Gastro Flashcards
(170 cards)
1
Q
What investigation would you get for suspected appendicitis?
A
Normally a clinical dx
You may need to get a pelvic USS to exclude ovarian cyst accident
CT abdomen - if uncertain
2
Q
What score can you use for appendicitis
A
Alvarado score
>4 is high likelyhood of it being appendicitis
3
Q
What are the three signs you can get in appendicitis
A
Rosvig’s sign
Cope’s sign
Psoas sign
4
Q
What is Rosvig sign
A
Pain worse in RIF when pressing down on LIF
5
Q
What is Cope sign
A
Pain on passive flexion and internal rotation of hip
6
Q
What is Psoas sign, and what does it indicate exactly
A
Pain on extending hip
Indicates RETROCAECAL APPENDIX
7
Q
How would you manage appendicitis
A
start prophylactic antibiotics before surgery
THEN laparoscopic appendicectomy
8
Q
what extra thing must you do if appendicitis is perforated
A
ABDOMINAL LAVAGE
9
Q
What is ascending cholangitis
A
INFECTION of the biliary traact
10
Q
What causes ascending cholangitis
A
Obstruction + infection
Obstruction can be caused by:
- gallstones
- ERCP
- cholaangiocarcinoma
- pancreatitis
- PSC
11
Q
How will pt with ascending cholangitis present
A
ACUTELY UNWELL - MAY BE SEPTIC
Charcot’s triad: fever + RUQ pain + jaundice
Reynaud’s pentad: + hypotension + confusion
12
Q
How do you investigate and manage suspected ascending cholangirtis
A
Bloods: Raised ALP and GGT
Ix: USS biliary tract (will show thickened wall and bile duct dilatation)
ERCP (ix and mx) - to clear obstruction
If cause was gall stones, may need cholecystectomy
13
Q
How do you manage acute cholangitis
A
IV Abx AND ERCP within 24-48h
14
Q
What are the three types of gallbladder disease you can get?
A
BILIARY COLIC: stones causing pain in gallbladder neck
CHOLECYSTITIS: inflammation of gallbladder
ASCENDING CHOLANGITIS: inflammation of bile duct
15
Q
Describe the three types of gall stones
A
cholesterol (if fat, poor diet)
pigment (if haemolytiic anaemia)
mixed
16
Q
What are RF for gallstones
A
Fat Fair Fourty Female FH
+ OCP, pregnancy, haemolytic anaemia
17
Q
What is a biliary colicj
A
stones in the neck of gallbladder causing pain on contraction
18
Q
Describe the pain in a biliary colic
A
Colicky (intermittent)
Triggered by eatiing fatty foods
Sudden, dull
In RUQ
19
Q
How do you investigate for gallbladder pathology
A
- bloods: FBC, CRP, LFT, amylase, blood cultures
- urinanalysis (inc preg test)
- Transabdominal USS of gallbladder and bile ducts
- MRCP if nothing visible (gold standard for gallstones)
20
Q
what do you see on USS of gallbladder in pathology
A
thickened wall
Bile duct dilatation
Gallstones
21
Q
How do you manage biliary colic
A
- Analgesia: regular paracetamol +/- NSAIDs +/- opiates analgesia
- Lifestyle advice: low fat diet, weight loss, exercise
- Offer elective laparoscopic cholecystectomy within 6 weeks of first presentation
22
Q
What are symptoms of cholecystitis
A
Pain: Constant, RUQ, may refer to shoulder/back)
Fever
23
Q
cholecystitis signs
A
- tender in RUQ
- tachycardia, fever
- assess for guarding, rigidity, rebound tenderness (peritonitis)
- murphy’s sign positive: apply pressure to RUQ, ask patient to inspire –> halt in inspiration due to pain
24
Q
How do you manage acute cholecystitis
A
NBM
IV FLUIDS
IV analgesia, antiemetics **
IV ABX (coamoxiclav +/- metronidazole**)
Laparoscopic cholecystectomy (<72h)
25
complications of biliary colic/cholecystitis
* **gallbladder empyema** (filled with pus --> sepsis)
