liver/GI Flashcards
(357 cards)
1
Q
list 4 functions of the liver
A
glucose/fat metabolism
detoxification and excretion
protein synthesis
defence against infection
2
Q
what does the liver detoxify/excrete
A
bilirubin
ammonia
drugs/hormones/pollutants
3
Q
which proteins does the liver synthesise?
A
albumin
clotting factors
4
Q
define hepatitis
A
inflamed liver
5
Q
what is 1 of the major consequences of chronic liver disease?
A
susceptibiliy to infection
6
Q
how does blood flow into the liver?
A
via the portal vein and hepatic artery
7
Q
how is the normal liver arranged?
A
in a regular way - acinar/lobular models
8
Q
where does the portal vein and hepatic artery lie
A
together, with a small bile duct in the portal tract (each of the corners of hexagon model)
9
Q
blood flows into a system of WHAT that bathe liver cells?
A
sinusoids
arranged in plates, before exiting via hepatic (central) vein
10
Q
what is the hepatic vein aka
A
central vein
11
Q
what is the central vein aka
A
hepatic vein
12
Q
liver cells within the lobule can be divided into which zones? why is this significant?
A
zones 1-3
receive progressively less oxygenated blood
13
Q
what are the 2 types of liver injury?
A
acute and chronic
14
Q
what are the 2 outcomes of acute liver injury?
A
liver failure or recovery
15
Q
what are the 3 outcomes of chronic liver injury?
A
liver failure
recovery
cirrhosis
16
Q
what are some causes of acute liver injury?
A
viral (A, B, EBV) drug alcohol vascular obstruction congestion
17
Q
what are some causes of chronic liver injury?
A
alcohol
viral (B, C)
autoimmune
metabolic (iron, copper)
18
Q
what may acute liver injury result in?
A
damage and loss of cells
19
Q
chronic damage eventually leads to what?
A
fibrosis
20
Q
what is the severest form of fibrosis termed?
A
cirrhosis
21
Q
how does acute liver injury usually present?
A
malaise nausea anorexia jaundice rarer: confusion, bleeding, liver pain, hypoglycaemia
22
Q
how does chronic liver injury usually present?
A
ascites oedema varices malaise anorexia wasting easy bruising itching hepatomegaly abnormal LFTs rarer: jaundice, confusion
23
Q
define cirrhosis
A
scarring and disorganisation of liver structure
24
Q
what do LFTs look @
A
serum bilirubin
albumin
prothrombin time
25
do serum liver enzymes give indication of liver function?
no
26
do LFTs give indication of liver function?
some
27
define jaundice
raised serum bilirubin
28
what are the 2 types of jaundice?
unconjugated (pre-hepatic)
| conjugated (cholestatic) [includes hepatic and post hepatic]
29
what is cholestasis?
decrease in bile flow due to impaired secretion by hepatocytes/obstruction of bile flow through bile ducts)
30
is liver disease hepatic or post hepatic?
hepatic
31
is bile duct obstruction hepatic or post hepatic?
post hepatic
32
what does cholestatic jaundice include?
hepatic and post-hepatic
33
what is urine in pre-hepatic jaundice like?
normal
34
what are stools in pre-hepatic jaundice like?
normal
35
what are LFTs in pre-hepatic jaundice like ?
normal
36
what is urine in cholestatic (hepatic/post hepatic) jaundice like?
dark
37
what are stools in cholestatic (hepatic/post hepatic) jaundice like?
may be pale
38
do u get itching in cholestatic (hepatic/post hepatic) jaundice?
maybe
39
what are LFTs in cholestatic (hepatic/post hepatic) jaundice like?
abnormal
40
if there's dark urine, pale stools and itching ... what don't they have?
pre-hepatic jaundice
41
why may u have biliary pain?
due to gallstones
42
why may u have rigorss?
bile duct stone(s)
43
which history is V important w the liver?
drug/herbs! idiosyncratic reaction is important sis
44
what should u look at when looking at social history in someone w/ liver issues?
alcohol !
potential hepatitis contact (sex, IVDU, travel, certain foods)
family Hx rarely helpful
45
what is a rigor?
sudden feeling of cold w/ shivering, accompanied by temp rise often w copious sweating
46
what tests will be done for jaundice ?
liver enzymes
biliary obstruction
further imaging
47
what can sickle cell cause?
jaundice
48
why can sickle cell cause jaundice?
bc sickle cells do not live as long as normal RBC they die faster than the liver can filter them out.
bilirubin from these broken down cells builds up in the system
49
where do most gallstones form
in the gallbladder
50
what are gallstones usually made up of?
80% cholesterol
30% pigment
± calcium
51
what are the 2 main types of gallstones?
cholesterol (usually yellow-green)
| pigment (darker and made of bilirubin)
52
if u have gallstones in the gallbladder, do get biliary pains and cholecystitis (inflammation of gallbladder)?
yes
53
define cholecystitis
inflammation of the gallbladder
54
if u have gallstones in the gallbladder, will u get obstructive jaundice?
maybe!
