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Gastroenterology Flashcards

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1
Q

What are the causes of hepatitis? (6)

A 
Hereditary - Wilson's, haemochromatosis, alpha anti-1-deficiency
Viral hepatitis
Autoimmune hepatitis
NAFLD
Drug-induced e.g. paracetamol overdose
Alcoholic hepatitis
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2
Q

Which of the viral hepatitis’ can cause cholestasis?

A

Hepatitis A

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3
Q

Which Ig indicates a recent or current infection of hepatitis B?

A

IgM

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4
Q

Which two blood tests are initially used to diagnose hepatitis B?

A

HBsAg and anti-HBc

Both of these suggest a current infection

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5
Q

Which antibody indicates immunity to hepatitis B?

A

anti-HBsAg

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6
Q

Which marker indicates hepatitis B is highly infective?

A

HBeAg

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7
Q

What do these results suggest?

———HBsAg + – – + +
——Anti-HBs – + + – –
——–HBeAg + – – +/– –
——Anti-HBe – +/– – +/– +
——Anti-HBc + + – + +
IgM anti-HBc + – – – –
—–HBV DNA + – – + + (low)
————-ALT H N N H N

A
  1. Acute infection
  2. Previous infection and immunity
  3. Vaccination
  4. Chronic infection - active
  5. Chronic infeciton - not active
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8
Q

Which hepatitis marker suggest high risk of chronicity and hepatocellular carcinoma?

A

HBV DNA

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9
Q

What type of medication is used to treat hepatitic C?

A

Direct acting antivirals

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10
Q

What are the 3 most common causes of cirrhosis in the UK?

A

Alcohol
Chronic hepatitis B and C
NAFLD

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11
Q

In which scenario can ELF be used to screen for cirrhosis?

A

NAFLD

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12
Q

What test is used first-line to detect hepatocellular carcinoma in those with cirrhosis?
How often should the test be done?

A

USS

Every 6 months

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13
Q

What is the MELD score?
How often do NICE recommend doing it?
What is in the MELD score? (5)

A

3 month mortality for those with compensated cirrhosis
Every 6 months
Bilirubin, INR, (i.e. liver) creatinine, sodium, whether they are on dialysis (i.e. kidney)

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14
Q

What are the complications of cirrhosis? (6)

A 
Malnutrition
Portal hypertension and variceal bleeding
Ascites and SBP
Hepatic encephalopathy
Hepato-renal syndrome 
Hepatocellularcarcinoma
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15
Q

What medication is used for stable varices?

A

Propranolol

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16
Q

What options are there for varices via endoscope?

A

Elastic band ligation

Injecting sclerosant

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17
Q

What is the treatment for bleeding varices? (4)

A

Terlipressin
Correct coagulation e.g. vitamin K, FFP
Prophylactic antibiotics
Urgent endoscopy

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18
Q

What is the management for ascites? (4)

A

Ascitic tap and drainage
Prophylactic antibiotics (e.g. ciprofloxacin)
Aldosterone antagonist
Low sodium diet

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19
Q

What is the antibiotic of choice for spontaneous bacterial peritonitis?

A

IV cephalosporin e.g. cefotaxime

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20
Q

Why does hepato-renal syndrome occur?

A

Reduction in circulating blood volume due to portal hypertension means blood flow to kidneys reduced
RAAS activated which vauses vasoconstriction of renal blood vessels

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21
Q

How do you manage hepatic encephalopathy? (3)

Study These Flashcards
A

Lactulose - helps to remove ammonia
Antibiotics e.g. rifaximin
Nutritional support

22
Q

Which value of SAAG suggests a transudate and exudate?

Study These Flashcards
A

> 11g/L - transudate i.e. portal hypertension

<11g/l - exudate i.e. malignancy, nephrotic syndrome, infection

23
Q 
What occurs at these times after withdrawing from alcohol?
6-12h:
12-24h:
24-48h:
24-72h:
Study These Flashcards
A
  1. Nausea, sweating, tremors
  2. Hallucinations
  3. Seizures
  4. Delirium tremens
24
Q

Which medication is commonly used to combat the effects of alcohol withdrawal?

