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gastro Flashcards

1
Q

zollinger ellison syndrome fx and ix

A

Zollinger-Ellison syndrome is condition characterised by excessive levels of gastrin, usually from a gastrin secreting tumour usually of the duodenum or pancreas. Around 30% occur as part of MEN type I syndrome

Features
multiple gastroduodenal ulcers
diarrhoea
malabsorption

Diagnosis
fasting gastrin levels: the single best screen test
secretin stimulation test

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2
Q

intestinal angina

A

classically characterised by a triad of severe, colicky post-prandial abdominal pain, weight loss, and an abdominal bruit

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3
Q

suntan and reduced libido

A

haemochromatosis

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4
Q

kantor’s string sign

A

small bowel enema- crohns

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5
Q

carcinoid fx

A

flushing (often earliest symptom)
diarrhoea
bronchospasm
hypotension
right heart valvular stenosis (left heart can be affected in bronchial carcinoid)
other molecules such as ACTH and GHRH may also be secreted resulting in, for example, Cushing’s syndrome
pellagra can rarely develop as dietary tryptophan is diverted to serotonin by the tumour

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6
Q

gastric cancer red flags

A

Red flag symptoms for gastric cancer includes
new-onset dyspepsia in a patient aged >55 years
unexplained persistent vomiting
unexplained weight-loss
progressively worsening dysphagia/
odynophagia
epigastric pain

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7
Q

Oesophageal/Gastric Cancer gold std ix

A

Endoscopic ultrasound (EUS) is better than CT or MRI in assessing mural invasion

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8
Q

serum-ascites albumin gradient high

A

due to portal hypertension

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9
Q

truelove and witts severity

A

Temperature greater than 37.8°C
Heart rate greater than 90 beats per minute
Anaemia (Hb less than 105g/ L)
Erythrocyte sedimentation rate greater than 30 mm/hour
for UC which requires admission

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10
Q

coeliac get pneumococcal vaccine due to

A

functional hyposplenism

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11
Q

sbp most common organism

A

e coli

ciprofloxacin prophylaxis

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12
Q

PBC m rule

A

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

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13
Q

conditions for urea breath test

A

should not be performed within 4 weeks of treatment with an antibacterial or within 2 weeks of an antisecretory drug (e.g. a proton pump inhibitor)

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14
Q

drug that causes cholestasis

A

COCP

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15
Q

cancer associated with achalasia

A

SCC

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16
Q

ix to differentiate IBS and IBD in GP

A

faecal calprotectin

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17
Q

coeliac causes deficiency in

A

iron folate and b12

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18
Q

infection causing fat malabsorption

A

gardia lamblia

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19
Q

Peutz-Jeghers syndrome

A

Genetics
autosomal dominant
responsible gene encodes serine threonine kinase LKB1 or STK11

Features
hamartomatous polyps in GI tract (mainly small bowel)
pigmented lesions on lips, oral mucosa, face, palms and soles
intestinal obstruction e.g. intussusception
gastrointestinal bleeding

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20
Q

paracentesis-induced circulatory dysfunction

A

large volume paracentesis (> 5 litres). It is associated with a high rate of ascites recurrence, development of hepatorenal syndrome, dilutional hyponatraemia, and high mortality rate
give albumin at same time

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21
Q

Plummer-Vinson syndrome

A

Triad of:
dysphagia (secondary to oesophageal webs)
glossitis
iron-deficiency anaemia

Treatment includes iron supplementation and dilation of the webs

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22
Q

carcinoid ix

A

urinary 5-HIAA

plasma chromogranin A y

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23
Q

barretts surveillance and mx

A

Endoscopic surveillance
for patients with metaplasia (but not dysplasia) endoscopy is recommended every 3-5 years

If dysplasia of any grade is identified endoscopic intervention is offered. Options include:
endoscopic mucosal resection
radiofrequency ablation

