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221 Cards in this Set
- Front
- Back
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What are the roles of the liver? |
Glucose + fat metabolism Detoxification + excretion - bilirubin, ammonia, drugs Protein synthesis - albumin, clotting/anti-clotting factors Defence against infection |
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How does acute liver injury present? |
Malaise, nausea, anorexia, jaundice Rarely: confusion, bleeding, liver pain, hypoglycaemia |
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How does chronic liver injury present? |
Ascites, oedema, haematemesis, varices, malaise, anorexia, wasting, easy bruising, itching, heatomegaly, abnormal LFTs Rarer: jaundice, confusion |
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What does raised alkaline phosphatase show? |
Cholestatic damage - ductular disease and obstruciton |
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What do raised transaminases (Aspartic transaminase, and alanine transaminase) show? |
Active liver damage |
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What tests give an indication of how well the liver is functioning? |
Serum bilirubin Albumin Prothrombin time |
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How does prehepatic jaundice present? |
Normal urine Normal stools No itching Normal liver tests |
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How does hepatic jaundice present? |
Dark urine Possibly pale stools May be itching Abnormal liver tests |
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What are the symptoms of jaundice? |
Biliary pain Rigors Itching Abdomen swelling Weight loss |
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How would you investigate jaundice? |
Very high AST/ALT Dilated intrahepatic bile ducts on US CT |
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What drug can cause jaundice? It's an NSAID |
Diclofenac |
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What are the usual suspects for drug-induced liver injury? |
Antibiotics - augmentin, flucloxacillin, erythromycin, TB drugs CNS drugs - ...pine, valporate Immunosuppressants Analgesics - diclofenac GI drugs - PPIs |
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How does paracetamol poisoning occur? |
Paracetamol converted to reactive intermediate - normally converted by Glutathione transferase to stable metabolite. This is finite. |
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How does primary biliary cirrhosis present? |
Itching and/or fatigue Dry eyes Joint pains Variceal bleeding Ascites |
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What condition usually accompanies primary sclerosing cholangitis? |
Colitis |
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How can helicobacter plyori be tested for? |
Urease test - positive |
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How does helicobacter plyori cause problems? |
Colonises over gastric epithelium
Induces inflammation and neutrophil infiltration in lamina propria
Ammonia production
Stimulates increased gastrin |
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How is helicobacterplyori treated? |
Amoxicillin + clarithromycin PPI - omeprazole |
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How does H. plyori lead to gastric cancer and ulcers? |
Reduces somatostatin - loss of gastrin inhibition Increased basal acid output Increased acidity in duodenum - gastric metaplasia - H. plyori can colonise |
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What does chronic infectious diarrhoea suggest about the cause? |
Giardiasis Cryptosporidisis Diarrhoea in immunocompromised |
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What are the mechanisms of E. coli causing diarrhoea? |
Toxin producing - ETEC, EHEC Invasive - EIEC Adherent - EPEC, EAEC, DAEC |
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How is Traveller's diarrhoea diagnosed? |
3 or more unformed stools per day + one of: abdo pain/cramps/nausea/vomiting/dysentery |
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What are the most common causes of traveller's diarrhoea? |
ETEC Then: salmonella, campylobacter, shigellosis |
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What are the causes of C. diff infection? |
Clindomycin Ciprofloxacin Co-amoxiclav Cephalosporins |
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What are the clinical features of a C. diff infection? |
Abdo pain Watery diarrhoea May be bloody diarrhoea Increased WBC May be toxic megacolon and perforation |
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How is C. diff diagnosed? |
Glutamate dehydrogenase or PCR screen for stool ELISA for toxin A and B Tissue culture cytotoxicity assay |
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How is C. diff treated? |
Metronidazole - don't drink!! Oral vancomycin Stool transplant - replace commensals |
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What are the clinical features of acute cholangitis? |
Charcot's triad - jaundice - abdo pain - fever with rigors |
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How is cholangitis investigated? |
Ultrasound ERCP MRCP LFTs Culture |
