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Medicine - Gastroenterology Flashcards

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1
Q

How do you differentiate between gastric and duodenal ulcers?

A

After a meal
Gastric = Greater pain
Duodenal = Decrease pain (pain when hungry)

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2
Q

What is associated with the majority of peptic ulcers?

A

H. pylori
95% of duodenal ulcers
75% of gastric ulcers

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3
Q

Name 4 drugs associated with peptic ulcers

A

NSAIDs
SSRIs
corticosteroids
bisphosphonates

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4
Q

Which syndrome is associated with peptic ulcers? What is the pathophysiology?

A

Zollinger Ellison Syndrome
rare cause characterised by excessive levels of gastrin, usually from a gastrin secreting tumour

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5
Q

Which type of peptic ulcer is more common?

A

Duodenal

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6
Q

What is the first line investigation for peptic ulcer disease?

A

H. pylori urea breath test or stool antigen test

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7
Q

Mx of peptic ulcer disease

A

-ve H. pylori: PPIs
+ve H. pylori: eradication therapy- PPI + Amoxicillin BD + Clarithromycin/ Metronidazole BD

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8
Q

What is the only test that can be used to check for H. pylori eradication?

A

Urea breath test

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9
Q

What is the investigation for C. dificile infection?

A

C. difficile toxin (CDT) in stool
C. difficile antigen positivity only shows exposure to the bacteria, rather than current infection

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10
Q

Mx of first episode C. difficile infection

A

1st: Vancomycin PO for 10 days
2nd-line: Fidaxomicin PO
3rd-line: Vancomycin PO +/- Metronidazole IV

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11
Q

Mx of recurrent C. difficile infection

A

<12w of Sx resolution: Fidaxomicin PO
>12w of Sx resolution: Vancomycin OR Fidaxomicin PO

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12
Q

Mx of life-threatening C. difficile infection

A

Vancomycin PO + Metronidazole IV
specialist advice - surgery may be considered

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13
Q

Describe the distribution of UC

A

Starts at Rectum (hence most common site for UC)
Continuous.
Never spreads beyond ileocaecal valve

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14
Q

Differentiate mild, moderate and severe flares of ulcerative colitis

A

Mild: <4 stools per day, little blood
Moderate: 4-6 stools per day, varying blood
Severe: >6 stools per day, bloody diarrhoea, systemic upset

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15
Q

What is the name of the criteria used to stage IBD, and what are the 6 criteria?

A 
Truelove + Witts: 
HR
Temperature
Bowel movements 
PR bleeding 
Haemoglobin
ESR
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16
Q

Give 4 gastro symptoms UC presents with

A

bloody diarrhoea
urgency
tenesmus
abdo pain, esp. left lower quadrant

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17
Q

Which 6 extra-intestinal manifestations of UC are related to disease activity?

A

Erythema nodosum
Pauci-articular Arthritis
Apthous ulcers
Episcleritis
Osteoporosis
VTE risk

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18
Q

Which 4 extra-intestinal manifestations of UC are NOT related to disease activity?

A

Axial arthritis: sacroiliitis/ ankylosing spondylitis
Pyoderma gangrenosum
Uveitis
Primary sclerosing cholangitis

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19
Q

Give 3 triggers for a UC flare

A

Stress
Drugs: NSAIDs, Abx
Cessation of smoking

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20
Q

What is seen on barium enema in UC? (3)

A

loss of haustrations
superficial ulceration, ‘pseudopolyps’
long standing disease: colon is narrow + short -‘drainpipe colon’

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21
Q

Recall 2 histological findings of the gut layer for Crohn’s and UC

A

Crohn’s: Increased goblet cells, granulomas
UC: Decreased goblet cells, crypt abscesses

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22
Q

When should a diagnostic colonoscopy for UC be avoided? What investigation is preferred?

A

In severe colitis- risk of perforation
Do flexible sigmoidoscopy

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23
Q

What is the most common affected portion of the bowel in Crohn’s vs UC?

