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Phase 4 > Gastroenterology > Flashcards

Gastroenterology Flashcards

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1
Q

What relieves the pain of pancreatitis?

A

Sitting forward

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2
Q

What signs might you see in acute pancreatitis?

A

Grey Turner’s and Cullen’s sign

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3
Q

What might you see on an AXR in pancreatitis?

A

Sentinel loop

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4
Q

How to assess the severity of pancreatitis

A 
PaO2 <8kPa
Age >55yrs
Neutrophilia (raised)
Calcium (low)
Renal function (raised urea)
Enzymes
Albumin (low)
Sugar (raised)
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5
Q

What can cause chronic pancreatitis?

A

Alcohol
Genetics: CF, Haemochromatosis
Pancreatic duct obstruction: tumours, stones

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6
Q

How to treat chronic pancreatitis?

A

Stop alcohol
Exocrine function - low-fat diet, pancreatic enzyme supplements
Endocrine insufficiency – diet, consider insulin
Surgery – pancreatectomy

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7
Q

What are the main symptoms of gastric Ca?

A

Dyspepsia (if >1m and age >50yr - warrants Ix)
Dysphagia
Vomiting
WL

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8
Q

How to Ix gastric Ca?

A

Gastroscopy + biopsies
Endoscopic USS - to assess depth
CT/MRI - for staging

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9
Q

What are the predisposing factors to colonic Ca?

A

Neoplastic polyps
Genetics (FAP, NHPCC)
Diet low in fibre and high in red/processed meats
Alcohol/smoking

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10
Q

Types of colonic polyps?

A

Inflammatory - UC/Crohns
Hamartomatous - in certain conditions
Neoplastic

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11
Q

What do you stain the liver biopsy with to see haemochromatosis?

A

Perl’s stain

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12
Q

What are the three main complications of liver cirrhosis?

A

Liver failure
Portal hypertension
HCC

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13
Q

What happens in liver failure?

A 
Coagulopathy (loss of F2, 7, 9, 10 causes raised INR)
Encephalopathy (liver flap, confusion)
Hypoalbuminaemia (oedema, leukonychia)
Sepsis (pneumonia, septicaemia)
Spontaneous bacterial peritonitis (SBP)
Hypoglycaemia
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14
Q

What happens in portal hypertension?

A

Ascites
Splenomegaly
Portosystemic shunt including oesophageal varices

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15
Q

How do you treat ascites?

A

Bed rest, fluid restriction, low-salt diet
Spironolactone first, if poor response – add furosemide
Chart daily weight
Therapeutic paracentesis with albumin infusion may be tried

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16
Q

What is the pathophysiology of Wilson’s Disease?

A

The absorption of copper and transportation to the liver is intact. The incorporation into caeruloplasmin in hepatocytes and its excretion into bile are impaired. Therefore copper accumulates in the liver and later in other organs

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17
Q

How to manage Wilson’s disease?

A

Low copper diet
Penicillamine
Screen siblings

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18
Q

What is Hesselbach’s triangle?

A

Medial to the inferior epigastric vessels
Lateral to the rectus abdominus
Superior to the inguinal ligament

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19
Q

Which structure is more susceptible to damage from a hernia repair?

A

The ilioinguinal nerve

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20
Q

What are the S+S of oesophageal achalasia?

A

Dysphagia of BOTH liquids and solids, dyspepsia, gastric reflux

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21
Q

How to Ix oesophageal achalasia?

A

Manometry (to assess tone), Ba swallow, CXR

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22
Q

How to Tx oesophageal achalasia?

A

Intra-sphincteric injection of botox

Heller cardiomyotomy

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23
Q

What symptoms might you see in oesophageal cancer?

A 
Dysphagia
WL
Retrosternal chest pain
Hoarseness
Cough
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24
Q

What causes a corkscrew oesophagus?