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How does acute cholecystitis present? |
RUQ pain Abdominal tenderness Fever Increased WBC No jaundice!! |
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What are some potential microorganism causes of biliary disease? |
E. coli, k. pneumoniae, bacteroides spp, enterococci |
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How do liver abscesses present? |
Fever Weight loss RUQ pain Tender hepatomegly Obstructive jaundice |
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How do diverticular abscesses present? |
Fever Colicky Abdo pain Diarrrhoea/constipation Increased WBC CT paracolic abscess |
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How does peritonitis present? |
Pain, tenderness, guarding Fever Increased WBC Ascites |
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What is the leading cause of diarrhoeal illness in children? |
Rotavirus |
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Other than hepatitis, what other viruses can cause acute hepatitis? |
EBv CMV Yellow fever virus Influenza Adenoviruses Coxsackie B |
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Which hepatitis viruses present acutely? |
A and E E can be chronic too |
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Outline the course of chronic hepatitis |
Uncontrolled inflammation -> increased ALT/AST -> fibrosis -> cirrhosis -> hepatocellular carcinoma |
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How can hepatitis be treated? |
Supportive care Boost immune system - interferon alpha Anti-viral durgs |
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What type of virus is hepatitis A? |
picoRNAvirus |
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What are the four phases of Hep B infection? |
Immune tolerance Immune clearance Inactive HBV carrier Reactivation |
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What are some antivirals used in hepatitis B? |
Tenofovir - needs renal monitoring Entecavir |
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What does hepatitis D need to infect someone? |
Ongoing Hep B infection - HBsAg needed for protection |
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Which is the only Hepatitis virus which is a DNA virus? |
hep B |
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What are some causes of pancreatitis? |
GET SMASHED - Gallstones - Ethanol - Trauma -Steroids - Mumps- Autoimmune - Scorpion stings - Hyperlipidaemia - ERCP - Drugs |
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How does pancreatitis present? |
Severe epigastric pain radiating into back Associated anorexia, nausea, vomiting Fever, dehydration, hypotension, tachycardia - septic shock Abdominal guarding Raised serum amylase |
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What are the signs of chronic liver disease? |
Leuconychia - white nails Terry's nails - distal reddened Clubbing Palmar erythema Hyperdynamic circulation Dupuytren's contracture Spider naevi Xanthelasma Gynaecomastia Atrophic testes Loss of body hair Parotid enlargement Hepatomegaly Small liver - late |
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How is pancreatitis investigated? |
Raised serum amylase - present in other pathologies Abdominal CT - loss of fat planes, oedema, swelling AXR Ultrasound Serum lipase - raised calcium Raised urea Low albumin |
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How is pancreatitis managed? |
Analgesia Catheterise Drainage of collections Antibiotics - usually cefuroxime/metronidazole Bowel rest Nutrition |
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How may alcohol cause pancreatitis? |
Causes proteins to precipitate in the ductal structre |
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Where is autoimmune chronic pancreatitis common? |
Japan |
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What is a volvus? |
A twist/rotation of segment of bowel - free floating |
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What is intessuption? |
telescoping of one hollow structure into a distal hollow structure |
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What does untreated bowel obstruction lead to? |
Ischaemia Necrosis Perforation |
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Where does most bowel obstruction occur? |
Small bowel |
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What is the major cause of bowel obstruction? |
Previous surgery - adhesions |
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Where are volvulus more common? |
African countries - narrower mesentery |
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What are the symptoms of mechanical bowel obstruction? |
Pain - colicky - poorly localised Vomiting - early in proximal Constipation - early in distal Abdominal distension - more distal = greater |
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What are the clinical findings in small bowel obstruction? |
Tachycardia, hypotension, raised temp Localised tenderness Swelling Dull resonance - if fluid Quiet bowel sounds - increased early Empty rectum |
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What is abdominal rigidity a sign of? |
Late peritonitis |
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How is small bowel obstruction managed? |
