3. Upper GI Disease Flashcards
1
Q
Diff btw oropharyngeal and oesophageal dysphagia
A
Oropharyngeal ⇒ can’t bring food from the mouth to the oesophagus ( ENT rather than gastro), diff initiating swallowing - may have choking or aspiration
2
Q
Eg. of oropharyngeal dysphagia
A
- Skeletal muscular disorders in context of stroke ⇒ dysphagia may be one of the early Sx, may take weeks to get better
- Neuromuscular - MND, bulbar pulsy
- Throat tumour or pharyngeal tumour would block the back of mouth ( mech obst.)
- Sjogren’s ( decreased saliva) is associated with primary BILIARY sclerosis or rheumatic diseases
- Alzheimer’s and depression
3
Q
Eg. of oesophageal dysphagia
A
- mech obstr due to narrowing of oesophagus eg. strictures
- Motility disorders
- Autonomic neuropathy due to diabetes
- Alcohol and GOR can also disorganize oeso motility
4
Q
What CN are involved if weak tongue or cheek muscles cannot move food around in the mouth for chewing?
A
V, VII
5
Q
What CN are possibly involved if pts are not able to start swallowing reflex that allows foods to move safely through pharynx? And what can cause this?
A
IX, X, XI, XII
Stroke, nervous system disorder
6
Q
What could progressive dysphagia suggest
A
Tumour getting worse?
7
Q
What does intermittent dysphagia suggest?
A
Dysmotility syndrome or oesophagitis
8
Q
If dysphagia to solids then liquids, is it likely to be obstructive or dysmotility
A
Obstructive, dysmotility more likely to be both
9
Q
What could cause odynophagia
A
Severe oesophagitis associated with inflammation
Red flag as may suggest malignancy
10
Q
Can benign UGI diseases cause weight loss
A
Yes if severe eg. severe strictures
11
Q
What does hoarse voice with dysphagia suggest
A
Tumour pressing on recurrent laryngeal nerve (branch of vagus nerve)
12
Q
What do chest pains associated with dysmotility suggest
A
- Oesophageal spasm ( may be caused by acid reflux)
- Referred pain ⇒ similar nerves from heart and oesophagus
13
Q
What are the likely causes of dyspjagia in an elderly patient?
A
Elderly patient ⇒ neurological causes if intermittent/ long standing, or sinister causes like oesophageal ca if new, progressive with regurgitation and weight loss
14
Q
What are the likely causes of dysphagia in an younger patients?
A
Oesinophillic oesophagitis ( with food bolus obstruction), or dysmotility
15
Q
What are the likely causes of dysphagia in middle aged patients?
A
Dysmotility eg. achalasia secondary to acid reflux
16
Q
Is dysphagia for liquids netter than for solids for achlasia
A
No, equal
17
Q
Regurg of prev day’s food, bad breath
A
Pharyngeal pouch
18
Q
Should endoscopy be done for pharyngeal pouch
A
No, risk of camera going into pouch and causing perforation during endoscopy
19
Q
What could Inflammation, bleeding, hyperplastic process on endoscopy suggest
A
Stricture
20
Q
Causes of struictures
A
- Benign :Acid reflux oesophagitis, Barrettt’s, extrinsic comppresion ( mediastinal tumour), post-radio, anastomotic from area of previous oesophagectomy, corrosive (alkali ingestion)
- Malignant stricture
21
Q
What sphincter is involved in Achalasia and what happens to it
A
Increased tone of LOS, inability to relax and high resting pressure, when oesophagus contracts, goes through stage of hypertrophy and dilatation ( baggy oeso)
22
Q
Test for achalasia
A
Oesophageal function test (manometry) can check for decreases motility of oesophagus- LOS is tight and fails to open completely
23
Q
What is treatment for benign strictures
A
- Dilatation
- Endoscopic Balloon or push dilators to stretch oeso
- PPIs ( long term therapy)
- Recurrent strictures → put stent to open oesophagus
24
Q
62 yo man, 3mo history of progressive dysphagia for solids- frequent choking and feeling of food stuck in middle of chest
Eventually also liquid dysphagia
longstanding smoker and drinker
lost 6 kg of weight but bmi 31
long standing gord, rennies for years
regurg even liquid and pain every time food gests into gullet
What are other more severe Sx possibly.
