Gastro 1 Flashcards
Side effects of PPI
- Hyponatraemia
- Osteoperosis
- Microscopic collitis
- INCREASE C.DIFFE INFECTION!
What drugs increase risk of C.diffe? (2)
- Clindamycin (classically)
- Now Cephlasporins
- PPI
C. diffe management
1st line
2nd line
3rd line
Life threatening- (2)
1st line - ORAL vancomycin
2nd line - oral fidaxomicin except if life threatening
3rd line - oral vancomycin +/- IV metronidazole
Life threatening- oral vancomycin AND IV metronidazole
specialist advice - surgery may be considered
How does ischaemic colitis present?
Sudden onset diffuse abdo pain after a meal, intermittent and severe pain, pain out of proportion to clinical findings)
As well as predisposing factors: prev. myocardial infarction, atrial fibrillation, hypertension
Features of achalasia?
1. STEM!
.2
3.
4.
malignant change?
- STEM! dysphagia of BOTH liquids and solids
- typically variation in severity of symptoms
- heartburn
- regurgitation of food
may lead to cough, aspiration pneumonia etc
malignant change in small number of patients
What do you need to do before having an appendectomy?
Give prophylactic IV ABX! (e.g. Co-amoxiclav TDS pending no penicillin allergy)
How do you differentiate between the 4 different familial CRC diseases?
Peutz-Jeghers syndrome (2)
FAP
Gardner’s Syn
Lynch Syn
Peutz-Jeghers syndrome
- numerous hamartomatous polyps in GI
- pigmented freckles on the lips, face, palms and soles
FAP
Gardner’s Syn
Lynch Syn
Familial CRC- what are the genetic patterns and genes affected in each
Familial CRC- what are the genetic patterns and genes affected in each
Peutz-Jeghers syndrome (2)
FAP
Gardner’s Syn
Lynch Syn
Peutz-Jeghers syndrome
- Auto Dom
- Codes for serine threonine kinase LKB1 or STK11
FAP
Gardner’s Syn
Lynch Syn
Plummer Vinson Syndrome
what is it?
what do you get?
(oesophageal web) may occur in association with iron deficiency anaemia (although rare).
Get dysphagia
Criteria for malnutrition:
1. BMI of…
- Unintentional weight loss of… in how long?
- If BMI < …. then weight loss of…
- BMI of less than 18.5
- Unintentional weight loss greater than 10% within the last 3-6 months is diagnostic of malnutrition
- If BMI < 20 and unintentional weight loss greater than 5% within the last 3-6 months
Which part of the bowel is most likely to be affected by ischaemic colitis?
And what artery?
splenic flexure
If its hypoperfusion:
Splenic flexure is in between vascular supply of midgut and hindgut (SMA and IMA) - more likely to be affected as in ‘watershed’ area
If its an emboli:
The Sup Mesenteric A. is the first branch off aorta- and the splenic flexure is the furthest point in this blood supply so it’ll get lodged there.
IBS what first-line investigation should you rule out first?
Anti-TTG just to rule out ceoliac
Coaliac disease can cause what bone condition and why?
Osteomalacia secondary to lack of Vit D absorption from GI due to villous atrophy
What is the guidance for max weekly alcohol intake
what about if preg/ planning on preg?
No more than 14 units
If you do as much as 14 units then spread it evenly over 3 days or more
For both men and women
safest approach is do not drink at all and if do keep to a minimum as can lead to long-term health affects for kid, more you drink the greater the risk
When looking at the history of dysphagia and a barium swaloow what would point to oesophageal cancer over achalasia?
Achalasia- smooth bieds beak and both solids AND liquids affected!!
Cancer- Irreg- APPLE CORE SIGN and mainly solids first have trouble, obvs FLAWS
What can affect coeliac screening antibody test?
Autoimmune hepatitis management (2)
How do you diff clinically between Auto-immune Hep and PBC (2)
Management- steroids +/- Immunosurpression azathioprine
Auto Hep
- ANA +ve
- Amenorrhoea in girls
PBC
- AMA +ve
- ANA +ve
What is and how does it Boerhaave syndrome present?
Rupture of his oesophagus
Severe vomiting → oesophageal rupture
Painless jaundice how to diff Cholangiocarcinoma (3 signs) vs Pancreatic cancer
Pancreatic cancer until proven otherwise, its more common
- just painless jaundice
- pain can be quite common
Cholangiocarcinoma
- palpable mass in the right upper quadrant (Courvoisier sign)
- periumbilical lymphadenopathy (Sister Mary Joseph nodes)
- left supraclavicular adenopathy (Virchow node)
First line investigation for pancreatic cancer
High resolution CT abdo
What are the typical features of a pharyngeal pouch (5)
Investigation (1)
Management (1)
- Dysphagia
- Regurg
- Halitosis- smelly breathe
- Neck swelling which gurgles on palp.
