Gastro Flashcards
(217 cards)
1
Q
What should patients with coeliac receive every 5 years?
A
PCV vaccine due to hyposplenism
2
Q
What should patients with spontaneous bacterial peritonitis receive?
A
Abx prophylaxis
3
Q
Patients with raised platelets and nausea need what?
A
Non urgent referral for endoscopy
4
Q
Management of patient with suspected upper GI bleed?
A
endoscopy within 24 hours of admission
5
Q
What is the treatment of wilsons?
A
Penicillamine
6
Q
Sudden onset severe abdo pain with vomiting and rapid bloody diarrhoea?
A
Acute mesenteric ischaemia
7
Q
Raised transferrin and ferritin with low TIBC suggests what?
A
Haemochromatosis
8
Q
Sudden onset abdo pain in someone with peptic ulcer disease?
A
Perforated peptic ulcer
9
Q
How are perforated peptic ulcers managed?
A
- Erect CXR which shows free air under diaphragm
- Refer to general surgery
10
Q
Tx of C diff?
A
- Oral vancomycin for 10 days
- If reoccurs: oral fidaxomicin
11
Q
Anti-mitochondrial antibodies suggest what?
A
Primary Biliary Cholangitis
12
Q
First line medication for PBC?
A
Ursodeoxycholic acid
13
Q
What is associated with UC?
A
Primary sclerosing cholangitis
14
Q
Investigation of choice for suspected pancreatic cancer?
A
High resolution CT
15
Q
Management of liver abscess?
A
Percutaneous drainage with IV Abx - usually amoxicillin, ciprofloxacin and metronidazole
16
Q
Vomiting followed by severe chest pain and signs of shock?
A
Oesophageal rupture (Boerhaave syndrome)
17
Q
What cancer is associated with PSC patients?
A
Cholangiocarcinoma
18
Q
What does pernicious anaemia predispose to?
A
Gastric carcinoma
19
Q
Management of C diff if symptoms still ongoing after 10 days?
A
Oral vancomycin and IV Metronidazole
20
Q
What should be measured to monitor treatment of haemachromatosis?
A
Transferrin saturation and serum ferritin
21
Q
Management of haemachromatosis?
A
- Venesection
- Desferrioxamine
22
Q
What should be given to patients with suspected variceal bleeding before endoscopy?
A
Terlipressin
23
Q
Coeliac disease increased risk of which cancer?
A
enteropathy associated T cell lymphoma of small intestine
24
Q
Diarrhoea with greasy stools in swimming pool user?
A
Giardia lamblia
25
What is SAAG (serum ascites-albumin gradient) used to measure?
- Portal HTN
- If >11, then portal HTN
26
How is dyspepsia managed?
- Trial of PPI for 1 month OR test and treatH pylori
- If either is unsuccessful, try the other approach
27
What are patients with haemochromatosis at risk of?
Hepatocellular carcinoma -> screening with US needed
28
sweet and fecal breath is indicative of what?
Liver failure
29
When should PPIs be stopped before upper GI endoscopy?
2 weeks before
30
Which artery is most likely to be the source of bleeding for someone with peptic ulcer disease?
Gastroduoedenal artery
31
Tenesmus is generally associated with which IBD?
Ulcerative Colitis
32
Crohn's Disease
N – No blood or mucus (PR bleeding is less common)
E – Entire gastrointestinal tract affected (from mouth to anus)
S – “Skip lesions” on endoscopy
T – Terminal ileum most affected and Transmural (full thickness) inflammation
S – Smoking is a risk factor
Other
- Terminal ileum
- Ulcer, cobblestone appearance
- Non-caseating granulomas
33
Ulcerative Colitis
C – Continuous inflammation
L – Limited to the colon and rectum
O – Only superficial mucosa affected
S – Smoking may be protective (ulcerative colitis is less common in smokers)
E – Excrete blood and mucus
U – Use aminosalicylates
P – Primary sclerosing cholangitis
34
What is the histology of UC?
- Large bowel
- Mucosal involvement only
- Crypt abscess, reduced goblet cells and no granulomas
- Continuous inflammation
- Pseudo polyps and ulcers may form
35
What is the histology of Crohns?
- Entire GI tract affected
- Transmural inflammation
- Non-caseating granulomas
- Discontinuous inflammation (skip lesions)
- Cobblestone appearance: fissures and deep ulcers
- Fistula formation
36
Diarrhoea, fatigue, osteomalacia?
Coeliac disease
37
What is carcinoid syndrome?
A condition usually when metastases are in the liver and then release serotonin into circulation
38
How does carcinoid syndrome present?