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24
Q

kochers scar

A

bile duct exloration

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25
modified glasgow score
``` Pa02 <8kPa Age >55 years Neutrophilia WBC >15x10^9 Calcium <2mmol/L Renal function Urea >16mmol/L Enzymes LDH >600 ; AST >200 Albumin <32g/L Sugar Blood glucose >10mmol/L ```
26
drugs that cause panc
azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate
27
grades of hepatic encephalopathy
Grade I: Irritability Grade II: Confusion, inappropriate behaviour Grade III: Incoherent, restless Grade IV: Coma
28
types of hepatorenal syndrome
Type 1 HRS Rapidly progressive Doubling of serum creatinine to > 221 µmol/L or a halving of the creatinine clearance to less than 20 ml/min over a period of less than 2 weeks Very poor prognosis Type 2 HRS Slowly progressive Prognosis poor, but patients may live for longer
29
mx of non variceal upper gi bleeding
NICE do not recommend the use of proton pump inhibitors (PPIs) before endoscopy to patients with suspected non-variceal upper gastrointestinal bleeding although PPIs should be given to patients with non-variceal upper gastrointestinal bleeding and stigmata of recent haemorrhage shown at endoscopy if further bleeding then options include repeat endoscopy, interventional radiology and surgery
30
trigger for liver decompensation
constipation, infection, electrolyte imbalances, dehydration, upper GI bleeds or increased alcohol intake.
31
refeeding syndrome
hypophosphataemia hypokalaemia hypomagnesaemia: may predispose to torsades de pointes abnormal fluid balance
32
how to distinguish raised ferritin with or without iron overload
transferring saturation
33
tracheo oesophageal fistula fix complicatino
oesophageal stricture
34
what medications to stop in c diff infection
opioids
35
genetics of colorectal cancer
HNPCC 5% FAP<1% A variant of FAP called Gardner's syndrome can also feature osteomas of the skull and mandible, retinal pigmentation, thyroid carcinoma and epidermoid cysts on the skin
36
most sensitive and specific lab finding for diagnosis of liver cirrhosis in those with chronic liver disease
thrombocytopenia (platelet count <150,000 mm^3)
37
HCC tumour marker
AFP
38
abx use and dysphagia
oesophageal candidiasis
39
coeliac vs IBS
a low ferritin and folate would not develop with IBS +/- gastroenteritis.
40
Melanosis coli
Melanosis coli is a disorder of pigmentation of the bowel wall. Histology demonstrates pigment-laden macrophages It is associated with laxative abuse, especially anthraquinone compounds such as senna
41
prophylaxis of oesophageal bleeding
propranolol
42
haemochromatosis mx
Venesection is the first-line treatment monitoring adequacy of venesection: transferrin saturation should be kept below 50% and the serum ferritin concentration below 50 ug/l
43
types of autoimmune hepatitis
Type I Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA) Affects both adults and children Anti-liver/kidney microsomal type 1 antibodies (LKM1) Type II Affects children only Soluble liver-kidney antigen Type III Affects adults in middle-age
44
ix for toxic megacolon
axr transverse colon being > 6 cm in diameter in combination with signs of systemic upset.
45
psuedopolyps
UC
46
PPI electrolyte imbalances
hyponatraemia, hypomagnasaemia
47
budd chiari ix
ultrasound with doppler
48
kantor string sign
Crohns narrowed terminal ileum in a 'string like' configuration
49
secondary prophylaxis of hepatic encephalopathy
lactulose
50
metaclopromide earliest EPSE
acute dystonia causing oculogyric crises
51
early signs of haemochromatosis
fatigue, erectile dysfunction and arthralgia
52
mx of hepatorenal syndrome
vasopressin analogues, for example terlipressin, have a growing evidence base supporting their use. They work by causing vasoconstriction of the splanchnic circulation volume expansion with 20% albumin transjugular intrahepatic portosystemic shunt
53
Ds of pellagra
Dermatitis, diarrhoea, dementia/delusions, leading to death | vit B3 def
54
Metabolic ketoacidosis with normal or low glucose
alcoholic ketoacidosis
55
lemon tinge, loss of vibration sense, pallor
pernicious anaemia
56
blood test before azathioprine or mercaptopurine
Thiopurine methyltransferase (TPMT) is an enzyme§
57
child pugh criteria (liver cirrhosis
``` Bilirubin (µmol/l) <34 34-50 >50 Albumin (g/l) >35 28-35 <28 Prothrombin time, prolonged by (s) <4 4-6 >6 Encephalopathy none mild marked Ascites none mild marked ```
58
factors in MELD
bilirubin, creatinine, and the international normalized ratio (INR) to predict survival
59
gluten free cereal
maize, rice, potato
60
malnutrition criteria
A body mass index of less than 18.5kg/m² (this is not present in this case as her body mass index is 33kg/m²) A body mass index of less than 20kg/m² and unintentional weight loss greater than 5% within the last 3-6 months (again not present due to her body mass index) Unintentional weight loss greater than 10% within the last 3-6 months (this is relevant in this case)
61
gastric adenocarnimoa histology
signet ring cells
62
loperamide mechanism
stimulation of μ-opioid receptors in the submucosal neural plexus of the intestinal wall. This, in turn, reduces peristalsis of the intestines decreasing gastric motility.
63
haemochromatosis inheritance
autosomal recessive
64
IDA vs ACD
TIBC is high in IDA, and low/normal in anaemia of chronic disease

revision (24 decks)

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