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Gastroenterology > Conditions > Flashcards

Conditions Flashcards

1
Q

Extraintestinal manifestations of Crohn’s

A

Erythema nodosum
Pyoderma gangrenosum
VTE
Primary sclerosing cholangitis
Uveitis
Anklyosing spondylitis

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2
Q

Induction therapy paediatric for Crohn’s

A

1st line
- Liquid based polymeric diet 8/52
- OR 2/12 Prednisolone 1mg/kg slow wean

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3
Q

Maintenance therapy paediatric Crohn’s

A

Azathioprine or MTX
Anti-tumour necrosis factor agents
- Infliximab

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4
Q

Inducing remission therapies Crohn’s

A

Prednisolone
5-ASA - mesalazine
antiTNF if refractory to steroids

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5
Q

Maintenance of remission Crohn’s

A

Azathioprine or MTX
Infliximab

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6
Q

Routine health maintenance of Crohn’s

A

Vaccinations
Osteoporosis prevention
Sexual health
Depression
Yearly skin check
Colon cancer screening

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7
Q

Wernicke encephalopathy sx + tx

A

Triad; ophthalmoplegia, ataxia, confusion
Tx
- Thiamine 500mg IV TDS 7/7 then 100mg IV daily for 2/52 then 100mg PO daily after

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8
Q

Ddx chronic diarrhoea

A

IBS
Functional diarrhoea
IBD
Coeliac / SIBO
C diff / Giardia
Drug - metformin, Abx, NSAID, Mg
Hyperthyroidism
Laxative abuse
Anxiety

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9
Q

Upper GIB hx

A

Reflux/epigastric pain
Weight loss
Odynophagia (oesophageal ulcer)
Alcohol intake
Retching coughing prior to haematemesis (mallory-weiss tear)
Excessive vomiting
NSAID/anticoagulants
Prev episodes of haematemsis/melaena

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10
Q

Cause of Upper GIB

A

Mallory-Weiss
Ruptured oesophageal varices
Gastritis
Bleeding ulcer
Angiodysplasia
Polyps
Malignancy

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11
Q

Mx Upper GIB

A

NBM
IV cannula x2 large bore
IV pantoprazole
Fluid resuscitation
Transfusion
Immediate gastro advice

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12
Q

Rome III criteria IBS

A

Abdo pain 3 days per month for last 3/12 with 2 of following
- Improvement after defecation
- Onset of sx assoc with change in bowel freq
- Onset of sx assoc with change in stool appearance

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13
Q

Mx IBS

A

Regular meal times + portion
Diet
- Avoid known triggers
- Fibre 25g female, 30g male
- Low FODMAP
CBT
Loperamide for diarrhoea
Pain
- Peppermint oil 0.2ml capsule 2 capsules TDS 30min prior to food
Antidepressant to reduce hypersensitivity and pain
- Amitriptyline 5mg nocte
Abx
- Rifaximin 550mg TDS for non-constipated IBS

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14
Q

H pylori mx

A

Esomeprazole 20mg BD 7/7
Amoxicillin 1g BD 7/7
Clarithromycin 500mg BD 7/7
Repeat breath test 4/52 post tx
Smoking cessation
Avoid triggering food
Stress management

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15
Q

DDx conjugated hyperbilirubinaemia

A

Intrahepatic
- ETOH liver disease
- Primary biliary cirrhosis
- Autoimmune hepatitis
- Drug induced
- Wilson’s disease
- HCC
- NALD
- Viral hepatitis
Extrahepatic
- Biliary atresia
- Gallstone
- Chronic pancreatitis
- Pancreatic cancer

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16
Q

Mx GB polyps

A

IF symptomatic or >10mm-> cholecystectomy
Surveillance
- 6-9mm size; USS 6/12 for 1 year - then annually
- <=5mm; USS annually

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17
Q

Acute cholangitis features

A

Charcot’s triad; RUQ, fever, jaundice
Reynold’s Pentad; Charcot’s triad PLUS hypotension and mental status changes

18
Q

Acute pancreatitis causes

A

Idiopathic
Gallstones
ETOH
Trauma
Steroids
Mumps
Autoimmune
Scorpion bite
Hyperlipidaemia
ERCP
Drugs; HCTHZ

19
Q

Mx pancreatitis

A

IV fluids
Morphine/fentanyl
Antiemetic
NBM

20
Q

Risk factors pancreatic ca

A

Smoking
Obesity
ETOH
DM >5 years duration
FDR
BRCA1 carrier

21
Q

Features of pancreatitis

A

> =60yo
weight loss
Back/upper abdo pain
altered bowel habit
nausea/vomiting
new onset diabetes

