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3B GH > GI > Flashcards

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
Q

constipation with abdo distension & active bowel sounds could indicate what?

A

bowel obstruction / stricture

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26
Q

describe the pathology and site of UC

A

relapsing and remitting inflammation of the colonic mucosa, not deeper, and never past ileocaecal valve, involves rectum and above/non patchy

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27
Q

sx of UC

A 
diarrhoea, episodic OR chronic, with blood and mucus
abdo cramps
bowel frequency
urgency
fever
anorexia
weight loss
malaise
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28
Q

examination signs of UC

A 
clubbing
episcleritis, conjunctivitis, 
erythema nodosum
mouth ulcers
arthritis
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29
Q

Ixs in UC

A 
bloods: FBC, CRP, ESR
blood culture
stool MC+S,  C diff toxin
faecal calprotectin
AXR
lower GI endoscopy
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30
Q

AXR findings in UC

A

mucosal thickening

colonic dilatation: toxic megacolon

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31
Q

UC complications

A

toxic megacolon
perf
VTE
colon CA

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32
Q

Mx of UC

A 
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

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33
Q

causes of erythema nodosum

A 
UC/crohns
sarcoid
strep
TB
drugs
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34
Q

describe the imflammation of crohns

A

transmural
granulomatous
mouth to anus
skip lesions [unaffected bowel in between]

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35
Q

crohns Sx

A 
abdo pain
diarrhoea
anorexia
malaise, fatigue
fever
weight loss/ failure to thrive
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36
Q

non GI signs and sx of crohns

A

clubbing
arthritis
erythema nodosum, pyoderma gangrenosum
conjunctivitis/episcleritis/iritis

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37
Q

crohns complications

A 
small bowel obstruction
toxic dilatation [more common in UC]
abscess
fistula
perforation
colon CA
primary sclerosing cholangitis
malnutrition
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38
Q

crohns Ixs

A 
FBC, haematinics
stool MC+S w/ C.diff toxin
faecal calprotectin
colonoscopy and biopsy/ capsule endosc
MRI
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39
Q

crohns Mx

A

pred
azathioprine [if relapse on steroid taper]
infliximab

exclude infection
VTE proph
?transfuse

surgery

[NO ROLE FOR 5-ASAs]

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40
Q

what is short bowel syndrome

A

malabsorption due to small bowel resection causing various metabolic disturbances

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41
Q

what factors may indicate a poor prognnosis in crohns disease?

A 
steroids needed at 1st presentation
<40 yrs
perianal disease
isolated terminal ileitis
smoking
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42
Q

what gene serotype is linked to coeliac

A

HLA DQ2

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43
Q

skin condition ass. w/ coeliac

A

dermatitis herpetiformis

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44
Q

Sx of coeliac

A 
smelly diarrhoea/steatorrhoea
abdo pain, bloating
weight loss
N+V
aphthous ulcers, angular stomatitis
fatigue
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45
Q

investigation findings in the diagnosis of coeliac

A

anaemia
low ferritin, B12
^anti-transglutaminase
duodenal biopsy: villous atrophy, crypt hyperplasia, ^intraepithelial WBCs

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46
Q

coeliac Mx

A

lifelong gluten free diet

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47
Q

complications/associations of coeliac

A 
osteomalacia/osteoporosis
dermatitis herpetiformis
anaemia
hyposplenism
GI T cell lymphoma
^CA risk (lymphoma, gastric, oesophageal, colorectal)
neuropathies
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48
Q

common causes of GI malabsorption on the UK

A

coeliac
chronic pancreatitis
crohns

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49
Q

pancreatitis Sx

A

epigastric pain radiating to back
bloating
steatorrhoea

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50
Q

causes of pancreatitis

A 
I GET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Malignancy/Mumps
Autoimmune
Scorpion venom
Hypercholesterolaemia/ Hypercalc
ERCP
Drugs [azathiop, oestrogens]
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51
Q

what can be seen on US or CT pancreas that confirm chronic pancreatitis?

