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Yr 4 - ACC > Corrections - GI pt. 2 > Flashcards

Corrections - GI pt. 2 Flashcards

1
Q

What does an AXR show in gallstone ileus?

A

SBO and air in the biliary tree

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2
Q

What happens in gallstone ileus?

A

A gallstone enters the small intestine where it lodges in the ileocaecal valve.

This is usually on a background of chronic cholecystitis.

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3
Q

What tool is used to screen patients for malnutrition?

A

The Malnutrition Universal Screening Tool (MUST)

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4
Q

What is the most common organism found on ascitic fluid culture in spontaneous bacterial peritonitis?

A

E. coli

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5
Q

What triad of features is seen in spontaneous bacterial peritonitis (SBP)?

A

1) ascites
2) abdo pain
3) fever

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6
Q

How is a diagnosis of SBP made?

A

Paracentesis –> neutrophil count >250 cells/ul

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7
Q

Who is SBP usually seen in?

A

Ascites 2ary to liver cirrhosis

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8
Q

What is given in the acute management of a variceal haemorrhage?

A

1) terlipressin

2) prophylactic IV Abx

Both should be given before endoscopy.

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9
Q

What is given for the prophylaxis of a variceal haemorrhage?

A

Propanolol & endoscopic variceal band ligation (EVL)

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10
Q

What is melanosis coli?

A

A condition characterised by the presence of pigment-laden macrophages in the lamina propria of the colon.

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11
Q

What is melanosis coli most commonly associated with?

A

Chronic use or abuse of anthraquinone-containing laxatives e.g. senna

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12
Q

What is the only test recommended for H. pylori post-eradication therapy?

A

Urea breath test

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13
Q

What is hepatorenal syndrome?

A

A type of functional kidney impairment that occurs in patients with advanced liver disease.

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14
Q

What are the 3 key features of hepatorenal syndrome?

A

1) ascites
2) low urine output
3) significant increase in serum creatinine

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15
Q

What is recommended first line for hepatorenal syndrome?

A

Terlipressin (a vasopressin analogue)

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16
Q

Role of terlipressin in hepatorenal syndrome?

A

It works by inducing splanchnic vasoconstriction which reduces portal pressure and improves renal blood flow.

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17
Q

What triad of symptoms is seen in Boerhaave syndrome?

A

1) vomiting/retching

2) severe retrosternal chest pain typically radiating to the back

3) subcutaneous emphysema

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18
Q

What is Boerhaave syndrome?

A

Transmural oesophageal perforation secondary to an episode of forceful emesis.

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19
Q

When should PPIs be stopped before an upper GI endoscopy?

A

2 weeks before

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20
Q

Why should PPIs be stopped 2 weeks before an endoscopy?

A

PPIs can reduce the size of ulcerative gastro-oesophageal malignancy, which can make them unidentifiable during endoscopic examination.

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21
Q

In B12 and folate deficiency, replacement of which takes priority?

A

Vitamin B12 replacement should always occur prior to folate replacement as folate replacement prior to B12 can precipitate subacute combined degeneration of the spinal cord.

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22
Q

What condition does the combination of deranged LFTs combined with secondary amenorrhoea in a young female strongly suggest?

A

Autoimmune hepatitis

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23
Q

Crypt abscess & goblet cells in UC vs Crohn’s?

A

UC:
- crypt abscesses seen (neutrophils migrate through the walls of glands to form crypt abscesses)
- depletion of goblet cells

Crohn’s:
- increased goblet cells

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24
Q

What is a long history of watery green diarrhoea post cholecystectomy caused by?

A

Bile-acid malabsorption –> this can be idiopathic, or seen in patient’s with Crohn’s disease.

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25
Q

Management of bile-acid malabsorption?

A

With bile acid sequestrants such as cholestyramine.

26
Q

What is the most sensitive and specific lab finding for diagnosis of liver cirrhosis in those with chronic liver disease?

A

Thrombocytopenia

27
Q

What is triple therapy indicated for H. pylori eradication?

A

PPI + amoxicillin + clarithromycin

or

PPI + metronidazole + clarithromycin

28
Q

How can the COCP affect LFTs?

A

Can cause cholestasis (+/- hepatitis).

This causes an obstructive LFT picture.

29
Q

Management of life-threatening C. difficile infection?

A

ORAL vancomycin and IV metronidazole

stop any other Abx

30
Q

Treatment for Wilson’s disease?

A

Penicillamine –> this is a copper chelating agent that promotes the urinary excretion of copper.

31
Q

What is used first-line in maintaining remission in ulcerative colitis patients with proctitis and proctosigmoiditis?

A

A topical (rectal) aminosalicylate +/- an oral aminosalicylate

32
Q

What 2 categories can an increased ferritin level be separated into?