A

Crohn’s: terminal ileum (so RIF mass)
UC: rectum

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24
Q

Describe the typical features of inflammation in Crohn’s vs UC

A

Crohn’s: Skip lesions, rose-thorn ulcers, cobblestoning, string sign of kantor (narrow ileum stricture)
UC: ‘lead-pipe’, pseudo-polyps, thumbprinting

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25
Which type of IBD carries the highest risk of colorectal cancer?
UC
26
In which form of IBD are fissures more common and why?
Crohn's - because it affects the full thickness of the bowel wall
27
Differentiate the appearance of stool in active Crohn's vs UC
Crohn's: non-bloody diarrhoea UC: bloody diarrhoea which may contain mucous
28
Which type of IBD is associated with gallstones and why?
Crohn's Bile acids are not properly absorbed as terminal ileum is affected
29
In which form of IBD can surgery be curative?
UC
30
Recall the possible extra-intestinal manifestations of IBD
``` A PIE SAC Aphthous ulcers Pyoderma gangrenosum (skin ulcers) I (eye) = uveitis, iritis, episcleritis Erythema nodosum Sclerosing cholangitis (UC Only) Arthritis Clubbing (Crohn's moreso) ```
31
Describe the process of inducing remission in Crohn's
Steroids: If mild: oral prednisolone If severe: IV hydrocortisone If no improvement after 5 days --> infliximab Oral budesonide can be used in disease between the distal ileum and the ascending colon Nutritional: Replace diet with whole protein modular diet - excessively liquid, for 6-8 weeks - this helps to replace lost weight
32
Describe the process of maintaining remission in Crohn's
First line: DMARDs (eg azothioprine) Alternatives: infliximab/ aminosalicylates
33
Mx of acute severe UC
Admit 1st: IV Hydrocortisone or Methylprednisolone 2nd: anti-TNF (ciclosporin/ infliximab) If severe intractable colitis: Colectomy
34
Induction of remission of moderate-severe UC
Prednisolone/ Budesonide PO or Infliximab/ Adalimumab +/- Azathioprine
35
Induction of remission of mild-moderate UC
Proctitis: Mesalazine TOP (rectal) Left sided: Mesalazine TOP + PO +/- Budesonide PO Extensive: Mesalazine PO +/- Prednisolone/ Budesonide PO
36
Maintenance of remission in mild-moderate UC
Mesalazine TOP alone (daily or intermittent) or Mesalazine PO + TOP (daily or intermittent)
37
Maintenance of remission in mild left sided and extensive UC
Mesalazine PO
38
Maintenance of remission in moderate to severe UC / if >2 flare-ups in 1y
Thiopurine: Azathioprine or Mercaptopurine PO or Biologic: Infliximab IV or Adalimumab SC
39
What is the main side effect of aminosalicylates to remember?
Acute pancreatitis
40
What are the options for surgery in UC?
Emergency: Hartmann's protosigmoidectomy + end ileostomy --> later IPAA (ileal-pouch ana anastomosis) Non-emergency: Protocolectomy + IPAA or Panprotocolectomy + end ileostomy
41
What are the criteria used to diagnose IBS?
It's a diagnosis of excusion based on the ROME III criteria: - Improvement with defaecation - Change in stool frequency - Change in stool form/ appearance/ consistency
42
Recall the grading of haemarrhoids
1st: in rectum after defaecation 2nd: prolapse at defaecation, spontaneous reduction 3rd: prolapse at defaecation, manual reduction 4th: persistently prolapsed
43
What is the first line management of haemorrhoids?
Increased fruit/ fibre Stool softener Topical analgesics Topical steroids (suppository)
44
Recall some non-operative ways of managing haemorrhoids?
Rubber-band ligation Sclerotherapy Electrotherapy Infrared coagulation
45
Recall 3 surgical options for managing haemorrhoids
Haemarrhoidectomy Haemorrhoidopexy HALO (haemorrhoidal artery ligation operation)
46
What is the standard treatment for C diff enterocolitis?
PO vancomycin 2nd line fidaxomicin If severe/unresponsive --> IV vanc + met
47
Which bacteria demonstrates "tumble weed motility"?
Listeria monocytogenes
48
How can listeria gastroenteritis be treated?
Amoxicillin/ ampicillin
49
Which 3 antibiotics are most associated with causing C diff enterocolitis?
Cephalosporin Clindamycin Ciprofloxacin
50
Which gastroenteritis-causing pathogen is associated with undercooked seafood?
Vibrio parahaemolyticus
51
Which gastroenteritis-causing pathogen is associated with shellfish handlers?
