Gastro Flashcards
(155 cards)
1
Q
primary biliary cholangitis M rule and path
A
raised IgM
anti mitochondrial abs (m2 subtype)
Middle aged females
Raised ALP bc obstructive ( autoimmune destruction of bile ducts in liver (chronic inflam = fibrosis of duct walls) = cholestasis and obstruction) which may lead to cirhosis
2
Q
primary biliary cholangitis presentation and complications
A
middle aged women
fatigue, pruritis, jaundice
xanthelsma/xanthomata
Hyperpigmentation over pressure points
10% RUQ pain
clubbing n hepatosplenomegaly
late = may progress to liver failure
3
Q
primary biliary cholangitis ix
A
immune
- AMA ABs
- IgM
LFT - Raised ALP
RUQ Ultrasound or MRCP - to exclude extrahepatic biliary obstruction
4
Q
Primary biliary cholangitis Mx
A
1st line = ursodeoxycholic acid
itch = cholestyramine
fat soluble vitamine supplements
liver transplant if bilirubin> 100
5
Q
PPI SE
A
hyponatramia hypomagnasaemia
osteoporisis –> inc risk of fractures
increased risk of C.diff
6
Q
refeeding syndrome electrolytes n what do they cause
A
hypophosphataemia !!
hypokalaemia
hypomagnesaemia
hypophos = muscle weakness, myocardial ->cardiac failure, diaphragm ->resp failure
hypomag = predispose to torsades de pointes
7
Q
coprescribed w isonizid and why
A
pridoxine (vitamin b6) to prevemt peripheral neuropath
8
Q
pharyngeal pouch ix and def mx
A
barium swallow w dynamic vid fluroscopy
surgical myotomy and resection
9
Q
what to give before endoscopy in pt w sustpected variceal haemorhage
A
terlipressin and abx
10
Q
prophylaxis of variceal haemorrhage
A
propanolol
ligation (EVL) (if medium to large varicies) 2 weekly until all eradicated (+PPI to prevent evl ulceration)
all fails = Transjugular intrahepaatic portosystemic shunt (TIPSS)
11
Q
alcoholic ketoacidosis when it happens n tx
A
chronic alcoholics after period of reduced food intake
IV fluids and thiamine
(rehydrate and prevent wernickes)
12
Q
ascites secondary to liver cirrhosis duiretic
A
aldosterone - spironalactone
13
Q
liver abcess tx
A
abx and image guided percutaneous drainage
if fails = surgical resection
Hydatid cyst = surgical resection 1st Differentiate from abcess by CT = better circumscribed
14
Q
upper GI bleed vs lower GI bleed
A
drop in haem
high urea = upper GI
15
Q
how long stop PPI before endoscopy
A
2 weeks
16
Q
liver cirhosis dx and monitoring
also who to screen with it
A
transient elastography (measures liver stiffness)
hep C
men >50units week alcohol women > 35
people dx w alchol related liver disease
17
Q
Further investigations in pt w new liver cirrhosis dx
A
endoscopy to check varices
liver US 6monthly =/- Alpha feta protein to check hepatocellular Ca
18
Q
constipation and diarohea in IBS tx
A
bulk forming laxative ie isphagula husk
avoid lactulose (increases gas = worsens sx )
constipation >12 months and max doses of previous laxatives from different classes not helped = linaclotide
diahorea = loperamide
19
Q
dont use PPI w what
A
clopidegrel = reduces efficacy
20
Q
pancreatic Ca presentation n what type
A
painless obstructive jaundice ( cholestatic LFTs)
pale stools, dark urine, itchiness
many pt non specific ie anorexia, wt loss, epigastric pain
maybe abdo mass
loss of exocrine fxn = steatorrhea
loss of endo fxn = DM
most are adenocarcinoma of head
21
Q
pancreatic ca ix
A
high resolution CT
double duct sign (dilitation of common bile ducts and pancreatic ducts
22
Q
pancreatic ca mx n Ses
A
most not suitable for surg at dx (only 20%)
whipples for resectable lesions on head. SE = dumping syndrome and peptic ulcer disease
adjuvent chemo post surg
ERCP with stenting for palliation
23
Q
spontaneous bacterial peritonitis (SBP) what is it n sx
A
Ascitic fluid infection
peritonitis in pt w ascites 2ndy to liver cirrhosis
= ascites abdo pain and fever
24
Q
SBP dx, mc organism mx
A
dx = paracentesis neutrphils > 250
E.coli
Mx = Iv cefotaxime
25
when to give proph abx in ascites
prevous episode of SBP
fluid protein< 15g/l and (childpugh>9 or hepatorenal syndrome)
oral cipro or norfloxacin
26
UC flare severity
mild = <4stools a day small blood
mod = 4-6, varying blood no system upset
sever= >6 bloody a day + system upset
27
small bowel bacterial overgrowth syndrome (SBBOS)