A

pancreatic calcifications

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52
Q

ixs for chronic pancreatitis

A 
US
CT
MRCP (MR cholangiopancreatography)
AXR
faecal elastase
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53
Q

mX CHRONIC pancreatitis

A 
analgesia
lipase
fat soluble vitamins
insulin
no alcohol
(low fat diet)
surgery (pancreatectomy/ duct drainage procedure)
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54
Q

complications of pancreatitis

A 
pseudocyst
diabetes
biliary obstruction
local artery aneurysm
splenic vein thromb
gastric varices
pancreatic carcinoma
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55
Q

risk factors for pancreatic CA

A 
male
>70 yrs
smoking
alcohol
chronic pancreatitis
central obesity
DM
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56
Q

presentation of pancreatic CA

A 
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]

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57
Q

examination signs of pancreatic CA

A 
jaundice
painless palpable gallbladder
epigastric mass
splenomegaly (portal vein ob) 
hepatomegaly (mets)
lymphadenopthy
ascites
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58
Q

why might a pancreatic CA pt get nephrosis

A

renal vein mets

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59
Q

ix in pancreatic ca

A 
LFT 
CA 19-9
US/CT [mass/dilated biliary tree/liver mets]
biopsy
ERCP/MRCP
endoccopic US
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60
Q

Mx pancreatic ca

A 
surgery [whipples/tail resection]
chemo
palliative:
stent for jaundice/anorexia
analgesia
radio
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61
Q

causes of unconjugated hyperbilirubinaemia (jaundice)

A

haemolysis
impaired hepatic uptake: drugs, ischaemic hepatitis
impaired conjugation: Gilbert’s
neonatal

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62
Q

which type of jaundice causes dark urine and pale stool? and why?

A

conjugated

conjugated bilirubin is water soluble so is excreted in the urine. Less enters gut which leaves faeces pale.

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63
Q

causes of conjugated hyperbilirubinaemia (jaundice)

A

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

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64
Q

on examination of a patient with painless jaundice, what does a palpable gallbladder indicate?

A

GB or pancreatic CA, NOT stones - stones lead to a fibrotic and inexpandable gallbladder

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65
Q

looking at a patient’s urine bilirubin and urobilinogen, how would you distinguish between pre-hepatic and obstructive jaundice?

A

pre-hepatic : bilirubin absent

obstructive: urobilinogen absent

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66
Q

bloods in jaundice

A 
LFT
FBC
clotting
blood film
coombs test
haptoglobins
malaria parasites
ebv
U+E
PCM levels
blood cultures
hepatitis serology
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67
Q

what imaging technique in a jaundiced Pt? and what are you looking for?

A

US: gallstones, liver mets, pancreas mass

ERCP/MRCP [CBD stones.. etc]

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68
Q

complications of ECRP

A

pancreatitis
bleeding
cholangitis
perforation

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69
Q

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?

A

urobilinogen

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70
Q

give 4 examples of drugs that can induce jaundice

A 
PCM overdose
steroids
statins
sulfonylurea [Glibenclamide, gliclazide]
valproate
co-amox, fluclox, nitrofurantoin
MOAIs
isoniazid/rifampicin/pyrazinamole
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71
Q

what is fulminant hepatic failure

A

massive necrosis of liver cells > severe liver fn. impairemnt

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72
Q

name 5 causes of liver failure

A

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

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73
Q

investigations in liver failure - bloods

A 
FBC
U+E
LFT
clotting
glucose
PCM level
hepatitis/ CMV/EBV serology
ferritin
alpha 1 antitrypsin
Ceruloplasmin [stores and carries copper]
autoantibodies
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74
Q

investigations in liver failure - imgaging

A

CXR, abdo US, portal/hepatic vein doppler

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75
Q

Mx of a patient in acute liver failure

A 
ABCDE
10% dextrose (avoid hypo)
treat the cause
phenytoin for seizures
(HD if renal failure)
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76
Q

what major compliactions should you be aware of in a patient in liver failure

A

bleeds! [GI/varices]
sepsis
hypoglycaemia
encephalopathy

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77
Q

Mx of cerebral oedema in liver failure

A

ITU
mannitol
hyperventilate

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78
Q

Mx of ascites in liver failure or cirrhosis

A 
fluid restrict
low salt diet
diuretics (spiro, then furos)
[paracentesis]
[albumin infusion]
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79
Q

