GI Flashcards

1
Q

Peptic ulcer disease - Types, RF, Sy, Ix, Comp, Mx, Zollinger-Ellison syndrome

A

T - Gastric - worse when eating, older patient, normal or low acid secretion. Duodenal - hunger pains esp at night, younger, most have H pylori, high acid secretion.

RF - Alcohol, smoking, NSAIDs.

Sy - nausea, epigastric pain, distension if obstruction.

Ix - gastroscopy and urease test on biopsy or CO2 breath test (using radioactive C in urea) for H Pylori.

Comp - acute bleeding, Fe def anaemia, perforation, obstruction due to scarring.

Mx - lifestyle, PPI, antacids, eradicate H pylori (metronidazole, PPI, clarithromycin).

Zollinger-Ellison - Gastrinoma, gastrin-secreting tumor of the duodenum or pancreas. Ix - fasting gastrin levels, ocreotide scan. Mx - ocreotide and surgery.

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2
Q

Hiatus hernia - def, Ix, Mx.

A

D - part of the stomach in the thorax. Usually sliding (both sides pop up, causes GORD) can be rolling (one side of stomach causes hiccough, volvulus, obstruction).

Ix - Endoscopy or CT if acute.

Mx - lifestyle, PPI, surgery if treatment-resistant or emergency.

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3
Q

GORD - Sy, Complications, Mx.

A

Sy - dyspepsia, acid in pharynx, worse at night, after large meals and when lying down.

C - Oesophagitis - causes irritation and erosion progressing to ulcers and strictures. Barett’s oesophagus - metaplasia normal squamous is replaced by columnar causing pre-malignant change.

Mx - Treat with PPI for one month, if doesnt improve, consider stool/breath test sample for H pylori (no PPI for 2wks and Abx for 4wks). Refer if new onset and old. Can do Nissen’s fundoplication to reinforce LOS.

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4
Q

Gastric cancer - Histology, RF, Sy, Ix, Mx

A

H - Adenocarcinoma.

RF - Nitrosamines (fish), chronic atrophic gastritis, blood group A, H pylori.

Sy - new/worsening dyspepsia, weight loss, anorexia, lethargy, anaemia, upper GI bleed. Palpable epigastric mass, Trosier’s sign (L supraclavicular lymph node).

Ix - Gastroscopy, CT.

Mx - If early can be resected with chemo, often presents late and will be palliative.

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5
Q

Upper GI bleeding - Causes and features, RF, Ix, Mx.

A

Peptic ulcer - fresh red blood with clots. Requires endoscopic coagulation.
Oesophageal varices - copious dark red vomiting caused by caput medusa portal HTN. Require endoscopic banding or IR.
Mallory-Weiss tear - trauma following vomiting/retching.
Also - vascular malformations, cancer, aortoenteric fistula.

RF - NSAIDs, steroids, alcohol, anticoagulants.

Ix - Endoscopy. Immidiately after recuss if unstable, within 24hrs if stable.

Mx - ABCDE recussitation, urgent OGD +- angiography. Varices - give terlipressin (constricts gut vessels) and Abx. Band ligation at endoscopy. Sengstaken-Blakemore gastro-oesophageal tube can be life saving.

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6
Q

Appendicitis - Sy, Si, comp, Ix, DDX, Mx.

A

Sy - Central pain moving to RIF (McBurney’s point). Peritonism suggests perforation, Malaise, anorexia, fever, diarrhoea. Palpation of LIF causes pain in right Rovsing’s sign.

Comp - Perforation, mass, abscess.

Ix - CT. USS if ovarian pathology suspected.

DDx - Children - Mesenteric adenitis (post-viral), Meckel’s diverticulitis, gynae. Adults - IBD Meckels diverticulitis, gastoenteritis, renal colic, gynae, tumours.

Mx - IV access, bloods, IV Abx. If sy settle do interval appendectomy after 6wks, if not do acutely, abscess can be drained via CT.

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7
Q

Fe deficiency anaemia - cause, Sy, Ix, Mx

A

Cause - blood loss (menstruation/GI), poor diet in children, malabsorption, hookworm in tropics.

