Gastro Flashcards
(27 cards)
Name four organisms that can cause bloody diarrhoea.
- Campylobacter spp
- Salmonella spp
- Escherichia coli
- Shigella spp
Name one organism that causes diarrhoea but not bloody diarrhoea.
Staphylococcus spp
Name the three things that cause a markedly increase in ALT/AST (over 1000s)
- Drug toxicity (Paracetamol OD)
- Acute Viral Hepatitis (Hep A/B/E, EBV, CMV)
- Liver Ischaemia
List Three causes of an increased INR/Prothrombin (PT)
- Vitamin K deficiency
- Liver disease (alcohol abuse)
- Consumption coagulopathy (DIC)
Name four drugs/drug types that can cause peptic ulcers.
- NSAIDs
- Bisphosphonates
- Aspirin/Clopidogrel
- Steroids
Wernicke’s Encephalopathy: Cause and list the triad of presentation.
Cause: Vitamine B12 Deficiency (Thiamine)
Triad:
- Ophthalmaplegia
- Confusion
- Ataxia
Name four drugs/drug types that can cause peptic ulcers.
- NSAIDs
- Bisphosphonates
- Aspirin/Clopidogrel
- Steroids
http://tmedweb.tulane.edu/pharmwiki/doku.php/nsaid_side_effects
Give three possible causes of an increased INR.
- Vitamin K deficiency
- Liver disease
- Consumptive coagulopathy (Disseminated Intravascular Coagulation)
Five Risk Factors of Chronic Mesenteric Ischaemia
- Hypertension
- Smoking
- Diabetes Mellitus
- Hypercholesterolaemia
- FHx of CVD
Three Risk Factors of Acute Mesenteric Ischaemia
These RFx reflect potential sources of emboli so:
- Atrial Fibrillation
- Recent MI
- Valvular Disease
Causes of Acute Pancreatitis (I GET SMASHED)
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps/HIV/Coxsackie
Autoimmune
Scorpion Venom
HyperCAlcaemia/hyperLIPIDaemia/hypothermia
ERCP
Drugs (sodium valproate, steroids, thiazides, azathioprine)
List some possible causes of a modest increase in amylase.
- Perforated Peptic Ulcer
- Mesenteric Ischaemia
- Bowel Obstruction
- Pancreatic Carcinoma
- Mumps
An increase in amylase >1000U/L aligns with a presentation of Acute Pancreatitis
Recall the triad for peritonitis.
- Motionless patient
- Tenderness and guarding on palpating
- Absent bowel sounds
Causes of bowel obstruction.
Adhesions Hernias Volvulus Endometriosis IBD Appendicitis Tumours Diverticulitis Ischaemic Bowel TB Intussusception (folding of bowel into bowel next to it)
What is Cullen’s Sign? Name 4 cases where a positive Cullen’s could be seen.
Bruising and discoloration seen around the umbilicus.
- Pancreatitis
- Ectopic Pregnancy
- Ruptured AAA
- Trauma to the abdomen
What is Grey Turner’s Sign? Name 5 cases where a positive Grey Turner’s could be seen.
Bruising and discoloration in the flank - sign of beleeding in the retroperitoneum.
- Pancreatitis
- Retroperitoneal haemorrhage
- Ectopic Pregnancy
- Ruptured AAA
- Trauma to the abdomen
What is Murphy’s sign?
Palpate abdomen just underneath right ninth costal cartilage and apply pressure and ask the patient to take a deep breath. Halting of inspiration suggests that there is cholecystitis (gall bladder inflammation)
What is Rovsing’s sign?
This is when you palpate the LIF and there is increase pain in the RIF. Highly suggestive of appendicitis.
A patient presenting with positive Anti-Mitochondrial Antibody (AMA) is 95% likely to have _________.
Primary Biliary Cirrhosis (a chronic inflammatory liver disease that involves:
intrahepatic destruction of bile duct -> cholestasis -> cirrhosis (result of inflammation caused by bile)
These patients will also typically have: - High ALP and GGT - High IgM - High cholesterol Check for TFTs as PBC is associated with autoimmune thyroid disease.
Patient is usually middle-aged women (women > men 9:1)
Define Charcot’s Triad and what is it usually associated with?
Charcot’s Triad:
- Fever with rigors
- RUQ pain
- Jaundice
Give the 5 risk factors for developing gallstones (5 F’s)
Fair (caucasian) Fat Fertile Forty Female
Describe the pathophysiology of Peptic Ulcer disease and give two risk factors/aetiology for their development.
Pathophysiology: Imbalance between the damagin action of pepsins made by stomach and the protective ability of the mucosa leading to ulcers which can bleed.
Risk Factors/Aetiology:
- Helicobacter pylori
- NSAIDs
Gastric Ulcers are associated with pain SHORTLY after meals. Duodenal Ulcers are associated with pain a FEW HOURS after meals
A Helicobacter positive bleeding peptic ulcer is medically managed by using:
Triple Eradication Therapy:
- PPI (Omeprazole)
- Clarithromycin
- Amoxicillin or Metronidazole (former preferred if pt has already been treated with metro for another infection)
Explain the difference between:
a) Biliary Colic
b) Cholecystitis
c) Ascending cholangitis
a) Pain in RUQ caused by the gallbladder trying to push against obstruction (e.g. commonly gall stones). The pain can cease if the gall stone falls back to the gall bladder or pushed out into the CDB.
b) This is the inflammation of the gallbladder caused by obstruction of the flow of bile out of the gallbladder. The bile becomes concentrated as water is absorbed by the gallbladder causing irritation and inflammation of the walls. The lack of drainage also increases the incidence of infection.
c) This is a complication of cholecystitis where the infection that’s normally confined in the gallbladder moves up to the CBD, to the liver and eventually to the systemic circulation causing sepsis. This has a mortality rate of 15% and Charcot’s Triad is often present. Can also be caused by strictures caused by recent surgery or tumour or gut bateria pushed up the tree due to ERCP. Mx include fluids, antibiotics (broad then specific and ERCP/PTC drainage)
