Gastroenterology 1 Flashcards

1
Q

Ix achalasia
Diagnostic test (1)
Other tests (2)

A

Oesophageal manometry
Barium swallow - birds beak appearance
CXR - wide mediastinum, fluid level

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2
Q

Birds beak barium swallow =

A

Achalasia

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3
Q

Treatment of achalasia
1st line
If recurrent or persistent
If high risk for surgery (1)
Medical therapy (2)

A

Pneumatic balloon dilatation

Surgical cardiomyotomy if recurrent or persistent
botox if high risk for surgery
Nitrates/ CCB

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4
Q

What is the psoas sign?

A

Pain on extending hip if retrocaecal appendix (appendicitis)

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5
Q

Small volume of fresh blood, often streaking vomit. Malena rare. Often ceases spontaneously. Usually history of antecedent GORD type symptoms.

A

Oesophagitis

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6
Q

Pain after eating and haematemesis =
Pain during eating and haematemesis =

A

Duodenal
Gastric

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7
Q

What is the Glasgow Blatchford score?
Interpretation

A

Used in determining whether patients can be managed as outpt or inpatient with UGI bleeding
0 = consider early discharge

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8
Q

Mx GI bleeds:
Platelet transfusion if less than?
FFP if PT >? or fibrinogen <?
What to give in those taking warfarin and actively bleeding?

A

ABC
Platelet transfusion if <50
FFP if PT 1.5x > normal
Fibrinogen <1
Prothrombin complex concentrate

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9
Q

When should endoscopy be done for GI bleed?

A

Within 24 hours

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10
Q

Mx of non-variceal bleeding
When to give a PPI

A

If non-variceal upper GI bleeding and stigmata of recent haemorrhage shown at endoscopy

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11
Q

Mx of variceal bleeding (4)

A

Terlipressin
Prophylactic abx
Band ligation
TIPS

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12
Q

AUDIT interpretation
Range of scores
Hazardous/ harmful scores
Dependency scores

A

0-40
7> F > 13
8> M >15
= Hazardous/ harmful alcohol consumption

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13
Q

FAST score interpretation
Score range
Hazardous drinking score

A

0-16
Hazardous drinking =>3

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14
Q

CAGE explained

A

Have you ever felt you should cut down?
Have people been annoying by your drinking?
Have you ever felt guilty?
Eye opener

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15
Q

Recommendation drinking

A

14 units spread thinly over 3 days or more

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16
Q

How to calculate units

A

Mls X ABV / 1000

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17
Q

Mx ETOH hepatitis
Acute (1)

A

Prednisolone - acute episodes

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18
Q

Bloods strongly suggestive of acute alcoholic hepatitis
(2)

A

AST:ALT ratio >3
GGT raised

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19
Q

5-ASA example

A

Sulphasalazine

20
Q

Name five side effects of sulphasalazine

A

Lung fibrosis
Heinz body anaemia/ megaloblastic
Oligospermia
Rashes
Headaches

21
Q

Mesalazine side effects (5)

A

GI upset
Headache
Agranulocytosis
Pancreatitis
Interstitial nephritis

22
Q

Autoimmune hepatitis is seen in which population?

A

Young females

23
Q

Autoimmune hepatitis types
I, II, III
Antibodies and age affected

A

I - ANA/ SMA adults and children

II - LKM1 antibodies affects children only

III - soluble liver kidney antigen adults middle age

24
Q

Common presentation for auto-immune hepatitis?
Mx (3)

A

Amenorrhoea
Mx steroids, AZT, liver transplant

25
Q

Inflammation extending beyond limiting plate
Piecemeal necrosis
Bridging necrosis

A

Autoimmune hepatitis biopsy

26
Q

Barrett’s
Cell change
Classification

A

Squamous to columnar
Short <3cm and long >3cm

27
Q

RF Barretts (4)

A

Central obesity
GORD
Male
Smoker

28
Q

Mx Barrett’s (2)
Mx if dysplasia of any grade (2)

A

Endoscopy surveillance every 3-5 years
High dose PPI

Mucosal resection/ ablation

29
Q

Bile acid malabsorption can cause a deficiency in what vitamins?
What other symptom?

A

KADE
Steatorrhoea

30
Q

Investigation of choice for bile acid malabsorption
Mx

Name three causes of bile acid malabsorption

A

SeHCAT
Mx cholestyramine

Coeliac’s, cholecystectomy, small intestine bacterial overgrowth

31
Q

What is Budd Chiari?
Triad symptoms

A

Hepatic vein thrombosis
AP, sudden onset, severe
Ascites
Tender hepatomegaly

32
Q

Causes of Budd Chiari (4)

A

Polycythaemia rubra vera
Thrombophillia
Pregnancy
COCP

33
Q

Budd Chiari
Ix

A

US with dopplers

33
Q

Budd Chiari
Ix

A

US with dopplers

34
Q

Carcinoid tumours
What is it?
Symptoms (6)

A

Tumour of neuroendocrine cells usually from bowel or lung
1. SOB/ bronchospasm
2. Diarrhoea
3. Flushing
4. Hypotension
5. Pellagra
6. Right heart valvular stenosis

35
Q

Carcinoid tumour Ix (2)
Mx (1)
Metastases to?

A

Urinary 5-HIAA
Plasma chromogranin

Mx
Somatostatin analogues (octreotide)

Liver

36
Q

Cholestyramine is used in the management of which two conditions?

A

Bile acid malabsorption
Hyperlipidaemia - reduced LDL

37
Q

Mx c. diff
First line
Second line
Third line

A

Vancomycin 10/7
PO fidaxomicin
PO vanc +/- IV metro

38
Q

Recurrent c. diff
Mx
<12 weeks of symptoms resolution
>12 weeks

A

PO fidaxomicin
PO vanc or fidax

39
Q

Classification of c. diff (4)

A

Mild normal WCC
Mod <15 WCC 3-5 loose stools
Severe >15 WCC/ increased creatinine/ T>38.5/ severe colitis
Life threatening hypotension/ toxic megacolon

40
Q

Conditions associated with Coeliac’s (3)

A

Dermatitis herpetiformis (vesicular, pruritic skin eruption)
T1DM
Autoimmune hepatitis

41
Q

Coeliac’s complications (6)

A

Iron/folate/B12 deficiency (folate more common than B12)
Hyposplenism
Osteoporosis
Lactose intolerance
T cell lymphoma
Subfertility

42
Q

Ix Coeliac (3)

A

Re-introduce gluten for 6 weeks
TTG antibodies
IgA (endomyseal) antibodies

43
Q

Gold standard diagnosis for Coeliac’s

A

Endoscopic intestinal biopsy

43
Q

Gold standard diagnosis for Coeliac’s

A

Endoscopic intestinal biopsy

44
Q

Coeliacs are offered which vaccine?

A

Pneumococcal - booster every 5 years