Gastro Flashcards
What symptoms are characteristic of irritable bowel syndorme (IBS)?
bloating
pain
diarrhoea +/- mucus
constipation
no bleeding
no weight loss
what marker is used to detect GI inflammation (in IBD)?
faecal calprotectin
what characterises infectious diarrhoea?
management?
sudden onset
other systemic features; fever and malaise
others with similar symptoms
oral rehydration and paracetamol
what diet changes can help with IBS?
exclude wheat fibre - white cereals not brown
less fruit and veg
can cut out FODMAPs
what drugs can help in IBS?
all are symptomatic:
antispasmodics
anticholinergics
anti diarrhoea e.g. loperamide
laxative is constipated
low doses of TCAs
probiotics can be helpful
Features more in UC than Crohn’s
continuous inflammation; rectum to IC valve
inflammation confined to submucosa
bloody diarrhoea
primary sclerosing cholangitis
uveitis
more associated with colon cancer
Features more in Crohn’s than UC
more painful
deeper infalmmation
bowel obstructions/fistulae
skip lesions mouth to anus
goblet cells
non-bloody diarrhoea
weight loss
causative organisms of infective diarrhoea
bacteria; E coli, campylobacter, salmonella, Cl.difficile
Viruses; Noro and rotaviruses
Parasites; Giardia, cryptosporidium, schistosomiasis
what is Wilson’s disease?
symptoms?
treatment?
autosomal recessive disorder of excess copper deposition in the tissues
liver and neurological symtpoms + kayser fleischer rings in the eyes
treatment is penicillamine- chellates copper
acute treatment of oesophageal bleeding
prophylaxis of oesophageal bleeding
acute; terlipressin + antibiotics
prophylaxis; non selective Beta-blocker e.g. propranolol
Band ligation
treatment for clostridium difficile infection
oral vancomycin
what is SAAG gradient?
what does a high SAAG >11 indicate?
Serum-ascitic albumin gradient.
SAAG indirectly measures portal pressure
high SAAG indicates portal hypertension and the ascitic fluid is a transudate
low SAAG indicates exudate
treatment of mild to moderate UC flare
rectal aminosalicylate (mesalazine, sulfalazine)
then oral aminosalicylate
treatment of severe UC flare
treat in hospital
IV corticosteroids
maintaining remission in UC
continue rectal aminosalicylate +/- oral aminosalicylate
after severe or >2 in a year: oral azathioprine or oral mercaptopurine
what is barrett’s oesophagus?
metaplasia of the lower oesophageal mucosa, with the usual squamous epithelium being replaced by columnar epithelium. There is an increased risk of oesophageal adenocarcinoma
manage with a PPI and surveillance
causes of upper GI bleeds
oesophageal varices: lots of bright red vblood
oesophagitis
cancer
mallory-weiss tear: mall to moderate volume of bright red blood following a bout of repeated vomiting
gastric ulcer, cancer, gastritis
duodenal ulcer: can erode to gastroduodenal artery
scoring systems for upper GI bleeds
pre endoscopy; glasgow-blatchford score
post; Rockall
what is ferritin? what does it show
protein that binds to iron in cells
high levels can show iron overload, or casued by acute inflammation, alcohol, liver/kidney disease
low levels correlate with reduced iron
carcinoid syndrome; causes & symptoms
usually liver mets producing vascoactive amines; 5HT, prostaglandins
abdominal pain, diarrhoea and flushing
2WW for upper GI cancers
anyone with dysphagia
OR
aged 55+ with weight loss and one of
- upper abdo pain
- reflux
- dyspepsia
Bowel cancer staging system
Duke’s
A - confined to mucosa
B - through to serosa but no LNs
C - local lymph node infiltration
D - organ metastasis
can also use TNM
Treatment for Crohn’s flare up
corticosteroids to induce remission
Azathioprine or mercaptopurine or methotrexate can be added
maintaining remission in Crohn’s
Azathioprine or mercaptopurine or methotrexate
immunnosuppressants may be used
Metronidazole and infliximab can also be used
drugs in triple therapy for H. Pylori
amoxicillin, clarithromycin, and omeprazole
achlasia management
pneumatic balloon
botulinum toxin injection
Heller cardiomyotomy surgery
what is haemachromatosis?
symptoms?
autosomal recessive disorder resulting in iron accumulation
fatigue, erectile dysfunciton and athralgia often of the hands
bronze skin pigmentation
diabetes, liver problems and heart problems
what malignancy is associated with coeliac disease
Enteropathy-associated T cell lymphoma
2WW for lower GI cancers
40+ unexplained weight loss and abdominal pain
or
50 + unexplained rectal bleeding
or
60 + iron deficiency anaemia or change in bowel habit
or
anyone with occult blood in faeces
assessing for fluid in the abdomen/thorax
FAST scan
what complications are associated with coeliac disease
- osteoporosis
- T cell lymphoma
- deficiency anaemias
- subfertility
- lactose intolerance
what is the most common cause of
- small bowel obstruction
- large bowel obstruction
small; adhesions then hernias
large; cancer
presentation of primary biliary cholangitis
treatment
fatigue, cholestatic liver biochemistry, positive mitochondrial antibodies and raised IgM
ursodeoxycholic acid
What is a Mallory Weiss tear
Lacerations at the gastro oesophageal junction resulting in haemetemesis, severe vomiting and pain
What is Boerhaaves syndrome
Oesophageal rupture- presents with vomiting, thoracic pain, subcutaneous emphysema. It typically presents in middle aged men with a background of alcohol abuse.
what drugs can cause a hepatocellular liver failure
paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin
what drugs can cause a cholestatic liver failure
combined oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
autoimmune hepatitis
- presentation
- antibodies
- management
presentation; most commonly seen in young females. signs of chronic liver disease, occasionally with acute hepatitis. amenorrhoea.
Anti Nuclear and/or anti Smooth-Muscle
Steroids, other immunosuppressants e.g. azathioprine
Liver transplantation
alcoholic ketoacidosis
non-diabetic euglycaemic ketoacidosis
metabolic acidosis
elevated ketones
normal glucose
treatment infusion of saline and thiamine
management of severe alcoholic hepatitis
prednisolone