22
Q

Ix pancreatic cancer

A

Urgent CT abdo + contrast
LFT
Lipase
Coag
Ca19.9, CEA

23
Q

DDx splenomegaly

A

CML
Lymphoma
Thalassaemia
Haemolytic anaemia
Malaria
EBV
Hepatitis
Vasculitis
Sarcoidosis/amyloidosis

24
Q

LFT patterns

A

AST:ALT >2 = ETOH
NAFLD: AST + ALT <4x upper limit
Acute viral/toxin; AST + ALT >25x upper limit
Cholestasis; ALP > 200 and >3x than ALT

25
Q

History for LFT derangement

A

Toxin; drug, ETOH, herbal
IVDU/tattoo/sex/endemic travel
Haemochromatosis; bronze skin, DM, arthritis, hypogonadism
Obesity
Pregnancy; gallstones
IBD; primary sclerosing cholangitis
Coeliac disease
Thyroid

26
Q

Raised ALP cause and work-up

A

DDx; #, osteomalacia, Pagets, hyperparathyroidism, hyperthyroidism, sarcoma, bony mets
Ix
- Ca, PTH, Vit amin D
- Bone scintigraphy

27
Q

Raised transaminases workup

A

Paracetamol level
Viral hepatitis serology
bHCG
Autoimmune screen; ANA, ASMA, Anti-LMK
USS

28
Q

Mx NALFD

A

Fibrosis staging; Fibrosis -4 score or Elastography
Avoid ETOH
Weight loss 5-7%
Hypocaloric diet 500 cal
If metabolic syndrome features -> needs specialist referral and consideration of biopsy
If nil metabolic features -> 6/12 lifestyle mx
Monitoring
- w/o fibrosis - 2 yearly liver scores/elastography
- cirrhosis; 6/112 HCC surveillance (USS + AFP)

29
Q

Indications to tx chronic hep B

A

Immune clearance
- Lower HBV, Raised ALT, HBeAg +ve
Immune escape
- High HBV, Raised ALT, HBeAg -ve, anti-HBe +ve

30
Q

Complications of decompensated cirrhosis

A

Variceal haemorrhage
Ascites
Spontaneous bacterial peritonitis
Hepatic encephalopathy
HCC
Hepatorenal syndrome
Hepatopulmonary syndrome

31
Q

Small intestinal bacterial overgrowth

A

Excess/abnormal bacteria in small bowel
Bloating, distension, flatulence
Glucose breath test positive

32
Q

Coeliac Ix

A

Coeliac serology
- Transglutaminase (tTG) antibody
- Deamidated gliadin peptide antibody
Total IgA can exclude coeliac-disease associated IgA deficiency
HLA DQ2/8 genotyping
- helps with diagnosis if unclear serology/biopsy - good for excluding

33
Q

Coeliac disease mx

A

Education
GF diet +/- dietician
Refer coeliac support group
Screen all FDR
BMD 2 yearly
Repeat gastroscopy 2 years after GFD
Monitor serology as marker of intestinal healing

34
Q

Diverticulitis mx

A

Mild-moderate; conservative
Diet
- Clear liquid 2/7
- Low fibre diet until pain improves
- Panadol +/- buscopan
Systemic features, fever, elevated WCC, failed conservative
- Augmentin 875/125mg BD 5/7
Prevention
- high fibre diet
- cease smoking

35
Q

Eosinophilic oesophagitis

A

Allergic disorder
Unclear cause - milk, wheat, soy, seafood implicated
Sx; dysphagia, heart burn, dyspepsia
Minimal tx with GORD tx
Not assoc with Barrett’s or Ca
Dx biopsy
Mx
- elimination diet - allergy testing
- Topical fluticasone + budesonide

36
Q

Monitoring of Barrett’s oesophagus

A

Short segment <3cm; 3-5 yearly
Long segment; 2-3 yearly

37
Q

Indications for endoscopy

A

Anaemia
Dysphagia/odynophagia
Haematemesis/melaena
Weight loss
New sx in older person
Changing sx
Severe/freq sx
Inadequate response to tx
Diagnostic clarification

38
Q

Distal oesophageal spasm mx

A

GTN 400mcg sublingual
Diltiazem 180mg daily

39
Q

Haemorrhoids mx

A

Avoid straining
Constipation mx
Proctosedyl
Rubber-band ligation

40
Q

Perianal haematoma (aka thrombosed external haemorrhoid) mx

A

Severe pain; excision under LA within 72hrs
Cool compress
Sitz bath BD
Donut pillow to relieve pressure
Increase fibre
Avoid exercise

41
Q

Anal fissure mx

A

High fibre
Stool softener
Sitz bath
GTN 0.2% ointment 1.5cm into anal canal TDS
Topical diltiazem
Botox
Surgical sphincterotomy

42
Q

Malnutrition workup

A

FBC
Blood film
Ferritin
Folate
INR
Albumin
U+E
Lipid
Vitamin D

Gastroenterology (1 decks)

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