Vibrio vulnificus (in immunocompetent usually causes cellulitis/ nec. fasciitis)
52
Recal the site of absorption of iron, folate and B12
Iron: Duodenum Folate: Jejunum B12: Ileum
53
Which skin condition is pathognomonic for coeliac disease?
Dermatitis herpetiformis
54
Describe the appearance of stool in coeliac disease
Waterey, grey, frothy
55
What system is used to grade coeliac disease?
Marsh system
56
Recall some typical histological findings in coeliac disease
Villous atrophy and crypt hyperplasia
57
Recall the name of the scoring system used to diagnose appendicitis and its components
Alvarado score: Signs: RLQ tenderness (+2) Fever Rebound tenderness Symptoms: Anorexia Nausea/vomiting Pain migration to RLQ Lab: Leucocytosis (WBC > 10,000) (+2) Left shift (>75% neutrophils)
58
Recall some eponymous signs on examination that are indicative of appendicitis
Rovsing's sign: Pain greater in RIF than LIF when LIF pressed Cope's sign: Pain on passive flexion and internal rotation of the hip
59
What does rebound tenderness indicate about appendicitis?
That it involves peritoneum
60
What sign can be used to demonstrate a retrocaecal appendix?
Pain on extending hip (Psoas sign)
61
How should an un-perforated appendix be managed?
Prophylactic antibiotics followed by laparoscopic appendectomy
62
How should a perforated appendix be managed?
Abdominal lavage
63
What is "Amirand's triangle"?
Triad of conditions that predisposes to gallstone disease: Low lecithin Low bile salts High cholesterol
64
How can the symptoms of cholecystitis and cholangitis be differentiated?
``` Cholecystitis = no jaundice Cholangitis = obstructive jaundice ```
65
How can the symptoms of cholecystitis and biliary colic be differentiated?
Biliary colic = RUQ pain | Cholecystitis = RUQ pain + fever
66
What is Charcot's triad?
Triad of classical symptoms of ascending cholangitis Jaundice RUQ pain fever
67
What is Reynauld's pentad?
``` Pentad of classical symptoms of severe ascending cholangitis Jaundice RUQ pain Fever Hypotension Confusion ```
68
Within what time frame should a laparoscopic cholecystectomy be performed for cholecystitis?
1 week (use antibiotics whilst waiting)
69
What is "Mirizzi syndrome"?
Impaction of common hepatic duct by a GB stone
70
What is the pathophysiology of "porcelain gallbladder"?
Chronic cholecystitis can --> calcification of GB walls
71
Recall some complications of acute cholecystitis
``` Chronic diarrhoea (GB removal --> more bile reaches large intestine --> more water and salt draw into bowel) Vitamin ADEK malabsorption (can --> bleeding due to less 2,7,9,10 production) ```
72
What is a SeHCAT study?
Selenium in Homocholic Acid Taurine - assesses bile acid retention to see if this is cause of diarrhoea
73
How can diarrhoea post-cholecystectomy be managed?
Cholestyramine (binds to bile acids and makes the biologically inactive)
74
How can ascending cholangitis be managed?
IV antibiotics followed by therapeutic ERCP within 48 hours
75
What are the key symptoms of cholangiocarcinoma?
Palpable gallbladder, obstructive jaundice
76
What is the gold-standard investigation for staging cholangiocarcinoma?
ERCP
77
Recall and compare the symptoms of PBC vs PSC
PBC: Pruritis, obstructive jaundice, RUQ pain in 10%, hyperholesterolaemia PSC: Pruritis, obstructive jaundice, steatorrhoea, splenomegaly
78
How can features of PBC be remembered?
The M rule: IgM anti-Mitochondrial antibodies, M2 subtype Middle aged females
79
Recall and compare the antibodies involved in PBC vs PSC
PBC: AMA PSC: p-ANCA
80
Recall and compare the best way to investigate PBC vs PSC
PBC: cholestatic liver biochemistry and AMA blood test (biopsy is diagnostic but often not carried out) PSC: MRCP is preferred to start (rosary sign), then p-ANCA + BIOPSY ('onion skin' appearance of obliterated cholangitis)
81
Recall and compare the management approaches for PBS vs PSC
PBS: ursodeoxycholic acid + cholestyramine + prednisolone for associated autoimmune disease PSC: observation --> liver transplant
82
What % of patients with PSC get cholangiocarcinoma?
10%
83
Which autoimune gallbladder disease is associated with IBD?
PSC (ulcerative colitis)
84
How are the 3 types of autoimmune hepatitis characterised?
T1: high titres of ANA or ASMA - adults and children T2: Anti-LKM-1,2,3 - affects children T3: Anti-SLA (soluble liver antigen) - middle age
