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Phase 4 > GI/Liver > Flashcards

GI/Liver Flashcards

1
Q

what is acute appendicitis?

A

an acute inflammation of the vermiform appendix

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2
Q

what age range is appendicitis most common in?

A

10-20 years

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3
Q

what are 3 risk factors for appendicitis?

A

low dietary fibre
improved personal hygiene
smoking

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4
Q

what is the pathophysiology of appendicitis?

A

Lumen of appendix is obstructed => fills with mucus => increased pressure => bacteria multiply (bacteriodes fragilis and E.coli) => distension of lumen => inflammation, oedema, ischaemia, necrosis, perforation => nausea, vomiting, pain, reflex anorexia

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5
Q

what are 6 manifestations of appendicitis?

A 
acute abdomen pain localising to RLQ with guarding
anorexia 
nausea + vomiting 
tense rigid abdomen
low grade fever
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6
Q

what is the gold standard diagnosis for appendicitis?

A

CT abdomen

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7
Q

what are 3 investigations that can be done for appendicitis?

A

FBC - WBCs raised
CRP/ESR - raised
Urinalysis - pregnancy, renal colic excluded

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8
Q

what are 3 differentials for appendicitis?

A

ectopic pregnancy
UTI
Diverticulitis

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9
Q

what are 3 complications of appendicitis?

A

perforation
generalised peritonitis
appendicular mass

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10
Q

What is Barrett’s oesophagus?

A

a change (metaplasia) in the normal squamous epithelium of the oesophagus to specialised intestinal metaplasia (stratified squamous to simple columnar)

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11
Q

what are 4 causes for Barrett’s oesophagus?

A

GORD
Lower oesophageal sphincter hypotension
hiatus hernia
gastric acid hypersecretion

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12
Q

what are 3 risk factors for Barrett’s oesophagus?

A

smoking
obesity
male

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13
Q

what is the pathophysiology of Barrett’s oesophagus?

A

Reduced lower oesophageal sphincter mule tone => increased relaxation allowing reflux of gastric acid through the LOS => damage to squamous mucosa and eventual metaplasia to columnar cells

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14
Q

what are 4 clinical presentations of Barrett’s oesophagus?

A

heartburn
regurgitation
dysphasia
SOB/wheezing and belching

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15
Q

what is the investigation for Barrett’s oesophagus?

A

Upper Gi endoscopy + biopsy = gold

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16
Q

what are 3 differentials for Barrett’s oesophagus?

A

osephagitis
GORD
oesophageal carcinoma

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17
Q

what is the management of Barrett’s oesophagus?

A

1 - PPIs (omeprazole), lifestyle changes, radio frequency ablation

repeat endoscopic surveillance

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18
Q

what are 3 complications of Barrett’s oesophagus?

A

oesophageal adenocarcinoma
oesophageal strictures
quality of life deficit

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19
Q

what is coeliac disease?

A

systemic autoimmune inflammatory disease affecting the small intestine triggered by dietary gluten peptides found in wheat, rye, barley, and related grains.

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20
Q

what is the trigger in coeliac disease?

A

prolamins found in gluten

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21
Q

what are 3 risk factors for coeliac disease?

A 
FHx
IgA deficiency
autoimmune disease (T1DM)
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22
Q

what immune cell is coeliac gluten intolerance mediated by?

A

T cell

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23
Q

what are 5 presentations of coeliac disease?

A 
Diarrhoea or steatorrhoea 
abdominal bloating/discomfort
anaemia 
indigestion 
dermatitis herpetiformis
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24
Q

what are 3 serological investigations for coeliac disease?

A

1 - Tissue transglutaminase antibodies and total IgA
2 - endomysial antibodies
anti-casein antibodies

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25
Q

what are 3 differentials for coeliac?

A

Crohn’s disease
peptic duodenitis
giardiasis

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26
Q

what are 3 complications of coeliac disease?

A

osteoporosis risk
increased risk of malignancy
Anaemia

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27
Q

what is Crohn’s disease?

A

a autoimmune inflammatory GI disorder characterised by transmural granulomatous inflammation of the GI tract from mouth to anus with skip lesions

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28
Q

are males of females more likely to be affected by Crohn’s and coeliac disease?

A

females

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29
Q

what are 3 risk factors for Crohn’s disease?

A

stress and depression
FHx
smoking

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30
Q

what is the pathophysiology of Crohn’s disease?

A

Transmural granulomatous inflammation of any part of GI tract => most common in terminal ileum and proximal colon.
skip lesions - cobblestone appearance
relapsing and remitting

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31
Q

what are 6 presentations of Crohn’s?

A 
chronic diarrhoea 
weight loss 
Abdo pain (RLQ most common) 
blood in stool (less common than in UC)
perianal lesions
mouth ulcers
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32
Q

what are 3 blood tests for Crohn’s disease?

A

CRP + ESR - raised
FBC - anaemia (B12/iron/B9)
U+Es

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33
Q

what are 3 differentials for Crohn’s disease?

A

ulcerative colitis
infectious cause
coeliac disease

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34
Q

what is the management for Crohn’s disease flare ups?

A

1st - Glucocorticoids (budenoside, prednisolone or hydrocortisone depending on severity)

elemental diet
Immunosuppresion - azathioprine, mercaptopurine and methotrexate
Biologics - inflixibab
antibiotics for peri-anal disease

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35
Q

what are 3 complications of Crohn’s disease?

A

malignancy
fistulae
intestinal obstruction

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36
Q

what is diverticulitis?

A

inflammation of diverticula

diverticula = out pouching of the mucosa and submucosa through the muscular layer of the colonic wall

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37
Q

what is the main cause of diverticulitis?

A

low fibre diet

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38
Q

what are 3 risk factors for diverticulitis?

A

50+
low fibre diet
obesity

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39
Q

what part of the colon is diverticulitis most common in?

A

sigmoid colon

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40
Q

what is the pathophysiology of diverticulitis?

A

Low fibre => increased intestinal transit time and straining on loo => increased intraintestinal pressure => diverticula herniations => foecal matter gets stuck => infection => complications

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41
Q

what are 5 presentations of diverticulitis?

A 
L lower quadrant pain/gaurding/tenderness
blood on DRE
fever 
diarrhoea/constipation
palpable abdominal mass
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42
Q

what is the gold standard for diverticulitis?

A

Abdo CT with contrast

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43
Q

what are 3 blood tests for diverticulitis?

A

FBC - leukocytosis
U+E+C - creatinine elevated, uraemia
CRP - raised

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44
Q

what are 3 differentials for diverticulitis?

A

endometriosis
colorectal cancer
appendicitis

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45
Q

what is the management for diverticulitis?

