Gastroenterology Flashcards
(171 cards)
1
Q
What are the 4 most common causes of liver cirrhosis ?
A
Alcohol-related liver disease
Non-alcoholic fatty liver disease (NAFLD)
Hepatitis B
Hepatitis C
2
Q
What are some rarer causes of liver cirrhosis?
A
Autoimmune hepatitis
Primary biliary cirrhosis
Haemochromatosis
Wilsons disease
Alpha-1 antitrypsin deficiency
Cystic fibrosis
Drugs (e.g., amiodarone, methotrexate and sodium valproate)
3
Q
What are some findings on examination of a patient with liver cirrhosis?
A
Cachexia
Jaundice
Hepatomegaly
small nodular liver
splenomegaly
palmar erythema
Gynaecomastia and testicular atrophy
bruising
excoriations
ascites
caput medusae
Leukonychia
asterixis
4
Q
What does a non-invasive liver screen involve?
A
USS
Hep B & C serology
Autoantibodies
Immunoglobulins
Caeruloplasmin
Alpha-1 antitrypsin levels
Ferritin and transferrin saturation
5
Q
What autoantibodies are relevant to liver disease ?
A
Antinuclear antibodies
Smooth muscle antibodies
Antimitochondrial antibodies
Antibodies to liver and kidney microsome type-1
6
Q
What would LFT’s show in decompensated cirrhosis?
A
Raised Bilirubin, ALT, AST, ALP
7
Q
Apart from LFT’s what other blood tests may be deranged in cirrhosis?
A
Low albumin
Increase prothrombin time
Thrombocytopenia
Hyponatraemia
Urea and creatinine deranged in hepatorenal syndrome
8
Q
What is the tumour marker for hepatocellular carcinoma ?
A
Alpha-fetoprotein
9
Q
What is the first line investigation for assessing fibrosis in non-alcoholic fatty liver disease?
A
Enhanced liver fibrosis blood test (ELF)
10.51 or above = advanced fibrosis
10
Q
What is used to diagnose non-alcoholic fatty liver disease?
A
Ultrasound = Increased echogenicity
11
Q
What type of scan can be used to determine the degree of fibrosis to test for liver cirrhosis?
A
Transient elastography (FibroScan)
12
Q
What is the MELD score?
A
Model for End-Stage Liver Disease
formula considers the bilirubin, creatinine, INR and sodium and whether they require dialysis, giving an estimated 3-month mortality as a percentage
score every 6 months
13
Q
What is the Child-Pugh score and what are the components?
A
Assesses the severity of cirrhosis and prognosis
A - albumin
B - bilirubin
C - clotting (INR)
D - dilation (ascites)
E - encephalopathy
14
Q
What is the monitoring protocol for liver cirrhosis?
A
MELD score every 6 months
Ultrasound and alpha-fetoprotein every 6 months for hepatocellular carcinoma
Endoscopy every 3 years for oesophageal varices
15
Q
What are the 4 key features of decompensated liver disease?
A
A - Ascites
H - Hepatic encephalopathy
O- Oesophageal varices bleeding
Y - Yellow (Jaundice)
16
Q
What is the overall 5 year survival rate in liver cirrhosis?
A
50%
17
Q
What are some important complications of cirrhosis?
A
Malnutrition and muscle wasting
Portal hypertension, oesophageal varices and bleeding varices
Ascites and spontaneous bacterial peritonitis
Hepatorenal syndrome
Hepatic encephalopathy
Hepatocellular carcinoma
18
Q
What is the prophylaxis management of varices?
A
Non-selective beta blockers (e.g., propranolol) first-line
Variceal band ligation (if beta blockers are contraindicated)
19
Q
What is the initial management of bleeding oesophageal varices?
A
Immediate senior help
Consider blood transfusion (major haemorrhage protocol)
Treat any coagulopathy (fresh frozen plasma)
Vasopressin analogues (terlipressin or somatostatin)
Prophylactic broad-spectrum antibiotics
Urgent endoscopy with variceal band ligation
Consider intubation and intensive care
20
Q
What are the management options for ascites?
A
Low sodium diet
Aldosterone antagonists
Paracentesis
Prophylactic antibiotics
Transjugular intrahepatic portosystemic shunt (if refractory)
Liver transplantation
21
Q
What are some presenting features of spontaneous bacterial peritonitis ?