85
What are the key symptoms of autoimmune hepatitis?
Amenorrhoea | Chronic liver disease OR acute hepatitis
86
Which type of autoimmune gallbladder disease can affect extrahepatic ducts?
PSC
87
How is autoimmune hepatitis managed?
Steroids + azothioprine | Eventual liver transplantation
88
What are the 4 signs of portal hypertension?
``` SAVE Splenomegaly Ascites Varices Encephalopathy ```
89
What is the triad of symptoms of Wernicke's encephalopathy?
Ataxia Confusion Ophthalmoplegia
90
Recall the mainstay of management for hepatic vs wernicke's encephalopathy
Hepatic encephalopathy: lactulose + rifaximin | Wernicke's encephalopathy: thiamine, magnesium, folic acid
91
What are the principles of managing ascites?
Diet: restrict EtOH and fluids, daily weights Diuretics: spironolactone (+/- furosemide) Prophylaxis (for SBP): ciprofloxacin + propranolol For refractory disease: TIPPS/ transplant
92
What is an abdominal paracentesis procedure used to treat?
Tense ascites
93
What is the most common pathogen in SBP?
E coli
94
What investigation is used to confirm ascites?
USS abdomen
95
How can SBP be confirmed?
Ascitic tap with PMN>250 and MC+S
96
What drugs are used to treat vs as prophylaxis for SBP
Treatment: piptazobactam/cefotaxime Prophylaxis: ciprofloxacin + propranolol
97
When should SBP prophylaxis be started?
Ascites protein <15g/L
98
What is the screening test for haemachromatosis?
Transferrin saturation - >55% in males and >50% in females may indicate further investigation
99
What stain can be used on liver biopsy to identify haemachromatosis?
Perl's stain
100
What is the 1st and 2nd line management for haemachromotosis?
1st line: Venesection | 2nd line: Desferrioxamine
101
Describe the typical presentation of NAFLD
Acute weight loss followed by jaundice
102
Recall the order in which you would order investigations for NAFLD
1st: LFTs (ALT will be > AST) 2nd: USS (will show increased echogenicity) 3rd: Enhanced Liver Fibrosis (ELF) panel OR a fibroscan 4th: Liver biopsy
103
What are the components of an ELF panel?
Hyaluronic acid Procollagen III Tissue inhibitor of metalloproteinase 1
104
What is the mainstay of management for NAFLD?
Lifestyle changes and wt loss
105
What are the classical symptoms of acute pancreatitis?
Severe epigastric pain radiating through to back with nausea and vomiting
106
What is Cullen's sign and what diagnosis does it support?
Cullen's sign = "superficial oedema with bruising in the subcutaneous fatty tissue around the peri-umbilical region" Indicative of acute pancreatitis
107
What is Grey Turner's sign and what diagnosis does it support?
Grey-Turner's sign = flank bruising | Indicative of acute pancreatitis
108
How raised is serum amylase likely to be in acute pancreatitis?
>3 times the upper limit of normal (in 75% of patients)
109
What is the most specific marker for acute pancreatitis that will be raised in the blood?
Serum lipase
110
What criteria are used to grade severity of acute pancreatitis?
Glasgow-Imrie
111
What criteria are used to estimate prognosis in acute pancreatitis?
``` PANCREAS PaO2 <8 Age >55 Neutrophils >15 Calcium <2 Renal urea >16 Enzymes (LDH>600, AST/ALT >200) Albumin <32 Sugar >10 ```
112
How long does an acute episode of pancreatitis have to last for to be considered 'severe'?
>48 hours
113
Recall and differentiate between the management of acute pancreatitis vs necrotising pancreatitis?
For both: Fluids, analgesia (stat boluses of IV morphine until comfortable), enteral feeding maintained, correct the cause Only if necrotising: antibiotics
114
Recall some possible early complications of acute pancreatitis
Haemorrhage SIRS/ARDS Hyperglycaemia (see pancreas critera) Hypocalcaemia (see pancreas criteria)
115
Recall some possible late complications of acute pancreatitis
25% --> peri-pancreatic fluid collection Pseudocysts (appear at around 4w) Pancreatic abscess (infected pseudocyst) Pancreatic necrosis
116
What % of chronic pancreatitis is due to alcohol excess?
80%
117
What are the signs and symptoms of chronic pancreatitis?
Symptoms: epigastric pain, typically worse 15-30 mins post-prandially Signs: Steatorrhoea, diabetes
118
What investigations can be done in suspected chronic pancreatitis?
