Extra GI Flashcards
(60 cards)
1
Q
Functions of vitamin A:
A
- retinol
- converted into retinal - visual pigment
- epithelial cell differentiation
- antioxidant
2
Q
Consequences vitamin A deficiency:
A
night blindness
3
Q
Vitamin B6 deficiency cause:
A
isoniazid therapy
4
Q
Consequences of vitamin B6 deficiency:
A
- peripheral neuropathy
- sideroblastic anaemia
- anaemia, irritability, seizures
5
Q
Function of vitamin B6:
A
- water soluble
- converted to pyridoxal phosphate
- cofactor for transamination, deamination and decarboxylation
6
Q
Functions of vitamin C:
A
- ascorbic acid
- water soluble
- antioxidant
- collagen synthesis
- facilitates iron absorption
- cofactor for norepinephrine synthesis
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
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
9
Q
Causes of thiamine (B1) deficiency:
A
- alcohol excess
- malnutrition
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
11
Q
Function of vitamin B3:
A
- niacin
- water soluble
- precursor to NAD+ and NADP+
12
Q
Consequences niacin deficiency:
A
pellagra: dermatitis, diarrhoea, dementia
13
Q
Vitamin B7 deficiency consequences:
A
- biotin
- dermatitis, seborrhoea
14
Q
Vitamin B9 deficiency consequences:
A
- folic acid
- megaloblastic anaemia
- deficiency during pregnancy: neural tube defects
15
Q
Vitamin B12 deficiency consequences:
A
- cyanocobalamin
- megaloblastic anaemia
- peripheral anaemia
16
Q
Other name for vitamin D:
A
- ergocalciferol
- cholecalciferol
17
Q
Vitamin E deficiency:
A
- tocopherol
- tocotrienol
- midl haemolytic anaemia in newborn infants, ataxia, peripheral neuropathy
18
Q
VItamin K deficiency:
A
- naphtoquinone
- haemorrhagic disease of newborn
- bleeding diathesis
19
Q
First line investigation of dysphagia:
A
- upper GI endoscopy
- motility disorders: fluoroscopic swallowing studies
- FBC
- achalasia and GORD: oesophageal pH and manometry
20
Q
What is the liver like in RHF:
A
firm, smooth, tender liver edge
pulsatile
21
Q
What is hepatomegaly like in malignancy?
A
hard, irregular liver edge
22
Q
What is hepatomegaly like in cirrhosis?
A
later disease: decreases in size
non-tender, firm liver
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
24
Q
What is the most common cause of HCC worldwide?
A
hepatitis B
25
What is the most common cause of HCC in Europe:
hepatitis C
26
Who should be screened for HCC?
- cirrhosis secondary to hep B and C or haemachromatosis
| - secondary to alcohol
27
Management options HCC:
- early disease: surgical resection
- liver transplantation
- radiofrequency ablation
- transarterial chemoembolisation
- sorafenib: multikinase inhibitor
28
What qualifies as malnutrition:
- 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
Consideration of IBS:
6 months of
- abdominal pain and/or
- bloating and/or
- change in bowel habit
30
Diagnosis of IBS:
-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
Red flag symptoms when diagnosing IBS:
- rectal bleeding
- weight loss
- family history of bowel or ovarian cancer
- onset after 60
32
Primary care investigations IBS:
- FBC
- ESR/CRP
- coeliac disease screen (TTG)
33
'urgent' symptoms indicating oesophageal or stomach cancer:
- all dysphagia
- upper abdominal mass
- >=55yo with weight loss and any of pain, reflux or dyspepsia
34
'non urgent' symptoms suggesting oesophageal cancer or stomach cancer:
- haematemesis
| - >=55yo with treatment resistant dyspepsia, or upper abdo pain with low Hb or raised platelet with symptoms etc.
35
How can you treat someone with dyspepsia which do not meet referral criteria?
1. review medications for possible causes
2. lifestyle
3. trial full dose PPI for 1 month or test and treat H pylori
36
Underweight BMI
<18.49
37
Normal BMI:
18.5-25
38
Overweight BMI
25-30
39
Obese I
30-35
40
Obese II
35-40
41
Obese III
>40
42
What type of tumours are most pancreatic tumours?
adenocarcinomas
43
Associations pancreatic cancer?
- hereditary non-polyposis colorectal carcinoma
- MEN
- BRCA 2
- KRAS
- chronic pancreatitis
- smoking
- diabetes
- age
44
Features of pancreatic cancer:
- painless jaundice
- pale stools, dark urine, pruritus
- cholestatic liver function tests
- steatorrhoea
- atypical back pain
- migratory thrombophlebitis (Trousseau)
45
Investigations pancreatic cancer:
- US
- high res CT - if diagnosis suspected
- double duct sign
46
Antidiarrhoeal agents:
-loperamide
-diphenoxylate
(opioid agonists)
47
What is metoclopramide used for?
- D2 receptor antagonist
- nausea
- GORD
- prokinetic - gastroparesis
48
ADR metoclopramide:
-extrapyramidal: oculogyric crisis
-hyperprolactinaemia
-tardive dyskinesia
-parkinsonism
avoid in bowel obstruction
49
Prophylactic ABx splenectomy:
penicillin V (500mgBD or amoxicillin 250mgBD)
50
Vaccination with splenectomies:
- elective: 2 weeks before
- Hib, meningitis A and C
- annual influenza
- pneumococcal
51
Type I herpatorenal syndrome:
- 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
Type II hepatorenal syndrome:
- slowly progressive
- poor prognosis
- may live longer
53
Management hepatorenal syndrome:
- vasopressin analogues e.g. terlipressin
- volume expansion 20% albumin
- TIPSS
54
ADR PPI:
- hyponatraemia, hypomagnesaemia
- osteoporosis - increased risk of fractures
- microscopic colitis
- increased risk of C diff
55
What is bile acid malabsorption:
- 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
Investigation bile acid malabsorption:
SeHCAT
57
Management bile acid malabsorption:
bile acid sequestrates e.g. cholestyramine
58
Risk factors small bowel bacterial overgrowth syndrome:
- neonates with congenital GI abnormalities
- scleroderma
- diabetes mellitus
59
Diagnosis small bowel bacterial overgrowth syndrome:
- hydrogen breath test
| - small bowel aspiration and culture
60
Antibiotic therapy for small bowel bacterial overgrowth syndrome:
rifaximin
| co-amoxiclav or metronidazole