Fluid resuscitation Bowel decompression Analgesia and anti-emetics Early surgical consultation Antibiotics |
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When is surgery needed immediately in bowel obstruction? |
Signs of strangulation Perforation |
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Where are colorectal tumours usually found? |
About 70% distal to transverse colon |
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How are large bowel obstructions diagnosed? |
CT |
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How are colorectal cancers treated? |
Resuscitation Relieve obstruction - stent Neoadjuvant therapy - rectal Empty bowel Remove tumour - wide resection Lymphadenectomy Neo-adjuvant chemo - rectal |
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How can NSAIDs block the intestine? |
Stick to side of bowel - fibrosis |
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What dietary feature causes diverticular disease? |
Lack of fibre - muscle has to push harder - mucosa pushed through holes in muscular wall |
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What is Hirschprung's disease? |
Lack of nerves in rectum - bowel doesn't move |
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What mutation causes adenomas in the bowel? |
APC mutation |
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What are the Duke's classifications of colon cancers? |
0 - just in mucosa A - in muscularis B - through muscularis propria C1 - through muscularis, lymph node C2 - ", high tide lymph node D - in lumen + metastases |
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What is a far from ideal thing to discover with a colorectal cancer? |
Peritoneal involvement - T4 even if no lymph nodes |
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What's the progression to a metastatic colorectal adenocarcinoma? |
Hyperproliferation Small adenomatous polyp Large polyp Severe dysplasia Adenocarcinoma Metastatic adenocarcinoma |
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What genes predispose to colorectal cancer? |
FAP, HNPCC |
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How do rectal carcinomas present? |
PR bleeding, mucus Thin stool, can't fully open bowels |
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How do left sided and sigmoid carcinomas present? |
Change in bowel habit - diarrhoea, constipation/diarrhoea, thin/altered stool PR bleeding |
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How do right sided colorectal carcinomas present? |
Anaemia Dirrhoea MAss May not see blood - stool may be black inside |
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How are colorectal cancers investigated? |
Guaiac test - haemoccult Tumour markers - CEA Colonoscopy - gold standard Contrast enema CT colonoscopy - for elderly |
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Why do oesophageal and gastric cancers have low 5yr survival? |
Late presentation |
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What are the symptoms of oesophageal cancer? |
Dysphagia Vomiting GI bleed Anaemia Weight loss Dyspepsia Reflux |
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What are the signs of oesophageal cancer? |
Anaemia, malnutrition, supraclavicular lymphadenopathy, pleural effusion/consolidation, hepatomegaly, ascites, vocal cord paralysis, sister mary joseph's nodule - umbilicus, Virchow's node - neck |
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What types of oesophageal cancer do smoking and Barrett's produce? |
Smoking - squamous Barrett's - adenocarcinoma |
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How are oesophageal cancers assessed? |
Endoscopy Ct scan PET scan Endoscopic ultrasound MRI Laparoscopy barium swallow Bronchoscopy |
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What gene mutation has an 80% chance of gastric cancer? |
E Cadherin gene - CDH1 |
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What are the end points of the Bristol Stool Chart? |
1 - severely constipated 7 - completely fluid |
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What is pseudomembranous colitis? |
Caused by C. diff Kills top layer of intestinal lining |
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What are the differences between Crohn's and ulcerative colitis? |
crohn's - anywhere, commonly small bowel. Pain, diarrhoea, weight loss. Skip lesions. PErianal disease. Transmural inflammation UC - only affects colon, diarrhoea and bleeding. Continous inflammation. Mucosal inflammation |
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In which gender is IBS more common? |
Women |
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How is IBS diagnosed? |
Rome III criteria Recurrent abdo pain at least 3 days a moth in past 3 months. With 2 or more of: - improvement with defecation - change in frequency of stool - change in form of stool |
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What are some other symptoms of IBS other than the rome III criteria? |
Bloating Worsened by eating Mucus in stool Lethargy, nausea, back ache, bladder symptoms |
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What are red flag symptoms when investigating possible IBS? |
