Week 14
Week 15
Week 16 & 17
100

Cirrhosis is irreversible/reversible diffuse fibrosis of the liver and the final common pathway of chronic liver disease

IRREVERSIBLE

100

3 types of diarrhoea (2013)

M - motility (doesn't really count i think)

I - inflammatory 

S - secretory

O - osmotic 

100

Patient presents with bowel obstruction. What are 4 symptoms. (2012)

Distension, Colicky abdominal pain, Nausea, Vomiting, Constipation

200

4 signs of peritonitis (2015) (2013)

Tenderness
Voluntary and involuntary guarding
Rebound tenderness
Rigidity
Reduced bowel sounds

200

Crohn’s disease (2020). Name 3 endoscopic features.

- Skip lesions throughout whole GI tract
- Transmural inflammation and ulceration
- Non-caseating granulomas (collection of macrophages)
- Fistulas

200

Patient presents with bowel obstruction. Name 4 causes. (2012)

  • Adhesions – from surgery, endometriosis
  • Hernia – weak point in the peritoneal cavity, causing protrusion of the peritoneum
  • Volvulus – torsion/twisting of a loop of bowel around its mesenteric base of attachment  
  • Tumour
  • Intussusception – part of intestine is constricted by a wave of peristalsis. It get’s pushed forward and telescoped into a distal segment.
300

What is the classic LFT pattern for someone with Alcoholic Liver Disease?

AST/ALT __ (number) 
___ ALT
___ ALP
___ GGT
___ bilirubin
___ albumin
___ PT

AST/ALT > 2 times 
ALT normal or only mildly elevated
Elevated ALP
Elevated GGT
Elevated bilirubin
Decreased albumin
Increased PT

300

Crohn’s disease (2020). Name 3 complications.

- Colorectal cancer risk
- Perforation due to deep ulcers
- Intestinal strictures due to inflammation
- Fistulas (connections between organs)

300

Name 6 risk factors for suicidality (2018) (2016)

  • Previous suicide attempt
  • Mental health conditions
  • Male
  • Older age
  • Social isolation
  • Recent stressor

400

Treatment of person with acute haematemesis (2015)


1. ABCDE Primary Survey

2. Fluid resuscitation:
> 20ml/kg of normal saline if required with 2 large bore IV cannulas + blood transfusion if anaemic (Hb < 70) and hypovolaemia, ensuring to get the correct type

3. Initial Investigations:
* FBC, UEC, LFTs (if liver contributing to bleeding), Coagulation Profile
* Group & Match
* ECG – electrolyte differences
* If shock = ABG, Lactate

4. Medications:
*IV PPI Inhibitor – prevent gastric acid secretion, stabilise clot formation at bleeding site
* IV Antibiotics – if liver cirrhosis

5. Surgery: banding (varices), clipping (ulcer)

400

4 extra-intestinal symptoms of Chron's Disease (2021)

  • Arthritis: Peripheral & Axial

  • Skin Manifestations; Erythema nodosum (tender red nodules, usually on shins)

  • Eye Involvement: Uveitis (painful red eye, photophobia, blurred vision)

  • Mouth Involvement: Aphthous ulcers

400

List 4 risk factors for gastric carcinomas.

1.     H. pylori infection

2.     Tobacco smoking

3.     Epstein-Barr virus

4.     Diet rich in nitrates and/or salts

5.     Obesity

500

Explain what would happen in paracetamol overdose & what benefit is there to the patient if you treat them with acetyl-cysteine post 30 tablet paracetamol overdose? (2017)

  • 90% paracetamol is metabolised in the liver via glucuronidation and sulfation.
  • 5% paracetamol converted to NAPQI, but is conjugated with glutathione, which create a non-toxic metabolite
  • When paracetamol overdose occurs, glutathione stores are overwhelmed, NAPQI accumulates
  • Toxic metabolite increases > liver hepatotoxicity    

NOTE: Acetylcysteine replenishes glutathione stores, allowing NAPQI to be detoxify > no liver damage

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