55
if u have jaundice in the gallbladder, will u get cholangitis/pancreatitis?
no
56
define cholangitis
inflammation of the bile duct
57
what is the difference btwn cholecystitis and cholangitis
```
cholecystitis = inflammation of gallbladder
cholangitis = inflammation of bile duct
```
58
if u have gallstones in the bile duct, will u get biliary pain?
yes
59
if u have gallstones in the bile duct, will u get cholecystitis (inflammation of gallbladder)?
no
60
if u have gallstones in the bile duct, will u have obstructive jaundice/pancreatitis/cholangitis (inflammation of bile duct)
yes
61
is fat intolerance/indigestion and upset bowel associated with gallstones presentation?
no
62
what is cholecystectomy ?
removal of gallbladder
63
90% of ppl w obstruction have what ?
dilated bile ducts
64
what is ALT?
alanine aminotransferase
65
why might there be low levels of ALT in the blood ?
expected/normal
66
why might there be high levels of ALT in the blood ?
liver disease ! v high levels (more than 10x usually due to acute hepatitis, sometimes viral infection
67
what is the commonest reason for drug withdrawal from formulary?
jaundice
68
what is DILI?
drug induced liver injury
69
what are the types of DILI
hepatocellular
| cholestatic
70
when looking at DILI, what is important?
not what drugs they are taking
| but what they started RECENTLY
71
what are the most common drugs for DILI?
ABs
72
what do cyp450 enzymes do
metabolise potentially toxic compounds incl drugs, bilirubin
73
what is the most common cause of acute liver failure?
paracetamol
74
how is paracetamol OD managed
N acetyl cysteine (NAC)
75
is liver damage detectable after a paracetamol OD?
not usually until at least 18h after
76
what are some causes of ascites ?
chronic liver disease
| neoplasia
77
what is the pathogenesis of ascites like ?
systemic vasodilation can lead TO portal hypertension (also incr intrahepatic resistance n low serum albumin can contribute )
this can also result in secretion of RA, NA and ADH thus fluid retention
78
how can ascites be managed?
]diuretics
| fluid n salt restriction
79
fat accumulation within hepatocytes is termed WHAT?
steasosis
80
what can a fatty liver result in ?
alcohol hepatitis
| cirrhosis
81
what is the main cause of liver death in the UK
ALD (alcohol liver disease)
82
what are some causes of portal hypertension
cirrhosis
fibrosis
portal vein thrombosis
83
what happens w portal hypertension?
increased hepatic resistanc/splanchnic blood flow can lead to varices and splenomegaly
84
what is the commonest serious infection in cirrhosis
spontaneous bacterial peritonitis
85
why are liver patients vulnerable to infection?
bc they have:
- impaired reticula-endothelial dysfunction
- reduced opsonic activity
- leucocyte function
- permeable gut wall
86
end stage liver disease is represented by what?
cirrhosis
87
what is the safest analgesic to prescribe to someone w/ liver disease?
paracetamol
bc sensitive to opiates
NSAIDs cause renal failure
88
autoimmune hepatitis requires what for diagnosis?
liver biopsy
89
do antihistamines help w cholestatic (bile ducts) itch?
they are little help
cholestyramine (cholesterol lowering, also anti-diarrhoea)
90
what are some risk factors for NAFL (non alcohol fatty liver)
obesity
diabete
hyperlipidaemia
91
what is the commonest cause of mildly elevated LFTs?
NAFL
92
why do liver patients get ascites?
high BP in the veins that bring blood to the liver (portal hypertension), which is usually due to cirrhosis.
In people with a liver disorder, ascitic fluid leaks from the surface of the liver and intestine and accumulates within the abdomen. a combo of factors is responsible:
they include the following:
- portal hypertension
- fluid retention by the kidneys
- alterations in various hormones and chemicals that regulate body fluids
93
acute hepatitis is when?
less than 6m
94
chronic hepatitis is when?
over 6m
95
describe a common acute hepatitis patient
```
can be asymptomatic
general malaise (tiredness, discomfort)
myalgia (muscle pain)
upset GI
abdo pain
± jaundice (pale stools, dark urine)
```
96
what are characteristic features of jaundice stool/urine sample
pale stools
| dark urine
97
what are the 2 causes of acute hep
infectious (viral vs non viral)
| non-infectious
98
list some viral infectious causes of acute hep
hep A, B etc
| herpes viruses
99
list some non viral infectious causes of acute hep
spirochaetes
mycobacteria
parasites
bacteria
100
list some non-infectious causes of acute hep
```
alcohol
NAFL
drugs
toxins/poisoning
pregnancy
```
101
describe a common chronic hep patient
can be asymptomatic/non specific symptoms
± signs of chronic liver disease (clubbing, dupuytren's contracture, spider naevi etc)
LFTs can be ormal
compensated - jaundice, ascites, low albumin etc
102
what are some common signs of chronic liver disease
clubbing
dupuytren's contracture
spider naevi
103
what are oesophageal varices
v dilated submucosal veins in lower third of oesophagus
| most often a cause of portal hypertension, commonly bc of cirrhosis. strong tendency to develop bleeding
104
what are the 2 types of chronic hep causes?
infectious n non-infectious
105
list some infectious causes of chronic hep
hepatitis B ± D
hep C
hep E
106
what are some non-infectious causes of chronic hep?
