Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Exam > MEDICINE - GASTROENTEROLOGY > Flashcards

MEDICINE - GASTROENTEROLOGY Flashcards

(73 cards)

Start Studying
1
Q

Liver cirrhosis

A

chronic inflammation and damage to liver cells (fibrosis and nodule formation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

4 main causes of liver cirrhosis

A

Alcohol-related liver disease
Non-alcoholic fatty liver disease (NAFLD)
Hepatitis B
Hepatitis C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

signs of liver cirrhosis

A

Cachexia (wasting of the body and muscles)
Jaundice
Hepatomegaly
Small nodular liver
Splenomegaly
Spider naevi (telangiectasia with a central arteriole and small vessels radiating away)
Palmar erythema caused by elevated oestrogen levels
Gynaecomastia and testicular atrophy in males due to endocrine dysfunction
Bruising due to abnormal clotting
Excoriations (scratches on the skin due to itching)
Ascites (fluid in the peritoneal cavity)
Caput medusae (distended paraumbilical veins due to portal hypertension)
Leukonychia (white fingernails) associated with hypoalbuminaemia
Asterixis (“flapping tremor”) in decompensated liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

non invasive liver screen

A

-US liver (used to diagnose fatty liver)
-Hepatitis B and C serology
-Autoantibodies (autoimmune hepatitis, primary biliary cirrhosis and primary sclerosing cholangitis)
-Immunoglobulins (autoimmune hepatitis and primary biliary cirrhosis)
-Caeruloplasmin (Wilsons disease)
-Alpha-1 antitrypsin levels (alpha-1 antitrypsin deficiency)
-Ferritin and transferrin saturation (hereditary haemochromatosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

autoantibodies in liver disease

A

Antinuclear antibodies (ANA)
Smooth muscle antibodies (SMA)
Antimitochondrial antibodies (AMA)
Antibodies to liver kidney microsome type-1 (LKM-1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

decompensated liver cirrhosis LFT

A

All raised:
-Bilirubin
-Alanine transaminase (ALT)
-Aspartate transferase (AST)
-Alkaline phosphatase (ALP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how to assess fibrosis in Non alcoholic fatty liver disease?

A

enhanced liver fibrosis blood test
- three markers (HA, PIIINP and TIMP-1) and score calculation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

enhanced liver fibrosis 10.51 or above

A

advanced fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

US in non alcoholic fatty liver disease

A

fatty changes, increased echogenicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

liver cirrhosis ultrasound signs

A

-Nodularity of the surface of the liver
-A “corkscrew” appearance to the hepatic arteries with increased flow as they compensate for reduced portal flow
-Enlarged portal vein with reduced flow
-Ascites
-Splenomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

screening for hepatocellular carcinoma

A

alfa-fetoprotein and US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

transient elastography (fibro scan)

A

assesses stiffness of liver and degree of fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

which pts are at risk of cirrhosis?

A

-Alcohol-related liver disease
-Heavy alcohol drinkers (men drinking more than 50 units or women drinking more than 35 units per week)
-Non-alcoholic fatty liver disease and advanced liver fibrosis (score 10.51 or more on the ELF blood test)
-Hepatitis C
-Chronic hepatitis B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what to assess when someone has portal hypertension?

A

oesophageal varices (via endoscopy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MELD score

A

% risk of 3 month mortality in pts with compensated cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Child Pugh Score

A

5 factors of severity of cirrhosis (min 5, max 15)
A – Albumin
B – Bilirubin
C – Clotting (INR)
D – Dilation (ascites)
E – Encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Monitoring complications of liver cirrhosis

A
  • MELD score every 6 months
  • Ultrasound and alpha-fetoprotein every 6 months for hepatocellular carcinoma
  • Endoscopy every 3 years for oesophageal varices
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

decompensated liver cirrhosis features

A

A – Ascites
H – Hepatic encephalopathy
O – Oesophageal varices bleeding
Y – Yellow (jaundice)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

5 year survival in liver cirrhosis

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

complications of liver cirrhosis?

A

-Malnutrition and muscle wasting
-Portal hypertension, oesophageal varices and bleeding varices
-Ascites and spontaneous bacterial peritonitis
-Hepatorenal syndrome
-Hepatic encephalopathy
-Hepatocellular carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

portal vein anatomy

A

comes from superior mesenteric and splenic veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

portal hypertension

A

increased back pressure on the portal system due to resistance to blood flow in the liver
results in splenomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

collaterals between portal and systemic venous systems

A

Distal oesophagus (oesophageal varices)
Anterior abdominal wall (caput medusae)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