A
Possible oeso cancer
Fistulation between the oesophagus and the trachea or bronchial tree leads to coughing after swallowing, pneumonia and pleural effusion. cachexia, cervical lymphadenopathy or other evidence of metastatic spread is common.
25
Squamous vs adenocarcinoma oeso cancer- different pop?
Adeno- GORD, overweight, younger, typically lower 3rd oeso
Squamous- Alcohol, smoking, most common worldwide
26
how to establish Dx of oeso cancer
Endoscopy and biopsy
27
oesophager CA T staging
- T4 - beyond to nearby tissues
- T1- usually mucosa or submucosa
- T2- muscularis
- T3- border of lesion
28
What imaging modality to stage tumour for oeso ca
Endoscopic US- allows to see through the wall and take biopsies of LNs, determin depth of penetration into oesophageal wall and LN involvement
29
How to look at mets and LN and what can be done to show met spread and invasion (if tumour is malignant)
CT scan best way to look at mets and LN, CT PET can show if tumour is malignant or not
30
Palliative care for malignant strictures
Stenting (SEM) ,
31
40 YO F , 9 mo history of intermittent dysphagia for liquids and solids
Weight gone down, normal UGE
Typical dysmotility, severe as weight has gone down
DO BARIUM SWALLOW- Dx of achlasia
32
Treatment for achalasia
- Pneumatic dilatiation using air filled balloon to disrupt sphincter
- Risk of perforation
- Surrgical myotomy
- done laprascopially to weaken LOS
- Most common in young people
- may need PPI after
- Botox injection at LOS in older people → much safer but need to repeat because last for only 1-1.5 yr
- Most common in older people
- POEM
- Open oesophagus and cut muscle
33
17Yo man, asthmatic, 3wks hx of dysphagia and bolus obstr.
Eosinophillic oesophagitis - FBO common presentation, pmhx of atopy of food allergies
34
How to make confirmation dx of Eosinophillic Oesophagitis
- esophageal biopsy - 3 in middle and 3 in lower oeso
- >15 eosinophils per HPF
- May have white spots ( eosinophillic abscesses,) tram line (linear ulcerations)
35
Tx of Eosinophillic Oesophagitis
An empiric 8-week trial of high-dose PPI can be used in the first instance. Around one-third of patients will respond to this, known as PPI-responsive oesophageal eosinophilia.
In patients who do not respond, 8–12 weeks of therapy with topical glucocorticoids can be used, such as fluticasone and budesonide. Treatment with topical steroids (orodispersible budesonide )
36
Can liquids be swallowed when there are stirctures
Yes, until it becomes severe
37
What drugs can cause benign strictures
Bisphosphonates, can cause intermittent dysphagia and oesophageal ulceration
38
Ix algorithm for dyspepsia
If alarm features eg. unintentional weight loss, anaemia, persistent vomiting, hematemesis and/or melaena, dysphagia, palpable abdominal mass - do urgent endoscopy OR above 55 despite alarm features, then endoscopy
If not, just H pylori test if persistent Sx eg. urea breath test or stool antigen
If positive, triple therapy, if not, treat Sx
39
Post-eradication confirmation of H.pylori
Urea breath test
40
Main causes of UGIB
Peptic ulcer - NSAIDs or aspirin, alendronic acid
Varices ( liver disease or portal vein thrombosis) , malaena more common , large volume of fresh blood
Retching can cause Mallory-Weiss tear (Moderate volume of bright red blood, maelena rare)
Ca (samll vol of blood usually, have dysphagia and weight loss etc.), Gastric ca may have vomit mixed with blood or frank haematmesis.