Sy - SOB, fatigue. Koilonychia, glossitis, angular chelosis, post-cricoid webs (Plummer-Vinson syndrome).

Ix - microcytic hypochromic anaemia, confirmed by low ferritin.

Mx - treat cause, PO iron (SE nausea, abdo discomfort, Diarr/cons, black stools). Give IV in renal failure.

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8
Q

Diverticular disease (not diverticulitis) - def, Ix, Sy, Mx

A

Def - outpouching of bowel wall at site of perforating arteries, usually in sigmoid, very common. Associated with constipation. Diverticulosis=exist, diverticular disease=sy, diverticulitis=inflammation.

Ix - Often incidental at colonoscopy if done to exclude cancer.

Sy - Altered bowel habit, left sided colic releived by passing stool/flatulence.

Mx - high fibre diet and antispasmodics (mebeverine).

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9
Q

Diverticulitis - Sy, Ix, Mx, Comp

A

Sy - LIF pain, pyrexia, peritonism.

Ix - CT best in acute flare, colonoscopy may rupture bowel.

Mx - Analgesia, NBM, IV fluids, Abx, CT guided drainage if abscess.

Perforation - ileus, gen peritonitis and shock. Mx - laparotomy and Hartmann’s
Haemorrhage - usually sudden and painless. Mx bed rest, may need transfusion or surgery.
Fistulae - surgery.
Abscess - swinging fever, localising signs. Mx - abx and drainage.

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10
Q

Appendicitis - Def, Sy, Si, Ix, Mx

A

Def - most common surgical emergency, usually in 10-20yrs, gut organisms invade appendix wall after lumen obstruction (foecolith, lymph).

Sy - periumbilical pain migrating to LIF (McBurneys point), anorexia, N/V, fever.

Si - Rosving’s sign - pain LIF>RIF when RIF pressed. Psoas sign (pain on extending hip), Cope sign (pain on flexing and internally rotating hip). Rebound and percussion tenderness.

Ix - bloods and CT.

Mx - Abx - metronidazole and cefuroxime and emergency appendicectomy.

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11
Q

RUQ pain DDX

A
Acute cholecystitis
Duodenal ulcer
Hepatitis
Pyelonephritis
Appendicitis
RLL pneumonia
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12
Q

LUQ pain DDX

A
Ruptured spleen
Gastric ulcer
AAA
Pyelonephritis
LLL pneumonia
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13
Q

Epigastric pain DDX

A

Pancreatitis
MI
Peptic ulcer
Cholecystitis

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14
Q

RLQ pain DDX

A
Appendicitis
Salpingitis
Ovarian abscess
Ectopic - sudden, shock
Renal stone - loin to groin
Strangulated hernia
Mesenteric adenitis - post-viral
Epiploic appendagitis - mild pain
Meckels diverticulum - child
Crohns - blood and mucus PR
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15
Q

LLQ pain DDX

A
Diverticulitis
Salpingitis
Ovarian abscess
Ectopic - sudden, shock
Renal stone - loin to groin
Strangulated hernia
Crohns - blood and mucus PR
UC
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16
Q

Umbilical pain DDX

A
Obstruction
Pancreatitis
Early appendicitis
Mesenteric thrombus
AAA
Diverticulitis
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17
Q

Bowel obstruction - Cardinal si, cause large and small, sy, Ix, Mx

A

Cardinal - vomiting, colicky pain, absolute constipation, distension.

Cause - Small - adhesions, hernias, interssusception. Large - Colon ca, constipation, diverticular strictures, volvulus (sigmoid or caecal).

Sy - NV, anorexia, faeculent vomiting, tinkling bowel sounds.

Ix - AXR, CT. Small bowel valvulae conniventes completely cross the lumen, large bowel haustra do not.

Mx - drip and suck (IVI and NG). Strangulation and closed loop obstruction require emergency surgery. Avoid operating in small bowel obs due to adhesions. In sigmoid volvulus do sigmoidoscopy and flatus tube.

