FINALS > GI > Flashcards

GI Flashcards

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1
Q

Liver cirrhosis causes

A
  • Alcohol related liver disease
  • NAFLD
  • Hep B
  • Hep C
  • Autoimmine hep
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2
Q

Non-invasive liver screen

A
  • USS liver
  • Hep B+C
  • Autoantibodies
  • Immunoglobulins
  • Caeruloplasmin
  • Alpha 1 antitrypsin
  • Ferritin and transferrin
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3
Q

4 key features of decompensated liver disease

A
  • Ascites
  • Hepatic encephalopathy
  • Oesophageal varices bleeding
  • Jaundice
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4
Q

what causes ascites

A
  • Fluid in peritoneal cavity
  • Increased pressure in portal system causes fluid to leak out of capillaries
  • Drop in circulating volume causes reduced BP in kidneys
  • Renin released therefore increased aldosterone = reabsorption of fluid and sodium in kidneys
  • cirrhosis = most common cause
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5
Q

2 types of ascites

A
  • transudate <25
  • exudate = more protein >25
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6
Q

what causes transudative ascites

A
  • HF
  • malnutrition
  • ## portal HTN
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7
Q

what causes exudative ascites

A
  • malignancy
  • TB
  • pancreatic ascites
  • budd chiari
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8
Q

Mx ascites

A
  • low na diet
  • aldosterone antagonist = spiro
  • paracentesis (drain)
  • Abx proph = cipro or norfloxacin
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9
Q

Hepatic encephalopathy caused by

A
  • build up of neurotoxic substances that affect the brain e.g. ammonia
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10
Q

S+S hep enceph

A

Acutely
- reduced cosnciousness
- confusion
Chronically
- personality change

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11
Q

Mx hep enceph

A
  • lactulose
  • abx to reduce bacteria producing ammonia (rifaximin)
  • nutrition support
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12
Q

Metabolic functions of liver and what goes wrong

A
  • Gluconeogenesis (using lactate)
  • Glycogen metabolism
    Failure:
  • Hypoglycaemia
  • High lactate
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13
Q

Synthetic functions of liver and what goes wrong

A
  • Vit K dependent clotting factors
  • Albumin
  • TPO
    Failure:
  • increased PT/INR
  • Ascites
  • thrombocytopenia
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14
Q

Excretion/detoxification functions of liver and what goes wrong

A
  • toxins/drugs
  • ammonia
    Failure:
  • build up of liver excreted drugs
  • High ammonia –> hepatic encephalopathy
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15
Q

blood findings in decompensated cirrhosis

A

Raised:
- Bili
- ALT
- AST
- ALP
- low albumin
- High PT

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16
Q

1st line investigation for fibrosis in NAFLD

A
  • Enhanced liver fibrosis blood test
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17
Q

ELF resuts

A
  • 10.51 or more = advanced fibrosis
  • <10.51 unlikely advanced fibrosis
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18
Q

USS findings in cirrhosis

A
  • Nodularity
  • corkscrew hepatic arteries
  • enlarged portal vein with reduced flow
  • ascites
  • splenomegaly
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19
Q

5 factos in child pugh score

A
  • albumin
  • bilirubin
  • clotting (INR)
  • dilation (ascites)
  • encephalopahty
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20
Q

Mx cirrhosis

A
  • treat underlying
  • MELD score 6m to assess severity
  • monitor complications (USS and AF every 6m)
  • manage complications
  • transplant
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21
Q

4 features decompensated liver disease

A

ascites
hepatic encephalopathy
oesophageal varices bleeding
yellow
= consider transplantation when decompensated

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22
Q

prophylaxis of bleeding in stable oesophageal varices

A
  • non-selective BB = propranolol
  • ligation
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23
Q

Mx bleeding oesophagela varices

A
  • ABCDE
  • major haemorrhage protocol
  • coagulopathy treated woth FFP
  • vasopressin analogues = terlipressin
  • broad spectrum abx
  • urgent endoscopy with ligation
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24
Q

