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Y6 Senior Med > Gastro > Flashcards

Gastro Flashcards

1
Q

What investigation would you get for suspected appendicitis?

A

Normally a clinical dx
You may need to get a pelvic USS to exclude ovarian cyst accident

CT abdomen - if uncertain

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2
Q

What score can you use for appendicitis

A

Alvarado score

>4 is high likelyhood of it being appendicitis

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3
Q

What are the three signs you can get in appendicitis

A

Rosvig’s sign
Cope’s sign
Psoas sign

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4
Q

What is Rosvig sign

A

Pain worse in RIF when pressing down on LIF

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5
Q

What is Cope sign

A

Pain on passive flexion and internal rotation of hip

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6
Q

What is Psoas sign, and what does it indicate exactly

A

Pain on extending hip

Indicates RETROCAECAL APPENDIX

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7
Q

How would you manage appendicitis

A

start prophylactic antibiotics before surgery

THEN laparoscopic appendicectomy

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8
Q

what extra thing must you do if appendicitis is perforated

A

ABDOMINAL LAVAGE

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9
Q

What is ascending cholangitis

A

INFECTION of the biliary traact

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10
Q

What causes ascending cholangitis

A

Obstruction + infection

Obstruction can be caused by:

  • gallstones
  • ERCP
  • cholaangiocarcinoma
  • pancreatitis
  • PSC
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11
Q

How will pt with ascending cholangitis present

A

ACUTELY UNWELL - MAY BE SEPTIC

Charcot’s triad: fever + RUQ pain + jaundice
Reynaud’s pentad: + hypotension + confusion

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12
Q

How do you investigate and manage suspected ascending cholangirtis

A

Bloods: Raised ALP and GGT
Ix: USS biliary tract (will show thickened wall and bile duct dilatation)
ERCP (ix and mx) - to clear obstruction
If cause was gall stones, may need cholecystectomy

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13
Q

How do you manage acute cholangitis

A

IV Abx AND ERCP within 24-48h

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14
Q

What are the three types of gallbladder disease you can get?

A

BILIARY COLIC: stones causing pain in gallbladder neck
CHOLECYSTITIS: inflammation of gallbladder
ASCENDING CHOLANGITIS: inflammation of bile duct

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15
Q

Describe the three types of gall stones

A

cholesterol (if fat, poor diet)
pigment (if haemolytiic anaemia)
mixed

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16
Q

What are RF for gallstones

A 
Fat 
Fair 
Fourty 
Female 
FH

+ OCP, pregnancy, haemolytic anaemia

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17
Q

What is a biliary colicj

A

stones in the neck of gallbladder causing pain on contraction

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18
Q

Describe the pain in a biliary colic

A

Colicky (intermittent)
Triggered by eatiing fatty foods
Sudden, dull
In RUQ

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19
Q

How do you investigate for gallbladder pathology

A

Abdo USS of gallbladder and bile ducts

MRCP if nothing visible (and suspected cholecystitis / biliary colic)

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20
Q

what do you see on USS of gallbladder in pathology

A

thickened wall
Bile duct dilatation
Gallstones

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21
Q

How do you manage biliary colic

A

IV analgesia

elective cholecystectomy within 6 weeks

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22
Q

What are symptoms of cholecystitis

A

Pain (constant, RUQ) + fever

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23
Q

How do you manage acute cholecystitis

A

IV Abx
IV analgesia, antiemetics
Laparoscopic cholecystectomy (<72h)

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24
Q

What are symptoms and signs of pancreatitis

A

severe epigastric pain radiating to back, N&V

Cullen’s (periumbilical), grey turner sign (retroperitoneal=

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25
Q

What Ix must you get for acute pancreatitis

A

serum amylase 3x normal upper range (although does not correlate to disease severity)
consider serum lipase (more S&S, not as available)
ABG (will need PO2 for Glasgow score)
FBC, U&E, LFT, Albumin, BG, calcium
USS (exclude gallstones)
CT abdo (if clinical uncertainty)

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26
Q

What scoring systems can you use for acute pancreatitis

A

Ranson
Apache II
Modified Glasgow

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27
Q

What are the contents of the glasgow score

A 
PANCREAS 
PaO2 <8 
Age >55
Neutrophils 
Calcium LOW 
Urea high 
Enzymes high (LDH>, AST/ALT>200) 
ALbumin (<32) 
Sugar >10
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28
Q

