bowel obstruction toxic dilatation [more common in UC] abscess fistula perforation colon CA primary sclerosing cholangitis malnutrition ```
38
crohns Ixs
``` FBC, haematinics stool MC+S w/ C.diff toxin faecal calprotectin colonoscopy and biopsy/ capsule endosc MRI ```
39
crohns Mx
pred azathioprine [if relapse on steroid taper] infliximab exclude infection VTE proph ?transfuse surgery [NO ROLE FOR 5-ASAs]
40
what is short bowel syndrome
malabsorption due to small bowel resection causing various metabolic disturbances
41
what factors may indicate a poor prognnosis in crohns disease?
``` steroids needed at 1st presentation <40 yrs perianal disease isolated terminal ileitis smoking ```
42
what gene serotype is linked to coeliac
HLA DQ2
43
skin condition ass. w/ coeliac
dermatitis herpetiformis
44
Sx of coeliac
``` smelly diarrhoea/steatorrhoea abdo pain, bloating weight loss N+V aphthous ulcers, angular stomatitis fatigue ```
45
investigation findings in the diagnosis of coeliac
anaemia low ferritin, B12 ^anti-transglutaminase duodenal biopsy: villous atrophy, crypt hyperplasia, ^intraepithelial WBCs
46
coeliac Mx
lifelong gluten free diet
47
complications/associations of coeliac
``` osteomalacia/osteoporosis dermatitis herpetiformis anaemia hyposplenism GI T cell lymphoma ^CA risk (lymphoma, gastric, oesophageal, colorectal) neuropathies ```
48
common causes of GI malabsorption on the UK
coeliac chronic pancreatitis crohns
49
pancreatitis Sx
epigastric pain radiating to back bloating steatorrhoea
50
causes of pancreatitis
``` I GET SMASHED Idiopathic Gallstones Ethanol Trauma Steroids Malignancy/Mumps Autoimmune Scorpion venom Hypercholesterolaemia/ Hypercalc ERCP Drugs [azathiop, oestrogens] ```
51
what can be seen on US or CT pancreas that confirm chronic pancreatitis?
pancreatic calcifications
52
ixs for chronic pancreatitis
``` US CT MRCP (MR cholangiopancreatography) AXR faecal elastase ```
53
mX CHRONIC pancreatitis
``` analgesia lipase fat soluble vitamins insulin no alcohol (low fat diet) surgery (pancreatectomy/ duct drainage procedure) ```
54
complications of pancreatitis
``` pseudocyst diabetes biliary obstruction local artery aneurysm splenic vein thromb gastric varices pancreatic carcinoma ```
55
risk factors for pancreatic CA
``` male >70 yrs smoking alcohol chronic pancreatitis central obesity DM ```
56
presentation of pancreatic CA
``` epigastric pain radiates to back relived by sitting forward obstructive jaundice weight loss DM acute pancreatitis ``` rarer: thrombophlebitis migrans hypercalc portal HTN [splenic vein thromb]
57
examination signs of pancreatic CA
``` jaundice painless palpable gallbladder epigastric mass splenomegaly (portal vein ob) hepatomegaly (mets) lymphadenopthy ascites ```
58
why might a pancreatic CA pt get nephrosis
renal vein mets
59
ix in pancreatic ca
``` LFT CA 19-9 US/CT [mass/dilated biliary tree/liver mets] biopsy ERCP/MRCP endoccopic US ```
60
Mx pancreatic ca
``` surgery [whipples/tail resection] chemo palliative: stent for jaundice/anorexia analgesia radio ```
61
causes of unconjugated hyperbilirubinaemia (jaundice)
haemolysis impaired hepatic uptake: drugs, ischaemic hepatitis impaired conjugation: Gilbert's neonatal
62
which type of jaundice causes dark urine and pale stool? and why?
conjugated conjugated bilirubin is water soluble so is excreted in the urine. Less enters gut which leaves faeces pale.
63
causes of conjugated hyperbilirubinaemia (jaundice)
hepatocellular dysfn. : viruses, drugs, alcohol, cirrhosis, liver mets, abscess, haemochrom, autoimmune, sepsis etc. impaired excretion/ cholestasis: CBD stones, primary biliary/schlerosing cholangitis, pancreatic CA, drugs, cholangiocarcinoma
64
on examination of a patient with painless jaundice, what does a palpable gallbladder indicate?
