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gastro Flashcards

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1
Q

features of type 1 hepatorenal syndrome

A

rapidly progressive
serum creatinine can double or halve in <2 weeks
poor prognosis

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2
Q

mx of hepatorenal syndrome

A

terlipressin to cause vasoconstriction of splanchnic circulation

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3
Q

moa of loperamide

A

decreases gastric motility through stimulation of opioid receptors

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4
Q

mx of variceal haemorrhage

A
  1. terlipressin and ABX (Quinolones), if terlipressin fails Sengstaken-Blakemore tube
  2. endoscopy - band ligation
  3. propranolol
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5
Q

expected liver transaminases in alcoholic hepatitis

A

AST>ALT 2:1

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6
Q

which levels are checked to ensure adequate response to hepatitis B immunisation?

A

anti-HBs

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7
Q

which cancer does Barrett’s oesophagus or GORD increase the risk of?

A

oesophageal adenocarcinoma

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8
Q

which cancer does achalasia increase the risk of?

A

squamous cell carcinoma of the oesophagus

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9
Q

mx of C.diff infection

A
  1. oral metronidazole 10-14 days
  2. oral vancomycin if severe or not responding to metronidazole
  3. oral vancomycin and IV metronidazole if life-threatening
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10
Q

PSC antibody results

A

AMA (antimitochondrial antibody) negative

pANCA positive

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11
Q

what is meant by ‘protein meal’?

A

following an upper GI bleed some blood can be digested causing raised urea but normal creatinine
patient may also have normocytic anaemia

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12
Q

ix to dx PSC

A

MRCP first

ERCP if MRCP not tolerated

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13
Q

polyps in GI tract + pigmented lesions on lips, face, palms and soles

A

Peutz-Jeghers syndrome

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14
Q

spontaneous bacterial petritonitis most common organism in ascitic fluid

A

E. coli

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15
Q

what is Courvoisier’s law

A

in the presence of painless obstructive (aka cholestatic) jaundice a palpable gallbladder is UNLIKELY to be due to gallstones, i.e. pancreatic cancer is possible

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16
Q

obstructive/cholestatic LFTs

A

ALP>ALT

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17
Q

when to 2ww refer patients with dyspepsia

A

all patients who have dysphagia too
all patients with upper abdo mass consistent w stomach cancer
patients >= 55 years with weight loss and any of upper abdo pain, reflux or dyspepsia

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18
Q

secondary prophylaxis of hepatic encephalopathy

A
  1. lactulose

2. rifaximin

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19
Q

classification of UC flares

A

mild <4 stools daily
moderate 4-6 stools daily
severe >6 stools daily

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20
Q

triad for Budd-Chiari syndrome (hepatic vein thrombosis)

A
  1. abdo pain - sudden onset and severe
  2. ascites
  3. tender hepatomegaly
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21
Q

features more common in Crohn’s than UC

A 
non-bloody diarrhoea
weight loss 
upper GI symptoms
skip lesions
abdominal mass in RIF
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22
Q

mx of spontaneous bacterial peritonitis

A 
IV cefotaxime
antibiotic prophylaxis (Ciprofloxacin) should be given too
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23
Q

