liver/GI

Question 1

what is hepatitis?

Answer 1

inflammation of liver

Question 2

what are the roles of the liver?

Answer 2

glucose & fat metabolism
detoxification & excretion (bilirubin, ammonia etc)
protein synthesis
infection defence

Question 3

which are the 2 blood supplies to the liver?

Answer 3

hepatic artery and portal vein

Question 4

what can cause chronic liver damage?

Answer 4

viruses (hep B, C)
alcohol
autoimmune
metabolic (iron copper excess)

Question 5

what does a raised eosinophil count in a patient with diarrhoea, often point towards?

Answer 5

parasite

Question 6

what commonly causes travellers diarrhoea?

Answer 6

enterotoxigenic E.coli

Question 7

which antibiotics increase the risk of c.diff diarrhoea?

Answer 7

clindamycin, cephalosporins, coamoxiclav

Question 8

what causes cholangitis?

Answer 8

stasis of bile usually due to lodged gallstones (also cancer and parasite)

Question 9

what makes up charcots triad?

Answer 9

RUQ pain, fever, jaundice

Question 10

what are the symptoms of cholangitis?

Answer 10

Charcots triad- RUQ pain, fever, jaundice

Question 11

what is ascites?

Answer 11

abnormal accumulation of fluid in peritoneal cavity (10-15ml+)

Question 12

what is exudate?

Answer 12

high protein fluid leaked from blood vessels

Question 13

what is transudate?

Answer 13

low protein fluid leaked from blood vessels

Question 14

what is coeliac disease?

Answer 14

inflammation of upper small bowel caused by gluten (specifically gliadin)

Question 15

what are common symptoms of coeliac?

Answer 15

abdominal pain
steatorrhea
bloating
weight loss
diarrhoea
anaemia

Question 16

what investigations can be carried out in coeliac disease?

Answer 16

FBC- anaemia and infection
electrolytes- malabs
LFT
*autoantibodies- tTG, endomysin, gliadin
endoscopy and biopsy

Question 17

what would you expect to find on an endoscopy/biopsy of a patient with coeliac who is eating gluten?

Answer 17

villus atrophy
crypt hyperplasia
high white cell

Question 18

which part of the gut is affected by ulcerative colitis?

Answer 18

continuous spread from rectum

Question 19

which part of the gut is affected by Crohns?

Answer 19

all but most commonly terminal ileum and proximal colon

Question 20

what is the macroscopic appearance of crohns?

Answer 20

patchy skip lesions
thickened and narrowed
cobblestoned appearance

Question 21

what is the macroscopic appearance of ulcerative colitis?

Answer 21

continuous inflammation of mucosa
ulcerations
pseudopolyps

Question 22

what is the microscopic appearance of ulcerative colitis?

Answer 22

superficial layer inflammation- mucosa only
depleted goblet cells
crypt abscesses

Question 23

what is the microscopic appearance of crohns?

Answer 23

transmural inflammation
granulomas
lymphoid hyperplasia

Question 24

where is the common site of pain in both uc and crohns?

Answer 24

uc- left lower quadrant

crohns- right ileac fossa

Question 25

what blood test may distinguish crohns and uc?

Answer 25

pANCA

Question 26

what is the treatment for mild ulcerative colitis?

Answer 26

5ASA's e.g.oral/rectal sulphalazine or mesalazine

Question 27

what treatment can be used with or instead of 5ASA's in ulcerative colitis?

Answer 27

corticosteroids e.g. prednisolone

Question 28

why is it important that corticosteroids aren't used long-term?

Answer 28

side effects e.g. osteoporosis and cataracts

Question 29

what are some short term effects of steroid use?

Answer 29

insomnia acne mood changes weight gain

Question 30

in more severe ulcerative colitis what types of drugs can be given?

Answer 30

immunosupressants and biologic medication

Question 31

what are two examples of drugs given in a severe flare up of ulcerative colitis?

Answer 31

infliximab (biologic) | ciclosporin (immune sup)

Question 32

what is the intervention used to treat severe ulcerative colitis which is unresponsive to medication?

Answer 32

colectomy (prevents disease reoccurring)

Question 33

what is the lifestyle advice given to someone with crohns disease?

Answer 33

stop smoking!

Question 34

what is the drug given to patients with mild/moderate crohns?

Answer 34

steroids e.g. prednisolone

Question 35

which 3 types of drug can be used to treat crohns?

Answer 35

steroids immunosupressants biologic medication

Question 36

what is an example of an immune suppressant used on crohns treatment?

Answer 36

methotrexate

Question 37

what is an example of a biologic medicine used in the treatment of crohns?

Answer 37

infliximab

Question 38

what intervention can be used to treat unresponsive crohns?

Answer 38

resection of the bowel (not permanent cure)

Question 39

what are 5ASA's?

Answer 39

aminosalicylates which reduce inflammation e.g. mesalazine sulphalazine

Question 40

what is GORD?

Answer 40

gastro oesophageal reflux disease

Question 41

what are the symptoms of GORD?

Answer 41

heartburn belching regurgitation cough/horse voice

Question 42

what is the lifestyle advice given to someone with GORD?

Answer 42

weight loss smoking cessation small meals avoid: spicy, citrus, fizzy

Question 43

what drugs can be given to someone with GORD?

Answer 43

PPI e.g. lansoprazole alginic acid e.g. Gaviscon antacid e.g. calcium carbonate H2 antagonist e.g. cimetidine

Question 44

what are the potential complications of long term GORD?

Answer 44

Barrats oesophagus | stricture

Question 45

what is barrets oesophagus?

Answer 45

long term acid damage to the oesophagus causing metaplasia of epithelium from squamous to collumnar

Question 46

why is barrats oesophagus serious?

Answer 46

it is a precursor of oesophageal adenocarcinoma

Question 47

what is an oesophageal stricture?

Answer 47

long term inflammation resulting in narrowing due to chronic fibrosis

Question 48

what is a peptic ulcer?

Answer 48

break in the epithelium that penetrates the muscularis mucosa of the stomach or duodenum

Question 49

what are the causes of peptic ulcer?

Answer 49

H pylori | NSAIDS

Question 50

what do G cells of the stomach produce?

Answer 50

gastrin

Question 51

what do D cells of the stomach produce?

Answer 51

somatostatin

Question 52

what do enterochromaffin like cells of the stomach produce?

Answer 52

histamine

Question 53

which substances promote HCl production in the stomach?

Answer 53

histamine, gastrin, Acetyl choline

Question 54

which substance inhibits HCl production in the stomach?

Answer 54

somatostatin

Question 55

a peptic ulcer in the lesser curvature of the stomach poses a threat to which blood vessel?

Answer 55

left gastric artery

Question 56

a duodenal ulcer in the posterior duodenum poses a threat to which blood vessel?

Answer 56

gastroduodenal artery

Question 57

what are the potential complications of PUD?

Answer 57

perforation peritonitis haemorrhage obstruction

Question 58

how can a Hpylori induced stomach ulcer be diagnosed?

Answer 58

``` breath test (urea) stool sample ```

Question 59

what pharmacological interventions can be used for PUD?

Answer 59

stop NSAIDS PPI e.g. lansoprazole antibiotics for H pylori e.g. amoxicillin or tetracycline H2 antagonists e.g. cimetidine