RFs, sx,
RFS =
neonates w congen GI abnormal
scleroderma
DM
crohns
features overlap w IBS
chronic diarrhoea
bloating flatulence
abdo pain
28
SBBOS dx and mx
dx
hydrogen breath test
if inconclusive = small bowel aspirate n culture
clinicans sometimes give abx course as diagnostic trial
mx
corection of underlying disorder
abx = rifaximin 1st (also coamox and metroni)
29
gastric ulcer presentation
pain during or after eating bc stomach produces acid to food
30
duodenal ulcer presentation
pain when stomach empty ie several hours after food
improved by eating
31
prolonged vomiting electrolytes n why
metabolic acidosis (inc pH and bicarb =)
hypokalaemia
too much vom = fluid loss = RAAS activated = more Na resorb at DCT (water follows) to inc blood vol = therfore by exchanging K --> too much k lost
32
crohns flare isolated peri anall disease
metronidazole
33
inducing remision in crohns
glucocorticoids
2nd line = mesalazine
add on aziathioprine/mercaptopurine or methotrex
34
when to use infliximab in crohns flare
refractory disease
fistulating crohns
pt typically continue on azath or methotre
35
maintaining crohns remission
stop smoking
1st line = azathioprine or mercaptoprurine (CHECK TPMT)
2nd = methotrexate
36
acalculous cholecystitis
inflammation of gallbladder with no stones
pt w underlying comorb eg DM, vasculitis, organ failure SLE
systemically unwell high fever RUQ pain, no jaundice
mx
pt fit = cholesystectomy
unfit = percut cholecystostomy
37
Crohns features NESTS
N no blood or mucus
E entire GI tract (mouth to anus)
S Skip lesions endoscopy
T terminal ileum most affected + Transmural inflam (full thickness)
S smoking risk factor
38
UC features CLOSEUP
C Continuous inflam
L limited to colon and rectum
O only superficial mucosa affected
S smoking protective
E Excrete blood and mucus
U Use aminosalicytes
P Primary sclerosing cholangitis
39
child with tracheooesphageal fistula followinf repair may develop
benign oesophageal fistulas
40
proctitis meaning
inflammation of anus and lining of rectum
41
chronic mesenteric ischaemia triad
intestinal angina
severe colicky post prandial abdo pain
weight loss
abdominal bruit
42
Budd chiari syndrome what is it, triad and ix
hepatic vein thrombosis usually seen in context of underlying procoagulant condition (inc preg and COCP)
triad
sudden onset sever abdo pain
ascites and abdo distension
tender hepatomegaly
Ix - US w doppler flow studies
43
ascites tap serum acistic albumin gradient (SAAG) <11g/l
hypoalbunaemia: nephrotic, severe malnut (kwashiorkor)
malignancy; peritoneal carcinomatosis
Infections; tuberculous peritonitis
others; pancreatitis, bowel obs. biliary ascites
post op lymphatic leak, serositis in connective tissue disease
44
ascites tap serum acistic albumin gradient (SAAG) >11g/l
indicates portal htn
liver: cirhossis, acute failure, liver mets
Cardiac: RHF, constrictive pericarditis
Other: budd chiari, portal vein thromb, veno occlusive disease, myxoedema
45
liver decompensation what is it and trigger factors ABCDI
significant decline in cirrhosis pts (jaundice and confusion)
Alcohol
bleeding
constipation
drugs (sedatives) or dehydration
infection
46
upper GI bleed score post endoscopy
Rockall score used after endoscopy and provides a percentage risk of rebleeding and mortality
47
investigation for perianal fistulae in pt w crohns
MRI pelvis
48
achalasia investigations
oesophageal manometry
- excessive LOS tone which doesn't relax on swallowing
barium swallow
- grossly expanded oespgagus
- BIRDs beak appearence
Chest xray
- wide mediastinum n air fluid level (bc lack of peristalsis)
49
primary sclerosing cholamngitis asx w which IBD
UC
50
TIPSS tx for osephageal varcies can cause what
excerbation of hepatic encephalopathy
bc shunt = blood bypasses liver into systemic cirulation w/o metabolism of nitrogenous waste products = build of ammonia which crosses BBB
51
haemorrhoids grading
grade 1 - do not prolapse out of anal canal
grade 2 - prolapse on defecation but reduce spontaneously
grade 3 - manually reduced
grade 4 cannot be reduced
52
mallory weiss tear
superficial tear of mucosa
post binge vomitting ie night out
self limiting
53
