gastro Flashcards
Primary biliary cholangitis - the M rule
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females
Primary biliary cholangitis
presentation?
- tx
ALP/BILI high, associated with sjogens, thyroid disease
first-line: ursodeoxycholic acid
Urgent gastro referral
All patients who’ve got dysphagia
All patients who’ve got an upper abdominal mass consistent with stomach cancer
Patients aged >= 55 years who’ve got weight loss, AND any of the following:
upper abdominal pain
reflux
dyspepsia
Non-urgent referral
Patients with haematemesis
Patients aged >= 55 years who’ve got:
treatment-resistant dyspepsia or
upper abdominal pain with low haemoglobin levels or
raised platelet count with any of the following: nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain
nausea or vomiting with any of the following: weight loss, reflux, dyspepsia, upper abdominal pain
Acute cholecystitis
Pain similar to biliary colic but more severe and persistent. The pain may radiate to the back or right shoulder.
The patient may be pyrexial and Murphy’s sign positive (arrest of inspiration on palpation of the RUQ)
in life-threatening C. difficile infection treatment is
first episode of c diff?
ORAL vancomycin and IV metronidazole
first-line therapy is oral vancomycin for 10 days
second-line therapy: oral fidaxomicin
60 yo with unpleasant symptoms two months including frequent flushing
diarrhoea
tightness in his throat that sounds to the GP like bronchospasm
weight loss
hypotensive.
?, what is raised?
Carcinoid tumours release serotonin, so will cause a raised urinary 5-HIAA
tx for carcinoid?
Diarrhoea?
somatostatin analogues e.g. octreotide
diarrhoea: cyproheptadine may help
alcoholic cirrhosis presents to the emergency department after 2 episodes of vomiting blood.
unstable
blood is given
going for endo
what else needs to be given before scope?
Both terlipressin and antibiotics should be given before endoscopy in patients with suspected variceal haemorrhage
key differences in crohns vs UC
features?
extra intestinal?
pathology?
key differences in crohns vs UC
histology?
radiology?
endo?
Hep serology
previous immunisation
previous hepatitis
previous hepatitis B, now a carrier
anti-HBc ?
previous immunisation: anti-HBs positive, all others negative
previous hepatitis B (> 6 months ago), not a carrier: anti-HBc positive, HBsAg negative
previous hepatitis B, now a carrier: anti-HBc positive, HBsAg positive
anti-HBc: caught, i.e. negative if immunized
Non-alcoholic fatty liver disease vs AFLD
AST/ALT?
Alcoholic liver disease is typically associated with an AST:ALT ratio >2 in contrast to non-alcoholic fatty liver disease which is associated with an ALT:AST ratio >2.
what medication causes increase C. difficile infection risk?
PPIs are a risk factor for C. difficile infection
What advice should you give a woman (who is NOT pregnant) if she asks what is the recommended amount of alcohol she can drink?
No more than 14 units of alcohol per week.
If you do drink as much as 14 units per week, it is best to spread this evenly over 3 days or more
Achalasia
Dysphagia of both liquids and solids from the start
Heartburn
Regurgitation of food - may lead to cough, aspiration pneumonia etc
Oesophageal candidiasis
whos at risk?
there may be a history of HIV or other risk factors such as steroid inhaler use
coeliac serology?
dx?
tissue transglutaminase (TTG) antibodies (IgA) are first-choice according to NICE
Endoscopic intestinal biopsy
cholestasis.. what diabetic meds causing it?
Sulphonylureas: gliclazide
Peutz-Jeghers syndrome
hamartomatous polyps in the gastronintestinal tract (mainly small bowel)
pigmented lesions on lips, oral mucosa, face, palms and soles
toxic megacolon features? dx?
uc complication
excessive stool bowel movemts
dx abdo x ray
severe flare of ulcerative colitis
mild-moderate flare?
severe: bowels more then x6, hr>90, CRP>30
IV corticosteroids
second line: IV ciclosporin
mild to moderate: just proctitis then rectal aminosalicylate, proctosigmoditis: rectal aminossylylates, extensive: rectal and oral aminosalicylates
deranged LFTs combined with secondary amenorrhoea in a young female
autoimmune hepatitis
Gastric cancer risk factors
Helicobacer pylori: triggers inflammation of the mucosa → atrophy and intestinal metaplasia
atrophic gastritis
diet: salt and salt-preserved foods, nitrates
smoking
blood group A
Spontaneous bacterial peritonitis (SBP)
Antibiotic prophylaxis should be given to patients with ascites if?
