Gastro Flashcards
1
Q
Ix and Mx of a sigmoid volvulous?
A
Ix = coffee bean sign, large bowel obstruction
Mx = R sigmoidoscopy and rectal tube insertion UNLESS Sx of peritonitis then urgent midline laparotomy
2
Q
What are the common causes of a caecal volvulus? How do you treat?
A
SBO or LBO, often secondary to adhesions or pregnancy
Mx = Right hemicolectomy
3
Q
What is the commonest type of oesophageal CA? What does it often occur secondary to?
A
Adenocarcinoma
Occurs secondary to transformation of squamous epithelium to columnar epithelium (Barrett’s oesophagus).
Seen in the lower 1/3rd of the oesophagus
4
Q
Which type of carcinoma is most commonly seen in the upper 2/3rds of the oesophagus? What does it often occur secondary to?
A
Squamous carcinoma.
Occurs secondary to achalasia
5
Q
What is achalasia?
A
Oesophageal paralysis, leads to difficulty swallowing EVERYTHING (solids and liquids)
6
Q
What are the common complications of enteral feeding?
A
Diarrhoea, aspiration, hyperglycaemia and refeeding syndrome
7
Q
Which part of the bowel wall is affected in UC and Crohn’s
A
UC = limited to the mucosa and sub mucosa. No skip lesions
Crohn’s = affects the entire lining but has goblet cells, granulomas and skip lesions
8
Q
What is Pellagra?
A
Vitamin B3 deficiency
Seen in those with malnutrition, strict diets and bowel disease
Sx = dermatitis, diarrhoea and dementia/delusions
9
Q
Name 2 complications of oesophagitis?
A
Strictures and Barrett’s oesophagus
10
Q
How does gastric volvulous present?
A
Triad of vomiting, pain and failure to pass NG tubes
11
Q
What is the Ix of choice in UC?
A
Colonoscopy unless there is a severe flare, then do sigmoidoscopy (due to risk of perforation)
12
Q
What does a raised faecal calprotectin indicste?
A
Bowel inflammation
13
Q
What is proctits?
A
Inflammation of the rectum and anus
14
Q
Can you see pseudopolyps on endoscopy in UC or Crohn’s?
A
UC
It is superficial ulceration
15
Q
Sx and Mx of anal fissures?
A
Bright red, painful rectal bleeding due to a tear in the squamous lining of the distal anal canal
Mx = <1 week = soften stool, lubricants and topical/simple analgesia
Chronic = topical GTN, if not effective after 8 weeks do sphincterotomy
16
Q
Which drugs should you stop before endoscopy and when should you stop them?
A
1 day before = Gaviscon/antacids
2 weeks before = PPIs
3 days before = H2 antagonists
4 weeks before = Abx
17
Q
Which drugs should you stop before urea breath test and when should you stop them?
A
2 weeks before = PPIs
4 weeks before = Abx
18
Q
How do we confirm hepatic steatosis (secondary to NAFLD)?
A
Liver USS
19
Q
How do we assess liver fibrosis secondary to NAFLD?
A
1st line = Enhanced liver fibrosis blood test
2nd line = NAFLD fibrosis score
3rd line = Fibroscan
20
Q
What should you do if dysplasia is detected on endoscopic screening in GORD patients?
A
If mild - radiofrequency ablation
If moderate or severe - endoscopic mucosal resection first line, oesophagectomy 2nd line
21
Q
What should you do if metaplasia is seen on endoscopic screening in GORD patients?
A
This is Barret’s oesophagus
Give PPIs and continue monitoring
22
Q
How should you treat dyspepsia?
A
Either
Treat with full dose PPIs for one month
Test for H.pylori and treat if positive
If the method you choose doesn’t work then switch
23
Q
What should you suspect in travellers presenting with watery diarrhoea, abdo cramps and nausea?
A
E. coli
If bloody = enteroinvasive or enteropathogenic
If non-bloody = enterotoxigenic
24
Q
What are the first line and gold standard investigations for Coeliac’s disease?
A
1st line = Anti-TTG and Anti-IgA antibodies
GS = endoscopy and jejunal biopsy
25
What is a lead pipe colon?
On X-ray you see loss of the haustral markings, this implies UC
26
Describe an ileostomy?
Will be in the right iliac fossa, single opening spouted from the skin (to avoid irritation of the skin)
27
Describe a colostomy
Will generally be in the left iliac fossa and will be flush with the skin
28
Mx of acute variceal haemorrhage? What is the prophylactic treatment?
Before endoscopy give Terlipressin and IV Abx. Do endoscopic band ligation.
