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finals > gastro > Flashcards

gastro Flashcards

1
Q

features of type 1 hepatorenal syndrome

A

rapidly progressive
serum creatinine can double or halve in <2 weeks
poor prognosis

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2
Q

mx of hepatorenal syndrome

A

terlipressin to cause vasoconstriction of splanchnic circulation

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3
Q

moa of loperamide

A

decreases gastric motility through stimulation of opioid receptors

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4
Q

mx of variceal haemorrhage

A
  1. terlipressin and ABX (Quinolones), if terlipressin fails Sengstaken-Blakemore tube
  2. endoscopy - band ligation
  3. propranolol
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5
Q

expected liver transaminases in alcoholic hepatitis

A

AST>ALT 2:1

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6
Q

which levels are checked to ensure adequate response to hepatitis B immunisation?

A

anti-HBs

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7
Q

which cancer does Barrett’s oesophagus or GORD increase the risk of?

A

oesophageal adenocarcinoma

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8
Q

which cancer does achalasia increase the risk of?

A

squamous cell carcinoma of the oesophagus

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9
Q

mx of C.diff infection

A
  1. oral metronidazole 10-14 days
  2. oral vancomycin if severe or not responding to metronidazole
  3. oral vancomycin and IV metronidazole if life-threatening
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10
Q

PSC antibody results

A

AMA (antimitochondrial antibody) negative

pANCA positive

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11
Q

what is meant by ‘protein meal’?

A

following an upper GI bleed some blood can be digested causing raised urea but normal creatinine
patient may also have normocytic anaemia

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12
Q

ix to dx PSC

A

MRCP first

ERCP if MRCP not tolerated

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13
Q

polyps in GI tract + pigmented lesions on lips, face, palms and soles

A

Peutz-Jeghers syndrome

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14
Q

spontaneous bacterial petritonitis most common organism in ascitic fluid

A

E. coli

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15
Q

what is Courvoisier’s law

A

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

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16
Q

obstructive/cholestatic LFTs

A

ALP>ALT

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17
Q

when to 2ww refer patients with dyspepsia

A

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

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18
Q

secondary prophylaxis of hepatic encephalopathy

A
  1. lactulose

2. rifaximin

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19
Q

classification of UC flares

A

mild <4 stools daily
moderate 4-6 stools daily
severe >6 stools daily

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20
Q

triad for Budd-Chiari syndrome (hepatic vein thrombosis)

A
  1. abdo pain - sudden onset and severe
  2. ascites
  3. tender hepatomegaly
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21
Q

features more common in Crohn’s than UC

A 
non-bloody diarrhoea
weight loss 
upper GI symptoms
skip lesions
abdominal mass in RIF
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22
Q

mx of spontaneous bacterial peritonitis

A 
IV cefotaxime
antibiotic prophylaxis (Ciprofloxacin) should be given too
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23
Q

histology of Crohn’s vs UC

A

Crohn’s - inflammation in all layers from mucosa to serosa

UC - no inflammation beyond submucosa

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24
Q

hepatocellular LFTs

A

ALT>ALP at least 5+

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25
Q

triad of intestinal angina (chronic mesenteric ischaemia)

A

severe, colicky post-prandial abdo pain
weight loss
abdominal bruit

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26
Q

mx of severe alcoholic hepatitis

A

corticosteroids (prednisolone)

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27
Q

what metabolic consequences can occur in refeeding syndrome

A

hypophosphataemia
hypokalaemia
hypomagnesaemia

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28
Q

when is oral azathioprine used to maintain remission of UC

A

following a severe relapse or 2 or more exacerbations in the past year

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29
Q

risk factors for oesophageal candidiasis

A

HIV
steroid inhaler use
systemic ABX

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30
Q

features of gallstone ileus

A

abdo pain, distension and vomiting

SBO secondary to impacted gallstone

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31
Q

mx of mild/moderate UC flare

A

topical/oral aminosalicylates

if remission not achieved, add oral prednisolone

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32
Q

histology of coeliac disease

A

villous atrophy
raised intra-epithelial lymphocytes
crypt hyperplasia

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33
Q

haemochromatosis iron study results

A

raised transferrin saturation
raised ferritin
raised serum iron
low TIBC

34
Q

ix for HCC

A

AFP will be raised

35
Q

how to calculate units

A

units = volume (ml) x ABV/1000

36
Q

features of primary biliary cholangitis

A

the M rule

IgM, AMA, Middle aged females

37
Q

cancers associated with HNPCC

A

colon cancer
endometrial cancer
gastric cancer
pancreatic cancer

38
Q

epigastric pain, known gallstones, vomiting, apyrexial

A

acute pancreatitis

39
Q

features of biliary colic

A

RUQ pain

no other features

40
Q

what is cholestyramine used for

A

it is a bile acid sequestrant used in bile acid malabsorption to prevent diarrhoea

