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Gastrointestinal Medicine Flashcards

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1
Q

A 19 year-old man presents with diarrhoea and abdominal pain. He is passing motions up to 10 times a day. He has lost 3 kg weight in the last week. What other symptoms would you ask about?

A

Gastroenteritis:
Any fever?
Any nausea+vomiting?
Any recent Abx use?
Any mucus in stools?
Any recent travel/food?

IBD:
Any extra-intestinal manifestations (arthritis, mouth ulcers, skin changes)
Any blood in stools?
Familial history?
WEIGHT LOSS?
Any urgency? (INDICATES LOWER BOWEL INFLAMMATION)
Smoking History?

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2
Q

A 19 year-old man presents with diarrhoea and abdominal pain. He is passing motions up to 10 times a day. He has lost 3 kg weight in the last week.
What are you looking for on examination?

A

On examination:
DRE (Crohn’s bottom)
E.I.M (arthritis, mouth ulcers)
Generalised abdo pain?
Look thin?

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3
Q

What conditions can Faecal Calprotectin be raised?

A

IBD
Infection
Drugs

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4
Q

How can the nutritional status of a patient be assessed in a history and what dietary measures should be used?

A

Food intake charts

Ask the patient:
Appetite?
Diet history?
Weight changes?
Oral intake changes?
BMI?

If concerned:
Refer to dietitian
1) Fortisips and don’t interrupt meal time
2) NG tube
3) PEG/RIG/PEGJ/RIGJ (more long term then NG)
4) Parenteral Nutrition (into veins - if GI tract is blocked or diseased massively)

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5
Q

What’s important when putting a NG tube in?

A

Ensure the tip is in the stomach and not in the lungs

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6
Q

A 19 year-old man presents with diarrhoea and abdominal pain. He is passing motions up to 10 times a day. He has lost 3 kg weight in the last week.
What investigations should you complete?

A

Investigations:
FBC (aneamic, high platelets)
U&Es (AKI/Abnormal electrolytes - GI Losses)
CRP (raised, but can’t exclude IBD if not)

Stool Cultures (exclude infective colitis)
Stool Faecal Calprotectin (raised, but not specific)

Flexible Sigmoidoscopy (most distal but safest with bloody diarrhoea)
Colonoscopy (can visualise large bowel)
Capsule Endoscopy (Views small bowel - Chron’s)

MRI + MRI Rectum (Chron’s small bowel/fistulas + Perianal Disease)

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7
Q

What features might help differentiate between Crohn’s and ulcerative colitis?

A

Chrons:
Familial
Affects anywhere in GI system
Skip Lesions
Transmural Inflammation
Increased Incidence in smokers
Perianal Disease

Ulcerative Colitis:
Not familial
Affects rectum + continues
Continuous pattern
Mucosal/Sub-mucosal Inflammation
Decreased Incidence in smokers
No perianal disease

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8
Q

What are the differential diagnosis of patients with bloody stools?

A

Gastroenteritis
Haemorrhoids
IBD
Diverticulitis
Colorectal Cancer
Recent NSAID use?

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9
Q

Which IBD gives you more weight loss?

A

Chron’s (as small bowels effected)

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10
Q

What’s important to consider with IBD?

A

PRO-THROMBOTIC STATE
(^risk of DVT)

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11
Q

How do you treat acute IBD flare up?

A

IV Hydrocortisone/Methylprednisolone
PO Prednisolone

Mesalazine

LMWH (DVT Risk)

AVOID OPIATES (reduce colonic movement - ^perforation risk)

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12
Q

What is steroid resistant acute IBD and how do you treat it?

A

Acute IBD that hasn’t reacted to steroids within 5 days (1 in 5)

1) Ciclosporin
2) Biologics (Infliximab)
3) Surgical Referral (Colectomy)

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13
Q

What is the long term treatment of IBD?

A

1) Azathioprine (takes 3/12 to act) (FBC-lymphocytopenia + ^MCV)
2) Methotrexate (Chron’s) (Teratogenic + liver/lung fibrosis)
2) Mesalazine (UC)
3) Infliximab

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14
Q

What are the acute + chronic complications of IBD?