USS for gallstones Contrast-enhanced CT Faecal elastase (measures exocrine function) Screen for diabetes and osteoporosis
119
What is faecal elastase used to measure?
Exocrine function
120
What histological type of cancer are 80% of pancreatic cancers?
Adenocarcinomas
121
What is the classical presentation of pancreatic cancer?
Painless obstructive jaundice, painless palpable gallbladder (courvoisier's law), FLAWS Symptoms of lost exocrine/endocrine function
122
What is trousseau's sign of malignancy, and in which types of cancer is it sometimes observed?
Migratory superficial thrombophlebitis (moves from one leg to the other) Strongly associated with adenocarcinoma of the pancreas and lung
123
What is the pathognemonic sign on High Resolution CT for head of the pancreatic/bile duct cancer?
"Double duct" sign | Shows simultaneous dilation of CBD and pancreatic duct
124
What is the definitive management of pancreatic cancer?
Whipple's procedure | Pancreaticoduodenectomy
125
What are the common complications of Whipple's procedure?
``` Dumping syndrome (gastric emptying of contents into duodenum too fast) PUD (if delayed gastric emptying instead of dumping syndrome) Bile/pancreatic link ```
126
What is the non-surgical management of pancreatic cancer (eg if metastatic/ unsuitable for resection)?
ERCP with stenting
127
What classification is used for diverticular disease?
Hinchey classification
128
What is the investigation of choice for: a) acute diverticulitis b) chronic diverticular disease?
a) CT abdomen | b) barium enema (can't do in acute phase as may cause perforation)
129
How does the management of mild and severe diverticular disease differ?
Medical: Mild: PO antibiotics Severe: IV antibiotics (cef + met) + drip and suck (due to BO) + soluble, high-fibre diet Surgical (only if severe) Hartmann's --> primary anastomosis
130
Recall some indications for an urgent (2ww) OGD on suspicion of gastric/oesophageal malignancy?
Dyspepsia Upper abdominal mass Age >55 AND weight loss AND any of dyspepsia/GORD/upper abdo pain nb if no weight loss --> NON-urgent OGD
131
What is the gold standard test for diagnosis of GORD?
24 hour oesophageal pH monitoring
132
What is the mechanism by which H pylori vs GORD produce dyspepsia?
H pylori --> ulcers --> dyspepsia | GORD --> dyspepsia
133
What are the 3 ways in which you can test for H pylori?
1. Carbon-13 urea breath test 2. Stool antigen test 3. Lab-based serology
134
What is the mainstay of management for H pylori?
Clarithromycin, amoxicillin, PPI
135
How does the medical management differ between endoscopically-proven vs endoscopically-negative GORD?
Proven: 2 months PPI trial followed by 1 month trial of double dose, 2nd line = add H2-RA Negative: 1 month trial of PPI, 2nd line = H2-RA
136
What is the surgical management option for refractory GORD?
Nissen fundoplication
137
What are the most common complications of nissen fundoplication?
Gas-bloat syndrome (can't belch/vomit) | Dysphagia (if wrap is too tight)
138
What is Maddrey's discriminant function?
For alcoholic hepatitis: | Predicts prognosis and who will benefit from steroids
139
What score is used to stage liver cirrhosis?
Childs Pugh
140
What is Budd Chiari syndrome and how is it classified?
Syndrome caused by blockage of the hepatic vein Type 1 = thrombosis Type 2 = tumour occlusion
141
What are the possible signs and symptoms of Budd-chiari syndrome?
Abdominal pain, ascites, tender hepatomegaly
142
What is the gold standard investigation for budd-chiari syndrome?
Abdominal USS with doppler
143
What are the 3 best investigations when suspecting achalasia?
LOS manometry Barium swallow CXR
144
Recall some signs and symptoms of the carcinoid syndrome, and recall which hormone is responsible for these symptoms
Flushing, diarrhoea, bronchospasm, hypotension, pulmonary stenosis, pellagra, endocrine over-function Serotonin
145
What 2 investigations can be used to investigate the carcinoid syndrome?
Urinary 5-HIAA | Plasma chromogranin A y
146
What is the first line management for the carcinoid syndrome?
Somatostatin analogues eg octreotide
147
Recall some antibiotics that may predispose to C diff infection
``` Amoxicillin Ampicillin Cephalosporin (eg cefuroxime, ceftriaxone) Clindamycin Co-amoxiclav Quinolones ```
