extra gastro Flashcards
what deficiencies cause angular chelitis
iron,
zinc
vitamins from the B group
- riboflavin (B2),
- niacin (B3),
- pyridoxine (B6),
- folate (B9)
- cyanocobalamin (B12)
if a pt is having a UC flare up and isn’t improving on oral and topical ASA what do you do
ADD oral prednisolone to the ASA
what are the components used to work out child pugh score for liver cirrhosis
bilirubin (high)
albumin (low)
PT (prolonged)
encephalopathy (marked)
ascites (marked)
(indicate poor prognosis of the liver cirrhosis)
what is small bowel overgrowth syndrome and what is the initial ix for it, in which pts shield you consider it
increase in number of bacteria in the small bowel
hydrogen breath test
consider in diabetic pts with symptoms of IBS
dull RUQ pain and raised Alanine aminotransferase in a pt with congestive fear failure
congestive hepatomegaly
what does raised alanine aminotransferase indicate
liver damage
what class of antibodies are raised in PBC
IgM (IgG is raised in AI hepatitis)
This middle-aged woman presents with itch along with clinical evidence of ascites (shifting dullness) and xanthelasma. Blood testing demonstrated deranged liver function tests with an obstructive pattern
diagnosis
PBC
what is the cause of Pigment laden macrophages suggestive of melanosis coli in the intestine
laxative abuse
which 2 meds are given for oesophageal varicose
terlipressin
prophylactic abx
then do endoscopic variceal band ligation and can give propanolol to reduce rebreeding
alcoholic pt with haematemsis and epigastric pain
likely diagnosis
oesophageal varicies
endoscopic intestinal biopsy showed villous atrophy, crypt hyperplasia, and an increase in intraepithelial lymphocytes
diagnosis
coeliac
pt with liver cirrhosis and ascites presents with abdo pain and fever
diagnosis?
SBP
pt has haematemesis several Horus after eating, what type of peptic ulcer is it and which artery is impacted
duodenal ucler
gatsroduodenal artery
which lung cancer presents with clubbing and gynaecomastia
adenocarcinoma
which lung cancers can cause flushing, and how to differentiate between them
carcinoid - not related to smoking
small cell lung cancer - heavily related to smoking
which typo of asthma med can cause cushingoid features
ORAL steroids - not inhaled, rare
difference between stool c diff antigen test vs stool c diff toxin test
antigen - shows exposure to the bacteria, past or present
toxin - shows current infection
urine copper, and serum caerulopasmin levels in Wilsons
urine copper raised
serum caerulopasmin reduced
(In Wilson’s disease, copper is instead deposited in tissue, thereby reducing the apparent need for caeruloplasmin, thereby reducing its levels in the blood)
how long should c diff pts be isolated for
until they’ve had no diarrhoea for 48 hrs
mx for hugh grade dysplasia in oesophagus
endoscopic intervention
oesophagectomy reserved for if dysplasia invaded submucosa/supporting tissues
M rule for PBC
Primary biliary cholangitis - the M rule
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females
abdominal distension, discomfort, and evidence of transudative ascites, alongside a SAAG of 12 g/L
diagnosis
portal htn
- not Budd chiari, would be more pain and would present with signs of liver failure eg jaundice, encephalopathy, coagulopathy
what is a jejunal biopsy used for
coeliac
tx for c diff which presents with sepsis or grossly dilated colon, or if to doesn’t respond to just the oral vancomycin
oral vancomycin (standard c diff tx) AND IV metranidazole
tx for acute alcoholic hepatitis
prednisolone
which IBD has crypt abscess and only mucosa inflammation
uc
how many bowel movements for mild uc and for moderate uc
less than 4 - mild
4 to 6 - moderate
what is the stool pattern for overflow diarrhoea and how do you treat it
type 7 stools with intermittent hard stools.