A
Fever
Abdo pain
Deranged bloods (raised WBC, CRP, creatinine, metabolic acidosis)
Ileus (reduced movement in intestines)
Hypotension
22
Q
What are the 2 most common organisms in spontaneous bacterial peritonitis?
A
E.coli
Klebsiella pneumoniae
23
Q
How is spontaneous bacterial peritonitis managed?
A
Take sample of ascitic fluid for culture before antibiotics
IV broad spectrum antibiotics
24
Q
What toxin builds up to cause hepatic encephalopathy?
A
Ammonia
25
What are some factors that can trigger or worsen hepatic encephalopathy?
Constipation
Dehydration
Electrolyte disturbance
Infection
GI bleeding
High protein diet
Medications
26
How is hepatic encephalopathy managed?
Lactulose (aim for 2-3 soft stools a day)
Antibiotics e.g. Rifaximin
Nutritional support
27
Describe the stepwise progression of alcohol-related liver disease
1. Alcoholic fatty liver (hepatic steatosis)
2. Alcoholic hepatitis
3. Cirrhosis
28
State 5 complications of alcohol consumption
Alcohol-related liver disease
Wernicke-Korsakoff syndrome
Pancreatitis
Alcoholic cardiomyopathy
Alcoholic myopathy
Increased risk of CVD and cancer
29
What blood test results would be suggestive of alcoholic-related liver disease?
Raised MCV
Raised ALT and AST
AST: ALT ratio above 1.5
Raised gamma-GT
Raised ALP
Raised bilirubin
Low albumin
Increased prothrombin time
Deranged U&E's in hepatorenal syndrome
30
Name 5 other investigations besides bloods that may be done in suspected alcohol-related liver disease
Liver USS
FibroScan
Endoscopy (oesophageal varices)
CT/MRI
Liver biopsy
31
What are the general principles of managing alcohol-related liver disease?
Stop drinking
Psychological interventions
Nutritional support (thiamine, high protein diet)
Corticosteroids (may improve inflammation in short term)
Treat complications
Liver transplant (6 months of abstinence required)
32
What are the CAGE questions?
C – CUT DOWN? Do you ever think you should cut down?
A – ANNOYED? Do you get annoyed at others commenting on your drinking?
G – GUILTY? Do you ever feel guilty about drinking?
E – EYE OPENER? Do you ever drink in the morning to help your hangover or nerves?
33
Name 2 screening tools for harmful alcohol consumption
CAGE
AUDIT
34
Describe the timeline of alcohol withdrawal symptoms
6-12 hours: tremor, sweating, headache, craving and anxiety
12-24 hours: hallucinations
24-48 hours: seizures
24-72 hours: delirium tremens
35
What are some presenting features of delirium tremens?
Acute confusion
Severe agitation
delusions and hallucinations
tremor
tachycardia
hypertension
hyperthermia
ataxia
arrhythmias
36
What can be used to score a patient on the alcohol withdrawal symptoms?
CIWA-Ar
37
What medications are given to combat the effects of alcohol withdrawal?
Chlordiazepoxide
Pabrinex (to prevent Wernicke-Korsakoff)
38
State 3 features of Wernicke's encephalopathy
Confusion
Oculomotor disturbances (disturbances of eye movements)
Ataxia (difficulties with coordinated movements)
39
What causes Wernicke-Korsakoff syndrome ?
Thiamine (B1) deficiency
40
State 2 features of Korsakoff syndrome
Memory impairment (retrograde and anterograde)
Behavioural changes
41
What are the stages of non-alcoholic fatty liver disease ?
Non-alcoholic fatty liver disease
Non-alcoholic steatohepatitis (NASH)
Fibrosis
Cirrhosis
42
State 5 risk factors for non-alcoholic fatty liver disease
Middle age onwards
Obesity
Poor diet and low activity levels
Type 2 diabetes
High cholesterol
High blood pressure
Smoking
43
What is metabolic syndrome a combination of?
hypertension, obesity and diabetes
44
What investigations can be done in suspected non-alcoholic fatty liver disease
ALT (raised)
Liver USS - confirms diagnosis
ELF bloods (1st line to assess fibrosis)
NAFLD Fibrosis score, Fibrosis 4
FibroScan
Liver biopsy
45
What are the management options for non-alcoholic fatty liver disease?