148
Recall the management of C diff colitis
1st episode: oral metronidazole 2nd episode/ severe 1st: oral vancomycin Life-threatening/ ileus: oral vancomycin + IV metronidazole ALL antibiotics over 10-14 day period
149
Recall 3 risk factors for small bowel overgrowth
Neonates with congenital abnormalities Diabetes mellitus Scleroderma
150
Recall the signs and symptoms of small bowel overgrowth
Very similar to IBS Chronic diarrhoea Bloating and flatulence Abdominal pain
151
Recall 3 ways of investigating for a small bowel overgrowth
Hydrogen breath test Folate (will be high as bacteria produce it) Diagnostic course of antibiotics
152
What is the usual first line antibiotic for small bowel overgrowth?
Rifamixin
153
What is Mackler's triad?
The triad of symptoms seen in Boerhaave's syndrome: Chest pain Vomiting Subcutaneous emphysema
154
In PUD, which artery is most likely to be a major source of bleeding?
Gastroduodenal artery
155
When should opioid analgesia NOT be used following major abdominal surgery, and what alternative should be used?
In respiratory disease eg COPD | Alternative is epidural anaesthesia
156
How should autoimmune hepatitis be treated?
30mg prednisolone PO, followed by introduction of azothioprine MUST have confirmation of diagnosis from biopsy first unless there is a CI to biopsy
157
How long does autoimmune hepatitis need to be treated for?
At least 2 years after blood results normalise before discontinuing therapy
158
How should benign peptic strictures be managed?
PPI to treat underlying GORD | Balloon dilatation following benign biopsy
159
What is the most common complication of balloon dilatation of a peptic stricture?
Oesophageal rupture (which may cause mediastinitis)
160
How can oesophageal rupture be imaged best?
CT with oral contrast
161
Recall some extra-articular manifestations of UC - saying which are related to disease activity and which are not
``` Examples of extra-intestinal conditions related to activity of colitis: Erythema nodosum Aphthous ulcers Episcleritis Anterior uveitis Acute arthropathy ``` Not related to activity of colitis: Sacroiliiitis /Ankylosing spondylitis Primary sclerosing cholangitis (info from capsule case 202)
162
What is the 1st line management for acute severe ulcerative colitis?
IV hydrocortisone
163
How can blood glusose be used to assess liver function?
Assesses synthetic function
164
How should variceal bleeds be managed when there is haemodynamic instability?
1. Fluid resuscitation with blood transfusion 2. IV vasopressin analogue eg terlipressin 3. IV antibiotics 4. Refer to endoscopy nb. No IV PPI given prior to endoscopy
165
What is the best surgical management for bleeding varices?
Band ligation or sclerotherapy
166
What is the most appropriate long term management of varices?
Non-cardioselective beta blocker
167
If variceal bleeding cannot be stopped with ligation, how can it be managed?
Insertion of Sengstaken Blakemore tube
168
What are the 5 components of the Childs Pugh score?
``` Serum bilirubin Serum albumin Prothrombin time Presence of ascites Presence of encephalopathy ```
169
Recall some differentials for the cause of ascites depending on whether the SAAG is low or high
High: portal HTN secondary to cirrhosis/ alcoholic hepatitis/ heart failure/ portal vein thrombosis Low: peritoneal cause eg. malignancy, infections, pancreatitis and nephrotic syndrome
170
If someone has a diagnostic ascitic tap, what 7 tests should the fluid be sent for?
``` Culture and sensitivity Cytology LDH Glucose Total protein content Albumin concentration Cell count and differential ```
171
Which 2 investigations are best for imaging chronic pancreatitis?
CT | MRCP
172
Recall 2 drugs and 2 drug classes that can cause drug-induced liver damage
Roziglitazone Flucloxacillin Macrolides Statins
173
When is mesenteric angiography used?
To find the source of a GI bleed when endoscopy cannot do so
174
What is the programme for screening for hepatocellular carcinoma?
In patients with cirrhosis, ultrasound every 6 months with additional CT/MRI if focal lesions seen on USS
175
What is BAM?
Bile acid malabsorbption Bile acids enter colon --> too many bile acids in colon --> profuse waterey diarrhoea Should be halted by fasting
176