- Aspiration
Investigation- Barium swallow
Management- Surgery
Who gets prophylytactic antiobiotics if peritonits? (2)
What abx?
oral ciprofloxacin or norfloxacin
- patients who have had an episode of SBP
- patients with fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome
NICE recommend: ‘Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less until the ascites has resolved’
Most common type of inherited colorectal cancer:
Hereditary non-polyposis colorectal carcinoma- Lynch
Upper GI 2ww referral -Dyspepsia
Urgent
First thing to rule out…
All with
All with +
Age and 1 from: (3)
Non-urgent
All with…
Age who have
- or
- or
-
-
Red flags: 2ww endo
- All with dysphagia
- All with upper abdo mass (gastric cancer)
Patients >= 55yo AND one from:
- upper abdominal pain
- reflux
- dyspepsia
Non-Urgent
- All patients with haematemesis
Patients aged >= 55 years who’ve got:
- treatment-resistant dyspepsia or
- upper abdominal pain with low haemoglobin levels or
- raised platelet count with any of the following: nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain
- nausea or vomiting with any of the following: weight loss, reflux, dyspepsia, upper abdominal pain
Metabolic ketoacidosis and normal glucose, think….
Alcoholic ketoacidosis
Upper GI bleed from oesophageal varicose vein- you’ve corrected clotting and awaiting OGD, what can you do while waiting?
Sengstaken-Blakemore tube has oesophageal and gastric balloons which can be inflated to tamponade the variceal bleeding. It is inserted through the nose.
if we think its alcoholic hep what do we look at on LFT?
The AST/ALT ratio in alcoholic hepatitis is 2:1
Alcohol units formula if given ml
Alcohol units = volume (ml) x % ABV / 1,000
pathognomonic secondary osteoarthritis STEM for Haemochromatosis (2)
hook-like osteophytes at the 2nd and 3rd digits at the metacarpophalangeal joints
slate-grey appearance of the skin.
Iron defiency anaemia vs. anaemia of chronic disease
Obvs both microcytic
TIBC is high in IDA
low/normal in anaemia of chronic disease
Investigation for C.diffe
Screening test =
Diagnostic test for active =
Screening test = C. difficile antigen positivity only shows exposure to the bacteria, rather than current infection
Diagnostic test for active = C. difficile toxin (CDT) in the stool
Acute Liver failure- synthetic function tests (2)
Which is better indicator in the acute scenario?
Prothrombin time (PT) increase
Hypoalbuminaemia
Prothrombin has a shorter half-life than albumin, making it a better measure of acute liver failure
Most common type of oesophageal cancer?
adenocarcinoma
arises in the lower third of the oesophagus, near the gastro-oesophageal junction.
autoimmune hepatitis
who is it seen in?
Type 1
antibody (2)
Affects who?
Type 2
Antibody (1)
Affects who?
Type 3
Antibody (1)
Affects who?
young females. Recognised associations include other autoimmune disorders, hypergammaglobulinaemia and HLA B8, DR3.
Type 1
antibody:
- ANA
- Anti-smooth muscle (SMA)
Affects both adults and kids
Type 2
Antibody:
LKM1- Anti-liver/kidney microsomal type 1
Affects who?
just kids
Type 3
Antibody:
Soluble liver-kidney antigen
Affects who?
Affects adults in middle-age
for all also raised IgG
Viral hep
what Ig is raised?
Management (2)
IgG
steroids, other immunosuppressants e.g. azathioprine
liver transplantation
Plummer-Vinson syndrome. triad
triad of
- dysphagia
- glossitis
- iron-deficiency anaemia (some definitions additionally include cheilitis in the syndrome).
Small bowel bacterial overgrowth syndrome (SBBOS)
Risk factors for SBBOS (3)
Diagnostic (3)
1st line-
2 other options
Management (1)
Risk factors for SBBOS
neonates with congenital gastrointestinal abnormalities
scleroderma
diabetes mellitus
Diagnosis
hydrogen breath test
small bowel aspiration and culture: this is used less often as invasive and results are often difficult to reproduce
clinicians may sometimes give a course of antibiotics as a diagnostic trial
Antibiotic therapy: rifaximin
Co-amoxiclav or metronidazole are also effective
A transjugular intrahepatic portosystemic shunt procedure connects which two vessels?
connects the hepatic vein to the portal vein