If band ligation is unavailable = balloon tamponade via a Sengstaken Blakemore tube
If band ligation is unsuccessful = transjugular intrahepatic portosystemic shunt
Prophylaxis for bleeding = propranolol
29
What is a transjugular intrahepatic portosystemic shunt?
Connects the hepatic and portal vein - is used to treat uncontrolled variceal bleeding
Mau increase the risk of hepatic encephalopathy
30
True or false lower lobe pneumonias can cause upper abdo pain?
TRUE
31
What should you suspect in someone who has watery green diarrhoea and has had a cholecystectomy? How do you manage?
Bile acid malabsorption
Mx = Cholestyramine
32
Describe Spontaneous Bacterial Peritonitis?
Seen in patients with known liver disease. Presents with fever, abdominal pain/distension, vomiting and altered mental state
E.coli is most commonly grown and after it has occurred offer patients prophylactic Ciprofloxacin
33
What is the diagnostic marker for carcinoid syndrome?
Urinary 5-hydroxyindolaecetic acid
34
How do you manage C.diff?
Oral vancomycin
Add IV metronidazole if life threatening
35
Which conditions can cause a raised serum amylase?
Pancreatitis and small bowel obstruction
36
How do you manage acute mesenteric ischaemia?
Immediate laparotomy
37
How does Giardia Lamblia present?
Non-bloody diarrhoea which is greasy and floats in the pan. It is resistant to chlorination so can be contracted in pools
38
How does Coeliac's disease commonly present in children?
Abdominal bloating, chronic diarrhoea and failure to thrive
39
Are perianal skin tags and fistulas more commonly associated with Crohn's or Ulcerative Colitis?
Crohn's
40
Sx of Diverticular Disease?
Intermittent left lower quadrant abdominal pain, bloating and a change in bowel habits (often on a BG of constipation)
41
Sx and Mx of Diverticulitis?
Severe left lower quadrant abdominal pain, nausea and vomiting, change in bowel habit, urinary symptoms, PR bleeding and low grade fever
Mx = oral antibiotics, if severe or symptoms do not settle in 72 hours give IV Abx
42
How do you induce remission in UC?
TOP Aminosalicylates
If extensive disease or not controlled ADD PO Aminosalicylates
If remission still not achieved add PO Steroids
43
How do you maintain remission in UC?
TOP or PO Aminosalicylates
If severe relapse (>6 stools per day) or >= 2 exacerbations/year give oral azathioprine or oral mercaptopurine
44
What does pernicious anaemia most commonly cause? What are the symptoms?
B12 deficiency
Sx = anaemia symptoms, symmetrical peripheral neuropathy affecting legs more than arms, mild jaundice, glossitis, cognitive issues, progressive weakness and ataxia
45
Ix of pernicious anaemia? What cancer is it associated with?
Ix = Macrocytic anaemia and anti-intrinsic factor antibodies
Increased risk of gastric cancer
46
Which antibiotic is known to cause cholestasis?
Co-amoxiclav
47
Sx of a perianal abscess? How should you manage in those with Crohn's disease?
Sx = pain worse on sitting, tender and swollen perianal lump, may be pus like discharge
Management in those with Crohn's = incision and drainage
48
How do we manage congenital hernias?
Congenital inguinal hernias must be surgically repaired ASAP
Congenital umbilical hernias can be managed conservatively
49
S/Es of PPIs?
They increase the risk of C.diffe and osteoporosis
They can cause low sodium and low magnesium
50
True or false, Diverticular disease can lead to a colovaginal fistula?
TRUE
51
What should you consider as the diagnosis in megaloblastic anaemia? How do you screen for this?
Pernicious anaemia leading to B12 deficiency
Ix = Intrinsic factor antibodies (most specific) and gastric parietal cell antibodies
52
What type of anaemia is Coeliac's disease associated with?
Microcytic anaemia secondary to iron deficiency (due to malabsorption)
53
What is the most common cause of a large bowel obstruction?
Bowel cancer
54
What should you do with any patient with a suspected GI bleed?
Refer for endoscopy within 24 hours of admission
55
What should you use in the intermediate management of variceal bleeding?
Terlipressin (a vasopressin analogue)
56
Wilson's disease is a AR condition, describe the Sx?
Copper deposition in the tissues. In children this presents with liver cirrhosis/hepatitis. In young adults it presents with neurological disease (e.g. psychiatric problems, asterixis, chorea and dementia)
It can also cause Kaiser-Fleischer rings, blue nails, haemolysis and Fanconi syndrome
57
Ix and Mx of Wilson's disease?