Spontaneous bacterial peritonitis (SBP) is a form of peritonitis usually seen in patients with ascites secondary to liver cirrhosis.
Antibiotic prophylaxis should be given to patients with ascites if:
patients who have had an episode of SBP
patients with fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome
NICE recommend: ‘Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less until the ascites has resolved’
Management of non-variceal bleeding i.e due to NSADS, patient on warfarin
IV prothrombin complex concentrate to reverse warfain
PPI only AFTER endoscopy if non-variceal bleed
recurrent episode of C. difficile within 12 weeks of symptom resolution
oral fidaxomicin
Proton pump inhibitors should be stopped …….. before an upper GI endoscopy
Proton pump inhibitors should be stopped 2 weeks before an upper GI endoscopy
Melanosis coli: pigment-laden macrophages, associated with
laxative abuse
what does it suggest when there is high ferritin level with either with vs without iron overload?
best test to see whether iron overload is present is transferrin saturation.
medical treatment to maintain remission for UC
maintain remission in left-sided or extensive ulcerative colitis?
patients who have had a severe relapse or 2 or more exacerbations in the past year?
oral aminosalicylate
Oral azathioprine
What cancer associated with GORD /Barrett’s?
Oesophageal adenocarcinoma is associated with GORD or Barrett’s
Urea breath test : what to stop for accurate test and for how long?
no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks
Iron defiency anaemia vs. anaemia of chronic disease:
TIBC is high in IDA, and low/normal in anaemia of chronic disease
paracetamol OD, levels of ALT, ALP and ALT/ALP ratio?
Think T for trauma…. increased ALT
Wilson’s disease
presentation?
Ix?
Mx?
neuropsychiatric symptoms, Kayser-Fleischer rings and family history of liver disease.
most common cause of hepatocellular carcinoma in the United Kingdom vs worldwide?
hepatitis B most common cause worldwide
hepatitis C most common cause in Europe
A sigmoidoscopy demonstrates localised proctitis, with no inflammation more proximally in the gastrointestinal tract. A new diagnosis of ulcerative colitis
tx?
In a mild-moderate flare of distal ulcerative colitis, the first-line treatment is topical (rectal) aminosalicylates i.e mesalazine
Acute pancreatitis
Severe epigastric pain
Vomiting is common
Examination may reveal tenderness, ileus and low-grade fever
Periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign) is described but rare
Ix for vitamin B12 deficiency,
intrinsic factor antibodies
many units of alcohol are in a 750ml bottle of red wine with an alcohol by volume of 12%?
Alcohol units = volume (ml) * ABV / 1,000
9units
Cyclical Vomiting Syndrome
main symptoms are severe nausea and vomiting which can last from a few hours to a few days, occurring in discrete episodes.
Achalasia- physiology
ix
tx
Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter (LOS) due to degenerative loss of ganglia from Auerbach’s plexus
very common complication of scleroderma (systemic sclerosis).
Malabsorption syndrome is a very common complication of scleroderma (systemic sclerosis). The bloods show evidence of impaired absorption of some vitamins (B12, folate), nutrients (iron) and protein (low albumin).
prophylaxis of oesophageal bleeding
non-cardioselective B-blocker (NSBB) : propranolol
typical presenting features of coeliac disease in children.
chronic diarrhoea, abdominal bloating and failure to thrive.
most common extra-intestinal feature in both Crohn’s and UC
Arthritis
Bile-acid malabsorption may be treated with
cholestyramine
Metoclopramide can cause extrapyramidal side effects….?
acute dystonia: eyes are trapped in strange position
patients with non-alcoholic fatty liver disease, what test should be performed next to identify extent of damage?
enhanced liver fibrosis (ELF) testing is recommended to aid diagnosis of liver fibrosis
investigation of choice for suspected perianal fistulae in patients with Crohn’s
mri pelvis
Endoscopic intestinal biopsy is the gold standard for diagnosis of coeliac disease.. what area of intestine?
jejunal
june has coeliacs
Isoniazid therapy can cause
what is the vitamin deficiency?
vitamin B6 deficiency causing peripheral neuropathy
‘burning sensation’ sole foot
Like Ice giving me pins and needles
Fisherman, with AkI, feeling jaundice, reports feeling unwell, cold, cough flu like symptoms?