Mx of bleeding in liver failure

A 
vit K
platelets
FFP
[blood]
[endoscopy]
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80
Q

Mx of encephalopathy in liver failure

A 
ITU
lactulose (traps NH3 in the colon)
rifaximin (Abx, reduce nitrogen-forming bacteria)
correct electrolytes
head-up tilt
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81
Q

drugs to avoid in liver failure

A

constipating (^risk of encephalopathy)
hypoglycaemics
saline (ascites risk)
warfarin (^ed effect)

hepatotoxic: PCM, methotrex, isoniazid, azathioprine, oestrogen etc

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82
Q

what is the pathology behind hepatic encephalopathy?

A

nitrogeous waste e.g. ammonia builds up. Enter brain, causing osmotic imbalance →cerebral oedema

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83
Q

what 3 factors make up hepatorenal syndrome

A

cirrhosis + ascites + renal failure

[if other causes of renal fialure have been excluded]

84
Q

the king’s college criteria in acute liver failure predict poor outcome and should prompt transplant consideration. What factors are included?

A

PCM-induced: acidosis OR [PT, creat, enceph]

non-PCM: PT OR
drug-induced, age <10/>40, >1week from jaundice to enceph, bili

85
Q

most common causes of cirrhosis

and give 3 other causes

A

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
Q

name 5 examination signs in cirrhosis

A 
leuconychia
clubbing
palmar erythema
dupytrens
spider naevi
xanthelasma
gynaecomastia
atrophic testes
loss of body hair
parotid enlargment
hepatomegaly
ascites
splenomeg
87
Q

complications of cirrhosis

A

hepatic failure: coagulopathy, encephalopathy, hypoalbuminaemia (oedema), sepsis, spont bact peritonitis, hypoglyc.

portal HTN: ascites, splenomeg, varices, caput medusae

HCC

88
Q

how might hypersplenism show on blood tests

A

low platelets

low WCC

89
Q

blood tests you might do do ascertain the cause of cirrhosis

A 
ferritin/iron/total iron-binding capacity
hepatitis serology
Ig.s
ANA/AMA/SMA
alpha-feto protein
caeruloplasmin
alpha1antitrypsin
90
Q

what might you see on a doppler US [duplex] in cirrhosis

A 
small liver in late stage
or hepatomeg, splenomeg
focal liver lesions
hepatic vein thrombosis
reversed flow in the portal vein
ascites
91
Q

imaging in cirrhosis

A

US + duplex (doppler)

MRI

92
Q

Mx of cirrhosis

- medical + other considerations

A

cholestyramine (pruritus)
Tx for specific cause e.g. penicillamine for wilsons

NO ALCOHOL
nutrition
no NSAIDs/sedatives/opiates
screen for HCC

transplant

93
Q

patient with cirrhosis and ascites deteriorates suddenly. An ascitic tap is performed and sent for MC+S. Neutrophils come back as 300/mm3. Diagnosis?

A

spontaneous bacterial peritonitis

94
Q

common organisms for spont bact peritonitis

A

E.coli
klebsiella
strep

95
Q

what abx will you prescribe for spontaneous bacterial peritonitis until sensitivities are back

A

e.g. piperacillin + tazobactam [Tazocin]

96
Q

what porphylaxis can you give to high risk patients for spontaneous bacterial peritonitis [prev. episode, low albumin, high PT/INR, low ascitic albumin.]

A

ciprofloxacin

97
Q

what prophylaxis can you give to patients for encephalopathy in cirrhosis

A

lactulose

rifaximin

98
Q

why does hepatorenal syndrome occur?

