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GASTROINTESTINAL > Week 7 > Flashcards

Week 7 Flashcards

1
Q

What percentage of liver disease in Scotland is alcohol related?

A

80%

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2
Q

What are the recommendations for weekly alcohol intake?

A

Men and women shouldn’t have more than 14 units of alcohol per week and this should be spread over 3 or more days and drinkers should limit the amount they have on single occasions.

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3
Q

What are some of the clinical signs of alcoholic liver disease?

A 
Portal hypertension 
Jaundice 
Ascites 
Encephalopathy 
Cirrhosis 
Hepatomegaly 
Fever 
Malaise 
Sepsis 
Deranged LFTs
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4
Q

What is ‘Childs - Turcotte - Pugh’?

A

A scoring system/ model for end stage liver disease which indicates COMPENSATION or DECOMPENSATION

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5
Q

What is ‘Maddney’s Discriminant Function?’

A

A model which predicts PROGNOSIS in alcoholic hepatitis

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6
Q

What is the ‘Glasgow Alcoholic Hepatitis Score’?

A

A model which predicts MORTALITY in alcoholic hepatitis patients

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7
Q

Which drug can be beneficial in for short-term prevention of mortality in alcoholic hepatitis but is not useful for medium/ long-term outcomes?

A

Prednisolone

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8
Q

What is the most common liver tumour in the absence of liver disease?

A

Haemangioma

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9
Q

List benign liver tumours

A

Haemangioma
Hepatic adenoma
Focal nodular hyperplasia
Liver cysts

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10
Q

List malignant liver tumours

A

Hepatocellular carcinoma
Cholangiocarcinoma
Hepatoblastoma
Fibro-lamellar carcinoma

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11
Q

Focal nodular hyperplasia tumours are benign tumours of the liver. What are they composed of?

A

They are nodules of normal liver tissue and contain all the liver ultrastructure (sinusoids e.t.c)

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12
Q

Hepatic adenomas are benign liver tumours. What are they composed of?

A

They are nodules purely composed of hepatocyte - they do not contain all the liver ultrastructure

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13
Q

Which has a higher risk of malignant degeneration and bleeding ; Focal nodular hyperplasia tumours or hepatic adenomas?

A

Hepatic adenomas

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14
Q

What are some of the benign liver cysts?

A

Simple cysts
Hydatid cysts
Liver abscesses

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15
Q

How is polycystic liver disease managed?

A

Somatostatin analogues (for symptom relief)
Defenestration/ aspiration
Liver transplantation

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16
Q

How are liver abscesses managed?

A

Antibiotics
Aspiration/ drainage
Resection

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17
Q

What is the most common primary liver cancer?

A

Hepatocellular carcinoma (HCC)

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18
Q

What are the risk factors for hepatocellular carcinoma?

A

CIRRHOSIS

  • Hep B
  • Hep C
  • Alcohol
  • Aflatoxins
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19
Q

What are the clinical features of HCC?

A

Weight loss
RUQ pain
RUQ mass
Liver bruit

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20
Q

What sites can primary liver tumours metastasise to?

A 
The rest of the liver 
Portal vein 
Lymph nodes 
Lung 
Bone 
Brain
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21
Q

What tests are used for the diagnosis of HCC?

A 
Elevated AFP 
Ultrasound 
CT 
MRI 
Biopsy
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22
Q

How is HCC managed/ treated?

A 
Liver transplantation 
Resection (small tumours with preserved liver function) 
Local ablation 
Chemoembolisation 
Systemic therapies
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23
Q

Fibro- Lamellar carcinoma is a malignant liver tumour which is not associated with cirrhosis. How would this be diagnosed? What typical signs does it show on investigation?

A

Normal AFP

CT shows stellate scar and persistent enhancement of the radial septa

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24
Q

What are the common site for secondary metastases TO the liver?