* **chronic cholecystitis**
* **Bouveret’s syndrome** (gallstones causing gastric outlet obstruction --> fisutla forms to small bowel)
26
What are symptoms and signs of pancreatitis
severe epigastric pain radiating to back, N&V
| Cullen's (periumbilical), grey turner sign (retroperitoneal=
27
What Ix must you get for acute pancreatitis
serum amylase 3x normal upper range (although does not correlate to disease severity)
consider serum lipase (more S&S, not as available)
ABG (will need PO2 for Glasgow score)
FBC, U&E, LFT, Albumin, BG, calcium
USS (exclude gallstones)
CT abdo (if clinical uncertainty)
28
What scoring systems can you use for acute pancreatitis
Ranson
Apache II
Modified Glasgow
29
What are the contents of the glasgow score
```
PANCREAS
PaO2 <8
Age >55
Neutrophils
Calcium LOW
Urea high
Enzymes high (LDH>, AST/ALT>200)
ALbumin (<32)
Sugar >10
```
30
How do you manage pancreagtitis
SUPPORTIVE tx
aggressive IV fluid resus > maintainance
analgesia (IV morphile 1-2mg STAT boluses until comfortable)
antiemetics
Consider NG tube and fluid balance chart (catheter)
Correct cause f possble
31
Pancreatits complications
EARLY: DIC, ARDS, hypocalcaemia, hyperglycaemia
LATE: pseudocyst, pancreatic abscess, pancreatic necrosis
32
What classification can you use for diverticulitis
Hinchley classification 1-4
33
What investigation do you go for acute diverticulitis
CT abdomen (never colonoscopy acutely, as perforation risk)
| fbc (high SCC), crp high, U+E, VBG, clottin, consider faeca calprotectin
34
acute diverticulitis symptoms
* acute abdominal pain
* sharp/cramping in nature
* **LIF**
* worsened by movement
* decreased appetite
* pyrexia
* nausea and vomiting
* bloating
* bleeding per rectum, mucus in stool
| use of corticosteroids or immunosuppressants can mask the sx
35
What is the management of acute diverticulitis
IV Abx, IV fluids, analgesia - NBM
If severely unwell: Hartmann's procedure (sigmoid colectomy with end colostomy > anastamosis at later date, only possible in 50% of patients)
36
what is the region affected by UC
colon only- starts in rectum and spreads proximally, in continuous manner (up to iliocaecal valce)
37
what is the levels of the gut layers affected by UC
SUPERFICIAL: Mucosa and submucosa only
38
What is the inflammation like pathologically for UC (so on biopsy)?
continuous (**leadpipe** colon = loss of haustra)
Mucosal ulcers -> **pseudopolyps**
**Goblet cell depletion**
**Crypt abscesses**
**thumbprinting**
**Friable mucosa** with loss of vascular markings
39
what condition is rellated to UC
PSC
40
What are typical symptoms of UC
BLOODY diarrhoea
MUCOUS
LIF pain
proctitis (inflammation of rectum) -> PR bleed, inc frequency, urgency, incontinence tenesmus
41
what is the layer affected by CD
Transmural, with NON CASEATING GRANULOMAs
42
what is the region of gut affected by CD
ALL OF IT
| Mouth to anus
43
what is the most common region affected by CD D
Terminal ileum
44
what are signs on biospy of histology for CD
skip lesions
rose thorn ulcers
cobblestone mucosa
string of kantor (narrow ileum stricture)
45
what IBD condition are abscesses / fissures common in
in CHRON's
46
What are chron's sx
non bloody diarrhoea
RIF mass and pain
mouth ulcers, fissures in ano, perianal skin tags
FAILURE TO THRVE
47
How unwell are patients during flares between CD and UC
CD: systemically unwerll
UC: well
48
what personal factor can precipitate a UC flare?