Unexplained weight loss PR bleed FHx of bowel/ovarian cancer Change in bowel habit > 50yrs old Nocturnal symptoms |
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What are the basic investigations in IBS? |
FBC, U&E, LFT CRP/ESR Coeliac serology (TTG +/- EMA) Colonoscopy - IBD/cancer Faecal calprotectin - IBD Ca125 - ovarian cancer TSH |
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How is IBS managed? |
Mild - education, reassurance, dietary modification - FODMAP Moderate - pharmacotherpy, psychological Severe - referral |
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What are the food to be avoided in a low FODMAP diet? |
Fermentable Oligosaccharides Diasaccharides Monosaccharides Polyols |
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What are the first line pharmacological treatments for IBS? |
Antispasmodics - mebeverine, buscopan Laxatives - movicol, sodium docusate, senna Antimotility agents - loperamide |
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How does loperamide act? |
Synthetic opioid - binds intestinal U receptors - decreases motility |
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What are the second line treatments for IBS? |
Tricyclic antidepressants - amitriptyline, nortriptyline SSRI's CBT Hypnotherpy |
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What are the types of diarrhoea? |
Osmotic Secretory Inflammation Abnormal motility |
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What causes osmotic diarrhoea? |
Large quantities of non-absorbed hypertonic subtances Magnesium Glucose |
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What causes secretory diarrhoea? |
Enterotoxins - cholera. E.coli, C. diff Hormones - VIP Bile salts - following ileal resection Fatty acids - follwing ileal resection Some laxatives |
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What infection causes inflammatory diarrhoea? |
Shigella |
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What is dyspepsia? |
One or more of the following: - postprandial fullness - early satiation - epigastric pain or burning |
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How do gastric ulcers present? |
Reflux Indigestion Heartburn Acid taste Bloating |
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Why do PPIs need to be given regularly for continued protection? |
New pumps synthesised within 24-96 hours |
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What is coeliac disease? |
A gluten sensitive enteropathy |
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Outline the mechanism of coeliac disease |
Gliadin peptides have direct toxic effect on epithelium Also transported to lamina propria - immune response |
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What is the commonest age for presentation of coeliac disease? |
30s-50s |
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What is the classical presentation of coeliac disease? |
Diarrhoea Steatorrhoea Weight loss Failure to thrive |
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What is the non-classical presentation of coeliac disease? |
IBS Iron deficiency anaemia Osteoporosis Chronic fatigue Dermatitis herpitiformis Ataxia Peripheral neuropathy Hyposplenism Ammenorhoea Infertility |
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What diseases are associated with coeliac disease? |
Type I diabetes, thyrotoxicosis, IgA deifiency, Sjogren's, osteoporosis, epilepsy, IBS, idiopathic dilated cardiomyopathy etc. |
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How is Coeliac disease diagnosed? |
Serology - tissue tansglutaminase (TG), anti-endomysial antibody (EMA), immunoglobulins. Endoscopy + duodenal biopsy - scalloping + villous atrophy Keep eating gluten before tests! |
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What is the scoring system for coeliac disease? |
Marsh 0-3c |
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How is coeliac disease managed? |
Gluten free diet Dietician review DEXA scan - osteoporotic risk Prescription entitlement |
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What layer is broken down in gastric ulcers? |
Mucin layer |
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What's the damaging protein in Coeliac disease? |
Gliadin protein |
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What's the macroscopic appearance in Crohn's? |
Cobblestone |
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What does a disaccharide defiency produce? |
Lactose intolerance |
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What are the bowel complications of Crohn's? |
Fibrosis, malabsorption, obstruction, fistulae, perforation, anal skin tags, fissures, neoplasia Systemic amyloidosis |
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What type of inflammation occurs in Crohn's? |
Granulomatous |
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What layers are affected by Crohn's? |
Mucosa, muscle wall, outside bowel |
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What layers are affected by ulcerative colitis? |
Just the mucosa |
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What are the differences between the complications of Crohn's and ulcerative colitis? |
Crohn's more bowel complications Ulcerative colitis - more systemic complications? |