Gastric erosions/ Gastritis due to NSAIDs and Alcohol , epigastric discomfort
Oesophagitis may also cause UGIB (streaking vomit, malaena rare)
stricture or malignancy can cause bleeds
41
Can melaena be caused by LGIB
Yes, may be from right side of colon
42
Should antithrombotic durgs be stopped during GIB
Yes, but aspirinn can be continued in UGIB
43
Treatment for non-variceal UGIB
Can treat endoscopically using cautherization or clips, with adrenaline. Haemospray as rescue therapy
give PPI IV to reduce gastrin secretion and promote clot stability
44
Tx for variceal blead
Band ligation, balloon tamponade if BL failed
45
Risk factors that may exacerbate dyspepsia Sx
Obesity ( related to diet) , trigger foods like tomatoes, fatty or spciy foods, smoking and alchol. Stress, anxiety and depression may worsen Sx
46
Drugs that can exacerbate dyspepsia -
Aspirin and NSAIDs
alpha-blockers, anticholinergics, benzodiazepines, beta-blockers, bisphosphonates, calcium-channel blockers, corticosteroids, nitrates, theophyllines, and tricyclic antidepressants.
47
Tx for dyspepsia
Usually just use antacid
IF H pylori +ve
Full dose PPI for 1 mo if no H pylori
OR
If positive, then PPI and amox and clarithro or metro
If allergic to pen, then clarithro and metro
If Sx recure, switch to alternate therapy and cpnsider alternate acid supression therapy with histamine receptor antagonist eg. ranitidine
48
For h pylori test, what should be ensured?
Pt has not taken PPI in past 2 weeks or abx in past 4 wks
49
Is tone of LOS increased or decreased in GORD
Decreased
50
What can exacerbate GORD
Smoking
51
Complications of GORD
Barrett's - pre-malignant condition due to chronic GORD
Oesophagitis ( may have stricture)
Ca
52
Barrett's - what kind of cells
Columnar instead of squamous
53
Risk factor for Barrett's
Age, male, obseity and smoking
54
Ix and Mx of Barrett's
Endoscopy is gold standard, multiple bipsies should be taken
Mx only for Sx of reflux compl eg. stricture - endoscopic resection + RFA or oesophagectomy
55
Ix for GORD
Usually treat empirically in young pts, but in older pts can do endoscopy to exclude other diseases
56
tx for GORD
Give lifestyle advice (weight loss, avoidance of dietary items that worsen symptoms, having small mails often, elevation of the bed head in those who experience nocturnal symptoms, avoidance of late meals and cessation of smoking.)
Antacids, then empric full dose PPIs,if severe and progressive Sx despite anatacid.
if stilll poor response then consider pH monitoring and perform fundoplication if positive
57
Pharyngeal pouch Ix and Tx
Barium swallow - will reveal incoordination of swallowing
Treatment is indicated in symptomatic patients, and can be via a surgical approach, such as cricopharyngeus myotomy (diverticulotomy), with or without resection of the pouch. or stapling
58
Achalasia Sx
Dysphagia to solids and liquids, regurg to saliva and food may occur, may have chest pain due to oeso spasm, weight loss
59
Causes of acute gastritis, Sx and usual treatment
NSAIDs + aspirin , alcohol, antacids and PPIs,
Sx include dyspepsia, anorexia, nausea or vomiting, and haematemesis or melaena
Tx include symptomatic therapy with antacids, and acid suppression using PPIs, prokinetics like domperidone or antiemetics like metoclopramide
60
Where are peptic ulcers commonly located