How do you manage pancreagtitis

A

SUPPORTIVE tx
aggressive IV fluid resus > maintainance
analgesia (IV morphile 1-2mg STAT boluses until comfortable)
antiemetics

Consider NG tube and fluid balance chart (catheter)
Correct cause f possble

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29
Q

Pancreatits complications

A

EARLY: DIC, ARDS, hypocalcaemia, hyperglycaemia
LATE: pseudocyst, pancreatic abscess, pancreatic necrosis

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30
Q

What classification can you use for diverticulitis

A

Hinchley classification 1-4

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31
Q

What investigation do you go for acute diverticulitis

A

CT abdomen (never colonoscopy acutely, as perforation risk)

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32
Q

What is the management of acute diverticulitis

A

IV Abx, IV fluids, analgesia - NBM
If severely unwell: Hartmann’s procedure (sigmoid colectomy with end colostomy > anastamosis at later date, only possible in 50% of patients)

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33
Q

what is the region affected by UC

A

UC Region: colon only (it’s in the name!) - starts in rectum and runs towards proximal colon (max until iliocaecal valce)

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34
Q

what is the levels of the gut layers affected by UC

A

UC: Mucosa and submucosa only (SUPERFICIAL - remember that this condition affects less of everything compared to chron’s)

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35
Q

What is the inflammation like pathologically for UC (so on biopsy?

A

continuous (leadpipe)
pseudo-polyps
thumbprinting

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36
Q

what condition is rellated to UC

A

PSC

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37
Q

What are typical symptoms of UC

A

BLOODY diarrhoea
MUCOUS
LIF pain
tenesmus

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38
Q

what is the layer affected by CD

A

Transmural, with NON CASEATING GRANULOMAs

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39
Q

what is the region of gut affected by CD

A

ALL OF IT

Mouth to anus

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40
Q

what is the most common region affected by CD D

A

Terminal ileum

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41
Q

what are signs on biospy of histology for CD

A

skip lesions
rose thorn ulcers
cobblestoning
string of kantor (narrow ileum stricture)

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42
Q

what IBD condition are abscesses / fissures common in

A

in CHRON’s

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43
Q

What are chron’s sx

A

non bloody diarrhoea
RIF mass and pain
mouth ulcers, fissures in ano, perianal skin tags
FAILURE TO THRVE

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44
Q

How unwell are patients during flares between CD and UC

A

CD: systemically unwerll
UC: well

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45
Q

what personal factor can precipitate a UC flare?

A

stopping smoking

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46
Q

what are extra intestinal manifestations of IBD

A 
A PIE SAC 
aphtous ulcers 
pyoderma gangrenosum 
iritis, uveitis, episcleritis
erythema nodosum 
sclerosing cholangitis (primary - UC) 
arthritis 
clubbing
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47
Q

What investigations shoulld you get for suspected IBD

A

faecal calprotectin (marker of inflamm)
Bloods (FBC, UE, CRP, LFT, pANCA)
Scope (colonoscopy +-OGD for chron’s)
Biopsy

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48
Q

what is the two key steps in mx of chron’’s

A

Induce remission&raquo_space; maintain remission

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49
Q

how do you indduce remission in chron’s

A

Steroids, then biologics

Nutritional: repllace diet with whole protein modular diet (excessively liquid for 6-8 weeks)

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50
Q

How do you maintain remission in chron’s

A

(beware that continuing steroids can have long term consequences)

  1. stop smoking
  2. DMARD (e.g. azatioprine, mercaptopurine, methotrexate)
    Alternatives to DMARD: aminosalicylate, biological thherapoy

also remember to vaccinate (not with live vaccines though)

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51
Q

How do you manage UC

A

Mesalazine FIRST

Then steroids and biologics ( Aminosallycates, azathioprine, mercaptopurine)

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52
Q

What must you always measure before starting someone on azathioprine

A

TPMT (enzyme required for its breakdown)

if TPMT is low, give methotrex instead

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53
Q

Which IBD type is surgery curative for?