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What are the systemic complications of ulcerative colitis? |
Liver - fatty change, sclerosing cholangitis Joints - ankylosing spondylitis, arthritis Colon - blood loss, toxic dilatation Eyes - iritis, uveitis, episcleritis Skin - erythema nodosum, pyoderma gangrenosum |
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What's a possible cause of Crohn's? |
mycobacteria |
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How much fluid can the peritoneum hold? |
5L |
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How does peritonitis present? |
Pain - hand on it makes it better Tenderness - localised -> generalised Nausea, chills, rigor Dizziness, weakness, inability to move due to pain |
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What investigations are performed if peritonitis is suspected? |
FBc - increased CRP, WCC, amylase X-ray - air under diaphragm = perforation, obstruction CT scan B-HCG - pregnancy ECG Culture - blood, ascitic fluid, dialysate fluid |
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What is found when testing the lactate in ascites in peritonitis? |
> 25mg/dl 100% sensitive |
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What are the complications of peritonitis? |
Hypovolaemia Kidney failure - distended abdomen presses Systemic sepsis Paralytic ileus Pulmonary pneumonia Portal pyaemia |
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What can cause abnormal intestinal motility? |
Diabetes Post-vagotomy Hyperthyroid |
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What are ascites? |
Effusion and accumulation of serous fluid in the abdominal cavity |
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What can cause ascites? |
Cirrhosis Cardiac failure Malignancy |
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What are the signs of ascites? |
Jaundice + other signs of liver disease Abdominal distension Shifting dullness Flanks fullness Fluid thrill Umbilical hernia Cachexia |
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What is the commonest form of volvulus? |
Sigmoid |
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How can alcohol units be calculated? |
Strength x amount / 1000 |
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What type of diarrhoea does giardia lead to? |
Chronic watery diarrhoea + malabsorption |
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What are the symptoms of alcohol withdrawal? |
6-24hrs later Tremor, insomnia, N + V, agitation, seizures |
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What is delerium tremens? |
Most severe form of alcohol withdrawal |
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What are the symptoms of delerium tremens? |
24-72hrs post cessation Hyperadrenergic state, disorientation, tremors, diaphoresis (sweating), impaired attention/consciousness, visual/auditory hallucinations |
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What causes Wernicke's encephalopathy? |
Exhaustion of thiamine reserves - malnutiriton, alcoholism |
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What are the symptoms of Wernicke's encephalopathy? |
Triad of ataxia, nystagmus/opthalmoplegia, confusion |
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What is Korsakoff syndrome? |
Untreated Wernicke's encephalopathy |
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What are the symptoms of Korsakoff's syndrome? |
Memory impairment, confabulation (distorted memories) |
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Which drugs predispose to GORD? |
tricyclic antidepressants, anticholinergics, nitrates, CCBs |
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What is a Mallory Weiss tear? |
Linear mucosal tear of oesophogastric junction produced by sudden increase in intra-abdominal pressure |
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What are the symptoms of a peptic ulcer? |
Epigastric pain - after eating Nausea oral flatulence, bloating, distension, intolerance of fatty food Heartburn |
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What may be deficienct in the presence of a peptic ulcer? |
Iron |
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How are varices treated? |
Terlipressin - vassopressin analogue Somatostatin Band ligation Balloon tamponade Intrahepatic portosystemic shunt |
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What is achlasia? |
disorder of motility of lower oesophageal or cardiac sphincter - functional stenosis |
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How is achlasia treated? |
Calcium channel blockers, nitrates Endoscopic and surgical treatment |
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What causes scleroderma? |
Excessive collagen production and deposition Immune activation |
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How does scleroderma present in the GI system? |
Dysphagia and heart burn Reflux |
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What genes on antigen presenting cells can cause coeliac disease? |
HLA-DQ2 or HLA-DQ8 |
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Why might the prevalence of coeliac disease be rising? |