SBP S+S

A
  • fever
  • abdo pain
  • deranged bloods
  • ileus
  • hypotension
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25
SBP common organisms
- E coli - Klebsiella pneumoniae
26
SBP Ix
diagnostic aspiration = raised neutrophil count
27
Mx SBP
- Culture ascitic fluid pre abx - IV broad spectrum abx - ceftriaxone or cefotaxime - IV human albumin
28
how many units per week
14
29
blood resuts in alchohol related liver disease
- increased MCV - increased ALT and AST - AST:ALT >1.5 - raised GGT
30
CAGE questions
Cut down Annoyed Guilty Eye opener
31
time in withdrawal for hall, seizures and DT
- 12-24 hrs = hallucinations - 24-48hrs = seizures - 24-72hrs delerium tremens
32
Mx withdrawal in hospital
- chlordiazepoxide reducing regime - Pabrinex then thiamine
33
wernickes encephalopathy
- confusion - oculomotor distirbance - ataxia
34
korsakoff sx
- memory impairement = retrograde and anterograde - behaviour changes
35
Hep A - TTVT and sx
- Type = RNA - Transmission = faeco-oral - Vaccine available - supportive Tx - Can cause cholestasis with pruritus,jaundice, dar wee and pale stool - Dx based on IgM
36
Hep B TTVT
- Type = DNA - Transmission = blood/fluids - Vaccine available - Tx = supportive/antiviral
37
Hep C TTVT
- Type = RNA - Transmit = blood/body fluids - No vaccine - Direct acting AV tx
38
Hep D TTVT
- Type = RNA - Transmitted with Hep B - NO vaccine - Tx = pegylated interferon alpha
39
Hep E TTVT
- Type = RNA - Transmit = faeco-oral - No vaccine - tx supportive
40
S+S hepatitis
- abdo pain - fatigue - flu like - pruritus - N+V - Jaundice
41
LFTs in hepatitis
- AST and ALT high - Less of a rise in ALP
42
HBsAg
active infection
43
HBeAg
high infectivity
44
HBcAB
past or current infection
45
HBsAB
vaccination or past/current infection
46
type 1 autoimmune hep
- WOmen in late 40s/50s - Around or after menopause - fatigue, liver disease features
47
type 2 autoimmune hep
- young girls - acute hep - high transaminases - jaundice
48
autoantibodies in type 1
ANA Anti-actin Anti SLA/LP
49
autoantibodies i tyoe 2
Anti LKM1 anti LC1
50
key histology findings in AH
- Interface hepatitis - Plasma cell infiltration
51
Mx AH
- high dose steroids
52
inheritance of haemochromatosis
- autosomal recessive - affects HFE gene on csome 6 - leads to iron overload
53
S+S haemochromatosis
- chronic tiredness - joint pain - bronze skin - testicular atrophy - erectile dysfunction - amenorrhoea - cognitive - hepatomegaly
54
initial ix for HH
serum ferritin
55
other ix HH
- transferrin saturation - genetic test - liver biopsy with perls stain - mri
56
mx HH
- venesection - monitor ferritin
57
inheritance of wilsons
autosomal recessive - wilson diesase protein on csome 13 - copper accumulation
58
S+S wilsons
- teens - chronic hepatitis - tremor, dysarthria, dystonia - parkinsonism - deression - kayser-fleischer rings - haemolytic anaemia
59
Ix wilsons
- serum caeruloplasmin low - 24hr urine copper assay - biopsy
60
mx wilsons
- copper chelation with penicillamine or trientine
61
inheritance of alpha 1 antitrypsin
autosomal co-dominant - csome 14
62
presentation of primary biliary cholangitis
- white woman 40-60 - fatigue - pruritus - GI sx - pale greasy stool - jaundice - dark urine
63
what is pbc
autoimmune damage to small bile ducts inside the liver
64
PBC S+S
- Similar PSC - Raised cholesterol = xanthelasma
65
autoantibodies in PBC
- AMA = key - ANA ALP also raised
66
Mx PBC
- ursodeoxycholic acid - cholestyramine (maybe check)
67