boerhaaves syndrome path signs, ix, tx
transmural spontanous rupture of oesphagus into chest
pt chronic wreching ie alcoholic or bulimic
fever dyspnea severe onset chest pain
air in mediatinum (sc emphysema) cxr and physical
IX - CT contrast barium swallow
tx - thoracotomy and lavage <12 hrs
54
acute mesenteric ischaemia
embolism in artery supplying small bowel
usually hx of AF
severer sudden onset abdo pain out of keeping with physical exam
increased lactate
immediate laparotomy
55
chronic mesenteric ischaemia
'GI angina'
colicky intermittent abdo pain w eating = avoid eating n wt loss
56
Ischaemic colitis
what is it
where
pt
ix
tx
acute transient compromise in blood flow to large bowel --> leading to inflam, ulceration and haemorhage
watershead areas ie splenic flexure
pt maybe hypotensive bc something else then == Painful bright red blood per rectum
abdo XR = thumbprinting
tx supportive unless too bad (peritonitis, perf etc) = surgery
57
mesalazine complication
pancreatitis
less so in sulfasalazine
58
associations with h.pylori
1 peptic ulcer disease (duo>gastric)
2 gastric adenocarcinoma
3 B cell lymphoma
4 atrophic gastritis
59
how to calculate units of alcohol
(ml x %)/1000
ie 25ml spirit (ABV 40%) = 25x40/1000 = 1unit
60
Vitamin C defiiciency
scurvy
easy bruising, gum bleeding, lethary, joint pain
poor diet ie nutrional deficiency
61
crohns sign on exam
abdo mass palpable in right iliac fossa (terminal ileum)
62
anaemia of chronic disease blood
serium iron low
total iron binding capacity = dec/normal
serum ferritin = Normal/ increased
63
iron def anaemia blood
serum iron low
TIBC = increased
serum ferritin = decreased
64
pancreatic cancer Ix and dx
USS first
High res CT for definitive
double duct sign ie common bile and pancreatic duct dilatation
65
life threat C diff
oral vanc
IV metronidazole
66
autoimmune hepatitis
antibodies
pt
ix
tx
anti smooth muscle
ANA
(Type2 kids only = antiliver/kidney LKM1)
young female
amenorhea
deranged LFTs
signs of chronic liver disease or acute hep ie fever jaundice
ix = liver biopsy, piecemeal necrosis and bridging necrosis
mx = steroids and azathioprine (immunosup)
liver transplant
67
haemochromatosis genetic
autosomal recessive
68
drug induced cholestatic +/- hepatitis
COCP
abx - fluclox. coamx, erthryro
anabolic steroids, testosterone
sulfonurea
69
coeliax disease associated Ca
enteropathy-associated T cell lymphoma
70
abx causing c diff
clindamycin
ceftriaxone
71
Peutz jeghers syndrome
autosomal dominant condition
hamartomous polyps in GI (mainly small bowel)
- ie common PC is small bowel obstruction bc intussusception
age 10-15
pigmented lesions on lips, oral mucosa, face palms and soles
72
predict mortality in liver cirrhosis pt
child pugh score
73
what blood marker to use to asses severity of liver cirrhosis
albumin
74
hepatic encephalopathy tx
lactulose and rifaximin
75
loperamide mechanism and indication
opioid receptor agonist (only on gut)
anti diarhoea
76
1st line IBS accordind to sx
pain = anti spasmodic
constipation = laxatives (avoid lactulose) ( if nothing works or constipated>12mths = 2ndline linaclotide)
Diarhorea = loperamide
77
barium enema UC
lead pipe colon in distal paart
ie loss of haustral markings
78
caused of increased ferritin without iron overload (ie normal transferrin saturation)
inflammation
alcohol excess
liver disease
ckd
malignancy
79
best measure of liver function in acute liver failure
prothombin
bc shorter half life than albumin sp changes more suddenly
80
initial screening test for haemochromatosis
general pop: transferrin sat> ferritin
family members: genetic testing
81
alcoholic hepatitis liver enzymes
AST/ALT 2:1 ratio
raised GGT
82
NAFLD found incidentally on uss
enhanced liver fibrosis (ELF) blood test
to check for fibrosis
83
lymphatic spread of gastric ca
left supraclavicular node (virchows)
periumbilical nodule (sister may joseph)
84
diagnosis of gastric ca
OGD with biopsy
signet ring cells --> more of them = worse prog
CT for staging
85
pt on aminosalicylate becomes unwell soar throat fatigue bleeding guma
agranulocytosis CHECK FBC
86
surgucak tx of achalasia if recurrent sx post pneumatic balloon dilation
what if high surgical risk?
