Gastroenterology Flashcards by Deba Osaghae

What are the invasive and non invasive H pylori tests

Non invasive

urea breath test C13
stool antigen test
Serology

Invasive
Endoscopy- Culture, giemsa stain + microscopy,

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How do you diagnose acute pancreatitis?

Serum amylase, lipase
CRP
CT scan to show necrosis

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Features of chronic pancreatitis?

Background alcoholism or history of gall stones with:
Long standing abdominal pain
Calcifications 
Raised GGT
DM
Malabsorption

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Pathophysiology of Chronic pancreatitis

Prolonged irritation of the yract leads to formation of calcifications on the tract causing blockage

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How do you screen for the presence of Hy Pylori after starting therapy?

Urea breath test

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What medications comprise the triple and quadruple therapy?

Triple- clarithromycin, amoxicillin and PPI

Quadruple- metro, tetra, bismuth citrate, ranitidine

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Two most important aetiologies of acute pancreatitis in the west?

Alcohol and gallstones

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What is absorbed in the
Duodenum
Jejunum
Ileum?

Duodenum- iron
Jejunum- most nutrients
Ileum- B12 and bile salts

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Gold standard for diagnosis of Achalasia?

Whats an alternative?

Manometry test is the good standard

Alternative is barium swallow

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Whats the initial investigation for achalasia?

Endoscopy

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Treatment options for achalasia?

Hellers myotomy- gold standard
Pneumatic dilation
Endoscopic injection of botulinum toxin

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Gold standard for diagnosis of GORD?

24 hr pH test

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Tretment options for GERD?

PPI
Lifestyle changes
Weight loss
Elevation of head in bed

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Bisphosphonates and NSAIDS worsen oesophagitis. How?

Because they aggravate GERD and irritation of the esophagus

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Occassional rectal pain that occurs in the absence of any organic disease?

Proctalgia fugax

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Barretts oesophagus is related to epithelial change from what to what?

Squamous to columnar

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Barrett’s is a risk factor for which kind of cancer?

Adenocarcinoma

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Whats the appearance of the oesophagus in achalasia on barium swallow called?

Bird’s beak appearance

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Differentials of dyspepsia/reflux?

Achalasia
GORD
PUD
Hiatus hernia

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Oesophageal pattern of DES on barium swallow?

Corkscrew

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Gold standard for disgnosis of DES?

Oesophageal Manometry

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Treatment of DES

Avoid triggering foods

Calcium channel blockers

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Plummer vinson syndrome triad?

Oesophageal webs
IDA
Dysphagia

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Treatment of plummer vinson?

Give iron supplements

Endoscopic dilation for persistent dysphagia

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Differentials of dysphagia?

``` Achalasia Pharyngeal pouch DES Esophageal strictures Plummer Vinson Oesophageal cancer Barrett’s oesophagus ```

When do you do a barium swallow first instead of endoscopy?

When there’s a pharyngeal pouch and you don’t want to rupture

Which imaging do you do for acute cholecystitis. Why?

USS- because gall stones are radio lucent

Features of zenker’s diverticulum?

Halitosis Dysphagia Reflux on lying down Cough

Whet kind of esophageal cancer does smoking cause?

SCC

What kind of dyphagias affect both solid and liquids vs just solids?

Structural- solids | Motility related- solids and liquids

Causes of internittent structural and intermittent functional/motility related

Intermittent structural- Oesophageal ring | Intermittent motility- DES, Achalasia

Whats the order of investigations to do for dysphagia?

Endoscopy first | Barium swallow next

Most commonly affected site in CD?

The terminal ileum

Most commonly affected site in UC?

Rectum

Mackler’s triad refers to which condition?

Esophageal rupture Chest pain Vomiting Subcutaneous emphysema

Wgat organs does copper deposot in Wilson’s disease?

Basal ganglia Eyes Liver

What is the Kayser Fleischer ring?

The deposition of copper ions in the des cement membrane of the cornea in Wilson’s disease

How is wilson’s dosease treated?

Penicillamine, which cheltes copper

Features of pernicious anaemia

``` Other autoimmune diseases Features of anemia Megaloblastic anemia Paraesthesia Numbness Subacute combined degeneration ```

How do you treat Giardiasis?

Metronidazole

How do you treat cryptosporidiosis diarrhea?

Oral anti fungal- nitazoxanide + HAART

What are the result expectations in CD for FBC, LFT, ESR, CRP?

