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Year 6 > Gastro > Flashcards

Gastro Flashcards

1
Q

Treatment of anal fissure?

A

o <6 weeks (acute):
Dietary advice (high fluid, high fluid)
1st line: bulk-forming laxatives
Optional: lubricants (petroleum jelly), analgesia (not opioids), steroids
o >6 weeks (chronic):
Above continued
1st line: topical GTN (or topical diltiazem or topical nifedipine)
2nd line (after 8 weeks 1st line): sphincterotomy (clean cut in sphincter), botox toxin

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2
Q

Ix consistent with alcoholic hepatitis?

A

o GGT very raised
o AST: ALT >2

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3
Q

Management of alcoholic hepatitis?

A

o Prednisolone (high DF)
o Pentoxyphylline

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4
Q

Budd-Chiari Syndrome

A
  • Caused by blockage of the hepatic vein (T1 = thrombosis; T2 = tumour occlusion)
    o RFs: OCP, PRV, thrombophilia, pregnancy
  • S/S: abdominal pain, ascites, tender hepatomegaly
  • Ix: abdominal USS with doppler
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5
Q

Achalasia

A
  • S/S: sudden-onset solid AND liquid dysphagia, halitosis, heartburn, regurgitation
  • Ix: LOS manometry (excessive LOS tone), barium swallow (bird’s beak), CXR
  • Mx: Heller cardiomyotomy > botulinum intra-sphincteric injection, oesophageal balloon dilatation
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6
Q

What is Carcinoid Syndrome?

A
  • Carcinoid syndrome  usually occurs with liver metastases that release serotonin into the systemic circulation
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7
Q
A
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8
Q

Signs of carcinoid syndorme?

A

o Flushing (often earliest symptom), diarrhoea
o Bronchospasm, hypotension Pulmonary stenosis = ESM, right-side

o Cardiac (right heart valvular stenosis – pulmonary stenosis; left heart can be affected in bronchial carcinoid)
o Endocrine (i.e. Acromegaly (GHRH) and Cushing’s (ACTH))
o Pellagra (dietary tryptophan is diverted to serotonin by the tumour)
 Dermatitis, diarrhoea, dementia
 Niacin B3 deficiency

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9
Q

Ix and mx of serotonin syndrome?

A

o Urinary 5-hydroxyindolacetic acid (5-HIAA; serotonin metabolite)
o Plasma chromogranin A y
o Somatostatin analogues e.g. octreotide
o Diarrhoea: cyproheptadine may help

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10
Q

Causes of C.diff?

A

o Ampicillin, amoxicillin, co-amoxiclav
o Cephalosporin
o Clindamycin
o Quinolones

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11
Q

Management of c.diff

A

o 1st episode, mild-moderate oral metronidazole 10-14 days
o 2nd episode, severe oral vancomycin 10-14 days
o Life-threatening, ileus oral vancomycin + IV metronidazole 10-14 days

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12
Q

Treatment of Small Bowel Overgrowth (SBO)?

A

o ABx (rifaximin > co-amoxiclav, metronidazole)

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13
Q

Ix of small bowel overgrowth syndrome?

A
  • Signs & symptoms (similar to IBS):
    o Chronic diarrhoea
    o Bloating, flatulence
    o Abdominal pain
  • Investigations:
    o Hydrogen breath test
    o Small bowel MC&S [not commonly used]
    o Diagnostic ABx course
    o Folate high (as bacteria produce it)
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14
Q

Treatment of Perianal Abscess?

A
  • S/S: pain worse on sitting, discharge, hardened perianal area
  • Mx: 1st line: I&D under LA (packed or left open) – ABx are rarely used unless systemic upset
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15
Q

o Urgent (2ww) OGD criteria:

A

 Dysphagia
 Upper abdominal mass (? stomach cancer)
 Age ≥55yo AND weight loss AND (any of):
* Dyspepsia
* Reflux / GORD Ix/Mx: BNF GORD
* Upper abdominal pain

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16
Q

“treatment-resistant dyspepsia, what needs to be done?

A

Non-urgent OGD

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17
Q

Treatment for H.pylori eradication?

A

PPI+amoxicillin+clari/met?

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18
Q

Surgery name: Indication: refractory GORD, hiatus hernia

A

Nissen fundoplication (gold-standard):

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19
Q

o H. pylori complications?

