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PHASE 2A > GI AND LIVER > Flashcards

GI AND LIVER Flashcards

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1
Q

What is Charot’s triad linked to and what is it?

A

It is linked to ascending cholangitis and primary sclerosing cholangitis and is made of:
Fever
Upper right quadrant pain
Jaudice (Dark urine and pale stools)

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2
Q

Which infections cause ascending cholangitis?

A

E.coli or Kelbsiella also enterococcus (group D strep) although it is usually due to gallstones blockage

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3
Q

What is primary sclerosing cholangitis?

A

Chronic inflammation and fibrosis of the bile ducts (Linked to ulcerative colitis

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4
Q

What is diverticulosis and diverticulitis?

A

Diverticulosis: Presence of diverticula (Mucosa that has ppouched through the muscular wall)
Diverticulitis: Inflammation from when faeces obstructs the neck

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5
Q

What are risk factors of GORD?

A

Smoking, alcohol, pregnancy, big meals, hernia and obesity

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6
Q

When is heartburn must often felt when you have GORD?

A

When lying down and just after eating.

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7
Q

What investigatiosn do you do for GORD?

A

Endoscopy to check red flags

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8
Q

What treatment do you give for GORD?

A

Life style changes, Antacids (Magnesium carbonate), h2 receptor blockers (Ranitidine) and PPIs (omeprazole)

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9
Q

When do you experience pain with stomach ulcers?

A

While eating

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10
Q

What can cause ulcers?

A

H.pylori and NSAIDs

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11
Q

How would someone with an ulcer describe the pain?

A

Burning

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12
Q

How would you test for H.pylori?

A

C13 Urea breath test, stool sample test, blood antibody test

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13
Q

How do we treat H.pylori?

A

Omeprazole, metronidazole and clarithromycin

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14
Q

How do we treat ulcers if no H.pylori?

A

Stop NSAIDs, PPI (Lansoprazole) and H2 blocker (Rantidine)

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15
Q

What is EIEC?

A

Enteroinvasive E.coli that causes bloody diarrhoea

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16
Q

What is EPEC?

A

Enteropathogenic E.coli

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17
Q

What is EAEC?

A

Enteroaggregative which causes Traveller’s diarrhoea and produces EAST toxin

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18
Q

What are varices?

A

Dilated veins between the systemic and portal vein system leading to haemorrhage

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19
Q

What can cause varices?

A

Chronic liver disease

Oesophageal- Portal hypertension

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20
Q

How do we treat varices?

A

EMERGENCY

Banding, beta blockers, treat underlying, liver transplant

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21
Q

What are causes of gastritis?

A

H.pylori, alcohol and NSAIDs

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22
Q

What is gastritis?

A

Inflammation of the mucosa

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23
Q

What on gluten causes coeliac disease?

A

Alpha Giladin

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24
Q

What gene is linked to Coeliac disease?