Stomach or duodenum
BUT may also occur in lower oeso, jejunum after surgical anastomosisto stomach, or in ileum adjacent to Meckel's diverticulum
61
What other non GI cancer can cause dysphagia
Lung cancer or mediastinal adenopathy can cause external compression of oesophagus
Goitre compression can cause oropharyngeal dysphagia
62
Ix for dysphagia -
If progressive and sever, or persistent, should do UGI endoscopy
63
Two largest risk factors for PUD
H pylori and Aspirin + NSAIDs
64
PUD sx
post prandial abd pain, localisation to epigastrium
Dyspesia, vomiting
Gastric outlet obst (persistent vomitting)
Perforation
Haemtemesis, coffee ground vomiting or malaena
65
Benign vs malignant ulcer
Shallow with no rolled edges vs craggy, quite deep
66
Red flag Sx for PUD
Epigastric pain with weight loss
67
Ix for PUD
Endoscopy with histologic biopsies to exclude cancer
+ H pylori testing- 1 wk triple therapy if +ve
+ 2 months high dose PPI for PUD
Requires follow up endoscopy for gastric ulcers to ensure healing and that they are not malignant
68
What kind of oesophagealcancer arises from Barrett's and where else can this type be found
Adenocarcinoma, can be found lower at GO jtn
69
Tx for Oeso Ca
Oesophagectomy if resectable, if not then chemo +radio
70
Common Sx of oesophagitis
Similar to GORD- Heartburn, regurgitation (provoked by bending, straining or lying down), water or acid brash
May have dysphagia or odynophagia
71
Risk factors for oesophagitis
Smoking, obesity, alcohol, hiatus hernia
72
What is dyspepsia
Discomfort in the epifastric area, usually after a meal
73
What is heartburn
Burning restrostenal sensation, often due to acid reflux
74
What is Schatzi ring
Fibrous rink at GOJ linked to acid reflux
75
How may H pylori lead to duodenal ulceration?
may have hypergastrinaemia and increased acid productionby parietal cells.
Or may have gastric atrophy and hypochlorohydria, allowing proliferation of bacteria- predispose to cancer
76
What should be prescrobed with long term NSAIDs
PPI
77
Recent flu-like illness, worsening abd pain despite analgesia, nausea with dark stools (also on PR exam), non-specific tennderness, HR 92, BP 107/65
On aspirin + PPI , B blocker and statin, apixaban
Non-smoker, 0.5 bottle wine thrice a week
Likely bloods?
UGIB
Low Hb, High Urea and Creatinine normal
78
Risk factors for bad outcome in acute UGIB
History of malignancy or cirrhosis, haematemesis, hypovolaemia, Hb <80
79
Should anticoag be stopped in pts with UGIB
Stop apix ( esp if only one DVT and not recurrent), continue aspirin
80
What does GBS predict and what does it consider
Risk stratifies pts at risk of UGIB
includes the need for endoscopic intervention
---
Blood urea as surrogate for increased protein absorption and digestion
Hb <100 is severe
SBP <90 is severe
Pulse>=100, melaena,syncope, hepatic disease, cardiac failure
81
Target for transfusion if have Sx
Hb>70
82
Timing of endoscopy for UGIB
24 hrs if haemodynamically stable, no persistent hematemesis, and can discontinue anticoag temporarily, otherwise < 12hrs
83
What to do if UGIB can't be controlled endoscopically
Interventional radiology
84
PPI post endoscopy
IV PPI continuous infusuion for 72 hrs
85
Should H pylori tx be given for PUD
Yes if +ve for H pylori, if -ve and not on NSAID just treat emprically
86
If alcohol history in pt with melena, suspect?
