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Week 14- GI/Liver > Lectures > Flashcards

Lectures Flashcards

(74 cards)

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1
Q

Upper GI bleed presentation

A

Haemateesis
Coffee ground vomiting
Malena

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2
Q

Causes of upper GI bleed

A 
Peptic ulcer
Oesophagitis
Gastritis
Duodenum is
Varices
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3
Q

Rockall reissue score components

A 
Age
Shock 
Comorbidities
Diagnosis
Stigmata of haemorrhage
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4
Q

Endoscopic therapy options

A

Adrenaline injection
Heater probe
Endoscopic clip
Hemostatic powder

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5
Q

If bleeding uncontrolled by endoscopic therapy

A

Radiological embolisation

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6
Q

Drugs to restart after UGIB

A

Aspirin after haemostasis achieved, add PPI
Stop NSAIDs
Restart clopidogrel after haemostasis

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7
Q

When to give blood products on UGIB

A

Transfuse= hub <7-8g/dL

Platelets= actively bleeding + plts <50x10^9/L

FFP= INR >1.5

Prothrombin complex concentrate= if on warfarin

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8
Q

Pathogenesis of varices

A

Increased hepatic pressure (cirrhosis)
Increased portal inflow

Increased portal pressure

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9
Q

Acute variceal bleeding treatment

A

Prophylaxis= b-blocker or band ligation

Acute bleed:
resuscitate
Abx + terlipressin 
Banding 1st line
TIPS for uncontrolled 
Balloon tamponade

Prevention= b-blocker + repeated band ligation

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10
Q

Hepatitis A clinical features

A

Incubation 30 days
Children asymptomatic
Mortality 1.5% if >50

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11
Q

Hep A treatment

A

Hydration, avoid alcohol
Usually self limiting
No vaccine

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12
Q

Diagnosis of Hep A

A 
Acute= IgM positive or HAV RNA
Previous= IgG positive
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13
Q

Hep A prevention

A

Vaccine= 95% efficacy after 4 weeks, 2nd dose life protection

Immune globulins= vaccine allergic, <4weeks until travel, 3-6 months immunity

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14
Q

Transmission of Hep E

A

Faecal oral
Pork
Minimal person to person

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15
Q

Clinical features of Hep E

A

Higher fatality in pregnant if genotype 1

Chronic in immunosupressed

Neuro manifestations in GT3 (GBS, encephalitis, ataxia, myopathy)

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16
Q

Hep B epidemiology

A

300million worldwide
2 million deaths per year
Vaccine preventable
0.3% UK population

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17
Q

Transmission of Hep B

A 
Transfusion
Fluids
Transplant
Mother to baby
Contaminated needles
Child to child
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18
Q

How age impacts Hep B

A 
Young= asymptotic but higher risk of chronic
Adult= symptomatic but cleared
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19
Q

Problems with Hep B

A

Weight loss, abdo pain, fever

Ache is
Mass in abdomen
Bloody ascites
sAg positive

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20
Q

Problems with chronic HBV

A 
Chronic liver disease
Cirrhosis
Decompensation
Hepatocellular carcinoma
Death
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21
Q

Hep B lab tests

A 
sAg= surface antigen (marker of infection)
sAb= surface ab (marker of immunity
cAb= core ab (have been infected)
eAg= e antigen (high infectivity)
eAb= e ab (low infectivity)
HBV DNA
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22
Q

Hep B treatments

A

Acute= no treatment

Chronic:

  • only if liver inflammation
  • interferon
  • tenofovir or entecavir
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23
Q

Prevention of mother to child

A

HBV vaccination to new born
HBV Ig if eAg positive or high VL
Tenofovir during last trimester