Ix = reduced total serum copper, reduced serum ceruloplasmin and increased 24 hour urinary copper secretion
Mx = penicillamine
58
What should you offer to patients who have new Sx of ?colorectal cancer but do not fit the 2WW criteria
FIT test
59
What is seen in refeeding syndrome?
Hypophosphatemia, hypokalaemia, hypomagnesaemia and abnormal fluid balance. It can lead to arrhythmias e.g. Torsade's de Points
60
Sx of thrombosed haemarrhoid?
Significant pain and a tender lump. There is a purplish oedematous and tender s/c perianal mass on examination
61
Does raised urea point to an upper or lower GI bleed?
Upper (i.e. oesophagus, stomach or duodenum)
62
Describe Primary Sclerosing Cholangitis?
Inflammation and fibrosis of the intra and extra hepatic bile ducts, strongly associated with UC.
Sx = cholestasis (jaundice, pruritis, raised bilirubin and ALP), RUQ pain and fatigue
Ix = MRCP/ERCP, pANCA positive
There is increased risk of colorectal cancer and cholangiocarcinoma
63
What will haematinics look like in iron overload? Name some possible causes?
Raised transferrin in the presence of raised ferritin
Causes include hereditary haemochromatosis or repeated transfusions
64
What is Lynch Syndrome? What screening should we offer patients?
Hereditary Non-Polyposis Colorectal Cancer
Offer colonoscopy every 1-2 years from 25
65
Familial Adenomatous Polyposis is an AD condition. What screening should we offer these patients?
Annual flexible sigmoidoscopy from 15 years old. If no polyps are found offer a 5 yearly colonoscopy, if polyps are found perform resection surgery
66
What is an important side effect of mesalazine?
Increased risk of pancreatitis
67
Which drugs can cause cholestasis?
CAPS
COCP, Antibiotics, Phenothiazines (e.g. chlorpromazine or prochlorperazine) and Sulphonylureas
68
Which drugs cause hepatocellular damage?
PASS
Paracetamol, Alcohol, Sodium valproate and Statins
69
Where are inguinal hernias located?
Superior and medial to the pubic tubercle. They disappear when pressure is applied or when lying down (unless incarcerated)
Direct are medial to the inferior epigastric artery, indirect are lateral to the inferior epigastric artery
70
What is Tratuzumab?
Also known as Herceptin, used in HER-2 receptor positive breast cancer
71
What should you consider the diagnosis in a patient with epigastric pain and a Hx of gall stones?
Pancreatitis
72
What is Choledocholithiasis?
The presence of a gallstone in the CBD. Presents with RUQ and jaundice in the absence of fever
73
What is the most common cause of hepatocellular carcinoma worldwide and in europe?
Worldwide = Hep B
Europe = Hep C
74
What might be seen on blood test in appendicitis? Do you need to do any further tests?
Neutrophil predominant leucocytosis
Clinical diagnosis although in females do pregnancy test and consider pelvic USS to rule out pelvic pathology
75
Describe Budd-Chiari Syndrome?
Hepatic vein thrombosis
Presents with sudden and severe abdo pain, ascites, abdo distension and tender hepatomegaly
Ix = US and doppler flow studies
It is often associated with haematological disease
76
What are most colorectal cancers?
Adenocarcionoma
77
What should you suspect in liver failure following cardiac arrest?
Ischaemic hepatitis
78
What should you consider in a deceleration injury followed by persistent hypotension?
Aortic rupture
79
True or false, pancreatic cancer can cause cholestatic LFTs?
True!
80
What are patients with hemochromatosis at increased risk of?
Hepatocellular carcinoma
81
What makes up the Child-Pugh classification of liver cirrhosis severity?
Albumin, Bilirubin, Clotting (prothrombin), Diffuse ascites and Encephalopathy
82
Mx of Haemachromatosis?
1st line = Venesection, aim to keep transferrin saturation below 50% and serum ferritin below 50ug/l
If venesection is not tolerated or the patient is very anaemic offer iron chelation
83
Which antiemetic should you avoid if bowel obstruction?
Metoclopramide - risk of perforation
84
Describe the haematinics in haemachromatosis?
Raised transferrin saturation and ferritin with a low total iron binding capacity
85
Describe Peutz-Jeghers syndrome?
AD. Causes hamartomatous polyps of the GI tract, pigmented freckles on the lips, face, palms and soles and SBO due to intussusception (often the presenting complaint). GI bleeding may also occur
86
Mx alcoholic hepatitis?
Glucocorticoids. Pentoxyphylline may also be used
87
C. diff treatment?
1st line = 10 days oral vancomycin
2nd line = oral fidaxomicin
3rd line (or if life threatening) = oral vancomycin and IV metronidazole
If there is a recurrent episode within 12 weeks give fidaxomicin. If after 12 weeks give fidaxomicin or vancomycin
88
What should you give prior to appendectomy?
