Gastro Flashcards
Which condition is gastroparesis associated with?
Diabetes / poor glycemic control
LFTs in ischaemic hepatitis
severely raised ALT (usually >1000 u/L)
there is often coexistent acute tubular necrosis due to renal hypoperfusion.
What is Boerhaave syndrome?
transmural perforation of the oeophagus following forceful vomiting (perf is caused by the increase in intrathoracic pressure).
RF: excessive drinking, repeated episodes of vomiting, coughing bouts
commonly affects the distal third of the oesophagus
Which of the following features are more commonly associated with UC and which ones with Crohn’s?
Tenesmus
Bloody diarrhoea
LLQ pain
RIF palpable mass
faecal incontinence
Tenesmus - UC
Bloody diarrhoea - UC
LLQ pain - UC
RIF palpable mass - Crohn’s
faecal incontinence - UC
What type of oesophageal cancer is associated with GORD/Barrets?
adenocarcinoma
What happens to ceruloplasmin in Wilson’s disease?
reduced
(synthesis is impaired in Wilson’s disease due to intracellular copper overload.
Screening test for coeliac
anti tissue transglutaminase antibodies
anti-endomysial are done if the anti-TTG is +ve because they are more specific (but less sensitive)
What site is most commonly affected in UC?
rectum
what is SBBOS?
small bowel bacterial overgrowth syndrome
-> excessive bacteria in the small bowel leading to GI symptoms (diarrhoea, bloating, flatulence, abdo pain)
-> diagnosed by hydrogen breath test or less commonly with small bowel aspiration and culture
-> managed by correction of the underlying disorder and abx therapy with rifamixin (co-amox and metronidazole are also effective in most patients)
What bug causes gastroenteritis with a short incubation period and severe vomiting?
Staph aureus
Typical presentation of acute cholecystitis
RUQ pain
positive murphy sign
guarding
fever
malaise
anorexia
leukocytosis
acute cholecystitis should always be suspected in a patient with a history of gallstones who presents with RUQ pain, fever and leukocytosis
How do you diagnose SBBOS?
-> diagnosed by hydrogen breath test or less commonly with small bowel aspiration and culture
Which meds can be used in alcohol withdrawal?
chlordiazepoxide or diazepam
also supplement thiamine (IV) to prevent Wernicke’s encephalopathy
Vit K can be given to correct clotting abnormalities
What are the King’s College Hospital Criteria for liver transplantation (paracetamol liver failure)
- pH <7.3 on ABG , 24 h after ingestion
- prothrombin time >100 s
- creatinine > 300 micromol/L
- grade III or IV encephalopathy
DM detection/monitoring in chronic pancreatitis
annual HbA1c
Does Coeliac disease increase CRP?
typically no
Which tests should be done before diagnosing IBS?
FBC
CRP
Coeliac screening
CA-125 (because gynae malignancy can present with diarrhoea and bloating)
which IBD is more likely to present with bloody diarrhoea?
UC is more likely to present with bloody diarrhoea
but colonic crowns disease also presents with bloody diarrhoea
Impact of smoking on IBD
worsens Crohn’s
improves UC sx
List causes of IBD
- IBD
- infection
- medication induced
- icshaaemia (acute and chronic)
- more…
gold standard for diagnosis of coeliac disease in adults
small bowel biopsy
prevalence of coeliac disease in europe
1%
What are the biopsy features of coeliac disease
villous atrophy
lymphocyte infiltration
(pts need to be on a gluten containing diet for about 2 weeks so that you don’t get a false negative)
HLA associations of coeliac disease
HLA-DQ2 (95%)
What is tropical sprue?
- malabsorption disease commonly found in tropical disease
- cause unknown, but through to be caused by pathogens
Sx of tropical sprue
- common in tropics
- intermittent diarrhoea
- weight loss
- tiredness
- malabsorptive state
Giardia dx
and mx
- stool microscopy for trophozoite and cysts (sensitivity around 65%)
- stool antigen detection assay (better sensitivity and faster results)
Mx: metronidazole
What is the mx of H. pylori
high dose PPI
amoxicillin
clarithromycin/metronidazole
-> 7 days
What is angiodyplasia
degenerative disorder of GI blood vessels in which abnormal connections between veins and capillaries are formed, potentially leading to upper and/or lower GI bleeding of variable severity.
precise aetiology is unknown but it is often linked to von Willebrand disease, end-stage renal disease and the use of LVADs.
MRCP vs ERCP
MRCP is completely non-invasive, done by radiologists
now the predominant option for diagnostic
ERCP: endoscopic retrograde
done by gastroenterologist
can be therapeutic (purely diagnostic ERCP rarely done)
PSC / PBC imaging
USS usually normal until very severe
MRCP is able to show strictures etc.
PBC - what are the commonest sx?
fatigue
pruritus
PBC - why splenomegaly?
suggests the disease is progressive and going towards portal HTN
PBC
primary biliary cirrhosis (could come up in PACES)
PSC
what are the features of chronic stable liver disease?
spider naevi
gynaecomastia
palmar erythema
Dupuytren’s contracture
clubbing
testicular atrophy
list the signs of portal hypertension
- caput medusae / visible veins on the abdomen
- oesophageal varices
- splenomegaly
ascites
Which conditions is gynaecomastia, spider naevi etc. a feature of?
Chronic stable liver disesase
how to demonstrate caput medusae?
IVCO vs portal HTN
use a vein that goes towards the pts feet (not cranially)
in IVCO the blood only goes from bottom up
What are the causes of ascites?
- portal HTN / thombosis
- IVC / hepatic vein obstruction
- ## constrictive pericarditis
What first line ix would you do in a patient with ascites?
send off a sample to check protein levels
high -> worried about cancer (or infection)
If the patient is jaundiced: is it hepatitic or obstructive?
hepatitic:
obstructive: scratch marks from itching (bile salts), pale stools on PR, urine dark but -ve for urobilinogen
CAH - liver
chronic autoimmune hepatitis
PBC CAH slide
How do you differentiate the kidney from spleen in PACES?
5 features of a spleen:
-
Why are peripheries warm in septic shock?
due to systemic vascular resistance (due to toxins secreted by the bacteria)
What are causes of erythema nodosum?
IBD
sarcoidosis
…
what is a rash made of target lesions called?
erythema multiforme
Causes of erythema multiforme
Mycoplasma
strep
TB
yersinia
histoplasmosis
vaccinia
What is erythema ab igne?
sign of heat
e.g. using a hot water bottle every night for a long time
seen in exposure to heat of any cause
List definitions of diabetes mellitus
HbA1c > 48 mmol/mol or >6.5%
Fasting plasma glucose of 7.0 mmol/L or more
random plasma glucose of 11.1 mmol / L or more
what type of hearing loss do you get in Paget’s?
can be conductive or sensorineural
explain paradoxical acidosis which occurs when IV bicarbonate is given fast.
Treatment of Paget’s
may not be needed
- simple analgesia
- calcitonin injections can suppress osteoclast activity
- bisphosphonates (great for pain but also helps with bone density)
colonoscopy findings in UC
crypt abscess and loss of goblet cells
1st line mx of acute severe UC
intravenous steroids