what is primary sclerosing cholangitis
- sclerosis and inflammation of biliary tree - associated with UC
68
primary sclerosing cholangitis S+S
- RUQ pain - itching - fatigue - jaundice - hepato and splenomegaly
69
Ix and Mxfor PSC
- MRCP - raised ALP first - bilirubin raised next - Mx = ERCP
70
what can psc cause
- cholangiocarcinoma - cirrhosis
71
screening for Ca in cirrhosis
- every 6 months - USS - alpha fetoprotein
72
S+S liver cancer
- weight loss - abdo pain - anorexia - N+V - jaundice - Pruritus - mass on palp
73
key presenting feature in cholangiocarcinoma
- obstructive jaundice = pale stool, dark wee, itching
74
tumour marker for cholangiocarcinoma
- CA19-9
75
contraindication for liver transplant
- significant co-morbidities - current illicit drug use - continuing alcohol misuse - untreated HIV - current or prev cncer
76
lining of stomach
columnar epithelial lining
77
red flag features in gord
- dysphagia - >55 - weight loss - upper ando pain - reflux - tx resistant dyspepsia - N+V - mass - anaemia - high platelets
78
GORD patho
- acid from stomach flows through lower oesophageal sphincter - irritates lining of oesophagus
79
oesophagus lining
squamoue epithelial lining
80
Ix GORD
- endoscopy
81
Mx GORD
- lifestyle changes - med review - antacids - PPI - Histamine H2 receptos antagonists - laparoscopic fundoplication
82
H pylori type of bacteria
gram negative aerobic bacteria - produces ammonium hydroxide
83
h pylori ix
- stool antigen - urea breath test - antibody test - rapid urease test
84
triple therapy for h pylori
- PPI = omeprazole - amoxicillin - clarithromycin 7 days
85
barrets oesophagus
- lower oesophageal epithelium changes from squamous to columnar epithelium
86
tx barrets
- endoscopic monitoring - PPI - endoscopic ablation
87
RF peptic ulcer
- NSAIDs - H pylori - increased stomach acid
88
RF duodenal ulcer
- HP - Steroids - SSRI - Smoking
89
RF gastric ulcer
- NSAIDs - HP - Smoking - Stress
90
presentation peptic ulcer
- epigastric discomfort - N+V - dyspepsia - duodenal = pain improves on eating - gastric = painful to eat = increase acid splash up
91
px upper gi bleed
- haematemesis - coffee ground vomit - melaena - haemodynamic instability
92
mx upper gi bleed
ABATED - A-E - Bloods - Access - Transfusions - Endocsopy in 24hrs - Drugs = stop offending surgery = clips, thermal coagulation, ligation
93
Crohns features
- No blood or mucus - Entire GI tract affected - Skip lesions - Transmural inflammation - smoking is a RF - strictures and fistulas - non caseating granulomas
94
UC features
- Continuous inflammation - limited to colon and rectum - only superficial mucosa affected - Smoking protective - Excrete blood and mucus - PSC
95
UC S+S
- gradual onset diarrhoea - crampy pains - bowel frequency related to severity - systemic symptoms in attacks
96
Ix UC
- stool to exclude infection - FBC - pANCA may be +ve - colonoscopy biopsy gold standard - faecal calprotectin
97
UC Mx
Mild-mod - aminosalicylate (oral or rectal e.g. mesalazine) - 2nd line corticosteroids Severe - IV steroids
98
UC maintaining remission
- 1st line oral or rectal mesalazine - azathioprine - mercaptopurine
99
UC complications
Colon = blood loss, toxic dilatation, colorectal cancer Joints = ankylosing spondylitis, arthritis Eyes = iritis, uveitis, episcleritis Skin = EN Liver = fatty change, chronic pericholangitis, sclerosing cholangitis
100
S+S crohns
- ulcers - RIF mass - perianal abscess, fistulae, tags - diarrhoea, abdo pain, weight loss
101
Ix crohns
