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Internal Medicine > Gastro > Flashcards

Gastro Flashcards

1
Q

Differentials liver always say (1)

A

hepatic dysfunction

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2
Q

AF + acute abdo pain

A

Acute mesenteric ischaemia

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3
Q

Chronic mesenteric ischaemia symptoms

A

Severe colicky post prandial abdom pain, weight loss (as eating hurts), upper abdo bruit.

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4
Q

Chronic colonic ischaemia - ischaemic colitis

A

Inferior mesenteric artery - lower left sided abdo pain plus or minus bloody diarrhoea

Treatment usually conservative, CT may be helpful but lower GI endoscopy gold-standard

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5
Q

PR interval

A

120-200 ms

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6
Q

QRS interval

A

<100

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7
Q

Normal axis

A

-30 to +90

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8
Q

IE hands

A

splinter haemorrhages, clubbing
Dukes criteria

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9
Q

Hep A symptoms

A

Abdo pain, fever, N&V
70% symptomatic

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10
Q

Hep A transmission

A

Faecal oral

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11
Q

Clinical course Hep A

A

full recovery 2-3 months - no chronic Hep A

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12
Q

Hep A treatment

A

Supportive care onl
Vaccine - very effective lifelong immunity

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13
Q

Hep A exposure

A

Can vaccinate after exposure

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14
Q

Hep B curable?

A

Incurable

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15
Q

Treatment Hep B

A

Antivirals - entecavir

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16
Q

Hep C treatment

A

Maviret 8 weeks TD - curable

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17
Q

Liver ask about urine

A

dark - bilirubin

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18
Q

All histories can ask about

A

Travel

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19
Q

Hep A lab

A

HAV IgM antibody

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20
Q

Hep B lab

A

HBV surface antigen

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21
Q

Hep C lab

A

HCV antibody

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22
Q

Haemochromatosis check

A

Ferritin

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23
Q

Ultrasound stone biliary then what?

A

ERCP, or cholecystectomy

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24
Q

ERCP complications

A

Pancreatitis
Post-sphincterotomy bleeding
Cholangitis
Failed cannulation
Abdo and throat discomfort
Aspiriation
Infection
Duodenal perforation

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25
Q

Koilonychia

A

Spooning nails - chronic iron deficiency anaemia

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26
Q

Gastro red flags

A

Weight loss, dysphagia, bleeding, age >55, odonophagia, family history, lymphadenopathy, persistent vomiting, jaundice, unexplained iron deficiency anaemia

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27
Q

ERCP risk of serious complications

A

6.9% risk, 0.33% mortality

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28
Q

Odynophagia meaning

A

Painful swallowing

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29
Q

Gastroscopy complication serious chance

A

0.13-0.15%

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30
Q

Laxsol =

A

Docusate + Sennoside B

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31
Q

Docusate mechanism

A

Stimulant & stool softener

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32
Q

Sennoside B mechanism

A

Stimulant

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33
Q

Molaxole drug & mechanism

A

Magrogol - osmolite

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34
Q

Anti diarrhoea

A

Loperamide

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35
Q

Gastroscopy patient advice

A

Do not eat or drink for a minimum of 4 hrs before ur appointment

Can do throat anaesthesia spray or sedation - if sedation can’t drive for 24 hrs

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36
Q

Gastroscopy complications

A

Throat discomfort 1-2 days, abdo discomfort, bleeding if take biopsy, perforation very rare

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37
Q

ERCP overnight

A

usually discharged arvo, but some stay overnight

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38
Q

ERCP sedation

A

yes

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39
Q

Colonoscopy preparation

A
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40
Q

Colonscopy sedation

A

With or without

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41
Q

Complications and risks colonoscopy

A

Abdo discomfort, bleeding if polyp removal, perforation, incomplete examination, missed lesions

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42
Q

Hepatic insufficiency increase in estradiol manifestations

A

Spider angiomas, gynacomastia, palmar erythema, testicular atrophy

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43
Q

Non estradiol related manifestations of hepatic insufficience

A

Jaundice, nail changes (terry nails (pale beds), muehchke nails (pale lines), clubbing.
Dupeytren’s contractures
Hypertrophic osteoarthropathy

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44
Q

Physical findings of cirrhosis or hepatic insufficiency

A

Parotid gland enlargement, feto hepaticus (sour breath), ascites, caput medusae, splenomegaly, asterixes
Bruising (abnormal clotting)
Leukonychia (hypoalbuminaemia)

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45
Q

Gall bladder pathology where start?