```
alcohol
NAFL
drugs
toxins
autoimmune
```
107
how can hep A be transmitted?
faeco-oral !!!!!
ingesting contaminated food/water
person-to-person contact
108
what are some risk factors of hep A
travel
household
sexual contact (MSM)
IVDU
109
how are the different hep's linked by transmissions? any trends?
A & E: faecal-oral route (travel, foooood)
| B & C: via blood (childbirth, IVDU, sex)
110
does hep A develop to chronic?
nope
111
does hep E develop to chronic?
nah
112
does Hep C develop to chronic?
usually !
113
does hep B develop to chronic?
in around 20%, but the younger u are the higher the risk
114
what is hep A aka
HAV
115
how can hep A be managed
supportive
monitor LFT
manage close contacts
primary prevention vaccinations
116
risk of chronic infection in Hep E is only to who?
immunosuppressed patients
117
how can hep E be managed
if acute: supportive
| if chronic: reverse immunosuppression
118
what is hep E aka
HEV
119
what is hep B aka
HBV
120
how is hep B acquired
blooooododddd
121
what is Hep C aka
HCV
122
what can hep c result in
cirrhosis
| linked to liver cancer (hepatocellular carcinoma)
123
how can u prevent Hep C
no vaccine
previous infection doesn't confer immunity either :/
BUT
u can screen blood products n have universal precautions when handling bodily fluids :)
also have lifestyle modification eg needle exchanges
124
helicobacter pylori is involved in the pathogenesis of what?
peptic ulcer disease
125
bacterial infection is a frequent cause of what ?
diarrhoea
126
clostridium difficile infection results when ?
broad spectrum antimicrobials allow this bacteria to overgrow in the gut :@
can result in diarrhoea in susceptible host patients (particularly elderly n immunocompromised)
127
what kills most swallowed pathogens
gastric acid
128
when are u classed as having diarrhoea
3+ loose/liquid stools in 24h
129
what are some infection causes of diarrhoea
intraluminal infection
| systemic infections eg sepsis, malaria *DON'T FORGET BITCH*
130
what are some non-infective causes of diarrhoea
```
cancer
chemical eg poisoning, side effects
IBD
malabsorption
endocrine eg T4
radiation
```
131
with intraluminal infection, WHAT is key?
history taking !
132
how does onset of diarrhoea differ?
acute onset: viral/bacterial
| chronic: parasites/non-infectious
133
how do the characteristics of diarrhoea stool differ?
floating: fat? malabsorption?
| blood/mucus: inflammation? cancer?
134
how does food history impact diarrhoea
```
takeaways: food poisoning
BBQs: campylobacter
rice: bacillus cereus
poultry: salmonella
shellfish: norovirus
```
135
what else can influence diarrhoea?
hobbies, fresh wateR/? swimming?
animals?
medications
136
what are some stool tests for diarrhoea
microscopy
culture
toxin detection
ova, cysts and parasites esp if been abroad
137
where is watery diarrhoea located
proximal small bowel
138
where is bloody, mucoid diarrhoea located
colon
139
watery diarrhoea: inflamm or non?
non-inflammatory
140
bloody/mucoid diarrhoea: inflamm or non?
inflamatory
141
in the UK, what are 50-70% of diarrhoea cases caused by?
viruses
142
traveller's diarrhoea occurs when?
within 2w of arrival in new country
143
what is travellers diarrhoea like?
3+ unformed stool per day PLUS 1 of following:
- abdo pain
- cramps
- nausea
- vomiting
144
what can cause cholera?
contaminated food/water
145
what are some consequences of cholera
vomiting
| profuse watery "rice water" diarrhoea
146
what are the red flags 4 diarrhoea? /:
```
dehydration
electrolyte imbalance
renal failure
immunocompromise
severe abdo pain
cancer risk factors
```
147
what are some cancer risk factors ...
