gastro Flashcards
features of type 1 hepatorenal syndrome
rapidly progressive
serum creatinine can double or halve in <2 weeks
poor prognosis
mx of hepatorenal syndrome
terlipressin to cause vasoconstriction of splanchnic circulation
moa of loperamide
decreases gastric motility through stimulation of opioid receptors
mx of variceal haemorrhage
- terlipressin and ABX (Quinolones), if terlipressin fails Sengstaken-Blakemore tube
- endoscopy - band ligation
- propranolol
expected liver transaminases in alcoholic hepatitis
AST>ALT 2:1
which levels are checked to ensure adequate response to hepatitis B immunisation?
anti-HBs
which cancer does Barrett’s oesophagus or GORD increase the risk of?
oesophageal adenocarcinoma
which cancer does achalasia increase the risk of?
squamous cell carcinoma of the oesophagus
mx of C.diff infection
- oral metronidazole 10-14 days
- oral vancomycin if severe or not responding to metronidazole
- oral vancomycin and IV metronidazole if life-threatening
PSC antibody results
AMA (antimitochondrial antibody) negative
pANCA positive
what is meant by ‘protein meal’?
following an upper GI bleed some blood can be digested causing raised urea but normal creatinine
patient may also have normocytic anaemia
ix to dx PSC
MRCP first
ERCP if MRCP not tolerated
polyps in GI tract + pigmented lesions on lips, face, palms and soles
Peutz-Jeghers syndrome
spontaneous bacterial petritonitis most common organism in ascitic fluid
E. coli
what is Courvoisier’s law
in the presence of painless obstructive (aka cholestatic) jaundice a palpable gallbladder is UNLIKELY to be due to gallstones, i.e. pancreatic cancer is possible
obstructive/cholestatic LFTs
ALP>ALT
when to 2ww refer patients with dyspepsia
all patients who have dysphagia too
all patients with upper abdo mass consistent w stomach cancer
patients >= 55 years with weight loss and any of upper abdo pain, reflux or dyspepsia
secondary prophylaxis of hepatic encephalopathy
- lactulose
2. rifaximin
classification of UC flares
mild <4 stools daily
moderate 4-6 stools daily
severe >6 stools daily
triad for Budd-Chiari syndrome (hepatic vein thrombosis)
- abdo pain - sudden onset and severe
- ascites
- tender hepatomegaly
features more common in Crohn’s than UC
non-bloody diarrhoea weight loss upper GI symptoms skip lesions abdominal mass in RIF
mx of spontaneous bacterial peritonitis
IV cefotaxime antibiotic prophylaxis (Ciprofloxacin) should be given too
histology of Crohn’s vs UC
Crohn’s - inflammation in all layers from mucosa to serosa
UC - no inflammation beyond submucosa
hepatocellular LFTs
ALT>ALP at least 5+
triad of intestinal angina (chronic mesenteric ischaemia)
severe, colicky post-prandial abdo pain
weight loss
abdominal bruit
mx of severe alcoholic hepatitis
corticosteroids (prednisolone)
what metabolic consequences can occur in refeeding syndrome
hypophosphataemia
hypokalaemia
hypomagnesaemia
when is oral azathioprine used to maintain remission of UC
following a severe relapse or 2 or more exacerbations in the past year
risk factors for oesophageal candidiasis
HIV
steroid inhaler use
systemic ABX
features of gallstone ileus
abdo pain, distension and vomiting
SBO secondary to impacted gallstone
mx of mild/moderate UC flare
topical/oral aminosalicylates
if remission not achieved, add oral prednisolone
histology of coeliac disease
villous atrophy
raised intra-epithelial lymphocytes
crypt hyperplasia
haemochromatosis iron study results
raised transferrin saturation
raised ferritin
raised serum iron
low TIBC
ix for HCC
AFP will be raised
how to calculate units
units = volume (ml) x ABV/1000
features of primary biliary cholangitis
the M rule
IgM, AMA, Middle aged females
cancers associated with HNPCC
colon cancer
endometrial cancer
gastric cancer
pancreatic cancer
epigastric pain, known gallstones, vomiting, apyrexial
acute pancreatitis
