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Gastroenterology Flashcards

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1
Q

Define Symptoms of dyspepsia

A

Also known as indigestion:

Heartburn/ retrosternal pain
Pain related to eating food 
Early satiety
Belching 
Nausea
G.I pain
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2
Q

2-5 hours following food intake, there is pain, what type of peptic ulcer is this related too?

A

Duodenal Ulcer

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3
Q

Why must gastric ulcers be biopsied?

A

Because they have an increased risk of developing into malignant ulcers.

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4
Q

What are the broad types of stomach cancer?

A

Adenocarcinoma

  • intestinal type
  • diffuse type

MALT

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5
Q

Following a diagnosis of gastric cancer, what important investigation should be next done?

A

H.Pylor testing

CT of Abdomen, thorax and pelvis to look for metastasis

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6
Q

What is the treatment of gastric cancer?

A

Stages 0 -1: endoscopic removal

Proximal cancers: Total Gastrectomy
Distal cancers (Antrum or pylorus): Partial Gastrectomy
+
Neoadjuvant and adjuvant chemotherapy

Reconstruction surgery:
- Roux-Y- Reconstruction (attaching Distal oesophagus to the intestines)

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7
Q

What investigations can be done into H.Pylori?

A

Biopsy Sample:
- Urea and pH reagent

Non - invasive samples:

  • Urea breath test
  • Stool antigen testing
  • blood serology

*urea breath test works by given Urea to drink which has radioisotope carbon 14 in it. When broken down this carbon is realised as CO2 and detected. demonstrates Urease activity is occurring in the stomach

before non - invasive testing a person should be omitted from PPIs as these can create false negatives.

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8
Q

Stress ulcers can occur because of:

A

Alcohol
Trauma/ sepsis
Intracranial pressure - cushing’s

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9
Q

What is the definition of Liver failure and list some causes:

A

Failure of the liver which is recognised by:

  • coagulopathy (INR >1.5)
  • Encephalopathy
  • Jaundice

Causes:

  • infections
  • Toxins
  • vascular
  • alcohol
  • autoimmune
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10
Q

What things must one be aware off in liver failure?

A

Sepsis
Bleeding (varicies)
Hypoglycaemia
cerebral oedema

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11
Q

What is the initial management of acute liver failure?

A

Admit to ICU - these patient deteriorate fast

ABCDE
A 
Protect air way -
NG tube to remove gastric contents 
20 degree head tilt to maintain airway and reduce intracranial pressure

B

C:

  • LFTs
  • FBC
  • U&Es
  • INR

Catheterisation to monitor fluids

D
Blood glucose monitoring every 4 hours
- place on Dextrose
- Avoid sedative drugs if possible.

Maintain nourishment

  • thiamine
  • folate supplements

Treat complications

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12
Q

What signs may you see in liver cirrhosis?

A

Leukonychia

hypoalbuminemia

Increased INR

Finger clubbing

Palmer erythema

Spider navi

Gynecomastia

Loss of body hair

Reduced testi size

Jaundice

Ascites

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13
Q

What is the definitive diagnostic procedure for cirrhosis?

A

Liver biopsy

  • fibrosis
  • nodular formation
  • loss of normal architecture

Done under US/ CT guidance
*can only be done when INR <1.5

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14
Q

What are the management options for hepatorenal syndrome?

A

Albumin
Terlipressin
TIPSS

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15
Q

What management can be implemented for encephalopathy?

A

Lactulose

Rifaximin - antibiotic that reduces gut flora that produce ammonia

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16
Q

What are the causes for acute pancreatitis?

A 
Gall stones 
Ethanol 
Trauma 
Steroids 
Mumps 
Autoimmune 
Scorpion venom 
Hypertriglyceraemia, hypercalamia, hypothermia 
ERCP 
Drugs - azathioprine

GET SMASHED

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17
Q

What is the most common presentation of Crohn’s in children?

A

Abdominal Pain

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18
Q

If a patient has suspected C. Diff infection, what is the most appropriate management?

A

Metronidazole initiated
+
48 hours isolation

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19
Q

What is the definitive diagnosis of C.Diff?

A

Stool analysis for C.diff Toxins

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20
Q

If a person has severe ascites, what is the management and what must be considered when doing so?

A

Large volume paracentesis
- up to 5L

this is to prevent fluid shifts.
if 5L is given then albumin must also be given along side.