```
over 50
chronic diarrhoea
weight loss
blood in stool
FHx cancer
```
148
how can diarrhoea be treated ?
fluids
electrolyte monitoring n replacement eg ORS
decrease K/Mg/phosphate, increase Na
antiemetics
149
what do antiemetics do ?
prevent nausea and vomiting
150
what is a common precursor of gastritis and peptic ulcers
helicobacter pylori infection
151
what is helicobacter pylori infection a risk factor for
gastric carcinoma
152
where does helicobacter pylori live
mucus layer overlying gastric mucosa
153
how can helicobacter pylori infection be diagnosed
stool antigen test
breath test
blood test for antibodies
154
what is Charcot's triad?
for cholangitis
1. jaundice
2. RUQ pain
3. fever
155
what are the 4F's of gallstone risk factors
fair
female
fat
fertile
156
what is enteric fever
typhoid !
157
what happens in typhoid/enteric fever
```
high fever
relative bradycardia
headache n myalgia
rose spots
constipation/green diarrhoea
```
158
clostridium difficile is linked w what?
antibiotic use
159
where is hep A mainly found (geographically)?
worldwide
160
where is hep B found geographically ?
asia and china
161
where is hep E found geographically
south east Asia, India, central america
162
what is the non-medical term for steatosis
fatty liver
163
what is HbF
foetal Hb
164
when does HbF change to HbA (foetal to adult)?
HbF is nearly completely replaced by HbA by approx 6m postnatally, except in a few thalassemia cases in which there may be a delay in cessation of HbF production until 3–5 yrs of age
165
men and women are advised not to drink regularly more than how many units of alcohol a week?
14
166
what is a UK unit?
8g/10ml of pure alcohol
167
how do u calculate the number of units?
strength of drink (% ABV) x amt of liquid in ml .... dividedd by 1000
eg
1 bottle of wine = (13.5% x 750ml)/1000 = 10 units
168
what's the diff in binge drinking btwn men and women?
men >8 units
| women >6 units
169
what are some acute effects of excessive alcohol
```
accidents/injury
coma and death (from rest depression)
aspiration pneumonia
oesophagitits
pancreatitis
cardiac arrhythmias
cerebrovascular accidents
```
170
what are some chronic effects of excess alcohol intake
```
pancreatitis
CNS toxicity
liver damage
hypertension
cardiomyopathy
osteoporosis
CHD
skin disorders
```
171
what is tremulousness ?
several distinct but not mutually exclusive clinical alcohol withdrawal syndromes caused by alcohol withdrawal eg shakes
172
what else can u get w alcohol withdrawal?
shakes
seizures
hallucinations
delirium
173
what is foetal alcohol syndrome ?
pre and post natal growth retardation bc of drinking pregnant mother
174
what are some signs of FAS
- CNS abnormalities (mental retardation, irritability, incoordination, hyperactivity
- craniofacial abnormalities (smaller head, distinctive facial features eg small eyes, thin upper lip)
- congenital defects of eyes, ears, mouth etc
175
what are some psychosocial impacts of f excessive alcohol consumption
- disturbances in interpersonal relationships eg violence, - depression
- work problems
- criminality
- social disintegration, poverty
- driving offences
176
how does NICE guidance prevent harmful drinking ?
making alcohol less affordable
import allowances
limit exposure to esp children, young ppl
177
what are some examples of health promotion against alcohol ? (primary prevention)
"know your limits" binge drinking campaign
drink aware - alcohol labelling
"THINK!" alcohol driving campaign
restriction on alcohol advertising
178
what is the diff btwn primary n secondary prevention again
primary - health promotion
| secondary - screening n intervention
179
what is secondary prevention of alcoholism ?
- ask abt it routinely as a doc
- think of it as an explanation for presenting symptom
- think of it as an explanation for presenting symptom
- detect problem drinking
180
what are some screening questions n tools for alcoholism ?
```
clinical interview
FAST (fast alcohol screening test)
CAGE questions
in ED
as part of routine exam
```
in patients who are:
- pregnant/trying to conceive
- likely to drink heavily (smokers, adolescents)
- have health problems that may be linked
- experiencing chronic illness not responding to treatment
181
what is alcohol dependence?
set of behavioural, cog and psych responses that can develop after repeated substance abuse
182
"determine where, in the past 12m, your patient has..." (complete_
- shown tolerance
- shown signs of withdrawal
- not been able to stick to drinking limits
- spent a lot of time drinking
- spent less time on other matters
- kept drinking despite issues
yes to 3+ = alcohol dependence
183
"determine where, in the past 12m, your patient's drinking has repeatedly caused/contributed to..." (complete)
- role failure
- risk of bodily harm
- run-ins with the law
- relationship trouble
yes to 1+ = alcohol abuse (proceed to assess for dependence symptoms)
184
how can alcohol dependence be treated?
pharmacologically and psychosocially
185
what are some medications for alcohol dependence ?
campral (thought to stabilize chemical signaling in the brain that would otherwise be disrupted by alcohol withdrawal)
antabuse (produces an acute sensitivity to ethanol so effects of hangover occurs immediately after alcohol is consumed)
selincro (opioid antagonist)
186
what are some psychosocial ways to tackle alcohol dependence?
therapy - cog and behavioural
| social support - 1 on 1 or group therapy
187
what is FRAMES
a summary of motivational interviewing
188
discuss FRAMES interviewing
Feedback abt the risk of personal harm/impairment
stress personal Responsibility for making change
Advice to cut down/strop dirnking
provide a Menu of alt strategies for changing drinking patterns
Empathetic interviewing style
Self-efficacy: intuitive style which lead es patient enhanced in feeling able to cope w goals they've agreed to
189
what is the 4-tier framework for alcohol/drug misusers?
