Gastroenterology Flashcards
(115 cards)
1
Q
Abx for spontaneous bacterial peritonitis
A
Cefotaxime
2
Q
SBP is complication of …
Causative organisms are …
A
Ascites secondary to cirrhosis (normally alcoholic)
E coli, Klebsiella, S pneumoniae, Enterococci
3
Q
Salmonella ABx
A
Ciprofloxacin
4
Q
Define chronic diarrhoea
A
3+ stools/day for >4 weeks
5
Q
Shigella ABx
A
Ampicillin or ciprofloxacin
6
Q
Campylobacter ABx
A
Erythromycin
7
Q
C diff Rx
A
Metronidazole, vancomycin
8
Q
Yersinia ABx
A
Tetracycline
9
Q
RFs for Small Bowel overgrowth (where CRP NORMAL)
A
Bowel surgery
Crohn’s
Motility disorders e.g. Scleroderma
10
Q
% mortality in severe acute pancreatitis
A
20%
11
Q
Ix for gastrinoma
A
Gastrin >1000
Then do secretin test (rise >200 = gastrinoma)
Then do pancreatic imaging
12
Q
Abdominal bloating, intermittent diarrhoea, strong farts
A
Giardiasis
13
Q
Whipples disease: demographic, causative organism
A
Middle aged male
Tropheryma whippelii
Often affects small bowel -> malabsorption
14
Q
Fatigue, weight loss, fever, arthralgia, diarrhoea, middle aged male
A
Whipple’s disease
15
Q
Whipples disease SB histology
A
Abnormal macrophages stain magenta with PAS
16
Q
What is transferrin
A
glycoprotein produced in the liver
transports iron to cells
regulated by body iron stores
17
Q
Transferrin levels in Fe deficiency and iron overload
A
transferrin production increases in Fe deficiency
iron overload decreases.
18
Q
What is ferritin?
Levels of ferritin in Fe deficiency and Fe overload
A
present in all cells, iron storage
reduced in states of iron deficiency
raised in states of iron overload.
19
Q
MOA hereditary haemochromatosis
A
increased iron absorption in the duodenum and proximal small intestine
20
Q
Inheritance hereditary haemochromatosis and gene mutation
A
AR
C282Y HFE mutation
21
Q
Organs affected in hereditary haemochromatosis
A
cirrhosis, restrictive cardiomyopathy, diabetes mellitus, arthropathy, skin hyperpigmentation, and gonadal failure.
22
Q
Ix hereditary haemochromatosis
A
transferrin saturation >45% = initial screening test
then genetic screening (C282Y HFE mutation)
NB if ferritin >1000 do liver biopsy
23
Q
% Down’s with ASD
A
40%
24
Q
GI manifestations in Down’s
A
Duodenal atresia - DOUBLE BUBBLE sign
Hirschprung’s disease
25
Perioral dermatitis + acral (hand and foot) erythema. Which deficiency post bowel resection?
Zinc deficiency
26
What is Mackler’s triad? Indicates?
vomiting, chest pain and surgical emphysema
oesophageal rupture
but absent in almost half the cases
27
Ix for oesophageal rupture
gastrograffin swallow
28
Melanosis coli due to
Chronic laxative abuse (containing anthraquinones)
29
LFTs for alcoholic hepatitis
AST >ALT 2:1
30
UC associated with which liver pathologies
PSC
| Cholangiocarcinoma
31
Lethargy + itching + BG UC
PSC
32
Ix for PSC
ERCP/ MRCP
multiple intrahepatic and extrahepatic bile duct strictures and dilatations
33
Refeeding syndrome comprises:
Low K, Phos, Mg
Deficiencies in vitamins, for example, thiamine
Fluid overload with oedema
34
Ix after excision colon adenocarcinoma
colonoscopy annually for at least two years
35
Carcinoid syndrome Sx
Flushing and diarrhoea
Release serotonin and other vasoactive peptides
Neuroendocrine tumour (gut, lungs)
36
Ix carcinoid syndrome
high urinary 5-hydroxyindoleacetic acid
37
Rx carcinoid syndrome
Rx = somatostatin analogue, surgical resection
38
Why use lactulose in cirrhosis/hepatic encephalopathy
Osmotic laxatives
Stops proliferation of ammonia-forming gut organisms
Increases protein clearance from gut
39
What is portal hypertensive gastropathy? Risks of it?