Variceal blead
87
What does low lactate in pt with melena and jaundice suggest
Patient hypoxic
88
What are platelet levels likely to be like in pt with splenomegaly and cirrhosis
Decreased levels as platelts will pool in spleen due to cirrhotic level
89
Na and K levels in pt with severe cirrhosis
Hyponatremia and hypokalaemia
90
How to manage pts with increased PT
Can give Vit K IV to stimulate pdtn of clottining factors
91
Mx of variceal bleed, time limit
IV abx and consider IV terlipressin to reduce blood into varices
Then endoscopy and variceal ligation
Should be done < 12h if stable, earlier if not
92
What drug should be given for long term Mx of variceal bleeds
Carvedilol
93
Ix for pt with variceal bleed and liver cirrhosis
Assess Liver function, liver screen for Hep B and C, US or CT (flow in portal vein) for complications like HCC, and
94
Another possible cause of ulcerative esophagitis and Tx
Alcohol, PPI
95
Indigestion presentation
Epigastric pain, gradul onset over 3 mo, dull ache constant after a meal, assoc with nausea, staying hungry helps
96
How do gallstones present
Colicky pain at epigastric are/RUQ after a meal (esp fatty ones)
97
What is pancreatic pain and what is Ix
Is pain sharp or dull
epigast pain that radiates to the back, esp with history of alcohol excess , consider CT abdomen to visualise pancreas
May be both dull or sharp
98
How can IBD be a differential for indigestion
If UGI or SB disease, may have diffuse abd pain. Inflammatory strictures can result in weight loss, abd pain and N+V as well
99
How to confirm Coeliac dx
endoscopy and duo biopsy
100
What is the most common type of gastric cancer
Adenocarcinoma
101
Sx of gastric ca
May have dyspepsia or reflux, also may have virchow's node, anaemia, weight loss, dysphagia, back pain or jaundice
102
When is gastric tumour considered advance
Invaded through stomach wall
103
how to Ix Gastric cancer
UGI endoscopy for sampling- may see signet ring cells , then CT CAP for staging, PET CT for lmyph node spread ( distal mets)
Staging laparoscopy if raidiologist is unsure if ca has penetrated beyond stomach wall
104
How to treat early and late gastric ca
Resect + - chemo if nodal disease
Stent for advanced ca
Surgical bypass or chemo for palliative care
105
Diff between cholecystitis and cholangitis
Inflam of gallbladder, typically assoc with gallstones but not always
vs
Obstructed biliary system, typically due to gallstones but may also be due to tumours
106
What is Charcot's triad for and what does it include
Fever, RUQ pain and Jaundice- for ascending cholangitis
107
Presentation of cholecystitis and what are the LFTs like
Pain in RUQ and right shoulder, N+V, fever and constant pain
Murphy's sign
Occasionally mildly deranged LFT's
108
Differentiate biliary colic from cholecystitis
No fever in biliary colic
PAIN in waves for biliary colic
bloods normal
109
Biliary colic pain and other sx
Worse postprandially, RUQ, may radiate to right shoulder, N+V common
110
Bloods in cholecystitis
Raised RCC, increased Bilirubin and GGT , rest of LFTs normal , increased CRP
111
Ix for cholecystitis
CXR shld be normal, US may show gallstones
112
Differentiate ascending cholangitis with cholecystitis
Jaundice in asc chol but not cholecystitis
Charcot's triad in AC- ever is the most common feature, seen in 90% of patients
RUQ pain 70%
jaundice 60%
hypotension and confusion are also common (the additional 2 factors in addition to the 3 above make Reynolds' pentad)
113
Mx of cholecystitis
Resusc + emergency laparoscopic cholecystectomy ( give Abx if LFT not normal)
114
Ix for Asc Cholan
US first- may show presence of gallstones
MRCP- obstructive stones in common bile duct
115
Mx of asc chol
IV Abx + fluid, and then first line ERCP to reliveve obstruction
Lap chol and bile duct expoloration as alternative
116
Are males or females more likely to have gallstones
F
117
What GI disease can increase risk of gallstones
CD as it interferes with bile salt absorption ( TI)