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18
Q

Inguinal/femoral hernia - def, Indirect inguinal, direct inguinal, femoral, Ix, Mx

A

D - protrusion of a viscus. Irreducible=cant be pushed back. Incarcerated=contents stuck inside by adhesions. Strangulated=ischaemia occurs, requires emergency surgery.

Indirect inguinal - Most common, can strangulate, go straight through inguinal canal. Ix - reduce and then cover deep ring (mid inguinal lig), then stand and cough and it won’t move.

Direct - less common, reduce easily and rarely strangulate.

Femoral - more common in females, frequently irreducible and strangulate. Point down the leg (rather than into groin) and tend to be more inferior and lateral.

Ix - difficult to distinguish direct from indirect unless mid op, matters little as same management.

Mx - surgical repair with mesh.

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19
Q

Colorectal Ca - Path, RF, Sy, Ix, classification, Mx

A

Path - adenocarcinoma. Rectum, sigmoid and caecum most common.

RF - Polyps, IBD, genetics (FAP, HNPCC), low fibre red meat diet, alcohol, smoking.

Prevention - 75mg/d aspirin.

Sy - Left sided - bleeding/mucus PR, CIBH, obstruction, tenesmus, mass PR. Right - Weight loss, anaemia, abdo pain.

Ix - Colonoscopy and CT. Screening = FOB (every 2yrs 60-75, flexi sig at 55).

Classification - dukes A=local, B=muscularis mucosae, C=regional LN, D=distant mets.

Mx - Surgery - sigmoid colectomy, anterior resection (low sig/high rectum), AP resection (low rectum), left hemi, right hemi or Hartmann’s in obstruction. Radio in palliative and chemo in palliative or adjuvant.

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20
Q

Polyps - Types, Ix, Mx

A

Inflammatory - IBD causes lymphoid hyperplasia. Hamartomatous - juvenile polyps seen in Peutz-Jeghers syndrome. Neoplastic - tubular or villous adenomas have malignant potential esp if >2cm.

Ix - colonoscopy.

Mx - Neoplastic should be removed and biopsied on colonoscopy.

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21
Q

Stomach Ca - path, Sy, Ix, Mx

A

Path - adenocarcinoma esp GOJ. V common in Japan.

Sy - Dyspepsia in >50yo, weight loss, vomiting, dysphagia, anaemia. Trosiers sign (Virchows node).

Ix - gastroscopy and ulcer biopsy, CT for staging, cytology of periitoneal washings.

Mx - total/partial gastrectomy with chemo. Often palliative at presentation, chemo and surgery to prevent obstruction.

22
Q

Oesophageal Ca - Path, RF, Sy, Ix, Mx

A

Path - SCC (prox) most common in west, adenocarcinoma distal (following Barretts, GORD, obesity).

RF - Diet, alcohol excess, smoking, alchalasia, Plummer-Vinson, obesity, low vitA/C, nitrosamine.

Sy - Dysphagia, weightloss, retrosternal chest pain. Hoarseness, cough, dysphagia.

Ix - oesophagoscopy with CT/MRI for staging.

Mx - Oesophagectomy neoadjuvant chemo, chemoradiotherapy in palliative.

23
Q

Mesenteric ischaemia - Def, Sy, Ix, Mx, Chronic

A

Def - usually arterial thrombosis/emboli in mesenteric vessels affecting small bowel.

Sy - Severe abdo pain, no abdominal signs, hypovolaemia and shock. Suspect if the degree of illness is out of keeping with clinical signs.

Ix - CT/MR angiography.

Mx - fluids, abx, emergency laparotomy, attempts to revascularise or resect bowel.

Chronic mesenteric ischaemia - intestinal angina. Severe colicky pain following eating (gut claudication), weight loss, PR bleed, N/V. Ix - CTangiography. Mx - Surgery - angioplasty and stent.

24
Q

Bariatrics - indications, procedures

A

Indicated is BMI >40 or 35 with comorbidities, failure of non-medical Mx for 6m, well informed and motivated and part of an integrated programme. First line if BMI >50. It is much more effective than any other Mx.

P - Laparoscopic adjustable gastric band - induces early satiety, less complications. Roux-en-Y gastric bypass - most effective, early satiety and malabsorption, requires vit supplements.

