Coeliac gene
HLA-DQ2
Coeliac diagnose
Tissue transglutaminase (TTG) antibody and IgA Endoscopic biopsy
Coeliac biopsy
Crypt hypertrophy
Villous atrophy
Treatment constipation
1) Lifestyle
2) Bulk forming - ispaghula
3) Osmotic - macrogol or lactulose
4) Stimulant - senna
Diagnose GORD
Clinical, endoscopy if red flag or failure treatment
If endoscopy -ve then 24h pH monitoring
Treatment GORD
1) Lifestyle
2) PPI one month
3) Lower dose if response, double if not
4) Surgery
Diagnose H Pylori
Urea breath test - 4w after antibiotic and 2w after PPI
Treatment H Pylori
7 days triple therapy:
- PPI + amoxicillin + (metronidazole or clarithromycin)
Upper GI bleeding scoring systems
Glasgow Blatchford - risk of having
Rochall - risk after endoscopy
Treatment oesophageal varices
1) Terlipressin and broad antibiotics
2) Vessel ligation
Identify IBS
6m:
- Abdominal pain
- Bloating
- Change bowel habit
Treatment IBS
Pain - hyoscine butylbromide
Constipation - laxative but avoid lactulose
Diarrhoea - lopameride
CBT if failure
Identify crohns
No blood
Entire tract
Skip lesions
Full thickness
Identify UC
Blood
Continues inflammation
Superficial mucosa
Crohns histology
Goblet cells
Granuloma
Crohns induce remission
1) Glucocorticoid
2) Consider adding immunosuppresant
Crohns maintain remission
1) Azithrioprine or mercaptopurine
2) Methotrexate
Diagnose crohns fistula
MRI
Treat crohns fistula
Metronodazole
Draining seaton if complex
UC flares classification
Mild - <4 stools
Moderate - 4 to 6 stools or mimimal systemic
Severe - >6 or systemic disturbance
Diagnosis UC
Colonoscopy and biopsy
IC endoscopy findings
Pseudopolyps
Crypt abscesses
UC induce remission in proctatitis
1) Topical aminosalicylate (eg mesalazine)
2) Oral mesolazine
UC induce remission in left sided
1) Topical mesalazine
2) Oral mesolazine or corticosteroid
UC induce remission in extensive disease
1) Topical mesalazine and oral
2) Stop topical and add oral corticosteroid
Induce remission in severe UC
1) IV steroids
2) IV ciclosporin
Maintain remission up to moderate UC
Proctatitis - topical mesalazine or oral
Left sided and extensive - oral mesalazine
Maintain remission in severe or 2 exacerbations a year UC
1) Oral azathioprine or mercaptopurine
Treatment peptic ulcer disease
Pylori -ve - PPI until healed
Pylori +ve - eradicaction
Diagnose peptic ulcer perforation
Clinical, but get CXR
Treatment peptic ulcer active bleeding
IV PPI
Endoscopic intervention, surgery if fails
Artery for peptic ulcer bleeding
Gastroduodenal artery
Identify refeeding syndrome
Low everything - phosphate, K, Mg
Screening malnutrition
MUST
Definition malnutrition
> 10% weight loss in 3-6m
or BMI <18.5
Identify plummer vinson syndrome
Tirad:
- Dysphagia secondary to webs
- Glossitis
- Iron deficiency anemia
Treatment plummer vinson syndrome
Iron and dilation webs
Identify mallory-weiss syndrome
Severe vomiting in alcoholics cause painful laceration
Identify Boerheave syndrome
Severe vomiting causing oesophageal rupture
Identify peptic stricture
Longer history dysphagia not progressive
Symptoms GORD
Identify achalasia
Dyphagia both solids and liquids
Regurgitation food
Treatment achalasia
1) Pneumatic balloon dilation
2) Surgery
Diagnose pharangeal pouch
Barium swallow
Vit A deficiency
Night blindness
Vit B1 deficiency
Wernicke-Karottkoff syndrome
Vit C deficiency
Scurvy - bleeding and poor wound healing
Vit B3 deficiency
Pallagra - dermatitis and dementia
Vit B6 deficiency
Peripheral neuropathy and sideroblastic anaemia
Vit B12 deficiency
Degermation cord
Treatment hep B
1) Pegylated interferon alpha
Hepatitis vaccines
A and B
Hepatitis foecal oral
A and E
Hepatitis needs B
D
Hepatitis greatest risk cancer
Hep C
Hepatitis worse in pregnancy
Hep E
Treatment autoimmune hepatitis
1) Steroids
2) Liver transplant
Identify autoimmune hepatitis
Anti-nuclear antibody
Identify alcoholic liver disease
AST:AKT 2:1
Increased gamma GT
U and E derranged in hepatorenal syndrome
Diagnose alcoholic liver disease
US - increased echogenicity
CT and MRI
Treatment alcoholic liver disease acute
1) Glucocorticoids
Alcohol screening
CAGE
AUDIT
Calculate units
(ml x ABV) / 1000
Ascites cause if SAAG > 11
Portal hypertension:
- liver
- cardiac
- Budd Chari
Ascites cause if SAAG < 11
Hypoalbuminaemia - nephrotic syndrome
Malignancy
Infection
Treatment ascites
1) Spironolactone and consider drainage
Prophylactic antibiotics in ascites
Oral ciprofloxacin
Measure severity liver cirrhosis
Child-Pugh score
Treatment liver cirrhosis
1) Lifestyle and US every 6m
2) Consider transplant
Liver cirrhosis US
Nodularity
Corkscrew appearance arteries
Treatment hepatic encephaltis
1) Lactulose and rifaximin
Identify non-alcoholic fatty liver disease
ALT>AST
Identify acute liver failure
Decreased albumin and prolonged prothrombin time
Diagnose lower GI bleeding
Unstable - CT angiogram
Stable - colonscopy