weight loss
healthy diet
exercise
stop smoking
avoid/limit alcohol
control diabetes, BP and cholesterol
vitamin E, pioglitazone, bariatric surgery, liver transplantation
46
What is the type of virus, transmission, vaccine and treatment for hepatitis A ?
type: RNA
transmission: Faecal-oral
vaccine: yes
treatment: supportive
47
What is the type of virus, transmission, vaccine and treatment for hepatitis B?
type: DNA
transmission: Blood/bodily fluids
vaccine: yes
treatment: supportive/antivirals
48
What is the type of virus, transmission, vaccine and treatment for hepatitis C?
type: RNA
transmission: blood
vaccine: no
treatment: direct-acting antivirals
49
What is the type of virus, transmission, vaccine and treatment for hepatitis D?
type: RNA
transmission: always with hepatitis B
vaccine: no
treatment: Pegylated interferon alpha
50
What is the type of virus, transmission, vaccine and treatment for hepatitis E?
type: RNA
transmission: faecal-oral
vaccine: no
treatment: supportive
51
What symptoms of viral hepatitis may a patient present with?
Abdominal pain
Fatigue
Flu-like illness
Pruritus (itching)
Muscle and joint aches
Nausea and vomiting
Jaundice
52
Describe the key viral markers in hepatitis B
Surface antigen (HBsAg) – active infection
E antigen (HBeAg) – a marker of viral replication and implies high infectivity
Core antibodies (HBcAb) – implies past or current infection
Surface antibody (HBsAb) – implies vaccination or past or current infection
Hepatitis B virus DNA (HBV DNA) – a direct count of the viral load
53
What are the differences between the 2 types of autoimmune hepatitis?
Type 1 typically affects women in their late forties or fifties. It presents around or after menopause with fatigue and features of liver disease on examination. It takes a less acute course than type 2.
Type 2 usually affects children or young people, more commonly girls. It presents with acute hepatitis with high transaminases and jaundice.
54
What would blood tests show in autoimmune hepatitis?
Investigations will show high transaminases (ALT and AST) and minimal change in ALP levels (a “hepatitic” picture). Raised immunoglobulin G (IgG) levels are an important finding.
55
What are the autoantibodies in type 1 autoimmune hepatitis?
Anti-nuclear antibodies (ANA)
Anti-smooth muscle antibodies (anti-actin)
Anti-soluble liver antigen (anti-SLA/LP)
56
What are the autoantibodies in type 2 autoimmune hepatitis?
Anti-liver kidney microsomes-1 (anti-LKM1)
Anti-liver cytosol antigen type 1 (anti-LC1)
57
How is autoimmune hepatitis managed?
High-dose steroids
immunosuppression e.g. azathioprine
Liver transplant in end-stage
58
What is the inheritance pattern of Haemochromatosis?
autosomal recessive
59
What is haemochromatosis?
excessive total body iron and deposition of iron in tissues
60
What gene is associated with hemochromatosis and where is it located?
human haemochromatosis protein (HFE) gene is located on chromosome 6
61
What mutation relates to haemochromatosis?
C282Y mutations
62
How may Haemochromatosis present?
Chronic tiredness
Joint pain
Pigmentation (bronze skin)
Testicular atrophy
Erectile dysfunction
Amenorrhoea (absence of periods in women)
Cognitive symptoms (memory and mood disturbance)
Hepatomegaly
63
What are some causes of a raised ferritin?
Haemochromatosis
Infections (it is an acute phase reactant)
Chronic alcohol consumption
Non-alcoholic fatty liver disease
Hepatitis C
Cancer
64
What investigations can be done for haemochromatosis?
Ferritin
Transferrin saturation
Genetic testing
Liver biopsy with Perl's stain
MRI
65
What are some complications of haemochromatosis?
Secondary diabetes
Liver cirrhosis
Endocrine and sexual problems (hypogonadism, erectile dysfunction, amenorrhea and reduced fertility)
Cardiomyopathy
Hepatocellular carcinoma
Hypothyroidism
Chondrocalcinosis
66
How is haemochromatosis managed?
Venesection
monitoring serum ferritin
Monitoring and treating complications
67
What is the inheritance pattern of Wilson's disease ?
autosomal recessive
68
Excessive accumulation of what causes Wilsons disease ?
Copper
69
What mutation causes Wilsons disease?
Wilson disease protein gene on chromosome 13 (also called the ATP7B copper-binding protein)
70
What are some features of Wilsons disease ?