1. non-substance misuse specific services
2. open access drug/alcohol services
3. specialist community-based services
4. specialist in-patient services
190
what is substance misuse?
recurrent substance use resulting in failure to fulfil major role obligations such as work, school or home life
191
what is dependence?
a state in which an organism functions normally only in the presence of a drug
manifests as physical disturbance when drug is withdrawn
192
what is tolerance?
a state in which an organism no longer responds to a drug
| a higher dose is required to achieve the same effect
193
what is alcohol
a depressant
194
what are the 3 ways in which intestines can be obstructed ?
- if s/t is in the lumen
- if s/t is in the wall
- if s/t is pressing outside of the bowel
195
what is a lymphoma?
malignant tumour of lymphoid cells
196
what are the 2 types of tumours ?
carcinoma and lymphoma
197
tumours on which side of the colon are more likely to cause obstruction due to hard faeces?
LHS
198
what is Crohn's disease?
inflammatory disease of the bowel (anywhere frogmouth to anus)
particularly affects terminal ileum - causes deep fissuring ulceration - fibrosis in btwn mucosa
199
what does Crohn's disease particularly affect?
terminal ileum
200
what is diverticulitis?
small outpourings of mucosa - causes increased pressure within colon
associated with low fibre diet
201
how does Crohn's present ?
crampy right iliac fossa pain and non-bloody diarrhoea
| fever, malaise n weight loss also common
202
does diverticulitis tend to affect younger or older ppl?
older
203
what are some inflammatory types of obstruction of bowel wall?
crohn's
| diverticulitis
204
what is a neural cause of bowel wall obstruction?
hirschprung's disease
205
what is hirschprung's disease?
a congenital GI cond
no ganglion cells (which coordinate cell contraction to move faeces) in lower section of colon
206
how does hirschprung's disease present?
intestinal obstruction n failure to pass meconium 24h after birth
207
what is meconium?
baby's 1st faeces- sticky, thick, and dark green and is typically passed in the womb during early pregnancy and again in the 1st few days after birth
208
what are types of extraluminal obstruction?
adhesions
volvulus
tumour
209
what is a volvulus?
when a loop of intestine twists around itself and the mesentery that supports it- resulting in a bowel obstruction.
210
what are some symptoms of volvulus?
abdominal pain/bloating, vomiting, constipation & bloody stool.
recurrent abdo pain as it may twist n untwist
211
what is gallstone ileum?
gallstone doesn't go down common bile duct
| gallbladder inflates, sticks to outside of small bowel
212
what is intramural obstruction
within the walls
213
what is mucosa like in Crohn's?
"cobblestone"
fibrosis in btwn bits
can cause intestinal obstruction
214
why may ovarian cancer be an issue ?
as the ovary is floating at the end of Fallopian tubes - can be a problem as cancer may spread to peritoneum
215
what are the 3 wall layers of intestines (deep to superficial)
serosa
muscularis
submucosa
mucosa
216
any foregut symptoms affect which region?
epigastric region
217
any midgut symptoms affect which region?
appendix
218
any hind gut symptoms affect which region?
suprapubic
219
define distensibility
ability to stretch n expand
220
what is gastric motility?
defined by the movements of the digestive system, and the transit of the contents within it.
when nerves or muscles in any portion of the digestive tract do not function with their normal strength and coordination, pt develops symptoms related to motility problems.
221
which part of intestine absorbs water?
small
222
where does the gut run from/to?
mouth to anus
223
what is intestinal obstruction?
blockage to lumen of the gut
commonly refers to blockage of intra-abdominal parts of intestine
224
how can u classify obstruction?
according to:
- site
- extent (partial/complete)
- mechanism (mechanical/true, paralytic/pseudo obstruction)
- pathology
225
what is SBO?
small bowel obstruction
226
what happens in small bowel obstruction?