41
Q

features of oesophagitis

A

hx of heartburn

odynophagia but no weight loss and systemically well

42
Q

crypt abscesses

A

UC

43
Q

goblet cells

A

Crohn’s

44
Q

granulomas

A

Crohn’s

45
Q

inducing remission in Crohn’s

A 
glucocorticoids first (prednisolne)
mesalazine (5-ASA) may be used if glucocorticoids are not effective
46
Q

most common inheritable form of colorectal cancer

A

HNPCC

FAP is second most common

47
Q

adverse effects of PPIs

A

hyponatraemia
hypomagnesaemia
osteoporosis
increased risk of C. diff infections

48
Q

FBC in alcoholic liver disease

A

macrocytic anaemia and thrombocytopenia

49
Q

what test is used to confirm eradication of H. Pylori

A

urea breath test

50
Q

diagnostic marker for carcinoid syndrome

A

urinary 5-HIAA

51
Q

when to stop meds before urea breath test

A

1 day - antacids
2 weeks - PPI
3 days - H2 antagonist, e.g. Cimetidine
4 weeks - ABX

52
Q

H. pylori eradication therapy

A

PPI + amoxicillin + clarithromycin
OR
PPI + metronidazole + clarithromycin

53
Q

liver failure following cardiac arrest

A

think ischaemic hepatitis

54
Q

which test is used to screen for hep B

A

HBsAg

55
Q

what conditions are associated with H. pylori

A

peptic ulcer disease
gastric cancer
B cell lymphoma of MALT tissue
atrophic gastritis

56
Q

adverse effects of methotrexate

A 
mucositis
pneumonitis
pulmonary fibrosis
myelosuppresssion
liver fibrosis
57
Q

Wilson’s disease bloods

A

reduced serum caeruloplasmin

reduced total serum copper

58
Q

PSC cancer

A

cholangiocarcinoma

59
Q

which ABX is used as prophylaxis against SBP

A

oral ciprofloxacin

60
Q

risk factors for small bowel bacterial overgrowth syndrome (SBBOS)

A

diabetes mellitus
scleroderma
neonates w congenital GI abnormalities

61
Q

poor prognostic factors for liver cirrhosis

A

ascites
encephalopathy
low albumin

62
Q

features of mesenteric ischaemia

A

severe abdo pain
history of vascular disease
lactic acidosis

63
Q

most common presenting features of Crohn’s

A

abdo pain - esp. in children
weight loss
lethargy
diarrhoea - esp. in adults

64
Q

mx of achalasia

A

pneumatic/balloon dilation
Heller cardiomyotomy for recurrent/persistent symptoms
high surgical risk patients - intra-sphincteric injection of botulinum toxin

65
Q

ix for UC flare

A

AXR for toxic megacolon

66
Q

mx of Campylobacter infection

A

self-limiting but if severe Clarithromycin can be used

67
Q

when is NG feeding used and when should it be avoided

A

used for patients with impaired swallow

avoid following head injury

68
Q

when is NJ feeding used

A

safe to use following oesophagogastric surgery

69
Q

when is feeding jejunostomy used

A

long-term feeding following upper GI surgery

70
Q

when is PEG (percutaneous endoscopic gastrostomy) feeding used and when should it be avoided

A

long-term feeding

avoid in vomiting as requires endoscopy

71
Q

when is TPN feeding used

why is a central vein needed

A

in all patients in whom enteral feeding is CI

needs to be via central vein as strongly phlebitis

72
Q

ix for small bowel bacteria overgrowth syndrome

A

hydrogen breath test

73
Q

autoimmune hepatitis bloods (AST/ALT vs ALP)

A

predominantly raised ALT/AST on LFTs than ALP

74
Q

mx of autoimmune hepatitis

A

steroids are first line

75
Q

mx of hiatus hernia

A

start with conservative therapy (weight loss, smoking cessation, dietary advice and PPI)
fundoplication if conservative measures fail

76
Q

how often are surveillance colonoscopies carried out in UC

A

low risk - every 5 yeas
medium risk - every 3 years
high risk - every year

77
Q

features of autoimmune hepatitis

A

amenorrhoea
chronic liver disease signs
ANA/SMA antibodies
raised ALT/AST

78
Q

liver failure triad

A

encephalopathy (confusion + liver flap)
jaundice
coagulopathy

79
Q

which anaemia follows ileocaecal resection

A

macrocytic anaemia due to vitamin B12 deficiency

80
Q

mx of diverticulitis

A

mild flare - oral ABX

if symptoms do not settle within 72 hours, or severe presentation, admit for IV ABX

81
Q

mx for symptomatic relief in carcinoid tumour

A

octreotide

finals (25 decks)

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