GB or pancreatic CA, NOT stones - stones lead to a fibrotic and inexpandable gallbladder
65
looking at a patient's urine bilirubin and urobilinogen, how would you distinguish between pre-hepatic and obstructive jaundice?
pre-hepatic : bilirubin absent obstructive: urobilinogen absent
66
bloods in jaundice
``` LFT FBC clotting blood film coombs test haptoglobins malaria parasites ebv U+E PCM levels blood cultures hepatitis serology ```
67
what imaging technique in a jaundiced Pt? and what are you looking for?
US: gallstones, liver mets, pancreas mass ERCP/MRCP [CBD stones.. etc]
68
complications of ECRP
pancreatitis bleeding cholangitis perforation
69
bilirubin is conjugated by the liver . Conjugate bili is secreted in bile and passes into gut. some is taken up by the liver again, and the rest is converted into what by gut bacteria?
urobilinogen
70
give 4 examples of drugs that can induce jaundice
``` PCM overdose steroids statins sulfonylurea [Glibenclamide, gliclazide] valproate co-amox, fluclox, nitrofurantoin MOAIs isoniazid/rifampicin/pyrazinamole ```
71
what is fulminant hepatic failure
massive necrosis of liver cells > severe liver fn. impairemnt
72
name 5 causes of liver failure
infection - viral hep drugs - PCM overdose vascular - Budd-chiari, veno-occlusive disease alcohol NAFLD primary biliary/ sclerosing cholangitis haemochromatosis, wilsons autoimmune hepatitis, alpha1-antitrypsin def malignancy
73
investigations in liver failure - bloods
``` FBC U+E LFT clotting glucose PCM level hepatitis/ CMV/EBV serology ferritin alpha 1 antitrypsin Ceruloplasmin [stores and carries copper] autoantibodies ```
74
investigations in liver failure - imgaging
CXR, abdo US, portal/hepatic vein doppler
75
Mx of a patient in acute liver failure
``` ABCDE 10% dextrose (avoid hypo) treat the cause phenytoin for seizures (HD if renal failure) ```
76
what major compliactions should you be aware of in a patient in liver failure
bleeds! [GI/varices] sepsis hypoglycaemia encephalopathy
77
Mx of cerebral oedema in liver failure
ITU mannitol hyperventilate
78
Mx of ascites in liver failure or cirrhosis
``` fluid restrict low salt diet diuretics (spiro, then furos) [paracentesis] [albumin infusion] ```
79
Mx of bleeding in liver failure
``` vit K platelets FFP [blood] [endoscopy] ```
80
Mx of encephalopathy in liver failure
``` ITU lactulose (traps NH3 in the colon) rifaximin (Abx, reduce nitrogen-forming bacteria) correct electrolytes head-up tilt ```
81
drugs to avoid in liver failure
constipating (^risk of encephalopathy) hypoglycaemics saline (ascites risk) warfarin (^ed effect) hepatotoxic: PCM, methotrex, isoniazid, azathioprine, oestrogen etc
82
what is the pathology behind hepatic encephalopathy?
nitrogeous waste e.g. ammonia builds up. Enter brain, causing osmotic imbalance →cerebral oedema
83
what 3 factors make up hepatorenal syndrome
cirrhosis + ascites + renal failure | [if other causes of renal fialure have been excluded]
84
the king's college criteria in acute liver failure predict poor outcome and should prompt transplant consideration. What factors are included?
PCM-induced: acidosis OR [PT, creat, enceph] non-PCM: PT OR drug-induced, age <10/>40, >1week from jaundice to enceph, bili
85
most common causes of cirrhosis and give 3 other causes
alcohol, hepB/C 1. genetic: haemochromatosis, alpha1antitrypsin, Wlsons 2. hepatic vein: budd-chiari 3. NAFLD 4. autoimm: PBC/PSC, autoimm hepatitis 5. drugs: amiodarone, methyldopa, methotrex
86
name 5 examination signs in cirrhosis
``` leuconychia clubbing palmar erythema dupytrens spider naevi xanthelasma gynaecomastia atrophic testes loss of body hair parotid enlargment hepatomegaly ascites splenomeg ```
87
complications of cirrhosis
hepatic failure: coagulopathy, encephalopathy, hypoalbuminaemia (oedema), sepsis, spont bact peritonitis, hypoglyc. portal HTN: ascites, splenomeg, varices, caput medusae HCC
88
how might hypersplenism show on blood tests
low platelets | low WCC
89
blood tests you might do do ascertain the cause of cirrhosis
``` ferritin/iron/total iron-binding capacity hepatitis serology Ig.s ANA/AMA/SMA alpha-feto protein caeruloplasmin alpha1antitrypsin ```
90
what might you see on a doppler US [duplex] in cirrhosis
``` small liver in late stage or hepatomeg, splenomeg focal liver lesions hepatic vein thrombosis reversed flow in the portal vein ascites ```
91
imaging in cirrhosis
US + duplex (doppler) | MRI
92
Mx of cirrhosis | - medical + other considerations
cholestyramine (pruritus) Tx for specific cause e.g. penicillamine for wilsons NO ALCOHOL nutrition no NSAIDs/sedatives/opiates screen for HCC transplant
93
patient with cirrhosis and ascites deteriorates suddenly. An ascitic tap is performed and sent for MC+S. Neutrophils come back as 300/mm3. Diagnosis?