```
incr. secretions
more dilation
decreased absorption
mucosal wall oedema
increased pressure
intramural vessels compressed
ischaemia
perforation
```
227
what can untreated obstruction lead to ?
ischaemia
necrosis - then sepsis
perfoation
228
what happens in large bowel obstruction?
similar to SBO
```
colon proximal to obhstruction dilates
incr colonic pressure decreases mesenteric blood flow
mucosal oedema
transudation of fluid/electrolytes
arterial blood supply compromised
mucosal ulceration
necrosis
perforation
bacterial translocation - sepsis
```
229
list some common causes of SBO
adhesions
hernias
intussusception
volvulus
230
list some common causes of LBO
tumours
sigmoid volvulus
diverticular strictures
231
how does SBO vs LBO presentation differ
both have acute colicky abdo pain, abdo pain and distension BUT
SBO: early vomiting onset, later constipation onset
LBO: early onset of constipation, later vomiting onset
232
what happens in LBO if ileocaecal valve is competent?
caecum is usual site of perforation
233
what happens in LBO if ileocaecal valve in incompetent?
faeculent vomiting
234
what is the majority of intestinal obstruction?
SBO
235
adhesive obstruction is usually secondary to what?
previous abdo surgery
236
define hernia
abnormal protrusion of viscera through normal or abnormal defects of body cavity
237
how do hernias usually present
as a lump or pain
238
name some common hernia locations
umbilical
inguinal
femoral
239
what is intussusception?
process in which a segment of intestine invaginates into the adjoining intestinal lumen, causing bowel obstruction.
when 1 intestine slips inside other intestine
240
what is severe/complete constipation?
obstipation
241
define adenoma
benign tumour of glandular tissue - has the potential to develop into cancer
242
diff btwn resection and excision?
resection - cutting all of a body part
| excision - cutting part of a body part
243
how many types of stool are there in the Bristol stool chart?
7
244
which stool type (BSC) is rabbit dropping like ?
type 1 - severe constipation
245
which stool type (BSC) is like a bunch of grapes?
type 2 - mild constipation
246
which stool type (BSC) is like corn on the cob?
type 3 - normal
247
which stool type (BSC) is like a sausage/snake?
type 4 - normal
248
which stool type (BSC) is like chicken nuggets?
type 5 - lacking fibre
249
which stool type (BSC) is like porridge?
type 6 - mild diarrhoea
250
which stool type (BSC) is like gravy?
type 7 - severe diarrhoea
251
what are some non-infective causes of diarrhoea?
neoplasm - hormonal
inflammatory - radiation
irritable bowel - chemical
aatomical
252
what are some infective causes of diarrhoea?
non-bloody
| bloody (dysentery)
253
what is dysentery?
infection of the intestines that causes diarrhoea containing blood or mucus.
other symptoms include: painful stomach cramps. nausea or vomiting, a fever of 38C
254
what are some direct routes of diarrhoea transmission?
STIs, faeco-oral route
255
what are some indirect routes of diarrhoea transmission?
vector-borne (malaria, dengue)
| vehicle-borne (hep B)
256
what are vector borne diseases?
caused by parasites, viruses and bacteria that are transmitted by mosquitoes, sandflies, triatomine bugs, blackflies, ticks, tsetse flies, mites, snails and lice etc
257
what are vehicle borne diseases?
when an inanimate object becomes contaminated with disease
258
what are the 3 types of transmission?
direct
indirect
airborne
259
what is an airborne route of diarrhoea transmission?
resp route
| eg TB
260
list some diarrhoea diseases
dysentery
typhoid
hepatitis
cholera
261
what is the major cause of winter vomiting?
norovirus
262
what happens w norovirus?
mainly causes vomiting
may cause: diarrhoea, nausea, cramps, headache, fever, chills, myalgia
lasts 1-3d
263
what is gastroenteritis?
infectious diarrhoea (stomach flu)
264
what is clostridium difficile (c diff)
bacteria that can infect the bowel and cause diarrhoea.
infection most commonly affects people who have recently been treated with (broad spectrum) ABs. can spread easily to others.
265
how is c diff spread?
faeco-oral route directly
| or through spores in the environment
266
how can c diff infection be prevented?
spores are highly resistant to chemicals so alcohol hand rubs don't destroy them
hand washing (soap/water) will remove them
267
what does enteric mean?
occurring in/to do with the intestines
268
how is c diff investigated?
stool samples
| can culture
269
why is diarrhoea an important PH issue?
2nd leading cause of death among children under. globally
kills more young children than AIDS, malaria and measles combined :(
270
what is the WHO-UNICEF diarrhoea treatment package?
fluid replacement to prevent dehydration
| zinc treatment
271
what are the 5 moments for hand hygiene?
```
before patient contact
before an aseptic task
after body fluid exposure risk
after patient contact
after contact with patient surroundings
```
272
what are notifiable diseases?
diseases, conditions and infections listed as notifiable under PH regulations 1988
legal obligation for any doc that suspects a case to inform proper officer
don't have to wait for a lab combo
273
why are they notifiable diseases?
- stuff that makes u very scared eg cholera, plague, rabies
- stuff that is quite nasty eg TB, leprosy, malaria
- vaccine preventable diseases eg diphtheria, MMR, whooping cough
- diseases that need specific control measures eg scarlet fever, food poisoning
274
how are communities protected from infectious diseases?
