finals gastro Flashcards
what sign is seen on imaging in pancreatic cancer?
double duct sign (CT, MRI, ERCP)
> dilatation of pancreatic and common bile duct
which tumour marker is associated with pancreatic cancer?
Ca 19-9 (think pancreas shaped like a 9)
what treatment is offered for dysplasia on biopsy in barrett’s oesophagus?
endoscopic mucosal therapy (radiofrequency ablation/endoscopic resection)
what is the management for wilson’s disease?
penicillamine (?tridentine now)
> chelates copper
anti-HBs -
anti-HBc +
HBs antigen +
IgM anti-HBc -
chronic hep B (prev acute infection still a carrier)
anti-HBs +
anti-HBc -
HBs antigen -
IgM anti-HBc -
prev immunisation
anti-HBs -
anti-HBc +
HBs antigen -
IgM anti-HBc -
prev hep B not a carrier
common side effect of metaclopramide?
diarrhoea (prokinetic)
what is the management for recurrence of c.diff within 12 weeks of symptom resolution?
oral fidaxomicin
what marker is positive in PSC?
pANCA
what bowel disease is PSC associated with?
ulcerative colitis
what is the management for life-threatening C-diff?
- ORAL vancomycin
- IV metronidazole
how is alcoholic ketoacidosis managed?
IV thiamine and saline
what is the mechanism of action of loperamide?
Reduction in gastric motility through stimulation of opioid receptors
what is the diagnostic investigation for PSC?
MRCP (sensitive and non-invasive)
what is grade I HE?
irritability
what is grade II HE?
confusion, inappropriate behaviour
what is grade III HE?
incoherent, restless
what is grade IV HE?
coma
what type of cancer is barrett’s oesophagus associated with?
oesophageal carcinoma
what type of cancer is achalasia associated with?
squamous cell carcinoma of the oesophagus
what score assesses risk of rebleeding after upper GI bleed (post endoscopy)?
rockall score
what does the child-pugh score assess?
severity of liver cirrhosis
what medication is given post-resuscitation for variceal haemorrhage?
terlipressin
what is the triad of features in intestinal angina?
- severe colicky post-prandial abdo pain
- weight loss
- abdominal bruit
what bloods are used to monitor treatment in haemochromatosis?
ferritin
transferrin
how does PBC present?
may be asymptomatic, or fatigue, pruritus
cholestatic jaundice, hyperpigmentation
> raised ALP on routine LFTs
how is PBC diagnosed?
AMA (highly specific)
raised serum IgM
how do you treat PBC?
ursodeoxycholic acid
which drugs should be stopped before 13C-urea breath test?
no abx last 4 weeks
no PPIs last 2 weeks
what drugs are used first line in patients with ascites secondary to liver cirrhosis?
aldosterone antagonist - spironolactone
what is carcinoid syndrome?
when metastases are present in the liver and release serotonin into the systemic circulation
what are the features of carcinoid syndrome?
- flushing
- diarrhoea
- bronchospasm
- hypotension
- RH valvular stenosis
how is carcinoid syndrome investigated?
urinary 5-HIAA
plasma chromogranin A y
how is carcinoid syndrome managed?
somatostatin analogues eg octreotide
for diarrhoea cyproheptadine may help
what does metabolic alkalosis + hypokalaemia suggest?
? prolonged vomiting
why do people with coeliac disease receive the pneumococcal vaccine?
hyposplenism
what lifestyle factors are used in mgt of ascites?
- reducing dietary sodium
- fluid restriction is sodium is >125mmol/L
what is a disadvantage of using a PPI long-term?
inc risk fractures + osteoporosis
what type of cancer does pernicious anaemia predispose to?
gastric carcinoma
what does dysphagia to both solids and liquids from the outset of symptoms suggest?
achalasia
what is the AST/ALT ratio in alcoholic hepatitis?
AST:ALT 2:1
toAST
which bowel condition is associated with gallstones?
crohn’s
how does pharyngeal pouch present?
- dysphagia
- regurgitation
- aspiration
- neck swelling which gurgles on palpation
- halitosis
What is the management for C. difficile?
Oral vancomycin
What are the key features of Peutz-Jeghers syndrome?
- autosomal dominant
- hamartomatous polyps in GI tract
> small bowel obstruction, GI bleeding - pigmented lesions on lips, oral mucosa, face, palms and soles
What is the most commonly affected part of the bowel in UC?
Rectum
Which malignancy is associated with coeliac disease?
EATL (enteropathy-associated T cell lymphoma)
What test is used for H.pylori post-eradication therapy?
Urea breath test
