Gastroenterology Flashcards
(111 cards)
1
Q
principles of managing ascites
A
- diet: restrict ETOH, fluids, daily weights
- diuretics: spironolactone
- prophylaxis for SBP: ciprofloxacin and propanolol
- refractory disease: TIPPS/transplant
2
Q
IBD staging aspects
A
Truelove and Witts
HR
Temp
Bowel Movements
PR bleeding
Hb
ESR
3
Q
inflammation in Chron’s vs UC
A
Chrons: skip lesiosn, rose thorn ulcers, cobblestoning, narrow ileum stricture
UC: lead pipe, pseudo-polyps, thumb-printing
4
Q
Alvarado score
A
signs: RLQ tenderness, fever, rebound tenderness
symptoms: anorexia, N/V, pain migration to RLQ
lab: leucocytosis , left shift
4
Q
Alvarado score
A
signs: RLQ tenderness, fever, rebound tenderness
symptoms: anorexia, N/V, pain migration to RLQ
lab: leucocytosis , left shift
5
Q
Glasgow score
A
PANCREAS
PaO2 < 8
Age > 55
Neutrophils > 15
Calcium < 2
Renal urea > 16
Enzymes (LDH >600, AST/ALT > 200)
Albumin < 32
Sugar > 10
6
Q
early complications of acute pancreatitis
A
haemorrhage
SIRS/ARDS
hyperglycaemia
hypocalcaemia
7
Q
Mackler’s triad
A
Boerhaave’s syndrome
- chest pain
- vomiting
- subcutaenous emphysema
8
Q
causes of ascites
A
portal HTN
constrictive pericarditis
ovarian malignancy
9
Q
grades of hepatic encephalopathy
A
- irritability
- confusion
- incoherent
- coma
10
Q
osmotic diarrhoea causes
A
laxatives, malabsorption
may be relieved by gasting
11
Q
secretory diarrhoea causes
A
enterotoxins, systemic (hormones, neuroendoocrine)
not relieved by fasting
12
Q
inflammatory diarrhoea causes
A
UC, Chrons
13
Q
abnormal motility causes of diarrhoea
A
hyperthyroidism
autonomic neuropathy
stimulant laxatives
IBS
14
Q
appropriate investigations in IBS
A
FBC, CRP, coeliac disease Abs
15
Q
Chron’s inflammation
A
transmural
non caseating granuloma
fissures and fistulas
16
Q
causes of colitis
A
infection (campylobacter, shigella, C diff, CMV)
radiation
medications
ischaemic (acute, chronic)
17
Q
causes of sub total villous atrophy
A
coeliac
infectious enteritis
giardia
Whipple’s
lactose intolerance
18
Q
ALT rise
A
liver dysfunction
acute phase reactant
19
Q
Hep B antigens and what they mean?
A
HBsAg: surface/viral envelope protein
HBeAg: pre core protein = marker for acute replication
HBcAg: core protein = role in replication
20
Q
Hep B treatment
A
entecavir
tenofavir
lamivudine
interferon
21
Q
PBC pathological changes
A
progressive destruction of small intrahepatic bile ducts
22
Q
PSC pathological changes
A
inflammation and scarring of bile ducts
23
Q
calculating SAAG
A
serum albumin - albumin level of ascitic fluid
24
causes of SAAG > 1.1 mg/dL
cirrhosis
alcoholic hepatitis
cardiac asicitis
portal vein thrombosis
25
causes of SAAG < 1.1. mg/dL
peritoneal carcinomatosis
bowel obstruction
nephrotic syndrome
26
causes of hepatomegaly
ALD
NAFLF
Cancer (mets, hepatocellular Ca)
viral hepatitis
CCF
27
causes of splenomegaly
haemotological (myelofibrosis, CML)
infection (TB, malaria)
portal HTN
infiltrative (sarcoidosis)
AI (SLE, Felty's)
28
causes of large kidney
PCKD
cyst
renal Ca
infiltrative
29
investigations in IBD
bloods (FBC, U&Es, CRP, LFTs, pANCA)
Stool (culture, calprotectin)
Scope (colonoscopy, endoscopy)
30
investigations in IBD - acute
CT AP
31
Chron's acute nutritional management to induce remission
replace diet with whole protein molecular diet (excessively liquid) for 6-8 weeks
32
what to check if starting azathioprine/mercatopurine?
