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Clinical Years / Progress Test > Gastro > Flashcards

Gastro Flashcards

1
Q

What symptoms are characteristic of irritable bowel syndorme (IBS)?

A

bloating
pain
diarrhoea +/- mucus
constipation
no bleeding
no weight loss

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2
Q

what marker is used to detect GI inflammation (in IBD)?

A

faecal calprotectin

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3
Q

what characterises infectious diarrhoea?
management?

A

sudden onset
other systemic features; fever and malaise
others with similar symptoms

oral rehydration and paracetamol

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4
Q

what diet changes can help with IBS?

A

exclude wheat fibre - white cereals not brown
less fruit and veg
can cut out FODMAPs

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5
Q

what drugs can help in IBS?

A

all are symptomatic:
antispasmodics
anticholinergics
anti diarrhoea e.g. loperamide
laxative is constipated
low doses of TCAs
probiotics can be helpful

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6
Q

Features more in UC than Crohn’s

A

continuous inflammation; rectum to IC valve
inflammation confined to submucosa
bloody diarrhoea
primary sclerosing cholangitis
uveitis
more associated with colon cancer

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7
Q

Features more in Crohn’s than UC

A

more painful
deeper infalmmation
bowel obstructions/fistulae
skip lesions mouth to anus
goblet cells
non-bloody diarrhoea
weight loss

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8
Q

causative organisms of infective diarrhoea

A

bacteria; E coli, campylobacter, salmonella, Cl.difficile
Viruses; Noro and rotaviruses
Parasites; Giardia, cryptosporidium, schistosomiasis

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9
Q

what is Wilson’s disease?
symptoms?
treatment?

A

autosomal recessive disorder of excess copper deposition in the tissues

liver and neurological symtpoms + kayser fleischer rings in the eyes

treatment is penicillamine- chellates copper

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10
Q

acute treatment of oesophageal bleeding

prophylaxis of oesophageal bleeding

A

acute; terlipressin + antibiotics

prophylaxis; non selective Beta-blocker e.g. propranolol
Band ligation

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11
Q

treatment for clostridium difficile infection

A

oral vancomycin

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12
Q

what is SAAG gradient?
what does a high SAAG >11 indicate?

A

Serum-ascitic albumin gradient.
SAAG indirectly measures portal pressure

high SAAG indicates portal hypertension and the ascitic fluid is a transudate

low SAAG indicates exudate

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13
Q

treatment of mild to moderate UC flare

A

rectal aminosalicylate (mesalazine, sulfalazine)
then oral aminosalicylate

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14
Q

treatment of severe UC flare

A

treat in hospital
IV corticosteroids

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15
Q

maintaining remission in UC

A

continue rectal aminosalicylate +/- oral aminosalicylate

after severe or >2 in a year: oral azathioprine or oral mercaptopurine

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16
Q

what is barrett’s oesophagus?

A

metaplasia of the lower oesophageal mucosa, with the usual squamous epithelium being replaced by columnar epithelium. There is an increased risk of oesophageal adenocarcinoma
manage with a PPI and surveillance

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17
Q

causes of upper GI bleeds

A

oesophageal varices: lots of bright red vblood
oesophagitis
cancer
mallory-weiss tear: mall to moderate volume of bright red blood following a bout of repeated vomiting

gastric ulcer, cancer, gastritis

duodenal ulcer: can erode to gastroduodenal artery

18
Q

scoring systems for upper GI bleeds

A

pre endoscopy; glasgow-blatchford score

post; Rockall

19
Q

what is ferritin? what does it show

A

protein that binds to iron in cells

high levels can show iron overload, or casued by acute inflammation, alcohol, liver/kidney disease

low levels correlate with reduced iron

20
Q

carcinoid syndrome; causes & symptoms

A

usually liver mets producing vascoactive amines; 5HT, prostaglandins
abdominal pain, diarrhoea and flushing

21
Q

2WW for upper GI cancers

A

anyone with dysphagia
OR
aged 55+ with weight loss and one of
- upper abdo pain
- reflux
- dyspepsia

22
Q

Bowel cancer staging system

A

Duke’s
A - confined to mucosa
B - through to serosa but no LNs
C - local lymph node infiltration
D - organ metastasis

can also use TNM

23
Q

Treatment for Crohn’s flare up

A

corticosteroids to induce remission
Azathioprine or mercaptopurine or methotrexate can be added

24
Q

maintaining remission in Crohn’s

A

Azathioprine or mercaptopurine or methotrexate
immunnosuppressants may be used
Metronidazole and infliximab can also be used

25
Q

drugs in triple therapy for H. Pylori

A

amoxicillin, clarithromycin, and omeprazole

26
Q

achlasia management

A

pneumatic balloon

botulinum toxin injection

Heller cardiomyotomy surgery

27
Q

what is haemachromatosis?

symptoms?

A

autosomal recessive disorder resulting in iron accumulation
fatigue, erectile dysfunciton and athralgia often of the hands
bronze skin pigmentation
diabetes, liver problems and heart problems

28
Q

what malignancy is associated with coeliac disease

A

Enteropathy-associated T cell lymphoma

29
Q

2WW for lower GI cancers

A

40+ unexplained weight loss and abdominal pain
or
50 + unexplained rectal bleeding
or
60 + iron deficiency anaemia or change in bowel habit
or
anyone with occult blood in faeces

30
Q

assessing for fluid in the abdomen/thorax

A

FAST scan

31
Q

what complications are associated with coeliac disease

A
  • osteoporosis
  • T cell lymphoma
  • deficiency anaemias
  • subfertility
  • lactose intolerance
32
Q

what is the most common cause of
- small bowel obstruction
- large bowel obstruction

A

small; adhesions then hernias
large; cancer

33
Q

presentation of primary biliary cholangitis

treatment

A

fatigue, cholestatic liver biochemistry, positive mitochondrial antibodies and raised IgM

ursodeoxycholic acid

34
Q

What is a Mallory Weiss tear

A

Lacerations at the gastro oesophageal junction resulting in haemetemesis, severe vomiting and pain

35
Q

What is Boerhaaves syndrome

A

Oesophageal rupture- presents with vomiting, thoracic pain, subcutaneous emphysema. It typically presents in middle aged men with a background of alcohol abuse.

36
Q

what drugs can cause a hepatocellular liver failure

A

paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin

37
Q

what drugs can cause a cholestatic liver failure

A

combined oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas

38
Q

autoimmune hepatitis
- presentation
- antibodies
- management

A

presentation; most commonly seen in young females. signs of chronic liver disease, occasionally with acute hepatitis. amenorrhoea.

Anti Nuclear and/or anti Smooth-Muscle

Steroids, other immunosuppressants e.g. azathioprine
Liver transplantation

39
Q

alcoholic ketoacidosis

A

non-diabetic euglycaemic ketoacidosis

metabolic acidosis
elevated ketones
normal glucose

treatment infusion of saline and thiamine

40
Q

management of severe alcoholic hepatitis

A

prednisolone

Clinical Years / Progress Test (24 decks)

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