stopping smoking
49
what are extra intestinal manifestations of IBD
```
**A RIPE SAC **
* **A**phtous ulcers
* **R**enal stones
* I (EYE) - episcleritis, anterior uveitis, iritis
* **P**yoderma gangrenosum
* **E**rythema nodosum
* Primary **S**clerosing cholangitis (UC)
* **A**rthritis
* **C**lubbing
```
50
What investigations shoulld you get for suspected IBD
* bedside: **DRE**
* **Bloods**: FBC, U+E, CRP, LFT, albumin, pANCA, blood culture, clotting
* **Stool:** Faecal calprotectin (marker of inflamm), microscopy and culure
* acute setting = AXR rule out toxic megacolon, CXR (rule out perforation)
* **Barium swallow** (fluoroscopy)
* **colonoscopy and biopsy**: GOLD STANDARD
51
what is the two key steps in mx of chron's disease
Induce remission --> maintain remission
52
how do you induce remission in chron's
* Mild-moderate attack = **Prednisolone** 40mg/PO for 1 week)
* Severe attack = admit, IV fluids, analgesia, IV steroids: **hydrocortison**e 100mg/6h IV or methylprednisolone 40mg/12h
5-ASA drugs (e.g. mesalazine) are used second-line to glucocorticoids but are not as effective
**Nutritiona**l: replace diet with whole protein modular diet (excessively liquid for 6-8 weeks)
53
How do you maintain remission in chron's
1. **stop smoking **
2. Immunosuppresives: **azathioprine, mercaptopurine, methotrexate**)
3. Alternatives: aminosalicylate, **biologics** (induce and maintain) ~** anti-TNF a (infliximab**)
| (beware that continuing steroids can have long term consequences)
54
How do you induce remission in UC
1. Mesalazine topical or oral
2. prednisolone or iv hydrocortisone (if severe)
55
how do you maintiain remission in UC
1. Aminosalicylate: mesalazine
2. Biologics: azathioprine, mercaptopurine
3. Offer colonoscopic surveillance if disease > 10 years and > 1 bowel segment affected
56
What must you always measure before starting someone on azathioprine
TPMT (enzyme required for its breakdown)
if TPMT is low, give methotrexate instead
57
Which IBD type is surgery curative for?
UC
58
What type of surgery is typically done for UC
Total proctocolectomy with ileostomy (removes colon, rectum and anal canal)
59
what is classic presentation of IBS
- **young, female** who is **anxious, stressed, depressed**
- 6 months+ of **colicky abdo pain** = **relieved by defecation/farting, worsened by eating**
- **bloating**
- **diarrhoea / constipation**
- altered stol passage: i.e **straining, urgency, ncomplete evacuation**
60
red flag smptoms for abdo pain
| ?colon cancer
* history < 6 months
* FLAWS
* anaemia
* PR bleeding
* late onset > 60
61
How do you diagnose IBS
Diagnosis of EXCLUSION, based on ROME III criteria
- improvement with defecatioon
- change in stool frequency
- change in stool form / appearance / consistency
62
management of IBS
Advice: **dietary modification** – fibre, lactose, fructose, wheat, starch, caffeine, alcohol, fizzy drinks may worsen symptoms
For **constipation**: **increase soluble fibre**, bisacodyl and sodium picosulfate
Medical:
- **Antispasmodics** (e.g. **buscopan**) – for colic/bloating
- **Prokinetic** agents (e.g. **domperidone**, metaclopramide) – promotes gastric emptying, given before endoscopy
- Anti-diarrhoeals (e.g. **loperamide**) –
- **Laxatives** (e.g. **senna, movicol, lactulose**) –
- **Low-dose tricyclic antidepressants** (may reduce visceral awareness) – for psychological symptoms/visceral hypersensitivity
Psychological therapy:
- **CBT**
- **Relaxation and psychotherapy**
63
What are haemorrhoids
vascular cushions that protrude through the rectum via straining on defecation
64
What are the four classes of haemorrhoids
1: in rectum