A

Ultrasound

THen labs Hep A,B,C

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46
Q

ERCP indications

A

Suspected or known choledocolithiasis
Jaundic patients with suspected biliary obstruction
Acute cholangitis with obstruction
Post-op biliary leak
Bile duct injury
Carefully selected patients with pancreatics disease

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47
Q

Rate of ERCP cause pancreatitits

A

3-5%

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48
Q

Hematochezia

A

Passage of fresh blood in stool

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49
Q

Floating stools due to

A

Increased gas content of the stool - steatorrhea will manifest as oil droplets

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50
Q

Steatorrhea smell

A

Will not need to ask

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51
Q

Colonoscopy indications (so many ):)

A

Acute Lower Gastrointestinal Hemorrhage
Suspected severe IBD to establish diagnosis
Known or suspected colorectal cancer
Unexplained rectal bleeding
Altered bowel habits and rectal bleeding
Altered bowel habit (more frequent and/or looser stool) above age…
Iron deficiency anemia
Imaging shows polyps
Suspected IBD for diagnosis/mapping
Surveillance after diagnosis of adenomatous polyps or colon cancer
IBD surveillance
Family history with FDR <55 or two FDR of any age
FAP, HNPCC, or other familial cancer syndrome

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52
Q

Colonscopy complication rate

A

0.05-0.28%

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53
Q

Upper Gastrointestinal Endoscopy Indications

A

Upper gastrointestinal bleeding
Esophageal or gastric foreign body
Caustic ingestion
Dysphagia
Dyspepsia/Reflux with red flag symptoms
Malignancy
Iron deficiency anemia
Persistent vomiting >2 weeks
Pernicious anemia
Coeliac testing
Variceal screening
Ulcer healing confirmation
Non-cardiac chest pain suggestive of oesophageal origin

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54
Q

Liver cirrhosis results from

A

Chronic inflammation and damage to liver - functional cells are replaced with scar tissue (fibrosis)

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55
Q

Cirrhosis leads to portal HTN

A

Due to increased resistance of blood flowing through liver

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56
Q

Four most common causes of liver cirrhosis are

A

Alcohol related liver disease, non-alcoholic fatty liver disease, Hep B, Hep C

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57
Q

Non-invasive liver screen

A

Ultrasound
Hep B & C serology
Autoantibodies (ANA, SMA, AMA)
Alpha-1-antitrypsin levels
Ferritin & transferrin

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58
Q

Advanced cirrhosis

A

Thrombocytosis
Low albumin
Increased prothrombin time
Hyponatrenua (fluid retention)

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59
Q

NAFLD diagnose via

A

Ultrasound - increased echogenicitiy

60
Q

Cirrhosis ultrasound show

A

Nodularitiy, enlarged portal vein, splenomegaly, ascites

61
Q

Hepatocellular carcinoma screened using

A

Ultrasound

62
Q

Transient elastography

A

Fibroscan - used to assess stiffness of the liver using high-frequency sound waves - determine degree of fibrosis to test for liver cirrhosis

63
Q

liver biopsy to confirm

A

Cirrhosis

64
Q

Severity of cirrhosis use

A

MELD
or
Child-pugh score
Albumin
Bilirubin
Clotting (INR)
Dilation (ascites)
Encephalopathy

65
Q

Management Cirrhosis

A

Treat underlying cause (alcohol, diet, antivirals, immunosuppression), monitor for complications, Manage complications, Liver transplant