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21
Q

What is the criteria for SBP? what other investigations should be done and what is the common pathogens?

A

SAAG <11.1g/L

Bacterial count >250

Cultures should also be done. 
Most common bacteria include: 
E.Coli 
Klebsiella
S. Pneumonia
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22
Q

What is the prophylactic treatment for varices?

A

Beta Blockers

Yearly endoscopic assessment

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23
Q

What cancer is HNPCC also correlated with in females?

A

Endometrial cancer

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24
Q

What is the criteria for severe C.Diff? What is the first line medication for severe?

A 
WWC >15 
Shock 
>50% baseline creatinine 
Fever >38.5 
Radiological findings - colonic diameter

first line medication for C.Diff is Vancomycin

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25
If a patient with Hepatitis B has acute deterioration in their liver functioning and is an IVDU, what should you worry about?
Hepatitis D - super infection. Risk factor being IVDU
26
Before carrying out the urea breath test, what must the patient be free off?
>4 weeks ago last use of antibiotics | >2 weeks ago lasy use of PPIs
27
What are the classic signs of a pharyngeal pouch?
Regurgitation Foul smelling breath dysphagia
28
Which hepatitis viruses are most likely to induce acute hepatitis?
A and B
29
In acute pancreatitis, what symptoms may point towards the underlying etiology?
Hepatitis - alcohol Swollen parotid gland - mumps Xanthoma - hypercholesterolemia
30
In acute pancreatitis what investigations should be done?
Amylase - 3x normal ABG - assess oxygenation and acid balance LFTs - obstruction the cause CT - this is best way to establish the severity US - if gallstones ERCP - if LFTs worsen and gallstones are suggested - done after acute phase CRP - higher = more severe
31
What are the early complications of acute pancreatitis?
Shock ARDS - pleural effusions can develop DIC AKI Hypoglycaemia Hypocalcaemia
32
What are some late complications of pancreatitis?
Pancreatic necrosis - antibiotics - necrosectomy Pseudocyst - 4 weeks later - remaining fever - amylase remains high Bleeding - erosion into the splenic artery
33
What are the causes of gastritis?
H. Pylori NSAIDs Autoimmune destruction Pyloric obstruction
34
Where are gastric ulcers most likely to be situated?
First part of duodenum Lesser curvature of the stomach
35
WHat drugs are associated with Gastritis and peptic ulcers?
NSAIDS SSRIs Bisphosphonates - need to be taken standing up for 30mins Steroids
36
What investigations should be done into suspected gastric carcinoma?
Endoscopy with biopsy Endoscopic ultrasound CT for staging
37
If there is an upper G.I bleed, where is it anatomically?
Above the ligament of Treitz / suspensory ligament of the duodenum
38
What are the differentials of upper G.I bleed?
``` Peptic ulcers Esophagitis Oesphageal varices Mallory Weiss tears AVM gastric Carcinomas ```
39
What does coffee ground blood suggest?
Suggest the blood has been oxidised by the acid in the stomach and that it has either: - stopped or - was a small amount
40
What is the name for PR bleeding?
Haematochezia
41
What key blood tests should be done in gastro- bleeding?
FBC - Hb (may not have changed in acute) U&Es - urea and kidney function LFTs - to assess if any risk from varices Group and save/ cross match if serious Coagulation studies - to rule out bleeding disorders
42
What are the endoscopic options for stopping peptic ulcer bleeding?
Thermocoagulation therapy Clipping Adrenaline - induce vasospasm
43
What are the endoscopic options for stopping variceal bleeding?
Endoscopic Oesphageal banding Endoscopic sclerotherapy Sengstaken Blakemore tube
44
What are the treatment options for diverticulosis?
Colonoscopy thermocoagulation therapy Injection of epinephrine Vessel embolism If not able to control bleeding then: - segmental colectomy
45
What is gold standard for assessing dysphagia in the setting of suspected esophageal cancer?
endoscopy
46
What drug should be used in acute alcohol withdrawal to stop hallucinations and induce calmness?
Chlordiazepoxide
47
What type of IBD causes granulomas?
Crohn's
48