Recall some examples of secretory diarrhoea
C diff E coli 157 Cholera Neuroendocrine tumours eg vasointestinal peptide-oma --> profound hypokalaemia without being fasted
177
Recall 3 examples of inflammatory diarrhoea
UC Crohn's Shigella
178
Recall 4 examples of diarrhoea due to abnormal motility
Hyperthyroidism Autonomic neuropathy (in DM) Stimulant laxatives eg senna IBS
179
What is the histological finding of "owl's eyes" pathognemonic for?
CMV
180
What is Zollinger Ellison syndrome?
A rare digestive disorder caused by a neuroendocrine tumour that produces gastrin which leads to excess gastric acid. This excess gastric acid can cause peptic ulcers in the stomach and intestine
181
How should autoimmune hepatitis be treated (broadly)?
Prednisolone and azothioprine
182
How to choose ERCP vs MRCP?
ERCP is only now used as a therapeutic test - do this if worried about cancer (to take samples) or if there is something you can stent MRCP is purely diagnostic (eg for PSC, see beading)
183
Recall 3 GI causes of clubbing
GI malignancy IBD Chronic liver disease
184
What is the cause of leukonychia?
Hypoalbuminaemia
185
Recall 3 differentials for hepatomegaly
Hepatitis NAFLD Haematological malignancy
186
How can you tell the spleen and kidney apart on palpation, apart from location?
``` Spleen: Moves down with inspiration You cannot get above it Has a notch Dull to percussion Not ballotable ```
187
Recall 3 differentials for splenomegaly
Haematological malignancies Alcohol misuse Primary sclerosing cholangitis
188
Recall 3 differentials for enlarged kidneys
Renal vein thrombosis (usually UL) Obstructive uropathy PCKD
189
Recall 3 causes of ascites
Portal hypertension Constrictive pericarditis Ovarian malignancy
190
Recall some causes of cholestasis
Pancreatic cancer physically obstructing the gut PBC (nb AMA pos, high IgM) Chronic active hepatitis (anti-nuclear factor pos, high IgG)
191
What drugs must be stopped to make a carbon13 Urea breath test reliable?
Amoxicillin 4w prior | PPI 2w prior
192
What is the difference in the metabolic derangement that can be caused by diarrhoea vs vomiting?
Diarrhoea: normal anion gap acidosis Vomiting: alkalosis
193
What vaccine is given every 5 years in coeliac disease?
Pneumococcal
194
How should a mild-moderate flare of UC be managed?
In a mild-moderate flare of ulcerative colitis extending past the left-sided colon, oral aminosalicylates should be added to rectal aminosalicylates, as enemas only reach so far (Passmed)
195
What medication change is required for gastroscopy?
Stop PPI (eg omeprazole) 2w before procedure
196
How should nutrition be managed in acute pancreatitis?
All patients with moderate to severe acute pancreatitis should be offered enteral nutrition (eg normal feeding or ng tube if needed) within 72 hours. They should only be offered parenteral nutrition if they cannot tolerate food (eg profuse vomiting).
197
How can Crohn's increase the risk of gallstones?
Terminal ileitis can reduce bile salt resorption
198
In which patients with sigmoid volvulus would you NOT treat with a therapeutic flexible sigmoidoscopy?
In patients with sigmoid volvulus who have bowel obstruction with symptoms of peritonitis
199
If mild/mod C difficile does not respond to oral vancomycin, what should be used 2nd line?
Oral fidaxomicin | If more severe infectiom = oral vancomycin + IV metronidazole
200
How should high grade dysplasia in Barret's oesophagus be managed?
Endoscopic ablation
201
What are the grades of hepatic encaphalopathy?
Grade I: Irritability Grade II: Confusion, inappropriate behaviour Grade III: Incoherent, restless Grade IV: Coma
202
How might subcutaneous emphysema appear on examination?
Mild crepitus in the epigastric region
203
What are the 2 most important blood tests for monitoring haemachromatosis?
Ferritin and transferrin saturation
204
How is alcoholic ketoacidosis managed?
Infusion of thiamine and saline
205
What is the limit of protein concentration in ascites for giving antibiotic prophylaxis, and what antibiotic is used?
Give antibiotics if protein concentration <15g/L | Abx of choice = ciprofloxacin
206
If coeliac needs to be confirmed by biopsy, what is biopsied?
Jejunum

YR6 Rotations (22 decks)

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