Liver - chronic hepatitis then cirrhosis
Neurological - tremor, dysarthria, dystonia, parkinsonism
Psychiatric - abnormal behaviour, depression, cognitive impairment, psychosis
Kayser-Fleischer rings in the cornea
Haemolytic anaemia
renal tubular damage
71
When does Wilson's disease usually present?
teenagers or young adults
72
How is Wilsons disease investigated?
Serum caeruloplasmin (low is suggestive of Wilsons)
24-hour urine copper assay (shows high urinary copper)
Liver biopsy
73
How is Wilson's disease managed?
copper chelation using either: Penicillamine or Trientine
others: zinc salts. liver transplant
74
What are the two main organs affected by alpha-1 antitrypsin deficiency?
Chronic obstructive pulmonary disease and bronchiectasis in the lungs (typically after 30 years old)
Dysfunction, fibrosis and cirrhosis of the liver (depending on the specific genotype)
75
What is the inheritance pattern of alpha-1 antitrypsin deficiency?
Autosomal co-dominant
76
What gene codes for alpha-1 antitrypsin and where is it found?
SERPINA1 gene
chromosome 14
77
How is alpha-1 antitrypsin deficiency diagnosed
Low serum alpha-1 antitrypsin (the screening test)
Genetic testing
78
What will liver biopsy show in alpha-1 antitrypsin deficiency ?
periodic acid-Schiff positive staining globules in hepatocytes, resistant to diastase treatment.
79
What are the management options for alpha-1 antitrypsin deficiency?
Stop smoking
Symptomatic management (e.g., standard treatment of COPD)
Organ transplant for end-stage liver or lung disease
Monitoring for complications (e.g., hepatocellular carcinoma)
Screening of family members
80
What is primary biliary cholangitis?
autoimmune condition where the immune system attacks the small bile ducts in the liver, resulting in obstructive jaundice and liver disease
81
How may a patient with primary biliary cholangitis present?
Fatigue
Pruritus (itching)
Gastrointestinal symptoms and abdominal pain
Jaundice
Pale, greasy stools
Dark urine
82
What may be seen on examination in a patient with primary biliary cholangitis?
Xanthoma and xanthelasma (cholesterol deposits)
Excoriations
Hepatomegaly
Signs of liver cirrhosis and portal hypertension in end-stage disease (e.g., splenomegaly and ascites)
83
What investigations can be done for primary biliary cholangitis and what will they show?
LFT's = raised alkaline phosphatase
autoantibodies = anti-mitochondrial antibodies, anti-nuclear antibodies
raised immunoglobulins
liver biopsy = staging
84
What is the treatment of primary biliary cholangitis?
Ursodeoxycholic acid
85
What are some complications of primary biliary cholangitis?
Liver cirrhosis - carcinoma, portal hypertension
Fat-soluble vitamin deficiency (A, D, E and K)
Osteoporosis
Hyperlipidaemia (raised cholesterol)
Sjögren’s syndrome (dry eyes, dry mouth and vaginal dryness)
Connective tissue diseases (e.g., systemic sclerosis)
Thyroid disease
86
What is primary sclerosing cholangitis?
intrahepatic and extrahepatic bile ducts become inflamed and damaged, developing strictures that obstruct the flow of bile out of the liver and into the intestines
87
What other condition is associated with primary sclerosing cholangitis?
Ulcerative colitis
88
State 4 risk factors for primary sclerosing cholangitis
Male
Aged 30-40
Ulcerative colitis
Family history
89
How may primary sclerosing cholangitis present?
Abdominal pain in the right upper quadrant
Pruritus (itching)
Fatigue
Jaundice
Hepatomegaly
Splenomegaly
90
What LFT will be raised in primary sclerosing cholangitis?
alkaline phosphatase
91
What investigation is used to diagnose primary sclerosing cholangitis?
Magnetic resonance cholangiopancreatography (MRCP)
92
How is primary sclerosing cholangitis managed?
Endoscopic retrograde cholangio-pancreatography (ERCP)
liver transplant
93
What are some complications of primary sclerosing cholangitis?
Biliary strictures
Acute bacterial cholangitis
Cholangiocarcinoma develops in 10-20% of cases
Cirrhosis and the related complications (e.g., portal hypertension and oesophageal varices)
Fat-soluble vitamin deficiency (A, D, E and K)
Osteoporosis
Colorectal cancer in patients with ulcerative colitis
94
What is the main type of primary liver cancer?