A

 PUD (95% of duodenal ulcers, 75% of gastric ulcers)
 Gastric cancer
 MALToma (B cell lymphoma of MALT; mx: eradication of H pylori  regression in 80% of patients)
 Atrophic gastritis

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20
Q

Ix for acute diverticulitis?

A

CT abdomen

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21
Q

Ix for chronic diverticular disease?

A

Barium enema

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22
Q

Mx of acute diverticulitis?

A

Severe: IV ABx, drip and suck, Hartmann’s, primary anastomosis
Mild: PO Abx

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23
Q

S/S of pancreatic cancer?

A

o Classically painless jaundice (Courvoisier’s law states that in the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones; however, normally anorexia, WL, epigastric pain)

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24
Q

Signs of obstructive jaundice?

A

 Pale stools, dark urine, and pruritus
 Cholestatic LFTs (AST/ALT normal, ALP/GGT raised, BR raised)

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25
Q
  • Investigations for pancreatic cancer?
A

High resolution CT - double duct” sign – presence of simultaneous dilatation of CBD and pancreatic duct)
Can also do an USS

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26
Q

Functions of the pancreas?

A

-Exocrine (digestion)
-Endocrine (produces insulin)

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27
Q

Management of pancreatic cancer?

A

Difficult to treat definitely as it often presents late.
o Definitive:
Whipple’s resection (pancreaticoduodenectomy), ix: resectable lesions in the head of pancreas
* Less than 20% suitable at presentation (CI: any invasion/metastasis)
Adjuvant chemotherapy is usually given following surgery
o Symptomatic (i.e. non-surgical):
ERCP with stenting

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28
Q

Causes of pancreatitis?

A

I GET SMASHED

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29
Q

Investigations for pancreatitis:

A

Serum amylase (look for >3x normal)
Lipase is a more sensitive marker
 USS (i.e. for gallstones)
 Contrast-enhanced CT

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30
Q

Scoring criteria for pancreatitis?

A

 PaO2 <8kPa
 Age >55yo
 Neutrophils >15x109/L
 Ca2+ <2mmol/L Ca2+ complexes with FFAs from released lipases so lower = worst
 Renal urea >16mmol/L N.B. hypercalcaemia can CAUSE pancreatitis
 Enzymes (LDH >600, AST/ALT >200)
 Albumin <32g/L
 Sugar >10mmol/L

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31
Q

Management of acute pancreatitis?

A

Acute pancreatitis - Fluids, analgesia (IV morphine, 1-2mg STAT boluses until comfortable)
Necrotising pancreatitis - fluids, analgesia, ABx
Key features:
* Maintain enteral route of feeding
* No ABx unless indicated
* Aggressive fluid resuscitation (3-6L of redistribution can occur)
* Correct the cause (GET SMASHED) – MRCP, ERCP

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32
Q

Management of infected pseudocyst?

A

mx: trans-gastric drainage / endoscopic drainage

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33
Q

Chronic pancreatitis: s/s & ix?

A

o Signs & Symptoms:
Pain is typically worse 15 to 30 minutes following a meal
Steatorrhoea (5 and 25 years after the onset of pain)
DM (>20 years after symptoms begin)
o Investigations:
USS (i.e. for gallstones)
Contrast-enhanced CT
Faecal elastase (measures exocrine function)
Screening (DM w/ annual HbA1c; osteoporosis w/ annual DEXA)

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34
Q

Ix for NAFLD?

A

 1st  LFTs (ALT > AST), lipids, cholesterol
 2nd  USS (increased echogenicity)
 3rd  Enhanced Liver Fibrosis (ELF) panel blood test OR a Fibroscan:
 4th  liver biopsy

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35
Q

Inheritance pattern of haemochromatosis?

A

Autosomal recessive

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36
Q

Sign of haemachromatosis on liver biopsy?

A

Perl’s stain

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37
Q

Management of haemachromatosis?

A

o Management:
 1st: venesection (TF kept <50%)
 2nd: desferrioxamine

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38
Q

Causes of SBP?

A

 Cause  E. coli > Klebsiella, Strep [complicated by hepatorenal symptoms in 30%]

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39
Q

 Ix of SBP?

A

USS (confirm ascites)  ascitic tap  PMN >250/mm3 + MC+S

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40
Q

Management and prophylactic treatment for SBP?