A

1) Without iron overload (around 90% of patients)

2) With iron overload

33
Q

What is the best test to see whether iron overload is present with an increased ferritin level?

A

Transferrin saturation

A normal transferrin saturation will EXCLUDE iron overload.

34
Q

What is ferritin?

A

An intracellular protein that binds iron and stores it to be released in a controlled fashion at sites where iron is required.

Ferritin is an acute phase protein and may be synthesised in increased quantities in situations where inflammatory activity is ongoing

35
Q

What are some causes of an increased ferritin level without iron overload?

A

1) Inflammation (due to ferritin being an acute phase reactant)

2) Alcohol excess

3) Liver disease

4) CKD

5) Malignancy

36
Q

What are 2 causes of an increased ferritin level with iron overload?

A

1) Primary iron overload (hereditary haemochromatosis)

2) Secondary iron overload (e.g. following repeated transfusions)

37
Q

What is the typical iron study profile in patients with haemochromatosis?

A

1) raised transferrin saturation

2) raised ferritin and iron

3) low TIBC

38
Q

What drug will you administer to reduce the risk of isoniazid induced peripheral neuropathy?

A

Pridoxine (vitamin B6

39
Q

What condition is isoniazid indicated in?

A

TB

40
Q

What medication is used in the management of severe alcoholic hepatitis?

A

Corticosteroids e.g. prednisolone

41
Q

Which form of IBD is associated with gallstone development?

A

Crohn’s disease (due to terminal ileitis).

This is the section of the bowel where bile salts are reabsorbed.

When this area is inflamed and the bile salts are not absorbed and people are prone to development of gallstones.

42
Q

What is the purpose of serum-ascites albumin gradient (SAAG)?

A

To determine if the ascites has been caused by portal HTN or not.

A raised SAAG (>11g/L) indicates that it is portal HTN that has caused the ascites.

e.g. Budd-Chiari syndrome

43
Q

What SAAG indicates that portal HTN has caused the ascites?

A

Raised (>11 g/L)

44
Q

What investigation is used to confirm Mallory Weiss syndrome?

A

Endoscopy

45
Q

What is Sister Mary Joseph node?

A

A palpable nodule in the umbilicus due to metastasis of malignant cancer within the pelvis or abdomen.

46
Q

Which vitamin is teratogenic in high doses?

A

Vitamin A

47
Q

What is carcinoid syndrome?

A

A neuroendocrine tumour.

This usually occurs when metastases are present in the liver and release serotonin into the systemic circulation.

48
Q

What is often the earliest symptom of carcinoid syndrome?

A

Flushing

49
Q

1st line investigation in carcinoid syndrome?

A

urinary 5-HIAA

50
Q

Management of carcinoid syndrome?

A

somatostatin analogues e.g. octreotide

51
Q

Carcinoid syndrome is associated with right-sided valvular pathology.

What is the most common pathology?

A

Tricuspid insufficiency and pulmonary stenosis.

52
Q

What is the investigation of choice for suspected perianal fistulae in patients with Crohn’s?

A

MRI pelvis

53
Q

What is achalasia?

A

A condition in which the muscles of the lower part of the oesophagus fail to relax, preventing food from passing into the stomach.

54
Q

What is the surgical treatment of achalasia?

A

Heller cardiomyotomy - this is a surgical procedure where the muscle around the lower oesophageal sphincter is loosened to allow easier passage of food and drink through the oesophagus and into the stomach.

55
Q

If a mild-moderate flare of ulcerative colitis does not respond to topical or oral aminosalicylates, what can be added?

A

Oral corticosteroids

56
Q

Bile contains bile acids. What are the 2 main purposes of bile acids?

A

1) Breakdown and absorption of fats and vitamins from food

2) Aid with removal of waste products

57
Q

Journey of bile salts?

A

Made in liver, stored in gallbladder, released into small intestine

58
Q

Where are virtually all bile acids resabsorbed?

A

Ileum (and then returned to the liver)

59
Q

Give some causes of bile acid malabsorption

A

1) Problem with ileum –> e.g. Crohn’s disease, removal of ileum in cancer treatment

2) Chronic pancreatitis

3) Coeliac disease

4) Gallbladder reoval

60
Q

What are 2 key symptoms of bile acid malabsorption?

A

1) Diarrhoea

2) GI upset e.g. bloating, cramping abdominal pain, flatulence

61
Q

How does bile acid malabsorption result in diarrhoea?

A

When bile acids are not re-absorbed from the ileum, they pass into the large intestine, irritating the lining of the colon and stimulating salt and water secretion.

Diarrhoea is usually frequent during the day and sometimes at night. It may be pale, greasy and hard to flush away or may be unusually coloured (green, yellow or orange).

62
Q
A

Yr 4 - ACC (73 decks)

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