A

dietary and lifestyle - fibre
analgesia

antibiotics - co-amoxiclav
surgical intervention
antispasmodics - dicycloverine

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46
Q

what are 3 complications of diverticulitis?

A

fistulae
abscesses
perforations

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47
Q

What is gastritis?

A

inflammation of the lining of the stomach associated with mucosal injury

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48
Q

what are 4 causes of gastritis?

A

NSAIDs
alcohol
H. Pylori infection
Autoimmune

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49
Q

what are 3 risk factors for gastritis?

A

H. Pylori infection
previous gastric surgery
autoimmune disease

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50
Q

what are 5 presentations of gastritis?

A 
dyspepsia/epigastric discomfort
fever
severe emesis (vomiting)
nausea 
haematemesis/malaena
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51
Q

what are 3 investigations for gastritis?

A

H. Pylori urea breath test/ faecal antigen test
endoscopy
anti-IF/parietal cell antibodies

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52
Q

what are 3 differentials for gastritis?

A

peptic ulcer disease
GORD
non-ulcer dyspepsia

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53
Q

what is the management for gastritis?

A

H. pylori eradication
PPIs
antacids
H2 antagonists

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54
Q

what are 3 complications of gastritis?

A

gastric carcinoma
gastric lymphoma
vitamin B12 deficiency

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55
Q

What is GORD?

A

the reflux of gastric contents into the oesophagus or beyond

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56
Q

what are 4 risk factors for GORD?

A

FHx
age
hiatus hernias
obesity

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57
Q

what are 5 presentations of GORD?

A 
heart burn 
regurgitation
chest pain/retrosternal pain
coughing/belching
Water brash
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58
Q

what are 3 investigations for GORD?

A

PPI trial
24 hour pH monitoring
endoscopy and biopsy

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59
Q

what are 3 differentials for GORD?

A

malignancy
stable angina
peptic ulcer disease

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60
Q

what are 4 managements of GORD?

A

PPIs - omeprazole
antacids
H2 receptor antagonist - ranitidine
life style changes

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61
Q

what are 3 complications of GORD?

A

Barrett’s oesophagus
strictures
oesophageal ulcer

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62
Q

what is IBS?

A

a chronic condition characterised by abdominal pain associated with bowel dysfunction where there is no structural abnormalities to explain the pain

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63
Q

what are 3 risk factors for IBS?

A

Female
stress
PTSD

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64
Q

what are the 3 different types of IBS?

A

IBS C - constipation
IBS D - Diarrhoea
IBS M - both

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65
Q

what are 5 presentations of IBS?

A

abdo discomfort / bloating
alteration of bowel habits
normal abdo exam
defecation urgency

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66
Q

what are 4 general bowel tests that can be run?

A

Faecal calprotectin
faecal occult blood tests
coeliac serology
foecal lactoferrin

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67
Q

what are 3 differentials for IBS?

A

crohn’s
coeliac
ulcerative colitis

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68
Q

what are the 2 main types of oesophageal cancer?

A

squamous cell carcinoma (smoking)

adenocarcinoma (GORD)

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69
Q

what are 4 risk factors for oesophageal cancer?

A

Barrett’s oesophagus
male
smoker
Achalasia

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70
Q

what are 6 presentations of oesophageal cancer?

A 
dysphagia (solids then liquids)
pain on swallowing 
weight loss
hoarse voice/cough 
melana 
lymphadenopathy
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71
Q

what are 3 investigations for oesophageal cancer?

A

oesophogastroduodenoscopy with biopsy - gold
CT chest abdomen and pelvis
Barium swallow

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72
Q

what are 3 differentials for oesophageal cancer?

A

benign stricture
achalasia
Barrett’s oesophagus

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73
Q

what is the management of oesophageal cancer?

A

endoscopic resection
oesophgectomy
chemo - platinin based
radiotherapy

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74
Q

what are 3 complications of oesophageal cancer?

A

postoperative pneumonia
Prost-resection acid reflux
trachea-oesophageal fistula

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75
Q

what is a mallory Weiss tear?

A

mucosal tear at oesophageal gastric junction due to a sudden increase in iata-abdominal pressure => coughing/dry heaving

causes haematesis, postural hypertension and dizziness

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76
Q

what are oesophageal varices?

A

abnormal, dilated veins in the lower 1/3rd of the oesophagus that occur at the lower end of the oesophagus; they account for 10-20% of upper GI bleeds. A complication of portal hypertension

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77
Q

what percentage of patients with cirrhosis have oesophageal varices?

A

50% at diagnosis

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78
Q

what are 3 risk factors for oesophageal varices?

A

portal hypertension
cirrhosis
alcoholism

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79
Q

what are 6 presentations of oesophageal varices?

A 
features of liver disease 
haematemesis 
melaena
cirrhosis/liver disease 
abdo pain 
blood loss/shock symptoms
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80
Q

what are 3 investigations for oesophageal varices?

A

upper GI endoscopy - gold
FBC - anaemia
serum LFTs - deranged
U+Es - raised urea in upper GI bleed

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81
Q

what are 3 differentials for oesophageal varices?

A

hiatus hernia
gastric varices
mallory weiss tear

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82
Q

what is the management for non-bleeding oesophageal varices?

A

beta blockers

endoscopic ligation

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83
Q

what are 3 complications of oesophageal varices?

A

spontaneous bacterial peritonitis
encephalopathy
rebleed

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84
Q

what 2 veins form the portal. vein?

A

superior mesenteric and splenic veins

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85
Q

what is the normal pressure in the portal vein?

A

5-8 mmHg

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86
Q

what is a peptic ulcer?

A

A break in the mucosal lining of the stomach or duodenum more than 5 mm in diameter, with depth to the submucosa

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87
Q

what causes peptic ulcers?

A

Due to imbalance between factors promoting mucosal damage
gastric acid, pepsin, helicobactor pylori, NSAIDs – and those promoting gastroduodenal defence – prostaglandins, mucins, bicarbonate, mucosal blood flow

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88
Q

what are 4 risk factors for peptic ulcers?

A

H. Pylori
NSAIDs
smoking
FHx

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89
Q

why does H. Pylori infection increase peptic ulcer risk?

A

H.pylori => impaired somatostatin secretion => increased gastrin release => gastric acid hypersecretion

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90
Q

what are 5 presentations of peptic ulcer?

A

can be asymptomatic

abdo pain 
early satiety 
anorexia 
anaemia symptoms 
hypotension/shock - gastro bleeding
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91
Q

what are 3 investigations for peptic ulcers?

A

upper GI endoscopy and biopsy - gold
h. pylori breath/stool antigen
FBC + U+e + LFTs

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92
Q

what are 3 differentials for peptic ulcers?