66
Q

Portal hypertension

A

Splenomegaly
Oesophageal varices
Haemorrhoids
Caput medusae

67
Q

Bleeding Oesophageal Varices

A

Life threatening emergency - blood transfusion, endoscopy with variceal band ligation.
B-blockers as prophylactic

68
Q

Spontaneous bacterial peritonitis

A

Complication of ascitis

69
Q

Hepatorenal syndrome

A

impaired kidney function caused by changes in blood flow attributable to portal hypertension

Poor prognosis unless patient has a liver transplant

70
Q

Hepatic encephalopathy symptoms

A

Build up of neurotoxic substances- especially ammonia

Presents with reduced consciousness and confusion acutely.
More chronically with changes to personality, memory and food

71
Q

Hepatic encephalopathy management

A

Lactulose - poop out the ammonia
ABx - Rifaximin - kills gut bacteria producing ammonia

72
Q

Alcohol related liver disease progression

A

Alcoholic fatty liver (steatosis)
->
Alcoholic hepatitis
->
Cirrhosis

73
Q

Examination findings suggestive of excessive alcohol consumption

A

Smelling of alcohol
Slurred speech
Bloodshot eyes
Dilated capillaries on the face (telangiectasia)
Tremor

74
Q

Alcohol related liver disease bloods

A
  • Raised mean cell volume (MCV)
  • Raised alanine transaminase (ALT) and aspartate transferase (AST)
  • Raised GGT (particularly notable with alcohol-related liver disease)
  • Raised alkaline phosphatase (ALP) later in the disease
  • Raised bilirubin
  • Low albumin
  • Increased prothrombin time
75
Q

Liver imaging options

A

Ultrasound, fibroscan, CT&MRI, biopsy

76
Q

CAGE questionnaire to screen for harmful alcohol use

A

C – CUT DOWN? Do you ever think you should cut down?
A – ANNOYED? Do you get annoyed at others commenting on your drinking?
G – GUILTY? Do you ever feel guilty about drinking?
E – EYE OPENER? Do you ever drink in the morning to help your hangover or nerves?

77
Q

Alcohol withdrawal

A

Mild -> delirium tremens

Hallucinations, seizures

Delirium tremens is emergency - Acute confusion
Severe agitation
Delusions and hallucinations
Tremor
Tachycardia
Hypertension
Hyperthermia
Ataxia (difficulties with coordinated movements)
Arrhythmias

78
Q

Alcohol withdrawal treatment

A

Benzos
Thiamine (B1) supplements

79
Q

Wernicke’s symptoms

A

Confusion, oculomotor disturbance, ataxia

80
Q

Stages of NAFLD

A

Non-alcoholic fatty liver disease
Non-alcoholic steatohepatitis (NASH)
Fibrosis
Cirrhosis

81
Q

NAFLD risk factors

A

Sames as for CVD
Diet, exercise, T2DM, smoking, HTN, hypercholesterolemia, obesity, older

82
Q

NAFLD blood measure fibrosis

A

ELF - enhanced liver fibrosis - measure HA, PIIINP< TIMP01 and calculate number indicate whether fibrosis

83
Q

Which Hep is DNA

A

B

84
Q

Faecal oral heps

A

A & E

85
Q

Blood heps

A

B & C

86
Q

Hep with D

A

B

87
Q

Hep LFTs

A

AST & ALT highhhh
ALP also a bit high & bilirubin

88
Q

Hep A - treatment

A

Usually resolves without treatment

89
Q

Hep B treatment

A

Most recover within 3 months, 5-15 become chronic

Antivirals slow progression, liver transplant

90
Q

Hep C treatment

A

Curable with direct acting antiviral medications
Without treatment 3/4 become chronic

91
Q

Chronic hep B&C can cause

A

Liver cirrhosis & hepatocellular carcinoma

92
Q

Hep E

A

Rare, mild and cleared within a month

Rarely bad in immunocompromised & pregnant

93
Q

Autoimmune hepatitis investigations
If Hep immunology -ve

A

High ALT & AST, raised IgG levels
Autoantibodies

94
Q

Autoimmune hepatitis management

A

High dose steroids, immunosuppressants (azathioprine)
Liver transplant may required in end stage liver disease

