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Gastro Flashcards

1
Q

What are oesophageal varices?

A

Dilated veins at the junction between the portal and systemic venous systems

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2
Q

Where are varices found?

A

Distal oesophagus

Proximal stomach

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3
Q

How do varices present?

A

Haematemesis
Malaena
Abdo pain
Shock

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4
Q

What are the causes of oesophageal varices?

A

Portal hypertension from alcoholic and viral cirrhosis
Portal vein thrombosis
Budd-Chiari syndrome

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5
Q

How are varices diagnosed?

A

Endoscopy
Clotting and INR
FBC, G&S
LFTs

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6
Q

What are the principles of management of oesophageal varices?

A

Resuscitation
Early risk stratification with Blatchford and Rockall score
Control variceal bleeding

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7
Q

How is a patient with oesophageal varices resuscitated?

A

ABCDE
Crystalloid bolus
Transfusion: platelets (if active bleeding and count <50x10^9) or FFP (if fibrinogen <1g/L)

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8
Q

How is arrest of variceal bleeding implemented?

A

Terlipressin

Stop after definitive haemostasis/after 5 days

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9
Q

What are other management options to stop variceal bleeding?

A

Balloon tamponade if uncontrolled haemorrhage
Band ligation
Transjugular intrahepatic portosystemic shunts (TIPS)

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10
Q

What are the causes of pancreatitis?

A 
Gallstones
Alcohol
Hypothermia
Post ERCP
Hyperparathyroidism
Malignancy
IBD
Uraemia
Thromboembolism
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11
Q

What are the symptoms of pancreatitis?

A

Severe epigastric/LUQ pain, penetrates to the back which steadily decreases over 72h, vomiting

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12
Q

What are the main signs of pancreatitis?

A

Cullen’s: bruising around the umbilicus
Grey Turner’s: bruising around the flanks

Both signs of retroperitoneal haemorrhage

Pyrexia, tachycardia, abdo tenderness with rigidity, hypotension

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13
Q

Why is morphine CI in pancreatitis?

A

Spastic effect on Sphincter of Oddi

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14
Q

How is pancreatitis diagnosed?

A

Serum amylase >3x normal
Lipase
CT with contrast

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15
Q

How is pancreatitis managed?

A

Pethidine or buprenorphine
IV fluids
NBM
IV abx if pancreatic necrosis

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16
Q

Name three complications of pancreatitis?

A

Pancreatic abscess/pseudocyst/necrosis
DIC, haemorrhage
Sepsis and renal failure

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17
Q

What is chronic pancreatitis and how does it occur?

A

Chronic inflammation of the pancreas which results in irreversible damage

Obstruction/reduction in bicarbonate excretion which activates pancreatic enzymes, leading to pancreatic tissue necrosis with fibrosis

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18
Q

What are the risk factors for chronic pancreatitis?

A

Alcohol
Smoking
Biliary tract disease
Cystic fibrosis

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19
Q

What are the symptoms of chronic pancreatitis?

A

Epigastric pain radiating to the back
Nausea and vomiting
Exocrine dysfunction (malabsorption, weight loss, diarrhoea, steatorrhoea)
Endocrine dysfunction (diabetes mellitus)

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20
Q

How is chronic pancreatitis diagnosed?

A

Normal amylase
Secretin stimulation test positive if 60% exocrine function damaged
CT or MRCP
Faecal elastase

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21
Q

What is the treatment of chronic pancreatitis?

A

Opiates/coeliac plexus block
Creon - replace pancreatic enzymes
SC octreotide
Pancreatoduodenoectomy

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22
Q

What is the treatment of IBS diarrhoea?

A

Loperamide

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23
Q

What is the treatment of IBS constipation?

A

Laxatives (not lactulose)

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24
Q

What is the treatment of IBS abdominal pain?