A

oesophageal cancer
GORD
gastritis

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93
Q

what is the management of non H.Pylori peptic ulcers?

A

PPIs

H2 antagonist - nizatidine

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94
Q

what are 3 complications of peptic ulcers?

A

gastroduodenal bleeding
perforation
penetration

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95
Q

what is ulcerative colitis?

A

a type of relapsing remitting inflammatory bowel disease that characteristically involves the rectum and extends proximally to affect a variable length of the colon (colon mucosa)

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96
Q

is cronh’s or ulcerative colitis more common?

A

UC

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97
Q

what are 3 risk factors for ulcerative colitis?

A

FHx
HLA-B27 genes
NSAIDs - flare ups

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98
Q

what is the pathophysiology of ulcerative colitis?

A

Arises in rectum, affects only colon up to ileo-caecal valve, continuous (no skip lesions), mucosa reddened, inflamed and bleeds easily, ulcers and psueudopolyps in severe disease, non-transmural inflammation, depleted goblet cells, no granulomata, increased crypt abscesses

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99
Q

what are 5 presentations of ulcerative colitis?

A 
blood and mucus in stools 
diarrhoea 
malnutrition and weight loss
fever - during attack 
arthritis/spondyloarthritis/uveitis
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100
Q

what is the gold standard investigation for UC?

A

colonoscopy and biopsy

red raw mucosa with shallow ULCERS
lamina propria inflammatory cell infiltrates (neutrophil)
pseudopolysps 
crypt abscesses
goblet cell depletion
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101
Q

what are 3 differentials for UC?

A

Crohn’s
indeterminate collitis
IBS

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102
Q

what are 3 complications of ulcerative colitis?

A 
toxic megacolon (most common cause of death)
colonic adenocarcinoma 
bowel obstruction
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103
Q

what is the treatment for mild ulcerative colitis?

A

1 - aminosalicylates - Sulfasalazine

2 - corticosteroids

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104
Q

where is B12 absorbed?

A

distal ilium

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105
Q

where is folate (B9) absorbed?

A

proximal jejunum/duodenum

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106
Q

where is iron absorbed?

A

duodenum

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107
Q

where is intrinsic factor secreted from?

A

stomach - parietal cells

needed for B12 absorptions

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108
Q

what is acute cholangitis?

A

an infection of the biliary tree, most commonly caused by obstruction.

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109
Q

what are 4 causes of acute cholangitis?

A

malignancies
strictures
cholethiasis (gallstones)
chronic pancreatitis

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110
Q

what are 3 risk factors for acute cholangitis?

A

50+
gall stones
post procedure injury

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111
Q

what is the pathophysiology of acute cholangitis?

A

Obstruction of bile duct results in bacteria in biliary tree, sludge forms providing a growth medium for bacteria, bile duct pressure increases => pressure gradient promotes extravasation of bacteria into blood stream => sepsis

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112
Q

what are 5 symptoms of acute cholangitis?

A 
URQ pain/tenderness
fever
jaundice 
pruritis, dark urine, pale stools
confusion
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113
Q

what are 3 investigations for acute cholangitis?

A

FBC - high WBCs
CRP - raised
ultrasound - 1st line
MRCP - gold

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114
Q

what are 3 differentials for acute cholangitis?

A

acute cholecystitis
peptic ulcer disease
acute

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115
Q

what is the management of acute cholangitis?

A 
IV Antibiotics - cefotaxime and metronidazole
IV fluids 
Analgesia 
biliary decompression - ERCP
surgical drainage
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116
Q

what are 3 complications of acute cholangitis?

A

sepsis
hepatic abscess
acute pancreatitis

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117
Q

what type of bacteria is acute cholangitis usually caused by?

A

gram negative bacili

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118
Q

What s acute cholecystitis?

A

acute gallbladder inflammation, and one of the major complications of cholelithiasis or gallstones.

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119
Q

who are gallstones most common in?

A

women over 50

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120
Q

what are 3 risk factors for acute cholecystitis?

A

gallstones
physical inactivity
low fibre intake

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121
Q

where is obstructed in acute cholecystitis?

A

gallbladder neck or cystic duct

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122
Q

what are 5 presentations of acute cholecystitis?

A

RUQ pain and tenderness (possible R shoulder pain) - Murphy’s sign
palpable mass
fever, chills, tachycardia
nausea and vomiting

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123
Q

what is the gold standard test for acute cholecystitis?

A

abdo ultrasound - thickened gallbladder wall, distended gallbladder, presence of stone

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124
Q

what are 3 investigations for acute cholecystitis?

A

ESR/CRP - raised
FBC - WBCs raised
LFTs - may be raised

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125
Q

what are 3 differentials for acute cholecystitis?

A

acute cholangitis
pancreatitis
peptic ulcer disease

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126
Q

what is the management for acute cholecystitis?

A

antibiotics - cefuroxime and metronidazole

analgesia

cholecystectomy

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127
Q

what are 3 complications of acute cholecystitis?

A

obstructive jaundice
gallbladder empyema
galstone ileus

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128
Q

what is acute liver failure?

A

a rapid decline in hepatic function characterised by jaundice, coagulopathy (INR >1.5), and hepatic encephalopathy in patients with no evidence of prior liver disease

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129
Q

what are 3 causes of acute liver failure?

A

Drugs - Paracetamol overdose
viruses - Hep A/B/CMV
autoimmune hepititis

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130
Q

what are 4 risk factors for acute liver failure?

A

chronic alcohol abuse
poor nutritional status
female
pregnant

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131
Q

what are 5 presentations of liver failure?

A 
jaundice 
signs of hepatic encephalopathy 
hepatomegaly 
bruising and GI bleeds (coagulopathy)
RUQ pain 
nausea and vomiting
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132
Q

what are 3 blood tests for acute liver failure?

A

LFTs - deranged including prothrombin time and INR

U+E - low urea and high creatinine

blood glucose - low

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133
Q

what are 3 differentials for acute liver failure?

A

severe acute hepatitis
cholestasis
haemolysis

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134
Q

what is the treatment of acute liver failure?

A

treat underlying

good nutrition - thiamine and folate

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135
Q

what are 3 complications of acute liver failure?

A

Sepsis
AKI
haemorrhage

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136
Q

what are the 10 causes of acute pancreatitis? (mnemonic)

A

I GET SMASHED

idiopathic (or infections)
Gallstones (50-60%)
Ethanol (25-30%)
Trauma
Steroids
Mumps 
autoimmune 
scorpion venom 
hyperlipidaemia
ECRP
Drugs
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137
Q

what are 3 risk factor for acute pancreatitis?