2. prolapse through anus, reduce spontaneously
3. prolapse though anus, manual reduction
4. persistently prolapsed (not prolapsed)
65
where are haemorrhoids usualy found
3, 7, 11 oclock
66
clincial features of hemorrhoids
Painless bright red rectal bleeding (if thrombosed = very painful)
pruritis
rectal fullness or anal lump
| most common cause of rectalbleeding
67
what type of procedure may need to be done if suspecting internal haemorrhoids
**proctoscopy** / flexible sigmoidoscopy
68
how do you manage haemorrhoids
Conservative: increase fluid/fibre,
Medical: stool softener, topical analgesia, steroids
Non-operative: **rubber band ligation**, **injection sclerotherapy**
Operative: **haemorrhoidectomy**
69
what is coeliac disease due to and what does it cause in the GI tract
gluten intolerance --> chronic intestinal malabsorption
* AUTOIMMUNINE response to gliadin (gluten, wheat, barley, rye)
* leads to shorter villli and flat mucosa
| SUBTOTAL VILLOUS ATROPHY + CRYPT HYPERPLASIA
70
What are the AI HLA associations of coeliac
HLA DQ2, HLA DQ8
71
What are symoptoms of coeliac
watery frothy stooll (staethorroea)
Failure to thrive
Insufficient growth in chikldren
72
what skin condition is pathomnemonic for coeliac
derrmatitis herpetiformis
| vesicular pruritic slin eruption
73
What substances can someone with coeliac be deficient to
iron
B12
folate
74
what else must you screen for if suspecting coelilac disease
T1DM, AI thyroid disease, IBS,
75
What initial investigations must you do for coeliac
- Bloods: **FBC, Iron studies (Low ferritin, low folate, iron deficiency anaemia), B12, U&Es, LFTs, CRP, Calcium**
- Serology: **anti TTG and anti EMA** + Total IgA
- blood smear (target cells and howell-jolly)
- **Stool culture** to exclude infection, faecal elastase to exclude pancreatitis, faecal calprotectin
| 1 in 600 are IgA deficient so check total IgA before doing serology
76
how do you confirm coeliac + findings
**OGD + small intestine biopsy**
* (villous atrophy, crypt hyperplasia, intra epithelial lymphocytes)
77
How do you manage coeliac
MDT
Conservative:
- dietary advice: **LIFELONG GLUTEN FREE DIET**, dietician referral if problems adhering to diet
- annual 6-12 month review
Medical
- **Iron, folate, calcium, vitamin d supplements**
- **Pneumococcal vaccine** + booster every 5 years (as they have a degree of functional **hyposplenism**)
78
complications of coeliac disease
* iron, folate > b12 deficiency
* osteomalacia and osteoporosis (DEXA every 3-5 years)
* Functional hyposplenism and splenic atrophy -> damaged spleen cant remove red cell inclusions -> Howell-jolly bodies on blood film
79
what is the difference in terms of location between PBC and PSC
```
PBC = intrahepatic bile ducts only
PSC = intra and extrahepatic bile ducts
```
80
Define PBC
chronic inflammation to INTRAHEPATIC bile duct, causing progressive cholestasis > CIRRHOSIS
presumed AI ORIGIN
81
What are other conditions associated with PBC
Sjogren
RhA
thyroid disease
systemic sclerosis
82
what are classical sx of PBC
itching in a middle aged woman
- pruritus
- obstructive jaundice
RUQ pain
83
What investigations should you get for PBC
Liver panel: raised GGT/ALP, normal transaminase
Autoantibodies: AMA, high IgM serum
Biopsy (only if in doubt)
84
How do you manage PBC
ursodeoxycholic acid
fat soluble vitaminb supplements
consider cholestyeramine for pruritus, pred if other AI disease
for end stage disease: liver transplant
85
What rule can you use to remember PBC
Rule of Ms
Middle aged women
AMA
raised IgM
86
What is PSC
biliary disease caused by INFLAMM and FIBROSIS in INTRA and EXTRAhepatic bile ducts
87