A

Anti-spasmodics - mebeverine

Hyoscine

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25
What are the characteristics of globus pharyngis?
Sensation of having a lump in the throat, intermittent, relieved by food and drink, swallowing saliva is difficult.
26
What is achalasia?
Disorder of motility of lower oesophageal sphincter Smooth muscle layer of oesophagus has impaired peristalsis and fails to relax Reduced secretion of nitric oxide
27
What are the symptoms of achalasia?
Dysphagia of solids Regurgitation Retrosternal chest pain/heartburn
28
What is seen on barium swallow in achalasia?
Dilated oesophagus Contrast passes slowly into the stomach as the sphincter opens intermittently Distal oesophagus - Bird's beak Then, oesophageal manometry
29
What is the treatment of achalasia?
CCB/nitrates Balloon dilatation of the LOS Heller myotomy
30
What is the appearance of oesophageal carcinoma on barium swallow?
Rat's tail
31
What is a pharyngeal pouch?
Posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
32
What are the symptoms of pharyngeal pouch?
Halitosis Dysphagia Regurgitation Aspiration and chronic cough
33
What are two risk factors for oesophageal candidiasis?
History of HIV | Steroid inhaler use
34
What are the oesophageal characteristics of systemic sclerosis?
Oeosphageal dysmotility and decreased pressure of LOS.
35
What are the symptoms of oesophageal carcinoma?
Weight loss Progressive dysphagia Anorexia Vomiting during eating
36
What is Wilson's disease?
Hepatic copper deposition caused by mutations in the ATP7B gene on chromosome 13
37
What is the inheritance of Wilson's disease?
Autosomal recessive
38
What is the pathophysiology of Wilson's disease?
Hepatocytes cannot move copper across intracellular membranes; serum copper concentrations are low and hepatic retention of copper develops
39
What are the symptoms of Wilson disease?
Asymptomatic hepatomegaly or elevation of serum aminotransferases Liver - Acute liver failure, chronic hepatitis and cirrhosis Psych - behavioural problems, tremor, basal ganglia degeneration, chorea Eyes - Kayser-Fleischer rings/sunflower cataracts
40
How is Wilson's disease diagnosed?
Low caeruloplasmin <0.1g/L Low serum copper Elevated 24h urinary copper Liver biopsy
41
What is the treatment of Wilson's disease?
Penicillamine
42
What is haemochromatosis?
Defects of HFE gene on C6 leading to deficiency of iron regulatory hormone hepcidin
43
What is the pathophysiology of haemochromatosis?
Increased intestinal absorption of iron causes accumulation in liver, pancreas, joints, heart, skin, gonads
44
How does haemochromatosis present?
Asymptomatic until late stages - 40s-60s Fatigue, weakness, arthropathy, erectile dysfunction, diabetes Hepatomegaly, grey skin, arrhythmias/cardiomegaly
45
How is haemochromatosis diagnosed?
High fasting transferrin saturation High serum ferritin LFTs and liver biopsy
46
How is haemochromatosis treated?
Venesection
47
What are the characteristics of ischaemic colitis?
Intermittent severe pain following a meal that is out of proportion with clinical findings Diarrhoea and rectal bleeding
48
What is the most common location of ischaemic colitis?
Splenic flexure
49
What is pellagra?
Vitamin B3 deficiency
50
What is Barrett's oesophagus?
Metaplasia of the lower oesophageal mucosa (squamous --> columnar)
51
What percentage of primary sclerosing cholangitis patients develop cholangiocarcinoma?
10%
52
What are the symptoms of cholangiocarcinoma?
Jaundice Weight loss Pruritus Persistent biliary symptoms
53
Name a risk factor for primary sclerosing cholangitis.
Ulcerative colitis (4%)
54
What is the most common organism causing spontaneous bacterial peritonitis?
E.coli
55
What are the symptoms of carcinoid syndrome?
``` Flushing Diarrhoea Bronchospasm Hypotension Right sided heart valvular fibrosis ```
56
When does carcinoid syndrome occur?
Carcinoid tumour | Liver mets release serotonin into the systemic circulation
57
What are the difference in symptoms in Crohn's disease and Ulcerative colitis?
CD: non bloody diarrhoea, WL, Upper GI disease and perianal disease, abdo mass RIF UC: Blood diarrhoea, tenesmus, abdo pain LIF
58
What is the difference in histology between CD and UC?
CD: transmural inflammation, goblet cells, granulomas UC: submucosal inflammation, crypt abscesses, no granulomas
59
What is seen on endoscopy in CD and UC?
CD: deep ulcers, skip lesions, cobblestone appearance UC: Pseudopolyps and widespread ulceration
60
What is seen on imaging in CD and UC?
