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Passmed - Gastro Flashcards

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1
Q

Metabolic alkalosis + hypokalaemia →

A

? Prolonged vomiting

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2
Q

Metabolic alkalosis causes?

A

vomiting / aspiration
(e.g. peptic ulcer leading to pyloric stenos, nasogastric suction)
vomiting may also lead to hypokalaemia
diuretics
liquorice, carbenoxolone
hypokalaemia
primary hyperaldosteronism
Cushing’s syndrome
Bartter’s syndrome

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3
Q

Metabolic alkalosis?

A

Metabolic alkalosis may be caused by a loss of hydrogen ions or a gain of bicarbonate. It is due mainly to problems of the kidney or gastrointestinal tract

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4
Q

PPI adverse effects?

A

hyponatraemia, hypomagnasaemia
osteoporosis → increased risk of fractures
microscopic colitis
increased risk of C. difficile infections

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5
Q

Loperamide, a mu-receptor agonist anti-diarrhoeal agent, adverse effects?

A

dry mouth, constipation and dizziness

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6
Q

Beta blocker adverse effects?

A

bronchospasm, cold peripheries and fatigue

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7
Q

Primary sclerosis cholangitis investigation?

A

MRCP

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8
Q

Pancreatic cancer features?

A

classically painless jaundice (pale stools, dark urine, and pruritus; cholestatic liver function tests)
Abdominal mass
Often non-specific way with anorexia, weight loss, epigastric pain
loss of exocrine function (e.g. steatorrhoea)
loss of endocrine function (e.g. diabetes mellitus)
atypical back pain is often seen
migratory thrombophlebitis (Trousseau sign) more common than with other cancers

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9
Q

Pancreatic cancer abdo masses that may be found (in decreasing order of frequency):

A

hepatomegaly - due to metastases
gallbladder - Courvoisier’s law states that in the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones
epigastric mass - from the primary tumour

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10
Q

Double duct sign?

A

Pancreatic cancer

the presence of simultaneous dilatation of the common bile and pancreatic ducts

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11
Q

Pancreatic cancer investigations?

A

USS (60-90% sensitivity)
HRCT scanning is investigation of choice if the diagnosis is suspected
imaging may demonstrate the ‘double duct’ sign - the presence of simultaneous dilatation of the common bile and pancreatic ducts

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12
Q

Pancreatic cancer management?

A

less than 20% are suitable for surgery at diagnosis
a Whipple’s resection (pancreaticoduodenectomy) for resectable lesions in the head of pancreas.
adjuvant chemotherapy is usually given following surgery
ERCP with stenting is often used for palliation

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13
Q

Whipple’s resection

A

(pancreaticoduodenectomy) is performed for resectable lesions in the head of pancreas.

Side-effects - dumping syndrome and peptic ulcer disease

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14
Q

Coeliac disease management?

A

Avoid gluten
Immunisation (due to hyposplenism)

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15
Q

Coeliac disease investigations?

A

tTG-IgA Test
+ IgA antibody

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16
Q

Iron defiency anaemia vs. anaemia of chronic disease

A

TIBC is high in IDA, and low/normal in anaemia of chronic disease

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17
Q

Anaemia of chronic disease bloods?

A

normochromic/hypochromic, normocytic anaemia
reduced serum and TIBC
normal or raised ferritin

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18
Q

Iron deficiency anaemia bloods?

A

TIBC raised
Ferritin low

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19
Q

first line antibiotic for use in patients with C. difficile infection

A

Oral vancomycin

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20
Q

life-threatening C. difficile infection treatment

A

ORAL vancomycin and IV metronidazole

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21
Q

life-threatening C. difficile infection treatment

A

ORAL vancomycin and IV metronidazole

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22
Q

IBS considered if following symptoms for 6 months: ABC

A

Abdominal pain, and/or
Bloating, and/or
Change in bowel habit

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23
Q

A positive diagnosis of IBS should be made if the patient has…

A

abdominal pain relieved by defecation or associated with altered bowel frequency stool form, in addition to 2 of the following 4 symptoms:
- altered stool passage (straining, urgency, incomplete evacuation)
- abdominal bloating (more common in women than men), distension, tension or hardness
- symptoms made worse by eating
- passage of mucus

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24
Q

Primary care investigations for IBS?

