Flashcards in GI Deck (46):
What does coffee ground vomit suggest?
Dark blood that has been altered by contact with gastric acid, suggest a small bleed
Song of upper GI bleeding but less acute than haematemesis
Causes e.g. gastritis, oesophagitis
What are the most common causes of upper GI bleeding?
What is important to ask in the history of an upper GI bleed?
Appearance of the blood
If this has happened before
Vomiting (eg Mallory Weiss tear)
Known ulcers/ varices/ liver disease
What scoring systems are used for upper GI bleeds?
What are some causes of gastritis?
What is the Rockall score?
Scoring for upper GI bleeds pre and post endoscopy to predict risk of rebleeding and mortality
What is the primary diagnostic investigation for an upper GI bleed?
Endoscopy within 24 hours of admission
(If severe do after resus)
Which scoring system for upper GI bleeds is used pre endoscopy?
What are oesophageal varices?
Collaterals between portal and systemic systems formed due to portal hypertension due to liver fibrosis
How would you manage variceal bleeding?
Stabilise (ABC, fluids/ transfusion)
Aspirin to prevent re bleeding
Dysphagia affecting both solids and liquids from the start is indicative of what condition?
What are some clinical features of achalasia?
- dysphagia of both solids and liquids
- some food regurgitation
What investigations would you do for suspected achalasia and what would they show?
- manometry would show excess tone in LOS
- barium swallow would show ‘birds beak appearance’
- CXR could show wide mediastinum
A combination of liver and neurological disease points towards which diagnosis?
What is a useful diagnostic marker for hepatocellular carcinoma?
CEA is a diagnostic marker for which cancer?
What is the main treatment for haemochromatosis?
Regular venesection (therapeutic phlebotomy)
What drug can you give as prophylaxis for variceal bleeding?
Non selective beta blocker eg propanolol
Which type of jaundice will present with very high levels of alkaline phosphatase?
Post hepatic (due to biliary obstruction)
Which type of jaundice will present with pale stool?
Post hepatic jaundice
(Along with dark urine as there is increased conjugated bilirub8n and this is water soluble so enters the urine)
What colour will the urinebe in pre hepatic jaundice?
As there is increased levels of unconjugated bilirubin, and this is insoluble so will not enter the urine
What is Charcot’s triad?
(Due to cholangitis)
What is the most common first line imaging in jaundice?
USS of liver and biliary tree
What are som signs of acute liver failure?
(If stigmata of chronic disease are present, this suggest acute on chronic liver failure?
What are some genetic causes of cirrhosis?
Alpha 1 antitrypsin deficiency
What are some stigmata of chronic liver disease?
What will bloods show for a patient with liver cirrhosis?
Raised LFTs (ALT, ALP, GGT, AST)
Low albumin (may have raised INR/ PTT)
Low WCC and platelets may indicate hypersplenism
Which diuretic is first line in liver failure?
Spironolactone +/- furesomide
Which organism causes pseudomembranous colitis?
Which antibiotics are used for C Diff infection?
If severe: oral vancomycin
(If NBM, IV meropenem)
What investigation would you do in a patient presenting with diarrhoea?
FBC: MCV reduced in coeliac, increased in alcohol abuse, B12 reduced in Crohn’s and coeliac, Raised CRP/ ESR may indicate infection or Ca or IBD
Faecal calprotectin: raised in IBD
Blood and stool culture to look for infective organism
TFT to look for thyrotoxicosis (low TSH)
U&Es to check for dehydration
Sigmoidoscopy and biopsy (IBD, Ca)
Coeliac serology (Raised transaminase antibodies)
How will the stools be in coeliac Disease?
Steatorrhea (foul smelling, hard to flush)
What pharmacological agents can be prescribed in irritable bowel syndrome?
For bloating and abdominal pain: antispasmodic
For diarrhoea: loperamide
For constipation: laxative e.g. ispaghula (avoid lactulose)
Low dose TCA e.g. amitriptyline
What is coeliac Disease?
Autoimmune disease of the small bowel due to gluten intolerance
Causes villus atrophy and malabsorption
HLA-DQ2 is associated with 95% of patients who suffer from which condition?
How may coeliac Disease present in a patient?
Failure to thrive (children)
Fe deficiency anaemia
Which antibodies are raised in coeliac Disease?
Jejenal biopsy for a patient with coeliac Disease will show what?
Increase in intraepithelial lymphocytes
Can a patient with coeliac eat wheats, barley, rice and potato?
Wheat and barley no
Rice and potato yes
What condition in primary slerosing cholangitis linked with?
(4% of UC px have PSC, but 80% of PSC Px will have UC)
What are some symptoms of primary sclerosis cholangitis?
What investigation can diagnose primary sclerosing cholangitis?
ERCP will show beads on a string appearance (due to the biliary strictures from areas of fibrosis)
Antimitochondrial antibodies are raised in which condition?
Primary biliary cirrhosis
What is a typical patient with primary sclerosing cholangitis?
Middle aged male with UC
What is primary biliary cirrhosis?
Autoimmune condition causing chronic inflammation of interlobular bile ducts
Presents with pruritis