- investigate
- identify and protect vulnerable persons
- exclude high risk persons from high risk settings
- educate, inform, raise awareness
- co-ordinate multi-agency responses
275
what are the 5 types of immunoglobulins?
```
G
M
A
D
E
```
276
what are the 2 types of active immunity?
cell-mediated
| antibody-mediated
277
what is passive immunity?
protection provided from transfer of antibodies from immune individuals - most commonly cross-placental transfer
278
what are vaccines made from?
```
inactivated
attenuated live organisms
secreted prods
constituents of cell walls/subunits
recombinant components
```
279
what is the diff btwn primary and secondary vaccine failure?
primary - person doesn't develop immunity from vaccine
| secondary - initially responds but protection wanes over time
280
define sequela
a condition which is the consequence of a previous disease or injury
281
all cases of suspected meningitis are notifiable and must eye notified without delay
regardless of cause
282
what is contact tracing for meningitis?
any person having close contact w/ a case in past 7d (kissing, sleeping with, spending night, spending >8H in same room)
283
what is the incubation period?
time from exposure to onset of symptoms (includes latent period and infectious period)
284
what happens w mucosal ischaemia?
```
less blood to the stomach
so cells have less supply
so cells not producing mucin
so acid can attack cells
they die
```
285
what is increased acid caused by?
caused by stress
helicobacter bugs increase acid secretion
aspirin n other drugs - NSAIDs
286
which drugs get rid of acid?
proton pump inhibitors
287
where does helicobacter pylori live? does it like acid?
in the stomach ad no
288
what does helicobacter pylori do
produces chemicals that induce inflammation and ilceration
289
where does peptic ulceration most commonly happen?
in the 1st part of the duodenum
290
what are the signs of malabsorption?
- can see patients weight loss but not eat enough food
- not absorbing fat properly
- ppl anaemic w/o explanation
- lymphocytes in gut to fight off bugs which has been ingested
- insufficient intake
- defective intraluminal digestion
291
what is Crohn's disease in simple terms?
inflammatory disease in the bowel - typically in the terminal ileum
292
what are the complications of Crohn's?
mostly to the bowel (malabsorption, obstruction, perforation, fistula etc)
293
where does ulcerative colitis affect?
the colon only
294
define metaplasia
change in differentiation of a cell from 1 fully differentiated type to a different fully differentiated type
295
what is the biggest cause of metaplasia?
obesity
296
what is a risk factor for oesophageal squamous cancer risk factor?
alcohol
297
what is a risk factor for adenocarcinoma?
obesity
298
what is the diff btwn early n late gastric cancer?
as log as it doesn't go out the submucosa into the muscular wall, even if it goes to lymph nodes - it's earlyyyy
if it goes through the muscular wall - it's late gastric cancer
299
define peritonitis
inflammation of the peritoneum
300
define peritonism
tensing of muscles to prevent movement of peritoneum
301
what causes inflammation?
```
inflamed organ
air
pus
faeces
luminal contents
blood
```
302
what are some common causes of peritonitis?
cholecystitis (gall bladder inflammation)
pancreatitis
appendicitis
diverticulitis
303
define diverticulitis
inflammation of a diverticulum, especially in the colon, causing pain and disturbance of bowel function
304
why do ppl die of peritonitis?
```
sepsis
multi-organ failure
CV events
resp complications (pneumonia, pul. embolus)
surgical complications
poor physiological reserve/frailty
```
305
what is the iff btwn laparotomy n laparoscopy?
laparotomy ie big cut
| laparoscopy ie key hole
306
how do u treat someone w/ peritonitis?
- surgery
- treat problem (patch hole, remove organ/cause)
- wash out infection
307
what is the aftercare for peritonitis like?
- intensive care
- kidney support
- physio/early mobilisation
- nutrition support
308
define ascites (dictionary def)
"effusion and accumulation of serous fluid in the abdomen cavity"
effusion = pouring out
exudate (actively) or transudate (passively)
309
define ascites (clinical def)
detectable collection of fluid in the peritoneal cavity
chronic accumulation of fluid within the peritoneal cavity
310
what are some synonyms for ascites?
abdominal dropsy
peritoneal dropsy
hydrops abdomini
??lol TF
311
how much fluid do healthy men normally have in their peritoneal cavity
none
312
how much fluid do healthy women normally have in their peritoneal cavity
up to 20ml
313
how can ascites be classified?
into 4 categories (S1-S4)
S1 - MILD - detectable only after careful exam/US scan
S2 - easily detectable but of relatively small volume
S3 - MODERATE - obvious, not tense ascites
S4 - LARGE - tense ascites
314
how can ascites be classified?
portal hypertension vs non-portal hypertension
315
what is ascites ?due? to portal hypertension?
