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Gastroenterology > Extra GI > Flashcards

Extra GI Flashcards

1
Q

Functions of vitamin A:

A
  • retinol
  • converted into retinal - visual pigment
  • epithelial cell differentiation
  • antioxidant
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2
Q

Consequences vitamin A deficiency:

A

night blindness

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3
Q

Vitamin B6 deficiency cause:

A

isoniazid therapy

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4
Q

Consequences of vitamin B6 deficiency:

A
  • peripheral neuropathy
  • sideroblastic anaemia
  • anaemia, irritability, seizures
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5
Q

Function of vitamin B6:

A
  • water soluble
  • converted to pyridoxal phosphate
  • cofactor for transamination, deamination and decarboxylation
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6
Q

Functions of vitamin C:

A
  • ascorbic acid
  • water soluble
  • antioxidant
  • collagen synthesis
  • facilitates iron absorption
  • cofactor for norepinephrine synthesis
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7
Q

Features vitamin C deficiency:

A
  • scurvy - defective collagen synthesis and capillary fragility
  • gingivitis, loose teeth
  • poor wound healing
  • bleeding from gums, haematuria, epistaxis
  • general malaise
  • follicular hyperkeratosis and perifollicular haemorrhage
  • ecchymosis, easy bruising
  • Sjogren’s
  • arhtralgia
  • oedema
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8
Q

Functions of vitamin B1:

A
  • thiamine
  • water soluble
  • phosphate derivative - thiamine pyrophosphate
  • co-enzyme in enzymatic reactions
  • catabolism of sugars and amino acids
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9
Q

Causes of thiamine (B1) deficiency:

A
  • alcohol excess

- malnutrition

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10
Q

Conditions associated with thiamine deficiency:

A
  • Wernicke’s encephalopathy: nystagmus, ophthalmoplegia and ataxia
  • Korsakoff’s syndrome: amnesia, confabulation
  • dry beriberi: peripheral neuropathy
  • wet beriberi: dilated cardiomyopathy
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11
Q

Function of vitamin B3:

A
  • niacin
  • water soluble
  • precursor to NAD+ and NADP+
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12
Q

Consequences niacin deficiency:

A

pellagra: dermatitis, diarrhoea, dementia

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13
Q

Vitamin B7 deficiency consequences:

A
  • biotin

- dermatitis, seborrhoea

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14
Q

Vitamin B9 deficiency consequences:

A
  • folic acid
  • megaloblastic anaemia
  • deficiency during pregnancy: neural tube defects
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15
Q

Vitamin B12 deficiency consequences:

A
  • cyanocobalamin
  • megaloblastic anaemia
  • peripheral anaemia
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16
Q

Other name for vitamin D:

A
  • ergocalciferol

- cholecalciferol

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17
Q

Vitamin E deficiency:

A
  • tocopherol
  • tocotrienol
  • midl haemolytic anaemia in newborn infants, ataxia, peripheral neuropathy
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18
Q

VItamin K deficiency:

A
  • naphtoquinone
  • haemorrhagic disease of newborn
  • bleeding diathesis
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19
Q

First line investigation of dysphagia:

A
  • upper GI endoscopy
  • motility disorders: fluoroscopic swallowing studies
  • FBC
  • achalasia and GORD: oesophageal pH and manometry
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20
Q

What is the liver like in RHF:

A

firm, smooth, tender liver edge

pulsatile

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21
Q

What is hepatomegaly like in malignancy?

A

hard, irregular liver edge

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22
Q

What is hepatomegaly like in cirrhosis?

A

later disease: decreases in size

non-tender, firm liver

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23
Q

What causes melanosis coli and what does histology show?

A
  • laxative abuse (anthraquinone e.g. senna)
  • pigmentation of bowel wall
  • pigment laden macrophages
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24
Q

What is the most common cause of HCC worldwide?

A

hepatitis B

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25
Q

What is the most common cause of HCC in Europe:

A

hepatitis C

26
Q

Who should be screened for HCC?

