Gastroenterology and Hepatology Summary for MRCEM intermediate SBA

Summary

This video covers key gastroenterology and hepatology topics, focusing on alcohol misuse, cirrhosis, hepatitis, gastroenteritis, and inflammatory bowel disease. It discusses definitions, complications, diagnostic tools, and treatment strategies, emphasizing the importance of recognizing symptoms and managing conditions effectively.

Takeaways

• 🍻 Alcohol misuse and withdrawal are significant topics in gastroenterology and hepatology, with definitions and consequences outlined in the script.
• 🚫 Problem drinking is defined as regular consumption of alcohol above recommended levels, while harmful drinking leads to physical or psychological health issues.
• 🌐 The AUDIT questionnaire is a crucial tool for screening alcohol use, with a shortened version called AUDIT C for time-limited assessments.
• 🔍 Alcohol withdrawal symptoms progress through stages, starting from mild to severe, including delirium tremens, which requires medical attention.
• 🏥 Management of alcohol withdrawal involves hospital admission for severe cases, use of benzodiazepines, and treatment with parenteral thiamine.
• 💔 Cirrhosis risk factors include alcohol misuse, hepatitis B and C, obesity, and other conditions, with clinical features ranging from chronic liver disease signs to severe impairment.
• 🌀 Ascites, a complication of cirrhosis, is primarily treated with diuretics like spironolactone, and in severe cases, paracentesis or shunt placement may be necessary.
• 🧠 Hepatic encephalopathy, another cirrhosis complication, is treated by addressing precipitating factors and using lactulose and antibiotics.
• 🔥 Hemorrhage from esophageal varices in cirrhosis is managed with volume support, blood transfusion, and a combination of endoscopic and pharmacological therapy.
• 🌡 Spontaneous bacterial peritonitis in cirrhosis requires prompt diagnosis and treatment with antibiotics and albumin, with lifelong prophylaxis recommended after an episode.

Q & A

What is the definition of problem drinking?

Problem drinking is defined as regular consumption of alcohol above recommended levels, which is 14 units of alcohol per week.

What are some complications of alcohol misuse?

Complications of alcohol misuse include cancers (mouth, throat, bowel, stomach, liver, breast), cardiovascular disease, liver disease (fatty liver, hepatitis, cirrhosis), gastrointestinal bleeding, pancreatitis, gout, psychiatric illness, Wernicke's encephalopathy, and Korsakoff psychosis.

What is the AUDIT questionnaire used for?

The AUDIT questionnaire is a screening tool for alcohol misuse. It has a shortened version called AUDIT-C for use when time is limited.

What are the early stage symptoms of alcohol withdrawal?

Early stage symptoms of alcohol withdrawal, starting as early as 4-6 hours after the last drink and peaking at 24-36 hours, include hypertension, tachycardia, anorexia, anxiety, emotional lability, insomnia, irritability, diaphoresis, headache, and fine tremor.

What are the risk factors for cirrhosis?

Risk factors for cirrhosis include alcohol misuse, hepatitis B and C infections, obesity, type 2 diabetes, autoimmune liver disease, genetic conditions, medications, Budd-Chiari syndrome, sarcoidosis, and glycogen storage disease.

How is ascites, a complication of cirrhosis, treated?

The first line treatment for ascites is diuresis with spironolactone. Furosemide may be added if there is no response. Paracentesis may be needed for some patients, and for those not suitable for liver transplantation, transjugular intrahepatic portosystemic shunt placement may be considered.

What is the clinical presentation of Wernicke's encephalopathy?

Wernicke's encephalopathy is characterized by ophthalmoplegia, ataxia, and confusion. It occurs due to severe thiamine deficiency as a result of alcohol consumption.

What causes pre-hepatic jaundice?

Pre-hepatic jaundice is caused by increased bilirubin production and can result from hemolytic anemias, drugs, malaria, Gilbert syndrome, and Crigler-Najjar syndrome.

What are the phases of hepatitis A?

Hepatitis A has three phases: the prodromal phase (flu-like and gastrointestinal symptoms), the icteric phase (jaundice, hepatomegaly, splenomegaly, lymphadenopathy), and the convalescent phase (malaise, anorexia, muscle weakness, hepatic tenderness).

What are the treatment options for chronic hepatitis B?

Treatment options for chronic hepatitis B include peginterferon alpha-2a, antiviral treatments, and liver transplantation.