A

Acute:
Anaemia
AKI
Toxic Megacolon
DVT/Infection/HAP

Chronic:
Colorectal Cancer (UC > CD)
Primary Sclerosing Colitis (Cirrhosis + Cholangocarcinoma)

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15
Q

What are the complication of the treatment of IBD? (steroids & biologics)

A

Steroids:
Mood change
Hypertension
Infection Risk
HYPERGLYCEMIA

Biologics:
Reduce Sperm count so need counciling

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16
Q

What are the common causes for GI bleeding?

A

Medications (NSAIDs/antiplatelets/anticoagulants)
Peptic Ulcers
Mallory-Weiss Tear (Oesophageal mucosa tear)
GI Cancers
Varices/Chronic Liver Disease

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17
Q

What are important clinical examination findings to document when a patient comes to you with GI bleeding?

A

Is it haematemesis (fresh blood)?
Is it coffee ground vomit (vomiting digested blood)?
Is there Malaena (black, smelly stools indicate an upper GI bleed)
Is there fresh PR bleeding (lower GI bleed, but a haemodynamically unstable patient may have a GI bleed with this)?
Any signs of liver disease peripheral stigmata? (ascites, fluid retention, jaundice, alcohol intake, splenomegaly)?
Weight loss (CANCER)?
Tachy or hypotensive (HAEMODYNAMICALY UNSTABLE/SHOCK)

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18
Q

What investigations would you recommend with someone with a GI bleed?

A

FBC (Low Hb - GI BLEED) (Thrombocytopenia - CLD, will need to give platelets if low anyway)
U&Es (^Urea - GI BLEED)
Clotting factors (abnormal clotting needs to be corrected to control bleeding)
Crossmatch 2 units of blood if become haemodynamically unstable
LFTs (to see for liver disease)
VBG - can see Hb quicker

URGENT ENDOSCOPY!!!

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19
Q

Explain the ROCKALL score

A

Used after endoscopy to estimate the risk of GI rebleeding/mortality

Age
Features of Shock (tachy/hypo)
Co-morbidities (CHF, CKD, IHD, Cancer)
Cause of bleeding (M-W tear or malignancy)
Endoscopic stigmata of recent GI bleeding

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20
Q

What is the management for an upper GI bleed? Pre endoscopy, non-variceal and variceal?

A

Pre-endoscopy:
IV Fluids
Blood transfusion (if unstable)
Platelet transfusion (if thrombocytopenic and active bleeding)
Prothrombin Complex Concentrate if on warfarin
Hold relevant meds

Non-variceal bleeds:
1) Endoscopy w/in 24hrs (clips)
2) Thermal Regulation
3) Refer to GI Surgeons
NO PPI BEFORE ENDOSCOPY

Variceal Bleeds:
1) IV Terlipressin (unless IHD OR peripheral VD)
2) IV Abx
3) Variceal Band Ligation, Linton Tube or TIPSS (transjugular intrahepatic portosystemic shunts) if not controlled

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21
Q

How should you manage GI bleeds with patients taking aspirin/NSAIDs/clopidogrel?

A

Hold the meds while active bleeding.
Once stable, start these again!

Can discuss with patient and MDT (e.g. cardiology w/ aspirin) afterwards

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22
Q

What monitoring would the nurses need to do post GI bleed?

A

Hourly HR,BP,JVP,Urine Output
Check vomit/stools for blood
NBM if high risk of rebleed

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23
Q

What is the long term management post GI-bleed?

A

FBC (Hb, platelets)
PPI (if non-variceal)
Repeat endoscopy if feel will rebleed

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24
Q

What is the pathophysiology of oesophageal varices?