Vascular disorder
Complication of chronic liver disease
Causes UGI bleed in patients with cirrhosis + portal HTN
40
Rx UGI bleed
Somatostatin or terlipressin
If bleeding stops then start on BB
Consider shunt if rebleed despite BB
41
Genotype associated w/ lowest levels a1at
PiZZ
42
Return from tanzania, acute watery diarrhoea with some blood. Likely cause? Rx?
E coli travellers diarrhoea
Ciprofloxacin
43
Causes bloody/mucus stool
E coli, Shigella, Yersinia
44
Offensive smelling diarrhoea insidious onset (3 days - 3 weeks). Cause?
Giardia
45
Ix Giardia
Cysts in stool
| Trophozoites in SB mucosal biopsy
46
Rx Giardia diarrhoea (insidious onset compared to E coli)
Metronidazole
47
MOA cholestyramine for intolerable itching
Anion exchange resin
| Interferes with absorption of fat soluble vitamins
48
Which drugs less effective after starting cholestyramine
Vitamin D
| As cholestyramine inhibits absorption of fat soluble vitamins
49
Swinging pyrexia, neutrophilia, high infl markers, RUQ pain. DDx?
Pyogenic liver abscess
| Amoebic liver abscess
50
How to differentiate pyogenic and amoebic liver abscess
Pyogenic - pleural effusions, BC positive
| Amoebic - no bowel Sx
51
Coeliac prevalence
Pt with anti SM ABs: Autoimmune hepatitis is often seen in individuals with other autoimmune disorders such as ulcerative colitis.
1%
52
Microscopic colitis Ix
colonoscopy and mucosal biopsy
because macroscopically colon appears normal.
53
Microscopic colitis Rx
Budesonide
54
What is Weil's disease?
severe form of leptospirosis
bacteria - Leptospira
If the infection causes jaundice, kidney failure and bleeding, it is then known as Weil's disease.
If it affects the lung and causes pulmonary haemorrhage, then it is known as severe pulmonary haemorrhage syndrome.
55
pruritus
hypercholesterolaemia
jaundice
raised ALP and GGT
primary biliary cirrhosis
56
Causes pigmentation + CLD
primary biliary cirrhosis (PBC) haemochromatosis
57
What is PBC?
chronic cholestatic inflammatory liver disease
aetiology probably autoimmune
commonly affects middle-aged women
58
What are cirrhosis patients hyponatraemic?
inability to excrete free water (increased ADH levels and systemic vasodilation contribute)
59
Gastric carcinoma staging Ix
endoscopic ultrasonography
is superior to CT scanning for local tumour staging.
60
Is incidence of proximal or distal stomach increasing?
proximal stomach is increasing
61
Organism causing of pseudomembranous colitis
Gram stain?
ABx causing p.c.?
Clostridium difficile
Gram-positive anaerobic bacterium
broad-spectrum antibiotics - cephalosporins, broad-spectrum penicillins, quinolones, and clindamycin
62
anti SM ABs
AI hepatitis
63
AI hepatitis associated with
UC
64
Common demographic for AI hepatitis
Sx onset
young and middle-aged women
1/4 acute hepatitis
but usually onset is insidious
some ASx for years and then have signs of chronic liver disease
65
Coeliac disease
hypersensitivity type reaction
T cell mediated hypersensitivity reaction to gluten
(Type IV)
causes intestinal inflammation and atrophy
66
diarrhoea/steatorrhoa
mild macrocytic anaemia
iron or folate deficiency
abnormal LFTs in 15%
Coeliac disease
67
Coeliac disease Ix
1)
2)
1) IgA anti-endomysial Ab
anti-tissue transglutaminase Ab
2) duodenal biopsy - villous atrophy
68
Type 2 diabetes increases risk of which gastro cancer?
40-60% increase in the risk CRC
69
commonest sites for CRC
rectum and sigmoid colon
70
Familial polyposis coli
Gardner's syndrome
Peutz-Jegher's syndrome
inheritance
autosomal dominant
71
dominant inheritance
perioral/ skin pigmentation
numerous hamartomas in the stomach and larger intestine
polyps rarely malignant BUT 50% die of GI cancer
Peutz-Jegher's syndrome
72
Familial polyposis coli
Increased risk of cancer?
increased cancer risk is due to inheritance of a mutated tumour suppressor gene
73
Give ABx in Campylobacter infection
No, only IVF and antiemetics
If do give, give erythromycin
74
Peutz-Jegher's syndrome
Increased risk of cancer?
Originally no
Rarely can be linked to malignancy
75
High bilirubin
ALP high
2nd or 3rd trimester
Intrahepatic cholestasis of pregnancy
NB. Gilbert’s = (isolated high bilirubin)
76
How is iron carried in blood/ role of transferrin?