A

 Mx: piptazobactam (tazocin) or cefotaxime
 Prophylaxis: ciprofloxacin + propranolol (beta blocker)
* If you have an ascites and a protein (not SAAG) of ≤15g/L, then START prophylaxis
* I.E. you don’t need a previous episode of SBP to warrant ciprofloxacin

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41
Q

Why do you get gynaecomastia in liver disease?

A

o Chest (gynaecomastia (failure of liver to break oestradiol down)

42
Q

4 causes of massive splenomegaly?

A

CML, Myelofibrosis, Malaria, Lymphoma

43
Q

Signs of portal hypertension?

A

 Splenomegaly
 Ascites
 Varices
 Encephalopathy
Remember by acronym SAVE
Look for caput medusae

44
Q

Ix for suspected liver disease?

A

I would like to check external genitalia, look for hernias, stool sample
o Bloods (FBC, U&Es, LFTs, CRP, clotting, AFP, iron studies, hepatitis serology, autoantibodies, caeruloplasmin)
USS abdomen (± Fibroscan ± biopsy)
 Haematoxylin and Eosin (H&E)
 Prussian blue (iron)
 PAS (A1AT)
 Rhodamine (copper)
 Congo red (amyloidosis)
o Endoscopy (OGD, colonoscopy)

45
Q

Management of ascites?

A

o Diet restrict ETOH and fluids (if Na+ <125mmol; <1.5L fluids/day), low Na+, daily weights
o Diuretics spironolactone (± furosemide)
o Prophylaxis (SBP) ciprofloxacin + propranolol
o Refractory TIPS, transplant

46
Q

Management of liver decompensation?

A

Lactulose, diuretic

47
Q

PBC antibodies?

A

Anti-mitochondrial antibodies

48
Q

S/S of PBC?

A

o Signs & symptoms (“itching in a middle-aged woman”):
 Pruritis Raised ALP AMA
 Obstructive jaundice RUQ pain (10%) Raised IgM
 Hypercholesterolaemia (xanthelasma) Mild Sjogren’s Middle-aged women (9: 1)

49
Q

Ix for PBC?

A

 Cholestatic liver biochemistry (raised GGT/ALP, normal transaminases)
 Autoantibodies (AMA [98% of patients]; raised serum IgM)
 Biopsy (this is required for a definitive diagnosis but not often carried out; only perform if doubt of dx)
Bloods, antibodies, biopsy

50
Q

Tx for PBC?

A

 1st line: ursodeoxycholic acid ± cholestyramine (pruritis) ± prednisolone (associated AI disease)
 2nd line (end-stage): Liver transplantation (e.g. if bilirubin > 100 (PBC is a major indication)
 Fat-soluble vitamin supplementation

51
Q

ERCP ‘beaded’ appearance = which condition?

A

PSC

52
Q

Antibodies in PSC?

A

pANCA

53
Q

Ix for PSC?

A

 Diagnostic: MRCP (preferred) > ERCP (‘beaded’ appearance from biliary strictures)
 p-ANCA
 Biopsy of bile duct (fibrous, obliterative cholangitis often described as ‘onion skin’)

54
Q

plate ‘piecemeal necrosis’, bridging necrosis indicative of what?

A

Autoimmune hepatitis

55
Q

Pain + fever + jaundice = ?

A

Cholangitis

56
Q

Mx of acute cholecystits?

A

IV ABx + laparoscopic cholecystectomy (within 1 week)

57
Q

S/s of acute cholangitis?

A

Charcot’s triad = fever > RUQ pain > jaundice (incl. blood test jaundice)
 Reynold’s pentad = + hypotension, confusion

58
Q

Mx of acute cholangitis?

A

IV ABx + ERCP (24-48 hours)

59
Q

 1st line in suspected GB cancer?

A

CT
* ERPC (gold-standard staging)
* MR abdomen (staging)

60
Q

Coeliac disease gold standard diagnosis?

A

Duodenal biopsy

61
Q

 Most sensitive antibodies in coeliac disease?

A

Anti-TTG antibodies

62
Q

Complications of coeliac disease?

A

micronutrient deficiency (vitamin D, iron), osteoporosis, EATL, hyposplenism)

63
Q

Ix for appendicitis?