A
  • cirrhosis secondary to hep B and C or haemachromatosis

- secondary to alcohol

27
Q

Management options HCC:

A
  • early disease: surgical resection
  • liver transplantation
  • radiofrequency ablation
  • transarterial chemoembolisation
  • sorafenib: multikinase inhibitor
28
Q

What qualifies as malnutrition:

A
  • BMI <18.5
  • unintentional weight loss greater than 10% within last 3-6months
  • BMI less than 20 and unintentional weight los greater than 5% in 3-6 months
29
Q

Consideration of IBS:

A

6 months of

  • abdominal pain and/or
  • bloating and/or
  • change in bowel habit
30
Q

Diagnosis of IBS:

A

-abdominal pain relieved by defecation with 2 of:
-altered stool passage
-abdominal bloating
-symptoms worse by eating
-passage of mucus
(also lethargy, nausea, backache, bladder)

31
Q

Red flag symptoms when diagnosing IBS:

A
  • rectal bleeding
  • weight loss
  • family history of bowel or ovarian cancer
  • onset after 60
32
Q

Primary care investigations IBS:

A
  • FBC
  • ESR/CRP
  • coeliac disease screen (TTG)
33
Q

‘urgent’ symptoms indicating oesophageal or stomach cancer:

A
  • all dysphagia
  • upper abdominal mass
  • > =55yo with weight loss and any of pain, reflux or dyspepsia
34
Q

‘non urgent’ symptoms suggesting oesophageal cancer or stomach cancer:

A
  • haematemesis

- >=55yo with treatment resistant dyspepsia, or upper abdo pain with low Hb or raised platelet with symptoms etc.

35
Q

How can you treat someone with dyspepsia which do not meet referral criteria?

A
  1. review medications for possible causes
  2. lifestyle
  3. trial full dose PPI for 1 month or test and treat H pylori
36
Q

Underweight BMI

A

<18.49

37
Q

Normal BMI:

A

18.5-25

38
Q

Overweight BMI

A

25-30

39
Q

Obese I

A

30-35

40
Q

Obese II

A

35-40

41
Q

Obese III

A

> 40

42
Q

What type of tumours are most pancreatic tumours?

A

adenocarcinomas

43
Q

Associations pancreatic cancer?

A
  • hereditary non-polyposis colorectal carcinoma
  • MEN
  • BRCA 2
  • KRAS
  • chronic pancreatitis
  • smoking
  • diabetes
  • age
44
Q

Features of pancreatic cancer:

A
  • painless jaundice
  • pale stools, dark urine, pruritus
  • cholestatic liver function tests
  • steatorrhoea
  • atypical back pain
  • migratory thrombophlebitis (Trousseau)
45
Q

Investigations pancreatic cancer:

A
  • US
  • high res CT - if diagnosis suspected
  • double duct sign
46
Q

Antidiarrhoeal agents:

A

-loperamide
-diphenoxylate
(opioid agonists)

47
Q

What is metoclopramide used for?

A
  • D2 receptor antagonist
  • nausea
  • GORD
  • prokinetic - gastroparesis
48
Q

ADR metoclopramide:

A

-extrapyramidal: oculogyric crisis
-hyperprolactinaemia
-tardive dyskinesia
-parkinsonism
avoid in bowel obstruction

49
Q

Prophylactic ABx splenectomy:

A

penicillin V (500mgBD or amoxicillin 250mgBD)

50
Q

Vaccination with splenectomies:

A
  • elective: 2 weeks before
  • Hib, meningitis A and C
  • annual influenza
  • pneumococcal
51
Q

Type I herpatorenal syndrome:

A
  • rapidly progressive
  • doubling of serum creatinine to >221micromol/L or halving of creatinine clearance to less than 20ml/min over less than 2 weeks
  • very poor prognosis
52
Q

Type II hepatorenal syndrome:

A
  • slowly progressive
  • poor prognosis
  • may live longer
53
Q

Management hepatorenal syndrome:

A
  • vasopressin analogues e.g. terlipressin
  • volume expansion 20% albumin
  • TIPSS
54
Q

ADR PPI:

A
  • hyponatraemia, hypomagnesaemia
  • osteoporosis - increased risk of fractures
  • microscopic colitis
  • increased risk of C diff
55
Q

What is bile acid malabsorption:

A
  • cause of chronic diarrhoea
  • excessive bile acid production or reduced absorption
  • leads to steatorrhoea and vitamin ADEK malabsorption
  • secondary causes: cholecystectomy, coeliac, small intestinal bacterial overgrowth
56
Q

Investigation bile acid malabsorption:

A

SeHCAT

57
Q

Management bile acid malabsorption:

A

bile acid sequestrates e.g. cholestyramine

58
Q

Risk factors small bowel bacterial overgrowth syndrome:

A
  • neonates with congenital GI abnormalities
  • scleroderma
  • diabetes mellitus
59
Q

Diagnosis small bowel bacterial overgrowth syndrome:

A
  • hydrogen breath test

- small bowel aspiration and culture

60
Q

Antibiotic therapy for small bowel bacterial overgrowth syndrome:

A

rifaximin

co-amoxiclav or metronidazole

Gastroenterology (4 decks)

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