Corrections Flashcards
Can a brisk upper GI bleed present with fresh blood PR rather than malaena?
Yes
If constipation doesn’t respond to a bulk-forming laxative such as isphagula husk, what should you try next?
Osmotic laxative e.g. macrogol
What triad of features is seen in liver failure?
1) encephalopathy
2) jaundice
3) coagulopathy
Triad of symptoms in Budd-Chiari syndrome?
1) sudden onset abdo pain
2) ascites
3) tender hepatomegaly
What is Budd-Chiari syndrome?
Hepatic vein thrombosis - usually seen in the context of underlying haematological disease or another procoagulant condition.
Transferrin saturation in haemochromatosis?
Raised
What is required during large-volume paracentesis for the treatment of ascites?
IV human albumin solution to avoid avoid paracentesis-induced circulatory dysfunction (PICD).
Mx of bile acid malabsorption causing diarrhoea?
Cholestyramine (bile acid sequestrant)
What liver disease is sudden weight loss associatged with?
NAFLD
What is the investigation of choice for suspected carcinoid tumours?
Urinary 5-HIAA
1st line mx for NAFLD?
Weight loss
What cancer does achalasia increase the risk of ?
Squamous cell carcinoma of the oesophagus
What is Plummer-Vinson syndrome?
Triad of:
1) iron def anaemia
2) dysphagia
3) atrophic glossitis
What type of duodenal ulcers are most likely to cause major upper GI haemorrhage?
Posteriorly sited ulcers –> gastroduodenal artery
What is used to monitor treatment in haemochromatosis?
Ferritin + transferrin saturation
1st line mx for achalasia?
Pneumatic (balloon) dilatation
Mx of achalasia if recurrent or persistent symptoms?
surgical intervention with a Heller cardiomyotomy should be considered
What is primary sclerosing cholangitis?
A biliary disease characterised by inflammation and fibrosis of intra and extra-hepatic bile ducts.
Most common association of PSC?
UC
Features of PSC?
1) cholestasis
- jaundice, pruritus
- raised bilirubin + ALP
2) RUQ pain
3) fatigue
Investigations of choice in PSC?
ERCP/MRCP
What are the 3 characteristic electrolyte disturbances seen in patients with refeeding syndrome?
1) Hypophosphataemia
2) Hypokalaemia
3) Hypomagnesaemia
What does an ‘apple core’ sign on barium swallow indicate?
Oesophageal carcinoma
What is primary biliary cholangitis (PBC)?
A chronic liver disorder, thought to be an autoimmune condition.
Interlobular bile ducts become damaged by a chronic inflammatory process causing progressive cholestasis which may eventually progress to cirrhosis.
Classic presentation of PBC?
Itching in a middle-aged woman
Give 4 associations with PBC
1) Sjogren’s (seen in up to 80%)
2) RA
3) Systemic sclerosis
4) Thyroid disease
What antibdies are present in PBC?
AMA M2 subtype
Mx of PBC?
first-line: ursodeoxycholic acid
Mx of pruritus in PBC?
cholestyramine
Complications of PBC?
1) Cirrhosis –> portal HTN –> ascites, variceal haemorrhage
2) Osteomalacia & osteoporosis
3) significantly increased risk of HCC
What cancer are those with PBC at an increased risk of?
HCC
What is Sister Mary Joseph node?
A palpable nodule in the umbilicus due to metastasis of malignant cancer within the pelvis or abdomen
What are the investigations of choice in primary sclerosing cholangitis? (PSC)
ERCP/MRCP
What do patients who have had an episode of SBP require?
Antibiotic prophylaxis (e.g. ciprofloxacin)
Mx of pharyngeal pouch?
Surgical repair
What is the typical diagnostic investigation in primary sclerosing cholangitis?
MRCP –> this usually shows typical beaded appearance of the bile duct
During infection, ferritin is an unreliable indicator of iron stored in the body as it is an acute phase protein.
What should be used instead?
Transferrin saturation
What is Courvoisier’s law?
A palpable, non tender, enlarged gallbladder accompanied with painless jaundice is unlikely to be due to gallstones.
Instead consider malignancy
1st line mx of primary biliary cholangitis?
Ursodeoxycholic acid
What is PBC?
An autoimmune liver disease.
Interlobular bile ducts become damaged by a chronic inflammatory process causing progressive cholestasis which may eventually progress to cirrhosis.
What is the classic presentation of PBC?
itching in a middle-aged woman
What condition is most associated with PBC?
Sjogren’s syndrome
Mx of patients with upper GI bleeding that has shown resistance to multiple endoscopic interventions?
Referral to general surgery
What antibodies are seen in autoimmune hepatitis?
ANAs
What antibodies are seen in PBC?
AMAs
What is the diagnostic investigation of choice for pancreatic cancer?
High resolution CT scanning
What is the investigation of choice for suspected carcinoid tumours?
Urinary 5-HIAA
Mx of dysplasia on biopsy in Barrett’s oesophagus?
Requires endoscopic intervention
What is used to monitor treatment response in haemochromatosis?
Ferritin & transferrin saturation
What is most likely to be identified if a colonoscopy were performed in Peutz Jeghers?
Hamartomas
1st line mx of Wilson’s?
Penicillamine
How can a TIPS result in confusion?
Cn cause hepatic encephalopathy (due to inadequate metabolism of nitrogenous waste products by the liver)
What investigation may be useful for diagnosing and monitoring the severity of liver cirrhosis?
Transient elastography (fibroscan)
1st line investigation in acute mesenteric ischaemia?
Serum lactate
Mx of asymptomatic gallstones?
Observation, lifestyle measures & diet
What is the investigation of choice for a suspected pharyngeal pouch?
Barium swallow with fluoroscopy
1st line mx of acute constipation?
Bulk forming laxative e.g. ispagula husk
1st & 2nd line mx of haemochromatosis?
1st line –> venesection
2nd line –> desferrioxamine
Mx of achalasia?
Heller cardiomyotomy
What investigation is most likely to provide diagnostic information in an acute abdomen following abdo surgery?
CT abdomen with IV contrast
What is the most important intervention to reduce the chance of further episodes of Crohn’s disease?
Stop smoking
Mx of a pancreatic pseudocyst?
Conservative mx initially
What is globus pharyngis?
The persistent sensation of having a ‘lump in the throat’ when there is none.
Symptoms are often intermittent and relieved by swallowing food or drink.
Swallowing of saliva is often more difficult.