25
Q

Angiodysplasia - def, Ix, Mx

A

Def - ANM causing PR bleeding in elderly.

Sy - painless fresh PR bleed.

Ix - PR and colonoscopy to exclude other causes. CT angio diagnostic.

Mx - Embolization, laser electrocoagulation, resection.

26
Q

Perianal disease - Anal fissure, anal fistula, anorectal abscess, haemorrhoids, perianal haematoma

A

Anal fissure - tear in lining of lower anal canal often with sentinel pile on external aspect. Usually due to hard stool. Mx - 5% lidocaine ointment and GTN ointment, stool softeners.

Anal fistula - tract between skin and rectum post infection or inflammation. Ix - MRI. Mx - Fistulotomy and excision.

Anorectal abscess - assoc with DM, IBD, malignancy, fistulae. Mx - incise and drain.

Haemorrhoids (piles) - dilated anal cushions by gravity and straining. May bleed if damaged by hard stool, are not usually painful unless thrombosed. Mx - increase fluid and fibre, stool softener, topical steroids. Can then use rubber band ligation, sclerosants, infrared coagulation, cryotherapy. Surgical excision if this fails.

Perianal haematoma - thrombosed external pile, dark blueberry under skin.

27
Q

Pancreatitis - Cause, Sy, Ix, Severity, Mx

A

Cause - GET SMASHED - Gallstones, Ethanol, Trauma. Steroids, Mumps, Autoimmune, Scorpion venom, Hyperlipidaemia/hypothermia/hypercalxcaemia, ERCP, Drugs (azathioprine, statins, metronidazole, metformin).

Sy - Severe epigastric/umbilical pain, radiates to back, releived by sitting forward, vomiting. Shock, jaundice, peritonism, rigid abdomen, Cullens (umbilical), Grey Turner (flank).

Ix - serum amylase (>100) but levels fall quickly so can check urine. Serum lipase most sensitivce and specific. CT to look for complications.

Severity - Glascow criteria - PANCREAS - PaO2, age, neutrophills, Ca, RF, Enzymes, Albumin, Sugar.

Mx - NBM, NG, fluids, analgesia (?pethidine as morphine may cause SoOddi to contract). ICU if deteriorates, ERCP if stones.

28
Q

Gallstones - stone types

A

Stones - Pigmented (bili - caused by haemolysis, small and many), cholesterol (large, solitary), mixed.

29
Q

Acute cholecystitis - def, sy, Ix, Mx, Mirizzi sy

A

Def - Stone or sludge impaction in the neck of GB.

Sy - continous epigastric/RUQ pain, ref to right shoulder, vom, fever, peritonism, GB mass. Murphy’s sign - 2 fingers over RUQ and ask patient to breath in.

Ix - USS - thick walled shrunked GB, stones, dilated CBD.

Mx - NBM, analgesia, fluids, cefuroxime IV. Lap chole either acute or delayed - patient choice.

Mirizzi’s syndrome - stone in neck presses on CBD causing jaundice.

30
Q

Chronic cholecystitis - Sy, Ix, Mx

A

Sy - Flatulent dyspepsia, abdo discomfort, distension, nausea, fat intolerance.

Ix - USS.

Mx - lap chole.

31
Q

Biliary colic - Def, Sy, Ix, Mx

A

Def - gallstones in the cystic or CBD.

Sy - RUQ, radiates to the back, +- jaundice. No fever or leokocytosis as no inflammation.

Ix - USS

Mx - Acute or elective lap chole, N.B. may have life threatening pancreatitis in wait. If causing obstructive jaundice will need ERCP with biliary trawl.

32
Q

Cholangitis - Sy, Mx

A

Sy - Charcots triad - RUQ pain, fever, jaundice.

Mx - cefuroxime and metronidazole.

33
Q

Gallstone ileus - def, Ix, Mx

A

Def - Stone erodes through GB to duodenum, may obstruct the terminal ileum.

Ix - AXR - pneumobilia (air in CBD), small bowel fluid levels and a stone.

Mx - surgery

34
Q

Ulcerative colitis - def, sy, Ix, severity, complications, mild mx, mod mx, severe mx, surgical mx.