Hepatocellular carcinoma
95
State 4 risk factors for hepatocellular carcinoma
Alcohol-related liver disease
Non-alcoholic fatty liver disease (NAFLD)
Hepatitis B
Hepatitis C
Rarer causes (e.g., primary sclerosing cholangitis)
96
Patients with liver cirrhosis are offered screening for hepatocellular carcinoma every 6 months with what investigations?
Ultrasound
Alpha-fetoprotein
97
What non-specific features are associated with liver cancer?
Weight loss
Abdominal pain
Anorexia
Nausea and vomiting
Jaundice
Pruritus
Upper abdominal mass on palpation
98
State 4 investigations that may be carried out to assess liver cancer?
Alpha-fetoprotein
Liver ultrasound is the first-line imaging investigation
CT and MRI scans are used for further assessment and staging of the cancer
Biopsy is used for histology
99
What are the management options for hepatocellular carcinoma?
Surgery (resection/transplant)
radiofrequency ablation
microwave ablation
transarterial chemoembolisation
Radiotherapy
targeted drugs
100
Where to Cholangiocarcinoma's originate?
Bile ducts
101
What condition is Cholangiocarcinoma associated with?
Primary sclerosing cholangitis
102
What is the key presenting feature of cholangiocarcinoma?
Obstructive jaundice:
Pale stools
Dark urine
Generalised itching
103
What is the tumour marker for cholangiocarcinoma?
CA19-9
104
State 3 contraindications in referring for a liver transplant
Significant co-morbidities (e.g., severe kidney, lung or heart disease)
Current illicit drug use
Continuing alcohol misuse (generally 6 months of abstinence is required)
Untreated HIV
Current or previous cancer (except certain liver cancers)
105
What are the names of the 2 incisions in a liver transplant?
Rooftop
Mercedes Benz
106
What is gastro-oesophageal reflux disease?
acid from the stomach flows through the lower oesophageal sphincter and into the oesophagus, where it irritates the lining and causes symptoms.
107
What cells line the oesophagus?
squamous epithelial
108
What cells line the stomach?
Columnar epithelial
109
What factors can exacerbate the symptoms of GORD?
Greasy and spicy foods
Coffee and tea
Alcohol
Non-steroidal anti-inflammatory drugs
Stress
Smoking
Obesity
Hiatus hernia
110
State some symptoms of GORD
Heartburn
Acid regurgitation
Retrosternal or epigastric pain
Bloating
Nocturnal cough
Hoarse voice
111
What are some red flags in a patient with GORD that require a 2WW?
Dysphagia (difficulty swallowing)
Aged over 55 (this is generally the cut-off for urgent versus routine referrals)
Weight loss
Upper abdominal pain
Reflux
Treatment-resistant dyspepsia
Nausea and vomiting
Upper abdominal mass on palpation
Low haemoglobin (anaemia)
Raised platelet count
112
What is a hiatus hernia?
herniation of the stomach up through the diaphragm
113
What are the 4 types of hiatus hernia?
Type 1: Sliding
Type 2: Rolling
Type 3: Combination of sliding and rolling
Type 4: Large opening with additional abdominal organs entering the thorax
114
What is a sliding hiatus hernia?
stomach slides up through the diaphragm, with the gastro-oesophageal junction passing up into the thorax
115
What is a rolling hiatus hernia?
a separate portion of the stomach (i.e., the fundus), folds around and enters through the diaphragm opening, alongside the oesophagus
116
What investigations may show a hiatus hernia?
Chest x-ray
CT scan
Endoscopy
Barium swallow test
117
What are the management options for GORD?
Lifestyle changes
Reviewing medications (e.g., stop NSAIDs)
Antacids (e.g., Gaviscon, Pepto-Bismol and Rennie) – short term only
Proton pump inhibitors (e.g., omeprazole and lansoprazole)
Histamine H2-receptor antagonists (e.g., famotidine)
Surgery
118
What lifestyle changes may be helpful in GORD?
Reduce tea, coffee and alcohol
Weight loss
Avoid smoking
Smaller, lighter meals
Avoid heavy meals before bedtime
Stay upright after meals rather than lying flat
119
What is the name of the surgery for reflux?
laparoscopic fundoplication
120
When do you need to stop using a PPI before H.pylori testing?
