Gastro Flashcards
dx:
Benign, self limiting, flu like prodrome, RUQ pain, tender Hepato-megaly, Jaundice, deranged LFTs
Hep A
HbsAg =
HbsAB =
HbcAG =
IgM =
, IgG =
HbeAg =
HbsAg = Active but if present >6m can be chronic
HbsAB = vacc/past/current
HbcAG = past/current infection
IgM = acute, IgG = past
HbeAg = infectivity
Tx Hep B and is it chronic?
Pegylated IF-A treatment
Most recover <2m - some chronic.
Can progress to HCC
After exposure - transient rise in lFTs/Jaundice, fatigue, arthralgia,
Usually in IVDU and in old blood transfusions - dx
Hep c - antivirals
3 types of autoimmune hepatitis and the common groups they are seen in and mx
T1 = women after menopause. ANA/SMA
T2 = Teens - jaundice, ↑AST/ALT, LKM1
T3 = ↑IgG
steroids , azathioprine
Mx of oesophageal varies in GI bleed
Terlipressin + props ABc
If all fails - sengstaken Blakemore tube
Mx H Pyloric
PPI + 2Abx (Amoxicillin + Clarithromycin) for 7 days
What is boerhave syndrome
Vomit -> severe chest pain/shock = oesophageal perforation +/- suprasternal crepitus
Diagnosis of Pharyngeal pouch
Barium swallow combined with dynamic video fluoroscopy
Painless jaundice (pale stool, dark urine, pruritus)
Cholestatic LFTs +/- mass, ↓ weight
DM, Steatorrhoea
CT scan - double duct sign
Diagnosis
Pancreatic cancer
What will bloods show for haemachromatosis
↑transferrin sat, ↑ ferritin, ↓TIBC, HFE gene C6
Type of inheritance of Wilsons disease, the diagnosis and mx
Autosomal Recessive
Liver biopsy is gold standard
Copper chelation - penicillamine, Trientene
Type of inheritance and 2 main problems in alpha 1 antitrypsin def
Autosomal recessive
Liver cirrhosis + emphysema
Jaundice in illness/exercise - isolated rise in bilirubin
What is this, pattern of inheritance and mx
Gilberts syndrome
Autosomal recessive
Jaundice in illness/exercise - isolated rise in bilirubin
Reassurance, no treatment
Mx small bowel overgrowth and a main RF
RF = Scleroderma
Rifaximin
How long before urea breath test for H.Pylori to stop antibacterials and PPIs
Urea breath test - not within 4 weeks or antibacterial or PPI
Achalasia - diagnosis and mx
Solid + liquid
Dx - oesophageal manometry - birds beaks in barium swallow
Pneumatic dilation
Heller cardiomyotomy
Hepatic vein thrombosis, abdo pain, ascites, tender hepatomegaly
What is the condition and how to diagnosis
Budd-Chiari
1.US doppler -> Dx -> hepatic venography
Persistent biliary colic, anorexia, jaundice, mass RUQ, periumbilical LNs + left supraclavicular LNS
diagnosis
CHolangiocarcinoma
Autosomal dominant, polyp, pigmented lesions
Peutz-jEGHERS
campylobacteria jej vs E.Coli
Campylobacter jej - Bloody, crampy travellers diarrhoea
(E.Coli is non bloody + watery)
C.Diff mx
PO VANC
PO Findaxomicin
If recurrent in 12 weeks = Findaxomicin.
If >12w then vanc
Severe (-<BP, toxic megacolon) = PO Vanc + IV metrondiaxole
Dx - CDT in stool (toxin)
What blood gas abnormality would you see in vomiting vs diarrhoea
Vom = metabolic alkalosis
Diarrhea = Normal anion metabolic acidosis
Remission and maintainance tx of UC
Remission = Aminosalicylate or 2. Corticosteroids
Maintenance = Aminosalicylates ( if >2 exac then PO azathioprine or PO Mercaptopurine)
Panprocolectomy
Difference between UC and Crohn’s
UC= Continuous, colon + rectum, superficial, bloody/mucus, smoking helps, ass with ankylosing spondylitis, PANCA, lead pipe on XR
Crohns = No blood/mucus, entire gIT, skip lesions, transmural, goblet cells, mostly ileum
Remission and maintianene mx of Crohn’s
R= Steroids
M = Azathioprine/ mercaptopurine (cgeck TPMT activity before)
Perianal abscess - incision and drainage
Symp perianal fistula - PO Metronidazole
Cpmplex perianal fistula - seton
What is give for Pain, Consitpation and diarrhoea in IBS
Pain - antispasmodic
Constipation - ispaghula husk
Diarrhoea - loperamide
Cholestasis - jaundice, pruritis, ↑bilirubin + ALP
RUQ pain, fatigue
what could be the diagnosis, what condition is a RF, and what is a compilation
PSC
UC is RF
Cn lead to cholangiocarcinoma
Dx of PSC
ERCP (beaded appearance - strictures)
CHolestatic jaundice + ↑IgM + Anti-mitochondrial Abs (AMA)
May be asymptomatic (eg raised ALP on routine LFTs) Itching + fatigue and may have cholestatic jaundice
Middle aged female
Dx and mx
PBC
Ursodeoxycholic acid + cholestyramine (itch control)
What would you find on US for NAFLD and the ELF test result
Increased ECHOgenecity on US
Elf test <1
AST/ALT ratio in alcoholic liver disease and the mx
AST/ALT ratio is 2:1
Glucocorticoids in acute episodes
Delirium tremens initial mx
Chlordiazepoxide for withdrawal
Mx of ascites 2ry to liver cirrhosis
Aldosterone antagonist, decrease Na in diet, might drain (TIPS) and possible Abx
How often do you screen for HCC in liver cirrhosis and how
Screen every 6m- HCC (US+AFP)
What ix and how often if you re at risk cirrhosis
If at risk of cirrhosis then fibroscan every 2 years (transient elastography)
tx of folate and Vet B12 def
Vitamin B12 replaced BEFORE folate
B12 IM 1 mg 3x weeks then 1mg every 3m
Most common cause of inherited colon cancer, pattern inheritance and the commonest extra colonic malignancy
Most common form inherited colon cancer - autosomal dominant
MSH2, MLH1 genes
Commonest extra-colonic malignancy is endometrial cancer
Rare autosomal dominant bowel cancer with lots polyps by 30-40
What is the mutation and what is Gardner’s syndrome (variant of this)
FAP
TSG (APC) mutation
Variant of this - gardner’s syndrome - can feature osteomas of skill, mandible, retinal pigmentation, thyroid ca and epidermoid cysts on skin
Pt presents with flushing, diarrhoea, bronchospasm
Colonoscopy reveals nothing
IBS tablets haven’t helped
Dx and Mx?
Carcinoid syndrome
Ocreotide
Cyproheptadine can help diarrhoea