A

Oesophageal spasm

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25
What are the symptoms of GORD?
Indigestions - relieved by lying, stooping, straining Belching Acid brash Water brash - mouth filling with saliva
26
What are the extra-oesophageal symptoms of GORD?
Nocturnal asthma Sinusitis/laryngitis Chronic cough
27
What are the complications of GORD?
``` Oesophagitis Ulcers Benign stricture Iron-deficiency Barret's oesphagus + Ca ```
28
What investigations are done for GORD?
Endoscopy if indicated Ba swallow 24hr oesophageal pH monitoring +/- manometry
29
How do you treat a duodenal and gastric ulcer?
Duodenal - 4 weeks PPI | Gastric - 8 weeks PPI
30
How do you treat gastritis?
Quadruple therapy | PPI, amox, clarithro, bismuth subcitrate
31
How do you manage acute oesophageal varices rupture?
Resuscitate with blood if needed Correct clotting abnormalities Endoscopic banding/sclerotherapy Sengsaken-Blakemore tube insertion if bleeding uncontrolled
32
How do you treat diverticulosis and diverticulitis?
Diverticulosis - high fibre diet, anti-spasmodics (mebeverine), resection as a last resort Diverticulitis - abx and bowel rest, may need fluids of drainage
33
Complication of diverticulitis?
Perforation Bleeding Fistulae Abscess
34
What type of gastroenteritis does E.coli give you?
Watery stools Abdo cramps + nausea Common in travellers
35
What type of gastroenteritis does Cholera give you?
Profuse, watery diarrhoea NO BLOOD Sever dehydration -> WL
36
What type of gastroenteritis does Shigella give you?
Bloody diarrhoea | Vomiting + abdo pain
37
What type of gastroenteritis does Staph aureus give you?
Sever vomiting | Short incubation
38
What type of gastroenteritis does Campylobacter give you?
A flu-like prodrome Maybe bloody diarrhoea May mimic appendicitis
39
What type of gastroenteritis does Bacillus cereus give you?
Vomiting within 6hrs | Diarrhoea illness after 6hrs
40
What are the incubation times of pathogens causing gastroenteritis?
* 1-6 hrs: Staphylococcus aureus, Bacillus cereus * 12-48 hrs: Salmonella, Escherichia coli * 48-72 hrs: Shigella, Campylobacter * > 7 days: Giardiasis, Amoebiasis
41
How to treat travellers diarrhoea and invasive diarrhoea?
Invasive - ciprofloxacin | Travellers + non-invasive - clarithromycin
42
Which drugs cause C. diff?
``` 5 Cs... Cephalosporins Co-amoxiclav Ciprofloxacin Clindamycin Carbapenem ```
43
What is the presentation of C. diff?
``` Typically 3-9 days post-abx Diarrhoea – green foul-smelling Abdo pain Raised WCC Toxic megacolon may develop ```
44
How to manage C. diff?
Metronidazole 10-14 days If severe/not responding, give oral vancomycin Stop opioids
45
What can C. diff do to the body?
Produces an exotoxin which causes intestinal damage and can lead to pseudomembranous colitis
46
What is pseudomembranous colitis?
swelling or inflammation of the large intestine
47
What ECG sign will you see in hypercalcaemia?
Short QT interval
48
What ECG sign will you see in hypocalaemia?
Prolonged QT interval
49
What are the two main causes of hypercalaemia?
Malignancy | Hyperparathyroidism
50
Which Ix is CI in suspected diverticular disease?
Barium enema - risk of perforation
51
What are the extra-intestinal signs of Crohns and UC?
``` Arthritis/arthralgia Clubbing Erythema nodosum Crohns: Mouth ulcers/anal tags ```
52
What does leuconychia show?
Hypoalbuminaemia
53
What does koilonychia show?
Iron-def anaemia
54
What does glossitis show?
Vitamin B12 deficiency
55
What are the S+S of pancreatic cancer?
-> Painless jaundice WL, anorexia, epigastric pain Loss of endocrine function - DM Loss of exocrine function - steatorrhoea
56
What is the pathophysiology of appendicitis?
Lumen obstruction -> intra-luminal pressure rise -> venous + lymphatic congestion -> loss of mucosal barrier
57
What signs can you check for in appendicitis?
Psoas, obturator, rovsing's
58
How to Tx appendicitis?
MAC Metronidazole Appendicectomy Cefuroxime
59
What can you see on an X-ray of a volvulus?
Double fluid level and gastric dilatation
60
What drugs are hepatotoxic?
``` PATIOS o Paracetamol o Azathioprine o Tetracycline o Isoniazid o Oestrogen o Salicylates o Methotrexate ```
61
What is the relationship between ALT and AST in NAFLD?
ALT>AST
62
Main imaging Ix for PBC?
USS
63
Main imaging Ix for PSC?
ERCP/MRCP
64
What are the signs of liver failure?
``` Coagulopathy (loss of factors 2, 7, 9, 10) Encephalopathy (liver flap, confusion) Hypoalbuminaemia (oedema, ascites) SBP Hypoglycaemia Sepsis ```
65
What are the symptoms of acute cholecystitis?
``` Continuous RUQ/epigastric pain Signs of infection - fever, local peritonism GB mass +ve murphy's sign NO jaundice ```
66
What are the symptoms of chronic cholecystitis?
Fat intolerance Flatulent dyspepsia Colic
67
What is a porcelain GB?
Calcification brought on by excessive gallstones that need removing
68
How to treat cholangitis?
Fluid resuscitation and abx (cefuroxime and metronidazole) | ERCP after 24-48hrs to relieve obstruction
69
What is the inheritance pattern of Wilson's disease?
AR
70
Whats Ix for Wilson's?
Blood - low serum copper and caeruloplasmin Urine - 24hr urine shows high copper excretion Genetic testing Slit lamp exam Liver biopsy MRI - may show BG degradation
71
What are the causes of cholangiocarcinomas?
Flukes, PSC, biliary cysts, HBV/HCV, DM
72
How to treat alcoholic liver disease?
``` Stop drinking Chlordiazepoxide for detox Vit K for 3 days Thiamine Prednisolone for 5 days based on a Maddrey Score >32 ```
73
What does the Maddrey score look at?
Prothrombin time and bilirubin
74
What are the complications of coeliac disease?
GI T-cell lymphoma Malignancies (small bowel, gastric, oesophageal) Anaemia Osteoporosis
75
What are the complications of liver failure and how to treat?
Cerebral oedema - ITU, 20% IV mannitol Bleeding - vit K, FFP + blood as needed Infection - IV cefriaxone Encephalopathy - avoid sedatives, lactulose and regular enemas to decrease the number of nitrogen-forming gut bacteria
76
What is the pathology in hepatitis?
Infiltration of inflamed cells into surrounding area
77
RF with hep A?
Shellfish Poor sanitation Low income countries
78
Causes of acute and chronic hepatitis?
Acute: viruses, drugs, alcohol, metabolic Chronic: viruses, drugs, alcohol, AI
79
Which symptoms are more common in hep B?
Arthralgia and urticaria
80
What is the iron chelating agent used in haemochromatosis?
Desferoximine

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