Gastro Flashcards
Where is most water absorbed in digestive system?
Jejunum
Cause of ascending cholangitis
E.coli infection and gallstones
Where is blockage ascending cholangitis
Biliary tree = jaundice
Sx ascending cholangitis
Charcot’s triad - RUQ pain, fever and jaundice
Tx ascending cholangitis
Biliary drainage and cefotaxime
Sx primary sclerosis cholangitis
Jaundice
Increased bilirubin and ALP
RUQ pain
Fatigue
Itchy
Ix primary sclerosis cholangitis
ERCP
+ PANCA
Associations primary sclerosing cholangitis
UC and Crohn’s
Tx primary sclerosis cholangitis
Liver transplant and antibiotics
Risk factors primary biliary cholangitis
Female, forty, fat, fertile
Ix primary biliary cholangitis
AMA M2 ABs
MRCP
Sx primary biliary cholangitis
Jaundice
Hyperpigmentation
RUQ pain
hepatosplenomegaly
Tx primary biliary cholangitis
Ursodeoxycholic acid
Cholestyramine for itch
What is biliary colic?
Blockage in bile duct = intermittent RUQ pain
Treatment biliary colic
Morphine and surgery
Investigations biliary colic
US and inflammation markers
Risk factors biliary colic
Female, fat, fertile, forty
Symptoms biliary colic
Colicky RUQ pain that radiates to shoulder
Pain worse after eating
N + V
+/- jaundice
What is cholecystitis
Gallstones in cystic duct = no jaundice
Treatment cholecystitis
Cholecystectomy
Metronidazole
Cefuroxime
Investigations cholecystitis
US and contrast imaging - GB not always seen
Symptoms cholecystitis
RUQ pain -> shoulder
Fever
+ve Murphy
Increased WCC and inflammatory markers
Cause of peptic ulcers
Helicobacter Pylori infection
Symptoms of peptic ulcers
Pain, haematemesis, melaena, hypotension, tachycardia
Treatment for peptic ulcers
2x ABx and 1x PPI
Endoscopic intervention is first line
Investigations peptic ulcers
Breath test for H.pylori
Endoscopy
Gastric ulcers
Reduced effectiveness of gastric mucosal repair = worse pain with food
Occur in lesser curve/antrum
Duodenal ulcers
Anterior/1st part of duodenum
Pepsin/acid action on normal lesion
Pain when hungry/better with food
What is liver cirrhosis?
Fibrosis of liver caused by inflammation
Causes of liver cirrhosis
Alcoholic liver disease
NAFLD
Hep B and C
Sx liver cirrhosis
Jaundice
Organomegaly
Spider naevi
Treatment stable varices
TIPS
Treatment bleeding oesophageal varices
Terlipressin and sengstacken
Stages of alcoholic liver disease
Alcohol related fatty liver - fat in liver, reversible
Alcoholic hepatitis - inflammation of liver, can be reversed
Cirrhosis: scar tissue, irreversible
How is hep A transmitted
Foeco-oral route (contaminated food and water)
Sx hep A
Nausea, anorexia, vomiting, jaundice
Cholestasis
Treatment hep A
Self-resolving 1-3 months
Spread of hep B
Direct contact with blood/bodily fluids (sex, needles, toothbrushes)
notifiable disease to PHE
hep a and b
What is haemochromatosis?
Excessive total iron and deposition in tissues
Cause of haemochromatosis
Mutation in HFE protein in chr 6- autosomal recessive
Sx haemochromatosis
Tiredness, joint pain, pigmentation, ED
Tx haemochromatosis
Venesection
Avoid alcohol
What is Wilson’s disease
Too much copper
Sx Wilson’s
Psychiatric problems
Concentration difficulties
Dysarthria
Disease causing Kayser-Fleischer rings in cornea on slit lamp exam
Wilson;s
Ix Wilson’s
Liver biopsy
Mx Wilson’s
Penicillamine
Ulcerative colitis sx
pANCA +ve, Just colon, continuous inflammation, mucosa and submucosa, bloody stool
Depleted goblet cells
Crohn’s disease
Any part of GIT, skip lesions, deeper layers of mucosa
UC management
Aminosalicylate
Corticosteroids
Drugs causing haemolytic
Primaquine, ciproflaxacin and sulph- containing drugs (sulphasalazine etc)
Pathway for haemoglobin breakdown
Hb - hame - biliverdin - bilirubin - liver (conjugation) - bile duct - gut - glucuronic acid removed - stercobilinogen - stercobilin
Dubin Johnson
Autosomal recessive
Mutation in protein MRP2
Causes increased conjugated bilirubin
Rotor syndrome
Autosomal recessive
Defect in bilirubin uptake and storage
Increased conjugated bilirubin
Hereditary spherocytosis
Autosomal dominant
North European affected
Sx = neonatal jaundice, gallstones, spherocytes
Dx = EMA binding
G6PD deficiency
Mediterranean/african heritage
X-linked recessive
Sx = neonatal jaundice, gallstones, splenomegaly, Heinz bodies
Dx = G6PD measure
Presents within first 24h of life
How does G6PD normally act?
