gastro Flashcards
what stimulates g cells to release gastrin
luminal peptides
plummer vinson syndrome
Triad of:
dysphagia (secondary to oesophageal webs)
glossitis
iron-deficiency anaemia
primary billiary cholangitis, CFs, symptoms, treatment, Ix
which autoimmune condition is also seen in 80% of PBC pts
middle aged females, IgM, ALP, raised bilirubin
CFs:
pruitus, clubbing, hepatosplenomegaly
Ix: bloods, MRCP (exclude extrahepatic cause)
Treatment: ursodeoxycholic acid- slow progression
cholestyramine- itching
fat soluvle vit supplementation
Liver transplant if bili>100
MOST associated w sjogrens
wilsons disease associated with which type of anaemia?
haemolytic anaemia
keiser fleischer rings =— what condition
wilsons disease
wilsons disease
symptoms;
hepatitis, cirrhosis, speech/psych problems
kayser fleischer rings
BLOODS:
reduced caeruloplasmin
reduced total serum copper
increased 24hr urinary copper excretion
ATP7B gene
Mx
penicillamine- chelates copper
Hep b serology
HBsAg
anti-HBc
Anti-HBs
IgM anti-HBc negative
HBsAg = ongoing infection, either acute or chronic if present > 6 months
anti-HBc = caught, i.e. negative if immunized
Anti-HBs = immunity
IgM anti-HBc negative= chronic infection
IgM anti-HBc positive= acute infection
what is budd chiari syndrome
hepatic vein thrombosis
what is budd chiari syndrome caused by
polychythaemic rubra vera
thrombophillia- protein c resistance, antithrombin 3 def
pregnancy
COCP
triad of symptoms budd chiari syndrome
- abdominal pain: sudden onset, severe
- ascites → abdominal distension
- tender hepatomegaly
c diff morphology
gram positive rod
alphafetoprotein elevated in Hepatocellular carcinoma or cholangiocarcinoma
hepatocellular carcinoma
underlying aetiology of hepatorenal syndrome?
Splanchnic vasodilation
hepatorenal syndrome treatment
vasopressors analogue -eg terlipressin
liver transplant
20% albumin
transjugular intrahepatic portosystemic shunt
Terlipressin= vasopressor= splanchnic CONSTRICTION
Boerhaave syndrome
severe vomiting causing oesophageal rupture – chest pain and shock
raised conjugated bilirubin, black liver
Dubin-Johnson syndrome
which anti emetic can cause tardive dyskineseia
metoclopramide
which anti emetic can cause tardive dyskineseia
metoclopramide
Familial adenomatous polyposis which chromosome is mutated
chromosome 5
elderly patient who has a history of aortic stenosis presents with rectal bleeding. A colonoscopy shows multiple small, flat, erythematous lesions with scalloped edges
Angiodysplasia
a man who presents with intussusception is noticed to have multiple polyps on colonoscopy. These are later shown to be hamartomatous. He also has pigmented lesions on his lips and palms
Peutz-Jeghers syndrome
LKB1 or STK11
Whipple’s disease
Tropheryma whippelii infection. It is more common in those who are HLA-B27 positive and in middle-aged men.
jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules
Management
oral co-trimoxazole for a year ., sometimes preceded by a course of IV penicillin
W-weight loss , worn out joints
H- Hyper pigmentation , Hyperactive bowel(diarrhea)
I- Inadequate absorption of minerals , vitmains
P-pleurisy
P-Pericarditis
L-Lymphadenopathy
E-elevated macrophages on Biopsy
Diarrhoea, weight loss, lymphadenopathy, arthralgia, fever in a question is most likely to indicate:
whipples disease
mesalazine or sulfasalazine more likely to cause acute pancreatitis?
mesalaizine
causes of cause of jejunal villous atrophy
Jejunal villous atrophy
coeliac disease
tropical sprue
hypogammaglobulinaemia
gastrointestinal lymphoma
Whipple’s disease
cow’s milk intolerance
which antibiotic can cause cholestasis
co amxiclav
which monoclonal antibody targets c diff
Bezlotoxumab
hereditary non-polyposis colorectal carcinoma HNPCC inheritance pattern
autosomal dominant
DNA Mismatch repair
HNPCC associated with which other type of cancer
endometrial
FAP
which chromosome affected
is a rare autosomal dominant condition which leads to the formation of hundreds of polyps by the age of 30-40 years.