95
Q

Haemochromatosis gene

A

HFE
Autosomal recessive mutation

96
Q

Haemochromatosis presentation

A

Chronic tiredness, joint pain, pigmentation (bronze skin), cognitive symptoms, hepatomegaly, diabetes

97
Q

Haemochromatosis raised ferritin differentials

A

Infection, NAFLD, hep C, cancer

Can distinguish as transferrin sats are also high

98
Q

Haemochromatosis treatment

A

Venesection
Monitoring

99
Q

Wilsons disease

A

Accumulation of copper, especially in liver

100
Q

Wilsons disease presentation

A

Typically teens or young adults
liver problems, neurological or psychiatric problems

101
Q

Wilsons disease diagnosis

A

Serum caeruloplasmin
- low

24 hour urine copper assay - high urinary copper

102
Q

Alpha-1-antitrypsin deficiency affects

A

Lungs - COPD & bronchiectasis
Liver - cirrhosis

103
Q

Primary biliary cholangitis

A

Autoimmune condition where the immune system attacks small bile ducts in the liver resulting in obstructive jaundice and liver disease - same as primary biliary cirrhosis

104
Q

Primary biliary cholangitis can lead to

A

liver fibrosis, cirrhosis and failure

105
Q

Primary biliary cholangitis presentation

A

The typical patient is a white woman aged 40-60 years. Often patients are asymptomatic at diagnosis, with the problem picked up on abnormal liver function tests. However, they may present with:

Fatigue
Pruritus (itching)
Gastrointestinal symptoms and abdominal pain
Jaundice
Pale, greasy stools
Dark urine

On examination, there may be:

Xanthoma and xanthelasma (cholesterol deposits)
Excoriations (scratches on the skin due to itching)
Hepatomegaly
Signs of liver cirrhosis and portal hypertension in end-stage disease (e.g., splenomegaly and ascites)

106
Q

Bloods for primary biliary cholangitis

A

ALP highhh
Autoantibodies

107
Q

Treatment primary biliary cholangitis

A

Ursodeoxycholic acid - non-toxic bile acid protects cholangiocytes from inflammation and damage

108
Q

Primary sclerosing cholangitis

A

Intrahepatic AND extrahepatic bile ducts inflamed and damaged - strictures form that obstruct the flow of bile out of the liver.

109
Q

Ulcerative colitis associated with

A

Primary sclerosing cholangitis

110
Q

Primary sclerosing cholangitis presentation

A

Often patients are asymptomatic at diagnosis, with the problem picked up on abnormal liver function tests. However, they may present with:

Abdominal pain in the right upper quadrant
Pruritus (itching)
Fatigue
Jaundice
Hepatomegaly
Splenomegaly

111
Q

Primary sclerosis cholangitis investigations

A

LFTs - ALP raised
Autoantibodies NOT helpful
MRCP - shows bile duct strictures

112
Q

Management primary sclerosing cholangitis

A

ERCP - treat dominant strictures - otherwise no treatments
Liver transplant

113
Q

Primary liver cancer is usually

A

Hepatocellular carcinoma - risk if have cirrhosis (from any cause)

114
Q

Presentation liver cancer

A

Usually non-specific

Weight loss
Abdominal pain
Anorexia
Nausea and vomiting
Jaundice
Pruritus
Upper abdominal mass on palpation

115
Q

Hepatocellular carcinoma tumour marker

A

Alpha-fetoprotein

116
Q

management hepatocellular carcinoma

A

Surgery if early, radiofrequency ablation, radiation, targeted drugs.

