Gastro Flashcards by Shila Uruci

What are associated with NASH?

Obesity
T2DM
hyperlipidaemia
jejunoileal bypass

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What are the features of NASH?

asymptomatic
hepatomegaly
increased echogenity on US

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Liver results for NASH

ALT>AST

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What is the treatment plan for NAFLD/NASH?

lifestyle changes
weight loss
monitoring

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What is the urea breath test used to check?

eradication of H.pylori

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How long after eradication therapy can you use urea breath test?

4 weeks post treatment

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What is barrett’s oesophagus?

normal stratified squamous epithelial lining of the distal oesophagus is replaced by metaplastic columnar epithelial ( glandular)

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What are the risk factors for Barrett’s oesophagus?

Over>50
male
Caucasian
smoking
obesity

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What are the investigations for Barrets?

OGD + biopsy

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How often should surveillance occur is someone has Barrets?

no dysplasia - 2-5years
Mild dysplasia - 6m
high grade - 3m

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What is main risk of barrets oesophagus?

Adenocarcinoma

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What are the symptoms of oesophageal cancer?

dysphagia
anorexia
weight loss
odynophagia
hoarse voice
vomiting

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What are the two types of oesophageal cancers and where are they typically found?

Squamous : upper 2/3 of oesophagus
Adenocarcinoma: distal 1/3

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Risk factors for Adenocarcinoma of the oesophagus

GORD
Barrets
Alcohol

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Risk factors for squamous cell cancer of oesophagus

smoking
alcohol
achalasia
plummer vinson

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What investigations are performed for suspected oesophageal cancers?

Endoscopy + biopsy
Ultrasound for local staging
CT chest, abdo and pelvis

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What are the most common causes of Acute upper GI bleed?

oesophagel varices
peptic ulcer

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Presentation of Acute upper GI bleed?

Haematemesis ( bright red, coffee ground)
malena
raised urea

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What are some differential diagnosis for acute upper GI bleed?

Oesophageal causes:
Varices
Oesophagitis
Cancer
Mallory Weiss tear

Stomach :
Gastric ulcer
gastric cancer
diulafoy lesion
gastritis

Duodenum :
ulcer
fistula

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Anatomy that counts as acute upper GI bleed?

oesophagus
stomach
duodenum

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Symptoms of Oesophageal causes of Acute Upper GI Bleed

Varices : large volume of fresh red blood, malena, hemodynamically unstable, stops and restarts

Oesophagitis: small volume of blood ( streaky) , no malena, stops randomly

Mallory Weiss tear: after a large bout of vomiting, bright red, no malena

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What risk assessment scores do you use for an acute upper gi bleed?

Blatchford ( pre assessment) –> determines whther patient is managed inpatient or not
Rockall (after endoscopy) –> risk of recurrence

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Within how many hours after presenting with an acute gi bleed must a patient have an endoscopy?

all should have an endoscopy within 24 hours

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Management for Acute GI bleed if patient needs resuscitation?

A-E assessment
2 large bore cannulas
blood transfusion
platelets (actively bleeding and platelet count of less than 50 x 109/litre)
FFP
Prothrombin complex concentrate if patient on warfarin and actively bleeding

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Management of variceal bleed

-Terlipressin (at presentation) -antibiotics (at presentation) -Band ligation for oesophageal -N-butyl-2-cyanoacrylate for gastric varices -transjugular intrahepatic portosystemic shunts (TIPS) offered if nothing else works

What blood test is good to monitor liver function in acute liver failure?

prothrombin time short half life

What is the gram staining of C.Diff?

gram positive rod

What causes C.diff?

Clindamycin 2nd and 3rd generation Cephalosporins

Investigation for C.Diff

stool sample detecting c diff toxin

Management of C.Diff

1st line - 10 days oral Vancomycin 2nd line - 10 days oral fidaxomicin 3rd line - oral vancomycin +/- IV metronidazole

What is first line treatment for Hepatorenal syndrome?

Terlipressin

What is the key test to determine the severity of C.diff?

WCC

Management of Crohns to induce remission

1st line - glucocorticosteroids ( pred) 2nd line - Mesalazine azathioprine or mercaptopurine may be added not used as monotherapy

1st line to maintain remission in crohns

azathioprine or mercaptopurine methotrexate second line

What are the features of spontaneous bacterial peritonitis?

ascites abdo pain fever

Investigations for diagnosis of SBP

paracentesis : neutrophil count > 250 cells/ul

What is the most common bacteria that causes SBP

E.coli

symptoms of Haemochromatosis

Fatigue ED Arthralgia bronze skin DM hepatic signs hypogonadism cardiac failure (2nd to dilated cardiomyopathy)

What is the inheritance pattern of haemochromatosis?

Aut rec mutation in HFE on Cr6

What management to perform if patient has variceal bleed but after initial treatment is still bleeding & awaiting OGD?

Sengstaken-Blakemore tube

What sign on xray suggest UC?