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24
Q

Hep D transmission and treatment

A

Co-infection with hep B
Requires Hep B to replicate
Treatment= IFN

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25
Hep C diagnosis
Anti-HCV IgG positive= chronic or cleared infection | PCR/antigen positive= current infection
26
Hep C treatment
Direct acting anti-viral inhabitants Cures 95% Given with methadone in pharmacy
27
Natural history of Hep C
25% symptomatic 70% chronic, 30% cleared 25% cirrhosis, 1-5% HCC
28
Chromosome instability pathway
Mutation in tsg (APC/TP53) Due to deletion, point mutation, hypermethylation of promoter region
29
Micro satellite instability pathway
Defective DNA repair | MSH2,6 genes
30
Adenocarcinoma sequence
Normal mucosa —> APC mutation —> aberrant crypt focus —>KRAS—> early adenoma —> late adenoma—> TP53, PIK3–> invasive carcinoma
31
Colorectal cancer risk factors
``` Adenoma History of IBD (ulcerative colitis) Increasing age Obesity Sedentary life style High fat/low fibre diet Smoking, alcohol Family history ```
32
TNM8 staging colorectal cancer
``` T: 1= submocosa 2= into but not through muscularis 3= through muscularis, into serosa 4= invasion of visceral peritoneum (a) other organs (b) ``` N: 0= no mets in LN, 1= 1-3, 2= >3 M: 0= no mets, 1= mets
33
Colorectal cancer treatment options
Stage 1-2= surgery Stage 3-4= adjuvant therapy (chemo/immune therapy
34
Infective colitis presentation
Short history of diarrhoea Abrupt onset and resolution Systemic upset and fevers Travel, unwell contact
35
Infective colitis investigation
Stool culture (need 4 for 90% sensitivity)
36
Ischaemic colitis presentation and investigation
More in elderly, CVD, HF Abrupt onset pain, bloody diarrhoea, SIRS CT
37
Investigations for colitis
Abdominal x-ray: - megacolon >5.5cm Flexible sigmoidoscopy
38
Acute changes in CIBD
Acute inflammation Ulceration Loss if goblet cells Crypt abscess formation
39
Chronic changes in CIBD
``` Architectural changes (haphazard glands) Paneth cells metaplasia Chronic inflammatory infiltrates (plasma cells) in laminate propria Neuronal hyperplasia Fibrosis ```
40
Ulcerative colitis clinical features
Diffuse involvement of lower GIT | No fibrosis or granulomas
41
Ulcerative colitis treatment
Acute: - IV methylprednisolone - if fails then infliximab Mesalazine Azathioprine (for severe relapse)
42
Complications of ulcerative colitis
Local: - haemorrhage - toxic megacolon Systemic: - skin= erythema nodosum, pyoderma gangrenosum - liver - eyes= uveitis - AnkSpon
43
Symptoms of Crohn’s disease
Abdominal pain Diarrhoea (watery) Weight loss Fistula, abscesses Extra-intestinal: - eyes - sacroilitis - erythema nodosum
44
Investigations for Crohn’s
Ileocolonoscopy Faecal calprotectin MR/CT enterography
45
Pathology of Crohn’s
``` Small and large bowed inflammation Proximal large bowel Patchy inflammation Skip lesions Transmural Granulomas ```
46
Treatment of Crohn’s
Azathiprine Methotrexate Biological: - infliximab (TNFa) - vedolizumab (intergins) - ustekinumab (il-12/23) Surgery
47
Presentation of gallstones
Right upper quadrant pain Usually after meals Crampy in nature No jaundice or fever
48
Investigations for suspected gallstones
LFT | US
49
Composition of gallstones
Pure (cholesterol or bile pigment) | Mixed
50
Causes ofBile stone formation
Excessive secretion of cholesterol Decreased secretion of bile salts Excess bilirubin
51
Common bile duct obstruction presentation
Severe+acute RUQ pain Darker urine Paler faeces Increased ALP, bilirubin
52
Investigations and treatment for blocked CBD
US MRCP Treatment= ERCP, lap chole
53
Presentation and causes of acute pancreatitis
``` Severe acute upper abdo pain Onset in hours Feverish light headed vomiting Abdo tender all over Tachycardia, pyrexial, hypotensive Increased amylase ``` Causes= gallstones, alcohol, ERCP, mumps, drugs
54
Complications of acute pancreatitis
Fat necrosis Haemorrhaging pancreatitis Pancreatic abscess
55
Presentation of pancreatic carcinoma
Painless obstructive jaundice New onset diabetes Abdo pain Obstruction of pancreatic and bile duct
56
Treatment options in pancreatic carcinoma
Whipples resection | Neoadjuvant therapy
57
Definition of cirrhosis
End stage liver disease | Diffuse process with fibrosis and nodule formation
58
Abnormal LFTs
``` Hepatic= AST, ALT, GGT, bilirubin Cholestatic= ALP, GGT, bilirubin ```
59
Investigations for acute liver injury
US Acute viral hepatitis (hep A-E, CMV) Autoimmune (ANA/SMA/LKM, IgG) Paracetamol level
60
Drugs cause it liver injury
Paracetamol Co-amoxiclav Methotrexate
61
Investigations for chronic liver injury
``` US Chronic hepatitis (HBV, CMV) Autoimmune: - AI hepatitis= ANA, SMA, LKM, IgG - PBC= ANA, IgM - PSC= ANCA ``` Metabolic: - haemochromatosis (ferritin, Tf) - Wilson’s (caeruloplasmin) - a1 anti-trypsin
62
Causes of chronic abnormal LFTs
``` Alcoholic fatty liver NAFLD Chronic hepatitis Autoimmune Haemochromatosis ```
63
Specific features of hep B
Ground glass cytoplasm in hepatocyte
64
Autoimmune hepatitis presentation
``` Non specific symptoms (fatigue, fever, general ill health) Acute jaundice arthralgia Middle RUQ pain Increased AST, ALT ANA, SMA, LKM, IgG ```
65
Autoimmune hepatitis treatment
Steroids (prednisolone, budesonide) | Azathioprine, mycophenolate
66
Features and treatment of primary biliary cholangitis
- most common chronic cholestatic disease - 9F:1M - 90% have AMA against pyruvate dehydrogenase complex - increased GGT, ALP (early) - symptoms= tiredness, itching, jaundiced - treatment= ursodeoxycholic acid
67
Wilson’s disease presentation and treatment
CLD 5% fulminant acute liver failure 50% neuro/psychological: - Parkinsonism, slurred speech, ataxia Treatment= copper chelation (penicillamine)
68
Hereditary haemochromatosis presentation and treatment
Presentation: - CLD - polyarthropathy - adrenal insufficiency - HF - diabetes - skin pigmentation Treatment= venesection
69
Alcoholic hepatitis features
Excess alcohol within 2 months Bilirubin >80umol/l Exclusion of other liver disease AST <500 (AST:ALT >1.5) Hepatomegaly, fever, leukocytosis, hepatic bruit
70
Ascites treatment
Low salt diet | Spironolactone, furosemide
71
Hepatic encephalopathy treatment
Non-absorbable disaccharides (lactulose) | Non-absorbable antibiotics (rifaximin)
72
Benign liver neoplasms
Hepatocellular adenoma Bile duct adenoma Haemangioma
73
Malignant liver neoplasms
Hepatocellular carcinoma Cholangio-carcinoma Angiosarcoma Metastases
74
Hepatocellular carcinoma treatment
``` Kinase inhibitors= sorafanib, lenvatanib Radio frequency ablation Transarterial chemoembolisation Resection Liver transplant ```

Week 14- GI/Liver (1 decks)

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