A

liver produces NO > vasodilation > hypoTN > activates RAAS > efferent vasoconstriction

99
Q

what factors can cause asymptomatic cirrhosis to become symptomatic (jaundice, enceph, ascites)/ decompensated

A 
dehydration
constipation
alcohol
infection
opiates
GI bleed
portal vein thrombosis
100
Q

indications for liver transplant

A

acute: kings college criteria [PT, creat, enceph, bili]
chronic: advanced cirrhosis of any cause, HCC

101
Q

contraindications for liver transplant

A 
extrahepatic malignancy
severe CV disease
sepsis
expected non-compliance w/ meds
ongoing alc. consump.
102
Q

complications following liver transplant

A

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
Q

patient’s LFTs show ^ALP. Looking at the gamma GT, how can you ascertain whether the rasied ALP is of liver or bone origin?

A

gamma GT also raised = liver pathology

gamma GT normal = bone pathology

104
Q

which areas of the body does alpha1-antitrypsin deficiency affect and what pathology does it cause?

A

lung [emphysema]

liver [cirrhosis + HCC]

105
Q

what is the chief genetic cause of liver disease in children?

A

alpha1 antitrypsin deficiency

106
Q

how might a patient with alpha1-antitrypsin deficiency present

A

dyspnoea from emphysema
cirrhosis
cholestatic jaundice

107
Q

tests in alpha1-antitrypsin deficiency

A

a1AT levels
genotyping
LFT (obstructive)
liver biopsy

108
Q

Mx of alpha1-antitrypsin deficiency

A 
smoking cessation
prompt Tx/vaccine prophylaxis for lung infection
liver transplantation
lung transplantation
(a1AT IV/inhaled maybe)
109
Q

what is the pathophysiology behind haemochromatosis and which areas of the body are effected

A

inherited
disorder of iron metabolism
^intestinal iron absorption
iron deposition in joints, liver, heart, pancreas, pituitary, adrenal, skin

110
Q

why do women present around 10 yrs later than men do in haemochromatosis?

A

menstrual blood loss is protective

111
Q

signs and Sx of haemochromatosis

A

nil or:
tired
low libido
arthralgia (2nd/3rd MCPJs, knee)

slate grey skin pigmentation
CLD signs [hepatomeg etc]

112
Q

haemochromatosis effect on pancreas

A

DM - “bronze diabetes”

113
Q

what effect does hypopituitarism in haemochromatosis have on patient?

A

hypogonadism [ED, amenorrhoea, etc.]

114
Q

Ix in haemochromatosis (include results plz)

A 
^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
Q

Mx of haemochromatosis, including screening for complications

A

venesect
(desferrioxamine)

monitor LFTs, glucose, screen for HCC with US and AFP

116
Q

dietary advice in haemochromatosis

A

no need to avoid iron rich foods
avoid alcohol
avoid uncooked seafood [bacteria that thrive on iron]

117
Q

what is the pathophysiology behind wilson’s disease + what areas of the body are affected?

A

inherited
disorder of copper excretion.
copper not incorporated into caeruloplasmin in liver.
excess deposition in liver + CNS [e.g. basal ganglia]

118
Q

mode of inheritance in wilsons

A

autosomal recessive

119
Q

wilson’s disease presentation. Give 5 type of presentation or features or symptoms

A

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
Q

tests in wilson’s disease

A
  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
Q

Mx wilson’s disease

A

PENICILLAMINE

avoid: liver, chocolate, nuts, mushrooms, legumes, shellfish + check water supplies for copper

liver transplant

screen siblings

122
Q

fatal events in wilsons

A

liver failure
bleeding
infection

123
Q

are Hep A-E DNA or RNA viruses

A

all RNA except B

124
Q

modes of spread for hep A-E

A

A + E faecal oral

B + C blood, IVDU, sex

125
Q

SIGNS AND Sx of hep A

A 
fever 
malaise
anorexia
nausea
arthralgia
then jaundice, hepatomeg, adenopathy
126
Q

findings for IgM and IgG in hepatitis A

A

IgM from day 25 - means recent infection

IgG detectable for life

127
Q

Mx of hep A

A

supportive/’ self limioting

avoid alcohol

128
Q

prognosis for hep A

A

usually self limiting
fulminant hepatitis rarely
no chronicity

129
Q

give 4 risk groups for hep B

A 
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
Q

signs and sx of hep b

A 
ARTHRALGIA
URTICARIA
fever 
malaise
anorexia
nausea
then jaundice, hepatomeg, adenopathy
131
Q

