Gastro Flashcards
What test is positive in UC and negative in crohn’s
pANCA
What would you seen in the histology of a patient with UC
lead piping due to loss of haustral markings and pseuopolyps
which is granulomatous, UC or crohns
UC is non and crohns is caseating gran
gold standard investigation and emergency treatment for UC
sigmoidoscopy with biopsy and surgery: proctocolectomy, topical ifnot prednisolone
treatment for functional dyspepsia
amitriptylline
which drugs would you avoid in someone with GERD
anticholinergics and calcium channel blockers
Which drugs can cause upper GI bleed
ODEVICES, Omeprazole, Disulfram Erythromycin, Valproate, Isonazid, Ciproflaxcin, Ethanol Sulphonamides
What is causes jaundice with metabolic acidosis
drug induced hepatitis
What causes AST:ALT ratio to be over 2
alcoholic liver disease
What causes ALT/AST to be over 1000IU
ischaemic hepatitis, viral hepatitis and atuoimmune hepatitis
what is the fetal equivalent of albumin
alpha fetoprotein
Disease with isolated bilirubin
gilberts syndrome
What is the ALT/AST/GGT/ALP pattern for viral hepatitis
ATL/AST grossly elevated and GGT and ALP is moderately elevated
What is the most common inheritable cause of colorectal cancer
lynch syndrome
Difference is clinical features between oesophageal cancer and achalasia
achalasia is difficulty with solids and liquids from the start
features of biliary colic
intermittent coliky upper quadrant right sided pain, no fever
stages of hepatic encephalopathy
1: mood change and disrupted sleep and wake cycle
2: dizziness, confusion, slurring speech
3: restlessness, incoherency, liver flap
4: coma
how many weeks with a previously healthy liver would you need to have to now be diagnosed with acute liver failure
less than 26 weeks
how would you treat renal dysfunction in acute liver failure
fluid resuscitation with human albumin solution rather than crystalloid solution
drugs you would use to treat encephalopathy and cerebral oedema
encephalopathy: oral lactulose and oedema: IV mannose
how would you treat recurring hepatic encephalopathy
rifamicin
went on holiday 3 weeks ago, GP suspects viral hepatitis and pt says she tried many different foods in spain. which infection is it likely to be
Hep A incubation period of 2-3 weeks and faecal-oral transmission
went on holiday 3 months ago, jaundice, itchiness. GP suspect viral hepatitis, what is the most likely causative agent?
Hep B, incubation test- 60-90 days and transmitted through sex and vertical transmission.
treatment for alcohol withdrawal first and second line
chlordiazepoxide and iv lorazepam
score used for cirrhosis
child-hugh score
Treatment of asities
fluid restriction, furosemide and spironolactone
treatment for pruritis
cholestyramine is a bile acid sequestrant so binds to bile acids and presents absorption
gi bleed and oesophageal varices will present with which type of anaemia?
normocytic
which electrolyte abnormality can lead to cirrhosis
low albumin and hyponatraemia
different types of autoimmune hepatitis
1: anti-smooth muscle antibodies and anti-nuclear antibodies
2: anti-liver microsomal antibodies
3: anti-soluble liver antibodies
what is the treatment for autoimmune hepatitis
30mg oral prednisolone: for immunsupressive therapy and aziathioprine as a DMARD and reduce over 2 years
pt presenting with jaundice, oedema and confusion with a paracetamol overdose 30mins ago. management?
activated charcoal
pt presenting with jaundice, oedema and confusion with a paracetamol overdose 5hours ago. management?
NAC
pt presenting with jaundice, oedema and confusion with a paracetamol overdose 3 hours ago. management?
wait another 4 hours and do a treatment line
pt presenting with jaundice, oedema and confusion with a paracetamol overdose but doesnt know how long ago management?
NAC immediately
What is the role of N-acetycysteine
a toxic metabolite of paracetamol: NAPQI which is toxic to the kidney and liver. Gluthiaone detoxifies it. and increased paracetamol depletes the stores, NAC replenishes these stores.
what is the most common type of gastric cancer
adenocarcinoma
When would you do an urgent referral in 2 weeks for stomach cancer
dysphagia at any age, 55 and over for unintentional weight loss
when would you refer for 6 weeks for stomach cancer
haematemesis at any age, 55 and over with treatment resistant dyspepsia, abdo pain and nausea and vomiting
investigation for stomach cancer
endoscopy, CTAP and MRI treatment with partial and total gastrectomy
treatment for barrett’s oesopahgus
surgery
apart from PPI therapy- what are the other treatment for ERD
antacids like magnesium trisilicate, alginates like gaviscon
two types of hiatus hernia and the most common
rolling and sliding and sliding is more common
First line investigation for hiatus hernia
barium swallow then oesophageal mano
which condition is increased gastric emptying a risk factor for
duodenal ulcer
which condition is delayed gastric emptying a risk factor for
gastric cancer
when is duodenal ulcer pain worse
without food or over night
when is a gastric ulcer more painful
with food pain intensifies
first and second line treatment for infectious colitis
oral vancomycin, and oral fidaxomicin. if severe: oral vanco and IV metronidazole
family history with colorectal cancer is likely to be at risk of which cancer
endometrial cancer
which feature would you see in acute liver disease
smooth tender hepatomegaly
does melaena suggest a lower GI or upper GI bleed
upper and at risk with NSAID
which GI disorder has halitosis:
peptic ulcer disease, GERD
GERD
difference between gastric and duodenal ulcer symptoms
gastric: shortly after food pain. duodenal is pain with hunger and made better with food
When are people offered the Hep B vaccine
8, 12 and 16 weeks of age
does gilbert syndrome have conjugated or unconjugated bilirubin
unconjugated
what does a streptoboccus infection predispose you too
infective endocarditis and colorectal cancer
recurrent clostridium difficile infection
oral fidaxomicin
Courvoisier’s law
palpable mass in the RUQ is more likely to be a malignant obstruction of the common bile duct rather than obstruction due to stones.
most common affected site in crohns
ileum
abdo pain and diarrhoea with duodenal ulcer s and high PTH
zollinger ellisons syndrome around 1/3 of these patients have multiple endocrine neoplasia type 1
what can transfer in swimming pools and causes a malabsorption
giardia lambia
for a PE do you used LMWH or a DOAC
DOAC
variceal haemorrhage treatment
terlipressin + IV antibiotic
what cancer is pernicious anaemia associated with
gastric cancers and carcinoid tumours
what cancer is zollinger-ellison associated with
gastrinoma
what cancer is hpylori associated with
MALT lymphoma
what cancer is coeliac disease associated with
t cell lymphoma
what cancer is ulcerative colitis associated with
cholangiocarcinoma and colorectal cancer
treatment for wilsons disease
d-penicillamine
treatment for achalasia
hellers cardiomyotomy