A

Cirrhosis/ALD (usually causes) portal hypertension
Causes distention/dilation of veins at the site of porto-systemic anastomoses (oesophagus,ano-rectal, umbilical)
This veins can rupture causing bleeding

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25
What is the pathophysiology of peptic ulcer disease?
Defect in the gastric or duodenal mucosa that extends through the muscularis mucosa RFs: H-Pylori, NSAIDs
26
What is the Glasgow-Blatchford Bleeding score?
Used to see the likelihood of a GI bleed High Urea Low Hb Low systolic BP Tachycardiac Syncope Malaena Hepatic Disease HF
27
A man presents with jaundice and abdominal bloating. What else do you want to ask him?
Alcohol intake? Diet? Any bleeding? Appear confused (build up of urea)? Any RUQ pain? N+V? Fever? (Hep infection) Paracetamol OD? Seizures/tremors? (Wilson's) Itchiness (bile under skin?)
28
What signs on clinical examination will you look for in liver disease?
Hands: Palmar Erythema Dupuytren's contracture Clubbing Terry's Nails (Leukonychia) Asterixis (liver flap)? Skin: Spider naevi Caput medusae Gynecomastia Ascites Jaundice Oedema Bruising Splenomegaly Hepatomegaly
29
What are some important investigations for decompensated chronic liver disease?
LFTs FBC + CRP U+Es (hepato-renal) Clotting Hep Serology USS liver? DEXA scan (osteoporosis risk) Endoscopy (if suspect varices) Liver CT/MRI?
30
What are the differential diagnoses for individuals presenting with jaundice?
Pre Hepatic: Haemoglobinopathies (sickle cell...) Haemolysis Hepatic: Viral (Hep/EBV/CMV) Hepatic Cancer (painless) Gilbert's Alcoholic Liver Disease/Cirrhosis Wilsons Drug-Induced PBC/PSC Post-Hepatic: Cholangiocarcinoma Biliary Stricture Gallstones Pancreatitis
31
What are the key investigations for patients with jaundice?
LFTs + ALP FBC U+Es (hepato-renal) Clotting ERCP or liver USS Bilirubin in urine Hep Serology Malaria blood film (if indicated)
32
Why might a patient with CLD be malnourished?
Reduced glycogen storage/gluconeogenesis Reduced vitamin storage Early satiety Low bile salts available Reduced protein metabolism
33
How do we manage nutrition in liver disease?
Reduce salt intake High protein intake Vit D supplements (osteoporosis risk) Graze (little and often) Supplemets (if poor appetite) Multivitamins Avoiding Alcohol
34
How should alcohol withdrawal be managed in patients admitted to hospital?
Chlordiazepoxide (benzodiazepine) + vitamin B (IM/IV) + thiamine (oral)
35
What services and treatments are available to help patients with alcohol addiction?
Disulfarim AA Rehabilitation
36
What long-term complications of cirrhosis should be monitored?
Hepato-renal syndrome Splenomegaly Portal HTN/Varcices Ascites/Oedema in legs Ascites > Spontaneous Bacterial Peritonitis Hepatic Encephalopathy (ammonia build up) Malnutrition Hepatocellular carcinoma risk?
37
What is NASH? What are the risk factors and how do we diagnose it?
Non-Alcoholic Steatohepatitis (Hepatomegaly w/ inflammation and fatty liver) Found by USS Increased risk in: - obesity - diabetes - metabolic syndrome (HTN,DMII,Obesity)
38
How do we treat NASH?
Weight loss Mediterranean diet Exercise Smoking cessation/reduce alcohol Control diabetes, BP, cholesterol Bariatric surgery/liver transplant
39
How can you screen for harmful alcohol use?
Cut down (do you think you should)? Annoyed at others for talking about your drinking? Guilty feeling about drinking? Eye opener (ever drink in the morning for nerves or cure a hangover)?
40
What does alcohol withdrawal appear and what time frames after you've stopped drinking?
6-12hrs: tremor, sweating, headache, craving, anxiety 12-24hrs: hallucinations 24-48hrs: seizures 24hrs+: delirium tremens
41
What's Wernicke-Korsakoff Syndrome?
THIAMINE (B1) DEFICIENCY Wernicke's encephalopathy: - confusion - oculomotor disturbances - ataxia Korsakoff syndrome: - memory impairment - behavioural changes
42
