Liver, Biliary Tree And Pancreas Flashcards
How do you manage acute alcohol poisoning?
Keep them awake
Keep them sat up
Give water if tolerated
If unconscious but breathing, put them in the recovery position
Keep them warm
Stay with them
How do you treat paracetamol overdose?
N-acetylcysteine or liver transplant.
Which hepatitis viruses can be immunised against?
Hepatitis A
Hepatitis B
What is the first line symptomatic treatment for delirium tremens?
Oral lorazepam
Or: parenteral lorazepam or haloperidol
What is the first line treatment for alcohol withdrawal syndrome?
Benzodiazepine or carbamazepine
Oral Chlordiazepoxide 10-50mg/6hrs for three days
Possible adjunct: benzodiazepine or carbamazepine.
May require vitamins if chronic alcoholic.
Who should be admitted and offered medically assisted alcohol withdrawal?
- People with alcohol withdrawal seizures (AWS)
- Those at high risk of AWS or delirium tremens
- Those under 16
- Those with learning disabilities
What is first line treatment for alcohol withdrawal seizures?
Quick acting benzodiazepine (lorazepam)
What is the first line treatment for suspected wernicke’s encephalopathy or for prophylaxis of this?
High dose thiamine
In the treatment of decompensated alcoholic liver disease, what are the two requirements for transplant?
- Three months abstinence
2. Three months best management hasn’t compensated the condition
What are the five steps that NICE recommends for the treatment of alcoholic liver disease?
(2 steps are dependant on comorbidities)
- Assess for liver transplant
- Treat active infections and GI bleeds
- Control any renal impairment
- Discuss and offer corticosteroids (Reduces inflammation in the liver)
- Offer nutritional support - consider nasogastric tube
How do we treat pancreatitis?
Symptomatic and curative
(Same for acute and chronic)
- Treat root cause if possible:
- Cholecystectomy or ERCP (If gallstone, large duct obstructive pancreatitis)
- Stop alcohol intake
- Offer coeliac axis block, splanchnicectomy (control pain in small duct obstructive pancreatitis) - IV fluids
- Nutritional support: enteral feeding (NG)
- Morphine or fentanyl
- Offer enzyme supplements if signs of exocrine insufficiency are due to chronic pancreatitis
- Offer benzodiazepines if cause is alcohol
A patient has just been diagnosed with diabetes type 2:
Which investigations do you want to do?
- Serum lipids (indicates risk factors for CVD)
- Serum creatinine (check kidney function for microvascular issues)
- Retinopathy (check for retinal damage)
What is the treatment pathway for diabetic ketoacidosis and hyperosmolar hyperglycaemic state?
- If BP<90mmhg 500ml 0.9% saline over 15 mins: (prevent cerebral oedema)
- If unconscious use airway protection
- Give potassium chloride solution (avoid arrhythmias)
- Give IV insulin infusion
- Continue any established insulin regimes: should give long acting insulin - might die if hyperglycaemic for too long
- LMWH (VTE prophylaxis)
- Monitor serum potassium, ketones and sugars
What is the treatment for severe hypoglycaemia?
- Glucose 10-20g PO and repeated after 15 minutes. (2 teaspoons of sugar)
- IV glucagon: if unconscious - works by releasing the stores of glycogen in the liver
Glucagon will not work in a patient with cirrhosis
What kind of things should be covered in a management care plan for diabetes type 1?
Condition education Nutrition education Insulin regime dose adjustment Self-monitoring Hypoglycemia management Pregnancy in diabetes advice Monitoring for complications CV risk information