Gastro 2 Flashcards by Anna Yaroslavtseva

Other conditions associated with Coeliac disease?

Autoimmune thyroid
Dermatitis herpetiformis
T1DM
1st degree relatives

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Complications associated with coeliac disease?

Anaemia- iron, B12, folate deficiency
Osteoporosis
Lactose intolerance
T-cell lymphoma of small intestine
subfertility
hypersplenism

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How is coeliac diagnosed in children?

-jejunal biopsy showing subtotal villous atrophy
-anti-endomysial and anti-gliadin antibodies for screening

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Investigations for diagnosis of coeliac in adults?

-Serology
-Biopsy (gold-standard)

Serology:
-First line serological tests such as anti-TTG IgA antibody and IgA level, followed by anti-TTG IgG, anti-endomyseal antibody,

Biopsy:
-Oesophago-gastroduodenoscopy (OGD) and duodenal/jejunal biopsy

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Histology finds on biopsy for coeliac?

villous atrophy
crypt hyperplasia
increase in intraepithelial lymphocytes
lamina propria infiltration with lymphocytes

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Common sites for colon cancer?

rectal: 40%
sigmoid: 30%

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At what ages is the colorectal cancer screening offered?

Every 2 years to all men and women aged 60 to 74 years in England

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Investigation for perforated gastric ulcer?
Findings in CXR?

Plain erect CXR
5% of patients with a perforated peptic ulcer will have free air under the diaphragm

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Investigations for pancreatitis?

Amylase >3x the upper limit
Lipase -> longer half-time than amylase and may be useful for presentations >24 hours

Imaging:
Diagnosis of acute pancreatitis can be made without imaging if characteristic pain + amylase/lipase > 3 times normal level
If imaging needed-> USS

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Factors indicating severe pancreatitis?

Hypoxia
>55
Hypocalcaemia
Hyperglycaemia
Neurophilia
Elevated LDH and AST

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Causes of pancreatitis?
GET SMASHED

G- gallstones
E- ethanol
T- trauma

S- steroids
M- mumps
A- autoimmune
S- scorpion venom
H- hypertriglyceridaemia, hyperchylomicronaemia, hypercalcaemia, hypothermia
E- ERCP
D- drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)

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Complications of pancreatitis?

Pancreatic fluid collections
Pseudocysts- may need CR, ERCP, MRI, USS and treated with endoscopic or surgical cystogastrostomy or aspiration
Pancreatic necrosis
Pancreatic abscess

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Acute pancreatitis management?
Conservative
Surgical

Fluid resus- with crystalloids
Analgesia
NBM
Abx- not offer prophylactic abx

Surgery:
-Patients with acute pancreatitis due to gallstones - early cholecystectomy
-Patients with obstructed biliary system due to stones-> early ERCP
-Patients who fail to settle with necrosis and have worsening organ dysfunction may require debridement, fine needle aspiration is still used by some
-Patients with infected necrosis should undergo either radiological drainage or surgical necrosectomy. The choice of procedure depends upon local expertise

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Which organism does the patient require a vaccination for in coeliac?

Streptococcus pneumoniae due to hypersplenism

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Causes of gallstones?

female
fair
fat
40
gallstones- 90%
infection- E. COLI, KLEB

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How should acute cholecystitis be diagnosed?

IV Abx
Cholecystectomy within 1 week of diagnosis (laparoscopic cholecystectomy)

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Name Charcot’s triad and what it is used for?

Fever
RUQ pain
Jaundice
Hypotension and confusion

Ascending cholangitis

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What is the typical iron study profile in patients with haemochromatosis?

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transferrin saturation > 55% in men or > 50% in women
raised ferritin (> 500 ug/l) and iron
low TIBC

What are the aim ranges in venesection for haemochromatosis?

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Transferrin saturation 50%
Serum ferritin <50%

Symptoms and signs for haemochromatosis?

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Arthralgia
Fatigue
ED
DM
Liver- cirrhosis, hepatomegaly
HF secondary to dilated cardiomyopathy
Skin pigmentation

Stepwise management for haemorrhoids?
and acutely thrombosed haemorrhoids?

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Dietary fibre and fluid intake
Topical local anaesthetics and steroids
Rubber band ligation
Surgical excision if no resolution

ATH: purplish, oedematous, tender subcutaneous perianal mass
If patient presents within 72hours then referral for surgery otherwise conservative management with ice, analgesia, stool softeners

Management for IBS?

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Antispasmodics- mebeverine
Laxatives but avoid lactulose
Loperamide- diarrhoea

2nd line:
Amitriptyline 5-10mg

Symptoms associated with Crohn’s?