spontaneous bacterial peritonitis
94
common organisms for spont bact peritonitis
E.coli klebsiella strep
95
what abx will you prescribe for spontaneous bacterial peritonitis until sensitivities are back
e.g. piperacillin + tazobactam [Tazocin]
96
what porphylaxis can you give to high risk patients for spontaneous bacterial peritonitis [prev. episode, low albumin, high PT/INR, low ascitic albumin.]
ciprofloxacin
97
what prophylaxis can you give to patients for encephalopathy in cirrhosis
lactulose | rifaximin
98
why does hepatorenal syndrome occur?
liver produces NO > vasodilation > hypoTN > activates RAAS > efferent vasoconstriction
99
what factors can cause asymptomatic cirrhosis to become symptomatic (jaundice, enceph, ascites)/ decompensated
``` dehydration constipation alcohol infection opiates GI bleed portal vein thrombosis ```
100
indications for liver transplant
acute: kings college criteria [PT, creat, enceph, bili] chronic: advanced cirrhosis of any cause, HCC
101
contraindications for liver transplant
``` extrahepatic malignancy severe CV disease sepsis expected non-compliance w/ meds ongoing alc. consump. ```
102
complications following liver transplant
hyperacute rejection [ABO incompatibility] acute (5-10days) rejection [T-cell mediated] sepsis hepatic artery thrombosis chronic rejection [6-9/12] disease recurrence graft-versus-host disease
103
patient's LFTs show ^ALP. Looking at the gamma GT, how can you ascertain whether the rasied ALP is of liver or bone origin?
gamma GT also raised = liver pathology gamma GT normal = bone pathology
104
which areas of the body does alpha1-antitrypsin deficiency affect and what pathology does it cause?
lung [emphysema] liver [cirrhosis + HCC]
105
what is the chief genetic cause of liver disease in children?
alpha1 antitrypsin deficiency
106
how might a patient with alpha1-antitrypsin deficiency present
dyspnoea from emphysema cirrhosis cholestatic jaundice
107
tests in alpha1-antitrypsin deficiency
a1AT levels genotyping LFT (obstructive) liver biopsy
108
Mx of alpha1-antitrypsin deficiency
``` smoking cessation prompt Tx/vaccine prophylaxis for lung infection liver transplantation lung transplantation (a1AT IV/inhaled maybe) ```
109
what is the pathophysiology behind haemochromatosis and which areas of the body are effected
inherited disorder of iron metabolism ^intestinal iron absorption iron deposition in joints, liver, heart, pancreas, pituitary, adrenal, skin
110
why do women present around 10 yrs later than men do in haemochromatosis?
menstrual blood loss is protective
111
signs and Sx of haemochromatosis
nil or: tired low libido arthralgia (2nd/3rd MCPJs, knee) slate grey skin pigmentation CLD signs [hepatomeg etc]
112
haemochromatosis effect on pancreas
DM - "bronze diabetes"
113
what effect does hypopituitarism in haemochromatosis have on patient?
hypogonadism [ED, amenorrhoea, etc.]