Change in endoscopic techniques Antibody screening Increased awareness of diversity in presentation |
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What histological changes are seen in coeliac disease? |
Villous atrophy Crypt hyperplasia Intraepithelial lymphocytes |
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What is tropical sprue? |
Severe malabsorption accompanied by diarrhoea Inflammation and villous flattening in the small intestine |
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How does tropical sprue present? |
diarhoea, anorexia, abdominal distension, weight loss, malabsorption, steatorrhoea, abdo pain, ankle oedema, fatigue, fever |
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How is tropical sprue treated? |
Leave the area Folic acid Antibiotic - tetracycline |
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What conditions does smoking protect against? |
Parkinson's Ulcerative colitis |
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How is Crohn's treated? |
Steroids Smoking cessation Monoclonal antibodies |
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What molecule is positive in ulcerative colitis? |
pANCA |
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How is ulcerative colitis treated? |
5-ASA - mesalazine Corticosteroids Thiopurines Ciclosporin - salvage therapy Infliximab |
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Where is there a watershed area in the bowel? |
Splenic flexure |
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How does ischaemic colitis present? |
Sudden onset abdo pain Bright red blood PR distended, tender abdomen Cardiovascular shock Lactic acidosis |
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How does pruritus ani present? |
Itchy bottom |
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How are anal fissures treated? |
GTN and diltiazem ointments Botulinum toxin in chronic fissures |
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How are anal fistula diagnosed? |
Ultrasound, MRI and examination |
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What are pilonidal sinuses? |
Hairs grow into skin rather than outwards Inflammation and infection |
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What are the types of IBS? |
IBS-c - constipation IBS-d - diarrhoea IBS- m - mixed |
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What can trigger IBS? |
Psychiatric disorders Stress + trauma GI infection Antibiotic therapy Abuse Pelvic surgery Eating disorders |
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What molecule shows inflammatory bowel disease? |
Faecal calprotectin |
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How does appendicitis present? |
Pain - vaguely periumbilical, moves to RIF Nausea Vomiting Anorexia Constipation/diarrhoea Low grade pyrexia |
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What are the signs of appendicitis? |
Guarding and rebound tenderness Palpation of LIF makes pain in RIF worse US CT Psoas test and obturator test Rectal examination for retro/pelvic appendix |
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What is Murphy's sign in cholycystitis? |
Pain on deep breathing with fingers on gallbladder |
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Where are the venous collaterals in portal hypertension? |
Gastro-oesophageal junction Anterior abdo wall - umbilical Anorectal junction Reptroperitneal viscera |
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What causes primary biliary cholangitis? |
Autoimmune process Serum anti-mitochondrial antibodies (AMA) Increased IgM synthesis |
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How is primary biliary cholangitis treated? |
Ursodeoxycholic acid - improves bilirubin and aminotransferase levels Steroids Supplement fat soluble vitamins - ADEK |
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Outline the mechanism of fatty liver disease |
Ethanol metabolised -> increased NADH Increased hepatic fatty acid synthesis Esterified to glycerides Impaired protein and carbohydrate metabolism TNF-a release from Kuppfer cells - cell damage Acetaldehyde produced - damages cells |
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What does alcohol do to stellate cells? |
turns them into collagen producing myofibroblasts |
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Which zone does alcoholic and fatty liver damage usually occur? |
3 - furthest from portal triad |
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What bodies form in alcoholic hepatitis? |
Mallory |
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What are the tests for alcoholic cirrhosis? |
Increased MCV US or CT Increased serum bilirubin Increased AST and ALT Increased ALP Increased PT Low albumin |
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What should be given upon long term alcohol withdrawal? |
Diazepam for delerium tremens IV thiamine for Wernicke's encephalopathy |
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What is haemochromatosis? |
Inherited disease - excess iron deposition - fibrosis and organ failure |
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How does haemochromatosis present? |
Often asymptomatic Fatigue, weakness, arthropathy, abdominal problems, erectile dysfunction, heart problems Diabetes, bronzing, hepatomegaly, arthropathy |