A

UC

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54
Q

What type of surgery is typically done for UC

A

Hartmann’s proctosigmoidoscopy + end ileostomy > later IPAA

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55
Q

what is classic presentation of IBS

A 
young 
femaille 
anxious, stressed, depressed 
pain
bloating and diarrhoea / constipation
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56
Q

How do you diagnose IBS

A

Diagnosis of EXCLUSION, based on ROME III criteria

  • improvement with defecatioon
  • change in stool frequency
  • change in stool form / appearance / consistency
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57
Q

What are haemorrhoids

A

vascular cushions that protrude through the rectum via straining on defecation

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58
Q

What are the four classes of haemorrhoids

A

1: in rectum
2. prolapse through anus, reduce spontaneously
3. prolapse though anus, manual reduction
4. persistently prolapsed (not prolapsed)

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59
Q

where are haemorrhoids usualy found

A

3, 7, 11 oclock

60
Q

what type of procedure may need to be done if suspecting internal haemorrhoids

A

proctoscopy / sigmoidoscopy

61
Q

how do you manage haemorrhoids

A

Conservative: increase fluid/fibre,

Medical: stool softener, topical analgesia, steroids

Non-operative: rubber band ligation, sclerotherapy

Operative: haemorrhoidectomy

62
Q

what is coeliac disease due to and what does it cause in the GI tract

A

due to AUTOIMMUNITY to gliadin (gluten, wheat, barley, rye)

leads to shorter villli and flat mucosa

63
Q

What is coeliac diisease incidence

A

bimodal (infants or middle aged)

64
Q

What are the AI HLA associations of coeliac

A

HLA DQ2, HLA DQ8

65
Q

What are symoptoms of coeliac

A

watery frothy stooll (staethorroea)
Failure to thrive
Insufficient growth in chikldren

66
Q

what skin condition is pathomnemonic for coeliac

A

derrmatitis herpetiformis

67
Q

What substances can someone with coeliac be deficient to

A

iron
B12
folate

68
Q

what else must you screen for if suspecting coelilac disease

A

T1DM, Ai thyroid disease, IBS, coeliac

69
Q

What initial investigations must you do for coeliac

A

Bloods: anti-TTG + Total IgA, FBC (iron deficiency), vit B12 / folate, vit D, + blood smear (target cells and howell-jolly)

70
Q

how do you confirm coeliac + findings

A

OGD + duodenal / jejunal biopsy (villous atrophy, crypt hyperplasia, intra epithelial lymphocytes)

71
Q

How do you manage coeliac

A

GLUTEN FREE DIET LIFELONG
dietician referral if problems adhering to diet
annual 6-12 month review

72
Q

what is the difference in terms of location between PBC and PSC

A 
PBC = intrahepatic bile ducts only 
PSC = intra and extrahepatic bile ducts
73
Q

Define PBC

A

chronic inflammation to INTRAHEPATIC bile duct, causing progressive cholestasis > CIRRHOSIS

presumed AI ORIGIN

74
Q

What are other conditions associated with PBC

A

Sjogren
RhA
thyroid disease
systemic sclerosis

75
Q

what are classical sx of PBC

A

itching in a middle aged woman

  • pruritus
  • obstructive jaundice
    RUQ pain
76
Q

What investigations should you get for PBC

A

Liver panel: raised GGT/ALP, normal transaminase

Autoantibodies: AMA, high IgM serum

Biopsy (only if in doubt)

77
Q

How do you manage PBC

A

ursodeoxycholic acid
fat soluble vitaminb supplements

consider cholestyeramine for pruritus, pred if other AI disease

for end stage disease: liver transplant

78
Q

What rule can you use to remember PBC

A

Rule of Ms
Middle aged women
AMA
raised IgM

79
Q

What is PSC

A

biliary disease caused by INFLAMM and FIBROSIS in INTRA and EXTRAhepatic bile ducts

80
Q

What condition is PSC associated with

A

UC

81
Q

Sx of PSC

A

pruritus
obstructive jaundice
RUQ pain
staethorroea

82
Q

Ix PSC

A

positive pANCA
MRCP > ERCP (beaded appearance)
Biopsy of duct (fibrous, obliterative cholangitis - onion skinn)