118
Dx of biliary coloc and what do LFT/CRP show
US should show echogenic debris in gallbladder, consistent with gallstones. Suffficent for diagnosis
LFT and CRP all normal
119
Mx of biliary colic
Analgesia for pain, main option is laparo chol, BUT ELECTIVELY as daycase
120
What are the complications of gallstones
Cholecystitis
Asc cholangitis
- Empyema of gallbladder
- Gallstone ileus ( gallbladder perforated into duo and decretes gallstones into ileum)
- Acute Pancreatitis
-Gallbladder cancer
- Perforation of gallbladder
- Mucocoele
121
What are the risk factors for pancreatic ca
Cigarette smoking, high fat diet, DM, familial pancreatitis/PC
NO strong assoc with alcohol consumpt
122
Most common type of pancreatic ca
ductal adenocarcinoma
123
What kind of pancreatic ca is likely to cause obstructive jaundice and what other kinds of presentations are likely to cause
Head of pancreas
Non tender distended gallbladder
124
What sx is associated with significant jaundice
Pruritis
125
Ix for pancreatic ca
US first for gallstones and biliary dilatation, may also pancreatic mass at head
CT for staging ( distal spread) and MRI for further staging - double duct sign may be obsevred
ERCP/EUS not essential in all cases but can take endoscopy if dx not cleatr
PET may also be used
126
treatment of pancreatic ca
Resection surgically (pancreaticoduodenectomy)
ERCP with stenting for palliation
127
Sx of pancreatic cancer
Painless haunduice, pale stools, dark urine, pruritus, palplable gallbladder or hepatomegaly, epigastric pain sometimes
128
Clinical presentation of pancreatitis`
Acute onset of persistent severe central epigastric pain and tenderness (can be vague pain, poorly localised tenderness)
MAY radiate to the back
N+V
129
What is specific for pancreatitis diagnosis
Serum amylase and lipase elevation (3x greater than upper limit of normal )
130
What imaging can be used for pancreatitis and what is the role of the findings in diagnosis
CT most commonly used, can exclude perforation or acute cholecystitis,
131
What is the finding of pancreatitis on CT
Pancreas will have swollen up in size. May have fat stranding from infalmmatory process that looks hazy
132
What are causes of pancreatitis
Gallstones and alcohol most commonly, may also include trauma, steroids, infections ( mumps and typhoid), autoimmune, drugs like steroids, oestrogen containing contraceptives, azathioprine.
May also be post operative or due to ERCP or pancreatic tumours
133
Pathophysiology of pancreatitis
What does pancreatic damage result in (enzymes and electrolytes)
Gallstones can cause duct obstruction - outflow obstruction of pancreatic enzymes
May be caused by direct acinar damage
Protease may be released due to the rupture of the pancreas and this may cause widespread destruction of pancreas and further release of enzymes
Lipase may also lead to calcium deposition by causing fat necrosis
Pancreatic damage or destruction can cause increased serum amylase and hypocalcaemia, hyperglycaemia and increased bilirubin and ALP ( due to swelling at head of pancreas)
134
What other ix should be done to exclude ddx for pancreatitis
ECG for MI and CXR for basal pneumonia
135
What is the Mx for pancreatitis
Fluid resuscitation, enteral nutrition ( J tubes), NO antibiotics unless other complications
136
What are possible complication in pancreatitis
ARDS, acute renal failure, multiorgan failure
137
What is the most common cause of chronic pancreatitis and what are the common sx
Alcohol
followed by gallstones
Pain, malabsorption and malnutrition, diabetes
138
what is the most common cause of fat malabsorption and how does this present as
Pancreatic disease, presents with steatorrheoa
139
where does fat absorption mainly occur in
proximal 2/3 of jejunum
140
What does carbohydrate malabsorption present as
Bloating and flatulence due to bacterial fermentation
May have watery diarrhoea, and milk intolerance
141