What condition is PSC associated with
UC
88
Sx of PSC
pruritus
obstructive jaundice
RUQ pain
staethorroea
89
Ix PSC
positive pANCA
MRCP > ERCP (beaded appearance)
Biopsy of duct (fibrous, obliterative cholangitis - onion skinn)
90
mx of PSC
supportive > liver transplant
91
how does gender change in PBC vs PSC
PBC mostly women,
| PSC mostly men
92
what signs can you find in chronic liver disease
hands: palmar erythema, duputyens, clubbing
eyes: specific for Wilson's Keiser-Fleisher ring, corneal arcus if hypercholesteraemia
Chest: gynaecomastia (failure of liver to break down cholesterol), axillary hair loss, spider naevi
93
What number of spider naevi is abnormal
anywhere > 5
94
Ix for suspected liver disease
* Blood panel (**FBC, UE, LFT, CRP, clotting, AFP, iron, hepatitis serology, autoantibodies, caeruloplasmin**)
*** USS abdomen**
* consider fibroscan and **liver biopsy **
* consider **endoscopy** to exclude other causes
95
How do you manage ascites
1. **Restrict alcohol and fluids, low sodium diet, daily weights**)
2. Diuretics (**spironolactone** +/- furosemide)
3. **Therapeutic paracentesis** (if not responding to meds)
4. Prophylaxis for SBP (**ciprofloxacin** + propanolol)
**abdominal paracentesis (for tense ascites**)
96
What is SBP
Spontaneous bacterial peritonitis (infection of ascitic fluid with no obvious cause)
97
How do you investigate SBP
```
USS (confirm ascites)
Ascitic tap (check neutrophils and SAAG)
```
98
How do you manage SBP
tazocin / cefotaxime
99
What is chromosomal inheritance pattern of haemochromatosis
Autosomal recessive - HFE gene mutation
100
What does haemochromatosis cause
Dirsorder of iron absorption and metabolism> excess iron accumulation > organ damage (liver, brain, pancreas, skin, heart)
101
s/sx of haemochromatosis
* Often ASYMPTOMATIC until the late stages of the disease
* Symptoms usually start between 40-60 yrs
* EARLY symptoms are vague:
o Fatigue
o Weakness
o Arthropathy
o Erectile dysfunction
o Heart problems
* LATE symptoms:
o DIABETES MELLITUS
o BRONZED SKIN
o HEPATOMEGALY
o Impotence
o Amenorrhoea
o Hypogonadism
o Cirrhosis
o Cardiac - arrhythmias and cardiomyopathy
o Neurological and psychiatric problems
102
How do you investigate haemochromatosis
* Iron studies: serum iron (HIGH), serum ferritin (HIGH), transferrin (LOW), transferrin saturation (HIGH), TIBC (LOW)
* LFT: raised AST and ALT
* genetic testing
* Liver MRI and biopsy
103
How do you manage haemochromatosis
* Diet
o Low in iron
o Restrict alcohol and vitamin C supplements
o Tea
* Therapeutic phlebotomy/venesection -> reduces number of RBC
o Initially 1-2 sessions per week
o After reaching target ferritin and Hb levels, every 2-4 months
o Target levels
Serum ferritin: 20-50ug/L
Hb > 12g/dL
Transferrin saturation < 50%
* Drug-induced iron chelation
o If phlebotomy contraindicated e.g. anaemia, heart disease
o Agents: **deferoxamine**,
104
What is the progression of NAFLD
steatosis > staetohepatitis > cirrhosis
105
investigations ofr NAFLD
LFTpanel, lipds, cholesterol
USS
Enhalced liver fibrosis panel OR fibroscan
liver bioosy
106
How do you manage NAFLD
lifestly change, weight loss
107
Chronic pancreatitis symptoms
* chronic pain: epigastric and back, radiates to back, relieved by sitting forward, aggravated by eating or drinking alcohol
* nausea and vomiting
* over years : weight loss, bloating, staetoorrhoea
DM
108
signs of chronic pancreatitis
* Endocrine insufficiency --> impaired glucose regulation -> eventually diabetes mellitus (type 3c/pancreatogenic diabetes)
* Exocrine insufficiency --> failure to produce digestive enzymes --> malabsorption, weight loss, diarrhoea, steatorrhoea