A

Def - relapse-remitting non-transmural inflammatory condition affecting rectum and sometimes up to the iliocaecal valve. More common in non-smokers.

Sy - episodic or chronic diarrhoea +- blood/mucus, abdo pain, bowel frequency, tenesmus. Erythema nodosum, iritis, arthritis, Anky spond, cholangiocarcinoma.

Ix - colonoscopy - disease extent and biopsy. Bloods and stool culture to rule out infection.

Severity - Truelove and Witts criteria - mild, mod, severe based on number of stools, PR bleed, obs, CRP.

Complications - bleeding, toxic megacolon, perforation, VTE, colon Ca (survellance colonoscopy every 4yrs).

Mild Mx - 5ASA (sulfasalazine(effects sperm count)/mesalazine/olsalazine) are mainstay. 20mg pred help induce remission and then wean off. Use azathioprine/methotrexate/infliximab if no remission with steroids.

Moderate Mx - if 4-6motions/d but otherwise well - 5ASA, pred 40mg followed by reducing regime, BD steroid enema.

Severe UC - unwell and >6motions/d - admit, BBM, IV fluids. Hydrocortisone IV, rectal steroids, when improve move to pred and 5ASA. If on day 3 and not improving need cyclosporin/infliximab/surgery. Long term can use tofacitinib (small molecule inhibitor) or infliximab.

Surgery - for perforation, massive haemorrhage, toxic dilation, failed medical therapy. do protocolectomy with terminal ileostomy, can be converted later to ileo-anal pouch.

35
Q

Crohn’s disease - def, Sy, complications, Ix, Mx, add on Mx

A

Def - affects whole of GI mucosa and transmural with skip lesions. Smoking increases risk, NSAIDs exacerbate disease.

Sy - diarrhoea, urgency, abdo pain, weightloss, fever malaise, anorexia. Clubbing, mouth ulcers, arthritis, iritis.

Comp - SB obstruction, toxic dilatation, abscess, fistulae, haemorrhage, perforation, PSC, cholangiocarcinoma.

Ix - colonoscopy with biopsy, bloods (inflammatory, FBC, haemotinics). Capsule endoscopy can be helpful.

Mx - if sy but systemically well 30mg pred with dose reduction. If severe admit for IV hydrocortisone, metronidazole, if improves stitch to pred, if not add infliximab. Surgery of drug failure or complication.

Can add on azathioprine, methotrexate, and infliximab if uncontrolled.

36
Q

Primary sclerosing cholangitis - Def, Sy, Ix, Mx

A

Def - inflammation and scarring of the bile ducts seen in IBD (esp UC of whole colon), autoimmune hepatitis.

Sy - pruritis, fatigue, jaundice, LF. Associated with bile duct, liver and colon cancer - need yearly colonoscopy.

Ix - Bloods (high alk phos and bili, autoimmune screen - ANCA). ERCF shows strictures and beaded appearance.

Mx - Ursodeoxycholic acid protects against cancer and improves LFTs, colestyramine for pruritis. Liver transplant for ESLF.

37
Q

Alcoholic cirrhosis - Def, cause, Sy, Si, Ix, Mx

A

Def - Irreversible liver fibrosis and nodular regeneration.

Cause - chronic alcoholl abuse, HBV/HCV.

Sy - May be none, deranged LFTs. LF - coagulopathy (increased INR), encephalopathy (asterixis, confusion/coma), spontaneous bacterial peritonitis. Portal HTN - ascites, varices.

Si - Leuconychia, clubbing, palmar erythema, Dupuytren’s, spider naevus, gynaecomastia (increased oestrogen), hepatomegaly.

Ix - Bloods (LFTs and clotting), liver USS, ascitic tap fluid for MC&S, serum-ascites albumin gradient (if high from portal HTN).

Mx - Nutrition (pabrinex), colestyramine for pruritis, fluid restrict, low salt diet, spirinolactone +- furosemide. Abx for SBP prophylaxis. Give albumin if removing large amounts of abdo fluid.

