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Year 3 Med > Gastro > Flashcards

Gastro Flashcards

1
Q

Management for asymptomatic cholelithiasis?

A

Observe

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2
Q

Management for symptomatic cholelithiasis?

A

Analgesia - paracetamol/diclofenac
Elective laparoscopic cholecystectomy

Consider anti-spasmodic e.g. hyoscine

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3
Q

Management for choledocholithiasis regardless of symptoms?

A

ERCP + biliary sphincterotomy + stone extraction
Laparoscopic cholecystectomy
Analgesia - paracetamol/diclofenac

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4
Q

Investigations (imaging) for acute cholecystitis?

A

Abdominal US (no sepsis)
Contrast-enhanced CT/MRI (sepsis)

Consider MRCP if no stones seen on US but bile duct is dilated/abnormal LFTs

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5
Q

Management of cholecystitis?

A

Analgesia - paracetamol/NSAID/opioid
Laparoscopic cholecystectomy within a week of diagnosis

Consider:
Antibiotics - local protocol
Fluid resus

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6
Q

Investigations for cholangitis

A

Abdominal US

Contrast abdo CT: If US -ve but still high suspicion

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7
Q

Management for ascending cholangitis?

A

Initial stabilisation:
- piperacillin + tazobactam
- IV fluids
- strong opioid + paracetamol

ERCP

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8
Q

Investigations for acute pancreatitis?

A

Serum lipase/amylase elevated

Imaging not needed for diagnosis but can be done to find possible causes/exclude diff diagnoses
- CXR/abdominal US

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9
Q

Management for acute pancreatitis?

A

Fluid resus
Analgesia e.g. NSAID, opioid
IV ABs only if infection strongly suspected
Nutritional support

Additional definitive management depending on scenario

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10
Q

What is the definitive management for gallstone pancreatitis + cholangitis?

A

Emergency ERCP within 24 hours

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11
Q

Definitive management for gallstone pancreatitis + no cholangitis

A

Cholecystectomy within 2 weeks

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12
Q

Definitive management for pancreatitis + bile duct obstruction

A

EUS to identify bile duct stones. If present wait 48 hrs for spontaneous improvement

ERCP + sphincterotomy

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13
Q

Alcoholic pancreatitis management

A

B1 (thiamine)
B9 (folic acid)
B12 (cyanocoblamin)

Alcohol abstinence and benzos for withdrawal

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14
Q

How is a clinical diagnosis of acute pancreatitis made?

A

3x normal amylase
Characteristic pain (epigastric radiating to back)

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15
Q

What are the investigations/management for appendicitis

A

If classical signs with thin, male patients —> laparoscopic appendicetomy

If female/unsure —> ultrasound

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16
Q

Investigation for primary sclerosis cholangitis?

A

MRCP - diagnostic (strictures, dilations inside/outside liver with hallmark beaded appearance

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17
Q

HBsAg

A

Positive 4 weeks after virus exposure
Persistence implies chronic infection

18
Q

Anti-HBs

A

Provides lifelong immunity
Suggests resolved infection

19
Q

Anti-HBc

A

Order IgM and IgG tests

If both +ve then acute infection
If only IgG +ve then chronic infection

20
Q

HbeAg

A

Usually disappears after peak in ALT. If present after 3 months suggest chronic infection

21
Q

Anti-Hbe

A

Positive if virus has been cleared
Sometimes +ve if patient is asymptomatic carrier

22
Q

Management for HAV?

A

Supportive care, no antiviral therapy

If worsening jaundice and encephalopathy —> liver transplant

23
Q

Management for HBV

A

Acute:
Supportive care.
If severe/acute liver failure give antiviral therapy and assess for transplant

Chronic:
Antiviral therapy
Transplant for decompensated cirrhosis

24
Q

Investigations for HCV?

A

HCV antibody immunoassay (EIA)
- indicates current/past infection

If +ve do HCV RNA PCR:
- indicates current infection

25
Q

Management for HCV?

A

Antiviral therapy

26
Q

Management of ascites

A

Spironolactone

If refractory:
Large volume paracentesis and albumin replacement/TIPSS

Consider liver transplant

27
Q

Who gets urgent 2WW referral colonoscopy for colorectal cancer?

A

> 40: unexplained weight loss AND abdominal pain

> 50: unexplained rectal bleeding

> 60: iron deficiency anaemia OR changed in bowel habit

Any age male and female with <110 and <100 Hb respectively

28
Q

Imaging for pancreatic cancer?

A

CT for all patients with suspected disease in 2 weeks

USS if urgent CT not possible

29
Q

Most common type of colorectal cancer?

A

Adenocarcinoma (>90%)

30
Q

Investigations for oesophageal cancer

A

OGD with biopsy (first line)

CT/MRI thorax + abdomen for visceral mets
PET if mets/nodal spread
EUS for local lymph node staging

31
Q

Management for alcoholic liver disease

A

Alcohol abstinence with withdrawal management
Nutrition supplementation
Influenza + pneumococcal vaccine

Prednisolone if severe:
Maddrey’s factor > 32 or hepatic encephalopathy

Liver transplant for end-stage ALD

32
Q

What is Maddreys discriminant function calculated with

A

PT and serum bilirubin

33
Q

Investigation for intusseption

A

Ultrasound for target like mass

34
Q

Crohn’s disease management

A

Induce remission: steroids, + immunosuppressants (azathioprine, mercaptopurine, methotrexate). Biologics (severe)/5ASAs (1st presentation) for steroids not tolerated

Maintain remission: immunosuppressants

Surgery e.g. small bowel resections

35
Q

Ulcerative colitis management

A

Acute hospitalisation: IV steroids + biologics if >3 days no change

Induce remission:
Mild - 5ASAs, steroids (2nd), biologics (3rd)
Moderate/severe - steroids + biologics

Maintain remission:
Mild/mod - topical (proctitis)/oral 5ASAs
Severe/2 or more exacerbations in past 12 months that needed steroids - azathioprine/mercaptopurine

36
Q

Classification of IBD flares

A

Mild: < 4 stools a day, no systemic
Moderate: 4-6 stools a day, minimal systemic
Severe: > 6 stools a day, systemic

Systemic includes: tachycardia, fever, abdo distension/tenderness, anaemia, reduced bowel sounds, hypoalbuminaemia, cachexia < 18.5/sudden weight loss

37
Q

Haemorrhoid grading

A
  1. No prolapse
  2. Prolapse on straining, return on relaxing
  3. Prolapsed but can be manually reduced
  4. Cannot be reduced
38
Q

Oesophageal cancer management

A

0-IA: endoscopic resection +/- ablation
IB-III: oesophagectomy (IIB-III): pre-op chemo +/- post-op chemo
IV: chemotherapy

39
Q

Which people are referred for an OGD via 2WW pathway for oesophageal/gastric cancer?

A

Any age dysphagia

> 55 years old:
- weight loss and:
— abdominal pain, reflux or dyspepsia

40
Q

Cirrhosis investigation

A

Transient elastography (fibroscan)
Acoustic radiation force impulse imaging

Year 3 Med (10 decks)

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