117
Q

Cholangiocarcinomas

A

Types of cancer originate in bild ducts - associated with primary sclerosing cholangitis

118
Q

Cholangiocarcinoma presentation

A

Obstructive jaundice - pale stools, dark urine, generalised itching

119
Q

Tumour marker cholangiocarcinoma

A

CA19-9

120
Q

GORD long term

A

Oesophagus - squamomus epithelium replaced with columnar (metaplasia)
Premalignant condition

Treat with monitoring endoscopically, PPI, radiofrequency ablation

121
Q

GORD exacerbated by

A

Greasy & spicy food, coffee, alcohol, NSAIDs, stress, smoking, obesity, hiatus hernia

122
Q

Dyspepsia means

A

Indigestion - non specific
Covers the symptoms of GORD

123
Q

Gord red flag

A

Suspicious of cancer - DYSPHAGIA - urgent endoscopy

Weight loss, >55 yrs

124
Q

Hiatus hernia

A

Herniation of stomach up through diaphragm

125
Q

Management GORD

A

Lifestyle, stop NSAIDS, omeprazole, surgery

126
Q

Anyone with dyspepsia can offer

A

H. Pylori test
Need two weeks without using a PPI before testing for H. Pylori for accurate result.

Stool antigen test
Urea breath test
H pylori antibody test (blood)
Rapid urease test (during endoscopy)

127
Q

H pylori eradication involves

A

PPI + two antibiotics - amoxicillin + Clarithromycin for 7 days

128
Q

Peptic ulcer risk factor

A

H Pylori
NSAIDs

+ stress, alcohol, caffeine, smoking, spicy foods

129
Q

Peptic ulcer bleeding risk increased if

A

NSAIDs, aspirin, anticoags, Steroids, ssri

130
Q

Peptic ulcer diagnosed

A

Endoscopy, during which do rapid urease test (CLO Test)

131
Q

Management peptic ulcers

A

Stop NSAIDs, treat H pylori infection, PPI

132
Q

Peptic ulcer complication

A

Bleeding, perforation, strictures

133
Q

Upper GI bleed causes

A

Peptic ulcer, oesophageal varices, stomach cancers

134
Q

Crohn’s - symptoms compared with UC

A

N – No blood or mucus (PR bleeding is less common)
E – Entire gastrointestinal tract affected (from mouth to anus)
S – “Skip lesions” on endoscopy
T – Terminal ileum most affected and Transmural (full thickness) inflammation
S – Smoking is a risk factor (don’t set the nest on fire)

135
Q

Ulcerative colitis features as opposed to crohns

A

C – Continuous inflammation
L – Limited to the colon and rectum
O – Only superficial mucosa affected
S – Smoking may be protective (ulcerative colitis is less common in smokers)
E – Excrete blood and mucus
U – Use aminosalicylates
P – Primary sclerosing cholangitis

136
Q

IBD diagnosis

A

Faecal calprotectin is around 90% sensitive and specific for inflammatory bowel disease in adults. It is used as an initial test before moving on to endoscopy. Colonoscopy + intestinal biopsies

137
Q

UC management

A

Mild to moderate - aminosalicylate first line
Severe - steroids

Surgery

138
Q

Crohn’s management

A

Steroids first line
Enteral nutrition as alternative (treats nutritional deficiencies, improve gut microbiome, removing inflammatory foods)

Methotrexate, azathioprine

Surgical resection

139
Q

IBS

A

At least 6 months of abdo pain or discomfort with at least one of
- pain relieved by opening bowels
- change in frequencies
- change in consistency

140
Q

IBS management

A

Low fodmap diet, probiotic supplements
Loperamide for diarrhoea
Laxatives - husk - for constipation

141
Q

Coeliac disease linked with

A

T1DM, thyroid disease

142
Q

Coeliac antibodies

A

Anti-tissue transglutaminase antibodies (anti-TTG)

143
Q

Coealiac disease presentation

A

Often asymptomatic

Failure to thrive in young children
Diarrhoea
Bloating
Fatigue
Weight loss
Mouth ulcers

144
Q

Diagnosis

A

antibodies
Endoscopy & jejunal biopsy - villous atrophy, crypt hyperplasia

145
Q
A

Internal Medicine (6 decks)

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