G6PD produces NADPH, which produces glutathione
Glutathione protects RBCs from oxidative stress
Gilbert’s syndrome
Decreased UGT = increased unconjugated bilirubin
Autosomal recessive
Occurs on stress e.g. exercise
Newborn jaundice
Normally physiological (e.g. hepatic immaturity) and occurs when baby is <24h old
Normally resolves in 14 days
Crigler-Najjar syndrome
No UGT so no conjugation = increased UCB
type 1 is most severe and no survival
type 2 is less severe and some survive
Pre-hepatic jaundice
Increased UCB
Issue occurs before liver
E.g. haemolysis, anaemias
Normal stools and urine
Normal ALP and AST
Hepatic jaundice
Increased conjugated and unconjugated bilirubin
Issue lies in liver - either damaged hepatocytes (hepatitis/cirrhosis) or can’t conjugate (Gilbert’s/Crigler Najjar)
Dark urine/pale stool
Increased ALP and AST
Post-hepatic jaundice
Increased CB but normal UCB
Impaired movement to intestines
E.g. cholecystasis, carcinoma of pancreatic head
Dark urine/pale stool
Increased ALP and AST
Which cells secrete intrinsic factor?
Parietal
Where is gastrin secreted?
G-cells (stomach)
Function of gastrin
G cell stimulated by stomach distension
Gastrin acts on ECl to increase HCl production
Function of cck
bile movement for digestion
Where is cck secreted?
I cells (small intestine)
where is secretin produced
s cells of small intestine
function of secretin
released bicarbonate and decreases gastric acid when pH is high
where is HCl released
parietal cells
where is histamine released
enterochromaffin cells
where is somatostatin produced
D cells
function of somatostatin
inhibits HCl
where is pepsinogen released
chief cells
function of pepsinogen
protein digestion
where is VIP produced
small intestine
function of VIP
inhibits acid and pepsinogen - activates somatostatin
Antibiotic causing c.diff infection
ceftriaxone
antibiotic for treating c.diff
oral vancomycin
What is Wilson’s disease
Autosomal recessive condition resulting from a defective ATP7B gene on chromosome 13 leading to copper deposits in tissues
Sx Wilson’s
liver - hepatitis and cirrhosis
basal ganglia degeneration
green/brown rings around iris
tx wilson’s
penicillamine
prophylaxis variceal haemorrhage
propanolol and banding
treatment of acute variceal haemorrhage
terlipressin
rovsing’s sign
Rovsing’s sign: more pain in RIF than LIF when palpating LIF
where is most iron reabsorbed
duodenum
Acute mesenteric ischaemia
Embolism occludes SMA - after history of AF
Abdo pain is severe, sudden onset and no other sx
risk factor for mesenteric ischaemia
AF
what is Barrett’s oesophagus?