83
Q

mx of PSC

A

supportive > liver transplant

84
Q

how does gender change in PBC vs PSC

A

PBC mostly women,

PSC mostly men

85
Q

what signs can you find in chronic liver disease

A

hands: palmar erythema, duputyens, clubbing
eyes: specific for Wilson’s Keiser-Fleisher ring, corneal arcus if hypercholesteraemia
Chest: gynaecomastia (failure of liver to break down cholesterol), axillary hair loss, spider naevi

86
Q

What number of spider naevi is abnormal

A

anywhere > 5

87
Q

Ix for suspected liver disease

A 
Blood panel (FBC, UE, LFT, CRP, clotting, AFP, iron, hepatitis serology, autoantibodies, caeruloplasmi) 
USS abdomen 
consider fibroscan and liver biopsy 
consider endoscopy to exclude other causes
88
Q

How do you manage ascites

A
  1. Restrict alcohol and fluids, low sodium diet, daily weights)
  2. Diuretics (spironolactone +- furosemide)
  3. Therapeutic paracentesis (if not responding to meds)
  4. Prophylaxis for SBP (ciproflox + propanolol)

abdominal paracentesis (for tense ascites)

89
Q

What is SBP

A

Spontaneous bacterial peritonitis (infection of ascitic fluid with no obvious cause)

90
Q

How do you investigate SBP

A 
USS (confirm ascites) 
Ascitic tap (check neutrophils and SAAG)
91
Q

How do you manage SBP

A

tazocin / cefotaxime

92
Q

What is chromosomal inheritance pattern of haemochromatosis

A

Autosomal recessive - HFE gene mutation

93
Q

What does haemochromatosis cause

A

Dirsorder of iron absorption and metabolism> excess iron accumulation > organ damage

94
Q

How do you investigate haemochromatosis

A

Iron studies (transferrin saturation >50%, ferritin raised, iron raised, TIBC low)

Liver biopsy

95
Q

How do you manage haemochromatosis

A

venesectiion (TF under 50% is aim)=

96
Q

What is the progression of NAFLD

A

steatosis > staetohepatitis > cirrhosis

97
Q

investigations ofr NAFLD

A

LFTpanel, lipds, cholesterol
USS
Enhalced liver fibrosis panel OR fibroscan
liver bioosy

98
Q

How do you manage NAFLD

A

lifestly change, weight loss

99
Q

Chronic paancreatitis symptoms

A

paain worse 15-30 mins after meal
staetoorrhoea
DM

100
Q

What is the commonest cause of chronic pancreatitisa

A

ALCOHOL in 80% of cases

101
Q

how to investigate chronic pancreatitis

A

Blood: faecal elastase (marker of pancreatic insufficiency)
USS (exclude gallstones)
contrast-enhanced CT

102
Q

what is the most common type of pancreatic xcancer (location + histology)

A

head of pancreas, adenocarcinoma

103
Q

what are classic sx of pancreatic cancer

A

painless jaundice

loss of exocrine function > staethorroea
loss of endocrine function > DM

thrombophlebitis

104
Q

what ix need to be carried out for pancreatic cancer

A

HR-CT (double duct sign, simultaneous dilatation of CBD and pancrsatic duct)

USS

105
Q

how do you manage pancreatic cancer

A 
Whipple resection (pancreaticoduodonectomy) - although less than 20% are suitable 
with adjuvant chemo
106
Q

What requires a 2 wk urgent referra for OGD withGORD symptoms

A 
dysphagia (suspect oesophageal cancer)
upper abdominal mass (suspect oral ancer)
Age > 55 AND WL and 
- dyspepsia
- reflux/GORD
- Upper abdo pain
107
Q

What requires nonurgent referra for OGD withGORD symptoms

A 
haematemesis 
Age >55 AND 
- treatment resistant dyspepsia 
- upper abdo pain with low Hb
- N&V+ reflux, WL, dyspepsia, upoper abdo pain
108
Q

what do you do if GORD symptoms and OGD negative

A

24 h oesophageal pH monitoring

109
Q

How do you manage GORD if no need to refer for OGD

A
  1. review meds for possible dyspepsia causes and give lifestyle afdbvice
  2. trial PPI (4 weeks= or test and treat for H pylori
110
Q