CD: Kantor's string sign, proximal bowel dilatation, rose thorn ulcers, fistulae UC: loss of haustrations, superficial ulceration, drainpipe colon
61
Name some extra-intestinal features of IBD that are related to disease activity.
Pauciarticular arthritis Erythema nodosum Episcleritis (CD) Osteoporosis
62
Name some extra-intestinal features of IBD that are unrelated to disease activity.
``` Polyarticular arthritis Uveitis Pyoderma gangrenosum Clubbing PSC (UC) ```
63
What is the treatment of crohn's disease?
Glucocorticoids to induce remission Stop smoking Azathioprine/mercaptopurine to maintain remission (MTX 2nd line)
64
What is the treatment of ulcerative colitis?
PR then PO aminosalicylate (mesalazine/sulfasalazine) IV steroids if severe colitis
65
What is Budd-Chiari syndrome?
Hepatic vein thrombosis
66
What is the triad of features in Budd-Chiari syndrome?
Severe sudden onset abdo pain Ascites Tender hepatomegaly
67
How is Budd-Chiari syndrome diagnosed?
Ultrasound with doppler flow studies
68
What is the gold standard diagnosis of primary sclerosing cholangitis?
MRCP
69
How does CD increase the risk of gallstones?
Terminal ileitis decreases bile salt reabsorption
70
Which antibodies is primary sclerosing cholangitis associated with?
ANCA | Anti-SM
71
How can an upper and lower GI bleed be differentiated?
Upper - raised urea Large protein "meal" of blood which is digested
72
What is the treatment of hepatic encephalopathy?
Lactulose (reduces production and absorption of ammonia) PO rifaximin if refractory
73
How is carcinoid syndrome diagnosed?
5HIAA Urinary 5-Hydroxyindoleacetic acid
74
What antibodies are associated with autoimmune hepatitis?
Anti-SM | ANA
75
How do you calculate the number of alcoholic units?
Volume (ml) x ABV /1000
76
How may iron deficiency anaemia cause dysphagia?
Post-cricoid webs, as part of Plummer-Vinson syndrome
77
What are the features of autoimmune hepatitis?
Signs of chronic liver disease Fever, jaundice Amenorrhoea1
78
Which antibodies are associated with primary biliary sclerosis and what other blood test is raised?
Anti-Mi (mitochondrial) | Also raised ALP
79
What is a prophylactic medication for oesophageal variceal bleeding?
Non specific beta blockers such as propranolol reduce portal inflow and reduce further episodes
80
What is the treatment of haemorrhoids?
Manage constipation Anusol Rubber band ligation/haemorrhoidectomy
81
What is the treatment of anal fissures?
Manage constipation Topical diltiazem/GTN Botox injection
82
What is c.difficile and what are the symptoms?
Overgrowth of c.diff bacteria following antibiotic use (usually ciprofloxacin) 3-9 days post abx High amount of green foul smelling stool with crampy abdo pain
83
What are the complications of c.difficile?
Toxic megacolon Perforation Spread of infection
84
What is the treatment of c.difficile?
``` Stop unnecessary antibiotics Isolate and barrier nurse IV fluids Oral metronidazole/vancomycin Stool transplant ```
85
What is the biomarker for malabsorption caused by chronic pancreatitis?
Faecal elastase
86
Name 3 fat soluble vitamins.
A, D, K
87
What are the histological features of coeliac disease?
Villous atrophy Crypt hyperplasia Invasion with lymphocytic cells
88
Define acute liver failure.
Acute encephalopathy, jaundice, and coagulopathy, without previous cirrhosis Usually within 12 weeks
89
What test results would you expect in acute liver failure?
Raised AST, ALT, ALP, bilirubin Low albumin PT raised
90
What tests form the non-invasive liver screen?
``` FBC, clotting, LFTs Hepatitis serology (HBsAg/anti-HCV) EBV and CMV serology Serum caeruloplasmin and transferrin saturation Anti-Mi, Anti-Sm, ANA ab ```
91
What is the management of acute liver failure?
A-E assessment Stop hepatotoxic drugs (NSAIDs, paracetamol, ACEIs, erythromycin, statins) Prophylactic abx IV 5% glucose Lactulose 10-20ml/8hr Treat the cause (if alcoholic - prednisolone) Transplant
92
What are the main problems of decompensated chronic liver failure?
Variceal bleeding Encephalopathy Coagulopathy Hypoalbuminaemia = ascites
93
Give five signs of liver failure.
``` Palmar erythema Liver flap Spider naevi Clubbing Dupuytrens contracture ```
94
What is the main characteristic of SBP?
Abdominal pain in presence of ascites. Fever, tachycardia, hypotension
95
What is cholangitis?
Infection of bile duct with Charcot's triad: fever, jaundice, RUQ pain
96
What is the treatment of acute severe alcoholic hepatitis?
Prednisolone

Phase 3B (20 decks)

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