heller cardiomyotomy
intra-sphincteric botox injection
87
NAFLD LFTs
ALT>AST - Lard = NAFLD
can also have mild elevations of ferritn
88
alcoholic hepatitis LFTS
AST>ALT - Spritis = alocholic hepatitis
89
Differentiating betweem primary bilary cholangitis
and
primary sclerosing cholangitis
PBC = +ve anti mitochond
PSC = +ve anti smooth muscle and ANA
Asssociated w UC
90
wilsons age path
autosomal recessive
faulty gene = liver can excrete copper = build up in all tissues
91
wilsons disease deposits where n also other fx
liver
brain
cornea
kidneys
haemolysis
blue nails
92
wilsons disease neuro deposition where and manifestaions
basal ganglia degen bc deposits in it esp putamin and globus pallidus
speech behavour psych problems (usually 1st manifestations)
asterixes chorea dementia parkinsonim
93
copper deposition in cornea in wilsons
= keiscer fleicher rings in around iris bc accum in descement membrane
94
copper deposition in kidneys wilsons
renal tubular acidosis (esp fanconi syndrome)
95
wilsons IX
serum caeruloplasmin (reduced)
serum copper (reduced)
24hr urinary copper (increased
confirm dx genetic test of ATP7B gene
96
wilsons gene
ATP7B
97
wilsons tx
penicillamine
trientine hydrochloride
98
King's College Hospital criteria for liver transplantation (paracetamol liver failure)
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
99
used to monitor haemochromatosis
ferritin and transferrin saturation
100
mc cause hypopitruitrism
non secretetory pitruatry macroadenoma
101
early signs haemochromatosis
fatigue, erectile dysfunction and arthralgia
102
wilsons blood
reduced caeruloplasmin
103
anaemia of chronic disease bloods
normocytic
low serum iron
low TIBC
raised ferritin
pt w chronic illness
104
iron studies in haemochromatosis
raised transferrin saturation
raised ferritin
low TIBC
105
haemochromatosis fertility complication
non reversible
hypogonadotrophic hypogonadism
bc pitruatry dysfunction
106
gluten free foods
rice
pottatos
corn (maize)
107
gluten avoid food
wheet = bread pasta pastry
barley = beer
rye
oats
108
primary biliary cholangitis complications
complications;
- cirhosis -> portal HTN -> ascites, variceal haemorhage
- osteomalacia and porosis
- inc risk of hepatocellular ca
109
barrets oesphagus
metaplasia ie from squamous to columnar
may resemble that of stomach/small intest ie
goblet cells
brush border
paneth cells
110
barrets mx
PPI
if metaplasia = endoscopy 3-5yrs
dysplasia of any grade identified =
endoscopic radiofrequency ablation
endoscopic mucosal resection
111
volvulus types and ix
sigmoid
caecal
abdo xr
112
sigmoid volvulus signs associations n tx
large bowel obstruction coffee been sign on xr
older
chronic constipation
chagas disease
neuro - parkinsons, duchennes
shizophrenia
flatus tube (thru rectum)
113
caecal volvulus associations n tx
all ages
adhensions
pregnancy
small bowel obstruction on xr
right hemicolectomy
114
hep A sx
flu ike sx
RUQ pain
tender hepatomegaly
deranged LFTs
raised billirubin
raised ALT/AST
normal/slight raised ALP
115
anal fistula investigation
MRI pelvis
116
Hep E
spread
incubation
place
feaco oral
3-8 weeks
central n south east asia, north n west africa, mexico
significant mortality during pregnancy
117
hepatitis spread
A and E spead faecally
B-D spell BlooD
118
diarohea and wt loss differentials
IBD
IBS
colorectal ca
coeliac
thyrotoxicosis
chronic panc
119
crohns histology
endoscopy
inflammation all layers from mucoas to serosa
inc goblet cells
granulomas
skip lesions
cobblestoning
deep ulcers
mouth to anus
120
extraintestinal fx crohns
erythema nodosum
iritis/conjuctivitis/episcleritis
larg joint arthritis
