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Gastro Flashcards

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1
Q

What is achalasia

A

Impaired oesophageal peristalsis due to degen of myenteric neurones (Auerbach’s plexus)

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2
Q

Symptoms of achalasia

A

gradual dysphasia
weight loss
heart burn
chest pain
regurgitation (cough, aspiration)

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3
Q

Gold standard diagnosis of achalasia

A

oesophageal manometry
high tone of LOS when swallowing, no peristalsis lower oesophagus

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4
Q

Management achalasia

A

1) pneumatic dilation
2) Hellers cardiomyotomy
Botox injections, meds (CCB, nitrates)

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5
Q

Appendicitis common ages

A

10-20

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6
Q

Appendicitis symptoms

A

pain central -> RIF (24h)
N&V
anorexia
low grade fever

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7
Q

appendicitis signs

A

Tender over McBurneys Point
Rovsings sign (RIF tenderness when palpating LIF)
Guarding and rebound tenderness (suggests rupture and perionitis)

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8
Q

Appendicitis Diagnosis

A

Clinical + high inflam markers
US pelvis in women/kids
CT if unsure
serum/blood HCG to rule out ectopic
diagnostic laparoscopy if sypmtomatic but investigations normal

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9
Q

Causes of acute pancreatitis

A

Gallstones, Alcohol, post ERCP

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10
Q

How do gallstones cause acute pancreatitis?

A

Block ampulla of Vater causing build up of bile/pancreatic juice causing inflamation

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11
Q

How does alcohol cause pancreatitis?

A

acute - directly toxic to pancreatic cells
chronic- causes fibrosis which leads to loss of function of pancreatic cells

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12
Q

How does acute pancreatitis present?

A

epigastric pain
N&V
Systemically unwell

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13
Q

Acute pancreatitis signs

A

abdo pain
Cullens
Grey Turners

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14
Q

How do you diagnose acute pancreatitis?

A

Clinically + amylase 3x normal upper limit
US to show cause - gallstones
CT abdo - look for complications

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15
Q

How do you assess severity of acute pancreatits?

A

Glasgow Score

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16
Q

How do you manage acute pancreatitis?

A

Supportive
Fluid resus, analgesia, treat gallstones
?IV Abx if complications

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17
Q

Complications of pancreatitis

A

Peripancreatic fluid collections
pseudocysts
pancreatic necrosis
abscess
haemorrhage

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18
Q

Causes of chronic pancreatitis

A

80% alcohol
cystic fibrosis, ductal obstruction

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19
Q

Sypmtoms of chronic pancreatitis

A

pain (15-20mins after eating)
steatorrhoea
diabetes (loss of endocrine function)

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20
Q

Investigations in chronic pancreatitis

A

Abdo XR, abdo CT show pancreatic calcification
faecal elastase to assess exocrine function

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21
Q

Management of chronic pancreatitis

A

lifestyle
analgesia
pancreatic enzyme replacement

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22
Q

What is alcoholic ketoacidosis

A

large alcohol intake, small food intake (or vomit foot which has been consumed) become malnourished. Following alcohol binge body breaks down fat producing ketones -> ketoacidosis

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23
Q

How do you treat alcoholic ketoacidosis

A

IV saline and thiamine

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24
Q

Acute and chronic management of anal fissure

A

Acute <6/52: stool softener, lubricant, topical analgesia
Chronic >6/52: topical GTN, refer for surgery (sphincterotomy) or botulinum toxin