* Abdomen tender in epigastrium
* Cachexia
109
What is the commonest cause of chronic pancreatitisa
ALCOHOL in 80% of cases
110
how to investigate chronic pancreatitis
* Blood: **faecal elastase** (marker of pancreatic insufficiency), FBC, CRP, glucose
* USS (exclude gallstones)
* **contrast-enhanced CT** (gold standard) --> pancreatic atrophy or calcification, pseudocysts
111
management for chronic pancreatitis
1. Treat reversible causes e.g. alcohol cessation, statin for hyperlipidaemia
2. Analgesia using WHO ladder
3. If exocrine dysfunction
* Digestive enzyme replacement
* Fat-soluble vitamin (A,D,E,K) supplementation
4. Insulin if diabetes + HbA1c surveillance
112
what is the most common type of pancreatic xcancer (location + histology)
head of pancreas, adenocarcinoma
113
what are classic sx of pancreatic cancer
* palpable gallbladder with painless jaundice (Courvoisier’s law)
* epigastric pain --> radiates to back and relieved by sitting forward
* FLAWS
* N+V
* loss of exocrine function > staethorroea
* loss of endocrine function > DM
* Trousseau’s sign of malignancy: superficial thrombophlebitis
114
what ix need to be carried out for pancreatic cancer
HR-CT (double duct sign, simultaneous dilatation of CBD and pancrsatic duct)
USS
115
how do you manage pancreatic cancer
```
Whipple resection (pancreaticoduodonectomy) - although less than 20% are suitable
with adjuvant chemo
```
116
how to relieve obstructive jaundice caused by pancreatic cancer
insert a biliary stent via ERCP or percutaneously
117
What requires a 2 wk urgent referra for OGD withGORD symptoms
```
dysphagia (suspect oesophageal cancer)
upper abdominal mass (suspect oral ancer)
Age > 55 AND WL and
- dyspepsia
- reflux/GORD
- Upper abdo pain
```
118
What requires nonurgent referra for OGD withGORD symptoms
```
haematemesis
Age >55 AND
- treatment resistant dyspepsia
- upper abdo pain with low Hb
- N&V+ reflux, WL, dyspepsia, upoper abdo pain
```
119
what do you do if GORD symptoms and OGD negative
24 h oesophageal pH monitoring
120
How do you manage GORD if no need to refer for OGD
1. review meds for possible dyspepsia causes and give lifestyle afdbvice
2. trial PPI (4 weeks= or test and treat for H pylori
121
How do you test for H pylori
C13 Urea breath test
OR stool antigen test
Or Lab based serology
122
How do you manage H pylori
CAP: clarythomycin, amoxicillin/metronidazolel, PPO
123
How do you treat GORD
trial PPI for 1 month then review
| If refractory: nissen fundoplication
124
what score assesses prognosis of cirrhosis
```
Child's Pugh ABCDE
Albumin
Bilirubin
Clotting (PT)
Disension (ascites)
Encepalopathy
```
125
How do you manage alcoholic hepatitis
consider pred
126
what abx can you give for C diff
```
oral metronidazole (mild)
oral vanc (severe)
oral vanc + IV met (life threatening9
```
127
what serology can you do for coeliacs disease
anti-TTg + total IgA
| anti- EMA (less sensitive)
128
how does cholangiocarcinoma present
* usually **asymptomatic**
* colicky RUQ pain, nausea, anorexia, vomiting, malaise, WL, palpable GB (**courvoisier's law**), FLAWS
* **Obstructive jaundice**: *pale stool, dark urine, pruritis*
129
how do you stage cholangiocarcinoma
CT abdo
| ERCP fgold standard stating
130
how do you manage cholangiocarcinoma
cholecystectomy if resectable
| chemotherapy + stenting if not resectable
131
tumour marker for Cholangiocarcinoma
Ca19-9
132
is PSC or PBC more likelly to cause cholangocarcinoma
PSC -- in 10% of patients
133
which IBD is most likeluy to cause fissures and fistulas
CHRONS
134
which IBD is smoking PROTECTIVE for
UC
135
true love and witts criteria for UC disease grading is?