- Flushing
- Diarrhoea
- Bronchospasm
- Hypotension
- urinary 5-HIAA should be measured with ocreotide to treat
39
What is a key intervention in patients with asictes?
Restrict dietary sodium
40
Management of Barret's?
High dose PPI + endoscopic surveillance
41
What should be avoided in patients with severe colitis?
Endoscopy -> risk of perforation -> use flexible sigmoidoscopy instead
42
What are the red flags for GI cancer?
new-onset dyspepsia in a patient aged >55 years
unexplained persistent vomiting
unexplained weight-loss
progressively worsening dysphagia/
odynophagia
epigastric pain
43
fatigue, erectile dysfunction and arthralgia?
Haemochromatosis
44
How can haemochromatosis present?
- Bronze skin
- Diabetes
- Liver disease
- Cardiac failure secondary to dilated cardiomyopathy
- Arthritis
45
signet ring cells are indicative of?
Gastric adenocarcinoma
46
How does achalasia present?
- Dysphagia of liquids and solids
- Heartburn
- Regurgitation of food
47
How is achalasia investigated?
- Gold standard: Oesophageal manometry which shows excessive lower oesophageal sphincter tone
- Barium swallow shows bird's beak appearance
48
How is achalasia managed?
- Pneumatic balloon dilation
- Surgical intervention: Heller cardiomyotomy
49
What sign may be seen in pancreatic cancer?
Double duct sign -> dilated common bile duct and dilated pancreatic duct
50
What does Riglers sign indicate?
- Gas in the peritoneal cavity: sign of perforation
51
How should gallstones be managed?
If asymptomatic and in the gallbladder, no treatment needed
If in the common bile duct, surgery should be considered
If symptomatic, surgery
52
What is acute mesenteric ischaemia?
Occlusion of an artery supplying the small bowel, usually superior mesenteric artery
History of AF is common
Sudden-onset, severe pain with normal examination
53
How does acute mesenteric ischaemic be managed?
- Test serum lactate which will be raised
- Urgent surgery needed
54
What is ischaemic colitis?
Occlusion of blood flow to the large bowel resulting in inflammation, ulceration and haemorrhage
55
Where is ischaemic colitis most likely to occur?
Splenic flexure
56
How will ischaemic colitis be managed?
Abdo X ray - thumbprinting seen
Supportive treatment, surgery if severe
57
How should a severe flare of UC be treated?
IV corticosteroids
58
Iron defiency anaemia vs. anaemia of chronic disease
TIBC is high in iron deficiency but low/normal in chronic disease
Think of TIBC as the amount of space in the body to store iron: this will be high in iron deficiency as no iron
59
What should be given alongside isoniazid to prevent peripheral neuropathy?
Pyridoxine (vitamin B6)
60
T2DM with abnormal LFTs
NAFLD
61
What blood test can be done alongside incidental findings of NAFLD?
Enhanced liver fibrosis test
62
Which drugs are used to maintain remission in Crohns?
Azathioprine or mercaptopurine
63
Mild vs Moderate vs Severe flares of UC
Mild - <4 stools daily with no systemic disturbance
Moderate - 4-6 stools per day with minimal systemic disturbance
Severe - >6 stools per day with systemic disturbance
64
What is a severe complication of IBD flare up?
Toxic megacolon -> abdo X-ray needed
65
Which scores are used in acute GI bleeds?
1. Glasgow Blatchford score to identify who can be managed as outpatient
2. Rockall score done after endoscopy to identify risk of rebleeding
66
Alcohol units formula?
volume (ml) * ABV / 1,000
67
What can be given as prophylaxis for episodes of hepatic encephalopathy?
Lactulose
68
Metabolic alkalosis + hypokalaemia
Vomiting
69
Which tool is used to assess for malnutrition in patients?
MUST - malnutrition universal screening tool
70
What is small bowel bacterial overgrowth syndrome?
- Excessive bacteria in the small bowel
- Diabetes and Scleroderma are associated with this
- Presents like IBS: abdo pain, diarrhoea, bloating
- Hydrogen breath test to diagnose
- Abx usually rifaximin used to treat alongside correcting cause
71
severe, colicky post-prandial abdominal pain, weight loss, and an abdominal bruit
Intestinal angina/chronic mesenteric ischaemia
72
What is alcoholic ketoacidosis?
- Euglycaemic ketoacidosis seen in those who drink alcohol excess
- Presents with metabolic acidosis, elevated ketones but NORMAL/LOW glucose levels
- Tx with IV fluids and thiamine
73
Which test should be used to test for eradication of H pylori?