Treat with faecal disimpaction
smooth enlarged firm tender liver with pulsatile edge
cause
right heart failure
diagnostic test for psc
MRCP
the antibodies are not specific so not diagnostic
gold standard ix to diagnose pancreatic cancer
HRCT
management of psc and pbc
ursodeoxycholic acid - all pts should be started on
but only defective tx for if they develop end stage liver failure is liver transplant
but can give symptomatic relief eg
cholestyramine for priorities
lifestyle mods for fatigue
why could oxycodone result in urinary retention
its an opioid which can cause constipation, which in turn causes urinary retention
how soon before upper GI endoscopy should PPIs be stopped
Proton pump inhibitors should be stopped 2 weeks before an upper GI endoscopy
what does monopsony test check for
glandular fever
main side effect of aminosalicylates and how to check for it
agranulocytosis
FBC
what is hepatorenal syndrome and what is used to treat it
a type of functional kidney impairment that occurs in patients with advanced liver disease
key features include
- ascites
- low urine output
- significant increase in serum creatinine
Terlipressin is the recommended first-line treatment for HRS
reduced libido, erectile dysfunction, muscle pain, suntan colour of skin
diagnosis
haemochromatosis
H pylori eradication meds
PPI + amoxicillin + clarithromycin
or
PPI + metronidazole + clarithromycin
common side effect of PPIs
hyponatraemia
what do pts recovering from SBP need to be discharged with
ciprofloxacin - abx prophylaxis
which alcohol cessation med cant be given to pts with liver cirrhosis
naproxen
DOAC advice regarding upper GI endoscopy
low-risk endoscopic procedures
- the morning dose of DOAC on the day of the procedure should be omitted
high-risk endoscopic procedures
- the last dose of DOAC be taken ≥ 48 hours before the procedure
main side effect of long term PPI usage
osteoporosis - fractures
first and second line tx for haemochromatosis
1st - venesection
2nd - desferrioxamine
which skin condition is a risk factor for small bowel bacterial overgrowth syndrome
scleroderma
tx for small bowel bacterial overgrowth syndrome
rifaximin antibiotic
Proliferation of ductal epithelial cells without evidence of basement membrane invasion
ductal carcinoma in situ
What drug will you administer to reduce the risk of isoniazid induced peripheral neuropathy?
Pridoxine (vitamin B6)
what is pseudomembranous colitis, cause of it and how it appears on sigmoidoscopy
swelling or inflammation of the large intestine (colon) due to an overgrowth of Clostridioides difficile (C difficile) bacteria
looks like yellow plaques on sigmoidoscopy
What feature should be used to determine the severity of c diff infection?
WCC
A barium swallow shows a dilated oesophagus that tapers at the lower oesophageal sphincter.
diagnosis
achalasia
diet recommendation for pts being tested for coeliac disease with upper GI endoscopy
Patients must eat gluten for at least 6 weeks before they are tested
A 54-year-old female presents one week following a hip replacement with profuse diarrhoea. What is the most likely diagnosis?
c Diff
(patient would have been given broad-spectrum antibiotics at the time of the operation)
most common site for UC
RECTUM
NOT SIGMOID COLON
prophylaxis tx for oesophageal varices
beta blockers
(terlipressin + abx is used in acute bleeding to treat it )
what medications need to be stopped before the urea breath test for H pylori, and how long before do they need to be stopped
no antibiotics in past 4 weeks,
no antisecretory drugs (e.g. PPI) in past 2 weeks
triad of intestinal angina
severe, colicky post-prandial abdominal pain,
weight loss,
abdominal bruit
what is secondary peritonitis
occurs when a patient develops an peritoneal infection secondary to another infection, such as diverticulitis or appendicitis.
This is less frequently associated with ascites and a more obvious focus of infection would be noted.
what is a key differential for abdominal pain and fever in patients with cirrhosis and portal hypertension
SBP
what nail changes can be seen in coeliac
koilonychia
Coeliac disease is associated with iron, folate and vitamin B12 deficiency
what condition causes nail pitting
psoriasis
what condition causes Onycholysis
psoriasis or fungal nail infections
what condition causes Subungual keratosis
psoriasis or fungal nail infections
what does hoarseness of voice indicate in a pt with dysphagia
oesophageal carcinoma - tumour compresses recurrent laryngeal nerve
what is the time frame for endoscopy for pts suspected of upper GI bleed
All patients with suspected upper GI bleed require an endoscopy within 24 hours of admission
give 2 other cancers caused by HNPCC aside from colorectal cancer
endometrial cancer - 2nd most common
pancreatic cancer
which cancer does pernicious anaemia predispose to
gastric cancer
triad of sudden onset abdominal pain, ascites, and tender hepatomegaly
Budd chiari
fatigue, erectile dysfunction and arthralgia in a man
haemachromatosis
tx for suspected variceal haemorrhage
terlipressin and IV antibiotics
THEN endoscopy and band ligation
4 main adverse effects of PPI use
hyponatraemia, hypomagnasaemia –> muscle aches
osteoporosis → increased risk of fractures
microscopic colitis
increased risk of C. difficile infections
which abx classically cause c diff
clindamycin
or 3rd generation cephalosporins eg cefotaxime
first line laxative for IBS
bulk