2 weeks
121
What are the investigations for H.Pylori ?
Stool antigen test
Urea breath test using radiolabelled carbon 13
H. pylori antibody test (blood)
Rapid urease test performed during endoscopy (also known as the CLO test)
122
What is Barrett's oesophagus?
lower oesophageal epithelium changes from squamous to columnar epithelium. This process is called metaplasia.
123
What does Barrett's oesophagus put you at risk of developing?
oesophageal adenocarcinoma
124
What is the treatment of Barrett's oesophagus?
Endoscopic monitoring for progression to adenocarcinoma
Proton pump inhibitors
Endoscopic ablation (e.g., radiofrequency ablation)
125
What is Zollinger-Ellison syndrome?
duodenal or pancreatic tumour secretes excessive quantities of gastrin causing excess production of stomach acid resulting in severe dyspepsia, diarrhoea and peptic ulcers
126
what type of peptic ulcer is most common?
duodenal ulcer
127
What are some risk factors of peptic ulcers?
H.Pylori
NSAIDS
stress
alcohol
smoking
caffeine
spicy foods
128
What drugs increase the risk of bleeding from a peptic ulcer?
Non-steroidal anti-inflammatory drugs (NSAIDs)
Aspirin
Anticoagulants (e.g., DOACs)
Steroids
SSRI antidepressants
129
What are some signs of a peptic ulcer?
Epigastric discomfort or pain
Nausea and vomiting
Dyspepsia
130
What are some signs of upper gastrointestinal bleeding?
Haematemesis (vomiting blood)
Coffee ground vomiting
Melaena (black, tarry stools)
Fall in haemoglobin on a full blood count
131
What are the characteristics of the pain with duodenal ulcers
improve immediately after eating, followed by pain 2-3 hours later
132
How are peptic ulcers diagnosed ?
Endoscopy
(CLO test for H.pylori may be performed during)
133
What are the key management options for peptic ulcers
Stopping NSAIDs
Treating H. pylori infections
Proton pump inhibitors (e.g., lansoprazole or omeprazole)
134
State 3 complications of peptic ulcers
bleeding
Perforation -> peritonitis
scarring + strictures
135
state 4 key sources of an upper GI bleed
Peptic ulcers (the most common cause)
Mallory-Weiss tear
Oesophageal varices
Stomach cancers
136
What are the presenting features of an upper GI bleed?
Haematemesis
Coffee ground vomit
Melaena
137
What score estimates the risk of a patient having an upper GI bleed?
Glasgow-Blatchford score
138
What is the Rockall score used for?
after endoscopy to estimate the risk of rebleeding and mortality
139
What is the initial management of an upper GI bleed?
get senior support early
A – ABCDE approach to immediate resuscitation
B – Bloods
A – Access (ideally 2 x large bore cannula)
T – Transfusions are required
E – Endoscopy (within 24 hours)
D – Drugs (stop anticoagulants and NSAIDs)
140
In a patient with an upper GI bleed what should you send bloods for?
Haemoglobin (FBC)
Urea (U&Es)
Coagulation (INR and FBC for platelets)
Liver disease (LFTs)
Crossmatch 2 units of blood
141
What are some general presenting features of IBD?
Diarrhoea
Abdominal pain
Rectal bleeding
Fatigue
Weight loss
142
What features can help to differentiate Crohn's ?
N – No blood or mucus (PR bleeding is less common)
E – Entire gastrointestinal tract affected (from mouth to anus)
S – “Skip lesions” on endoscopy
T – Terminal ileum most affected and Transmural (full thickness) inflammation
S – Smoking is a risk factor (don’t set the nest on fire)
143
What features can help differentiate ulcerative colitis?
C – Continuous inflammation
L – Limited to the colon and rectum
O – Only superficial mucosa affected
S – Smoking may be protective
E – Excrete blood and mucus
U – Use aminosalicylates
P – Primary sclerosing cholangitis
144
Sate 4 conditions associated with IBD
Erythema nodosum
Pyoderma gangrenosum
Enteropathic arthritis
Primary sclerosing cholangitis (particularly with UC)
Red eye conditions (e.g., episcleritis, scleritis and anterior uveitis)
145
What blood tests may be done in suspected IBD?
FBC (for low haem and raised platelets)
CRP
U&E
LFT's (low albumin if severe)
TFT (hyperthyroidism may cause diarrhoea)
anti-TTG (for coeliac)
146
What stool investigations may be done in suspected IBD?