Urea breath test
74
What is the most common cause of inherited colorectal cancer?
HNPCC - hereditary nonpolyposis colorectal cancer
75
What are aminosalicylates associated with?
Agranulocytosis - check FBC
76
Pain on swallowing (odynophagia) can be a sign of what?
Oesophageal candida
77
What is used to determine the severity of the C diff infection?
WCC
78
Bleeding gums and receding
Scurvy
79
liver and neurological disease
Wilsons disease
80
Electrolyte imbalances of refeeding syndrome ?
Hypophosphataemia, hypokalaemia and hypomagnesaemia
81
Abdominal pain, Bloating and Change in bowel habit
IBS
82
Cholestasis vs liver damage on bloods?
Liver injury - >10 times increase in ALT and <3 times increase in ALP
Cholestasis - <10 times increase in ALT and >3 times increase in ALP
83
Which drugs can cause cholestasis?
- COCP
- Abx including flucloxacillin, co-amoxiclav
84
Coeliac disease is associated with deficiency of what?
iron, folate and vitamin B12 deficiency
85
Which IBD is associated with gallstones?
Crohns
86
What is used to assess whether glucocorticoid therapy may be beneficial in alcoholic hepatitis?
Maddreys function - serum bilirubin and prothrombin time
87
Antinuclear antibodies, anti-smooth muscle antibodies and raised IgG levels
Autoimmune hepatitis
88
dysphagia, glossitis and iron-deficiency anaemia
Plummer-Vinson syndrome
89
watery green diarrhoea post cholecystectomy
Bile acid malabsorption -> treat with cholestyramine
90
What is decreased in Wilsons disease?
serum caeruloplasmin
91
Haemochromatosis is a cause of what?
Hypogonadotropic hypogonadism
92
Patients with a suspected GI bleed require what?
OGD within 24 hours
93
What LFTs can indicate pancreatic cancer?
Cholestatic picture
94
What is an unreliable indicator of iron stored in the body during illness?
Ferritin -> use transferrin saturation instead
95
What can be used to differentiate between and upper and lower GI bleed?
Urea levels - high in upper GI bleed
96
Investigations for PSC?
1. US scan
2. MRCP
97
What is used for prophylaxis of oesophageal bleeding?
Propranolol
98
Management of severe alcoholic hepatitis?
Steroids
99
Which cancers are associated with HNPCC?
- Colorectal
- Endometrial
- Ovarian
- Pancreatic
100
What is the treatment of hypophosphatemia?
Intravenous infusion of phosphate polyfusor
101
Most common organism causing SBP?
Gram negs - E coli, Klebsiella
102
Management of Dysplasia on biopsy in Barrett's oesophagus
Endoscopic intervention
103
What should you test to screen for haemochromatosis?
Transferrin saturation
104
Psychosis is a complication of what?
Wilsons disease
105
What is the investigation of choice for perianal fistulae in Crohns?
MRI
106
Bleeding vs perforated peptic ulcer?
Perforated ulcer should present with signs of peritonitis e.g. abdo pain, distension, guarding
107
Deranged LFTs and AKI in someone with septic shock?
Think ischaemic hepatitis
108
Patients allergic to aspirin may also react with what?
Sulfasalazine
109
What is Richter's hernia?
A rare hernia which causes a firm, erythematous mass -> often presents with symptoms of strangulation (ischaemia/necrosis over the skin)
110
What should be given for prophylaxis of variceal bleeds?
Propranolol
111
Management of SBP
Acute: IV Cefotaxime
Abx prophylaxis if they have ascites: Ciprofloxacin until ascites resolves
112
Back pain worse on lying down, appetite loss and weight loss
Pancreatic cancer
113
What is the most common type of oesophageal malignancy in patients with GORD?
Adenocarcinoma
114
What can cause a wheeze in people with GORD?
Inhalation of small amounts of gastric contents
115
What is the gold standard investigation for GORD?
Oesophageal pH manometry
116
What surgery can be done for GORD and what does this do?
Nissen fundoplication - fundus wrapped around the abdo oesophagus to improve strength of the gastro-oesophageal junction
117
What is a complication of Nissen fundoplication?
Dysphagia from compression of the junction
118
Examination signs of chronic liver disease
- Clubbing
- Palmar erythema
- Dupuytren's contracture
- Hepatosplenomegaly
- Ascites
119
What are complications of liver cirrhosis?
- Encephalopathy
- Sepsis
- SBP
- Ascites
- Varices
120
What dietary advice would you give someone with ascites?
- Fluid restriction
- Low sodium
121
Why is lactulose given in encephalopathy?