What is the management for achalasia?
Calcium channel blockers Intersphincteric Botulism injection Balloon dilation Heller's myotomy
49
Which drugs are likely to cause pancreatitis?
azathioprine mesalazine sodium valproate Steroids
50
What viral hepatitis is most likely in the UK to cause liver cancer?
Hepatitis C in the UK Hepatitis B in the world
51
What other cancer are patients with HNPCC with MSH2 gene likely to get?
Endometrial Pancreatic
52
If gallstones are discovered incidentally, what should their management be?
Reassurance. | Gallstones are common and if asymptomatic shouldn't be treated
53
What are the autoantibodies that can be tested for in coeliac disease?
IgA antibodies against Endomysium / Anti - EMA IgA against tTG / Anti - TTG Deamidated gliadin peptide antibodies / Anti - DGPs
54
If a patient is IgA deficient and there is suspicion of celiac disease, what additional tests should be done?
deamidated gliadin peptide antibodies - Anti DGPs + Biopsy
55
What two other physical signs may be seen in acute appendicitis other than McBurney's point?
Rovsing's sign Psoas Sign
56
If there is a reduced ceruloplasmin and reduced serum copper what is the likely diagnosis?
Wilson's disease *the low serum copper is counterintuitive but occurs since 95% of it is carried by the ceruloplasmin
57
What is first line medication for moderate UC flare?
Moderate flare: 4-6 stools, with varying blood and no systemic symptoms. Topical mesalazine
58
If someone has Gilbert's syndrome would you expect to see any bilirubin in the urine? and why?
No. Because it is not conjugated thus is not water soluble.
59
Following an episode of SBP what medication should be they be started on?
Ciprofloxacin Prophylactic antibiotic
60
What are the red flags for referral with a patient presenting with dyspepsia?
Dysphagia Upper abdominal mass >55years + weight loss and: - treatment resistant dyspepsia - anaemia - N&V
61
How is autoimmune liver disease managed and what are the autoantibodies associated?
Type 1: - Anti Smooth muscle - Anti - soluble liver antigen - ANA Type 2: - Anti liver/ kidney microsomal type 1 antibodies (associated with type 2) Managed: - steroids - azathioprine - liver transplant
62
What would be two diagnostic features of haemochromatosis?
Increased ferritin Increased Transferrin saturation (>50%) Reduced TIBC/ transferrin
63
What scoring system is used for Liver cirrhosis?
Child Pugh Classification
64
What is the prophylactic management of variceal ulcers?
Propranolol - if not previously bleed Prevention of recurrent rebleeding: - Propranolol - 2 weekly banding to abolish the variceal
65
What are the biggest risk factors determining an anastomotic leak?
Blood supply Tension Seal of the stitches
66
What are some causes of intra abdominal sepsis?
Gallbladder gangrene Ascending cholangitis Cholecystitis Pelvic abscess Appendicitis mass *all should get a CT
67
What are the two screening methods being used for colorectal carcinoma?
qFIT - 50 to 74 years old (England 60-74) - every 2 years Flexible sigmoidoscopy - one off >55 year old
68
What is the preferred initial triple therapy?
``` PPI + Amoxicillin + Clarithromycin ```
69
What is the best management for NAFLD?
Weight loss
70
In the setting on acute bleeding - when should PPIs be given?
After the endoscopy - otherwise they may hide the source of the bleeding
71
Where is the most likely place for ischemic colitis to affect?
Splenic flexure
72
What can cause a falsely elevated ca125?
Ascites - virtually all patients with ascites will have elevated CA125
73
What is the treatment of Hep B?
Refer to gastro Contact public health Fibroscan Anti-virals 1st Line: Interferon Alpha 2nd line: Nucleus reverse transcriptase Inhibitors - tenofivir - entacavir
74
What are the symptoms of carcinoid syndrome and what has to occur first in order for there to be these symptoms?
Facial flushing Diarrhoea Itching Hear dysfunction Asthma - it must have metastasized to the liver
75
How is carcinoid syndrome investigated for?
24 hour 5HIAA urine test - 5 hydroxyindoleacetic acid CT Chest/ Abdo/ Pelvis Octreoscan Echocardiogram - to establish for carcinoid disease of heart
76
How is carcinoid syndrome treated?