- pANCA -ve - colonoscopy biopsy - faecal calprotectin
102
UC surgery
- removing large bowel and rectum - permanant ileostomy or J pouch
103
Mx Crohns
Induce remission - steroids maintaining remission - Azathioprine or mercaptopurine
104
crohns surgery
- resecting distal ileum - treat stricutres and fistulas
105
key features IBS
- Intestinal discomfort - Bowel habit abnormalities - stool abnormalities
106
NICEIBS Dx
- Exclude DD - at least 6m pain or discomfort with 1 of: . Relief on BO . Bowel habit abnormalities . Stool abnormalities - And 2 of . Straining, incomplete emptying or urgency . Bloating . Worse after eating . Mucus
107
IBS1st line emds
- Loperamide for diarrhoe - Bulk forming laxatives if const - Antispasmodics - mebeverine
108
3 antibodies relating to coeliacs
- Anti -TTG - Anti EMA - Anti DGP
109
coeliac affect on villi
- villous atrophy - crypt hypertrophy
110
S+S coeliac
- fail to thrive - diarrhoea - bloat - fatigue - weight loss - ulcers - dermatic herpetiformis - anaemia
111
Dx coeliac
- Total IgA levels - Anti TTG - ENdoscopy and jejunal biopsy = crypt hyperplasia and villous atrophy
112
signs of peritonitis
- guarding - rigidity - rebound tenderness - coughing test - percussion tenderness
113
S+S appendicitis
- central to RIF pain - N+V - Low grade fever - Rovsings - Guarding - Rebound tenderness
114
where is mcburneys point
- 1/3 of the distance from ASIS to umbilicus
115
Dx appendicitis
- Clinical - CT
116
causes of bowel obstruction
- adhesions (small bowel) - hernias (small bowel) - malignancy (large bowel)
117
S+S pbstruction
- \Vomiting = green bilious - abdo distension - diffuse pain - absolute constipation and lack of flatulence - tinkilng bowel sounds
118
initial mx obstruction
-A-E - bloods - drip and suck = NBM, IV fluids, NG tube with free drainage - AXR - Contrast CT - surgery
119
key to look out for in obstruction
- electrolyte imbalance - metabolic alkolosis - bowel ischameia
120
causes of ileus
- injury - surgery - inflammation or infection - electrolyte imblance
121
S+S ileus
- vomiting green - distension and pain - absent boel sounds treat underlying cause
122
volvulus definition
- bowel twists around itself and the mesentery it is attached to = closed loop obstruction
123
sigmoid volvulus
- older pt - cause = chronic constipation = overloaded with faeces = sinks
124
RF volvulus
- neuropsychiatric disorders - chronic constipation - high fibre - pregnancy - adhesions
125
Ix volvulus
- AXR = coffee bean sign in sigmoid volvulus - Contrast CT
126
Mx volvulus
- same as bowel obstruciton - endoscopic decompression - surgery
127
3 complications hernias
- incarceration = ireducible - obstruction - strangulation
128
Dx SBP
- Paracentesis = neutrophil count >250
129
SBP prophylaxis
- Give iv fluid protein <15 - Ciprofloxacin
130
what is an indirect inguinal hernia
- Bowel herniates through inguinal canal - When reduced and pressure applied to deep inguinal ring hernia will remain reduced
131
what is a direct inguinal hernia
- Weakness in abdominal wall at Hesselbach's triangle = protrudes through abdo wall - pressure of inguinal ring will not stop herniation
132
Hesselbach's triangle boundaries
RIP - Rectus abdominis muscle - Inferior epigastric vessels - Pouparts ligament
133
Boundaries of femoral canal
- Femoral vein - Lacunar ligament - Inguinal ligament - Pectineal ligament
134
4 types of hiatus hernia
1 = sliding 2 = rolling 3 = combo 4 = large opening with an additional abdoman organs entering
135
what is a HH