Metaplasia of lower oesophageal mucosa with squamous epithelium replaced by columnar epithelium
which type of cancer does Barrett’s oesophagus increase the risk of
oesophageal adenocarcinoma
what is budd-chiari syndrome
blockage of hepatic veins which causes back up of blood into liver
sx budd-chiari
- Abdo pain = severe and sudden onset
- Ascites and abdo distension
- Hepatomegaly
c.diff infection
Gram +ve rod bacilli infection developing when gut flora are suppressed by cephalosporins
Sx c diff infection
- Diarrhoea
- Abdo pain
- Raised WCC
tx c diff infection
oral vancomycin 10 days
treatment haematemesis
A-E
stop NSAIDs/anti-coagulants
2 units of crossmatched blood
what is a mallory Weiss tear
tear of mucous membrane of oesophagus
sx, ix, tx renal colic
severe loin to groin colicky pain (10/10)
Ix CT KUB
tx diclofenac
most common renal stone
calcium oxalate
struvite stones
recurrent UTIs, staghorn appearance
functional constipation
persistent stomach pain that doesn’t resolve with typical treatment - may come and go
gastroenteritis
infection of the GIT caused by rotavirus - normally self limiting
sx coeliac disease
abdo pain + bloating + cramping + diarrhoea
dermatitis herpetiformis
primary biliary choloantitis
ix coeliac
iron deficiency anaemia, raised IgA tTG
crypt hyperplasia, atrophy of villi
side effect PPI
hyponatraemia and hypokalaemia (prevents H+/K+ ATPase pump)
What is pernicious anaemia?
Anti - IF antibodies - no IF means no B12 absorbed
Sx pancreatic cancer
painless jaundice, pale stools, dark urine
what type of cancer is pancreatic cancer most commonly
adenocarcinoma of pancreatic head
tx pancreatic cancer
Whipple’s
What is Mallory-Weiss syndrome
lots of vomiting -> lacerations -> haematemesis
common in alcoholics
most common type of oesophageal cancer
adenocarcinoma
What is achalasia?
Failure of oesophageal peristalsis due to degenerative loss of Auerbach’s plexus
Sx achalasia
both food and liquid dysphagia
heartburn
Tx achalasia
balloon dilation
Roving’s sign for appendicitis
Pressing LIF gives pain on right
how to calculate alcohol units
(ml x ABV) / 1000
risk factor for c.diff
clindamycin and PPIs
treatment for c diff infection
vancomycin 10 days
which vaccine is it that people with Coeliac disease have?
pneumococcal
tx c.diff
PPI, amoxicillin and clindamycin for 7d
sx IBS
- Abdo pain
- Bloating
- Change in bowel habit
Tx IBS
- Antispasmodics
- Laxative - NOT LACTULOSE
- Loperamide
Rovsing’s sign
Palpating LIF = pain in RIF
vitamin A deficiency
night blindness
vitamin B1 deficiency
Wernicke-Korsakoff
vitamin B12 deficiency
peripheral neuropathy
vitamin C deficiency
scurvy (bleeding and poor wound healing)
most common extra-intestinal symptom of IBD
arthritis
induce and maintain remission Crohn’s
glucocorticoids
azathioprine
induce and maintain remission UC
aminosalicylate for both
what is pernicious anaemia?
Autoimmune condition caused by antibodies against intrinsic factor
No IF means no B12 absorbed from parietal cells
sx pernicious anaemia
anaemia sx
peripheral neuropathy
subacute combined degeneration of the spinal cord
management pernicious anaemia
IM B12
what is a pharyngeal pouch?
posterior diverticulum through Killian’s dehiscence
Sx pharyngeal pouch
dysphagia, regurgitation, aspiration, halitosis
Ix pharyngeal pouch
barium swallow
what is diverticulitis?
Diverticulae: outpouchings of the sigmoid colon
Diverticulosis: the asymptomatic presence of diverticulae
Diverticular disease: the patient gets symptoms from diverticulosis
Diverticulitis: one of the diverticulae becomes infected
sx diverticulitis
- LIF pain
- Anorexia
- N and V
- Diarrhoea
mx diverticulitis
metronidazole + cephalosporin
thumb printing on x-ray
ischaemic colitis
ileus vs mechanical obstruction
ileus: peristalsis stops but no structural problem, no bowel sounds
mechanical obstruction: physical blockage, tinkling bowel sounds
colorectal cancer screening programme
Male and female, 60-74, every 2 years
coffee bean sign on abdo xray
sigmoid volvulus
embryo sign on abdo X-ray
caecal volvulus
what is liver cirrhosis?
fibrosis of the liver from chronic inflammation
portal hypertension -> varices -> bleeding
Symptoms liver cirrhosis
jaundice
hepatomegaly
spider nave
ascites
child-push score
mx liver cirrhosis
treat varies - if stable do TIPS, if unstable escalate
