Weeks 14-17 Summary REVISION (PW)

Week 14

100

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

IRREVERSIBLE

200

4 signs of peritonitis (2015) (2013)

Tenderness
Voluntary and involuntary guarding
Rebound tenderness
Rigidity
Reduced bowel sounds

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

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)

Week 15

100

3 types of diarrhoea (2013)

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

I - inflammatory 

S - secretory

O - osmotic 

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

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)

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

Week 16 & 17

100

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

Distension, Colicky abdominal pain, Nausea, Vomiting, Constipation

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

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

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

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