What to pts with protein malabsorption present with
What abnormality in bloods can be observed
Weight loss, muscle atrophy and oedema
Reduced albumin
142
Where do folate, calcium and iron get absorbed
Proximal 1/2 of the small bowel
143
Where is vitamin B12 and Mg absorbed
ileum and distal jejunum - recognises B12- intrinsic factor complex and Mg
144
Malabsoption of what can cause anaemia
Folate, B12 and IRON
145
What are 2 signs of Vitamin B12 deficiency
Paraesthesiae and angular stomatitis
146
How does ALP level change in calcium and Vit D deficiency affect
May increase esp if there are fractures
147
What gene is implicated in Coeliac disease
HLA DQ2
148
What triggers celiac
Gliadins, in wheat, rye and barley
Oats controversial
149
What is the pathological finding in coeliac disease
Villous atrophy and crypt hyperplasia
If haven IEL accumulation and +ve serolofy despite no villpus atrophy- possible coeliac
150
Clinical presentations of coeliac disease
Villous atrophy, malabsorption- anemia, diarrhoea, weight loss, staetorrhoea
May have bloating, pain, anaemia, altered bowel habit
Dermatitis herpatiformis
151
How to dx coeliac disease and what ix should be done before
Endoscopy/ small intestinal biopsy
anti-Ttg-IgA before - pecific and sensitice
152
What follow up ix for Coeliac should be considered after Dx
DEXA if malabsorb/weight loss
Measure Ca2+/VIt-D/ALP
Measure anti-TtG IgA yearly
Pneumococcus vacc
153
What are possible complications of coeliac
Small bowel lymphoma
154
Sx of perforated peptic ulcer and Ix
epigastric pain, later becoming more generalised
Abd distension, N+V
Shoulder tip sign,
abd tenderness, peritonitis, fever, tachyc
patients may describe syncope
155
How to diff duodenal and gastric ulcer
Duodenal ulcer worsens on empty stomach, opp for gastric ulcer
156
Signs of UGIB
Haematemesis, Melena (tarry black stool), freh blood PR or haematochezia (purple or plum coolour mixed with stool) , coffee ground vomit
157
Acute Mx of UGIB
Wide bore access, take ABG for Hb and lactate, FBC, U+E, coag screen, glucose +lactate, samples for crossmatch
Crystalloid resusc
Check for evidence of encephalopathy
Abdo exam and PR
158
Signs pointing to variceal bleed
Spider naevi, jaundice, hepatosplenomegaly, encephalopathy, ascites
159
Risk factors of cholangiocarcinoma
PSC main risk factor
160
Fx of cholangiocarcinoma
associated with anorexia, jaundice and weight loss
a palpable mass in the right upper quadrant (Courvoisier sign)
periumbilical lymphadenopathy (Sister Mary Joseph nodes) and left supraclavicular adenopathy (Virchow node) may be seen
Carbohydrate antigen (CA) 19-9 and carcinoembryonic antigen (CEA) levels may be elevated
161
Ix for cholangiocarcinoma
LFT and CA, then Abd US first, can
162
Sx of choledocholithiasis
Pain and jaundice. Pain may be intermittent or constant. Pain may grow after eating a meal
163
What lymphocytes are found inCoeliac disease
CD4+ gluten reactive T cells found in SI lamina propria
164
What infectious diarrheoa outbreak is linked to norovirus
Nursing home
165
What infective cause of diarrhoea can cause liver abscesses
Amoebic dysentry
166
Is giardiasis a public health indication
Yes, inform close household contacts
167
What pathogens cause acute bloody diarrhoea
Campylobacter, shigella, salmonella
168
169
How many qfits should be positive to suspect possible colorectal cancer
2
170
What kind of diarrhoea does ETEC cause
Self limited water diarrhoea, common in traveller's
171
Most common protozoal cause of dairrhoea in UK
Cryptosporodiosis - watery diarrhoea
abdominal cramps
fever
172
Risk factors for giardiasis and how is it transmitted and sx
Spread by faeco-oral route
Risk factors include: foreign travel
swimming/drinking water from a river or lake
male-male sexual contact
non-bloody diarrhoea
steatorrhoea
bloating, abdominal pain
lethargy
flatulence
weight loss
malabsorption and lactose intolerance can occur
173
Shigella sx
Diarrhoea, fever, cramps, bloody diarroea possible
174