Octreotide - blocks tumours mediators Loperamide - for diarrhea Surgical resection - endoscopically - radioablation - segmental removal * depends on size * tumours are bright yellow
77
What is carcinoid crisis?
Where the tumour outgrows its blood flow or is handled too much during surgery. causes: - life threatening vasodilation - hypotension - bronchoconstriction Octreotide and supportive measures are needed
78
What are the features of malabsorption and name some common causes:
``` Diarrhea weight loss Pale Lethargy Bloating ``` ``` Signs: anaemia Bleeding disorders oedema - albumin loss Metabolic bone disease ``` Causes: - Coeliac disease - Cystic fibrosis - Chronic pancreatitis - Crohn's disease - Bacterial overgrowth - giardiasis infection
79
What investigations should be done into malabsorption?
Bloods: - FBC - Anaemia screen - INR - Celiac serology Orifices: - Sudan stain for fat globules - stool microscopy Endoscopy + Biopsy Breath hydrogen analysis - bacterial overgrowth
80
What are some of the complications of celiac disease?
Anaemia Osteoporosis Dermatitis herpetiformis Enteropathy related T cell lymphoma B12 deficiency - neurological abnormalities Pneumococcal disease (Functional Hyposplenism)
81
What can be a mimic of IBS which one needs to be aware of?
Ovarian cancer Endometriosis
82
What are the symptoms of IBS?
``` Abdominal discomfort Relieved by defecating Diarrhea/ constipation Mucus PR worsen symptoms after eating ```
83
What symptoms of IBS would make you think of other diseases?
``` >60 years old Anorexia loss of weight waking up at night mouth ulcers Abnormal CRP ESR ```
84
What investigations should be done into diarrhoea?
Bloods: - FBC - Anaemia Screen - ESR - CRP - U&Es - K? - Celiac serology Orifices: - Microscopy, cultures and sensitivities - C. DIff toxin - if suspicion - faecal elastase - Sudan fat stain Endoscopy/ colonoscopy if suspicion of underlying disease. Video capsules.
85
How is Haemochromatosis diagnosed? and what are some complications?
Liver biopsy - Pearl stain Genetic testing Liver failure Joint damage Diabetes Cardiomegaly
86
What does C. Diff antigen show? and how should it be treated?
Show previous exposure. does not suggest infection. No treatment is required.
87
What investigation features would you expect to seein NAFLD?
Increased ALT>AST Fibroscan Echogenicity
88
What is the genetic susceptibility into celiac disease?
HLA DQ2/ DQ8
89
What would be likely on the blood film of someone with celiac disease?
Howell jolly bodies Target cells * hyposplenism * Iron deficiency
90
What investigations should be done into coeliac disease?
Bloods: - FBC - Haematinics - LFTs - low albumin - INR - Low - lack of vitamin K - Bone profile Orifices: - Stool cysts - gardia X-rays: - Endoscopy + biopsy Special tests: - IgA - Anti tTG - Anti Endomysial - Anti - deamidated gliadin peptide
91
What foods are okay to eat in coeliac disease?
Maize Soya Rice
92
What is the mediators of Crohn's and Ulcerative colitis?
UC: TH2 Crohns: TH17
93
What investigations do you want into ascites? and what are the causes?
Cell count Gram staining Biochemistry - albumin level. proteins Cytology - assess for malignancy Amylase High SAAG causes: - Cardiac failure - cirrhosis - Budd Chiari Low SAAG: - Cancer - pancreatitis - TB infection - SBP - Serositis
94
If a person develops SBP what is there now an indication for?
Referral to Liver transplant clinic
95
What is the neuropsychiatric condition that can develop in cirrhosis and what are some signs of it?
Hepatic encephalopathy/ Portosystemic encephalopathy - Reversal of sleep wake cycle - Personality change - Reduced intellect - Asterixis - Hyperreflexia - Up going planters - Foetor hepaticus
96
What additional tests can be done into Hepatic encephalopathy?
EEG Visual evoked responses Arterial Blood Ammonia
97
How do you assess for budd chiari syndrome?
Ultrasound with doppler flow
98
What are the grading scores for encephalopathy?
I - altered mood/ sleep disturbance II - Drowsiness/ confusion / Asterixis III - Incoherent / Clonus/ Nystagmus IV: Coma
99
What are carcinoid tumours?
Neural Crest tumours that appear predominantly in the appendix. - often cause obstruction or acute appendicitis Only cause carcinoid syndrome when metastasized to the liver and release serotonin

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