FBC- Raised platelets, raised WBC, if malabsorption- anemia LFT- hypoalbuminemia ESR- raised CRP- raised

The role of NSAIDS and stress in IBD?

They worsen it and trigger relapses

Medications for induction of remission in CD?

Steroids - oral prednisone

Medications for maintenance of remission in CD?

Mercaptopurine, azathioprine, methotrexate

What substance in stool can be used to differentiate IBD from IBS?

Fecal calprotectin

How does proctitis in UC present?

Tenesmus, hematochezia, urgency

Can patients with UC have aphthous ulcers?

Yep!

Presentations of UC and respective symptoms?

UC rectal- proctitis UC sigmoid/ left sided- left sided pain, hematochezia, severe diarrhea UC extensive - same as above Toxic mega colon- acutely ill, fever, distension, tenderness,

Features of toxic megacolon on xray?

Lead pipe appearance- loss of haustrations | Dilated colon

Treatment of the different forms of UC?

``` Proctitis- rectal mesalazine Left sided- topical mesalazine enema Extensive- oral mesalazine plus enema All of them plus/minus oral prednisone me Severe colitis- IV hydrocort ```

Is PANCA positive in UC?

Yep!

Where are the locations of ulcers in ZES?

Distal Duodenum and proximal jejunum

Treatment of ZES?

PPIs | Surgical resection of tumor

What gene is implicated in Hereditary haemochromatosis?

HFE

What is responsible for the bronze skin nature in haemochromatosis?

Melanin deposition in the skin

Investigations in haemochromatosis?

Transferrin- saturation increased Increased ferritin LFT- increased ALT and AST HFE gene

How is hemochromatosis treated?

Phlebotomy | Liver transplant

A condition with decresed UDPGT causing jaundice in the face of stressors?

Gilbert syndrome

Whst 2 things are lost in villous adenoma?

Protein and potassium

First line for pseudomembrabous colitis?

Vancomycin

Bloody diarrhea organism acronym? | Clue- symptom in iron def anaemia

PECAS

Demographics for primary biliary cirrhosis?

Middle aged female with another autoimmune disease

Primary biliary cirrhosis/primary sclerosing cholangitis, which one is associated with IBD? (Remember- inflammation begets inflammation)

PBC- Coeliac | PSC- IBS

What antibody is associated with PBC?

Anti mitochondrial antibody

Treatment of PBC?

Ursodeoxycholic acid | Cholestyramine

Demographic for PSC?

Middle aged male | Background IBD

Which immunoglobulin is deficient in coeliac’s disease?

IgA

Histological changes in coeliac disease?

Villous atrophy Crypt hyperplasia Lymphoid infiltration

The characteristic rash in coeliac dosease

Dermatitis herpetiformes

Diagnostic test of coeliac dosease?

Duodenal/jejunal biopsy

What are the antibodies involved in coeliac dosease? | Which is tested first?

Tissue transglutaminase antibody | Anti endomysial antibody

Whats the duration of time between eating and endoscopy permitted?

6 hours

Whats the relationship between GGT abd Alcoholic liver dx? | Also, AST/ALT ratio?

Alcohol raises GGT levels | AST/ALT ratio = 2:1

Cancers associated with coeliac?

Lymphoma, small bowel adenocarcinoma, esophageal cancer

What differentiates HELLP syndrome from AFLP?

Hypoglycemia, ammonia

Criteria for liver transplantation after paracetamol overdose?

Arterial pH <7.3 24 hrs after ingestion PT > 100 secs Creatinine > 300micromol/L Grade III or IV encephalopathy

Charcot’s triad for acute cholangitis?

RUQ pain Fever Murphy’s sign

Whats the difference between hemosiderosis and hemochromatosis?

Hemosiderosis usually occurs with Iron deposition, usually doesn’t cause tissue injury. Deposits are more centrally placed and are found in kupffer cells. Hemochromatosis is a genetic disorder which occurs when there is excessive iron absorption. Deposits focus more peripherally and do not involve Kupffer cells

Kantor string and Rose thorn ulcers are seen in?

Chrons disease

Dark purple lump under the skin at the anal margin is called?

Anal hematoma

Where will a gallstone need to be found for urgent action to be taken? (With or without symptoms)

The common bile duct

How do the neutrophils look in b12 deficiency?

Hypersegmented

Gastroenterology Flashcards

(83 cards)