Gastro Flashcards
What is Plummer Vinson syndrome
Difficulty swallowing (oesophageal webs)
Glossitis (Smooth tongue)
Iron-deficiency Anaemia
Koilonychia
What is achalasia
Neuromuscular failure of co-ordinated paralysis and relaxation at the lower end of the oesophagus due to degeneration of the myenteric plexus
What is ursodeoxycholic acid
Indications
Side effects
Reduces elevated liver enzyme levels by facilitating bile flow through the liver and protecting liver cells
Used in Primary biliary cirrhosis 12-16mg/kg OD
Side effects
- Diarrhoea
- Pale faeces
Avoid in
- Chronic liver disease (except PBC)
PBC what is it?
Epidemiology
Symptoms/signs
Buzzword
Interlobular bile ducts are damaged by chronic autoimmune granulomatous inflammation causing cholestasis which may –> fibrosis, cirrhosis, and portal hypertension.
Epidemiology
♀:♂≈9:1.
Age of presentation ~50
Symptoms/signs Often asymptomatic and diagnosed after incidental finding ↑alp. Lethargy, sleepiness, and pruritus may precede jaundice by years. - Jaundice - Skin pigmentation - Xanthelasma, xanthomata - Hepatosplenomegaly
Complications
- Those of cirrhosis
- Malabsorption of vit A, D, E, K due to cholestasis
- Osteoporosis common
- HCC
Buzzword
AMA - +ve in 95%
PBC management
Symptomatic
- Pruritus: try colestyramine 4–8g/24h po; naltrexone and rifampicin may also help.
- Diarrhoea: codeine phosphate, eg 30mg/8h po.
- Osteoporosis prevention
Specific
- Fat soluble vitamin malabsorption: Vit A, D, K
- Consider ursodeoxycholic acid - may improve survival and delay transplantation
Liver transplant
- For end stage disease or intractable pruritus
Monitoring
- Regular LFTs
- US and AFP twice yearly if cirrhotic
What is Boerhaaves syndrome
Presentation
Diagnosis
Treatment
Spontaneous rupture of the oesophagus that occurs as a result of repeated episodes of vomiting.
Presentation
- sudden onset of severe chest pain that may complicate severe vomiting.
Diagnosis
- CT contrast swallow
Treatment
- Thoracotomy and lavage
PPIs mechanism of action
Examples
Side effects
Proton pump inhibitors (PPI) cause irreversible blockade of H+/K+ ATPase of the gastric parietal cell.
Examples include omeprazole and lansoprazole.
Adverse effects
hyponatraemia, hypomagnasaemia (muscle weakness)
osteoporosis → increased risk of fractures
microscopic colitis
increased risk of Clostridium difficile infections
Chron’s disease management
neral points
patients should be strongly advised to stop smoking
some studies suggest an increased risk of relapse secondary to NSAIDs and the combined oral contraceptive pill but the evidence is patchy
Inducing remission
glucocorticoids (oral, topical or intravenous) are generally used to induce remission. Budesonide is an alternative in a subgroup of patients
enteral feeding with an elemental diet may be used in addition to or instead of other measures to induce remission, particularly if there is concern regarding the side-effects of steroids (for example in young children)
5-ASA drugs (e.g. mesalazine) are used second-line to glucocorticoids but are not as effective
azathioprine or mercaptopurine* may be used as an add-on medication to induce remission but is not used as monotherapy. Methotrexate is an alternative to azathioprine
infliximab is useful in refractory disease and fistulating Crohn’s. Patients typically continue on azathioprine or methotrexate
metronidazole is often used for isolated peri-anal disease
Maintaining remission
as above, stopping smoking is a priority (remember: smoking makes Crohn’s worse, but may help ulcerative colitis)
azathioprine or mercaptopurine is used first-line to maintain remission
methotrexate is used second-line
5-ASA drugs (e.g. mesalazine) should be considered if a patient has had previous surgery
Surgery
around 80% of patients with Crohn’s disease will eventually have surgery
see below for further detail
Colorectal cancer screening
All aged 60 to 74: FOB test Every 2 years, they’re sent a home test kit, which is used to collect a poo sample. .
Additional one-off test called bowel scope screening is gradually being introduced in England. This is offered to men and women at the age of 55.
Define colon polyps
Types
Risk factors for malignant change in most common type of polyp
Abnormal growth of tissue projecting into the intestinal lumen from the normally flat mucosal surface.
Polyps may be single or multiple and are usually asymptomatic.
- Most polyps in the colon are adenomas, which are the precursor lesions of most colorectal cancer (CRC).
- Other types are hyperplastic, inflammatory (in patients with IBD) and hamartomatous, of which only the latter carry a malignant potential.
Risk factors for malignant change in Adenomatous polyps
- Size >1cm
- Sessile polyps (base attached to colon wall) > pedunculated polyps (mucosal stalk is interposed between polyp and colon wall)
- Severe dysplasia > mild dysplasia
- Villous histology > tubular
- Polyp number: multiple > single.
Name the family colon cancer syndrome including
- description
- mutated gene
- risk of cancer
(1) HNPCC (Lynch syndrome)
- Accelerated progression from adenoma to CRC; Increased risk of extra-colonic malignancy (endometrial)
- DNA mismatch repair genes
- Over half develop CRC, onset in 40s
(2) FAP
- Numerous colorectal polyps (>100) develop in teens; Increased risk of extra-colonic malignancies
- APC gene
- 100% lifetime risk of CRC, onset in young adults
(3) Peutz-Jeghers syndrome
- Numerous pigmented spots on lips and buccal mucosa; Multiple hamartamous polyps; Small intestine polyps may bleed/rupture/cause obstruction
- Increased risk of non-GI and GI cancer (through adenomatous change in polyps_
What is Rosvig’s sign
Palpation in LLQ elicits pain in RLQ
- Suggests appendicitis
NB McBurney’s point is 1/3 of way from R ASIS to umbilicus
What is Murphy’s sign
Ask pt to exhale
Place hands below costal margin on R side mid-clavicular line
Get pt to inspire
+ve Murphy’s sign (Acute cholecystitis)
= Pt stops breathing in and winces with a catch in breath
Pancreatitis acute vs chronic presentation
Acute
- Pain
- High amylase
Chronic
- Pain, weight loss
- Loss of exocrine function - won’t be digesting food, steatorrhoea, weight loss
- Loss of endocrine function - may be diabetic
- LOW faecal elastase
- NORMAL amylase
Pancreatic cancer tumour marker
Ca 19-9
