Gastro Flashcards
Patient with Crohns and illeal resection develops kidney stones, what is the composition
Ca oxalate
NB applies to ileal resection for any reason
Drugs that commonly cause dyspepsia
Steroids
NSAIDs
Nitrates
Theophyllines
Bisphosphonates
Ca channel blockers
Treatment of reflux in pregnancy
Antacids and alginates
Note: theses are widely used and as far as is possible to tell are safe. 2nd line tx would be H2 blockers. Conflicting reports about PPIs in pregnancy
1st line treatment of ascites?
Depends on severity
if v large volume and symptomatic: paracentesis
if less severe: dietary salt restriction and spironolactone
Patients with irritable bowel syndrome often have food intolerance T/F
T
Other features: increased intestinal contractile and electrical activity with increased sensitivity to visceral stimulation
Patients with achalasia are at increased risk of which malignancy
squamous cell carcinoma of the oesophagus
What effect has theophylline on the lower oesophageal sphincter
Theophylline lowers the pressure of the lower oesophageal sphincter.
Pellegra what deficiency and presentation
Niacin (B3)
Dementia
Dermatitis
Diarrhoea
Death
Presentation of scurvy
Perifollicular haemorrhage
Bleeding gums
Poor wound healing
Corkscrew hair
What is the 2 year mortality rate of SBP
50%
Neutrophils over what on an ascitic tap support diagnosis of SBP?
> 250cell/mm
SBP is typically multiorganism T/F
F - typically mono organism (typically gram -ve)
NB initial tx with broad spec abx such as cefotaxime
Mgmt of a pre meno female presenting with Fe def anaemia?
If no significant FHx bowel Ca, no upper GI symptoms and negative coeliac screen, trial oral Fe replacement first.
Note: def of significant fam hx is two affected first-degree relatives or just one first-degree relative affected before the age of 50 years.
A patient undergoes appendectomy and about a year later presents with abdominal pain and is found to have a caecal mass. What is the most likely diagnosis?
Actinomycosis
Abdominal and pelvic actinomycosis usually follows introduction of the organism through surgery (for example, laparotomy, perforation, cholecystitis) or from intrauterine device placement.
Can also have cervicofacial, thoracic or CNS infections
What is the most common site of carcinoid tumor in the bowel?
Terminal ileum
How is the hepatic venous pressure gradient calculated and what is the relevance?
Free - wedged venous pressure
Normal 1-5. If normal in portal hypertension is the obstruction must be pre-sinusoidal. Hence, not related to post-sinusoidal intrinsic liver disease such as cirrhosis or post-hepatic venous obstruction (HV thrombosis).
Typical presentation of Budd Chiari syndrome
Triad of
-abdominal pain
-ascites
-hepatomegaly
which develop over several months
Note: aetiology is obstruction of the main hepatic veins by thrombus
Presentation of acute and chronic portal vein thrombosis
Acute: abdominal pain, fever and signs of mesenteric infarction
Chronic: presentation is with complications of portal hypertension, although ascites is rare.
Aspirin must be stopped 7 days prior to an endoscopic procedure T/F
F
Aspirin is not associated with the same degree of bleeding as clopidogrel and may be continued in those already taking it even prior to endoscopic intervention with a high risk of bleeding.
Note: if on clopidogrel stop 7 days prior - depending on indication for clopidogrel may need to discuss with cardiologist
Ddx for elevation of transaminases to > 100 x ULN
Paracetamol overdose
or
Ischaemic hepatitis
The use of phenytoin is not recommended in patients with underlying liver impairment. T/F
T
Therefore not used in status epilepticus secondary to alcohol withdrawal.
Hepatotoxic in high doses even in fairly advanced chronic liver disease paracetamol can be used safely as long as doses do not exceed 2-3 g per day. T/F
T
Note: main exception to this is alcoholic liver disease where the patient continues to drink, in this setting induction of enzymes and depletion of glutathione increases the chances of hepatotoxicity.
Primary biliary cirrhosis is treated with steroids T/F
F
Note: Mainstay of treatment is ursodeoxycholic acid. Despite extensive research, no role for immune suppression in PBC.
Mgmt of pt with Na 118, on diuretics with b/g alcoholic liver disease and ascites
If serum sodium is ≤120 mmol/L diuretic therapy should be stopped and patients should receive volume expansion with colloid or normal saline
Note: fluid restriction only used in patients who are clinically euvolaemic, not on diuretics and have severe hyponatraemia with a normal serum creatinine.
Na126-135 mmol/L: No specific intervention other than careful monitoring
Na121-125 mmol/L where the serum creatinine is normal, diuretic therapy may be continued but may need to be reduced with a view to stopping if necessary.
Abdominal cramps, bloating and flatulence accompanied by yellow, frothy, greasy and offensive-smelling diarrhoea (steatorrhoea). Likely infection?
Giardia
Note: Fever and vomiting are less usual. Diarrhoea may be chronic if undiagnosed and can lead to small bowel malabsorption. Cryptosporidium is usually self limiting if occurs in non immunosuppressed
Ameobic dysentry causes ___ diarrhoea
bloody
Urea breath test sensitivity and specificity?
90% sensitivity and 96% specificity for H. pylori
Anti-mitochondiral antibodies are positive in 95% of cases of ___
primary biliary cirrhosis
Anti-liver kidney microsomal antibodies are found in ___
autoimmune chronic hepatitis
Mgmt of patients over the age of 55 with persistent and unexplained dyspepsia of recent onset?
Referred for urgent endoscopy as suspected cancer
Note: urgent is within 2 weeks, can be OPD
Gold std of diagnosis of primary sclerosing cholangitis (PSC)?
ERCP
Note: in practise most pts with get MCRP first
Liver lesion on CT described as hypovascular with central scarring. Most likely dx?
Cholangiocarcinoma
Most common complication of ERCP?
Pancreatitis
In tx of hep C what genotypes are likely to have good response to interferon therapy?
Other good prognostic factors?
Genotypes 2 and 3 have a far better response to treatment than genotype 1.
After that:
Females
Younger age
Lack of cirrhosis
Non black origin
Low hepatic Fe
Which is assoc with inflammatory bowel disease - primary biliary cirrhosis or primary sclerosing cholangitis?
Primary sclerosing cholangitis
Deomgraphic in primary biliary cirrhosis?
90% are middle age females
Note: there is also an assoc with AI disease
Patients with Peutz-Jeghers syndrome require colonoscopy every ___ years after the age of __ for evaluation of the presence of polyps and polypectomy.
Every 2 yrs
After age of 25
Decompensated liver failure is an indication for transjugular intrahepatic portosystemic shunt. T/F
F
Note: it is an contraindication
Intractable ascites is an indication for transjugular intrahepatic portosystemic shunt. T/F
T
What LFTs typically seen in alcoholic liver disease?
AST more than twice the level of ALT
Indications for referral to liver center in paracetamol overdose
Any of:
An arterial pH <7.3
INR >2.0 at or before 48 hours or >3.5 at or before 72 hours s (or prothrombin time >50 seconds)
Oliguria
Creatinine >200 µmol/L
Hypoglycaemia
Any degree of encephalopathy 48 hours after ingestion is also an indication.