A

HLA DQ2 AND HLA DQ 8

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25
What are the signs and symptoms of coeliac disease?
Abdominal pain and bloating, steatorrhoea, diarrhoea, weight loss, anaemia, failure to thrive
26
What antibody do you find in coeliac disease?
Anti-transglutamase (type of IgA)
27
What are the investigations for coeliac disease?
Anti-transglutamase, if positive do a duodenal biopsy (villous atrophy and crypt hyperplasia)
28
Where does Crohns effect?
The entire GI tract
29
Where does ulcerative collitis effect?
The terminal ileum
30
What symptoms does UC cause?
Cramp/colicky abdo pain and diarrhoea with blood and mucus
31
What is the macroscopic apprearances of chrons?
Skip lesions
32
What is the macroscopic appearance of UC?
Continuous involvement in the colon only
33
What are the microscopic signs of chrons?
Inflammation in all the layer and granulomas
34
What are the microscopic signs of UC?
Mucosal only inflammation and no signs of granulomas
35
What helps remember Chron's?
GALS- Granuloma All Layers Skip lesions
36
What investigations should be done for inflammatory bowel disease?
Bloods- low HB but high WCC, ESR and CRP A colonoscopy biopsy differentiates between the 2 A x ray shows the involvement extent
37
What is the treatment for Crohns?
Mild- Prednisolone | Severe- IV hydrocortisone
38
What is preventive treatment for Crohns?
5-ASA analogues (mezalazine), corticosteroids (prednisolone) and surgery
39
What is the treatment for ulcerative colitis?
Mild- 5-ASA analogues (mesalazine) and steroids Moderate- steroids Severe- IV hydrocortisone, ciclosporin (immunosuppresant) and surgery
40
In the UK what is the most common cause of diarrhoea?
Rotavirus
41
What can cause hernias?
Muscle weakness, chronic cough, trauma damage, heavy weight lifting, pregnancy and constipation
42
What is incarceration of a hernia?
Where the contents of the hernial sac are stuck inside by adhesions.
43
What are the 5 types of hernias?
``` 1- Hiatal (stomach-oesophageal hiatus of diaphragm) 2-Inguinal (most common) 3-Femoral 4-Incisional (after surgery) 5-Umbilical (<6 will correct itself) ```
44
What are the causes of acute pancreatitis?
GET SMASHED Gallstones Ethanol Trauma ``` Steroids Mumps Autoimmune Scorpion sting Hyperlipideamia ERCP Drugs ```
45
What are the signs of acute pancreatitis?
Cullen's- periumbilical brusing | Grey Turner's- flank bruising
46
What does acute pancreatitis present with?
Epigastric or central abdo pain radiating to the back Pain relived by sitting forwards Nausea and vomitting, jaundice
47
What are the investigations for acute pancreatitis?
See 3x higher serum amylase sensitive lipase levels A contrast CT or MRI confirms the diagnosis
48
What is the management of acute pancreatitis?
Fluids, analgesia, o2 and potentially surgery
49
What causes chronic pancreatitis most commonly?
Alcohol and presents with steatorrhoea
50
How do we test for chronic pancreatitis?
USS/ abdominal X ray for pancreatic calcification
51
What is the treatment for chronic pancreatitis?
Lifestyle, analgesia, pancreatic enzyme supplements
52
Who is appendicitis rare in?
The very young and the very old | 10-20 most common
53
What are the signs of appendicitis?
Patient guards so prefers to have their legs bent Vomiting Diarrhoea loss of appetite,
54
What can appendicitis lead to?
Peritonitis if the obstruction bursts, releasing the infected and faecal matter
55
What is Barrett's metaplasia?
Linked to oesophageal cancer and a change from squamous to columnar.
56
What investigations are done for osphageal cancer?
Biopsy and endoscopy along with a CT scan for staging
57
What is familial adenomatous polyposis?
1000s of adenocarcinoma in the large bowl caused by genetic factors
58
What is the screening for cholorectal cancer?
Biannual faecal occult blood tests for people 60-69 years old
59
What is a Mallory Weiss tear?
Haematemesis (throwing up blood) from a tear in the mucosa of the oesophagus
60
What can cause a Mallory Weiss tear?
Prolonged vomiting (bulimia), chronic cough or alcohol excess
61
How do we find a Mallory Weiss tear?
Endoscopy
62
Sign and symptoms of peritonitis?
Pain, fever, vomiting, rebound tenderness, SILENT ABDOMEN, patient avoids moving
63
What does a peritonitis ERECT chest X-ray show?
Air under the diaphragm
64
What score is used for a Mallory Weiss tear?
The Rockall score
65
Does vomiting appear earlier in large or small bowel obstruction?
Small bowel
66
Does constipation appear earlier in large or small bowel obstruction?
Large bowel
67
What is a sign of mechanical obstruction?
Tinkling bowel sounds
68
What are the causes of mechanical obstruction?
``` Abdominal adhesion's from surgery Strangulated hernia Malignancy Volvus Intussusception (telescoping) ```
69
How do we treat a mechanical obstruction?
Fluids, surgery, intestinal compression.
70
What is ascites?
Fluid build up in the peritoneal cavity
71
How do treat ascites?
Treat cause, limit sodium intake, diuretics, surgical shunts
72
What is haemorrhoids?
Plies from traumatised passage of hard stools in preganancy
73
What does the liver do?
Produce albumin Regulate oestrogen Produce clotting factors Regulate bilirubin Protect against infection using kupffer cells Store glycogen
74
What bug causes liver abscesses?
Entamoeba histolytica
75
What is the treatment of liver abscesses?
Metronidazole and drainage
76
Which hepatitis are spread via blood?
B,C and D
77
Which hepatitis is DNA?
B
78
How do we detect hepatitis?
Serology for antibodies and antigens
79
Which forms of hepatitis have vaccines?
A and B
80
What is the treatment for chronic hepatitis B?
Pegylated interferon alpha 2a
81
What is the treatment for chronic hepatits C?
Velpatasvir/sofobuvir
82
How do we manage drug induced liver injury (i.e. Paracetamol overdose)?
N-acetyl-cysteine or activated charcol
83
What is the presentation of liver failure?
Confusion, drowsy, disorientated, jaundice, can present with sepsis
84
What is liver cirrhosis?
Irreversible liver damage from fibrosis and abnormal nodules
85
What is the classification system for cirrhosis?
Child-pugh or MELD
86
What investigations do we do for liver cirrhosis?
A liver biopsy or TRANSIENT ELASTOGRAPHY for alcohol VS. Hep C virus
87
How do we monitor liver cirrhosis?
Screen for HCC with alpha-fetoprotein every 6 months
88
What are complications of cirrhosis?
Hepatic failure, odema, coagulopathy, ascites
89
How does alcoholic liver disease occur?
Less oxidation of fat mean that is accumulates in hepatocytes. ROS is produced more with alcohol and this can damage hepatocytes
90
What do we see raised in alcoholic liver disease?
Gamma glutamyl transpeptidase Aspartate transaminase Alanine transaminase
91
What is wilson's disease?
Excess copper in liver. Causes kayser-fleischer rings and neurological signs. Do serum caeruloplasmin and give penicillamine and reduce copper
92
What is Haemochromatosis?
Genetic excess iron everywhere causing bronze diabetes and heart issues. Managemant- Desferrioxamine
93
What is the epi for gallstones?
Fat, female, forty and fertile
94
What turns Charot's into Reynold's pentad
Hypotension and confusion
95
What relives IBS?
Pooing and passing wind
96
What is primary bilary cholangitis?
Granlomatous inflammation destroying the bile duct. Young female Only in live

PHASE 2A (14 decks)

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