A 
Colon 
Breast
Lung 
Stomach 
Pancreas 
Melanoma
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25
Describe the appearance of urine and stools in the 3 different forms of jaundice
Prehepatic - Normal urine and stools (Intra)Hepatic - Dark Urine + normal/ pale stools Posthepatic - Dark urine and pale stools
26
What extra things should be asked about in a history of a patient who might have jaundice?
``` Travel history Drugs Sexual history Blood transfusions Tattoos PMH of jaundice ```
27
What are the useful tests that can be done for a patient with suspected jaundice?
``` U&Es FBC LFTs CRP Virology Ultrasound ```
28
Describe what is meant by prehepatic jaundice
Excess haemolytic - too much bilirubin is produced e.g haemolytic anaemia
29
Describe what is meant by intrahepatic jaundice
Hepatocytes are dead/ injured and therefore can't conjugate and excrete bilirubin/ bile
30
What are some of the causes of intrahepatic jaundice?
Hepatitis Cirrhosis Drugs Pregnancy
31
Describe what is meant by post hepatic jaundice
There is obstruction of drainage of bile - it can't get into the small intestine
32
What other terms are used to describe post hepatic jaundice?
Extrahepatic jaundice | Obstructive jaundice
33
Define jaundice
Yellowing of the skin and sclera of the eyes due to increased bilirubin levels. = 'Clinically apparent hyperbilirubinaemia'
34
Describe the typical LFT patterns of the different types of jaundice, focusing on bilirubin, ALT/AST and Alkaline phosphatase
Prehepatic - Increased bilirubin, Normal ALT/AST and ALP Intrahepatic - Increased bilirubin, Very high ALT/AST, elevated ALP Posthepatic - Increased bilirubin, Elevated ALT/AST, Very high ALP
35
What kind of LFTs will non-alcoholic fatty liver disease show?
Hepatic LFTs - increased ALT and AST
36
What kind of LFTs will viral hepatitis show?
Hepatic LFTs - increased ALT and AST
37
What kind of LFTs and other test results are associated with autoimmune hepatitis?
Hepatic LFTs - Increased ALT and AST Increased PT Increased IgG Anti-smooth muscle antibodies
38
What kind of LFTs/ other results are associated with PBC?
Cholestatic LFTs - Increased ALP, Bilirubin and ALT | Increased IgM
39
Which things should be tested for in haemochromatosis?
- Serum iron | - Ferritin/ Transferrin saturations
40
Which things should be tested for in Wilson's disease?
- Serum and urine copper | - Serum caeruloplasmin
41
What is meant by cardiac cirrhosis?
Liver cirrhosis secondary to high right sided heart pressure (incompetent tricuspid valve, congenital, rheumatic fever, constructive pericarditis)
42
What are the two classes of portal hypertension?
Prehepatic (blockage of the portal vein before the liver e.g portal vein thrombosis) Intrahepatic (distortion of liver architecture e.g Budd Chiari)
43
What are some of the causes of post hepatic jaundice?
Gallstones Carcinoma at the head of the pancreas PSC Strictures of the common bile duct
44
What is meant by colonisation, infection, bacteraemia and sepsis?
Colonisation - bug present but not necessarily an inflammatory response Infection - Inflammation in response to a bug Bacteraemia - Bug in the blood Sepsis - Inflammatory systemic response to infection
45
Define sepsis and septic shock
Sepsis - life threatening organ dysfunction cause by a host response to infection Septic shock is a subset of sepsis in which there is circulatory and metabolic dysfunction and a higher risk of mortality
46
List some of the causes of peritonitis
Perforated tumour Perforated ulcer Ruptured appendix Pancreatitis
47
What criteria is used to determine whether a patient has sepsis?
The SIRS criteria
48
What 3 things are needed to diagnose septic shock?
Signs of sepsis + SIRS score + organ failure
49
What are coliforms?
Gram negative rod-like bacteria found normally in the GI tract E.g E.coli
50
Name 3 bugs which can be found in the mouth
Strep viridians Neisseria Candida
51
What antibiotic treatment is given for intra-abdominal infections?
AMOXICILLIN GENTAMICIN METRONIDAZOLE
52
If a patient is allergic to penicillin, what can they be given instead of amoxicillin?
Vancomyin
53
Why can abscesses sometimes not be treated with antibiotics?
They have a low blood supply meaning antibiotics can't always reach them
54
What is the clinical presentation of septic shock?
Lactate above normal levels Hypotension Confusion Cold and clammy
55
What is included within the SEPSIS 6?
``` High glow oxygen IV fluids Take blood cultures IV antibiotics Measure lactate and FBC Monitor hourly urine output ```
56
What are the categories of gall stones, which is the most common and what colour are they?
Mixed (most common) Cholesterol (yellow) Pigment (black)
57
What are some of the risk factors for gallstones?
``` Caucasian >40 yrs old High fat diet / obesity Hyperlipidaemia Pregnancy ```
58