herniation of stomach up through diaphraghm
136
classification of haemorrhoids
1st = no prolapse 2nd = prolapse when straining, return relax 3rd = prolapse, don't return relax, push back 4 = permanent prolapse
137
Mx haemorrhoids
- Topical = anusol, HC, germoloids - Fibre, fluids, laxatives - rubber band - surgery
138
what is diverticulosis
- presence of diverticula without inflammation or infection
139
what is diverticulosis and itis
- symptoms experienced - itis = inflammation and infection
140
patho of diverticulosis
- Increased pressure causes gap to form in circular muscle = mucosa herniates
141
RF diverticulosis
- age - low fibre - obesity - NSAIDs
142
Dx and mx diverticulosis
- Colonoscopy - CT - bulk forming laxatives = avoid stimulant
143
S+S acute diverticulitis
- Pain in LIF - fever - diarrhoea - N+V - rectal bleed - Abdo mass - Raised inflam
144
Diverticulitis mx in GP
- oral co-amox 5 days - analgesia - clear liquids - 2 day follow up
145
mesenteric ischaemia
- lack of blood flow through mesenteric vessels
146
3 main branches of abdominal aorta
- Coeliac artery = foregut - SMA = midgut - IMA = hindgut
147
triad of mesenteric ischaemia
- colicky central abdo pain after eating - weight loss - abdominal bruit
148
Dx and mx mesenteric ischaemia
- CT angiography - modifiable RF - secondary prevention = statin, aps - revascularisation
149
key RF of acute mesenteric ischaemia
- AF
150
Ix for acute MI
- contrast CT - Met acidosis and raised lactate - Surgery
151
RF bowel cancer
- FHx - FAP - HNPCC - IBD - age, diet etc.
152
inheritance of FAP
- autosomal dominant - lafunctioning of tumour suppressor genes
153
RF bowel cancer
- CIBH - weight loss - Rectal bleeding - Abdo pain - ID anaemia - Mass
154
2ww criteria bowel ca
- >40 with pain and weight loss - >50 with unexplained bleeding - >60 with CIBH or IDA
155
when to use FIT test in GP
- >50 with unexplained weight loss and no other sx - <60 with CIBH
156
age screening
60-74
157
Ix bowel ca
- colonoscopy - sigmoidoscopy - CT colonography and staging scan - CEA
158
1st line ix for gallstones
- USS - then MRCP
159
treatemnt gallstones
ERCP cholecystectomy
160
cholecystitis patho
- gallstone stuck in cystic duct
161
S+S cholecystitis
- RUQ and shoulder pain - Fever - N+V - murphys
162
Ix and Mx cholecystitis
- USS - MRCP Mx = same as stones - Cholecystectomy within 1 week
163
2 main causes of cholangitis
- obstruction in bile duct stopping flow - infection during ERCP
164
Most common organisms for cholangitis
- E coli - Klebsiella - Enterococcus
165
S+S cholangitis
- RUQ - Fever - Jaundice
166
Mx cholangitis
ERCP
167
RF for cholangiocarcinoma
- Primary sclerosing cholangitis - Liver flukes
168
S+S cholangiocarcinoma
- Obstructive jaundice = pale stool, dark urine, itching - weight loss - RUQ - palpable gallbladder
169
tumour marker raised in cholangiocarcinoma
CA 19-9
170
key presenting feature pancreatic cacner
- painless obstructive jaundice = yellow skin, dark urine, pale stools, itch
171
NICE referral for pancreatic ca
- 2WW = >40 and jaundice - >60 with weight loss and another sx = ct abdo
172
3 main causes pancreatitis
- Gallstones - Alcohol - ERCP
173
S+S pancreatitis
- Epigastric pain - Radiates to back - Vomiting - Tender - Unwell
174
Ix pancreatitis
full bloods - amylase - lipase - abg - erect CXR to exclude gastrodueodenal perforation - contrast CT post 72 hrs for prognosis
175
Glasgow score criteria
PaO2 <8 Age >55 Neurophils >15 Calcium <2 Urea >16 Enzymes AST.ALT >200 Albumin <32 Sugar >10