CHROMOSOME 5
APC gene
way to remember coeliac HLA genes
That person with coeliac disease is da cutie (DQ2) and quiet (Q8)
which chromosome haemochromatosis and which deficiency causes it>
haemachromotoSIS (SIX)
HFE deficient
first line management NAFLD
weight loss
ischaemic colitis- most likely to affect ?part of colon
splenic flexure
superior and inferior mesenteric arteries.
secondary prophylaxis of hepatic encephalopathy
medications
lactulose
rifaximin
how to remember recessive vs dominant
MRDS- MR Denotes Surgeon
(Metabolic-Recessive; Dominant-Structural)
UC- which part of colon most commonly affected
terminal ileum
Cholestasis Drugs:
Choleostasis Drugs: FAt-E CRAPS (Steatorrhea)
- Fibrates
- Antibiotics (penicillin, co amox, erythromycin, fluclox)
- Erythromycin
- COCP
- Rare (nifepdipine)
- Anabolic steroids/testosteorne
- Phenothiazides
- Sulphonylureas
nicotinic acid test tests which condition
gilberts syndrome
what type of anaemia common in alcoholics
macrocytic
heart condition as result of hypomagnesia in refeeding syndrome
torsade des pointes
first line type of gastric band surgery
laparoscopic-adjustable gastric banding (LAGB)
eosinophilic oesophagitis management
DIET and steroids
fluticasone
which laxative is carcinogenic
co danthramer
diarrhoea + pigment laden macrophages on colonoscopy=?
laxative abuse
reversal dabigatran
Idarucizumab (Praxbind)
avoid which type of laxative and what laxative in iBS
avoid lactulose and stimulant laxatives
chronic pancreatitis gold standard Ix
CT pancreas- look for calcification
management eosinophilic oesophagitis
diet modification
fluticasone topical steroid
which monoclonal antibody can be used for c diff?
bezlotoxumab
Small bowel bacterial Overgrowth investigation test
and abx treatment
hydrogen breath test
rifiximin
what indicates severe pancreatitis (6)
age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST
macrocytic anaemia + hypothyroid = what type of anaemia
pernicious anaemia
crohns=
GOBLET AND GRANULOMAS
kantors string sign
rose thorn ulcers
proximal bowel dilation
where do VIPomas arise from
pancreas
thumbprinting assosicated with?
ischaemic colitis
risk factors for oesophageal cancer: SCC vs adenocarcinoma
SCC= smoking, alcohol, plummer vinson, achalasia
Adenocarcinoma= barretts oesophagus
what reduces mortality in alcoholic pts with UGI bleed
prophylactic abx
how to tell if pt has secondary haemochromatosis vs primary
secondary= older pts, ass’d with regular blood transfusions, new onset diabetes
pancreatitis cause= hyper triglyceride or hyper cholesterol
HIGH TRIGYLCERIDS=== RISK FOR PANCREATITIS
(not high cholesterol)
drugs causing hepatocellular damage- can lead to hepatitis– ALT is more increased
paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin
coeliac investigation
You cannot interpret TTG level in coeliac disease without looking at the IgA level
how to test exocrine function in chronic pancreatitis pt
faecal elastase
Post-cholecystectomy syndrome
recognised complication of cholecystectomies. Typically symptoms of dyspepsia, vomiting, pain, flatulence and diarrhoea occur in up to 40% patients post surgery.
Cholestyramine, to bind the excess bile acids and thus preventing lower gastrointestinal signs
abx prophylaxis for patients with ascites
to prevent spontatnious bacterial peritonitis :
PO ciprofloxacin
or norfloxacin
most common bac= e coli
causes of NAFLD (5)
Associated factors
obesity
type 2 diabetes mellitus
hyperlipidaemia
jejunoileal bypass
sudden weight loss/starvation
is gilberts syndrome conjugated or unconjugated bili
gilberts= unconjugated
haemochromatosis Ix bloods
transferrin and ferritin
how to differentiate HNPCC and FAP
hundreds of polyps= FAP, caused by nutation in tumour suppressory gene ACP
double duct sign==?dilatation of the common bile duct and pancreatic ducts.
pancreatic cancer
PPI side effects
and MOA
incr c diff risk
MICROscopic colitis
hypo natremia hypo magnesia
osteoporosis
MOA= Proton pump inhibitors (PPI) cause irreversible blockade of H+/K+ ATPase of the gastric parietal cell.
Spontaneous bacterial peritonitis
cfs
group most at risk
tx
ix
form of peritonitis usually seen in patients with ascites secondary to liver cirrhosis.
Features
ascites
abdominal pain
fever
Diagnosis
paracentesis: neutrophil count > 250 cells/ul
the most common organism found on ascitic fluid culture is E. coli
Tx= IV cefotaxime
when to give abx prophylaxis regarding spontaneous bacterial peritonitis
and which abcx to give
give ciproflox
IF:
-prev episode SBP
- high fitz pugh score (9) or hepatorenal syndrome
- fluid protein LOW (<15)
what is the iron study profile in pt with haemochromatosis
Typical iron study profile in patient with haemochromatosis
transferrin saturation > 55% in men or > 50% in women
raised ferritin (e.g. > 500 ug/l) and iron
low TIBC
how to Ix microscopic colitis as a result of PPI use
colonoscopy and biopsy
gold standard Ix for achalasia (difficult to pass scope down)
oesophageal manometry
acute fatty liver of pregnancy
what stage of preg does it occur
cfs
tx
occurs third trimester
or the period immediately following delivery.