A

full blood count
ESR/CRP
coeliac disease screen (tissue transglutaminase antibodies)

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25
Primary biliary cholangitis - the M rule
IgM anti-Mitochondrial antibodies, M2 subtype Middle aged females
26
Most important intervention to stop further Crohn’s episodes?
Smoking cessation
27
A severe flare of ulcerative colitis should be treated…
in hospital with IV corticosteroids
28
Adenocarcinoma is now the most common type of oesophageal cancer and is more likely to develop in patients with a history of…
gastro-oesophageal reflux disease (GORD) or Barrett's.
29
gold standard for diagnosis of coeliac disease
Endoscopic intestinal biopsy
30
Coeliac -> koilonychia?
Koilonychia = sign of hypochromic anemia (esp iron-def) Bloating, fatigue, foul-smelling and greasy stools combined with her elevated serum anti-tTG levels = coeliac disease -> malabsorption in the gut due to villous atrophy -> iron-def anaemia because dietary iron is not adequately absorbed. Iron deficiency -> koilonychia.
31
metastatic HCC treatment?
Sorafenib
32
Mesenterio ischaemia triad?
CVD, high lactate and soft but tender abdomen
33
first-line in maintain remission in ulcerative colitis patients with proctitis and proctosigmoiditis?
A topical (rectal) aminosalicylate +/- an oral aminosalicylate is used E.g. topical mesalazine
34
first-line medication for primary biliary cholangitis?
Ursodeoxycholic acid
35
mainstay of treatment in haemochromatosis
Regular venesection desferrioxamine may be used second-line
36
mild-to-moderate exacerbation of left-sided ulcerative colitis management?
topical (rectal) mesalazine or sulphasalazine - topical aminosalicylates
37
Severe ulcerative colitis management?
IV steroids (IV ciclosporine if steroids contraindicated)
38
HBsAg positive, anti-HBs negative, IgM anti-HBc positive
Acute hepatitis B
39
Courvoisier's law
A palpable, non tender, enlarged gallbladder accompanied with painless jaundice is unlikely to be due to gallstones. Instead consider malignancy
40
HBsAg negative, anti-HBs positive, IgG anti-HBc positive
previous infection, not a carrier (vaccine would only lead to anti-HBs antibodies)
41
C. diff management?
first-line therapy is oral vancomycin for 10 days second-line therapy: oral fidaxomicin third-line therapy: oral vancomycin +/- IV metronidazole Life-threatening - oral vancomycin AND IV metronidazole
42
Aminosalicylates?
Sulphasalazine, mesalazine, olsalazine variety of haematological adverse effects, including agranulocytosis
43
The following drugs tend to cause a hepatocellular picture:
paracetamol sodium valproate, phenytoin MAOIs halothane anti-tuberculosis: isoniazid, rifampicin, pyrazinamide statins alcohol amiodarone methyldopa nitrofurantoin
44
The following drugs tend to cause cholestasis (+/- hepatitis):
combined oral contraceptive pill antibiotics: flucloxacillin, co-amoxiclav, erythromycin* anabolic steroids, testosterones phenothiazines: chlorpromazine, prochlorperazine sulphonylureas fibrates rare reported causes: nifedipine
45
Patients with ascites secondary to liver cirrhosis should be given
an aldosterone antagonist e.g. spironolactone
46
Positive anti-HBc IgG, negative anti-HBc IgM and negative anti-HBc in the presence of HBsAg
chronic HBV infection
47
Coeliac disease increases the risk of developing
anaemia hyposplenism osteoporosis, osteomalacia lactose intolerance enteropathy-associated T-cell lymphoma of small intestine subfertility, unfavourable pregnancy outcomes
48
Antinuclear antibodies, anti-smooth muscle antibodies and raised IgG levels
autoimmune hepatitis
49
Type I autoimmune hepatitis?
Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA) Affects both adults and children
50
Type II autoimmune hepatitis?
Anti-liver/kidney microsomal type 1 antibodies (LKM1) Affects children only
51
Type III autoimmune hepatitis?
Soluble liver-kidney antigen Affects adults in middle-age
52
Alcoholic hepatitis management?
Glucocorticoids (e.g. prednisolone)
53
diagnostic investigation of choice for pancreatic cancer
High-resolution CT scanning
54
investigation of choice for suspected perianal fistulae in patients with Crohn's
MRI
55
Liver failure triad?
encephalopathy, jaundice and coagulopathy
56
Acute liver failure features?
jaundice coagulopathy: raised prothrombin time hypoalbuminaemia hepatic encephalopathy renal failure is common ('hepatorenal syndrome')
57
In life-threatening C. difficile infection treatment is with
ORAL vancomycin and IV metronidazole
58
key investigation for a suspected perforated peptic ulcer
Erect chest x ray
59
Overflow diarrhoea =
type 7 stools with intermittent hard stools. Treat with faecal disimpaction
60
MSH2/MLH1 gene mutations are associated with
hereditary non-polyposis colorectal carcinoma
61
Early signs of haemochromatosis are
fatigue, erectile dysfunction and arthralgia
62
Vomiting / aspiration ABG
metabolic alkalosis
63
Hepatic encephalopathy management?
Lactulose
64
Primary biliary cholangitis - the M rule
IgM anti-Mitochondrial antibodies, M2 subtype Middle aged females
65
Crypt abscesses associated with?
UC
66
? may be useful for diagnosing and monitoring the severity of liver cirrhosis