check TPMT levels
33
hemorrhoid's main investigation and finding
do DRE
most commonly at 3,7,11 o clock
34
coeliac genetics
DQ2, DQ8
35
diagnosing coeliac
anti-TTG is most sensitive
jejunal/duodenal biospy
36
acute cholecystitis complications
chronic diarrhoea
vitamin malabsorption (A, D, E, K)
Jaundice
37
antibodies if the different types of AI hepatitis and who it affects
T1: ANA, AMSA (adults, children)
T2: anti-LKM-1,2,3 (children)
T3: anti-soluble-liver antigen (middle-aged adults)
38
CLD S/S
palmar erythema
Dupuytren's
Clubbing
Gynaecomastia
Axillary hair loss
Spider naevi
39
Enhanced Liver Panel aspects
hyaluronic acid
procollagen III
tissue inhibitor of metalloproteinase 1
40
what does fibroscan measure?
liver stiffness measurement
41
late complications of pancreatitis
peri-pancreatic fluid collection
pseudocysts
abscess
pancreatic necrosis
42
investigations in chronic pancreatitis
USS
contrast enhanced CT
43
HR-CT finding in Pancreatic Ca
double duct sign
= simultaneous dilatation of CBD and pancreatic duct
44
indications for urgent 2ww OGD
dysphagia
upper GI mass
age >55yo + weight loss + dyspepsia/GORD/upper GI pain
45
indications for non-urgent OGD
- haematemesis
- age >55yo + tx-resistant dyspepsia/ UGI pain with low Hb
46
when is an anal fissure chronic? tx?
more than 6 weeks
treat with topical GTN, sphinceterotomy
47
aspects of Child Pugh score
ABCDE
Albumin
BR
Clotting (PT)
Distention (ascites)
Encephalopathy
48
how to treat alcoholic hepatitis
prednisolone (if high DF)
49
what is Budd-Chiari and what are the S/S?
blockage of hepatic vein
S/S: abdo pain, ascites, tender hepatomegaly
50
carcinoid syndrome investigations
urinary 5-HIAA
51
Small bowel overgrowth treatment
rifaxicim
52
Types of oesophageal cancer and RFs
Adenocarcinoma (GORD, lower 3rd)
SCC (smoking, upper/middle third)
53
Management of oesophageal cancer
Most are palliative
Others: stenting, secretion, analgesia, radiotherapy
54
When to do OGD in GORD
>55
ALARMS
Anaemia
Loss of weight
Anorexia
Recent onset progressive ax
Malaena
Swallowing difficulties
Persistent despite treatment
55
Complications of Nissan fundiplication
Gas bloat syndrome
Dysphagia
56
Symptoms of duodenal vs gastric ulcer
DU: pain before meals and at night, relived by eating
GU: worse on eating
57
Rockall score
Prediction of re bleeding and mortality
58
Pre hepatic causes of portal HTN
Portal vein thrombosis
59
Hepatic cause of portal HTN
Cirrhosis
Schisto
Sarcoidosis
60
Post hepatic cause of portal HTN
Budd Chiari
RHF
61
What is a TIPSS procedure?
Artificial channel between hepatic vein and portal vein
Dec portal pressure
62
What scan to do in a perforated viscus ?
Erect CXR = air under diaphragm
63
Zollinger Ellison syndrome causes
Gastrinoma = inc gastric
PUD and chronic diarrhoea
64
Presentation and treatment of Zollinger Ellison
Abdo pain, dyspepsia, refractory PUD
Treatment: high dose PPI, sugars
65
Criteria to meet for Bariatric Surgery
BMI >40 or >35 with surgical comorbidity
Failure of non surgical management of weight loss for 6 months
Fit for surgery
Integrated program for guidance on diet/exercise
66
Complication of gallstones in gut
Gallstone ileus
67
When doing an USS for gallstones, what to look for ?
Stones
Dilated ducts
Inflamed GB
68
Mirizzi’s syndrome
Large stone in GB presses on common healthcare duct
= obstructive jaundice
69
How does a gallstone ileus form?