176
score results
0-1 = mild 2 - mod 3 = severe
177
Mx acute pancreatitis
- A-E - treat cause - Abx
178
Courvoisiers sign
- Painless enlarged gallbladder and mild jaundice = pancreatic cancer likely
179
What drug can cauae cholestasis
Co-amoxiclav
180
what does a right hemicolectomy remove
- caecum - ascending colon - proximal transvere colon
181
what does a left hemicolectomy remove
distal transverse and descending colon
182
high anterior resection removes
sigmoid colon
183
low anterior resection removes
sigmoid colon and upper rectum
184
abdomino-perineal resection removes
rectum and anus (permament colostomy)
185
Hartmanns procedure
- rectosigmoid colon - colostomy created
186
mx in acute alcoholic hepatitis
- glucocorticoids = prednisolone - pentoxyphylline
187
isolation time in c diff
48 hours
188
site most commonly affected in uc
rectum
189
what is haemachromatosis
- iron overload - autosomal recessive
190
S+S haemachromatosis
- chronic tiredness - joint pain - pigmentation - erectile dysfunction - amenorrhoea - bronze skin - cognitive - hepatomegaly
191
blood tests haemachromatosis and ix
- high ferritin - transferrin saturation high - genetic testing - MRI - used to biopsy with perls stain
192
hyposplenism
- less or no spleen action
193
causes hyposplenism
- coeliac - sickle cell - ibd - ald
194
hyposplenism blood film
pitted erythrocytes and howell jolly bodies
195
196
paed jaundice <24hr after birth means
pathological reason = bad
197
how long paed jauncidce ongoing before prolonged
- term babies = >14d - >21 in prem babies
198
biggest cause in first 24 hrs
- neonatal sepsis - haemolytic disease of newborn - abo incompatibility
199
>24 hour jaundice causes
- breastmilk jaundice = suboptimal milk levels - physiological jaundice - infection - haemolysis
200
prolonged baby jaundice causes
- biliary atresia - high gi obstruction - hypothyroidism
201
tx options neonatal jaundice
- plot on gestation specific chart - phototherapy - exchange transfusion
202
ix neonatal jaundice
- direct coombes test - fbc and film - conj bili - blood type testing - cultures for infection thyroid g6pd
203
artery supplying foregut
coeliac trunk
204
artery supplying midgut
SMA
205
artery supplying hindgut
IMA
206
S+S colorectal cancer
- Rectal bleeding - Weight loss - Abdo pain - IDA - Obstruction
207
2ww in colorectal when
- Abdo mass - CIBH - IDA - <40 unexplained weight loss - < 50 w rectal bleed + pain/wl - >50 with any sx
208
colon cancer mx stage 1-3
- Surgical resection - Adjuvant chemo
209
what surgery if tumour >8cm from anal canal
Anterior resection
210
When is ALT released
- Hepatocellular damage as found in hepatocytes - If increased = intrahepatic cause
211
when is AST released
- Intrahepatic injury - AST:ALT >2:1 = ALD
212
when is ALP released
- Obstructive picture - Found in bone, gut, placenta
213
when is GGT released
- GGT found in bile duct cells - Increased in biliary disease
214
LFTs indicating liver synthetic function
- PT - Albumin - Bilirubin
215
RF for refeeding syndrome
- BMI <16 - Excessive exercise - rapid weight loss - dehydration or water loading - Fasting 5+ days
216
Brief overview refeeding
- Caused by sudden intro of glucose after starving - Glucose causes insulin release = pushes glucose into cells - Causes demand for P,K, Mg - Therefore hypop, hypok, hypomg
217
transjugular intrahepatic portosystemic shunt connects what 2 vessels
hepatic vein and portal vein
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