Complications of hep B

A 
cirrhosis
fulminant hepatic failure
HCC
cholangiocarcinoma
cryoglobulinaemia
membranous nephropathy
polyarteritis nodosa
132
Q

Mx of hep B

A

adults often clear
avoid alcohol
immunise sexual contacts
chronic [got as baby/child] -tenofovir

133
Q

complications of hep C

A 
chronic infection
cirrhosis
HCC
glomerulonephritis
cryoglobulinaemia
thyroiditis
autoimmune hepatitis
Polyarteritis nodosa
polymyositis
134
Q

other infecttive causes of hepatitis than hep A-E

A 
EBV
CMV
leptospirosis
malaria
Q fever
syphilis
yellow fever
135
Q

which of the body systems are affected by alcoholism

A 
liver 
CNS
gut
blood
heart
reproduction
TRAUMA while in toxicated
136
Q

describe the ways in which alcohol affects the liver

A

fatty liver
cirrhosis
alcoholic hepatitis
hepatic failure

137
Q

how does alcoholism affect the CNS

A 
memory loss
reduced cognition
cortical atrophy
retrobulbar neuropathy [behind eyeball]
fits
falls
wide based gait
neuropathy
confabulation/ korsakoffs syndrome
wernicke's enceph
138
Q

how does alcoholism affect the GI tract

A 
obesity
D+V
gastric erosions
peptic ulcers
varices
pancreatitis
CA [many]
oesophageal rupture
139
Q

an alcoholic presents with chest pain, shock, and subcutaneous/ surgical emphysema in the neck. This suggests what?

A

oesophageal rupture [Boerhaave syndrome]

140
Q

how does alcoholism affect the blood

A 
^MCV. 
Anaemia - from:
marrow suppression
GI bleed
folate def
haemolysis
sideroblastic
141
Q

how does alcoholism affect the heart

A

arhythmias
HTN
cardiomyopathy
sudden death in binge drinker

142
Q

how does alcoholism affect the reproductive system

A

testicular atrophy
low testosterone / progest
high oestrogen
fetal alcohol syndrome

143
Q

features of fetal alcohol syndrome

A

low IQ
short palpebral fissure
absent philtrum
small eyes

144
Q

low long after the last drink does withdrawal start in alcoholism?

A

10-72hrs

145
Q

sign of withdrawal

A

tachycardia, hypoTN, tremor, confusion, fits, hallucinations [delirium tremens],

146
Q

Mx of withdrawal in alcoholism

A

chlordiazepoxide
(thiamine)
acamprosate to prevent relapse [helps anxiety, insomnia, craving]

147
Q

drug used for chronic alcohol dependence

A

disulfiram [antabuse] - acts like metronidazole/ makes Pt feel awful if they drink: flushing, throbbing headache, palpitations

148
Q

signs and Sx of alcoholic hepatitis

A 
↑temp
↑RR
↑HR
malaise
anorexia
D+V
tender hepatomeg
\+/- jaundice
bleeding
ascites
149
Q

iX in alcoholic hepatitis + results of note

A

FBC, clotting, LFT, U+E

↑WCC
↓Platelets (toxic effect or hyposplen)
↑INR
↑AST
↑MCV
↑urea
150
Q

Mx of alcoholic hepatitis

A
  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
Q

what’s the pathophysiology behind korsakoff’s syndrome

A

hypothalamic damage + cerebral atrophy form thiamine deficiency

152
Q

features of korsakoff’s syndrome

A

reduced ability to acquire new memories
confabulation
lack of insight
apathy

153
Q

what is the classical triad of wernicke’s encephalopathy and what causes it?
Give some other possible features.

A

confusion, ataxia, opthalmoplegia

thiamine deficiency

memory disturbance, hypoTN, hypothermia, reduced consciousness.