Transient elastography
67
The AST/ALT ratio in alcoholic hepatitis is
2:1
68
Raised transferrin saturation and ferritin, with low TIBC is the characteristic iron study profile
in haemochromatosis
69
Early signs of haemochromatosis are…
fatigue, erectile dysfunction and arthralgia
70
A combination of liver and neurological disease points towards
Wilson's disease
71
x should be co-administered with isoniazid to prevent y
x - Pridoxine (vitamin B6) y - peripheral neuropathy
72
UC mild:
< 4 stools/day, only a small amount of blood
73
moderate UC
moderate: 4-6 stools/day, varying amounts of blood, no systemic upset
74
Severe UC
severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
75
Severe UC management
IV corticosteroids (hydrocortisone or methylprednisolone) in order to induce remission
76
upper gi bleed vs lower gi bleed urea
high can suggest upper
77
In an acute upper GI bleed, the x can identify low risk patients who may be discharged
Glasgow-Blatchford score
78
If a patient with ulcerative colitis has had a severe relapse or >=2 exacerbations in the past year they should be given either
oral azathioprine or oral mercaptopurine to maintain remission
79
Positive anti-HBc IgG, negative anti-HBc IgM and negative anti-HBc in the presence of HBsAg implies
chronic HBV infection
80
HBsAg positive, anti-HBs negative, IgM anti-HBc positive
acute infection
81
SAAG > 11g/L - indicates x
x = portal hypertension
82
causes of SAAG >11g/L (transudate)
Portal hypertension Liver disorders most common cause - cirrhosis/alcoholic liver disease, acute liver failure, liver mets Cardiac - right heart failure, constrictive pericarditis Other - Budd-Chiari syndrome, portal vein thrombosis, veno-occlusive disease, myxoedema
83
Causes of SAAG <11g/L (exudate)
Hypoalbuminaemia nephrotic syndrome severe malnutrition (e.g. Kwashiorkor) Malignancy - peritoneal carcinomatosis Infections - tuberculous peritonitis Other - pancreatitis, bowel obstruction, biliary ascites, postoperative lymphatic leak, serositis in connective tissue diseases
84
transudate vs exudate SAAG?
transudate = SAAG >11g/L exusate = SAAG <11g/L
85
Ciprofloxacin and omeprazole are high-risk for
Clostridium difficile
86
Patients with Crohn's who develop a perianal abscess require
incision and drainage
87
x is the only test recommended for H. pylori post-eradication therapy
Urea breath test
88
H. pylori eradication:
PPI + amoxicillin + clarithromycin, or PPI + metronidazole + clarithromycin
89
Primary sclerosing cholangitis can have positive
p-ANCA
90
A non-cardioselective B-blocker (NSBB) is used for the prophylaxis of
oesophageal bleeding
91
Haemochromatosis inheritance pattern
autosomal recessive
92
signet ring cells
Gastric adenocarcinoma
93
Surgical treatment of achalasia
Heller cardiomyotomy
94
Iron defiency anaemia vs. anaemia of chronic disease:
TIBC is high in IDA, and low/normal in anaemia of chronic disease
95
Budd-Chiari syndrome presents with the triad of
sudden onset abdominal pain, ascites, and tender hepatomegaly
96
Acute mesenteric ischaemia causes a raised
lactate
97
Metabolic alkalosis + hypokalaemia →
?prolonged vomiting
98
If a patient with ulcerative colitis has had a severe relapse or >=2 exacerbations in the past year they should be given either
oral azathioprine or oral mercaptopurine to maintain remission
99
Histology of coeliac disease:
villous atrophy, raised intra-epithelial lymphocytes, and crypt hyperplasia
100
Ferritin is low in iron deficiency anaemia but x in anaemia of chronic disease
high or normal
101
x with biopsy is the investigation of choice for suspected gastric cancer
Oesophago-gastro-duodenoscopy
102
x are the investigations of choice in primary sclerosing cholangitis
ERCP/MRCP
103
Positive anti-HBc IgG, negative anti-HBc IgM and negative anti-HBc in the presence of HBsAg implies x
chronic HBV infection
104
Both x should be given before endoscopy in patients with suspected variceal haemorrhage
terlipressin and antibiotics
105
x is the second most common association of HNPCC after colorectal cancer
Endometrial cancer
106
Bleeding on dabigatran? Can use x to reverse
idarucizumab
107
x is a treatment option for patients with metastatic HCC
Sorafenib
108
x are more useful than gastric parietal cell antibodies when investigating vitamin B12 deficiency, given low specificity of gastric parietal cell antibodies
Intrinsic factor antibodies
109
Peptic ulceration, galactorrhoea, hypercalcaemia -
multiple endocrine neoplasia type I
110
Barrett's oesophagus: x is the preferred treatment for low-grade dysplasia
radiofrequency ablation
111
If a patient with ulcerative colitis has had a severe relapse or >=2 exacerbations in the past year they should be given either
oral azathioprine or oral mercaptopurine to maintain remission
112
x is useful in the management of Crohn's patients who develop a perianal fistula
Oral metronidazole
113
First-line pharmacological management of acute constipation is x
a bulk-forming laxative such as isphagula husk
114
X is used first-line to maintain remission in patients with Crohn's
Azathioprine or mercaptopurine

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