Diagnose intestinal ischaemia
CT scan
Diagnosis SBP
Paracentesis - neutrophil count >250
Most common cause SBP
E coli
Treatment SBP
IV cefotaxime
Identify primary biliary colangitis (AKA cirrhosis)
Anti-mitochondrial antibody (AMA) positive
Increased IgM
Diagnose primayr biliary colangitis
MRCP and immunology
Treatment primary biliary colangitis
1) Ursodeoxycholic acid
2) Liver transplant
Identify primary sclerosing colangitis
Associated UC
Cholestasis
Maybe pANCA positive
Diagnose primary sclerosing cholanigits
ERCP or MRCP
Diagnose acute cholecystitis
1) US
Treatment acute cholecystitis
IV antibiotics and laparoscopic cholecystectomy
Identify ascending cholangitis
Charcots triad:
- RUQ pain
- fever
- jaundice
Renolds pentad:
- hypotension
- confusion
Diagnose ascending cholanigtis
US
Treatment ascending cholanitis
IV antibiotics and ERCP to relive obstruction
Identify biliary colic
Colicky abdominal pain worse after fatty food
No fever
Diagnose biliary colic
US
Treatment biliary colic
Elective laparoscopic cholecystectomy
Diagnose hiatus hernia
bariums swallow
Treatment hiatus hernia
1) Conservative
2) PPI
3) Surgery
Acute pancreatitis signs
Cullens - periumbilical discolourisation
Grey turner - flank discolourisation
Diagnose acute pancreatitis
Amylase/lipase and symptoms, or imaging with CT
Scoring systems acute pancreattiis
Randon
Glasgow
APACHE II
Treatment acute pancreatitis
IV opiods and aggressive fluid
Surgery to rleieve obstruction or necrosis
Oestophageal cancer histology
Upper 2/3 - SCC
Lower 1/3 - adenocarcinoma
Oesophageal cancer smoking
SCC
Treatment Barrets
Endoscopic surveillance and biopsy every 3-5y
PPI
Pancreatic cancer histology
Adenocarcinoma
Identify pancreatic cancer
Painless jaundice
Cholestatic LFTs
Pale stools
Diagnose pancreatic cancer
CT scan - double duct sign
Most common cause small bowel obstruction
Adhesions
Diagnose small bowel obstruction
1) Xray first
2) CT definitive
Diagnose chronic pancreatitis
CT - calcifications
Diagnose gastric cancer
Endoscopy and biopsy - signet ring cells
CT for staging
Diagnose appendicitis
Men - clinical
Female - US
Treatment appendicitis
Appendicectomy and IV antibiotics
Colorectal cancer screning
Every 2y to people aged 50-74y:
- Foecal immunochemical test
Colonoscopy if abnormal
Diagnose colorectal cancer
Colonoscopy and biopsy, sigmoidoscopy if bleeding
CT CAP staging
What is diverticular disease
Herniation colonic mucosa through muscle wall
Diverticular disease diagnosis
Clinic - colonoscopy
Acute - identified on xray for perforation
Diverticular classification
Hickley
Diverticular treatment
Increase fibre
Mild - antibiotics
Abscess - drainage
Recurrent - consider surgery
What is diverticulitis
Infection of diverticulum
Treatment diverticulitis
Mild - antibiotics
Severe - IV antibiotics
Identify haemorrhoids
Painless bleeding
Pruritis
Treatment haemorrhoids
1) Increase fibre and fluid
2) Rubber band ligation
3) Surgery
Sigmoid volvulus identify
Most common
Coffee bean sign
Coecal volvulus identify
Looks like foetus
Volvulus diagnosis
Xray
Volvulus treatment
Sigmoid - right sigmoidoscopy with rectal tube
Caecal - right hemicolectomy
Anal cancer histology
SCC
Anal fissure treatment
1) bulk forming laxative and lubricants
2) Topical GTN
3) Surgery
Diagnose necrotising enterocolitis
Neonate
AXR - dilated bowel loops, intramural gas
Inguinal hernia location and treatment
Superior and medial to pubic tubercle
Surgery
Femoral hernia location and treatment
Inferior and lateral to pubic tubercle
Surgery
Identify alcoholic ketoacidosis
Metabolic acidosis increase anion gap
Increased ketones
Normal glucose
Treatment alcoholic ketoacidosis
Saline infusion and thiamine
Identify Budd Chairi syndrome
AKA hepatic vein thrombosis
Triad:
- abdominal pain sudden and severe
- ascites
- tender hepatomegaly
Diagnose Budd chari
US
Blood film pernicious anaemia
Hypersegmented polymorph
Treatment perncious anaemia
B12 replacement then folic acid
Variceal haemorrhage treatment
1) Endoscopy and band ligation
2) Sengstakan blackmore tube
3) TIPS
Prevention variceal haemorrhage
Propranolol
Treatment Wilsons
Penicillamine
Diagnose Wilsons
Decreased copper
Diagnosis Borheaves syndrome
CT contrast swallow
Oesophageal cancer barium sign
“Apple core”
Carcinoid syndrome treatment
Octreotide
Cause of pigmented gallstones
Sickle cell disease
Colorectal cancer histology
Adenocarcinoma
Incercerated hernia
Unable to be reduced
Body area for burns
Wallace rules of 9
Lund and Browder chart
Classification burns
Superficial - red and painful
Partial thickness (superficial dermal) - painful and blisters
Partial thickness (deep dermal) - white, reduced sensation
Full thickness - white/brown/black, no blisters no pain
Burn when to refer
All deep dermal and full thicken
Superficial if >3% body
Inhalation injnury
Parkland formula for IV fluid
4 x surface area x body weight
50% first 8h