114
Ix in haemochromatosis (include results plz)
``` ^ferritin deranged LFTs ^transferrin saturation (as ferritin is ^ed by inflamm) HFE genotyping XR - chondrocalcinosis MRI liver and heart - Fe overload liver biopsy - iron loading and fibrosis ```
115
Mx of haemochromatosis, including screening for complications
venesect (desferrioxamine) monitor LFTs, glucose, screen for HCC with US and AFP
116
dietary advice in haemochromatosis
no need to avoid iron rich foods avoid alcohol avoid uncooked seafood [bacteria that thrive on iron]
117
what is the pathophysiology behind wilson's disease + what areas of the body are affected?
inherited disorder of copper excretion. copper not incorporated into caeruloplasmin in liver. excess deposition in liver + CNS [e.g. basal ganglia]
118
mode of inheritance in wilsons
autosomal recessive
119
wilson's disease presentation. Give 5 type of presentation or features or symptoms
paeds: hepatitis, cirrhosis, fulminant liver failure tremor, dysarthria, dysphagia, dyskinesia, dystonia, dementia, parkinsonism (ataxia, clumsiness) ↓memory, slow to solve problems, ↓IQ, delusions, mutism, depression, mania, ↑/↓libido, personality change kayser fleisher rings, haemolysis, Grey skin, hypermpobility, arthritis
120
tests in wilson's disease
1. urine copper high 2. LFT deranged 3. serum copper 4. low serum caeruloplasmin 5. genetic test 6. slit lamp examination - KF rings 7. liver biopsy: ↑copper, hepatitis, cirrhosis 8. MRI: degen of basalG, fronto-temp, cerebellar, brainstem
121
Mx wilson's disease
PENICILLAMINE avoid: liver, chocolate, nuts, mushrooms, legumes, shellfish + check water supplies for copper liver transplant screen siblings
122
fatal events in wilsons
liver failure bleeding infection
123
are Hep A-E DNA or RNA viruses
all RNA except B
124
modes of spread for hep A-E
A + E faecal oral | B + C blood, IVDU, sex
125
SIGNS AND Sx of hep A
``` fever malaise anorexia nausea arthralgia then jaundice, hepatomeg, adenopathy ```
126
findings for IgM and IgG in hepatitis A
IgM from day 25 - means recent infection | IgG detectable for life
127
Mx of hep A
supportive/' self limioting | avoid alcohol
128
prognosis for hep A
usually self limiting fulminant hepatitis rarely no chronicity
129
give 4 risk groups for hep B
``` IVDU + their partners/ carers health workers haemophiliacs men who have sex with men haemodialysis + chronic RF sexual promiscuity foster carers close family member of carrier staff/residents of institutions/prisons baby of +ve mum from endemic area ```
130
signs and sx of hep b
``` ARTHRALGIA URTICARIA fever malaise anorexia nausea then jaundice, hepatomeg, adenopathy ```
131
Complications of hep B
``` cirrhosis fulminant hepatic failure HCC cholangiocarcinoma cryoglobulinaemia membranous nephropathy polyarteritis nodosa ```
132
Mx of hep B
adults often clear avoid alcohol immunise sexual contacts chronic [got as baby/child] -tenofovir
133
complications of hep C
``` chronic infection cirrhosis HCC glomerulonephritis cryoglobulinaemia thyroiditis autoimmune hepatitis Polyarteritis nodosa polymyositis ```
134
other infecttive causes of hepatitis than hep A-E
``` EBV CMV leptospirosis malaria Q fever syphilis yellow fever ```
135
which of the body systems are affected by alcoholism
``` liver CNS gut blood heart reproduction TRAUMA while in toxicated ```
136
describe the ways in which alcohol affects the liver
fatty liver cirrhosis alcoholic hepatitis hepatic failure
137
how does alcoholism affect the CNS
``` memory loss reduced cognition cortical atrophy retrobulbar neuropathy [behind eyeball] fits falls wide based gait neuropathy confabulation/ korsakoffs syndrome wernicke's enceph ```
138
how does alcoholism affect the GI tract
``` obesity D+V gastric erosions peptic ulcers varices pancreatitis CA [many] oesophageal rupture ```
139
an alcoholic presents with chest pain, shock, and subcutaneous/ surgical emphysema in the neck. This suggests what?
oesophageal rupture [Boerhaave syndrome]
140
how does alcoholism affect the blood
``` ^MCV. Anaemia - from: marrow suppression GI bleed folate def haemolysis sideroblastic ```
141
how does alcoholism affect the heart
arhythmias HTN cardiomyopathy sudden death in binge drinker
142
how does alcoholism affect the reproductive system
testicular atrophy low testosterone / progest high oestrogen fetal alcohol syndrome
143
features of fetal alcohol syndrome
low IQ short palpebral fissure absent philtrum small eyes
144
low long after the last drink does withdrawal start in alcoholism?