prophylaxis of bleeding in stable oesophageal varices

A

Non-selective beta blockers (e.g., propranolol) first-line
Variceal band ligation (if beta blockers are contraindicated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Mx of bleeding esophageal varices
- fresh frozen plasma - blood tranfusion - vasopressin analogues (terlipressin and somatostatin) - broad spectrum Abx - variceal band ligation under endoscopy - Sengstaken-Blakemore tube - TIPS
26
what is TIPS
Transjugular intrahepatic portosystemic shunt - so blood flows directly from portal vein to hepatic vein
27
what is the protein content of cirrhosis ascites?
low - transudative
28
mx of ascites
-paracentesis - tips - aldosterone antagonists - prophylactic abx (ciprofloxacin or norfloaxacin) when <15g/L protein in ascitic fluid
29
most common organisms in spontaneous bacterial peritonitis
-Escherichia coli -Klebsiella pneumoniae
30
hepatorenal syndrome
impaired kidney funciton caused by changed in blood flow to the kidneys due to liver cirrhosis and portal hypertension. liver transplant is treatment
31
Hepatic encephalopathy
(portosystemic encephalopathy) due to build up of ammonia (as liver metabolism of ammonia is impaired and ammonia bypasses the liver due to collateral vessels)
32
acute presentation of hepatic encepatholpathy
reduced consciousness and confusion +- changed to personality, memory, mood
33
Factors that trigger hepatic encepatholpathy
dehydration constipation infection GI bleed electrolyte disturbance
34
Mx of hepatic encephalopathy
- lactuose - Abx (rifaximin or alternatively metronidazole or neomycin)
35
Alcohol-related liver disease steps
1. Alcoholic fatty liver (hepatic steatosis) 2. Alcoholic hepatitis 3. Cirrhosis
36
Excessive alcohol consumption
- slurred speech - bloodshot eyes - telangiectasia - tremor
37
Blood test results in alcohol-related liver disease
- raised MCV - raised ALT and AST - AST:ALT ratio >1.5 - raised gamma GT - raised ALP and bilirubin - Low albumin
38
early alcoholic liver disease US
fatty changes and increased echogenicity
39
Liver biopsy
to confirm alcohol related hepatitis or cirrhosis
40
Mx of alcohol-related liver disease
- corticosteroids - liver transplant - vitamin B - psychological interventions
41
CAGE questions
C – CUT DOWN? Do you ever think you should cut down? A – ANNOYED? Do you get annoyed at others commenting on your drinking? G – GUILTY? Do you ever feel guilty about drinking? E – EYE OPENER? Do you ever drink in the morning to help your hangover or nerves?
42
AUDIT questionnaire
alcohol use disorders identification test (8or more is harmful)
43
alcohol withdrawal steps
6-12 hours: tremor, sweating, headache, craving and anxiety 12-24 hours: hallucinations 24-48 hours: seizures 24-72 hours: delirium tremens
44
delirium tremens
alcohol stimulates GABA receptors (relaxing) and inhibits glutamate (NMDA) receptors (excitatory) - when alcohol is removed there is down regulation of gaba and up regulation of NMDA.
45
delirium tremens presentation
Acute confusion Severe agitation Delusions and hallucinations Tremor Tachycardia Hypertension Hyperthermia Ataxia (difficulties with coordinated movements) Arrhythmias
46
Chlordiazepoxide (librium)
benzodiazepine to combat effects of alcohol withdrawal
47
diazepam
used to reduce effect of alcohol withdrawal - orally, 10-40mg every 1-4h and reduced over 5-7days
48
what vitamin is given in delirium tremens?
IM high dose vit B (PABRINEX) and long term oral thiamine - to prevent Wernicke-Korsakoff syndrome
49
what does thiamine deficiency lead to?
Wernicke’s encephalopathy and Korsakoff syndrome.
50
features of Wernicke’s encephalopathy
Confusion Oculomotor disturbances (disturbances of eye movements) Ataxia (difficulties with coordinated movements)
51
features of Korsakoff syndrome
Memory impairment (retrograde and anterograde) Behavioural changes
52
which one is irreversible? wernickes vs korsakoff
korsakoff syndrome
53
how many adults have non alcoholic fatty liver disease?
25%
54
stages of non alcoholic fatty liver disease?
Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis (NASH) Fibrosis Cirrhosis
55
risk factors for non alcoholic fatty liver disease?
Middle age onwards Obesity Poor diet and low activity levels Type 2 diabetes High cholesterol High blood pressure Smoking
56
what is non alcoholic fatty liver disease associated with?
metabolic syndrome
57
what is a metabolic syndrome?
HTN, obesity, and diabetes
58
non alcoholic fatty liver disease blood tests/ diagnosis
- raised ALT - enhanced liver fibrosis >10.51 - hepatic steatosis and increased echogenicity on US liver -Fibroscan - Liver biopsy - NAFLD fibrosis score - Fibrosis 4 (FIB4)
59
AST ALT ratio <1
normal
60
AST ALT ratio >0.8 in NAFLD
advanced fibrosis
61
AST ALT ratio >1.5
alcohol related liver disease
62
Gold standard test to diagnose NAFLD
Liver biopsy
63
Mx of NAFLD
exercise, stop smoking, reduce BP and cholesterol, limit alcohol, weight loss; + vit E, pioglitazone, bariatric surgery, liver transplant
64
Hep A details
RNA, faecal-oral transmission, vaccine, treatment supportive
65
Hep B details
DNA, blood/bodily fluids transmission, vaccine, supportive+antiviral treatment
66
Hep C
RNA, blood transmission, no vaccine, direct acting antivirals treatment
67
Hep D
RNA, transmision is with Hep B, no vaccine, pegylated interfereon alpha treatment
68
Hep E
RNA, faecal-oral transmission, no vaccine, supportive treatment
69
is vital hepatitis a notifiable disease?
yes - UK Health security agency
70
Other (non viral) causes of hepatitis
Alcoholic hepatitis Non-alcoholic steatohepatitis (NASH) Autoimmune hepatitis Drug induced hepatitis (e.g. paracetamol overdose)
71
presentation of viral hepatitis
Abdominal pain Fatigue Flu-like illness Pruritus (itching) Muscle and joint aches Nausea and vomiting Jaundice
72
hepatitic picture on LFTs
high AST and ALT proportionally less rise in ALP
73

Exam (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions