Gastro Flashcards
Ranking severity of UC/Crohns
Mild- <4 stools, minimal blood
Mod- 4-6- vary blood, no systemic
Severe- >6 bloody stools, systemic
Scores for Upper GI bleed
Blatchford- determine if managed at OP- 0
Endoscopy within 24hrs
Rockall- after endoscopy- determines mortality and risk of rebreeding
Mx of achalasia
Heller cardiomyotomy
CCB or nitrates, botox- since is a failure to relax
Mx of crohns fistula and abscess
If symptomatic Oral metronidazole
If complex- draining seton
Abscess- incision and drainage
Mx of crohns
Induce with steroids
Mild- Oral pred, severe- IV HC
Maintains with azathioprine or mecapto
Ix of coeliac
Anti TTG
Jejunal biopsy or duodenal
Mx of alcoholic hepatitis
Maddrey discriminant- benefit from Prednisilone
Plummer Vinson Sx
Triad- dysphagia, glossitis, IDA
Mx of UC
Inducing remission
Topical aminosalicylates
If not induced in 4 weeks add oral
Add CS if still not working
Extensive disease- topical and rectal 4w
CS after
Severe fulminant - IV steroids
Maintaining remission
Topical aminosalicylates- add oral
Extensive- oral
Severe or 2 or more relapses per year- azathioprine /mercaptopurine
Areas where you get Haemorrhoids
3, 7, 11
Signs in appendicitis
Rovsing- pain greater in RIF when pressure on left
Psoas- pain when extending hip
Colic vs cholecystitis vs cholangitis
Pain- colic
Pain + fever- cholecystitis
Pain + fever + jaundice- cholangitis
Mx of cholecystitis and cholangitis
IV Abx
Laparoscopic cholecystectomy within 1 week- cholecystitis
ERCP within 24-48hrs for cholangitis
PBC vs PSC
PBS- anti-mitochondrial - diagnostic
Sjogrens
Middle aged women
Jaundice
PSC- pANCA
Intra and extra
Male
UC
Dx- with MRCP
Chronic stable liver disease Sx
Palmar erythema
Dupuytrens
Clubbing
Gynaecomastia
Spider nave
Sx of acute decompensation liver
Portal hypertension SAVE
Splenomegaly
Ascites
Varices
Encephalopathy
Failes synthetic funciton
GI can precipitate this
Dx of SBP
USS to confirm ascites
Ascites tap- PMN >250
Mx of SBP
Tazocin
Cipro and propanolol prophylaxisif ascites and SAAG <15
Ix of Haemachromatosis
Raised ferritin
TIBC reduced- reduced transferrin production
TF saturation- >55% male, 50 female
Pearl stain of liver biopsy
Acute Pancreatitis Sx
Epigastric pain
Cullen, grey turner
Vomitting
Prognosis scoring of pancreatitis
PANCREAS
PaO2- <8
Age 55
Neuts- >15
Ca <2
Renal urea- >16
Enzymes- AST/ALT >200
Albumin <32
Sugar- >10
Sx of chronic pancreatitis
Pain 15-30- mins after meal
Steatorrhoea
DM- 20 yrs after
Ix for acute pancreatitis
Serum amylas, lipase
USS for stones
Contrast CT
Ix for chronic pancreatitis
USS and contrast CT
Faecal elastase- reduced
Ix of diverticulitis
CT abdomen - acute
Barium enema- chronic
Mx of diverticulitis
Acute mild- PO ABx
Severe- IV ABx, drip and suck hartmanns
Chronic- high fibre diet
Urgent 2ww OGD
Dysphagia
Upper abdo mass
AGe >55 + weight loss and dyspepsia, gord, upper abdo pain
Non urgent OGD
Haematemesis
Age >55- pain with low Hb and pain, N+V with reflux, raised Plt and wt loss nausea
Ix for dyspepsia
If alarm features- OGD
No alarm- breath/stool test for H pylori
Mx of dyspepsia
Review medication
Then PPI 4w
Then test H pylori
Anal fissure mx acute and chronic
Acute- laxatives
Chronic- GTN then spincterectomy if not resolved after 8 weeks
Prognosis scoring of alcoholic hepatitis
Child Pugh
ABCDE
Albumin, Bilirubin, Clotting, distention (ascites), encephalopathy
Budd chiari syndrome Sx and IX
Block of hepatic vein
Pain, ascites, tender hepatomegaly
Abdo USS
Sx of carcinoid syndrome
Flushing, diarrhoea, bronchospasm
Perianal abcess Sx and Mx
Pain worse when sitting, discharge
Drain under local
Boerhaaves Sx
Chest pain
SC emphysema- air under skin
Vommiting
Shock
Ischaemic colitis Sx and Ix
Occlusion of IMA
Pain, bloody, large intestine- splenic flexure
Sigmoidoscopy
Acute vs chronic ischaemia
Acute- sudden, pain, normal exma
Chronic- colic pain
Small intestinal bowel overgrowth- RF, sx and mx
DM- risk factor
Chronic diarrhoea, flatulence and pain
Rifampicin
Pellagra sx
Diarrhoea, dermatitis, dementia
B3
Index for measuring malnutrition
MUST
Wilson disease sx
Liver
Neuro- psychiatric
Haemachromatosis
Fatigue, ED, arthralgia
Bronze skin
DM
Liver
CF
Mx of ascites secondary to liver disease
Spironolactone
Pharyngeal pouch sx
Halitosis
Problems swallowing
Dysphagia causes
Mechanical- stricture- Plummer vinson, malignancy, pharyngeal pouch
Neuro/motility- bulbar/pseudobulbar palsy, achalasia, CREST, MG
Inflammation- oesophagitis, candida, pharyngitis, tonsilitis
Achalasia Ix
Mamometry
Barium swallow
OGD- exclude malignancy
Oesophageal cancer Ix
Endoscopy and biopsy
If barium swallow- apple core
GORD sx
Acid taste
Worse laying down
Worse after eating
Mx of GORD
Lose wt, less alcohol
Antacids then PPI
Sx of duodenal ulcers
Epigastric pain before meals and at night
Relieved by eating
Ix of Peptic ulcers
Bloods, breath test, OGD- biopsy ulcers
Mx of perforated ulcer
DU: abdominal washout + omental patch repair
GU: excise ulcer and repair defect
No medical mx needed apart from stop meds that might be causing
Gallstone ileus Sx
Rigler triad- pneumobillia, SBO, gallstone in RLQ
CT signs of pancreatitis
Panc has lost its defined architecture
Fat stranding- CT
When is MRCP used
If dilated duct on USS - for CBD occlusions
PSC
Raised amylase weeks after acute panc
Pseudocyst
Tx of pancreatic pseudocyst
<6- spontaneous
>6cm- drainage
Complications of pancreatitis
Early
Resp- ARDS, effusion
Shock
Renal failure
DIC
Metabolic
Late- pancreatic necrosis, infection, access, thrombosis, pseudocyst
Chronic cholecystitis sx
Abdo discomfort
Sx exacerbated by fatty foods
Nausea
Flatulence
RF for cholangiocarcinoma
PSC
UC
Tx of cholagiocarcinoma
Poor prognosis: no curative Rx
Palliative stenting by ERCP
Differentials for appendicitis
Diverticulitis
Meckel diverticulitis
Ectopic- preg test !!!
Cyst torsion
UTI
Extra abdominal sx of IBD
Erythema nodosum
Clubbing
Arthritis
Iritis
Type of ulceration in each IBD
UC- shallow broad
Crohsn- deep, wavy- cobblestone mucosa
Microscopic features of UC and crohns
Crohns- fibrosis, granuloma, fistulae, goblet cells
Strictures- macro
UC- crypt abcsess, pseudopolyps
Ix of diverticula disease
Contrast CT
Colonoscopy- not in acute attack
Enema
Complications of diverticulitis and their Tx
Perf- sudden pain, shock- Hartmanns
Haemorrhage- painless red PR- mesenteric angio- may stop spon
Abcess- swinging fever- abs and drainage
Fistulae- enterocoelic SB and LB, colovaingal, colovesicular- resection
Strcitutres- resection or standing
Types of bowel obstruction
Simple- 1 obstruction
Closed- 2 points- volvulus
Strangulated- localised, constant pain, peritoneum, fever, High WCC
Tx of Bowel obstruction
Medical- Drip and suck
NBM
Fluids
Catheterise- monitor UO
Analagesia
ABx
Gastrogaffin study
Surgical- if closed, strangulated
Colorectal cancer Ix
Bloods
FBC: Hb
LFTs: mets
Tumour Marker: CEA
Imagining- CXR, CT and MRI- better for rectal and liver
Endoscopy + biopsy
TNM staging of colorectal cancer
TIS: carcinoma in situ
T1: submucosa
T2: muscularis propria
T3: subserosa
T4: through the serosa to adjacent organs
N1: 1-3 nodes
N2: >4 nodes
Dukes staging
A- bowel wall- 90% 5 yr
B- through wall no LN- 60%
C- regional LN- 30%
D- distant- <10%
Differentials for anal pain
Proctalgia fugax- crampy anal pain in young men at night
Anal fissure - pain when defacating, fresh bleed, constipated
Thrombosed haemorrhoid
Fistula- discharge persistent
Peri anal abscess- worse on sitting, fever
Surgery for Femoral hernia
Need surgery ASAP
Elective- Lockwood- herniotomy and herniorrharpy
Emergency- McEvedy- allows resection of non viable bowel
How anal fistulas are treated
Low- fistulotomy- heals as flat scar
High- suture- tighten it over months
Inducing remission UC
Topical mesalazine
Mod- add oral
Sev- Add CS
> /= 2 relapses or severe- azathioprine or mercaptopurine
Maintaining remission UC
Mild-mod- topical /+ oral
Extensive- oral
Severe/ >2 in a year- oral azathioprine or mercapto
What type of oesophageal cancers are found where
Adeno- bottom 1/3
Squamous- middle 1/3
Prophylaxis of variceal bleed
Beta blockers- propanolol
Endoscopic variceal band ligation
Acute tx of variceal bleed
ABC
FFP, Vit K
Terlipressin
IV ABx
During endoscopy- band ligation
If uncontrollable bleed and too long for endoscopy- sengstaken Blakemore tube
After- propanolol
Wilsons disease Sx
Neuro- incoordination basal, psychiatric
Liver - cirrhosis
Kayser Fleischer
Blue nails
Ix for Wilsons
Reduced caeruloplasmin
Reduced copper
Tx of Wilsons
Penicillamine
Flare up with chronic Hep B infection
Hep D superinfection
Jaundice, fever, pruritus
Mx of C diff
Oral vancomycin
2nd- fidaxomicin
3rd- Oral Vancomycin +/- iv met
Which artery can be damaged and caused massive GI bleed with ulcers
Gastroduodenal ulcer
Most common cause of chronic pancreatitis
Alcohol abuse
Haemachromatosis iron studies
TS- high
Ferritin- high- correlate to iron storage
TIBC- low
Travellers diarrhoea organism
ETEC
Dull ache of RUQ with mildly raised ALT with HF
Congestive hepatomegaly
Which anti-emetic to avoid in bowel obstruction
Metoclopramide
Deficiency in what causes wernickes encephalitis
Thiamine
B1
SE of PPI
OP and fractures
Puetz jeghers sx
Obstruction
Freckles on lips
Met Bowel cancer causing obstruction, what drugs in syringe driver
Hyoscrine and morphine
Drugs to prevent hepatic encephalopathy
Lactulose and riftximin
Mx of massive variceal bleed
Terlipressin
Sengstaken Blakemore tube
Endoscopic ligation
Niacin deficiency sx
Dermatitis
Dementia
Diarrhoea
Pellagre
Small bowel overgrowth syndrome sx
Chronic diarrhoea
Bloating, flatulence
Abdo pain
SBOS dx
Hydrogen breath test
Tx of haemachromatosis
Venesection 1st
Desferrioxamine 2nd
What can exacerbate NAFLD
Sudden weight loss
SE clindamycin that patients should be made aware of
C diff
Triad of Budd chiari
Sudden severe abdo pain
Ascites
Tender hepatomegaly
Ix of Budd chiari
US with doppler flow
What is prescribed with large paracentesis
IV Human albumin solution
Sx of achalasia
Dysphagia of food and liquids from the start
Heartburn
What is the most specific and sensitive lab marker for CLD turning into cirrhosis
Plt <150
Screening for PCKD
US
What is used to monitor tx in haemachromatosis
Ferritin
Transferrin saturation
Vaccine for coeliac
Pneumococcal
Due to hyposplenism
Haemachromatosis inheritance
AR
Mx of chronic anal fissure
Topical GTN if not effective after 8 weeks
Consider surgery or botulism
When should you refer urgent 2ww colorectal
> 40 with unexplained wt loss and abdo pain
50 unexplained rectal bleeding
60 with IDA or bowel habit change
Refeeding syndrome sx
Low phosphate, potassium, Mg, abnormal fluid balance, arrhythmia
Tx of ascites medically
Spironolactone
Grading hepatic encephalopathy
1- irritable
2- confusion
3- incoherent
4- coma
Tx of H pylori with pen allergy
Clarithro, metronidazole, omeprazole
Skin signs in abdo exam
Erythema nodosum- on shins- IBD
Pyodeerma gangrenosum- ulcer- IBD
Jaundice- liver
Slate grey- Haema
Scars in abdo exam and uses
Kocher- biliary
Rutherford morrison- kidney transplant
Nephrectomy- lower midline
Laparotomy- AAA, Hartmans
Xanthelasma- PBC
Signs in chronic liver diases
Hands- dupuytrens, clubbing, leuconychia, erythema
Asterixis, ascites - decomp
Spider naevi, gynaecomastia
Jaundice
Splenomegaly
Causes of cirrhosis
Alcohol
Hep B and C
AI Hep
PBC, PSC
Wilsons
Haemachromatosis
NAFLD
Budd chiari
A1AT
Cause of ascites
Chronic liver disease
Malignancy
Nephrotic syndrome
Areas where hepatitis is prevalent
Africa
Asia
Anal fissure tx
Laxatives and high fibre
Chronic- topical GTN
Resistant- sphincterotomy
If dysplasia on endoscopy in barrels what is mx
EMR- resection
Electrolyte imbalance caused by diarrhoea
Metabolic acidosis with low K
Organism in ascites
E coli
Blood results of upper GI bleed
High urea
Anaemic
Description of NAFLD on USS
Increased echogenicity
What is dx of malnutrition
> wt loss than 10% in 3-6 months
Tx of IBS diarrhoea
Loperamide
Maintaining remission with crohns
Mercaptopurine or azathioprine
If TMPT + in crowns what should be used in remission
Methotrexate
Tx of C diff if repeat episode within 12 weeks
Fidoxomicin
Intestinal angina/ chronic mesenteric ischaemia sx
Triad- colicky pain, weight loss, abdominal bruit
When to stop statins
When 3x ULN LFTs
Peritonitis secondary to peritoneal dialysis organism
Staph epidermis
Tx of fistula in crohns
Seton
Which drug is a RF for C diff that’s not an AB
PPI
Women with deranged LFTs and secondary amenorrhea ant tx
AI Hepatitis
Steroids- liver transplant
If pernicious anaemia which cancer predisposed to
Gastric
What changes the efficacy of hydrogen breath test
Antibiotics in last 4 weeks
PPIs in last 2
Appendicitis symptoms what ix
USS
How TIPS works, what it treats and its complications
Shunt from portal vein to hepatic to bypass liver for variceal bleeds
As bypassing liver- can cause build up of nitrogen waste products
Puetz Jeghers sx
Hamartomas
Freckled lips
Ix for liver cirrhosis
Transient elastography
When to ix for liver cirrhosis
Hep C infection
>50 units men, 35 women
Alcohol related LD
Ix of ascites
USS then tap
confirm for SBP
Lymphoma associated with coeliac
Enteropathy T cell lymphoma
Diarrhoea causes what metabolic disturbance
Acidosis normal anion gap
Cause of highly pigmented colon
Laxative abuse
Melanosis coli
Tx of AI hepatitis
Steroids
If going for diagnostic biopsy for coeliac what should the patient continue to do
Eat gluten
Dysentry after long incubation
Amoebi
Nicorandil SE
GI ulceration
Most common complaint of peutz jegher syndrome
Small bowel obstruction
How does pseudomembranous colitis look on sigmoidoscopy
Yellow plaques in lumen
Cause of IDA returning from India
Hookworm
If H pylori + but have ALARMD sx what do you do
Endoscopy- main - if ALARMD sx or >55
Treat H pylori too- usually if <55
ALARMD- anaemia, Loss of weight, anorexia, recent, Selena, dysphagia
Prev severe UC remission tx
Azathioprine
Ix for mesenteric ischaemia
VBG- lactate
Life threatening C diff infection
Hypotension
Toxic megacolon
Then treat with oral vans and IV met
Gluten free common foods
Rice, maize/corn, potatoes
Tx of campylobacter
Clarithromycin
Dx of carcinoid
Urinary 5 HIAA
Main causes of pruitis
IDA
Lymphoma
Polycythaemia
Liver failure
CKD
Hepatocellular carinoma marker
AFP
Floating stools coming back from Egypt/Russia
Giardia- long incubation period
Long lasting
Tx of PSC
Observe
?liver transplant
Good indication alcoholic hepatitis needs steroids
High PT and Bilirubin
In Maddrey Discriminant
What is caecal volvulus associated with
Malignancy
Gastrectomy complications
Dumping sydrome- sugar moves too fast into bowel
Casues- distention, flushing, fainting, sweating
Hep A tx and cancer lieklehood
No increase in chance of cancer
Supportive tx
Tx of Hep B
Peginterferon alfa-2a
Foul smelling discharge at old age and constipated
Diverticulitis- fistula
What is CI in bowel obstruction
Laparascopic surgery
How should total parenteral nutrition be administered
Through central vein
Spider nevi vs telangiectasia
SN- fill centrally
What causes dupytres contraction
Alcoholic liver disease
Bloody supply of each section in gut
Foregut- coeliac- until 2nd duodenum
Mindgut- SMA- 2/3 along transverse
Hindgut- IMA- rectum
What can cause decompensation of cirrhosis
Alcohol, Bleeding, Constipation, drugs, infection
AB in AI Hepatitis
Anti Smooth muscle
ANA
Raised IgG
ALKM- types 2
UC on barium enema
whole colon, without skip lesions, is affected by an irregular mucosa with loss of normal haustral markings
Checking NG tube is in correct position
If pH <5.5
If unable to get aspirate or pH isn’t acidic- get CXR
Smoking in IBD
Increases relapse in Crohns
Decreases in UC
UC on x ray
Lead pipe
What to do with PPI before endoscopy
Stop 2 weeks before
Liver transplant guidance for paracetamol
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
Pedunculated polyps colon cancer
Adenoma