10-72hrs
145
sign of withdrawal
tachycardia, hypoTN, tremor, confusion, fits, hallucinations [delirium tremens],
146
Mx of withdrawal in alcoholism
chlordiazepoxide (thiamine) acamprosate to prevent relapse [helps anxiety, insomnia, craving]
147
drug used for chronic alcohol dependence
disulfiram [antabuse] - acts like metronidazole/ makes Pt feel awful if they drink: flushing, throbbing headache, palpitations
148
signs and Sx of alcoholic hepatitis
``` ↑temp ↑RR ↑HR malaise anorexia D+V tender hepatomeg +/- jaundice bleeding ascites ```
149
iX in alcoholic hepatitis + results of note
FBC, clotting, LFT, U+E ``` ↑WCC ↓Platelets (toxic effect or hyposplen) ↑INR ↑AST ↑MCV ↑urea ```
150
Mx of alcoholic hepatitis
1. stop alcohol! 2. ascitic drain (may need to treat spont bact peritonitis) 3. treat any infection 4. vit K 5. thiamine 6. nutrition if malnourished (7. treat withdrawal -chlordiaz) (8. pred)
151
what's the pathophysiology behind korsakoff's syndrome
hypothalamic damage + cerebral atrophy form thiamine deficiency
152
features of korsakoff's syndrome
reduced ability to acquire new memories confabulation lack of insight apathy
153
what is the classical triad of wernicke's encephalopathy and what causes it? Give some other possible features.
confusion, ataxia, opthalmoplegia thiamine deficiency memory disturbance, hypoTN, hypothermia, reduced consciousness.
154
other recognised causes of wernicke's encephalopathy other than alcoholism
malnutrition eating disorders prolonged vomiting e.g. with chemo, GI malignancy, hyperemesis G.
155
Tx of wernicke's encephalopathy
thiamine | if hypoglyc, give glucose [MUST BE AFTER THIAMINE OR YOU'LL MAKE IT WORSE]
156
which part of the liver is damaged in primary biliary cholangitis? what causes the damage?
interlobular bile ducts chronic granulomatous inflammation
157
what are the consequences of the damage seen in primary biliary cholangitis?
cholestasis > fibrosis, cirrhosis, portal HTN osteoporosis, osteomalacia, coagulopathy [reduced absorption of fat soluble vits] HCC
158
give 4 causes of liver granulomas
``` primary biliary cholangitis TB sarcoid infections in HIV [toxoplasmosis, CMV, mycobact] polyarteritis nodosa SLE granulomatosis with polyangiitis lymphoma syphilis isoniazid, quinidine, carbamazepine, allopurinol ```
159
what is the cause of primary biliary cholangitis
?pollutant/bacteria trigger genetic predisposition *AMA [antimitochondrial antibodies]*
160
primary biliary cholangitis risk factors, including age and sex predominance
``` women 9:1 ~50yrs FH UTIs smoking past preg autoimm diseases nail polish/hair dye ```
161
how does primary biliary cholangitis present?
often asymp/incidental finding on LFT lethargy pruritus. yrs -jaundice
162
signs in primary biliary cholangitis
jaundice xanthalasma, xathomata skin pigmentation hepatosplenomeg
163
Ix.s in primary biliary cholangitis
``` LFT AMA Immunoglobs, esp IgM TSH cholesterol US [exclude extra-hepatic cholestasis] (biopsy - rule out drug-induced/sarcoid) ```
164
Tx for primary biliary cholangitis
``` colestyramine [itch] codeine [diarrhoea] bisphos [osteoporosis] fat soluble vits ursodeoxycholic acid transplant ```
165
pathophys of primary sclerosing cholangitis
bile duct inflamm and strictures > cholestasis
166
presentation of primary sclerosing cholangitis
``` pruritis fatigue ascending cholangitis cirrhosis hepatic failure ```
167
associations of primary sclerosing cholangitis [including associated diseases, antigens, gender predominance]
``` male HLA-A1, HLA-B8, HLA-DR3 autoimmune hep IBD [usually UC] colorectal/bile duct/ gallbladder/ liver CA ```
168
Ix findings in primary sclerosing cholangitis
``` LFT deranged ^Ig.s [hypergammaglobulinaemia] AMA -ve ANA/SMA/ANCA may be +ve ERCP/MRCP Liver biopsy [fibrous obliterative cholangitis] ```
169
Tx of primary sclerosing cholangitis
liver transplant colestyramine for pruritis Abx for bacterial cholangitis
170
jaundiced, itchy patient with UC. ERCP shows many strictures in the biliary tree with a beaded appearance, diagnosis?