What tests are used to diagnose gallstones?
Ultrasound CT MRCP/ERCP EUS
59
How are uncomplicated gallstones managed (e.g occasionally cause biliary colic after a heavy meal)
Lifestyle modifications and painkillers
60
How is acute cholecystitis managed?
``` IV antibiotics IV fluids Ultrasound Cholecystectomy ERCP ```
61
How can gallstones cause acute pancreatitis?
By blocking the sphincter of oddi there can be back-flow of bile up into the pancreas
62
How can gallstones cause gallstone ileus?
A fistula can form between the gall bladder and the duodenum - if a stone escapes into the S.I it can cause blockage in the distal ileum and cause intermittent colic
63
How is Hep A transmitted? Are there carrier states/ is it a chronic infection?
Faecal-oral spread (poor hygiene and overcrowding) - No carrier state
64
What investigation result can indicate acute Hepatitis A?
Hepatitis A IgM
65
Hep E is clinically very like Hep A, but how does it differ?
Hep E can cause *chronic infection
66
Where in the world is Hep E most common?
In the tropics
67
Hepatitis D can only be found alongside another form of viral hepatitis, which other Hep is this?
Hep B | - infection with Hep D exacerbates Hep B infection
68
How is Hepatitis B transmitted? Does it involve a chronic/ carrier state?
Sex Vertical transmission Blood *It can involve carriers/chronic infection
69
What groups of people are at highest risk of contracting Hep B?
People born in areas of high prevalence Multiple sexual partners People who inject drugs Children of infected mothers
70
What test results indicate infectious, low infectivity and chronic infection with Hep B?
HBsAG+ = infectious - For more than 6 months = chronic Anti-HBe = low infectivity
71
What is present in the blood of all patients infected with the hepatitis B virus?
HBsAg
72
What is the most common cause of acute viral hepatitis in Tayside?
Hepatitis E
73
How is Hep C transmitted?
It is less easily transmitted than Hep B (less infectious) but can be transmitted by similar ways (sex, blood)
74
Which is the rarest form of viral hepatitis?
Hep D
75
How many months define chronic infection with viral hepatitis?
6 months
76
What is the typical time span from infection with viral hepatitis to development of cirrhosis?
Typically >20 years
77
Name antivirals used for Hepatitis C | - What are some of the side effects?
Interferon Alfa and Ribavirin Side effects of IA; (LOTS) Flu like symptoms, Autoimmune disease e.g SLE and pyschosis)
78
What is meant by Sustained virological Response / SVR in Hepatitis C therapy?
Loss of HCV RNA in blood, sustained for 6 months after the end of treatment
79
Name some of the newer antivirals for HCV therapy
Simeprevir, Ledipasvir
80
Describe the embryological development of the pancreatic duct?
The main pancreatic duct comes from the ventral bud
81
Describe the two main functions of the pancreas, what cells make up these and what the cells secrete
Exocrine - Acinar cells - Enzymes | Endocrine - Islets of Langerhan- Hormones
82
Within the Islets of Langheran, there are Alpha, Beta, Delta and F cells. What do these secrete?
Alpha - Glucagon Beta - Insulin Delta - Somatostatins (inhibit the release of gastric hormones) F cells - Pancreatic polypeptides
83
How much pancreatic fluid is produced per day?
1 - 1.5 L
84
What are the causes of acute pancreatitis? | I GET SMASHED
``` IDIOPATHIC GALLSTONES ETHANOL (alcohol) STEROIDS MUMPS AUTOIMUNE STINGS/ SCORPIONS HYPERCALCAEMIA/HYPERLIPIDAEMIA ERCP DRUGS (E.g azathioprine) ```
85
What are the *MOST COMMON causes of acute pancreatitis?
Gallstones and alcohol
86
What signs visible on examination might pancreatitis present with?
Cullen's sign Grey Turner's sign Guarding
87
Which scoring systems can be used for pancreatitis?
Glasgow Criteria | Ranson's Criteria
88
What are some of the possible complications of pancreatitis?
``` Pseudocysts Abscesses Necrosis Ascites Pleural effusion Pulmonary oedema ```
89
What are some of the possible causes of chronic pancreatitis?
``` Alcohol and smoking Genetics - (CF and Pancreas Divisum) Gallstones ERCP Drugs ```
90
What does 'creons' do in the management of chronic pancreatitis?
Replaces pancreatic enzymes
91
What are some of the complications of chronic pancreatitis?
- Splenic vein thrombosis - Pseudoaneurysm over the splenic vein - Duodenal/ bile duct obstruction - Exocrine dysfunction
92
What is the most common pancreatic cancer?
Exocrine tumours (adenocarcinomas)
93
Describe the production of hormones and enzymes from the different parts of the pancreas, with reference to the specific cells
EXOCRINE - acing cells - enzymes ENDOCRINE - Islets of Langerhan - A cells - Glucagon - B cells - Insulin - D cells - Somatostatin - F cells - Pancreatic polypeptide

GASTROINTESTINAL (13 decks)

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