Gastroenterology Pathologies (Remember LFTs, Us and Es) Flashcards
Achalasia (definition, signs and symptoms, tests and management)
Definition: failure of lower oesophageal sphincter to relax
Signs and symptoms: dysphagia, regurgitation, retrosternal chest pain/heartburn, weight loss
Tests: endoscopy and barium swallow
Management: botulinum toxin injections, surgery
Ascending cholangitis (definition, signs, causes, tests and management)
Definition: bacterial infection of biliary tree
Signs: right upper quadrant pain, fever, jaundice, (hypotension, tachycardia and confusion when severe)
Causes: biliary calculi, stricture of biliary tree, malignancy
Tests: FBC, CRP and LFTs (raised), MRCP imaging is best but can use US
Treatment: ERCP, supportive care (fluids, drainage of biliary tree etc)
Autoimmune hepatitis (signs and symptoms, tests, treatment)
Signs and symptoms: jaundice, fatigue, loss of appetite, hepatomegaly, splenomegaly, abdo pain
Tests: LFTs (raised ALT and bilirubin, normal/slightly raised ALP)
Treatment: steroids (predisone) (sometimes azathioprine is added - immunosuppressant)
Barrett’s Oesophagus (definition, complications, treatment)
Definition: when long standing gastro-oesophageal disease results in changes to the distal oesophagus from squamous epithelium to metaplastic columnar epithelium
Complications: risk of progression to oesophageal adenocarcinoma
Treatment: high dose PPI with endoscopic surveillance, if severe endoscopic resection, surgery
Pancreatitis (signs, tests and treatment)
Signs: epigastric pain which can be relieved by sitting forward, can have steatorrhoea, nausea, vomiting
Tests: abdominal x-ray, CT (look for pancreatic calcification)
Management: analgesia, good diet, stop drinking, pancreatic enzyme replacement
Coeliac disease (definition, signs and symptoms, tests, management)
Definition: T-cell mediated autoimmune disease
Signs and symptoms, abdo pain, distension, nausea and vomiting, diarrhoea, steatorrhoea, fatigue, weight loss
Tests: stool culture (to exclude infection), OGD and duodenal/jejunal biopsy (before and after gluten withdrawal), FBC, Us and Es, LFT (albumin may be low due to malabsorption), iron, B12, folate
Treatment: life-long gluten free diet
Dyspepsia/indigestion = peptic ulcer disease (signs and symptoms, risk factors, management)
Signs and symptoms: fullness, bloating, nausea and intolerance of fatty foods
- duodenal ulcers (90% H.Pylori) = relieved by food and milk
- gastric ulcers = worse upon eating (higher risk of malignancy)
Risk factors: NSAIDs, steroids, H. Pylori infection
Treatment: lifestyle changes, antacids, stool antigen test for H.Pylori (if positive give PPI, clarithromycin and amoxicillan, if negative give PPI (omeprazole)/H2 receptor antagonist (cimetidine))
GORD (symptoms, risk factors and treatment)
Symptoms: dyspepsia/heartburn, epigastric/chest pain, nausea, bloating, belching
Risk factors: obesity, alcohol and smoking, certain foods (eg. coffee, spicy foods etc.)
Treatment: lifestyle changes (weight loss, diet changes, elevate head in bed, avoid eating late at night), PPI (omeprazole), antacids for symptoms
How do you test for H.Pylori infection?
Do an endoscopy and get a gastric biopsy for a rapid urease test.
What are the tests for Hep A, B and C?
Hep A = Hep A IgM
Hep B = HbsAg/HBeAg/anti HBc IgM (acute), anti HBc IgG (chronic)
Hep C = Hep C RNA
List the treatments for Hep A, B and C
Hep A = no treatment
Hep B = suppress viral
replication (entecavir, tenofovir), activate genes in immunity (pegylated interferon alpha)
Hep C = direct antivirals, paritaprevir (protease inhibitor), ledipasvir (Ns5A inhibitor), sofosbuvir (RNA polymerase inhibitor)
What are the types of hiatus hernias?
sliding hiatal hernia = when the gastro-oesophageal junction slides up into the chest (can cause acid reflux)
rolling hiatal hernia = gastro-oesophageal junction still in abdomen but part of the stomach protrudes into the chest (urgent treatment to prevent volvulus)
What are the signs, tests and treatment of a hiatus hernia?
Signs: heartburn, dysphagia, regurgitation, odynophagia, SOB, chronic cough and chest pain
Tests: barium swallow
Management: lifestyle changes (elevate head of bed, avoid large meals before bed, avoid alcohol and smoking, avoid caffeine and chocolate)
Medical management: PPI and assess response
What is the diagnostic criteria for IBS and what tests would you run to exclude other disease?
Diagnostic criteria: at least one day a week in last 3 months with 2 or more of:
- related to defecation
- associated with change in frequency of stool
- associated with change in form/appearance of stool
Tests: faecal calprotectin, FBC and ESR/CRP (all not raised in IBS)
What urinalysis results would you expect in jaundice?
Prehepatic: bilirubin absent, urobilinogen increased
Hepatic: bilirubin present, urobilinogen increased
Post-hepatic: bilirubin present, urobilinogen decreased/absent