primary sclerosing cholangitis
171
causes of gallstones + risk factors for them becoming symptomatic
haemolysis [pigment stones] female, age, obesity, ^cholesterol [cholesterol stones] smoking, parity
172
what causes biliary colic?
cystic duct or CBD obstruction
173
Mx of biliary colic
morphine fluids NBM elective lap cholecystectomy
174
whats the pathophys behind acute cholecystitis
stone or sludge impaction in neck of GB
175
presentation of acute cholecystitis
``` continuous RUQ/epigastric pain R/F to R shoulder vomiting fever local peritonism GB mass ```
176
how is binary colic differentiated from acute cholecystitis
acute cholecystitis = inflamm component [local peritonism, fever, ^WCC]
177
Ix findings in acute cholecystitis
``` ^WCC US: thick walled shrunken GB pericholecytic fluid stones CBD dilated ```
178
what is a porcelain GB ass. w/
CA
179
mx of acute cholecystitis
``` NBM pain relief IV fluids co-amox lap chole [open if perf] ```
180
sx of chronic cholecystitis
'flatulent dyspepsia' - vague abdo discomfort, distention, nausea, flatulence, fat intolerance [=GB contraction]
181
mx of chronic cholecystitis
cholecystectomy
182
differentials for of chronic cholecystitis/ flatulent dispepsia
``` IBS peptic ulcer hiatus hernia chronic pancreatitis tumour ```
183
what is cholangitis? triad of SX? Mx?
bile duct infection RUQ pain, jaundice, rigors [charcot] Mx = abx
184
how does a gallstone ileus occur?
stone erodes through GB into duodenum, obstructs termminal ileum
185
Ix of choice in gallstone ileus and findins
AXR air in CBD small bowel fluid level stone
186
complications of gallstones
``` in GB: biliary colic cholecystitis mucocoele [GB full of mucus] empyema [fulll of pus] carcinoma ``` in ducts: obstructive jaundice cholangitis pnacreatitis gallstoe ileus
187
distinguish B.colic, acute cholecystitis, cholangitis. based on RUQ pain, fever, ^WCC, jaundice
biliary colic -RUQ pain acute chole - RUQ pain, fever, ^WCC cholangitis - RUQ pain, fever, ^WCC, jaundice
188
age and sex usually affected by automimune hepatitis
women | 10-30 + >40
189
automimm hep presentation
acute hepatitis, fever, malaise, urticarial rash, polyarthritis, pleurisy, pulm infiltration, glom neph or gradual jaundice amenorrhoea
190
tests in autoimmune hepatitis
``` autoantibodies [ASMA, ANA, IgG, LKMI] LFT hypergammaglobulinaemia FBC [anaemia, low WCC, low plts] liver biopsy MRCP [exclude PSC] ```
191
Mx of autoimmune hep
pred azathioprine transplant
192
associations of AIH
``` PA UC glom. neph. autoI thyroiditis autoI haemolysis DM PSC HLA A1, B8, DR3 ```
193
what marker is ^ in 50-80% of HCC
alpha fetoprotein
194
if cholangiocarcinoma is suspected what Ix might you do?
ERCP + biopsy
195
causes of HCC
``` cirrhosis [alc/haaemochrom/PBC] hepB/C autoimmune hep NAFLD anabolic steroids ```
196
diagnosis of HCC
CT w/ contrast MRI biopsy
197
mx of HCC
resection, ablation, tumour embolisation sorafenib transplant
198
causes of cholangiocarcinoma
``` flukes PSC biliary cysts HepB/C DM ```
199
cholangiocarcinoma mx
palliative - stent | rarely surg
200
causes of liver adenoma
anabolic steroids | OCP, preg
201
mx of liver hemangioma and adenoma
nothing, benign. If Sx then treat
202
common origins of liver mets in men and in women
men - stomach, colon, lung | women - stomach, colon, breast, uterus
203
65 yr old with deepening jaundice, pruritus, pale stools, WL 1 stone in 3 months, poor appetitie, firm knobbly liver on palpation. Recently been diagnosed with DM. what is the most liekly diagnosis? and what Ix would you do to confirm?
carcinoma of pancreas CT abdo
204
need to prescribe a diuretic to a patient with hypercalcaemia. Which diuretic will promote Ca2+ loss?
furosemide
205
diuretics that promote hypercalc
thiazides
206
imaging in suspected gallstones
US consider MRCP if no stones in CBD of US consider endoscopic US

3B GH (16 decks)

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