Faecal calprotectin
Stool microscopy + culture (rule out infection)
147
What is the diagnostic test for IBD?
Colonoscopy with multiple intestinal biopsies
148
How is mild to moderate acute UC treated?
1st: Aminosalicylate (e.g. oral or rectal mesalazine)
2nd: Corticosteroids (oral/rectal prednisolone)
149
How is severe acute UC treated?
1st: IV steroids (hydrocortisone)
others: IV ciclosporin, infliximab, surgery
150
What are some options for maintaining remission in UC?
1st: Aminosalicylate
2nd: Azothioprine or mercaptopurine
151
What surgery can be used for UC?
panproctocolectomy
152
How can you induce remission in an exacerbation of Crohn's disease?
1st: Steroids (oral pred or IV hydrocortisone)
Others: Enteral nutrition, + azothioprine, mercatopurine, methotrexate, infliximab, adalimumab
153
What is first line for maintaining remission in Crohn's disease?
Azathioprine or
Mercaptopurine
2nd: methotrexate
154
What are 3 key features of IBS?
I – Intestinal discomfort (abdominal pain relating to the bowels)
B – Bowel habit abnormalities
S – Stool abnormalities (watery, loose, hard or associated with mucus)
155
What factors may triggers symptoms in IBS?
Anxiety
Depression
Stress
Sleep disturbance
Illness
Medications
Certain foods
Caffeine
Alcohol
156
State 4 differential disgnoses for IBS
Bowel cancer
Inflammatory bowel disease
Coeliac disease
Ovarian cancer
Pancreatic cancer
157
What investigations may be done in suspected IBS?
done to exlude red flags
FBC
ESR/CRP
anti-TTG
Faecal calprotectin
CA125
158
What is the NICE criteria for diagnosing IBS?
differentials need to be excluded, and the patient should have at least 6 months of abdominal pain or discomfort with at least one of:
Pain or discomfort relieved by opening the bowels
Bowel habit abnormalities (more or less frequent)
Stool abnormalities (e.g., watery, loose or hard)
For a diagnosis, patients also require at least two of:
Straining, an urgent need to open bowels or incomplete emptying
Bloating
Worse after eating
Passing mucus
159
How is IBS managed?
lifestyle advice: drink fluids, regular small meals, adjusting fibre, limit caffeine, low FODMAP diet, probiotic, exercise, reduce stress
1st line medications: Loperamide for diarrhoea, bulk forming laxatives for constipation, antispasmodics for cramps e.g. mebeverine
160
What laxative should be avoided in IBS due to bloating?
lactulose
161
what diseases are associated with Coeliacs?
T1DM
autoimmune thyroid disease
162
What are the 3 antibodies associated with coeliacs?
Anti-tissue transglutaminase antibodies (anti-TTG)
Anti-endomysial antibodies (anti-EMA)
Anti-deamidated gliadin peptide antibodies (anti-DGP)
163
How does coeliacs affect the bowel?
Inflammation particulalry in jejunum causes atrophy of intestinal villi and crypt hypertophy resulting in malabsorption
164
What 2 HLA genotypes are associated with coeliacs?
HLA-DQ2
HLA-DQ8
165
What are some presenting features of coeliacs disease?
Failure to thrive in young children
Diarrhoea
Bloating
Fatigue
Weight loss
Mouth ulcers
Dermatitis herpetiformis
anaemia
rarely neurological symptoms
166
What are the 1st line blood tests for coeliacs?
Total immunoglobulin A levels (to exclude IgA deficiency)
Anti-tissue transglutaminase antibodies (anti-TTG)
167
What are the biospy findings in coeliacs?
Crypt hyperplasia
Villous atrophy
168
What is the management of coeliacs?
Lifelong gluten-free diet
169
What are some complications of coeliac disease?
Nutritional deficiencies
Anaemia
Osteoporosis
Hyposplenism
Ulcerative jejunitis
Enteropathy-associated T-cell lymphoma (EATL)
Non-Hodgkin lymphoma
Small bowel adenocarcinoma
170
What type of cancer are people with coeliac disease more likely to get?
enteropathy-associated T-cell lymphoma of small intestine
171
What is the most common type of inherited colorectal cancer?
Hereditary non-polyposis colorectal carcinoma (HNPCC), also known as Lynch syndrome.