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25
What is angiodysplasia
vascular deformity of the gastrointestinal tract which predisposes to bleeding and iron deficiency anaemia
26
How do you diagnose and manage angiodysplasia?
Diagnosis colonoscopy mesenteric angiography if acutely bleeding Management endoscopic cautery or argon plasma coagulation antifibrinolytics e.g. Tranexamic acid oestrogens may also be used
27
what is liver cirrhosis and what are the main causes?
chronic scarring/damage to liver which leads to non reversible changes (fibrosis) alcohol, NAFLD, viral hep B/C
28
Pathophysiology of liver cirrhosis
hepatocyte damage, stellate cells produce collagen, fibrosis/scar tissue formation
29
Main complications of liver cirrhosis
Portal hypertension -> ascites, splenomegaly, hepatorenal failure Reduced liver function Increased ammonia (hepatic encephalopathy) Increased oestrogen (gynaecomastia, palmar erythema) Increased uncong. bili (jaundice) Decreased albumin Decreased clotting factors
30
Symptoms of early liver cirrhosis
asymptomatic, general (fatigue, weight gain, weakness)
31
Symptoms of late stage liver cirrhosis
Jaundice, itch, ascites, confusion, bruising
32
Diagnosis of liver cirrhosis
biopsy (regenerative nodules, fibrosis) Fibroscan (transient elastography)
33
Management of liver cirrhosis
stop drinking antivirals (if hep +ve) transplant
34
Screening for liver cirrhosis
fibroscan Hep C +ve men who drink >50 units/week women who drink >35 units/week alcohol related liver disease
35
Causes of acute liver failure
PCM OD hep A/B alcohol fatty liver of pregnancy
36
In liver failure, which clotting factor is not low and why
factor VIII Synthesised in endothelial cells throughout body not just liver Requires good hepatic function to clear from blood stream
37
Scoring system for liver cirrhosis
Model for End-Stage Liver Disease (MELD) Child-Pugh classification
38
Pathophysiology of alcoholic liver disease
alcohol converted to acetaldehyde in liver this essentially causes neutrophils to invade liver biproduct of conversion is NADH which causes more fatty acid production
39
Bloods which would indicate alcohol related liver disease
AST ++ ALT + GGT + ALP + thrombocytopenia
40
Management of alcoholic liver disease
Stop drinking steroids to suppress immune system
41
c. diff pathophysiology
anaerobic gram-positive, spore-forming, toxin-producing bacillus transmission: via the faecal-oral route by ingestion of spores
42
c diff symptoms
diarrhoea abdominal pain a raised white blood cell count (WCC) is characteristic if severe toxic megacolon may develop
43
Crohns colonscopy/biopsy findings
deep ulcers, skip lesions transmural inflammation, goblet cells, granulomas cobblestone appearance
44
Crohns SB enema findings
Kantors String sign, rose thorn ulcers
45
Crohns management for inducing remission
1st line - glucocorticoids 2nd line - 5ASA e.g mesalazine
46
Crohns management for maintaining remission
1st line - azathioprine or mercaptopurine 2nd line - methotrexate
47
Extra intestinal features of inflam bowel disease related to disease activity
asymmetric arthritis erythema nodosum episcleritis
48
Extra intestinal features of inflam bowel disease not related to disease activity
symmetric arthritis uveitis pyoderma gangremosum clubbing primary sclerosing cholangitis
49
Colonoscopy/biopsy findings in UC
No inflam beyond submucosa reduced goblet cells crypt abscssess ulceration and pseudopolyps
50
Barium enema findings in UC
reduced haustrations pseudopolyps drain pipe colon
51
Management for inducing remission in mild/mod UC
topical aminosalicylate -> PO aminosalicylate-> PO corticosteroids
52
Management for inducing remission in severe UC
admit IV steroids +/- IV ciclosporin
53
Associations with autoimmune hepatitis
HLA DR3 autoimmune disorders hypergammaglobulinaemia
54
Types of autoimmune hepatits
1: ANA and /or SMA (adults and kids) 2: LKM1 (kids) 3: Soluble liver-kidney antigen (adults)
55
Presentation of autoimmune hepatitis
chronic liver disease acute hepatitis amenorrhoea
56
Ix and Mx autoimmune hepatitis
ANA, SMA, LKM1 biopsy: piecemeal necrosis Mx: steroids, transplant
57
Management of UGIB caused by varices