Features
abdominal pain
nausea & vomiting
headache
jaundice
hypoglycaemia
severe disease may result in pre-eclampsia
Investigations
ALT is typically elevated e.g. 500 u/l
Management
support care
once stabilised delivery is the definitive management
antibodies (LKM1) positive in?
autoimmune hep type 2
high titres of igg
dubin johnson syndrome inheritance
cfs
Dubin-Johnson syndrome is a benign autosomal recessive disorder
CONJUGATED hyperbilirubinaemia
Ongoing diarrhoea in Crohn’s patient post-resection with normal CRP →
cholestyramine to manage symptoms
refeeding syndrome electrolytes
hypophosphataemia
hypokalaemia
hypomagnesaemia: may predispose to torsades de pointes
abnormal fluid balance
LOW EVERYTHING
Child-Pugh A cirrhosis
B
C management
Child-Pugh A cirrhosis: without signs of portal hypertension who have single lesions <2cm in size should be treated with surgical resection
Child-Pugh A and B cirrhosis and 2-3 tumours <= 3 cm or 1 tumour <=5 cm without vascular invasion or extrahepatic spread should be considered for liver transplantation. As a bridge to liver transplantation these patients can be treated with TACE or RFA.
Child-Pugh A or B cirrhosis , good performance status, and evidence of vascular, lymphatic or extrahepatic spread the multiple tyrosine kinase inhibitor, Sorafenib, has been shown to prolong survival.
Those with Child-Pugh C cirrhosis have end-stage liver disease and are poor candidates for therapy as they lack any hepatic functional reserve to tolerate either resection, TACE or RFA. These patients are best treated symptomatically
peutz jeughers
inheritance
cf
tx
cause
autosomal dominant condition characterised by numerous hamartomatous polyps in the gastrointestinal tract.
freckles on lips
pigmented freckles on the lips, face, palms and soles
LKB1 or STK11
Features
hamartomatous polyps in the gastronintestinal tract (mainly small bowel)
small bowel obstruction is a common presenting complaint, often due to intussusception
gastrointestinal bleeding
pigmented lesions on lips, oral mucosa, face, palms and soles
IDA
Tx = conservative unless problems
Metabolic ketoacidosis with normal or low glucose: CAUSE LIKELY?
ALCOHOL EXCESS
hypokalemia
eg 3 polyps in colon ==?
vilous ademona
causes hypo kalemia
secondary prophylaxis of hepatic encephalopathy
lactulose
rifiximin
severe alcoholic hepatitis mx
prednisolone
when to screen for hep carcinoma HCC : which groups
patients liver cirrhosis secondary to hepatitis B & C or haemochromatosis
MEN (not females) with liver cirrhosis secondary to alcohol
. A sigmoidoscopy is performed which shows multiple white plaques adhered to the gastrointestinal mucosa ==?
psudomembranous colitis
assd with c diff
marker of severity acute pancreatitis
CRp
signet ring cells associated with?
gastric adenocarcinoma
investigation of choice for bile acid malabsorption
SeHCAT scan
investigation carcinoid syndrome
urinary 5-HIAA
plasma chromogranin A y
primary sclerosing cholangitis Ix
MRCP= definitive
pANCA may be positiv e
when is urea breath test inaccurate
should not be performed
within 4 weeks of treatment with an antibacterial
or within 2 weeks of PPI (e.g. a proton pump inhibitor)
NICE bariatric referral cut-offs
NICE bariatric referral cut-offs
with risk factors (T2DM, BP etc): > 35 kg/m^2
no risk factors: > 40 kg/m^2
which genetic conditions is the most prevalent in a Caucasian population?
haemochromatosis
must eat gluten for how many weeks before coeliac testing
6 weeks
. What is the most likely vessel to be responsible? in variceal bleed
gastroduodenal artery
negative HVC RNA but positive anti HCV==?
previous hep c infection
increase risk of HCC
Aflatoxin
achalasia CFs
Ix
tx
food and drink, regurg, heart burn
Ix= oesophageal manometry
barium swallow= birds beak
RETROCARDIAL air fluid level
Tx
ballon dilation first line
severe and sx needed= hellers myotomy
angiodysplasia Ix
capsule endoscopy
unsafe drugs in acute intermittent porphyria
Drugs unsafe in acute intermittent porphyria:
If you go to a BAR on a BENZ,say HALO to a guy,take a SULFi,have some ALCOHOL n dont forget the OCP.(barbiturates;Benzodiazepines,HAloperidol,Sulfonamides;alcohol and OCP.
obeticholic acid
FXR agonist
it is used in PBC