154
Q

other recognised causes of wernicke’s encephalopathy other than alcoholism

A

malnutrition
eating disorders
prolonged vomiting e.g. with chemo, GI malignancy, hyperemesis G.

155
Q

Tx of wernicke’s encephalopathy

A

thiamine

if hypoglyc, give glucose [MUST BE AFTER THIAMINE OR YOU’LL MAKE IT WORSE]

156
Q

which part of the liver is damaged in primary biliary cholangitis?

what causes the damage?

A

interlobular bile ducts

chronic granulomatous inflammation

157
Q

what are the consequences of the damage seen in primary biliary cholangitis?

A

cholestasis > fibrosis, cirrhosis, portal HTN

osteoporosis, osteomalacia, coagulopathy [reduced absorption of fat soluble vits]

HCC

158
Q

give 4 causes of liver granulomas

A 
primary biliary cholangitis
TB
sarcoid
infections in HIV [toxoplasmosis, CMV, mycobact]
polyarteritis nodosa 
SLE
granulomatosis with polyangiitis
lymphoma
syphilis
isoniazid, quinidine, carbamazepine, allopurinol
159
Q

what is the cause of primary biliary cholangitis

A

?pollutant/bacteria trigger
genetic predisposition
AMA [antimitochondrial antibodies]

160
Q

primary biliary cholangitis risk factors, including age and sex predominance

A 
women 9:1
~50yrs
FH
UTIs
smoking
past preg
autoimm diseases
nail polish/hair dye
161
Q

how does primary biliary cholangitis present?

A

often asymp/incidental finding on LFT
lethargy
pruritus.
yrs -jaundice

162
Q

signs in primary biliary cholangitis

A

jaundice
xanthalasma, xathomata
skin pigmentation
hepatosplenomeg

163
Q

Ix.s in primary biliary cholangitis

A 
LFT
AMA
Immunoglobs, esp IgM
TSH
cholesterol
US [exclude extra-hepatic cholestasis]
(biopsy - rule out drug-induced/sarcoid)
164
Q

Tx for primary biliary cholangitis

A 
colestyramine [itch]
codeine [diarrhoea]
bisphos [osteoporosis]
fat soluble vits
ursodeoxycholic acid
transplant
165
Q

pathophys of primary sclerosing cholangitis

A

bile duct inflamm and strictures > cholestasis

166
Q

presentation of primary sclerosing cholangitis

A 
pruritis
fatigue
ascending cholangitis
cirrhosis
hepatic failure
167
Q

associations of primary sclerosing cholangitis [including associated diseases, antigens, gender predominance]

A 
male
HLA-A1, HLA-B8, HLA-DR3
autoimmune hep
IBD [usually UC]
colorectal/bile duct/ gallbladder/ liver CA
168
Q

Ix findings in primary sclerosing cholangitis

A 
LFT deranged
^Ig.s [hypergammaglobulinaemia]
AMA -ve
ANA/SMA/ANCA may be +ve
ERCP/MRCP
Liver biopsy [fibrous obliterative cholangitis]
169
Q

Tx of primary sclerosing cholangitis

A

liver transplant
colestyramine for pruritis
Abx for bacterial cholangitis

170
Q

jaundiced, itchy patient with UC. ERCP shows many strictures in the biliary tree with a beaded appearance, diagnosis?

A

primary sclerosing cholangitis

171
Q

causes of gallstones

+ risk factors for them becoming symptomatic

A

haemolysis [pigment stones]

female, age, obesity, ^cholesterol [cholesterol stones]

smoking, parity

172
Q

what causes biliary colic?