Ankspond
apthous ulceration
121
how doesinfliximab work in cohns
TNF inhib
tumor necrosis factor imporant in establishing inflammation and granulomatos inflammation
122
upper GI bleed causes
oesphageal varices
peptic ulcer
mallory weiss tear
gastric ca
oesphagitis
aortic enteric fistula
bleeding disorders
123
site of portosystemic shunts (bc liver cirhossis) and sx
superior rectal vein shunt --> haemorrhoids
paraumbilical vein shunt --> caput medusae
124
traumatic tap
blood makes way into LP
125
disease inc risk of berry aneurysms ie SAH
polycystic kidneys
ehlers danlos
coarctation of aorta
126
kernigs sign
bend hip and knee to 90degrees
pain when straightening knee =positive sign
=meningeal irritation
127
why is pain in appendicitis first felt in the periumbilical region before mcburneys point
Irritation of the visceral peritoneum by the inflamed appendix is felt in the T10 dermatome, which corresponds to the periumbilical region. This is because the visceral peritoneum has no somatic innervation, so the brain perceives visceral signals as being from the same dermatome as where the visceral signals enter the spinal cord. As the appendix is found in the midgut, the corresponding dermatome is T10 .
As the disease progresses, the parietal peritoneum becomes affected. As this receives somatic innervations, the pain is well
localised to the area o f inflammation. (1)
128
ALARMS sx dyspepsia
anaemia
loss of weight
anorexia
recent onset progressive sx
malena/haemetasis
swalling difficulty
virchows node
129
whats mc duo or gastric ulcer
duo = 4x more common
130
why do u get noctural asthma (wheeze) in GORD
inhalation of small amouns of gastric contents
131
indications for nisse fundo in gord
all 3 of
severe sx
refractory to medical therapy
confirmed reflux by ph monitering
132
hiatus herna types
sliding (MC) GOJ slides into chest
rolling
mixed
133
which hernia to repair
rolling bc may strangulate
134
post hep juaundice urine stools and why
dark urine
pale stools
billirubin that has conjugated with gluconuride in hepatocytes = water soluble
dissolves in urine
135
post hep jaundice ix
urine inc billirubin
bloods
abdo USS
ercp
136
panc ca therapeutic tx
ercp w stenting
137
cx persistent jaundice
inc suscept to infexn
pruritis
liver dysfxn
aki
138
hepatitis at risk groups
IVDU
sex workers
health workers
haemophiliacs
139
distaste for cigarrettes hep
viral hep A
140
viral hepatitis mx
supportive
no alcohol
or hepatotoxic dx ie aspirin
anti viral
indicated in chronic disease
hep b = PEGinterferon
hep C = PEGinterferon n ribvarin
141
hep b n c cx
chronic hep
cirhossis
hepatocell ca
142
hep b may also be infected w
hep c and d
HIV
143
blood for synthetic liver fxn
albumin
PT/INR
144
cirhossis cx
ascites
SBP
coagulopathy
encephalopathy
hypoglycaemia
145
portal htn sequelae cx
SAVE
splenomeg
ascites
varices (oesp,caput med, worsens existing piles)
encephalop
146
ascites mx
fluid restirct low na
ascitic tap
duiretics - spiro
albumin infusion
147
why lactulose in hepatic enceph
inc bowel transit
= reduce nitrogen producing bact in gut which contribute to hepatic enceph
148
coeliac path
autoimmune abs againt gluten
= modifed and presented to T cells
= inflam of small bowel
149
mc source gluten
wheat
150
why might anti endomysial abs be -ve inceoliacs
seevre malabsorb = Iga and other protein deficiency
151
coeliac histo
crypt hyperplasia
villous atrophy
lymphocytic infiltration
152
ca associated w coeliax
GI T cell lymphoma
gastric
oesphageal
153
unexplained iron def anaemia
colonscopy
id right sided colonic tumor
154
COLON ca rf
IBD
neoplastic polyps
HNPCC
low fibre
155