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Abdominal pain
Non-blood diarrhoea
Weight loss
Mouth ulcers
Bowel obstruction/ fistulae
Erythema nodosum
Arthritis

Inflammation in all layers
Goblet cells and granulomas
Skin lesions

Symptoms associated with UC?

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Blood diarrhoea
PSC
Uveitis
Colorectal cancer
Erythema nodosum
Arthritis

No inflammation beyond the mucosa
Crypt abscess
Depletion of goblet cells

Complications of Crohn's?

fistulas strictures abscesses malabsorption perforation nutritional deficiency colon cancer osteoporosis intestinal obstruction and toxic megacolon

Most common affected site in UC of the bowel?

Rectum

Common causes of duodenal ulcers?

H. pylori -> most common NSAIDs SSRIs Chronic steroid use Smoking Accelerated gastric emptying Blood group O Increased gastric acid

Common causes of gastric ulcers?

NSAIDs H. Pylori infection Smoking Delayed gastric emptying Severe stress

Causes of oesophageal varices?

Portal HTN due to liver cirrhosis (most common) Portal vein thrombosis Schistosomiasis Hepatic fibrosis

Causes of pernicious anaemia?

Autoimmune destruction of gastric parietal cells Intrinsic factor deficiency caused by autoimmune destruction Vitamin B12 deficiency Haemolysis

Symptoms of pernicious anaemia?

Fatigue Pallor Glossitis Pernicious anaemia may cause neuropathy, affecting balance, sensation, and coordination. Jaundice - due to haemolysis Cognitive Impairment - memory problems, confusion, and mood changes may occur

Management for pernicious anaemia?

Lifelong replacement is achieved through quarterly treatment with hydroxycobalamin and close monitoring to ensure early diagnosis of any subsequently unmasked iron deficiency. Folate replacement is also often necessary.

Complications of pernicious anaemia?

Gastric cancer Peripheral neuropathy Subacute combined degeneration of the cord Optic atrophy Dementia

Causes of UGI bleeds from the oesophagus and causes?

Oesophageal varices -> portal HTN due to cirrhosis Oesophagitis -> GORD, medications MWT -> N&V Oesophageal cancer -> friable blood vessels

Causes of UGI bleeds from the stomach and causes?

PUD -> H. Pylori Gastric varices -> Portal HTN Gastritis -> H. Pylori, NSAIDs, alcohol, stress Gastric cancer -> tumours causing ulcerations Vascular malformations

Common causes of UGI bleeds from the duodenum and causes?

Duodenal ulcers -> H.Pylori, NSAIDs Aorto-enteric fistula: a rare but life-threatening condition where an abnormal connection forms between the aorta and the gastrointestinal tract, usually following abdominal aortic aneurysm repair

Summarise the management for an UGI bleed?

Activate major haemorrhage protocol Secure airway if needed IV fluid resuscitation or blood transfusion Correct coagulopathy UGI endoscopy (OGD) AVOID PPIs PRIOR TO OGD Review meds (hold DOACs, warfarin, antiplatelets) but can continue aspirin

Common causes of NAFLD?

Obesity T2DM Hyperlipidaemia HTN PCOS OSA Hypothyroidism Rapid weight loss Prolonged starvation Jejunal bypass surgery

Investigations for NAFLD? Bloods Imaging Specialist

Bloods: FBC U&Es LFTs Fasting lipids and glucose Rule out other causes- viral sereology (hepatitis B/C), autoabs, serum iron Imaging: USS-> firstline Fibro-scan -> measures liver stiffness for fibrosis ELF test -> blood markers for fibrosis Specialist: Liver biopsy -> gold-standard for NASH

First-line treatment for dermatitis herpetiformis?

Dapsone

Alcohol withdrawal management?

Calculate CIWA score First-line: chlordiazepoxide (benzo) for liver-disease patients: lorazepam/ oxazepam -Alcohol withdrawal seizures: IV lorazepam) -Delirium tremens: oral lorazepam, with parenteral lorazepam or haloperidol being second line options -Pabrinex (1 pair of ampoules once daily) should be given to prevent Wernicke's encephalopathy - if there are signs or symptoms such as ataxia or nystagmus, give treatment dose (two pairs of ampoules TDS) Monitor bloods for refeeding syndrome in malnourished patients Ensure patients are followed up on discharge and referred to community support services

Monitoring tests for NAFLD?

Liver USS AFP testing To check for HCC

Rashes common in Crohn's?

Erythema nodosum- painful nodules/ plaques Pyoderma gangrenosum- well defined purple ulcers with overhanging edge

Gastro 2 Flashcards

(43 cards)