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Year 6 > Gastro > Flashcards

Gastro Flashcards

1
Q

Which condition is gastroparesis associated with?

A

Diabetes / poor glycemic control

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2
Q

LFTs in ischaemic hepatitis

A

severely raised ALT (usually >1000 u/L)

there is often coexistent acute tubular necrosis due to renal hypoperfusion.

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3
Q

What is Boerhaave syndrome?

A

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

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4
Q

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

A

Tenesmus - UC
Bloody diarrhoea - UC
LLQ pain - UC
RIF palpable mass - Crohn’s
faecal incontinence - UC

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5
Q

What type of oesophageal cancer is associated with GORD/Barrets?

A

adenocarcinoma

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6
Q

What happens to ceruloplasmin in Wilson’s disease?

A

reduced

(synthesis is impaired in Wilson’s disease due to intracellular copper overload.

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7
Q

Screening test for coeliac

A

anti tissue transglutaminase antibodies

anti-endomysial are done if the anti-TTG is +ve because they are more specific (but less sensitive)

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8
Q

What site is most commonly affected in UC?

A

rectum

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9
Q

what is SBBOS?

A

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)

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10
Q

What bug causes gastroenteritis with a short incubation period and severe vomiting?

A

Staph aureus

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11
Q

Typical presentation of acute cholecystitis

A

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

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12
Q

How do you diagnose SBBOS?

A

-> diagnosed by hydrogen breath test or less commonly with small bowel aspiration and culture

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13
Q

Which meds can be used in alcohol withdrawal?

A

chlordiazepoxide or diazepam

also supplement thiamine (IV) to prevent Wernicke’s encephalopathy

Vit K can be given to correct clotting abnormalities

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14
Q

What are the King’s College Hospital Criteria for liver transplantation (paracetamol liver failure)

A
  • pH <7.3 on ABG , 24 h after ingestion
  • prothrombin time >100 s
  • creatinine > 300 micromol/L
  • grade III or IV encephalopathy
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15
Q

DM detection/monitoring in chronic pancreatitis

A

annual HbA1c

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16
Q

Does Coeliac disease increase CRP?

A

typically no

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17
Q

Which tests should be done before diagnosing IBS?

A

FBC
CRP
Coeliac screening
CA-125 (because gynae malignancy can present with diarrhoea and bloating)

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18
Q

which IBD is more likely to present with bloody diarrhoea?

A

UC is more likely to present with bloody diarrhoea

but colonic crowns disease also presents with bloody diarrhoea

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19
Q

Impact of smoking on IBD

A

worsens Crohn’s
improves UC sx

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20
Q

List causes of IBD

A
  • IBD
  • infection
  • medication induced
  • icshaaemia (acute and chronic)
  • more…
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21
Q

gold standard for diagnosis of coeliac disease in adults

A

small bowel biopsy

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22
Q

prevalence of coeliac disease in europe

A

1%

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23
Q

What are the biopsy features of coeliac disease

A

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)

24
Q

HLA associations of coeliac disease

A

HLA-DQ2 (95%)

25
Q

What is tropical sprue?

A
  • malabsorption disease commonly found in tropical disease
  • cause unknown, but through to be caused by pathogens
26
Q

Sx of tropical sprue

A
  • common in tropics
  • intermittent diarrhoea
  • weight loss
  • tiredness
  • malabsorptive state
26
Q

Giardia dx

and mx

A
  • stool microscopy for trophozoite and cysts (sensitivity around 65%)
  • stool antigen detection assay (better sensitivity and faster results)

Mx: metronidazole

27
Q

What is the mx of H. pylori

A

high dose PPI
amoxicillin
clarithromycin/metronidazole

-> 7 days

28
Q

What is angiodyplasia

A

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.

29
Q

MRCP vs ERCP

A

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)

30
Q

PSC / PBC imaging

A

USS usually normal until very severe

MRCP is able to show strictures etc.

31
Q

PBC - what are the commonest sx?

A

fatigue
pruritus

32
Q

PBC - why splenomegaly?

A

suggests the disease is progressive and going towards portal HTN

33
Q

PBC

A

primary biliary cirrhosis (could come up in PACES)

34
Q

PSC

A
35
Q

what are the features of chronic stable liver disease?

A

spider naevi
gynaecomastia
palmar erythema
Dupuytren’s contracture
clubbing
testicular atrophy

36
Q

list the signs of portal hypertension

A
  • caput medusae / visible veins on the abdomen
  • oesophageal varices
  • splenomegaly
    ascites
37
Q

Which conditions is gynaecomastia, spider naevi etc. a feature of?

A

Chronic stable liver disesase

38
Q

how to demonstrate caput medusae?

A
39
Q

IVCO vs portal HTN

A

use a vein that goes towards the pts feet (not cranially)

in IVCO the blood only goes from bottom up

39
Q

What are the causes of ascites?

A
  • portal HTN / thombosis
  • IVC / hepatic vein obstruction
  • ## constrictive pericarditis
40
Q

What first line ix would you do in a patient with ascites?

A

send off a sample to check protein levels

high -> worried about cancer (or infection)

41
Q

If the patient is jaundiced: is it hepatitic or obstructive?

A

hepatitic:

obstructive: scratch marks from itching (bile salts), pale stools on PR, urine dark but -ve for urobilinogen

42
Q

CAH - liver

A

chronic autoimmune hepatitis

43
Q

PBC CAH slide

A
44
Q

How do you differentiate the kidney from spleen in PACES?

A

5 features of a spleen:

-

45
Q

Why are peripheries warm in septic shock?

A

due to systemic vascular resistance (due to toxins secreted by the bacteria)

46
Q

What are causes of erythema nodosum?

A

IBD
sarcoidosis
…

47
Q

what is a rash made of target lesions called?

A

erythema multiforme

48
Q

Causes of erythema multiforme

A

Mycoplasma
strep
TB
yersinia
histoplasmosis
vaccinia

49
Q

What is erythema ab igne?

A

sign of heat

e.g. using a hot water bottle every night for a long time

seen in exposure to heat of any cause

50
Q

List definitions of diabetes mellitus

A

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

51
Q

what type of hearing loss do you get in Paget’s?

A

can be conductive or sensorineural

51
Q

explain paradoxical acidosis which occurs when IV bicarbonate is given fast.

A
52
Q

Treatment of Paget’s

A

may not be needed
- simple analgesia
- calcitonin injections can suppress osteoclast activity
- bisphosphonates (great for pain but also helps with bone density)

53
Q

colonoscopy findings in UC

A

crypt abscess and loss of goblet cells

54
Q

1st line mx of acute severe UC

A

intravenous steroids

Year 6 (37 decks)

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