features of biliary colic
RUQ pain
no other features
what is cholestyramine used for
it is a bile acid sequestrant used in bile acid malabsorption to prevent diarrhoea
features of oesophagitis
hx of heartburn
odynophagia but no weight loss and systemically well
crypt abscesses
UC
goblet cells
Crohn’s
granulomas
Crohn’s
inducing remission in Crohn’s
glucocorticoids first (prednisolne) mesalazine (5-ASA) may be used if glucocorticoids are not effective
most common inheritable form of colorectal cancer
HNPCC
FAP is second most common
adverse effects of PPIs
hyponatraemia
hypomagnesaemia
osteoporosis
increased risk of C. diff infections
FBC in alcoholic liver disease
macrocytic anaemia and thrombocytopenia
what test is used to confirm eradication of H. Pylori
urea breath test
diagnostic marker for carcinoid syndrome
urinary 5-HIAA
when to stop meds before urea breath test
1 day - antacids
2 weeks - PPI
3 days - H2 antagonist, e.g. Cimetidine
4 weeks - ABX
H. pylori eradication therapy
PPI + amoxicillin + clarithromycin
OR
PPI + metronidazole + clarithromycin
liver failure following cardiac arrest
think ischaemic hepatitis
which test is used to screen for hep B
HBsAg
what conditions are associated with H. pylori
peptic ulcer disease
gastric cancer
B cell lymphoma of MALT tissue
atrophic gastritis
adverse effects of methotrexate
mucositis pneumonitis pulmonary fibrosis myelosuppresssion liver fibrosis
Wilson’s disease bloods
reduced serum caeruloplasmin
reduced total serum copper
PSC cancer
cholangiocarcinoma
which ABX is used as prophylaxis against SBP
oral ciprofloxacin
risk factors for small bowel bacterial overgrowth syndrome (SBBOS)
diabetes mellitus
scleroderma
neonates w congenital GI abnormalities
poor prognostic factors for liver cirrhosis
ascites
encephalopathy
low albumin
features of mesenteric ischaemia
severe abdo pain
history of vascular disease
lactic acidosis
most common presenting features of Crohn’s
abdo pain - esp. in children
weight loss
lethargy
diarrhoea - esp. in adults
mx of achalasia
pneumatic/balloon dilation
Heller cardiomyotomy for recurrent/persistent symptoms
high surgical risk patients - intra-sphincteric injection of botulinum toxin
ix for UC flare
AXR for toxic megacolon
mx of Campylobacter infection
self-limiting but if severe Clarithromycin can be used
when is NG feeding used and when should it be avoided
used for patients with impaired swallow
avoid following head injury
when is NJ feeding used
safe to use following oesophagogastric surgery
when is feeding jejunostomy used
long-term feeding following upper GI surgery
when is PEG (percutaneous endoscopic gastrostomy) feeding used and when should it be avoided
long-term feeding
avoid in vomiting as requires endoscopy
when is TPN feeding used
why is a central vein needed
in all patients in whom enteral feeding is CI
needs to be via central vein as strongly phlebitis
ix for small bowel bacteria overgrowth syndrome
hydrogen breath test
autoimmune hepatitis bloods (AST/ALT vs ALP)
predominantly raised ALT/AST on LFTs than ALP
mx of autoimmune hepatitis
steroids are first line
mx of hiatus hernia
start with conservative therapy (weight loss, smoking cessation, dietary advice and PPI)
fundoplication if conservative measures fail
how often are surveillance colonoscopies carried out in UC
low risk - every 5 yeas
medium risk - every 3 years
high risk - every year
features of autoimmune hepatitis
amenorrhoea
chronic liver disease signs
ANA/SMA antibodies
raised ALT/AST
liver failure triad
encephalopathy (confusion + liver flap)
jaundice
coagulopathy
which anaemia follows ileocaecal resection
macrocytic anaemia due to vitamin B12 deficiency
mx of diverticulitis
mild flare - oral ABX
if symptoms do not settle within 72 hours, or severe presentation, admit for IV ABX
mx for symptomatic relief in carcinoid tumour
octreotide