histology of Crohn’s vs UC

A

Crohn’s - inflammation in all layers from mucosa to serosa

UC - no inflammation beyond submucosa

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24
Q

hepatocellular LFTs

A

ALT>ALP at least 5+

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25
triad of intestinal angina (chronic mesenteric ischaemia)
severe, colicky post-prandial abdo pain weight loss abdominal bruit
26
mx of severe alcoholic hepatitis
corticosteroids (prednisolone)
27
what metabolic consequences can occur in refeeding syndrome
hypophosphataemia hypokalaemia hypomagnesaemia
28
when is oral azathioprine used to maintain remission of UC
following a severe relapse or 2 or more exacerbations in the past year
29
risk factors for oesophageal candidiasis
HIV steroid inhaler use systemic ABX
30
features of gallstone ileus
abdo pain, distension and vomiting | SBO secondary to impacted gallstone
31
mx of mild/moderate UC flare
topical/oral aminosalicylates | if remission not achieved, add oral prednisolone
32
histology of coeliac disease
villous atrophy raised intra-epithelial lymphocytes crypt hyperplasia
33
haemochromatosis iron study results
raised transferrin saturation raised ferritin raised serum iron low TIBC
34
ix for HCC
AFP will be raised
35
how to calculate units
units = volume (ml) x ABV/1000
36
features of primary biliary cholangitis
the M rule | IgM, AMA, Middle aged females
37
cancers associated with HNPCC
colon cancer endometrial cancer gastric cancer pancreatic cancer
38
epigastric pain, known gallstones, vomiting, apyrexial
acute pancreatitis
39
features of biliary colic
RUQ pain | no other features
40
what is cholestyramine used for
it is a bile acid sequestrant used in bile acid malabsorption to prevent diarrhoea
41
features of oesophagitis
hx of heartburn | odynophagia but no weight loss and systemically well
42
crypt abscesses
UC
43
goblet cells
Crohn's
44
granulomas
Crohn's
45
inducing remission in Crohn's
``` glucocorticoids first (prednisolne) mesalazine (5-ASA) may be used if glucocorticoids are not effective ```
46
most common inheritable form of colorectal cancer
HNPCC | FAP is second most common
47
adverse effects of PPIs
hyponatraemia hypomagnesaemia osteoporosis increased risk of C. diff infections
48
FBC in alcoholic liver disease
macrocytic anaemia and thrombocytopenia
49
what test is used to confirm eradication of H. Pylori
urea breath test
50
diagnostic marker for carcinoid syndrome
urinary 5-HIAA
51
when to stop meds before urea breath test
1 day - antacids 2 weeks - PPI 3 days - H2 antagonist, e.g. Cimetidine 4 weeks - ABX
52
H. pylori eradication therapy
PPI + amoxicillin + clarithromycin OR PPI + metronidazole + clarithromycin
53
liver failure following cardiac arrest
think ischaemic hepatitis
54
which test is used to screen for hep B
HBsAg
55
what conditions are associated with H. pylori
peptic ulcer disease gastric cancer B cell lymphoma of MALT tissue atrophic gastritis
56
adverse effects of methotrexate
``` mucositis pneumonitis pulmonary fibrosis myelosuppresssion liver fibrosis ```
57
Wilson's disease bloods
reduced serum caeruloplasmin | reduced total serum copper
58
PSC cancer
cholangiocarcinoma
59
which ABX is used as prophylaxis against SBP
oral ciprofloxacin
60
risk factors for small bowel bacterial overgrowth syndrome (SBBOS)
diabetes mellitus scleroderma neonates w congenital GI abnormalities
61
poor prognostic factors for liver cirrhosis
ascites encephalopathy low albumin
62
features of mesenteric ischaemia
severe abdo pain history of vascular disease lactic acidosis
63
most common presenting features of Crohn's
abdo pain - esp. in children weight loss lethargy diarrhoea - esp. in adults
64
mx of achalasia
pneumatic/balloon dilation Heller cardiomyotomy for recurrent/persistent symptoms high surgical risk patients - intra-sphincteric injection of botulinum toxin
65
ix for UC flare
AXR for toxic megacolon
66
mx of Campylobacter infection
self-limiting but if severe Clarithromycin can be used
67
when is NG feeding used and when should it be avoided
used for patients with impaired swallow | avoid following head injury
68
when is NJ feeding used
safe to use following oesophagogastric surgery
69
when is feeding jejunostomy used
long-term feeding following upper GI surgery
70
when is PEG (percutaneous endoscopic gastrostomy) feeding used and when should it be avoided
long-term feeding | avoid in vomiting as requires endoscopy
71
when is TPN feeding used | why is a central vein needed
in all patients in whom enteral feeding is CI | needs to be via central vein as strongly phlebitis
72
ix for small bowel bacteria overgrowth syndrome
hydrogen breath test
73
autoimmune hepatitis bloods (AST/ALT vs ALP)
predominantly raised ALT/AST on LFTs than ALP
74
mx of autoimmune hepatitis
steroids are first line
75
mx of hiatus hernia
start with conservative therapy (weight loss, smoking cessation, dietary advice and PPI) fundoplication if conservative measures fail
76
how often are surveillance colonoscopies carried out in UC
low risk - every 5 yeas medium risk - every 3 years high risk - every year
77
features of autoimmune hepatitis
amenorrhoea chronic liver disease signs ANA/SMA antibodies raised ALT/AST
78
liver failure triad
encephalopathy (confusion + liver flap) jaundice coagulopathy
79
which anaemia follows ileocaecal resection
macrocytic anaemia due to vitamin B12 deficiency
80
mx of diverticulitis
mild flare - oral ABX | if symptoms do not settle within 72 hours, or severe presentation, admit for IV ABX
81
mx for symptomatic relief in carcinoid tumour
octreotide

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