What are the causes of cirrhosis?
1) ALD 2) NAFLD 3) Hep B/C Wilson's CF Haemochroamtosis PBC Autoimmune hepatitis
43
What will you find in your investigations for liver cirrhosis?
Raised LFTs (ALT/AST/ALP/Bilirubin) Low albumin Increased PT Thrombocytopenia Hyponatraemia (fluid retention) High urea Raised ELF (Enhanced Liver Fibrosis) blood test +ve FibroScan (Transient Elastography)
44
What are the key features of decompensated liver disease?
Ascites Hepatic Encephalopathy (confusion, lethargy) Oesophageal Varices bleeding Yellow (jaundice) AHOY
45
What are the common symptoms associated with paracetamol OD?
Can be asymptomatic N+V RUQ pain Jaundice Reduced consciousness/coma (if w/ alcohol)
46
What investigations would you arrange with a patient with a paracetamol overdose?
LFTs Serum Paracetamol Conc Glucose FBC INR ABG
47
What clinical guidance/tool would you use to determine specific treatment for paracetamol overdose?
Paracetamol overdose treatment nomogram Takes time since overdose and plasma paracetamol concentration into account Maximal conc at 4 hrs
48
What is the management for paracetamol overdose and how does it work?
1) Activated charcoal (within first hr) - absorbs the toxins 2) Aceylcystiene IV (replenishes glutathione to prevent build up of toxic NAPQI)
49
How would you conduct a Mental State Examination?
1) Observe (signs of neglect, self harm, weight) 2) Can patient hold normal conversation 3) Eye contact too intense or not there? 4) Body language? (threatening, withdrawn or restless) 5) Speech? (rate, tone, volume, fluency/rhythm) 6) Mood? (Low or manic) 7) Thought form? (Flow of conversation, trail of thought) 8) Perception? (hallucinations etc) 9) Cognition? (understand what's going on) 10) Insight? (do they know what's wrong with them) 11) Hold normal judgement? 12) Risk to themselves or others?
50
What would be the criteria for safely discharging a patient after a paracetamol overdose?
Physically fit for discharge Psych review and risk assessed for future overdose attempts Need to be linked with outpatient mental health/addiction services
51
A young man presents with pneumonia. He has a BMI of 17 kg/m2, what further info would you like to know about this guys weight?
Appetite? Oral intake? Diet history? Weight changes? Was this was recent weight loss? If so was it planned or not? How long has it took to lose this weight? Any mental health conditions for this? Any physical reasons why he is unable to eat?
52
What is the MUST (Malnutrition Universal Score Tour) and how is it calculated?
Calculates overall risk of malnutrition. 1 = medium risk, 2+ = high risk BMI: 18.5-20 = 1 <18.5 = 2 Unexplained weight loss in last 3-6 months: 5-10% = 1 >10% = 2 Acutely ill patient/no nutritional intake for 5+ days = 2
53
What are the possible causes of malnutrition?
Acutely ill = loss of appetite Mental health conditions = depression Mental conditions = stroke, dementia Poor dental health/dentures Dysphagia GI causes = chron's Cancer Social isolation/Loss of mobility
54
How is malnutrition best managed?
Has to be individualised to that patient (try and solve the cause) 1) Encouragement with food (don't interrupt meal times, make sure teeth/dentures are ok) 2) Food supplements (e.g. fortisips) If unable to meet nutritional demands, unsafe swallow or non-functioning GI tract: 3) NG Tube (short-term) - look at pH to see if it is in stomach and not the lungs 4) PEG (Percutaneous Endoscopic Gastrostomy tube) - tube placed directly in stomach Can be placed in jejunum too 5) Parenteral Nutrition (into veins)
55
What is refeeding syndrome? What factors predispose someone to it? How can it be prevented?