teripressin and Abx before endoscopy band ligation TIPS if above fails
58
symptoms of ascending colangitis
charcots triad 1) fever 2) RUQ pain 3) jaundice +hypotension and confusion
59
Ix and mx ascending colangitis
US IV Abx ERCP after 24-48hrs
60
How is ascites categorised
serum ascites albumin gradient more or less than 11
60
Causes of ascites SAAG <11
low albumin malignancy TB pancreatitis obstruction
60
Causes of ascites SAAG >11
liver: cirrhosis, ALF, mets RHF, C pericarditis Budd-Chiari
61
Management of ascites
spiro drainage prophylactic Abx ( SBP cipro) if ascitic protein <15
62
Presentation of SBP
abdo pain, ascites, fever
63
Ix, cause and Mx SBP
E. coli paracentesis neutrophils >250 IV cefotax
64
What is Barretts and what are the risk factors
squamous cell -> columnar (goblet cells, brush border) GORD, male, smoking
65
Management Barretts
high dose PPI metaplasia: endoscopy 3-5 years dysplasia: radio-frequency ablation
66
What is c. diff + risk factors + transmission
gram +Ve rod clindamycin, cephlosporins, PPI faeco-oral
67
Management of 1st episode c.diff
vanc -> findax -> vanc ± IV met
68
Management of 2nd episode c. diff
<12 weeks: PO findax >12 weeks: PO findax or PO vanc
69
Coeliac associations
Dermatitis herpetiformis HLA DQ2 and HLA DQ3
70
Complications coeliac
Anaemia hyposplenism OP lactose intolerance subfertility
71
Investigations of coeliac
eat gluten 6/52 prior bloods: TTG antibodies, endomyseal anitbody Biospy: villous atrophy crypt hyperplasia increased intraepithelial lymphocytes lamina propria infiltration with lymphocytes
72
Management of coeliac
stop eating gluten pneumococcal vaccine
73
What is haemochromatosis?
autosomal recessive chromosome 6 accumlation of iron
74
How does haemachromatosis present, which features are reversible and irreversible
Rev - bronze skin -HF (DCM) Irreversible -DM - liver disease - arteritis
75
Investigations of haemachromatosis
transferrin saturation - >55% m >50% f increased ferritin and iron genetic testing
76
Mangement haemachromatosis
1st venesection aim transfer <50% and ferr <50 2nd desferrioxamine
77
What is Wilsons
autosomal recessive, chromosome 13 Increased copper ATP7B gene
78
presentation of wilsons
hepatitis, cirrhosis speech, behavioural Kayer fletcher rings blue nails
79
Diagnosis of Wilsons
Genetic analysis ATP7B gene Slit lamp Low serum caeruloplasmin
80
Management Wilsons
penicillamine trientine hydrochloride
81
Management of hepatorenal syndrome
terlipressin albumin TIPS
82
Features of IBS
abdo pain relieved when bowels opened or associated with altered bowel frequency +2 -altered stool passage -abdo bloating -worse when eating -passage of mucus
82
Red flags of abdo pain
Rectal bleeding weight loss Fhx >60
83
What does thumbprinting on abdo XR indicate
ishaemic colitis, most likely at splenic flexure
84
What is Meckels Diverticulum
congenital remnant of vitellointestinal duct
85
How does Meckels present
usually asympotmatic massive painless GI haemorrhage in kids obstruction
86
Ix and Mx Meckels
Meckels scan or mesenteric arteriography Surgical removal
87
Presentation of PBC
middle aged woman with itch jaundice hyperpigmentation clubbing liver failure (late) (raised ALP incidental finding)
88
What conditions is PBC associated with?
Sjogrens RA systemic sclerosis thyroid disease
89
How do you diagnose PBC
AMA M2 SMA Raised IgM MRCP
90
Mx PBC
ursodeoxycholic acid Cholestyramine (itch) liver transplant if bili >100
91
Complications of PBC
OP hepatocellular ca
92
what is PSC
inflam and fibrosis of intra and extra hepatic bile ducts
93
How does PSC present
cholestasis: jaundice, itch, increased bili and ALP RUQ pain fatigue
94
What is PSC associated wtih
US Crohns HIV
95
How do you investigate PSC
ERCP/MRCP (beaded) pANCA +ve Biopsy - onion skin
96
Metabolic markers of refeeding syndrome
low Mg, K+ phosphate
97
What is Whipples
Rare multi-system disorder caused by tropheryma whippelii
98
Presentation of Whipples
middle aged man (HLA-B27) diarrhoea, weight loss lymphadenopathy arthralgia hyperpigment and photosensitivity opthalmopegia
99
Whipples investigation
jejunal biopsy: macrophages containing PAS granules
100

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