Study These Flashcards
A

Chlordiazepoxide (Librium)

25
What are the complications of alcohol abuse? (6)
``` Alcoholic liver disease Cirrhosis Alcohol dependence and withdrawal Wernicke-Korsakoff syndrome Alcohol cardiomyopathy Pancreatitis ```
26
In what scenario is coeliac disease tested for, even if there are no symptoms?
New diagnosis fo type 1 diabetes
27
What signs and symptoms would you expect in someone with coeliac disease?
Diarrhoea, weight loss, fatigue, anaemia (e.g. iron, B12, folate), mouth ulcers
28
What special rash do people with coeliac get and where does it tend to present?
Dermatitis herpetiformis | Typically occurs on abdomen
29
What are the rare neurological signs of coeliac? (3)
Peripheral neuropathy Cerebellar ataxia Epilepsy
30
What are the complications of untreated coeliac disease? (6)
``` Nutritional deficiencies Anaemia Hypospenism Osteoporosis Malignancy (e.g. lymphoma) Refractory disease ```
31
What are the red flags for dyspepsia?
``` Anorexia Loss of weight Anaemia Recent onset/progressive Melaena or other GI bleed Swallowing difficulty ```
32
Which scoring system can you use if you suspect an upper GI bleed? What score indicates high risk?
Glasgow-Blatchford - a score of more than 0 is high risk
33
Which score can you use to assess the risk of re-bleeding after treating an upper GI bleed?
Rockall score
34
What is the management for an upper GI bleed?
ABCDE assessment Bloods Access i.e. 2 large bore cannulas Transfuse Endoscopy - urgent if unstable, otherwise within 24h Drugs - stop any NSAIDs or anticoagulants
35
What bloods should you order in an upper GI bleed? (6)
FBC, U&Es (urea), LFTs, coagulation screen, INR, crossmatch
36
What special tests should you order in suspected dyspepsia or ulcer disease? (2)
H pylori | FIT
37
What type of bacteria is H pylori?
Gram negative bacilli
38
What is triple therapy for H pylori?
PPI, amoxicillin and either clarithromycin or metronidazole
39
What test is used to screen for Zollinger-Ellison disease?
Fasting serum gastrin
40
What imaging is available to investigate dysphagia? (4)
Endoscopy Barium swallow Videofluroscopy (difficulty swallowing vs food sticking) Oesophageal motility
41
Which medications may precipitate GORD?
``` CCBs Bisphosphoates NSAIDs Anticholinergics TCAs ```
42
What lifestyle advice can you give for GORD? (7)
``` Smaller, more frequent meals Avoid caffeinated drinks Weight loss Raise bed using blocks Stay upright after meals Avoid large meals before bedtime Avoid smoking ```
43
What are the features of ulcerative colitis?
``` Continuous inflammation Limited to colon and rectum Only superficial mucosa Smoking is protective Use aminosalicylates first line Primary sclerosing cholangitis ```
44
What are the features of Crohn's disease?
``` No blood or mucus Entire GI tract Skip lesions Transmural Smoking worsens symptoms ```
45
What systemic features are used in the scoring of severity for UC? (4)
Raised ESR (>30) Heart rate (>90) Anaemia Fever
46
How many stools per day are in the following severity categories for UC? Mild Moderate Severe
1. <4 2. 4-6 3. >6
47
What are the 3 options for inducing remission in UC?
Aminosalicylates Steroids Calcineurin inhibitors e.g. tacrolimus
48
What are the 3 options for maintaining remission in UC?
Aminosalicylates Immunosuppressants e.g. azathioprine BIologics
49
What are the 3 options for inducing remission in Crohn's?
Steroids Immunosupperssants Biologics
50
What are the 3 options for maintaining remission in Crohn's?
Azathioprine or mercaptopurine Methotrexate Biologics
51
What lifestyle changes can help the following symptoms in IBS? 1. Bloating 2. Diarrhoea 3. Constipation
1. Oats and linseeds, avoid beans and pulses 2. Reduce alcohol and fizzy drinks and sorbitol 3. Limit high fibre foods
52
What pharmacological options are there for IBS? Bloating Diarrhoea Constipation - what can be used second line? Other
Bloating - buscopan, colpermin Diarrhoea - loperamide Constipation - laxatives (apart from lactulose); linaclotide can be used second line Amitryptiline, SSRIs

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