Potentially fatal shifts in fluids and electrolytes in malnourished patients on refeeding following a period of starvation. Low BMI Unintentional weight loss (15%+ in last 3-6 months) Little or no nutritional intake for >10 days Low levels of potassium, phosphate, or magnesium before feeding Hx of alcohol misuse Drugs (insulin, chemo, antacids, diuretics) Start on 10Kcal/kg/day and slowly raise Restore circulating volume (monitor fluid balance) Ensure daily multivitamin + thiamine/B12 Provide Mg, K and phosphate supplements (oral/IV)
56
How many types of autoimmune hepatitis are there and what are the typical presentation of these?
Type 1 - middle-aged women around or after menopause with fatigue/liver disease signs Type 2 - Acute hepatitis presentation (jaundice) with children/YA
57
58
What investigations are key in autoimmune hepatitis?
Raised ALT/AST (slight ^ALP) High IgG Type 1: Anti-nuclear antibodies (ANA) Type 2: Anti-LKM1 +ve liver biopsy
58
How do we manage autoimmune hepatitis?
Azathioprine Prednisolone Liver transplant
59
What are the genetics behind hameochromatosis?
Autosomal recessive C282Y mutation in HFE gene
60
How does haemochromatosis present?
- 40yrs + (later in females due to menstruation) - chronic tiredness - joint pain - bronze skin - testicular atrophy - erectile dysfunction/amenorrhea - memory/mood disturbance - hepatomegaly
61
What investigations are needed to diagnose haemochromatosis?
Raised serum ferritin Raised transferrin saturation HFE Gene testing Liver biopsy (Perl's stain - iron conc in liver) MRI (can see iron conc in liver)
62
What are the complications of haemochromatosis?
Secondary diabetes Liver cirrhosis/Hepatocellular carcinoma Cardiomyopathy Hypothyroidism Chondrocalcinosis (Ca in joints) Endocrine/Sexual issues (hypogonadism, infertility)
63
How do we manage haemochromatosis?
Venesection Monitor serum ferritin Monitor and then treat complications
64
What's the genetics behind Wilson's disease?
Autosomal recessive on chromosome 13
65
How does Wilson's disease present?
Teenagers/YAs Hepatic Symptoms: RUQ pain Jaundice Fatigue Neurological Symptoms: Tremor Dysarthria Dystonia Parkinsonism Psychiatric Symptoms: Abnormal Behaviour Depression/Psychosis Cognitive Impairment Eyes: Kayser-Fleischer Rings (green-brown circles around iris)
66
How can we diagnose Wilson's disease?
Low serum caeruloplasmin (protein that carries copper) 24hr urine copper assay Kayser-Fleischer Rings on slit lamp exam MRI brain (double panda sign) Low Hb
67
How do we treat Wilson's disease?
Penicillamine/Trientine (copper chelation) Zinc salts (inhibit copper absorption in GI tract) Liver transplantation
68
What are the genetics behind alpha-1-antitrypsin deficiency? What is alpha-1 antitrypsin?
Autosomal co-dominant Both gene copies are expressed and contribute to disease severity Protease inhibitor
69
What organs are affected in alpha-1 antitrypsin deficiency and how does it present?
Lungs: - COPD - ^protease enzymes attack connective tissues leading to elastic tissue destruction - bronchiectasis + emphysema Liver: - cirrhosis - A-1A produced in liver - mutant version of A-1A builds up and is toxic to hepatocytes
70
What investigations are needed for alpha-1 antitrypsin deficiency?
Low serum alpha-1 antitryspin Genetic deficiency CXR/HRCT thorax Liver biopsy
71
What is the management of alpha-a antitrypsin deficiency?
Smoking cessation COPD treatment Organ transplant Monitor complications (hepatocellular carcinoma) Family members screening
72
What is the pathophysiology behind Primary *Biliary* Cholangitis (PBC)?
Autoimmune condition Autoimmune **inflamation** of small bile ducts in liver (intrahepatic ducts) Causes cholestasis (reduced flow of bile) Bile/bilirubin/cholesterol unable to be excreted so levels in blood build up
73
How does PBC present?
White woman 40-60 yrs Can be asymptomatic Symptoms: - Fatigue - Pruritis (^bile) - GI symptoms (^bile) - Abdo pain (^bile) - Jaundice (^bilirubin) - Pale stools (^bilirubin) - Dark urine (^bilirubin) Signs: - Xanthoma/Xanthelasma - Excoriations (scratches on skin due to itching) - Liver cirrhosis/portal hypertension signs (end stage)
