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Gastroenterology Flashcards

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1
Q

What happens in GORD?

A

Acid from the stomach refluxes into the oesophagus and irritates the epithelium

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2
Q

What is the presentation of GORD?

A

*Heartburn
*Retrosternal/epigastric pain
*Bloating
*Hoarse voice
*Nocturnal cough

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3
Q

What is the management of GORD?

A
  • Avoid triggers: alcohol, caffeine, quit smoking, lose weight, smaller lighter meals, stay upright after eating
    *Gaviscon/rennies
    *PPI: omeprazole or ranitidine
    *Surgery: laparoscopic fundolipcation
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4
Q

How do you check for H.pylori infection?

A

*Urea breath test
*Stool antigen
*Rapid urease test during endoscopy

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5
Q

How is H. pylori eradicated?

A

*Triple therapy
*PPI
*2x antibiotics: amoxicillin and clarithromycin
*7 days

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6
Q

What are the complications of H.pylori infection?

A

*Barrett’s oesophagus
*Oesophagitis
*Anaemia
*Ulcers
*Oesophageal carcinoma
*Benign strictures

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7
Q

What are the features of an upper GI bleed?

A

*Haematemesis
*Melena
*A raised urea may be seen due to protein in blood
*Haemodynamic instability if loss is large

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8
Q

What are the causes of upper GI bleeds?

A

*Oesophageal varices (most common)
*Peptic ulcer: gastric or duodenal
*Cancer
*Mallory weiss tear

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9
Q

What score is used on first presentation of an upper GI bleed?

A

Glasgow-Blatchford Score (can it be managed as an outpatient or an inpatient?)

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10
Q

What is the management of an upper GI bleed?

A

*Resuscitation: ABC, wide bore IV access, platelet transfusion if actively bleeding
*Endoscopy within 24 hours
*Stop anticoagulants and NSAIDs
*Bloods: FBC, UEs, Coag, LFTs, Crossmatch

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11
Q

What is the specific management of oesophageal varies?

A

*Terlipressin
*Broad spectrum antibiotics (prophylactic)
*Band ligation

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12
Q

What are the features of acute liver failure?

A

*Jaundice
*Coagulopathy: raised prothrombin time (INR>1.5)
*Hypoalbuminaemia
*Hepatic encephalopathy
*May have abdominal pain, nausea, vomiting
(must not have had liver failure prior otherwise it is acute on chronic)

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13
Q

What investigations should be carried out in someone presenting with acute liver failure?

A

*LFTs
*Prothrombin time
*Basic metabolic profile
*FBC
*Consider viral hepatitis PCR

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14
Q

What are the symptoms of acute alcohol withdrawal?

A

*Anxiety
*Nausea and vomiting
*Autonomic dysfunction
*Insomnia
*May progress to seizures and delirium

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15
Q

When do symptoms of alcohol withdrawal start?

A

6-12 hours after last alcoholic drink

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16
Q

What investigations should be carried out in someone presenting with alcohol withdrawal?

A

*Blood glucose
*Venous gas
*FBC
*UEs

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17
Q

What is the management of acute alcohol withdrawal

A

*GMAWS: if ≥2 then give benzodiazepines
*Correct metabolic abnormalities
*Give IV fluids if required

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18
Q

What symptoms of IBD overlap?

A

*Diarrhoea
*Arthritis
*Erythema nodosum
*Pyoderma gangrenosum

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19
Q

What are the symptoms of Crohn’s disease?

A

*Chronic diarrhoea
*Weight loss
* RLQ pain

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20
Q

What investigations should be carried out in someone presenting with Crohns?

A

*FBC
*iron studies
*Fecal calprotectin
*B12
*Vit D
*Endoscopy + histology

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21
Q

Describe endoscopy in crohns

A

*Deep ulcers
*Skip lesions

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22
Q

Describe histology of crohns

A

*Goblet cells
*Granulomas
*Inflammation of all layers

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23
Q

How do you induce remission in crohn’s?