A

obesity
Diet
T2DM

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138
Q

what is the pathophysiology of acute pancreatitis?

A

The destructive effect of premature activation of pancreatic enzymes which cause self-perpetuating pancreatic inflammation by enzyme mediated autodigestion.

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139
Q

what are 6 presentations of acute pancreatitis?

A 
severe epigastric pain radiating to back 
nausea and vomiting 
signs of hypovolaemia 
jaundice and steatorrhoea  
poor urinary output
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140
Q

what are 3 investigations for acute pancreatitis?

A

serum lipase/amylase - >3x normal - gold
FBC with differential - leukocytosis
haematocrit >44%
CRP - elevated

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141
Q

What are the 3 stages of alcoholic liver disease?

A

fatty liver (steatosis), alcoholic hepatitis (inflammation and necrosis), and alcoholic liver cirrhosis

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142
Q

what are 3 risk factors for alcoholic liver disease?

A

prolonged alcoholism
female
hepatitis C

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143
Q

how is alcohol metabolised?

A

in liver by alcohol dehydrogenase and cytochrome P-450 2E1 => chronic alcohol use causes cytochrome P-450 to produce more free radicals and alcohol dehydrogenase when converted to NADH inhibits gluconeogenesis and increases fatty acid oxidation

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144
Q

what are 7 signs of alcoholic liver disease?

A 
caput medusa 
splenomegaly 
palmar erythema 
Dupuytren's contracture - thick palmar fascia - flexed fingers
leuconychia - white lines on nails
gynaecomastia 
spider naevi
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145
Q

what are 4 biochemical investigations for alcoholic liver disease?

A

LFTs - aminotransferase (AST) and alanine aminotransferase (ALT) elevated

FBCs - thrombocytopenia

serum bilirubin - elevated
serum albumin - low

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146
Q

what is the gold standard investigation for chronic liver disease (alcohol/nonA)?

A

liver biopsy - may show Mallory bodies, large mitochondria, neutrophil infiltrate, hepatocyte allowing, fibrosis and cholestasis

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147
Q

what are 3 differentials for alcoholic liver disease?

A

hepatitis A/B/C
cholecystitis
hepatic vein thrombosis

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148
Q

what is the management of alcoholic liver disease?

A 
alcohol abstinence
hydration 
nutrition
steroids - predisolone - cirrhosis 
reduce salt 
avoid liver metabolised drugs 
liver transplant
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149
Q

what are 3 complications of alcoholic liver disease?

A

hepatocellular carcinoma
peptic ulcers
varices

150
Q

what is ascites?

A

a pathological collection of fluid in the peritoneal cavity.

151
Q

what is the most common cause of ascites?

A

cirrhosis - 75%

152
Q

what are 4 manifestations of ascites?

A

Abdominal distension
fluid on exam with shifting dullness
shortness of breath
fatigue

153
Q

what are 3 differentials for ascites?

A

Hep C
alcoholic liver disease
congestive heart failure

154
Q

what is the management for ascites?

A

treat underlying cause
limit sodium
diuretics - spironolactone
paracentesis

155
Q

what are the stages of ascites?

A

1 – detectable only after careful exam
2 – easily detectable but small volume
3 – obvious but not tense
4 – tense

156
Q

What is cholelithiasis?

A

gallstones

the presence of solid concretions in the gallbladder. They may exit into the bile ducts in choledocholithiasis.

157
Q

what are gallstones usually made out of n the developed world?

A

cholesterol - 90%

158
Q

what are 5% of gallstones made out of?

A

polymerised calcium billirubinate - black pigment stones

159
Q

what are the risk factors for cholelithiasis?

A 
Female 
Fat 
Forties 
Fertile 
Fair (white)
160
Q

what is the pathophysiology of cholelithiasis?

A

=> bile is super saturated by cholesterol from liver => nucleating factors precipitate in the gallbladder where hypomotility provides time for stone growth

161
Q

what are 4 presentations of cholelithiasis?

A

RUQ pain - biliary colic
jaundice
fever
dietary upset/nausea

162
Q

what are 3 investigations for cholelithiasis?

A

LFTs
CRP
abdo ultrasound - gold

163
Q

what are 3 differentials for cholelithiasis?

A

peptic ulcers
gallbladder cancer
gallbladder polyps

164
Q

what is the management of cholelithiasis?

A 
laparoscopic cholecystectomy 
analgesia 
observation and life style management - lower cholesterol diet, stop smoking 
ECRP 
radiological drain 
cholecystectomy
165
Q

what are 3 complications of cholelithiasis?

A

cholecystitis
cholangitis
pacreatitis

166
Q

what is gallstone ileus?

A

Gall stone eroded though gallbladder into duodenum and causes constipation

167
Q

What is chronic pancreatitis?

A

Debilitating continuing inflammatory process of the pancreas resulting in progressive loss of exocrine pancreatic tissue which is replaced by fibrosis

168
Q

what are 4 causes of chronic pancreatitis?

A

alcohol - 60-70%
CKD
hereditary - defects in trypsinogen, CF
autoimmune - raised IgG4

169
Q

what are 3 risk factors for chronic pancreatitis?

A

alcohol
smoking
FHx

170
Q

what is the pathogenesis of chronic pancreatitis?

A

Obstruction/reduction in bicarb secretion leading to activation of trypsinogen to trypsin in the pancreas as pH rises leading to pancreatic tissue necrosis and eventual fibrosis.

171
Q

what are 5 manifestations of chronic pancreatitis?

A 
epigastric pain radiating to back
steatorrhoea and diarrhoea
weight loss and fatigue
diabetes melitus 
nausea and vomiting
172
Q

what are 3 differential diagnosis of chronic pancreatitis?

A

pancreatic cancer
acute pancreatitis
biliary colic

173
Q

what is the management of chronic pancreatitis?

A

diet and lifestyle modification
analgesia - NSAIDs and paracetamol
pancreatic enzyme replacement

pancreatectomy

174
Q

what are 3 complications of chronic pancreatitis?

A

malabsorption
pancreatic pseudocystitis
pancreatic cancer

175
Q

what is recurrent acute pancreatitis?

A

dentifiable cause of chronic pancreatitis that doesn’t lead to chronic

176
Q

what is cirrhosis?

A

The pathological end-stage of any chronic liver disease characterised by fibrosis and conversion of normal liver architecture to structurally abnormal nodules known as regenerative nodules.

177
Q

what are 4 causes of liver cirrhosis?

A

alcohol related liver disease
non-alcoholic fatty liver disease
chronic viral hepatitis
Budd-Chiari syndrome

178
Q

what are 3 risk factors for cirrhosis?