74
What investigations are needed for PBC? (blood investigations + imaging)
LFTs (^ALP) (All LFTs^ in later disease) Anti-mitochondral Antibodies (AMA) Anti-nuclear Antibodies (ANA) Raised IgM USS (excludes differentials)
75
How can we treat PBC?
Ursodeoxycholic Acid (makes the bile less harmful to epithelial cells) Colestyramine (pruritus) Replacement of fat-soluble vitamins Immunosupression with steroids (potentially)
76
How does PBC progress and what are the potential complications?
LIVER CIRRHOSIS > portal HTN + hepatocellular carcinoma Sjogren's Hyperlipidaemia Vit A,D,E,K deficiency Osteoporosis Thyroid disease
77
What is Primary Sclerosing Cholangitis (PSC)?
Intrahepatic ducts and extra hepatic bile ducts become inflamed and damaged Strictures form causing cholestasis Combined genetic + environmental factors? Still Unclear
78
How does PSC usually present?
Male 30-40s Family Hx ULCERATIVE COLITIS (could still have w/ chron's but less likely) RUQ Pain Prutitis Fatigue Jaundice Hepatomegaly Splenomegaly
79
What investigations are needed for PSC?
LFTs (^ALP) (All LFTs^ in late disease) MRCP (Magnetic Resonance Cholangiopancreatography) will show bile duct strictures Colonoscopy (UC Dgx?)
80
What is the management for PSC?
Endoscopic Retrograde Cholangio-Pancreatography (ERCP): - endoscopy to dilate strictures using stents. - Abx given also to reduce bacterial cholangitis Colestyramine (pruritis) Fat-soluble vitamin replacement Complications monitoring
81
What are the complications of PSC?
Biliary strictures Acute Bacterial Cholangitis Cholangiocarcinoma Cirrhosis (+ portal HTN/varices) A,D,E,K deficiency Osteoporosis
82
What's the pathophysiology behind GORD?
Gastro-oesophageal reflux disease Acid flows through LOS Oesophagus squamous epithelium more sensitive to acid then stomachs columnar epithelium
83
What factors can worsen GORD symptoms?
Greasy/spicy foods Coffee/tea Alcohol NSAIDs Smoking Obesity Hiatus hernia
84
What is the typical presentation of GORD?
Epigastric pain worse on eating Heartrburn Acid taste in mouth Cough
85
What is the management of GORD?
Lifestyle changes: - Reduce tea, coffee, alcohol - Weight loss - Smoking cessation - Smaller, lighter meals - Avoid meals before bed Medical management: - Antacids (short-term) - PPIs - Stop NSAIDs Surgery - laparoscopic fundoplication
86
What is the pathophysiology behind coeliac disease?
Autoimmune condition triggered by eating gluten Causes inflammation affecting the jejunum (small bowel) Atrophy of intestinal villi cause malnutrition
87
How does coeliac disease present?
Diarrhoea Bloating Fatigue Weight Loss Mouth ulcers INFERTILITY
88
What investigations are needed for coeliac disease?
Anti-tissue transglutaminase antibodies (Anti-EMA if this is borderline) Total IgA levels (to exclude IgA deficiency) [if IgA low then this is the issue] FBC (Hb - anemia) If +ve Abs: Endoscopy Jejunal biopsy (crypt hyperplasia + villous atrophy/flattening)
89
What is the management and potential complications of coeliac disease?
Lifelong gluten-free diet Avoid: Barley Rye Oat Wheat Nutritional Deficiencies Anaemia Osteoporosis Small bowel adenocarcinoma Ulcerative jejunitis SMALL BOWEL LYMPHOMA
90
What are the key features of IBS?
6/12 hx of: Intestinal discomfort Bowel habit abnormalities Stool abnormalities Abdo Pain Diarrhoea Constipation Bloating Worse after eating Improved by opening bowels Passing mucus Worsened by: anxiety/stress sleep disturbances illness
91
What diagnoses are needed to be excluded before IBS and how?
Bowel Cancer IBD Coeliac disease Ovarian cancer Pancreatic cancer FBC (Hb) ESR/CRP anti-TTG (coeliac) Faecal calprotectin (IBD) Ca125 (ovarian cancer)
92
How do we manage IBS?
Drink fluids Regular small meals Adjust fibre dependent on diarrhoea/constipation Limit caffeine, alcohol, fat Loperamide (diarrhoea) Bulk-forming laxative e.g. ispaghulxa husk (constipation) Antispasmodics (cramps)