Reduce number of nitrogen producing bacteria in the gut which contribute to hepatic encephalopathy
122
Why can anti-EMA antibodies be negative in severe malabsorption in coeliac?
Deficiency in proteins such as IgA
123
Haematemesis + distended abdomen
Variceal bleeding
124
What is an indicator of pancreatitis severity?
Hypocalcaemia
125
What is the most common cause of large bowel obstruction?
Tumour then volvulus/diverticular disease
126
What do Hepatitis B serology markers mean?
HBSAg - acute infection (if > 6 months then chronic infection)
Anti-HBs - immunity
Anti-HBc - previous/current infeection
127
Causes of different types of jaundice
Pre - Sickle cell, G6PD, Hereditary spherocytosis
Hepatic - Hepatitis, PBC, PSC, EPV, HCC
Post hepatic - biliary atresia, gallstones, pancreatitis
128
Stages of liver disease
Steatosis -> Fibrosis/Steatohepatitis -> Cirrhosis
129
When is liver transplant indicated in liver disease?
In chronic liver disease, patients must have stopped alcohol for atleast 6 months
130
What are complications of GORD?
- Barret's
- Adenocarcinoma
- Oesophageal stricture
- Chronic cough
131
What are complications of UC?
- Colon cancer
- Toxic megacolon
- Bowel perforation
132
Where does volvulus cause large bowel obstruction?
Sigmoid
133
What is coffee bean sign indication of?
Sigmoid volvulus
134
What is the management of sigmoid volvulus?
Stable - rigid sigmoidoscopy with flatus tube insertion
Unstable - Urgent laparotomy
135
Palpable fullness in the gallbladder with painless jaundice?
Think pancreatic cancer
136
Fever, abdo pain, cirrhosis and portal HTN?
Think SBP
137
Hypertrophic pulmonary osteoarthropathy is associated with what?
Squamous cell carcinoma of lung
138
Achalasia increases the risk of what?
Squamous cell carcinoma of the oesophagus
139
What is the best way to assess someone response to Hep C treatment?
Viral load
140
Ongoing jaundice + pain post cholecystectomy?
Gallstone in common bile duct
141
Management of malignant distal obstructive jaundice due to unresectable pancreatic carcinoma
Biliary stenting
142
Flu like illness with RUQ pain, tender hepatomegaly and deranged LFTs?
Think Hep A
143
What would biliary colic blood show?
Everything normal
144
What should you not do in someone with suspected pancreatitis?
Make them nil by mouth - enteral feeding should be offered
145
What is the treatment for symptomatic perinala fistulae in Crohn's?
Oral metronidazole
146
History of vascular disease and lactic
acidosis
Think mesenteric ischaemia
147
What is the most sensitive/specific test for pancreatitis?
Lipase
148
What is the marker of choice to assess liver synthetic function?
INR (prothrombin time)
149
What are some components of Child-Pugh score?
- Bilirubin
- Albumin
- PT
- Encephalopathy
- Ascites
150
What should be the first investigation in A+E if someone comes in with pain/vomiting?
Erect CXR to look for pneumoperitoneum suggestive of perforation
151
What are the components of Glasgow score for pancreatitis?
Pa02
Age > 55
Neutrophils
Calcium < 2
Renal function
Enzymes
Albumin
Sugar
152
Why is US scan helpful in pancreatitis?
Assess for presence of gallstones
153
What are the 2 signs of pancreatitis?
Grey Turners - Bruising along flanks suggestive of haemorrhagic pancreatitis (sign of retroperitoneal bleeding)
Cullen - Bruising around umbilicus
154
Pigmented gallstones are associated with what?
Sickle cell anaemia
155
pseudomembranous colitis is what?
C diff colitis
156
What is the treatment for cholecystitis?
IV Abx with laparoscopic cholecystectomy within 1 week of diagnosis
157
What can be used to manage complex anal fistulae?
Draining seton
158
What is the most common disease pattern in UC and Crohns?
UC - Proctitis
Crohns - Ileitis
159
What drugs should be stopped in C diff infection?
Opioids
160
anorectal pain and a tender lump on the anal margin
Thrombosed haemorrhoids
161
short incubation period and severe vomiting
Staph aureus gastroenteritis
162
Which Abx can be used for Campylobacter infection if severe/immunocompromised?
Clarithromycin
163
Charcot's triad plus hypotension and confusion
Reynolds pentad
164
What is necessary before a diagnosis of PBC?
Imaging to exclude a extrahepatic biliary obstruction
165
Management of acute anal fissues?
Bulk forming laxatives
166
What is Troisier's sign?