38
Q

Liver ca - path, Sy, Ix, HCC, cholangiocarcinoma

A

Path - usually metastatic from bowel, breast, bronchus. Primary usually HCC or more rarely cholangiocarcinoma. Benign - haemoangiomas or adenoma (anabolic steroids, COCP).

Sy - fever, malaise, anorexia, weightloss, RUQ pain, jaundice. HSmegaly, chronic liver disease, decompensation.

Ix - USS and CT, look for primary. Bloods - LFT, FBC, clotting, hepatitis serology, alpha-fetoprotein (up in HCC).

HCC - common in china/africa, HBV leading cause, also cirrhosis. Ix - 4-phase CT. Mx - resect solitary tumours or transplant.

Cholangiocarcinoma - less common, caused by schistosomiasis, PSC, hepatitis. Jaundice early feature. Poor prognosis, Mx usually palliative stenting.

39
Q

Viral hepatitis - types

A

A/E - foecal-oral, self limiting. Fever, malaise, anorexia, nausea, arthralgia then jaundice.

B - blood/body fluid. mother/IVDU/sexual, similar presentation to A. Mx - antivirals (ribavirin, PEGinterferon), vaccinate contacts.

C - blood/body fluid. IVDU/sexual - usually presents as chronic infection. Mx - antivirals (ribavirin, PEGinterferon).

D - with hep B.

40
Q

Liver failure - causes, sy, Ix, Mx

A

C - viral hepatitis, yellow fever, drugs (paracetamol OD, halothane, isoniazid), Budd-chiari (hepatic vein thrombosis), chronic hepatitis, autoimmune.

Sy - Jaundice, ascites, hepatic encephalopathy (ammonia in brain causes cerebral oedema) - altered mood, poor sleep, drowsiness, confusion, liver flap, coma, death. Si of chronic disease.

Ix - USS liver. Bloods (normal, clotting, hep/CMV/EBV serology, ferretin, antitrypsin), ascitic tap.

Mx - Escalate to ITU, 20” head up tilt, dextrose to avoid hypo, treat cause, pabrinex, vit K, ceftriaxone SBP prophylaxis. Lorazepam for seizures, dialysis if RF, endoscopy if bleeds.

41
Q

Hepatitis causes - haematochromatosis, alpha1-antitrypsin deficiency, primary biliary cirrhosis, autoimmune hepatitis, non-alcoholic fatty liver disease, Wilsons disease

A

Haemochromatosis - AR genetic condition where Fe absorbtion is increased and deposited in joints, liver, heart, pancreas, adrenals, and skin. Sy - bronze skin, diabetes, LF. Ix - ferritin, FE transferrin, MRI liver. Mx - venesection

Alpha1-antitrypsin deficiency - mutation in inflammatory cascades causes LF/HCC and emphysema. Ix - serum A1AT levels. Mx - resp support, liver transplant.

Primary billiary sclerosis - Chronic autoimmune inflammation of biliary duct. Ix - high serum AMA. Mx - colestyramine for itch, ADEK vitamins.

Non-alcoholic fatty liver disease - Steatosis causing inflammation and fibrosis. Mx - bariatric surgery.

Wilsons disease - Disorder of biliary copper excretion, builds up in liver and CNS. Kayser-Fleisher rings. Ix - increased urinary copper, serum caeruloplasmin very low. Mx - avoid copper, penicillamine, liver transplant.

42
Q

Autoimmune hepatitis - Sy, Ix, Mx

A

Sy - youngish women, acute hepatitis, fever, malaise, urticarial rash, arthritis, RF. Strongly associated with other autoimmune conditions.

Ix - Bloods - high ASMA, ANA, IgG. Liver USS and biopsy. MRCP to rule out PSC.

Mx - Prednisolone +- azothioprine 2yrs.

43
Q

Pancreas Ca - Path, Sy, Ix, Mx

A

Path - Adenocarcinoma, usually in head.

Sy - Painless obstructive jaundice, epigastric pain radiating to the back and releived on sitting forward, weight loss, pancreatitis. Thrombophlebitis migrans (muliple thrombus in veins over body).

Ix - Bloods - alk phos, CA19-9. EUS best, CT/USS also.

