The Working Life of a Gastroenterology Nurse Quiz

Answer: ERCP

ERCP is an abbreviation for endoscopic retrograde cholangio-pancreatography. This procedure involves an endoscopic camera being inserted into the stomach and then a dye being injected to allow x-rays to be taken of the pancreatic and bile ducts.

MRCP stands for magnetic resonance cholangio-pancreatography and essentially looks at the same structures as an ERCP but via a MRI scanner instead.

OGD is an oesophogastroduodenoscopy which is a common procedure, also known as an endoscopy or gastroscopy. An OGD allows the medical staff to visualise the oesophagus, stomach and duodenum.

EUA is an abbreviation for examination under anaesthetic - a common surgical procedure.

Answer: Constipation

Constipation is not a typical symptom of alcoholic liver disease. In fact many patients who have ALD present with diarrhoea.

Ascites is a term for the collection of fluid in the abdominal cavity. The precise mechanics of how this develops is still not properly understood.

Jaundice is a symptom of liver failure and manifests in a yellowish skin colour.

Encephalopathy (also known as hepatic encephalopathy) manifests in the final stages of alcoholic liver disease. Encephalopathy can lead to confusional states, cerebral oedema, coma and then death. The link between liver failure and encephalopathy is still not fully understood, but it is thought to be linked to the accumulation of toxic substances in the bowel, such as ammonia, which then travel to the brain and cause brain cells to swell. The effectiveness of lactulose in preventing the build up of toxins in the bowel has been recently questioned.

Answer: Vomiting blood

Haematemesis literally means "vomiting blood". It is most commonly caused by agastric or duodenal ulcer. Other potential causes include oesophageal varices which can be caused by excess alcohol, tumours or a mallory weiss tear.

Haemoptysis is the term for coughing up blood.

Haematuria is the term for passing blood in the urine.

As far as I'm aware there is no technical term for vomiting up bile.

Answer: Paracentesis

Paracentesis is the correct medical term for an ascitic drain. When the drain is inserted the patient can drain as much as 10 litres or more. For this reason, it is vital to monitor the patient's observations for signs of hypovolaemic shock and to ensure that the patient receives the correct fluid replacement, for example albumin solution.

Pleurodesis is a procedure to treat a pleural effusion or pneumothorax.

Extra ventricular drain is a procedure where a drain is inserted in the ventricles of the brain relieving pressure.

Epidural is a procedure where medications such as pain relief or steroids are injected into the spinal canal.

Answer: Gluten

Celiac disease is an autoimmune disorder whereby gluten products cause an inflammatory reaction in the intestines. The only treatment for celiac disease is to go onto a gluten free diet.

Answer: Inflammatory bowel disease

Inflammatory bowel disease is not to be confused with IBS (irritable bowel syndrome), which is a completely different disease.

Duodenitis is inflammation of the duodenum and gastritis inflammation of the stomach.

Answer: Yes

Quite a few healthcare staff believe that if there is liver damage than paracetamol is not safe to give. The only complete contraindication for giving paracetamol would be a paracetamol overdose.

Professor F. Prescott in an article called "Paracetamol, Alcohol and the Liver" concluded with:

"It is astonishing that clinicians and others have unquestioningly accepted this supposed interaction in man for so long with such scant regard for scientific objectivity."


http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2014937

Answer: PPI

PPI stands for proton pump inhibitors, and these work by inhibiting gastric acid production. Other PPI drugs include lansoprazole, rabeprazole and esomperazole.

The other answers are all gastroenterology drugs which are used for different conditions.

Answer: Troponin

Troponin is a blood test that helps to determine whether a patient has had a cardiac event. We do sometimes do troponin tests on our ward, but it is not one of the routine blood tests.

LFTs stands for liver function tests, and these are done almost daily on most of our liver patients. Liver function tests include alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ASP), total and direct bilirubin and gamma glutamyl transpeptidase (GGT).

Clotting screen measures the clotting time of blood, and includes tests like prothrombin time (PT), international normalised ration (INR) and activated partial thromboplastin time (APTT). It is important to monitor these as one of the liver's functions is to produce clotting agents.

FBC stands for full blood count and comprises haemoglobin, white cell count, haematocrit and platelets. These blood tests help identify patients who may be anaemic or have infections brewing, amongst other common clinical conditions.

Answer: PTC

PTC is a percutaneous transhepatic cholangiography and is used when there is an obstruction in the bile duct that can't be opened endoscopically.