Pancreas & alcohol

Question 1

3 most common causes of acute pancreatitis

Answer 1

• alcohol
• gall stones
• post ERCP

Question 2

typical symptoms presentation of acute pancreatitis

Answer 2

Sudden onset mid epigastric/LUQ abdo pain, radiating to back

N&V

Question 3

pathophysiology of acute pancreatitis

Answer 3

Inflammation of the pancreas, pancreatic enzymes (amylase&lipase) attack the pancreatic tissue causing epigastric pain radiating to the back

Question 4

score used to assess severity of acute pancreatitis

Answer 4

Glasgow score

Question 5

PANCREAS pneumonic for Glasgow score

Answer 5

P - PaO2 
A - Age > 55 years
N - Neutrophils (WCC >15) 
C - Calcium < 2 
R - Urea > 16 
E - Enzymes (LDH > 600 or AST/ALT > 200) 
A - Albumin <32
S - Glucose >10

Question 6

complications of acute pancreatitis (4)

Answer 6

• Pancreatic necrosis
• Infection in necrosis areas
• Pseudocytes
• Chronic pancreatitis

Question 7

Management of acute pancreatitis

Answer 7

1) fluid resuscitation
2) pain relief & antiemetic
- careful monitoring
Consider ERCP
- endoscopic drainage of large pseudocysts
- ABx IF evidence of infected pancreatic necrosis
- surgery to remove infected pancreatic necrosis

Question 8

what to suspect if Charcot’s triad is present

Answer 8

cholangitis

Question 9

what is Charcots triad

Answer 9

• jaundice
• fever & rigors
• RUQ pain

Question 10

2 important diagnoses to rule out in ACUTE ABDOMEN

Answer 10

• Perforation

- Bowel obstruction

Question 11

2 scores to use to assess risk of bleeding BEFORE & AFTER endoscopy

Answer 11

Before: Glasgow blatchford
After: Rockall

Question 12

Resuscitation for acute upper GI bleed

Answer 12

• ABC, wide bore IV access
• platelet transfusion
• fresh frozen plasma
• prothrombin complex concentrate (if pt actively bleeding or taking warfarin)

Question 13

what procedure should all patients with severe upper GI bleed have within 24 hours

Answer 13

Endoscopy

Question 14

Management of NON variceal bleed

Answer 14

Give PPI if endoscopy shows non variceal bleeding or stigmata of recent haemorrhage

Question 15

management of variceal bleeding (3)

Answer 15

Terlipressin & prophylactic abx before endoscopy

Band ligation for oesophageal varices & injections of N-butyl-2-cyanoacrylate

TIPS

Question 16

what is TIPS and when should it be offered

Answer 16

Transjugular intrahepatic portocystemic shunt

offered after giving terlipressin & band ligation of varices

Question 17

mechanism of terlipressin

Answer 17

synthetic vasopressin analogue. causes vasoconstriction of vessels in splanchnic circulation –> reducing portal pressure

Question 18

adverse effects of terlipressin

Answer 18

• low cardiac output
• AF
• MI
• HF
• GI upset
• low sodium

Question 19

3 steps of progression of alcohol affecting liver

Answer 19

1) Alcohol related fatty liver
2) Alcoholic hepatitis
3) Cirrhosis

Question 20

what is recommended alcohol consumption

Answer 20

no more than 14 units in a week, should be spread evenly over 3 days or more
& no more than 5 units a day

Question 21

screening tool for harmful alcohol use:

Answer 21

CAGE questionairre

Question 22

what is CAGE questionairre

Answer 22

C - Ever thought you should cut down your alcohol intake

A - Do you get annoyed at others commenting on your drinking

G - Do you ever feel guilty about your drinking

E - Ever drink in the morning to help your hangover/nerves

Question 23

signs of liver disease

Answer 23

• jaundice
• hepatomegaly
• spider naevi
• ascites
• capat medusae
• asterixis
• palmar erythema
• gynaecomastia
• bruising

Question 24

markers for reduced synthetic function of the liver

Answer 24

low albumin

elevated prothrombin time

Question 25

when do alcohol withdrawal symptoms begin to occur and what are these

Answer 25

6-12 hours tremor, sweating, headache, craving, anxiety

Question 26

at what time frame of alcohol withdrawal do hallucinations and seizures occur

Answer 26

12-24 hours: hallucinations 24-48 hours: seizures

Question 27

what time frame does 'delirium tremens' tend to occur at

Answer 27

24-72 hours after abstaining from alcohol consumption

Question 28

mechanism of action of alcohol withdrawal causing delerium tremens

Answer 28

Alcohol Stimulates GABA receptors & inhibits glutamate receptors. therefore in chronic alcoholics the GABA system is upregulated & Glutamate receptors are downregulated in alcohol withdrawal, GABA under functions & glutamate overfunctions --> causing extreme excitability of the brain with excess adrenergic activity

Question 29

presentation of delerium tremens

Answer 29

- acute confusion - severe agitation - delusions/hallucinations - tremor - tachycardia - HTN - ataxia - arrhythmia

Question 30

management of alcohol withdrawal

Answer 30

chlordiazepoxide (Librium)

Question 31

3 features of wernicke's encephalopathy

Answer 31

- confusion - ataxia - occulomotor disturbances

Question 32

what can wernicke's encephalopathy progress into

Answer 32

``` Korsakoff syndrome (memory impairment & behavioural changes) ```

Question 33

management of wernickes encephalopathy

Answer 33

Thiamine (Vit B1)