A

alcohol missuse
IVDU
unprotected sex

179
Q

what is the pathophysiology of liver cirrhosis?

A

Hepatic fibrosis due to activation of hepatic stellate cells and kupfer cells leading to accumulation of type I+III collagen in hepatic parenchyma and space of disse => sinusoids lose characteristic fenestration => altered exchange between plasma and hepatocytes

180
Q

what are 8 presentations of liver cirrhosis?

A 
hepatosplenomegaly  
palmar erythema and spider naevi and bruising
Dupuytren's contracture
leuconychia and clubbing 
oedema
loss of body hair and gynaecomastia
181
Q

what are 3 investigations of liver cirrhosis?

A

liver biopsy - gold
LFT - deranged
ultrasound and duplex

182
Q

what are 3 differentials for liver cirrhosis?

A

Budd-chiari syndrome
portal vein thrombosis
splenic vein thrombosis

183
Q

what is Budd chiari syndrome?

A

rare condition of hepatic vein occlusion

184
Q

what is the treatment of cirrhosis?

A 
treat underlying disease
monitor for complications
sodium restriction and diuretics
liver transplant 
trans jugular intrahepatic portosystemic shunt
185
Q

what are 3 complications of cirrhosis?

A

ascites
visceral haemorrhage
jaundice

186
Q

what are the 4 clinical stages of cirrhosis?

A
  • Stage 1
    o Patient without GO varices or ascites
  • Stage 2
    o Patient with GO varisces (but no bleeding) and no ascites
  • Stage 3
    o Patient with ascites but with or without GO varices but no bleeding
  • Stage 4
    o Patients with GI bleeding due to portal hypertension with or without ascites
187
Q

which is the only Hepatitis virus that is DNA?

A

HBV

188
Q

which two hepatitis viruses are faecal oral transmission?

A

A and E

189
Q

which 3 hepatitis viruses are blood-blood/sexual transmission?

A

B, C, D

190
Q

what is the pathophysiology of Hepatitis viruses?

A

travels through mesenteric veins to liver => enters hepatocytes => replication

191
Q

what are 6 manifestation of hepatitis?

A 
fever
malaise
myalgia
nausea + vomiting (GI upset)
jaundice 
hepatomegaly + RUQ pain
192
Q

what is the serology for HAV?

A

HAV IgM + IgG - +ve

IgM positive soon after symptoms and for a few months

IgG positive 5-10 days post symptoms and for rest of life - recovery OR vaccination

193
Q

what are 3 differentials for

Hepatitis viruses?

A

other acute hep virus
Wilsons disease
autoimmune hepatitis
alcoholic liver disease

194
Q

what is the management for HAV?

A

hep A vaccines and or immunoglobulins
supportive care
liver transplant

195
Q

what are 5 complications of hepatitis viruses?

A 
prolonged cholestasis 
acute pancreatitis 
hepatocellular carcinoma 
cirrhosis 
rheumatological complications
196
Q

what hepatitis virus do you need to be infected with in order to get infected with hepatitis D?

A

Hepatitis B - chronic in 5%

197
Q

what is hepatitis B?

A

the most common liver infection

May result in self-limiting disease requiring no treatment or in chronically infected state (more likely in children)

198
Q

what are 3 risk factors for hepatitis B/C/D?

A

perinatal exposure
high risk sexual behaviours
IVDU

199
Q

what are the investigations for hepatitis B?

A

HBsAg – infection acute or chronic

HBeAg – active viral replication => active infection acute or chronic

Anti-HBs – immunity to HBV => natural or vaccine

Anti-HBc IgG– recovered or chronic infection

Ant-HBc IgM – recent infection (last 6 months)

Anti-HBc – past or chronic infection

Anti-HBe – implies seroconversion and is present for life

200
Q

what fraction of HCV patients present with an acute illness and progress to chronic?

A

01-Mar

201
Q

what are the investigations for HCV?

A

hepatitis C PCR - gold, current/active infection (chronic or acute)

Hep C virus antibody enzyme immunoassay - implies current or previous infection

LFTs - raised AST and ALT

202
Q

what is the management for HCV?

A

oral direct acting antivirals - ending -ASVIR or -BUVIR

203
Q

what are 4 risk factors for hepatitis A/E?

A

contaminated water
poor sanitation
ingestion of undercooked meat/shellfish
travel to endemic areas

204
Q

what group of people is HEV worst in?

A

pregnant - 10-30% mortality

1% in general pop

205
Q

is HEV usually self limiting or not?

A

usually self limiting

206
Q

what percentage of immunocompetent adults with HBV achieve seroconversion without treatment?

A

95%

207
Q

what is jaundice?

A

the result of accumulation of bilirubin in the bloodstream and subsequent deposition in the skin, sclera, and mucous membranes

208
Q

describe the breakdown of bilirubin

A

heam is broken down by macrophages to biliverdin then to lipid soluble unconjugated bilirubin => enters blood bound to albumin

unconjugated B taken up by hepatocytes + conjugated with glucuronic acid

conjugated B is water soluble and excreted in bile

gut bacteria convert bilirubin to urobilogen and stercobillinogen => excreted in urine and stool respectively

209
Q

what are 3 broad causes of prehepatic jaundice?

A

increase bilirubin production
increased RBC destruction
increased unconjuated bilirubin

210
Q

what are 2 conditions that can cause prehepatic jaundice?

A

haemolysis

Gilbert’s syndrome

211
Q

what so the stools and urine look like in prehepatic jaundice?

A

normal stools and urine

212
Q

what are 4 causes of intrahepatic jaundice?

A

Hepatitis viruses
HIV/parasitic infections
toxins
genetics - Wilsons disease

213
Q

what is are 6 causes of post hepatic jaundice?

A 
post operative stricture
cholelithiasis (gallstones)
ascending cholangitis
IgG4 cholangiopathy
infections 
malignancy
214
Q

what does the urine and stools look like in intrahepatic jaundice?

A

urine - dark

stools - normal

215
Q

what does the urine and stools look like in post hepatic jaundice?

A

urine - dark

stools - pale

216
Q

what are 5 manifestations of jaundice?

A 
yellowing 
pruritus 
anorexia
nausea and vomiting 
RUQ pain
217
Q

what are 3 investigations of jaundice?

A

Prothrombin time and INR
serum LFTs
liver ultrasound

218
Q

What is non-alcoholic fatty liver disease?

A

a spectrum of conditions characterised histologically by macrovesicular hepatic steatosis in those who do not consume alcohol in amounts generally considered harmful to the liver.

219
Q

what is the most common cause of liver disease in the west?

A

non-alcoholic fatty liver disease

220
Q

what are 4 risk factors for NAFLD?

A

obesity
T2DM
hyperlipidaemia
hypertension

221
Q

what are 5 presentation of NAFLD?

A 
RUQ discomfort 
pruritus + jaundice 
spider angiograms, palmar erythema and caput medusa
bruising, petechiae, melaena
peripheral oedema and ascites
222
Q

what are 3 investigations for NAFLD?

A

LFTs - AST, ALT, APT, bilirubin raised
FBC - anaemia/thrombocytopenia
prothrombin time + INR - elevated

223
Q

what are 3 differentials for NAFLD?

A

alcoholic liver disease
autoimmune/viral hepatitis
Wilsons disease

224
Q

what is the treatment for NAFLD?

A

lifestyle modifications
liver transplant

vitamin E
insulin sensitiser (metformin)
lipid lowering therapy (statin)
weight loss surgery/pharmacy

225
Q

what are 3 complications of NAFLD?

A

ascites
vatical haemorrhage
hepatocellular carcinoma

226
Q

What is primary biliary cholangitis?

A

chronic granulomatous autoimmune disease of small intrahepatic bile ducts that is characterised by progressive bile duct damage (and eventual loss) occurring in the context of chronic portal tract inflammation

227
Q

what are 3 risk factors for primary biliary cholangitis?

A

female
autoimmune conditions
FHx

228
Q

what is the pathophysiology of primary biliary cholangitis?

A

Progressive destruction of biliary epithelial cells lining the small intrahepatic bile ducts => precipitated by cholestasis => fibrosis => cirrhosis

AMA antibodies present

229
Q

what are 5 presentations of primary biliary cholangitis?

A 
pruritus 
fatigue and weight loss 
skin hyperpigmentation 
clubbing 
mild heptosplenomegaly
230
Q

what are 3 investigations for primary biliary cholangitis?

A

antimitochondrial antibodies (AMA - most specific) or antinuclear antibodies (ANA)

serum cholesterol - raised
LFTs - raised ALP, GGT and bilirubin

231
Q

what are 3 differentials for primary biliary cholangitis?

A

obstructive bile duct lesions
primary sclerosis cholangitis
malignancy

232
Q

what its the treatment of primary biliary cholangitis?

A

bile acid analogue - ursodeoxycholic acid

fat soluble vitamin supplements
Cholestyramine - anti-pruritus
codine and bisphosphonates

Liver transplant

233
Q

what are 3 complications of primary biliary cholangitis?

A

cirrhosis
hypercholesterolaemia
osteroporosis

234
Q

what is primary sclerosing cholangitis?

A

A chronic progressive cholestatic liver disease, characterised by inflammation and fibrosis of the intrahepatic and/or extrahepatic bile ducts, resulting in stricture formation

235
Q

what is the epidemiology of primary sclerosing cholangitis?

A

young and middle aged men
often with underlying IBD
relatively rare

236
Q

what is the pathophysiology of primary sclerosing cholagitis?

A

Inflammation of medium/large bile ducts => fibrosis and strictures => bile stasis => bile stones and retained bile slats => jaundice, pruritus, biliary cirrhosis => end stage liver disease

237
Q

what are 5 manifestations of primary sclerosing cholangitis?

A

may be asymptomatic

jaundice and pruritus
abdo pain 
fatigue and weight loss
steatorrhoea 
ascites/encephalopathy
238
Q

what are 4 investigations for primary sclerosing cholangitis?

A

LFTs - raised ALP, bilirubin, GGT, ALT and AST
MRCP/ERCP - gold - bead shaped appearance
antibodies screening - may be pANCA +ve, AMA -VE!, may be ANA +ve

239
Q

what are 3 differentials for primary sclerosing cholangitis?

A

secondary sclerosing cholangitis
IgG4 cholangitis
immune hepatitis

240
Q

what is the management for primary sclerosing cholangitis?

A

liver transplant - only non-symptom treatment

observations and lifestyle
cholestyramine - pruritus relief
fat souble Vitamin replacement

241
Q

what are 3 complications of primary sclerosing cholangitis?

A

cholangitis
cholangiocarcinoma
osteoporosis

242
Q

what are 2 stool tests for Crohn’s?

A

Feacal calprotectin - raised in inflammation

stool microscopy and culture

243
Q

what is the gold standard for Crohn’s?

A

colonoscopy + biopsy

transmural inflammation, deep ulcers, skip lesions, cobblestone mucosa, granulomas, goblet cells

244
Q

what is the management for crohn’s in remission?

A

1 - azathioprine or mercaptopurine

2 - methotrexate, infliximab, adalimumab

245
Q

what are 4 surgeries can be offered in Crohn’s?

A

ileocaecal resection
partial hemicolectomy
colectomy with ileostomy
resection of bowel

246
Q

what does faecal calprotectin help differentiate between?

A

IBS and IBD - raised in IBD

247
Q

what is the treatment for severe UC?

A

1 - IV corticosteroids
2 - IV ciclosporin

surgery - J pouch or ileostomy

248
Q

what does UC look like on barium enema?

A

loos of haustrations
widespread superficial ulceration and pseudopolyps

LEAD PIPE COLON

249
Q

what disease in pANCA most associated with?

A

ulcerative colitis

250
Q

what disease is ASCA more associated with?

A

Crohn’s disease

251
Q

what scoring system is used for the severity of UC?

A

Truelove and Witt’s severity index

252
Q

where is crohn’s most common?

A

terminal ileum

253
Q

what are 4 histological features of coeliac disease?

A

villous atrophy
crypt hyperplasia
increase in intraepithelial lymphocytes
lamina propria lymphocyte infiltration

254
Q

what is the most common gastric/intestinal cancer?

A

adenocarcinoma

255
Q

where in the world is gastric cancer most common?

A

Japan

256
Q

what are 5 manifestations of gastric cancer?

A 
iron deficiency anaemia 
mass 
melaena 
weight loss and malaise 
early satiety
257
Q

what are 3 differentials for gastric cancer?

A

peptic ulcer
oesophageal stricture
achalasia

258
Q

what are 2 risk factors for small intestine cancer?

A

coeliac disease

Crohn’s disease

259
Q

what staging is used in colorectal cancer?

A

Duke’s staging

260
Q

what 3 inherited conditions can cause colorectal cancer?

A

familial adenomatous polypososis
Hereditary non-polyposis colon cancer
Peutz-Jeghers syndrome

261
Q

what is the inheritance pattern for FAP and HNPCC?

A

autosomal dominant

262
Q

what part of the colon is most affected in familial adenomatous polyposis?

A

left colon and rectum

263
Q

what part of the colon is most affected in Hereditary non-polyposis colon cancer?