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How is haemochromatosis treated? |
Venesection |
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What is Wilson's disease? |
Defect in copper transport - chromosome 13 Copper deposition |
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Where does copper accumulate in Wilson's? |
Liver, basal ganglia, cornea |
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How does Wilson's disease present? |
Acute liver failure asymetrical tremor, dysarthria, involuntary movements, excessive salivation, dementia Kayser-Fleisher ring - cornea ring Flaconi's syndrome, osteopenia, arrhythmias |
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How is Wilson's diagnosed? |
Low serum cooper and caeruloplasmin Increased urinary copper Haemolysis and anaemia |
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How is Wilson's treated? |
Penicillamine - chelates copper Trientine and zinc acetate |
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Where is the defect for alpha1-antitrypsin deficiency? |
Chromosome 14 |
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What happens in A1ATD? |
Breakdown of alveolar walls |
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What is a hepatic flap called? |
Asterixis |
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What can be given to reduce ICP in liver failure? |
Mannitol |
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How are ascites treated? |
Diuretics - spironolactone Paracentesis Sodium restriction Shunts |
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How does trapped gas resonate on percussion? |
Tympanic |
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What is the most common type of liver tumour? |
Secondary - particularly GI, breast or bronchus |
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Which hepatitis puts you at risk of liver cancer? |
Hep B |
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Why is the prognosis for pancreatis cancer so dire? |
Late presentation, early metastases |
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What is the most common type of pancreatic cancer? |
Adenocarcinoma |
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How does pancreatic cancer present? |
Abdo pain Jaundice Pruritus Acute pancreatitis weight loss Steatorrhoea Epigastric mass - late Palpable gallbladder Gastric obstruction Haematemesis, melaena, iron deficiency |
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Where do indirect and direct hernias form? |
Indirect - through inguinal canal direct - though wall, inside inferior epigastric vessels |
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When are hernias most painful? |
On coughing |
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What vitamin may be raised on liver damage? |
B12 |
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What's Raynaud's pentad in ascending cholangitis? |
Jaundice RUQ pain Fever Hypotension Confusion |
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What's Murphy's sign? |
Breathing in with fingers under gall bladder hurts |
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What antibiotics are used in ascending cholangitis? |
Cefotaxime and metronidazole |
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What are the signs of primary biliary cholangitis? |
Skin pigmentation Xanthelasma and xanthomas Hepatosplenomegaly Jaundice |
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What is the characteristic antibody for primary biliary cholangitis? |
AMA - anti mitochondrial antibody |
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What is used to treat itch in liver failure? |
Colestyramine |
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What are the blood differences between PBC and PSC? |
PBC - increased ALP, AMA+VE PSC - increased ALP, AMA-ve, pANCA+ve, ANA+ve |
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What bodies are found in alcoholic liver disease? |
Mallory |
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What are the three danger signs in alcoholic liver disease? |
Jaundice Encephalopathy Coagulopathy |
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How does delirium tremens present? |
Tremor Shiver Sweating Arrhythmia Hyperthermia Seizures |
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How is delirium tremens treated? |
Chlorodiazepoxide |
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What is the triad of Wernicke's symptoms? |
Confusion Ataxia Ophthalmoplegia |
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How does Korsakoff's present? |
Comfabulation Cannot make new memories Lack of emppathy and insight |
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How can hepatitis B be treated? |
Tenofovir Entecavir PEG-IFN |
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What's the normal pressure of the portal vein? |
5-10mmHg |
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What's the most common type of primary liver cancer? |
Hepatocellular carcinoma |
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How does liver failure cause hepatic encephalopathy? |
Ammonia build up Passes through BBB Causes cerebral oedema |