Prophylactic ABx
89
True or false damage of the common sciatic nerve can lead to foot drop?
True - it branches into the common peroneal and tibial nerves
90
Solitary rectal ulcers are associated with chronic constipation. What should you do with them?
Biopsy to exclude malignancy
91
Describe Carcinoid tumours?
Liver metastases which release serotonin.
Sx = flushing, diarrhoea, bronchospasm, hypotension, weight loss, Cushing's and pulmonary stenosis/tricuspid insufficiency
Ix = urinary 5-HIAA and plasma chromogranin Ay
Mx = octreotide and cyproheptadine
92
What is ascorbic acid? What does its deficiency lead to?
Vitamin C
Deficiency leads to scurvy = bleeding/receding gums, easy bruising and poor wound healing
93
What is fetor hepaticus?
Sweet faecal breath seen in liver failure
94
When should you think acute fatty liver of pregnancy is the likely diagnosis?
If there is jaundice, abdo pain and pruritius in pregnancy
95
What is the grading of hepatic encephalopathy?
I = irritability
II = confusion and inappropriate behaviour
III = incoherent and restless
IV = coma
96
Are rectal bleeding and crypt abscesses more associated with UC or Crohn's
UC
97
What are the Sx of C.diff? What is the leading cause?
Sx = diarrhoea (watery +/- blood), abdo pain and a raised WCC
Most commonly caused by cephalosporins
98
Describe small bowel bacterial overgrowth syndrome?
Associated with scleroderma, DM and congenital issues in neonates.
Sx = bloating, diarrhoea and malnutrition
Ix = positive hydrogen breath test
Mx = treat the cause and give rifaximin
99
True or false, metoclopramide can cause constipation?
False
It is prokinetic and can cause diarrhoea
100
What is a gallstone ileus?
A gall stone becomes lodged in the ileocaecal valve, this leads to obstruction of the bowel.
AXR will show small bowel obstruction and air in the biliary tree
101
Mx of IBS symptoms?
Pain = anti-spasmodics e.g. Mebeverine
Constipation = laxatives but NOT lactulose
Diarrhoea = loperamide
102
What should you give before endoscopy in a ?variceal bleed?
IV antibiotics and IV terlipressin
103
Should you replace B12 or folate first?
B12!! Give via IM injection
104
What should you offer to all patients who have had a spontaneous bacterial peritonitis?
Ciprofloxacin or Norfloxacin prophylaxis
105
Describe Primary Biliary Cholangitis?
Seen in middle aged females
It is autoimmune-associated e.g. with Sjogren's syndrome and RA
Sx = Fatigue, pruritis, jaundice, clubbing and hepatosplenomegaly
Ix = AMA (M2) positive, increased serum IgM
Mx = Ursodeoxycholic acid and cholestyramine for the itch
There is an increased risk of hepatocellular carcinoma
106
How do we confirm the eradication of H.pylori?
Urea breath test
107
What is the diagnosis of epigastric pain worse after eating?
Gastric ulcer
108
What is the diagnosis of epigastric pain worsened by hunger and better after eating?
Duodenal ulcer
109
Ix noted in autoimmune hepatitis?
Increased antinuclear antibodies, anti-smooth muscle antibodies and IgG alongside raised ALT and AST
110
What should you assess before starting azathioprine or mercaptopurine?
Thiopurine Methyltransferase (TMPT) antibodies, deficiency can lead to over dose
111
What is the Ix of choice in Primary Sclerosing Cholangitis?
ERCP
112
How can we assess C.diffe severity?
WCC
Mild = normal WCC
Moderate = raised but <15x10^9
Severe = >15x10^9
113
Which type of drug should you always stop in a C.diffe infection?
Opioids
114
What type of cancer can increased AFP be a marker of?
Testicular or hepatocellular carcinoma
115
What does increased SAAG (>11g/L) indicate is the likely cause of ascites?
Portal HTN
e.g. Budd-Chiari syndrome (if there is sudden onset abdo pain, ascites and tender hepatomegaly)
116
How will faecal material appear in ileostomy and colostomy?
It is more liquid in ileostomy and more solid in colostomy
117
Are increased goblet cells seen more in UC or Crohn's?
Crohn's
118
What can we use to dysfunction the colon to protect an anastomosis?
A loop ileostomy
119
What should you do if terlipressin fails to control a severe variceal haemorrhage?
Insert a Sengstaken-Blakemore tube to control the bleed
Once the bleed is controlled you can do endoscopic variceal ligation