A

right colon

264
Q

what are 4 risk factors for colorectal cancer?

A

increased age
red and processed meats
low dietary fibre
hereditary conditions

265
Q

what are 5 presentations of R sided colorectal cancer?

A

often asymptomatic

iron deficiency anaemia 
progressive change in bowel habit
large bowel obstruction 
weight loss and fatigue 
abdo discomfort
266
Q

what are 5 presentations of L sided colorectal cancer?

A 
rectal mass 
progressive change in bowel habit 
abdo discomfort
large bowel obstruction
weight loss and fatigue
267
Q

what are 3 investigations for colorectal cancer?

A

colonoscopy and biospy - gold
FBC and U+E
fecal occult blood test

268
Q

what is the pain like in a duodenal ulcer?

A

worse when hungry or a few hours after eating, relieved by eating

269
Q

what is the pain like in a gastric ulcer?

A

made worse by eating

270
Q

what is the management of H. Pylori peptic ulcers?

A

omeprazole, clarithromycin and amoxicillin (metronidazole if allergic)

271
Q

what is Rovsing’s sign?

A

in appendicitis - pain in the R iliac fossa worsened by pressing on the left iliac fossa

272
Q

what is posoas sign?

A

appendicitis pain worsened in extending hip

273
Q

what is obturator sign?

A

appendicitis pain worsened by flexing and internally rotating hip

274
Q

what is the most common cause of small bowel obstruction?

A

postoperative adhesions

275
Q

what is the most common cause of large bowel obstruction?

A

Volvulus

276
Q

what are 5 manifestations of small bowel obstruction?

A 
abdominal pain and distension 
tinkling/absent bowel sounds 
empty rectum
early vomiting and nausea
constipation
277
Q

what is the 1st line imaging investigation for bowel obstruction?

A

abdominal X-ray

small - dilated small bowel and fluid level
Large - coffee bean sign (sigmoid volvulus)

278
Q

what is the 1st line management of bowel obstruction?

A

IV fluids
NG tube (suck)
IV antibiotics
analgesia and anti-emetics

279
Q

what are 3 complications of bowel obstruction?

A

ischaemia and perforation
sepsis
aspiration pneumonia

280
Q

is large or small bowel obstruction more common?

A

small

281
Q

what is Hirschsprung’s disease?

A

neonates born without complete innervation of colon and rectum causing large bowel obstruction

282
Q

what are 5 manifestations of large bowel obstruction?

A 
abdo pain and distension
tinkling sounds early on absent later 
empty rectum 
bloating and constipation (early)
vomiting - late
283
Q

what symptoms point to an infective cause of diarrhoea?

A

sudden onset

cramps abdominal pain and fever

284
Q

how long does acute diarrhoea last?

A

<2 weeks

285
Q

name 1 anti-diarrhoeal agent?

A

loperamide

286
Q

what is contained in the foregut?

A

stomach, duodenum to sphincter of odd, biliary system, liver, pancreas

287
Q

what is the blood supply of the foregut?

A

coeliac artery

288
Q

what is contained in the midgut?

A

duodenum to 1st half of transverse colon

289
Q

what is the blood supply of the midgut?

A

superior mesenteric artery

290
Q

what is the blood supply of the hindgut?

A

inferior mesenteric artery

291
Q

how long is the anus?

A

3-4 cm

292
Q

what is the name of the line separating the histologically different parts of the anal canal?

A

the (pectinate) dentate line

293
Q

what is hyper acute liver failure?

A

hepatic encephalopathy <7 days of noticing jaundice

294
Q

what is subacute live failure?

A

hepatic encephalopathy within 5-12 weeks of noticing jaundice

worst prognosis - usually associated with shrunken liver

295
Q

what is classed as acute liver failure?

A

hepatic encephalopathy within 8-28 weeks of noticing jaundice

296
Q

what is fulminant hepatic failure?

A

clinical syndrome resulting from massive necrosis of liver cells leading to sever impairment of liver function

297
Q

what are the signs of hepatic encephalopathy?

A

altered mental status
confusion
apraxia - difficulty motor planning
asterisks - flapping

298
Q

what is the grading system for heptic encephalopathy called?

A

the west haven criteria

299
Q

what are 4 functions of the liver?

A

storage
breakdown
synthesis
immune function

300
Q

what are 5 signs of decompensated liver disease?

A 
encephalopathy
ascites
jaundice
GI bleeding 
coagulopathy
301
Q

what is the treatment for hepatic encephalopathy?

A

1 - laxatives (lactulose)

2 - antibiotics (rifaximin) long term

302
Q

what are black pigment gallstones and when do they occur?

A

stones of billirubinate - occur in patients with increased haemolysis (haemolytic anaemias)

303
Q

what are brown pigment stones and when do they occur?

A

calcium bilrubinate and calcium salts of fatty acids

associated with infection and cholecystectomy

304
Q

what is Murphy’s sign?

A

As the patient breathes out, place your hand below the right costal margin. As the patient breathes in an inflamed gallbladder moves inferiorly, the patient catches their breath. To be considered positive, it should be absent on the left side. => acute cholecystitis

305
Q

what does ERCP stand for?

A

endoscopic retrograde cholangiopancreatography

306
Q

what is Charcot’s triad?

A

for ascending cholangitis

RUQ pain
jaundice
fever

307
Q

what is Cullen’s sign?

A

for pancreatitis - periumbilical bleeding

308
Q

what is Grey Turner’s syndrome?

A

flank bleeding secondary to retopritoneal haemorrhage in pancreatitis

309
Q

what is the management of acute pancreatitis?

A 
IV fluids
catherterisation 
O2 
opiate analgesia 
early nutritional support
310
Q

what are 3 complications of pancreatitis?

A

pancreatic abscess
haemorrhage
necrotising pancreatitis

311
Q

what is the treatment for pruitus?

A

cholestyramine

312
Q

what is the treatment for ascites?

A

fluid restriction and reduced salt intake

spironolactone

313
Q

what is the treatment for hepatic encephalopathy?

A

prophylactic lactulose and rifaximin

314
Q

what score is used to grade liver cirrhosis?

A

child-pugh score

315
Q

what are 3 complications of liver cirrhosis?

A

coaglopathy
encephalopathy
hepatocellular carcinoma

316
Q

what are 2 causes of pre-hepatic portal hypertension?

A

portal vein thrombosis

splenic vein thrombosis

317
Q

what are 4 causes of intra-hepatic portal hypertension?

A

cirrhosis - most common UK
schistosomiasis - most common worldwide
sarcoidosis
congenital hepatic fibrosis

318
Q

what are 4 cause of post hepatic portal hypertension?