A

cystic duct or CBD obstruction

173
Q

Mx of biliary colic

A

morphine
fluids
NBM
elective lap cholecystectomy

174
Q

whats the pathophys behind acute cholecystitis

A

stone or sludge impaction in neck of GB

175
Q

presentation of acute cholecystitis

A 
continuous RUQ/epigastric pain
R/F to R shoulder
vomiting
fever
local peritonism
GB mass
176
Q

how is binary colic differentiated from acute cholecystitis

A

acute cholecystitis = inflamm component [local peritonism, fever, ^WCC]

177
Q

Ix findings in acute cholecystitis

A 
^WCC
US: 
thick walled shrunken GB
pericholecytic fluid
stones
CBD dilated
178
Q

what is a porcelain GB ass. w/

A

CA

179
Q

mx of acute cholecystitis

A 
NBM
pain relief
IV fluids
co-amox
lap chole [open if perf]
180
Q

sx of chronic cholecystitis

A

‘flatulent dyspepsia’ - vague abdo discomfort, distention, nausea, flatulence, fat intolerance [=GB contraction]

181
Q

mx of chronic cholecystitis

A

cholecystectomy

182
Q

differentials for of chronic cholecystitis/ flatulent dispepsia

A 
IBS
peptic ulcer
hiatus hernia
chronic pancreatitis
tumour
183
Q

what is cholangitis?

triad of SX?

Mx?

A

bile duct infection

RUQ pain, jaundice, rigors [charcot]

Mx = abx

184
Q

how does a gallstone ileus occur?

A

stone erodes through GB into duodenum, obstructs termminal ileum

185
Q

Ix of choice in gallstone ileus and findins

A

AXR
air in CBD
small bowel fluid level
stone

186
Q

complications of gallstones

A 
in GB:
biliary colic
cholecystitis
mucocoele [GB full of mucus]
empyema [fulll of pus]
carcinoma

in ducts:
obstructive jaundice
cholangitis
pnacreatitis

gallstoe ileus

187
Q

distinguish B.colic, acute cholecystitis, cholangitis. based on RUQ pain, fever, ^WCC, jaundice

A

biliary colic -RUQ pain
acute chole - RUQ pain, fever, ^WCC
cholangitis - RUQ pain, fever, ^WCC, jaundice

188
Q

age and sex usually affected by automimune hepatitis

A

women

10-30 + >40

189
Q

automimm hep presentation

A

acute hepatitis, fever, malaise, urticarial rash, polyarthritis, pleurisy, pulm infiltration, glom neph

or gradual jaundice

amenorrhoea

190
Q

tests in autoimmune hepatitis

A 
autoantibodies [ASMA, ANA, IgG, LKMI]
LFT
hypergammaglobulinaemia
FBC [anaemia, low WCC, low plts]
liver biopsy
MRCP [exclude PSC]
191
Q

Mx of autoimmune hep

A

pred
azathioprine
transplant

192
Q

associations of AIH

A 
PA
UC
glom. neph.
autoI thyroiditis
autoI haemolysis
DM
PSC
HLA A1, B8, DR3
193
Q

what marker is ^ in 50-80% of HCC

A

alpha fetoprotein

194
Q

if cholangiocarcinoma is suspected what Ix might you do?

A

ERCP + biopsy

195
Q

causes of HCC

A 
cirrhosis [alc/haaemochrom/PBC]
hepB/C
autoimmune hep
NAFLD
anabolic steroids
196
Q

diagnosis of HCC

A

CT w/ contrast
MRI
biopsy

197
Q

mx of HCC

A

resection, ablation, tumour embolisation
sorafenib
transplant

198
Q

causes of cholangiocarcinoma

A 
flukes
PSC
biliary cysts
HepB/C
DM
199
Q

cholangiocarcinoma mx

A

palliative - stent

rarely surg

200
Q

causes of liver adenoma

A

anabolic steroids

OCP, preg

201
Q

mx of liver hemangioma and adenoma

A

nothing, benign. If Sx then treat

202
Q

common origins of liver mets in men and in women

A

men - stomach, colon, lung

women - stomach, colon, breast, uterus

203
Q

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?

A

carcinoma of pancreas

CT abdo

204
Q

need to prescribe a diuretic to a patient with hypercalcaemia. Which diuretic will promote Ca2+ loss?

A

furosemide

205
Q

diuretics that promote hypercalc

A

thiazides

206
Q

imaging in suspected gallstones

A

US
consider MRCP if no stones in CBD of US
consider endoscopic US

3B GH (16 decks)

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