Enlarged hard left supraclavicular lymph node which indicates metastatic abdo malignancy
167
What are risk factors for gastric cancer?
- H pylori
- Gastric polyps
- Pernicious anaemia
- Gastric ulceration
168
What does TNM staging assess?
Size of tumour
Presence of lymph nodes
Evidence of metastases
169
What is the marker for HCC?
AFP
170
Surgical procedures for pancreatic cancer?
- Pancreaticoduodenectomy
- Whipples
171
flu-like symptoms, RUQ pain, tender hepatomegaly and deranged LFTs
Hepatitis A
172
Hepatitis serology
IgM - acute infection
IgG - chronic infection
173
Severe hepatitis in a pregnant woman
Hep E
174
Man returns from trip abroad with maculopapular rash and flu-like illness
Think HIV seroconversion
175
Undercooked pork?
Hepatitis E
176
Right-sided tenderness on PR exam
Acute appendicitis
177
What is the surgery for bilateral/recurrent inguinal hernias?
Laparoscopic repair with mesh
178
Mesalazine can cause what?
Drug induced pancreatitis
179
lemon tinge to the skin
Pernicious anaemia
180
pH < 7.3 at 24 hours post paracetamol overdose?
Liver transplant consideration
181
periodic acid-Schiff- (PAS-) positive macrophages
Whipples disease
182
dysphagia, iron deficiency anaemia and glossitis
Plummer Vinson syndrome
183
What is a TIPS procedure?
Artifical channel within the liver used for variceal bleeding refractory ascites
Major complication is hepatic encephalopathy
184
severe abdominal pain, ascites and tender hepatomegaly
Budd-Chiari syndrome
185
Which laxative to prescribe when starting patients on opiates?
Senna
186
Management of diverticulitis flare?
Oral Abx with admission to hospital if symptoms do not improve within 72 hours
187
Why give albumin for large volume ascites?
reduce paracentesis-induced circulatory dysfunction and mortality
188
What is usually normal with acute cholecystitis?
LFT tests
189
classic epigastric pain which is relieved on sitting forwards
Think chronic pancreatitis
190
What will AST:ALT ratio be in alcoholic hepatitis?
2:1
191
caput medusae and splenomegaly in a known alcoholic suggest what?
Portal HTN
192
Antibodies for PBC
Anti-mitochondrial - most common
Anti-smooth muscle
193
What does a score of 3 or more on Glasgow criteria suggest for pancreatitis?
May need ITU input
194
slate-grey skin pigmentation
Haemochromatosis
195
Diarrhoea after rice?
Bacillus cereus
196
What are the anti emetics of choice in gastroparesis?
- Metoclopramide
- Domperidone
197
fever, malaise, abdo pain and rose spots on trunk?
Typhoid fever -> treat with fluids and Ciprofloxacin
198
Raised ALP and bilirubin suggests what?
Cholestatic picture
199
What marker is raised in cholangiocarcinoma?
CA19-9
200
MSH2/MLH1 mutation?
HNPCC
201
What is the AST:ALT ratio in alcoholic liver disease?
2:1 - AST 2 times higher than ALT
202
Gastroenteritis incubation periods?
1-6 hours: Staph aureus
12-48 hours: Salmonella, E coli
48-72 hours: Shigella, Campylobacter
>7 days: Giardiasis, Amoebiasis
203
mural thickening of the colon and the presence of pericolic fat stranding in the sigmoid colon
Diverticular disease
204
What is the weight loss definition for malnutrition?
Loss of >10% in the last 3-6 months
205
What should the prothrombin time be in order to qualify for liver transplant?
>100seconds
206
First line test for coeliac in GP?
Total IgA and IgA tissue transglutaminase
207
When should a repeat endoscopy be done after the start of PPI therapy for ulcer?
6-8 weeks
208
Autoimmune hepatitis antibodies?
Type 1 - ANA, anti-smooth muscle
Type 2 - Anti-LKM-1
209
What can help to confirm SBP from Ascitic fluid?
Raised neutrophils
210
triad of vomiting, pain and failed attempts to pass an NG tube
Gastric volvulus
211
Post prandial vomiting and abdo pain in someone with chronic pancreatitis?
Pancreatic pseudocyst
212
Blockage where does not cause jaundice?
Cystic duct or gallbladder
213
ALT/AST in the 10,000s?
Think paracetamol overdose
214
AST vs ALT
AST - alcohol overdose
ALT - drug overdose/viral hepatitis
215
Suspected cholecystitis in GP?
Refer to hospital for urgent admission
216
spiral or comma-shaped gram negative
Campylobacter
217