A

R Heart failure
budd-chiari syndrome
constrictive pericarditis
veno-occlusive disease

319
Q

where can hepatic varices form?

A 
gastro-oesophageal junction
rectum
left renal vein
diaphragm
 the anterior abdominal wall via the umbilical vein
320
Q

what is the management for bleeding oesophageal varices?

A 
ABCDE 
IV fluids
Blood transfusion
Terlipressin - ADH analogue
prophylactic antibiotic 
balloon tamponade
321
Q

how long does acute hepatitis last?

A

< 6 months

322
Q

what are 5 infective causes of acute hepatitis?

A 
Hep A/E
Herpes viruses 
leptospirosis 
toxoplasmosis 
coxiella
323
Q

what are 6 causes of non-infective acute hepatitis?

A 
alcohol
drugs
toxins/poison
pregnancy
autoimmune
hereditary
324
Q

what LFTs are raised in acute hepatitis?

A

AST and ALP +/- bilirubin

325
Q

what are 2 infective causes of chronic hepatitis?

A

Hep B +/- D

Hep C virus

326
Q

what are 4 non-infective causes of chronic hepatitis?

A

alcohol
drugs
autoimmune
hereditary

327
Q

is hepatits A chronic?

A

NO

328
Q

are hepatitis viruses notifiable?

A

YES

329
Q

which hep viruses have vaccines?

A

A and B

330
Q

what is the incubation period of HBV?

A

1-6 months

331
Q

what are the serological investigations for Hep D?

A

IgM anti-HD
IgG anti-HD
HDAg - neg in chronic
HDV RNA

332
Q

what is the treatment for hep D?

A

interferon alpha

333
Q

what are 3 investigations for HEV?

A

serology - IgM = active, IgG = recovery
HEV PCR
LFTs - elevated AST and ALT

334
Q

what are 3 antibodies that are associated with autoimmune hepatitis?

A

Antinuclear (ANA)
anti-smooth muscle - ASMA
anti-SLA/LP

335
Q

what is the treatment for autoimmune hepatitis?

A

immunosuppression - prednisolone and azathioprine

336
Q

what is the main cause of travellers diarrhoea?

A

enterotoxigenic E. coli

337
Q

what toxins does E. coli produce?

A

shiva toxins

338
Q

what are 4 viral causes of infective diarrhoea?

A

rotavirus - most common in children
norovirus - most common in adults
adenoviruses
astroviruses

339
Q

what is the most common bacterial cause of diarrhoea?

A

campylobacter jejuni - associated with poultry

340
Q

what bacteria can cause diarrhoea after eating undercooked pork?

A

yersinia enterocolitica

341
Q

what bacteria produced rice water stools?

A

vibrio cholerae

342
Q

what antibiotics cause diarrhoea?

A

rule of Cs

clindamycin
ciprofloxacin (quinolones)
Co-amoxiclav (penicillins)
cephalosporins

343
Q

what is the most common parasitic cause of diarrhoea?

A

giardia lamblia

344
Q

what are 4 risk factors for pseudomembranous colitis?

A

elderly
antibiotics
long hospital stay
immunocompromised

345
Q

name an anti-emetic?

A

metoclopramide

346
Q

what is haemochromatosis?

A

multisystem disorder of dysregulated dietary iron absorption and increased iron release from macrophages.

347
Q

what causes haemochromatosis?

A

Autosomal recessive HFE gene mutation on chromosome 6

chronic transfusions
high iron intake
alcoholism

348
Q

what protein from the liver controls iron levels?

A

Hepcidin

349
Q

what are 7 manifestations of haemochromatosis?

A 
skin hyperpigmentation - bronze 
arthritic joints 
testicular atrophy hepatomegaly 
congestive cardiac failure 
osteoporosis 
T1DM
350
Q

what investigations do you of for haemochromatosis?

A

serum ferritin - high

seum transferritin - high, more specific

351
Q

what is the treatment for haemochromatosis?

A

venesection - draining small amounts of blood
maintenance phlebotomy
low iron diet

352
Q

what are 4 complications of haemochromatosis?

A

cirrhosis
hepatocellular carcinoma
DM
congestive HF

353
Q

what is the inheritance pattern of Wilson’s disease?

A

autosomal recessive

354
Q

what is the gold standard test for Wilson’s disease?

A

liver biopsy - test for copper contents

355
Q

what is the 1st line treatment for Wilsons disease?

A

Copper chelation - D-penicillamine

356
Q

what is alpha-1-antitrypsin deficiency?

A

autosomal recessive disorder causing liver and pulmonary disease

357
Q

what does alpha-1-antutrypsin deficiency cause?

A

early onset COPD

liver cirrhosis and hepatocellular carcinoma

358
Q

what is the most common primary liver cancer?

A

hepatocellular carcinoma

359
Q

what can cause liver adenomas?

A

anabolic steroids, oral contraceptive pill, pregnancy

360
Q

what part of the pancreas is usually affected in pancreatic cancer?

A

the head

361
Q

what are 6 symptoms of pancreatic cancer?

A 
painless jaundice
non-specific symptoms 
new onset diabetes 
nausea and vomiting 
steatorrhoea 
dark urine and pale stools
362
Q

what is Whipple’s resection?

A

pancreaticoduodenectomy for resectable lesions of the head of the pancreas. This removes the antrum of the stomach, proximal duodenum, head of the pancreas, common bile duct and gallbladder => pancreatic cancer

363
Q

what is a hernia?

A

the protrusion of an organ through a defect in the wall of it’s cavity into an abnormal position

364
Q

what are 3 risk factors for inguinal hernia?

A

male
chronic cough
constipation

365
Q

how much paracetamol can be fatal in adults?

A

24 x 12g tablets

150 mg/Kg

366
Q

what is the management for paracetamol overdose?

A 
activated charcoal (within 1 hour)
N-Acetylcysteine
367
Q

what are 3 complications of paracetamol overdose?

A

acute liver failure
acute kidney injury
anaphylactoid reaction

368
Q

what are the 2 antibodies present in coeliac disease?

A

IgA tissue transglutaminase

IgA anti-endomysial

369
Q

what are the causes of peritonitis/ (mnemonic)

A

ACUTE ABDOMEN

AAA
Collapsed inferior vena cava
Ulcer (perforated viscus)
Trauma 
Ectopic pregnancy
Appendicitis 
Biliary tract
Distended bowel loop
Obstructive uropathy 
Men: testicular torsion
Women: ovarian torsion.
370
Q

what is the management for bleeding varices?

A

IV terlipressin

371
Q

what is the treatment for bleeding varicose in someone with ischaemic heart disease?

A

IV somatostatin

Phase 4 (19 decks)

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