93
What's Peutz-Jeghers syndrome (PJS) and how does it present?
Polyp formation in GI tract Freckles/brown spots in lips, mouth, fingers or toes GI symptoms (pain, bleeding) Increases risk of breast and GI cancers!
94
What drugs increase the risk of bleeding from peptic ulcers?
NSAIDs + Aspirin DOACS Steroids SSRI (antidepressants)
95
How do peptic ulcers present?
Epigastric pain/discomfort N+V Dyspepsia (indigestion) If bleed: Haematemsis/coffee ground vomit Melaena
96
What investigations are needed if suspect peptic ulcer disease?
FBC (Hb drop?) Endoscopy (can be seen) Rapid Urease test (H.pylori?) Biopsy (exclude malignancy?)
97
How do we treat peptic ulcers?
Stop NSAIDs Give PPI Treat H. pylori: Omeprazole Amoxicillin Clarithromycin/Metronidazol Repeat endoscopy (4/8 weeks post bleed)
98
What are the complications of peptic ulcer disease?
Bleed Perforation > Peritonitis Stricture/Pyloric stenosis
99
What is Barrett's Oesophagus? How is it managed?
Metaplasia where the lower oesophageal epithelium changes from squamous to colomnar epithelium GORD the biggest risk factor 1) PPIs 2) Endoscopic monitoring to see if progresses to adenocarcinoma 3) Endoscopic ablation of cells
100
What blood tests are seen in an upper GI bleed?
High Urea Normal Creatinine Low Hb Cirrhosis/liver disease: Normal Urea High Ammonia (HEPATIC ENCEPHALOPATHY) Low Hb
101
What is Zollinger–Ellison Syndrome?
Duodenal/pancreatic tumour secreting gastrin causing dyspepsia
102
What is the normal ranges for Hb & MCV?
Men Hb: 130 -180 Women Hb: 120 -170 MCV: 80-100
103
Where is folate and B12 absorbed in the GI tract?
Folate: duodenum + proximal jejunum B12: terminal ileum (Chron's)
104
What are some microcytic causes of anaemia?
Iron Deficiency: Cancer IBD Coeliac Dietary deficiency Haemoglobinopathies
105
What are some macrocytic causes of anaemia?
B12 deficiency Folate deficiency Alcohol (direct toxicity to bone marrow so have ^reticulocytes) Hypothyroidism Toxins/drugs (phenytoin, azathioprine)
106
How long in duration are the B12 and folate stores?
B12: 2/3 years Folate: 3 months
107
What are some normocytic causes of anaemia?
Acute GI bleed (incl. angioectasia) Urinary tract bleed Anaemia of CD Myeloma Mixed deficiency (iron+folate) Iron deficiency + iron tablets
108
How would myeloma present?
AKI Hypercalcaemia High globulins High IgG
109
What will extra iron blood tests show if you suspect iron deficiency anaemia?
Low Fe Low ferritin Low transferrin saturation High iron binding capacity
110
How do you treat folate and B12 deficiency?
1) B12 (Im) 2) Folate first (p.o.) 3) (neurological issues - degeneration of cord - w/ low B12)
111
What age groups/genders do we investigate anaemia in?
All Men Women child bearing age - No (unless diarrhoea or symptomatic) Older Women
112
How do we see if there are haemoglobinopathies?
haemoglobin electrophoresis
113
Who's vulnerable to iron deficiency anaemia? What are some good sources?
Vegan/vegetarians RED MEAT
114
What are some cause of folate deficiency?
Dietary Coeliac Pregnancy Methotrexate Chrons
115
What are some causes of B12 deficiency?
Chron's Pernicious anaemia Chronic active gastritis (h.pylori) Metformin
116
What investigations should you order if somebody comes in with anaemia?
FBC Iron studies B12 Folate Coeliac (anti TTG) OGD/Colonoscopy
117
What do you do if somebody comes to you with a previously corrected anaemia that now has returned after they have stopped taking iron tablets? (Hb: 90 > 140 - stopped tablets > 90)
Redo OGD/colonoscopy Small bowel issue??? : Small bowel MRI Capsule endoscopy
118
How do you treat normocytic anaemia?
Look for any deficiencies and replace them Exclude myeloma Transfuse Do nothing
119
How does gastroparesis present?
erratic blood glucose control, bloating and vomiting Tx - metoclopromide
120

Yr 3 Medicine (11 decks)

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