A

*Glucocorticoids

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24
Q

Maintenance crohns

A

Azathioprine or mercaptopurine

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25
What must you assess before starting someone on azathioprine?
TPMT
26
What are the symptoms of ulcerative colitis?
* Bloody diarrhoea * Urgency * Tenesmus (feeling like you still need to pass stool despite havng just gone) * LLQ abdo pain
27
What is seen on endoscopy in UC?
* Continuous inflammation * Colon to rectum
28
How do you induce remission in UC?
Aminosalicylate e.g. mesalazine
29
Maintenance of Ulcerative collitis
* Mesalazine * Azathioprine * Mercaptopurine
30
What are the causes of gastritis?
* H.pylori * NSAIDs * Alcohol * Stress secondary to mucosal ischaemia * Autoimmune
31
What are the symptoms of gastritis?
* Nausea and vomiting * Severe emesis * Acute abdominal pain - epigastric area * Fever
32
What are the investigations for gastritis?
* H pylori * FBC * Consider endoscopy and gastric mucosal histology
33
What is the treatment of Gastritis?
* H.pylori triple therapy if indicated * Discontinue NSAIDs, consider PPI or H2 antagonist (famotidine)
34
What are the symptoms of peptic ulcer?
* Abdominal pain- epigastric * nausea * Gastric ulcers are worse on eating, duodenal are received by eating
35
What are the causes of peptic ulcers?
* H.pylori * Zollinger-Ellison syndrome (excessive gastrin) * NSAIDs, SSRIs, steroids, bisphosphonates
36
What are the investigations for peptic ulcers?
* Upper GI endoscopy * H.pylori urea breath test * FBC
37
What is the treatment of peptic ulcers?
* If no h pylori and no bleed: PPI, H2 antagonist 2nd line * If active bleed: urgent evaluation, resuscitation and supportive care and endoscopy
38
What causes oesophageal varies?
Portal hypertension, usually due to cirrhosis
39
What are the features of oesophageal varices?
* Haematemesis * Malaena * Haematochezia (bright red blood from anus)
40
What investigations should be carried out in suspected oesophageal varices?
* Gastroscopy * FBC: expect low Hb and platelet, macrocytosis may be seen in alcoholism * LFTs, UEs * Coagulation- INR and prothrombin time
41
What are the causes of chronic liver disease?
* Alcoholic liver disease * Non-alcoholic fatty liver disease * Hepatitis B * Hepatitis C * Rare: haemochromatosis, Wilsons disease, cystic fibrosis, autoimmune hepatitis, drugs (amiodarone, methotrexate, sodium valproate)
42
What are the symptoms of chronic liver disease?
* Abdominal distension * Jaundice and pruritus * Haematemesis and malaena * Muscle wasting
43
Diagnosis and management of alcoholic liver disease
* Liver biopsy in the context of alcohol abuse * Stop alcohol
44
Diagnosis and management of non alcoholic fatty liver disease
* diagnosis of exclusion: no alcohol abuse * Diet and exercise, liver transplant, consider pioglitazone and vitamin E
45
Diagnosis and management of Hepatitis B?
* Serology * Antiviral therapy, liver transplant, tenofovir, interferon
46
Diagnosis and management of hepatitis C
* HCV imunoassay, Hep C RNA PCR * Anti-viral therapy: intent is to cure
47
What are the 3 stages of alcoholic liver disease?
* Fatty liver (steatosis) * Alcoholic hepatitis * Alcoholic liver cirrhosis
48
Hep B sAg
Currently infected if positive
49
Hep B sAb
Immunity marker - infection or vaccine
50
Hep B cAb
Positive if infected
51
eAg
High infectivity
52
Hep B eAb
Low infectivity
53
What is achalasia?
Degnerative loss of ganglia from auberbach's plexus
54
What are the features of achalasia?
- dysphagia of solids and liquids - heartburn - regurgitation of food
55
Investigation for achalasia
- barium swallow - birds beak appearance, expanded oesophagus and fluid level
56
Management of achalasia
Pneumatic balloon dilation
57
Alcoholic liver disease LFTs
- high GGT - AST:ALP >2
58
Management of alocholic hepatitis
steroids
59
Side effects of sulfasalazine
- rash - oligospermia - headache - heinz body anaemia - megaloblastic anaemia - lung fibrosis - agranulocytosis
60
side effects of mesalazine
- GI upset - headache - agranulocytosis - pancreatitis - interstitial nephritis
61
Management of Barrett's oesophagus
- PPI - endoscopic surveillance and biopsy - if there is any dysplasia then endoscopic intervention is offered
62
Budd-chairi syndrome symptoms
- abdominal pain - ascites leading to abdo distension - tender hepatomegaly
63
C diff management of recurence
If within 12 weeks then fidaxomicin
64
Coeliac disease on biopsy
- lamina propria infiltration with lymphocytes - increased intraepithelial lymphocytes - crypt hypoplasia - villous atrophy
65
HNPCC cancer
- colorectal cancer - increased risk of endometrial cancer
66
Amsterdam criteria
- HNPCC - 3 family members with colon cancer - At least 2 generations - At least one onset before age 50
67
1st line constipation
Bulk forming: ispaghula
68
2nd line constipation
Osmotic: macrogol
69
Perianal fistula in crohns
- MRI - give oral metronidazole if symtpoms - draining seton if complex
70
Perianal abscess in crohns
Incision and drainage and antibiotics
71
Gastric cancer spread
- Virchows node: left supraclavicular - sister mary joseph node: periumbilical
72
Gilbert's
Defective bilirubin conjugation
73
Haemochromatosis
- Autosomal recessive - Defective bilirubin conjugation
74
Symptoms haemochromatosis
- fatigue - arthralgia - erectile dysfunction - bronze skin - diabetes - liver/cardiac failure
75
Classical blood results haemochromatosis
- High transferrin - high iron - low total iron binding capacity
76
Management of haemochromatosis
- venesection - monitor the transferrin saturation (keep less than 50%) and serum ferritin (below 50) - desferrioxamine 2nd line
77
Causes of hepatocellular carcinoma
- hep B - hep C - haemochromatosis - alcohol - Primary biliary cirrhosis
78
Signs of hepatocellular carcinoma
- jaundice - ascites - RUQ pain - hepatomegaly - pruritus - splenomegaly - hepatomegaly - raised AFP
79
Plummer vinson syndrome
- iron deficiency anaemia - dysphagia - glossitis
80
Associations of primary biliary cholangitis
- sjogrens - RA - systemic sclerosis - thyroid disease
81
Features of primary biliary cholangitis
- fatigue - pruritus - jaundice - hyperpigmentation - xanthelasma
82
Antibodies primary biliary cholangitis
- anti mitochondrial (90%) - smooth muscle antibodies - raised IgM
83
Investigations for primary biliary cholangitis
- antibodies - MRCP to exclude obstruction
84
Management of primary biliary cholangitis
- ursodeoxycholic acid to slow progression - cholestyramine for pruritus
85
Associations of primary sclerosing cholangitis
- ulcerative colitis - crohns (less than crohns) - HIV 10% develop cholangiocarcinoma
86
Features of primary sclerosing cholangitis
- fatigue - jaundice - RUQ pain - pruritus - increased bilirubin and ALP - pANCA may be positive
87

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