Gastro

Question 1

what are some stigmata of chronic liver disease

Answer 1

spider naevi
gynacomastia
ascites
caput medusa
palmar erythema
jaundice
splenomegaly

Question 2

what are some precipitants of hepatic encephalopathy

Answer 2

UGIB
alcohol ingestion
portal vein thrombosis
SBP

Question 3

what are some differentials for confusion and low GCS

Answer 3

alcoholic encephalopathy
alcohol/drug intoxication
electrolyte disturbanc eg hyponatremia
endocrine eg hypoglycaemia
head injury eg SDH

Question 4

what are the 5 components of Child-Pigh score for ALD

Answer 4

BAAIE

ascities
albumin
INR
encephalopathy
bilirubin

Question 5

name some things than can exacerbate chronic liver disease plus how you would test

Answer 5

• SBP - ascitic tap
• GI bleed - PR
• head trauma - CT
• alcohol - serum alcohol
• drug ingestion - UDS
• hypo - BSL
• hepatic vein thrombosis - US

Question 6

what are the management step for suspected button battery ingestion?

Answer 6

1. NBM
2. X ray neck (lateral) chest and abdo to look for battery
3. hx to obtain likelihood and number of batteries
4. assess patient for signs of complications eg resp distress, stridor, SOB, haematemesis abdo pain etc

Question 7

with button battery ingestion what the indications for immediate endoscopy?

what conditions need to be met for conservative management?

discharge advice?

Answer 7

endoscopy:
* symptomatic
* magnet co-ingestion
* battery lodged in oesophagus

Conservative
* asymptomatic
* battery under 12mm
* single battery
* no pre-existing oesophageal disease
* reliable caregiver
* proximity to hospital

advice’
* avoid laxitives
* immediate return if GI/resp sx
* regular diet and encourage activity
* examine stool to look for it
* return if not passed in 10-14 days

Question 8

what two factors affect whether attempt to resite PEG

Answer 8

time since PEG placement
Ig under 4 weeks may not have matured and risk of tube misplacement

Time since peg removal
should be within 24 hours

Question 9

What are some PEG complications that can present to ED

Answer 9

• accidental removal
• bleeding
• leaking
• blockage
• pneumoperitomeum
• gastric ulceration
• gastric outflow obstruction
• ileus
• aspiration

Question 10

describe and interpret key abnormalities

Answer 10

• hepatic failure with non obstructive pattern
• hypoglycaemia
• impaired synthetic function with low albumin and high INR
• ?hepatic encephalopathy as drowsy

Question 11

Potential causes?

Answer 11

• toxins eg paracetamol
• alcoholic liver cirrhosis
• viral hepatitis
• ischaemic liver injury
• budd chiari
• wilsons
• malignancy
• autoimmune

Question 12

Interpret and justify

Answer 12

• unconjugated hyperbilirubinaemia
• heptatocellular pattern as ALT/AST >ALP/GGT - likely hepatitis
• low albumin likely from impaired synthetic function of liver

Question 13

non infective cause of hepatitis

Answer 13

malignancy
tox - paracemtaol
wilsons
budd chiary
autoimmune
NAFLD
alcoholc ciirrhosis

Question 14

what investigations would you perform in suspected variceal bleed?

Answer 14

VBG - degree of hypoperfusion/lactate/HB
HB - guide RBC replacement
Coags - guide replacement
BSL - likely in liver failure and can replace
CT tri phasic - degree of bleeding

Question 15

what is the initial management of variceal bleed?

Answer 15

• fluid resis and blood replacement
• urgent endoscopy for variceal banding
• ocreotide 50mcg bolus
• IV abx
• ?AWC

Question 16

causes of extrhepatic biliary obstruction

Complications?

Answer 16

• pancreatic mass
• cholangiocarcinoma
• choledocholithiasis

Complications:

cholangitis
reduced absorption of vit K

Question 17

what are the anaesthesia options for removal in ED?

Non anaesthesia

Answer 17

Anaesthesia:
* regional anaesthesia - perianal block
* procedural sedation eg fent/prop

Non anaesthesia
* valsalva with lubricant
* gentle traction with lubricant
* foley catheter wth 50ml balloon and lubricant

Question 18

Answer 18

aortoenteric fistula
supratherapeutc anticoagulation
embolic mesenteric iscahamia

Question 19

what can be used to reverse dabigatran

Answer 19

Idarucizumab

Question 20

what organisms can cause vascular prosthetic infection?

Answer 20

s.aureus
e.coli
enterococcus
salmonella
q-fever

Question 21

two possible causes?
List three further tests and rationale

Answer 21

• bone mets
• pagets disease

Tests
* FBC - ?anaemia in malignancy
* calcium - hypercalcaemia in malignancy
* PSA - ?prostate ca

Question 22

what cancers common metastasize to bone

Answer 22

prostate -NB SCLEROTIC
breast
bladder
lung
thyroid
kidney

Question 23

uc v crohns

Answer 23