FOFTAR
* Frequency of stool > 6
* Overtly bloody stool
* Fever >37.5
* Tachycardia > 90
* Anaemia Hb <105
* Raised ESR > 30
136
what is the severity index for IBD
True Love and Witts criteria
137
causes of granuloma
TB (caseating)
| Chron's, sarcoid (non-caseating)
138
causes of subtotal villous atrophy (other than coeliac)
```
Giarda
Tropical sprie
infectious enteritis
lymphoma
Whipples infection
Lactose intolerance
```
139
Wernicke's triad
Opthalmoplegia
Ataxia
Confusion
140
Korrsakoff's
Wernicke's PLUS confabulation and amnesia
141
How do you test for Wilson's disease on blood test
serum caeruloplasmin
142
How do you test for Haemochromatosis on blood test
Iron panel (raised iron , raised ferritin, low TIBC)
143
when do you refer for an URGENT 2 week OGD
any patient presenting with new-onset dysphagia OR
aged > 55 + weight loss + abdominal pain/reflux/dyspepsia
144
How do you manage dyspepsia
1. review meds for possble causes, give lifestyle adice
| 2. Test for H Pylori (stool antigen test) OR trial full dose PPI
145
How long myst you wait after PPI to test for H pylori
2 weeks
146
What is management if H pylori +ve
amoxicilli + clarythromycin + PPI for ONE WEEK
147
what are dangerous associations/ complications of H pylori
PUD
Gastric cancer
MALToma
Altriphic gastritis
148
How can you manage anal fissue
<6 weeks: dietary advice (more fluids), bulk forming laxatives, OTC analgesia
>6 weeks: topical GTN / diltaziem > sphincterotomy
149
What is Gilberts and how does it present
Deficiency in glucoronyl transferase (enzyme required for conjugation of bilirubin in the livrr)
Presents as asymptomatic jaundice during other infection
Self-resolving
150
how do you diagnose c diff
detect C. difficile toxin (CDT) in the stool
151
clinical features of c diff infection
* diarrhoea
* abdominal pain
* a raised white blood cell count (WCC) is characteristic
* if severe toxic megacolon may develop
152
toxic megacolon s/sx
* severe abdominal pain, abdominal distension, pyrexia and systemic toxicity
153
management of toxic megacolon
* URGENT SURGERY -> Requires urgent decompression of bowel (due to risk of perforation)
154
how do you treat C diff (mild-moderate)
oral vancomycin 10 days
155
how do you treat C diff (severe, 2nd episode=
<12 weeks = oral fidaxomicin
> 12 weeks = oral vancomycin
156
how do you treat LIFE THREATENING c diff
oral vanc + IV metronidazole
157
which antibodies are elevated in AI hepatitis
ANA, ASMA
Anti-LMK
Anti-SLA
Raised IgG
158
S/S AI hepatitis
Jaundice, RUQ pain, fever
| AMENORRHOEA
159
MX AI hep
steroids
| liver transplant
160
what iss plummer vinson syndrome + triad
due to post cricoid webs, presents as:
- dysphagia
- glossitis
- IDA
161
triad of boerhaves oesophagus
Chest pain
SC emphysema
Vomiting
162
what should you always examine in a young man with RIF pain
examine the scrotum (ballllls) --> infection or torsion?
163
management for chronic pancreatitis
1. Treat reversible causes e.g. alcohol cessation, statin for hyperlipidaemia
2. Analgesia using WHO ladder
3. If exocrine dysfunction
* Digestive enzyme replacement
* Fat-soluble vitamin (A,D,E,K) supplementation
4. Insulin if diabetes + HbA1c surveillance
164
symptoms of gastric cancer
* Early: asymptomatic
* **Abdominal pain**--> vague
* **dyspepsia** (indigestion) --> new-onset or not responsive to PPI
* **Dysphagia**: in tumours of gastric cardia (proximal stomach)
* **Early satiety**
* **Nausea and Vomiting**
* **Melaena** --> anaemia
* **FLAWS**
165
risk factors for gastric cancer
* male
* h pylori
* chronic gastritis/PUD
* increasing age
* smoking
* diet
166
signs of gastric cancer
* may be normal
* epigastric mass
* abdominal tenderness
* ascites
* signs of anaemia
* if lymphatic spread: Virchow’s Node (aka Troisier’s sign) and Sister Mary Joseph’s Nodule:
167
what is virchow's node
* Left supraclavicular lymph node
168
what is Sister Mary Joseph’s Nodule
* Periumbilical nodule
169
investigations for gastric cancer
* Bloods: FBC, LFTs
* Urgent **oesophago-gastro-duodenoscopy (OGD) with biopsy** (GOLD-STANDARD)
* **CT CAP**
170
management for gastric cancer
* Specialist upper GI cancer MDT approach
* Nutritional status assessment with dietician review
* surgical options depend on the extent and side but include:
**endoscopic mucosal resection
partial gastrectomy
total gastrectomy**
* chemotherapy