- a state of Na water imbalance
| - interplay of various neurohormonal agents - R, A, SNS, NO
316
what is ascites ?due? to non-portal hypertension
- malignancy
- cardiac failure
- syndrome
317
what is exudate ?
| what is transudate ?
actively
| passively
318
what is the history of ascites like ?
relating to liver disease
- LT heavy alcohol consumption
- infection
- non-alcoholic steatohepatitis (cirrhosis)
319
what is NASH? (non-alcoholic steatohepatitis)
advanced form of NAFLD (non-alcoholic fatty liver disease)
320
what are the clinical symptoms of ascites?
- abdominal distension (clothes tighter, maybe weight gain)
- nausea, loss of appetite
- constipation
- cachexia, weight loss
- associated symptoms of underlying cause
321
define cachexia
weakness and wasting of the body due to severe chronic illness
322
if there's malignancy with ascites, what do u get?
pain/discomfort
323
if there's no malignancy with ascites, is it painful?
no
324
what are some clinical presentations of ascites?
jaundice
- abdo distension
- puddle sign
- shifting dullness
- flanks fullness
- fluid thrill
325
what investigations do u for ascites?
naked eye assessment
chemistry (proteins, amylase)
microscopy (cytology, organisms)
culture
326
what biochem do u do for ascites?
serum ascites album gradient (SAAG)
| S Alb
327
what treatment is there for ascites?
treatment of underlying cause
adjuncts
- 95% portal hypertension
- shunts
328
what is the gallbladder for
storage n conc of bile
329
where does the gallbladder empty into
2nd part of duodenum
330
* look @ enterohepatic circulation *
-
331
what is the most common biliary problem seen, esp in west
gallstones !
332
list 3 risk factors for gallstones
raised cholesterol
oestrogen exposure ? (contraceptive pill?)
haemolytic anaemia (pigment gallstones, esp for hereditary ones but not many)
333
what are the 5 f's for gallstones
female forty fertile fat fair
334
how do gallstones present (7 :/)
mucocoele (big sterile fluid collection around stone, kinda like an abscess)
biliary colic
cholecystitis (gallbladder inflammation)
choledocholithiasis (bile duct stone)
cholangiitis (bile vessel inflammation)
pancreatitis
gallstone ileus
335
what is general diagnostic approach for gallstones?
sick or not? if not causing issues, no reason as to why it should be removed
bloods : FBC,
LFT (elevated liver enzymes suggest inflammation
elevated bilirubin suggests blockage of biliary system
U&E (biliary system problems can cause renal failure)
PT
USS abdomen
336
is gallbladder foregut/midgut/hindgut?
foregut - epigastric/RUQ (probs localised) pain
337
what does colicky pain feel like?
"grabbing and squeezing insides"
338
what is surface marking of gallbladder?
midclavicular line, underneath bottom rib
339
what is cholecystitis/biliary colic pain like (4)
RUQ/epigastric
colicky
radiating to shoulder tip
typically LFTs normal
340
what is treatment for biliary colic/cholecystitis (3)
analgesia!!!
ABs if infection (coamoxiclav, 3-5d)
laparoscopic cholecystectomy
341
biliary colic for 3+ days ..... ?
cholecystitis
biliary colic usually in response to food and doesn't last long
342
what is Murphy's sign
clinical sign for cholecystitis
343
what does choledocholithiasis mean
bile duct stone
344
what does cholangiitis mean
inflammation of the bile duct system that is usually related to a bacterial infection
345
bile in the bowel does what?
colours faeces - PALE stool
346
with choledocholithiasis/cholangitis, what do u also get
also fever and rigors
347
why might u get rigors? (3)
lobar pneumonia
pyelonephritis
choledocholithiasis/cholangiitits
348
what is the treatment for bile duct stones/inflammation of bile duct system (choledocholithiasis/cholangitis)
ABs
IV fluids
correct clotting
MRI to confirm diagnosis
ERCP to drain
cholecystectomy w/ duct exploration
349
what is the ampulla of vater
opening to biliary system
350
galllllstone ?exam reference ??????
idk
351
what are the 2 major causes of pancreatitis?
gallstones and alcohol
352
symptoms of acute pancreatitis?
pain
nausea
vomiting
relieved sitting forward (bc pancreas sits on spine, so taking pressure off as leaning forward)
SUDDEN ONSET
353
signs of acute pancreatitis?
epigastric tenderness
bruising signs - Cullens = central/umbilicus and Turners = flanks
354
diagnosis tests for acute pancreatic?
amylase/lipase if >3x upper limit of normal - HAVE pancreatitis
CT if unwell
355
* treatment for acute pancreatitis *
1st line - analgesia
2nd line - fluid management - remember chat w Marcus about leaking blood vessels n low BP but no fluid left in vessels ....... )
356
complications for acute pancreatitis?
ARDS (acute resp distress syndrome)
renal failure
hepatic failure
357
how do u predict severity of acute pancreatitis
PANCREAS mnemonic
glasgow coma score?