How do you test for H pylori

A

C13 Urea breath test
OR stool antigen test
Or Lab based serology

111
Q

How do you manage H pylori

A

CAP: clarythomycin, amoxicillin/metronidazolel, PPO

112
Q

How do you treat GORD

A

trial PPI for 1 month then review

If refractory: nissen fundoplication

113
Q

what score assesses prognosis of cirrhosis

A 
Child's Pugh ABCDE 
Albumin 
Bilirubin 
Clotting (PT) 
Disension (ascites) 
Encepalopathy
114
Q

How do you manage alcoholic hepatitis

A

consider pred

115
Q

what abx can you give for C diff

A 
oral metronidazole (mild) 
oral vanc (severe) 
oral vanc + IV met (life threatening9
116
Q

what serology can you do for coeliacs disease

A

anti-TTg + total IgA

anti- EMA (less sensitive)

117
Q

how does cholangiocarcinoma present

A

usually asumptomatic
RUQ, nausea, anorexia, vomiting, malaise, WL, palpable GB
Obstructive jaundice: pale stool, dark urine

118
Q

how do you stage cholangiocarcinoma

A

CT abdo

ERCP fgold standard stating

119
Q

how do you manage cholangiocarcinoma

A

cholecystectomy if resectable

chemotherapy + stenting if not resectable

120
Q

is PSC or PBC more likelly to cause cholangocarcinoma

A

PSC – in 10% of patients

121
Q

which IBD is most likeluy to cause fissures and fistulas

A

CHRONS

122
Q

which IBD is smoking PROTECTIVE for

A

UC

123
Q

what is the severity index for IBD

A

True Love and Witts criteria

124
Q

causes of granuloma

A

TB (caseating)

Chron’s, sarcoid (non-caseating)

125
Q

causes of subtotal villous atrophy (other than coeliac)

A 
Giarda 
Tropical sprie 
infectious enteritis 
lymphoma 
Whipples infection 
Lactose intolerance
126
Q

Wernicke’s triad

A

Opthalmoplegia
Ataxia
Confusion

127
Q

Korrsakoff’s

A

Wernicke’s PLUS confabulation and amnesia

128
Q

How do you test for Wilson’s disease on blood test

A

serum caeruloplasmin

129
Q

How do you test for Haemochromatosis on blood test

A

Iron panel (raised iron , raised ferritin, low TIBC)

130
Q

when do you refer for an URGENT 2 week OGD

A

Dysphagia
Upper abdominal mass (? stomach cancer)
55yo + WL + dyspepsia / reflux / upper abdo pain

131
Q

How do you manage dyspepsia

A
  1. review meds for possble causes, give lifestyle adice

2. Test for H Pylori (stool antigen test) OR trial full dose PPI

132
Q

How long myst you wait after PPI to test for H pylori

A

2 weeks

133
Q

What is management if H pylori +ve

A

amoxicilli + clarythromycin + PPI for ONE WEEK

134
Q

what are dangerous associations/ complications of H pylori

A

PUD
Gastric cancer
MALToma
Altriphic gastritis

135
Q

How can you manage anal fissue

A

<6 weeks: dietary advice (more fluids), bulk forming laxatives, OTC analgesia
>6 weeks: topical GTN / diltaziem > sphincterotomy

136
Q

What is Gilberts and how does it present

A

Deficiency in glucoronyl transferase (enzyme required for conjugation of bilirubin in the livrr)

Presents as asymptomatic jaundice during other infection
Self-resolving

137
Q

how do you treat C diff (mild-moderate)

A

oral metronidazole

138
Q

how do you treat C diff (severe, 2nd episode=

A

oral vanc

139
Q

how do you treat LIFE THREATENING c diff

A

oral vanc + IV metronidazole

140
Q

what ix confirms C diff dx

A

C diff TOXIN

141
Q

which antibodies are elevated in AI hepatitis

A

ANA, ASMA
Anti-LMK
Anti-SLA

Raised IgG

142
Q

S/S AI hepatitis

A

Jaundice, RUQ pain, fever

AMENORRHOEA

143
Q

MX AI hep

A

steroids

liver transplant

144
Q

what iss plummer vinson syndrome + triad

A

due to post cricoid webs, presents as:

  • dysphagia
  • glossitis
  • IDA
145
Q

triad of boerhaves oesophagus

A

Chest pain
SC emphysema
Vomiting

Y6 Senior Med (29 decks)

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