Gastro Flashcards
Ulcerative colitis is associated with which biliary disease
Primary sclerosing cholangitis
Crohn’s disease usually has non-bloody diarrhoea vs bloody (in Ulcerative colitis).
Ulcerative colitis tends to have abdo pain in the LLQ, what does Crohn’s disease have in the RIF?
Abdominal mass palpable in the right iliac fossa - Crohn’s disease
Which type of inflammatory bowel disease has:
Lesions may be seen anywhere from the mouth to anus
Skip lesions may be present
Crohn’s disease
Endoscopy = deep ulcers, skip lesions with cobblestone appearance
Where is inflammation in Crohn’s disease versus Ulcerative colitis
Crohn’s disease - there is inflammation in all layers from mucosa to serosa - increased goblet cells, granulomas
Ulcerative colitis - no inflammation beyond submucosa (unless fulminant disease) - inflammatory cell infiltrate in lamina propria
Kantor’s string sign shows?
Strictures on small bowel enema
Crohn’s disease
Rose thorn ulcers indicates…
Crohn disease - on small bowel enema imaging
Also may see fistulae + strictures (Kantor’s string sign)
Loss of haustrations, psueodpolyps and narrowed/short colon (drainpipe colon) is seen in…
ulcerative colitis
Smoking worsens which inflammatory bowel disease
Crohn’s disease
Severity of ulcerative colitis flares
Mild, Moderate, Severe
Mild - <4 stools daily, no blood
Moderate - 4-6 stools daily
Severe - >6 stools daily, blood, systemic disturbance i.e. fever, tachycardia, anaemia, raised CRP/ESR
Peutz-Jeghers syndrome mode of inheritance
autosomal dominant
- hamartomatous polyps in the gastrointestinal tract, pigmented lesions on lips, oral mucosa, face, palms and soles.
- GI bleeds, small bowel obstruction
Hereditary non-polyposis colorectal carcinoma (HNPCC i.e. Lynch syndrome) is the most common form of genetic colon cancer. what is the mode of inheritance and common genes involved
automsal dominant
MSH2 (60% of cases)
MLH1 (30%)
familial adenomatous polyposis (FAP) has what mode of inheritance and what gene is mutated
Autosomal dominant
Adenomatous polyposis coli gene (APC) located on chromosome 5 is mutated. This is a tumour suppressor gene
The Amsterdam criteria are sometimes used to aid diagnosis of hereditary non-polyposis colorectal carcinoma (HNPCC) i.e. Lynch syndrome.
What are the 3 criteria
- at least 3 family members with colon cancer
- cases span at least two generations
- at least one case diagnosed before the age of 50 years
A variant of familial adenomatous polyposis (FAP) called Gardner’s syndrome can also feature…
- Osteomas of skull and mandible
- Retinal pigmentation
- Thyroid carcinoma
- Epidermoid cysts on the skin
Urgent 2ww criteria for upper GI referrals
- Dysphagia
- Upper abdominal mass
- Over 55 years, weight loss and one of the following: dyspepsia, reflux, upper abdominal pain
Patients who have reflux/dyspepsia who do not meet criteria for referral, what is the management
- Lifestyle
- PPI for 1 month
- or test and treat for H.pylori
What is the test for H.pylori
Carbon-13 urea breath test
Or stool Ag test
Or lab based serology
There is no need to check for H.pylori eradication if symptoms have resolved. However, if repeat testing is required, what test is used
Carbon-13 urea breath test
What is the treatment for H.pylori eradication
PPI + amoxicillin (or metronidazole) + clarithromycin
Which peptic ulcer is more common
DUODENAL ulcers
Child Pugh score for liver cirrhosis uses which 5 elements
- Bilirubin
- Albumin
- PT time
- Encephalopathy
- Ascites
The model for end stage liver disease (MELD) scoring system is used with Child Pugh score for liver disease now. What are the 3 elements of MELD
- Bilirubin
- Creatinine
- INR
What is management for C.diff
- Oral vancomycin for 10 days
- Oral fidaxomicin
- Oral vancomycin +/- IV metronidazole (for life-threatening)
What is the treatment of recurrent C.diff
(a) within 12 weeks
(b) after 12 weeks
(a) within 12 weeks - oral fidaxomicin
(b) after 12 weeks - oral vancomycin OR fidaxomicin