Mx - If mets (majority) give chemo +-stent, if not Whipples and chemo.

44
Q

Nutrition - Scurvy, Beriberi, pellagra, xeropthalmia

A

Scurvy - vit C. Poor/pregnant/odd diet. Sy - Anorexia, gingivitis, loose teeth, bleeding from gums/hair follicles/bladder/gut, muscle pain. Mx - ascorbic acid.

Beriberi - thiamine (B1) deficiency - HF with oedema (wet) or neuropathy (dry). Mx - pabrinex.

Pellagra - nicotinic acid (B3). Triad of Diarrhoea, Dementia, Dermatitis. Mx - nicotinamide.

Xeropthalmia - Vit A def = conjunctival spots and blindness.

45
Q

IBS - Sy, Ix, Mx

A

Sy - abdo pain relieved by defecation or associated with urgency, incomplete evacuation, bloating, mucous, worse after food.

Ix - diagnosis of exclusion, check bloods (FBC, ferritin, A-tissue transglutaminase, foecal calprotectin).

Mx - Bisacodyl for constipation, loperamide for constipation, mebeverine for bloating/pain. Consider CBT and amitriptyline.

46
Q

Carcinoid sy - Path, Sy, Ix, Mx

A

Path - neuroendocrine tumour of GI tract. Secrete 5-HT, histamine and many more.

Sy - SOB, hot flushes, diarrhoea, heart valvular pathology. Hypotensive crisis.

Ix - 24hr 5hydroxyindoleacetic acid. CT/MRI.

Mx - Ocreatide (blocks release of hormones) and surgery.

47
Q

Malabsorption - Sy, cause, Ix

A

Sy - diarrhoea, steatorrhoea (fatty, hard to flush), weight loss, lethargy, bloating. Anaemia, bleeding disorders, oedema, neuropathy.

Cause - Coeliac, chronic pancreatitis, Chohns. More rare - primary biliary sclerosis, pancreas ca, CF, Whipple’s disease, tropical sprue (infection).

Ix - Bloods (FBC, haemotinics, INR, coeliac, inflammatory). Colonoscopy/further imaging.

48
Q

Coeliac disease - def, Sy, Ix, Mx

A

Def - T-cell autoimmune disease against gliadin causing villous atrophy and malabsoption. Increased risk of GI T-cell lymphoma/malignancy.

Sy - steatorrhoea, diarrhoea, abdo pain, bloating, N+V, weight loss, fatigue. Dermatitis hepetiformis.

Ix - alpha gliadin, transglutaminase, anti-endomysial Abs. Duodenal biopsy at endoscopy - villous atrophy, crypt hyperplasia. Reverses with gluten free diet.

Mx - gluten free diet.

49
Q

Chronic pancreatitis - Cause, Sy, Ix, Mx

A

C - Usually alcohol. rarely - familial, CF, haemochromatosis, duct obstruction.

Sy - epigastric pain rad to back, relieved by sitting forward, bloating, steatorrhoea, brittle diabetes.

Ix - USS and CT (pancreatic calcification confirms).

Mx - Analgesia, creon, ADEK vits, insulin, no alcohol, low fat diet. Surgery for unremitting pain.

50
Q

Diarrhoea - Watery, blood/pus, food poisining, reheated rice, travellers

A

Watery - s aureus, rotavirus (esp children), norovirus.

Blood/pus - Shigella (high fever). C diff - HAI postAbx or immunosuppressed, causes pseudomembranous colitis (metronidazole first line then vanc). E coli O157, C jejuni, S typhi.

Food poisoning - Campylobacter - undercooked poultry, significant pain, can cause Guillian Barre. Salmonella (esp poultry/dairy).

Reheated rice - Bacillus serus.

Travellers diarrhoea - E.coli - O157 is haemorrhagic and can cause haemorrhagic colitis and HUS.

51
Q

Peritonitis - types, Sy, Mx

A

Types - localised to a specific area or generalised.

Si - prostration, shock, lying still, tender with rebound/percussion pain, rigidity, gaurding, no BS.

Mx - usually requires a laparotomy except in pancreatitis.