Iron is carried in the blood bound to transferrin
Fe2+ (ferrous iron) is oxidised to Fe3+ (ferric iron) by caeruloplasmin
to bind to transferrin which is about one-third saturated with iron.
77
What does transferrin saturation measure?
Level in iron deficiency?
measure of iron stores
16% is indicative of iron deficiency
78
iron deficiency
both rise
79
Pregnancy and the OCP
| effects on transferrin level
increase transferrin level
80
Haemochromatosis
transferrin level
TIBC
both fall
81
microangiopathic haemolytic anaemia
thrombocytopenia
acute kidney injury
HUS
82
low plt
bloody diarrhoea
AKI
HUS
| haemolysis -> bloody diarrhoea
83
Loss sensory myenteric plexus neurones
-> LOS dysfunction
failure to relax LOS in response to swallowing
Achalasia
84
Commonest Sx in achalasia
Dysphagia to SOLIDS
85
Rx to reduce Sx of achalasia
Nifedipine (relaxes LOS but effects short-lived)
| Surgical cardiomyotomy
86
```
Chronic diarrhoea
joint Sx
weight loss
LNs
abdominal pain
```
Whipple’s disease
| No LNs with Coeliac and giardiasis
87
Cause profuse BLOODY diarrhoea
Shigella
88
Cause watery diarrhoea (2)
E coli
| Giardia (Sx more insidious onset)
89
Common SE of ciclosporin (e.g. for UC, psoriasis, eczema)
HTN
90
Positive Hydrogen breath test
Causes (2)
Bacterial overgrowth syndrome
| lactose intolerance
91
```
Chronic cholestasis
AMA
Liver biopsy
- non-suppurative destructive cholangitis +
interlobar BD dilatation
```
Primary biliary cirrhosis
92
Rx primary biliary cirrhosis
Ursodeoxycholic acid (to reduce conc toxic bile acids)
93
Confusion
Oculomotor signs
Ataxia
Wernicke’s encephalopathy
94
Cause of Wernicke’s encephalopathy
Vitamin B deficiency
95
Skin condition associated with gastric adenocarcinoma
Acanthosis nigricans
96
Skin condition associated with lymphoma
Ichthyosis (scaly skin)
97
Skin condition associated with oesophageal carcinoma
Tylosis (palmar and plantar keratosis)
98
Virus that increases risk aplastic crisis in sickle cell anaemia or hereditary spherocytosis
Parvovirus B19
99
```
Diarrhoea
no blood
patient post R hemicolectomy
BG of Crohn’s disease
Bloods normal
```
Cause?
Rx?
Loss terminal ileum -> bile salt malabsorption
| Cholestyramine (stops bile acid absorption)
100
What is VIPoma
Neuroendocrine tumour
| Pancreas secretes vasoactive intestinal peptide
101
```
Watery diarrhoea
Low K and low Cl
Dehydration and flushing
Achlorhydria (no HCL secretion)
Hyperglycaemia (as gluconeogenesis)
```
VIPoma
102
Gastrin secreting duodenal (or pancreatic) tumour
Diarrhoea + peptic ulcer
gastrinoma / Z-E syndrome
103
Skin condition associated with glucagonoma
Migratory erythema
104
Carcinoid syndrome associated with which deficiency
Niacin (-> pellagra)
105
Wilson disease chromosome
Chromosome 13
106
Rx large volume ascites that is symptomatic vs non-symptomatic
Symptomatic = Paracentesis
Not symptomatic = reduce dietary salt + spironolactone
107
What stimulates and inhibits gastrin secretion from G cells of stomach
Stimulates gastrin = Amino acids (from food)
Inhibits = somatostatin
108
Bug most associated with cryoglobulinaemia
Hepatitis C
109
Conditions where see subtotal villous atrophy
Coeliac disease
Gastroenteritis
Whipple’s disease
110
GI condition associated with functional hyposplenism
Coeliac disease
111
How to differentiate PSC and PBC
PSC more common in men, with IBD
112
Acute intermittent porphyria inheritance
AD
113
Ascitic tap results for SBP
PMN >250
114
Serum albumin ascites gradient >11g/L. Cause?
```
Portal HTN
Liver causes - cirrhosis, acute hepatitis, HCC, massive liver mets
CHF
Portal vein thrombosis
Budd-chiari syndrome
```
115
What is hepatorenal syndrome
Renal failure in patients with severe liver disease (acute or chronic), in absence of any other identifiable cause