Large stone erodes from GB to duodenum
May impact distal ileum = obstruction
Mx: remove stone via enterostomy
70
Meaning of Glasgow score
1 = mild
2 = moderate
3 = severe
71
Pancreatic pseudo cyst presentation
4-6 weeks after acute attack
Persisting abdominal pain
Epigastric mass = early satiety
72
Causes of chronic pancreatitis
Alcohol
Genetic (CF, HH)
Immune (IgG4)
73
UC complications
Toxic mega colon
Bleeding
Malignancy
Cholangiocarcinoma
74
Chron’s complications
Fistulae
Strictures
Abscesses
Malabsorption
75
UC pathology
Lead pipe
Thumb printing (mucosal thickening)
Pseudopolyps
76
Additional therapies in UC
Azathioprine
Infliximab
77
Chron’s pathology
Skip lesions
Rose thorn ulcers
Cobblestoning (ulceration and mural oedema)
String sign of Kantor (narrow terminal ileum)
78
Maintaining remission in Chron’s
1. Azathioprine / mercatopurine
2. Methotrexate
3. Infliximab
79
Complications of diverticulitis
Perforation
Haemorrhage
Abscess
Fistulae
Strictures
80
Paralytic ileus
Adynamic bowel secondary to absence of normal peristalsis
Usually SBO
81
Causes of paralytic ileus
Post op
Peritonitis
Pancreatitis
Metabolic (dec K, Na, Mg)
82
BS in Ileus vs Mechanical Obstruction
Ileus = dec BS
Mechanical obstruction = inc BS
83
SBO AXR
>3cm
Central
Valvulae coniventes (completely across)
Many loops of bowel
84
LBO AXR
>6cm
Peripheral
Haustra (partially across)
Few loops of bowel
85
Colorectal Ca RFs
Diet (inc fibre)
IBD
Familial (FAP, HNPCC)
Smoking
86
Rectal Ca: anterior resection indication
Tumour 4-5cm from anal verge
Defunct in with loop ileostomy
87
Rectal Ca: AP resection
<4cm from anal verge
Permanent colostomy
88
Sigmoid Ca operation
High anterior resection or sigmoid Colectomy
89
Transverse Ca operation
Extended R hemicolectomy
90
FAP defect
APC gene
91
HNPCC defect
Mismatch repair genes
92
Anal cancer HPV mutations
16, 18, 31, 33
93
Definition of hernia
Protrusion of a viscus or part of a viscus through the walls of its containing cavity into an abnormal position
94
Inguinal hernia RFs
Cough
Constipation
Obesity
Heavy lifting
95
Questions to ask about inguinal hernia
Reducible
Every had episode of obstruction/strangulation
96
Complications of inguinal hernia repair
Early: haematoma, infection, intra-abdo injury
Late: recurrence, chronic groin pain
97
H. pylori eradication
PAC 500
PPI: Lansoprazole 30mg BD
Amoxicillin: 1g BD
Clarithromycin 500mg BD
98
pathophysiology of GORD
LOS dysfunction
99
GI bleeding (not varices) endoscopic treatment of vessel/ulcer problem
- adrenaline injection
- thermal/laser coag
- fibrin glue
- endoclips
100
what is hepatorenal syndrome?
renal failure in patients with advances CLF
due to underfilling of renal circulation
101
management of hepatorenal syndrome
IV albumin and terlipressin
102
criteria for liver transplant in paracetamol induced LF
pH < 7.3 after 24 hrs
or all of:
- PT >100 s
- Cr > 300
- Grade 3/4 encephalopathy
103
what are the complications of cirrhosis?
1. decompensation (jaundice, encep, dec albumin, coag, dec glucose)
2. SBP
3. Portal HTN
4. inc risk of HCC
104
what does Child Pugh score do?
predicts risk of bleeding and mortality and need for treatment
105
SAAG and causes
>1.1g/dL = portal HTN (cirrhosis)
<1.1g/dL = other causes
106
score used to determine treatment in Alcoholic Hep?
Maddrey score
107
which ducts affected in PBC vs PSC?
PBC = intra-hepatic
PSC = intra and extra hepatic
108
extra-articular of IBD
- skin (clubbing, erythema nodosum)
- eyes (iritis, conjunctivitis)
- joints (arthritis, AS)
- HPB (PSC, gallstones, fatty liver)
109
what does lead pipe mean?
no haustra
110
what does cobblestoning mean?
ulceration and mural oedema