Lead pipe colon

What medication should be avoided in bowel obstruction?

metoclopramide causes bowel obstruction

Whats the management of life threatening C.Diff?

Oral Vancomycin IV metronidazole

How long after last diarrhea episode should a patient with C.Diff be kept in isolation?

48 hours

What is pernicious anaemia?

autoimmune condition causing vitamin B12 deficiency antibodies against intrinsic factor blocking B12 binding site antibodies against gastric parietal cells

symptoms of pernicious anemia

anaemia symptoms: dyspnoea, pallor, lethargy pins and needles, weakness, ataxia, numbness, memory loss, poor concentration glossitis

Investigations of pernicious anaemia

FBC- low Hb, high MCV, Bloodfilm - hypersegmented Vitamin B12 and Folate levels antibodies for intrinsic factor

What is the management of pernicious anaemia?

Vitamin B12 replacement therapy regime for non neuro symptoms: 3 injections per week for 2 weeks followed by 3 monthly treatment of vitamin B12 injections

What is the criteria for mild flare of UC?

less that 4 stools a day ( with or without blood) no systemic features

What is the criteria for moderate flare of UC?

4-6 stools a day mild systemic symptoms

What is the criteria for Severe flare of UC?

>= 6 stool a day ( with blood) systemic symptoms - fever, abdo pain, hypoalbuminemia,

What to do if someone presents with new found dysphagia?

urgent referral for endoscopy

What is Achalasia?

failure of peristalsis and relaxation of LOS due to degeneration in auerbach's plexus

What are the symptoms of achalasia?

- dysphagia of solids and liquids - heart burn - regurgitation of food

What are the investigations of achalasia?

Oesophageal manometry --> Xs LOS tone after swallowing Barium swallow test --> birds beak look --> expanded oesophagus Chest Xray -->widened mediastinum --> Fluid level

What is first line management of achalasia?

pneumatic (balloon) dilation

What are the features of wilsons disease?

Brain --> basal ganglia degeneration --> speech, behavioural and psychiatric manifestations --> psychosis --> asterixis, parkinsonism Liver --> acute hepatitis --> Cirrhosis Cornea --> keyser fischer rings

What investigation confirms diagnosis of Wilsons?

ATP7B testing

What else is seen in investigations for Wilsons?

reduced serum caeruloplasmin reduced total serum copper increased 24hr urinary copper excretion

Management of wilsons

What should you also examine if a young male presents with lower abdominal pain?

testicular examination

What does a positive pANCA suggest?

PSC

Presenting features of pharyngeal pouch

cough halitosis difficulty swallowing regurgitation

What does High SAAG indication?

Portal hypertension liver cirrhosis, failure cardiac failure, constrictive pericarditis

How to manage ascites?

1) Spironolactone 2) prophylactic antibiotics to reduce risk of SBP Can drain

What type of hepatitis is associated with shell fish?

Hep A

What is triple therapy for H.Pylori?

1) PPI + Clarithro + metronidazole 2) PPI + Clarithro + amox

What is Sister Mary Joseph node indicative of?

metastatic umbilical lesion

Triad for Boerhavre syndrome

subcutaneous emphysema pain vomiting

What is gallstone ileus?

small bowel obstruction secondary to gallstones

What is used in the management of acute alcoholic hepatitis?

prednisolone

What investigation should be performed in all patients with suspected IBS?

Anti-TTG eliminate celiac

What is Melanosis coli?

abnormal pigmentation of the large bowel commonly associated with Laxative abuse

What location of an anal fissure should be concerning for Crohns?

Lateral anal fissure

Causes of macrocytic anaemia

F: Foetus A: Alcohol excess T: Thyroid (hypothyroid) R: Reticulocytosis (due to haemolytic anaemia as RBC precursors are bigger) B: B12/folate deficiency C: Cirrhosis (liver) M: Myeloproliferative disorders C: Cytotoxic drugs (e.g. 5-fluorouracil)

Brown coloured urine + diverticular disease + signs of large bowel obstruction

colovesical fistula

Induce remission of Crohns

Glucocorticosteroids Eternal feeding 5-ASA second line

What is Reynolds pentad?

Charcots triad + hypotension + confusion

What hepatitis is associated with undercooked pork?

Hep E

What needs to be administered for a large paracentesis of ascites?

IV human Albumin

How is SAAG calculated?

Serum Albumin - ascitic albumin

What does this describe : Extraluminal air is present along with a paracolic fluid collection

bowel perforation

What is tested for exocrine function of pancreas?

Faecal elastase

Severe abdominal pain + history of AF + PR bleeding

Acute mesenteric ischaemia

What test do you perform for acute mesenteric ischaemia?

Serum lactate

What are causes of normocytic anemia?

- Haemolytic anameia - blood loss - aplastic anaemia - anaemia of chronic disease - CKD

What investigation to perform for Crohns patients with fistula?

MRI pelvis

What antibiotics to use for anal fistula in Crohns patients?

oral metronidazole

Gastro Flashcards

(88 cards)