A

CT

64
Q

Mild/moderate/severe IBD flare?

A

 Mild (<4 stools/day, little blood)
 Moderate (4-6 s/d, varying blood, no systemic upset)
 Severe (>6 bloody stools, systemic upset)

65
Q

Ix in IBD flare?

A

Investigations:
1st: bloods (FBC, U&Es, CRP, LFTs, pANCA) 1st: stool cultures
Scope (capsule endo, colonoscopy, etc.)
Faecal calprotectin
Barium (or gastrograffin) enema
Acute  CT-AP

66
Q

Histology crohn’s

A

Skip lesions, rose-thorn ulcers, cobblestoning
String sign of Kantor (narrow ileum stricture)
Granulomas, goblet cells

67
Q

Histology UC

A

Continuous, ‘lead-pipe’, pseudo-polyps, thumbprinting
CRC risk higher in UC than CD, PSC
Mucosa & submucosa (goblet cells, crypt abscesses)

68
Q

IBD extramaifestations:

A

 A Aphthous ulcers [CD>UC]
 P Pyoderma gangrenosum S Sclerosing cholangitis (primary) [UC]
 I (eye) – iritis, uveitis, episcleritis [CD>UC] A Arthritis
 E Erythema nodosum C Clubbing [CD>UC]

69
Q

Inducing remission in Crohn’s?

A

o Mild  oral prednisolone
o Severe  IV hydrocortisone  no improvement after 5 days IV  infliximab
o Distal ileal, ilio-caecal, R-sided colonic  oral budesonide

  • Nutritional: can be very effective
    o Replace diet with whole protein modular diet – excessively liquid, for 6-8 weeks
    o Products are easily digested, provide all nutrients needed to replace lost weight
70
Q

Maintaining remission in crohn’s disease?

A
  • 1st: DMARDs (azathioprine (pro-drug 6MP), mercaptopurine, methotrexate)
    o Check TPMT levels first: if low levels, consider methotrexate
    o Vaccines (no live vaccines): pneumococcal, influenza
  • Alternative: aminosalicylates (e.g. mesalazine)
  • Alternative: Anti-TNF antibodies in biologic therapies (e.g. infliximab)
71
Q

SE of mesalazine?

A

Pancreatitis

72
Q

Treatment of UC

A

 1st line, distal colitis: topical (4 weeks)  oral aminosalicylates (± topical)
 1st line, extensive colitis (past splenic flexure): topical + oral aminosalicylates

 2nd line: topical  oral corticosteroid (beclomethasone)
 3rd line: oral tacrolimus
 4th line: biological agents (infliximab, adalimumab and golimumab)
 5th line: surgery

73
Q

Tx of severe UC, sudden onset?

A

IV steroids ± IV ciclosporin/infliximab (if no improvement in 72h)  colectomy

74
Q

Tx of UC with >2 or equal to 2 severe exacerbations yearly

A

oral azathioprine or oral mercaptopurine

75
Q
A
76
Q

Severe, non-fulimant UC disease treatment?

A

topical aminosalicylates + oral aminosalicylates + oral corticosteroid

77
Q

Ix for haemorrhoids?

A

o Abdominal exam inc. DRE
 Found commonly at 3, 7 and 11 o’clock
o Proctoscopy/sigmoidoscopy (internal haemorrhoids)

78
Q

Mx of haemorrhoids?

A

o Medical, 1st line – increased fluid/fibre, stool softener, topical analgesics, steroids (supp.)

o Non-operative – rubber-band ligation, sclerotherapy (phenol), electrotherapy, infrared coagulation

o Surgical – haemorrhoidectomy, haemorrhoidopexy , HALO (Haemorrhoidal Artery Ligation Operation)

79
Q

Bacillus cereus associated with what?

A

Reheated rice

80
Q

Traveller’s diarrhoea

A

E.coli

81
Q

Treatment for salmonella typhi?

A

Ceftriaxone, switch to cipro if sensitive

82
Q

Multiplies in Peyer’s patches
Indolent, Rose spots, fever, constipation
Splenomegaly, anaemia, leucopoenia
Condition?

A

Typhoid

83
Q

Dysentery organisms?

A

CHESS
Campylobacter, haemorrhagic E.coli, entamoeba histolytica, shigella, salmonella

84
Q

Rice-water stool?

A

Cholera

85
Q

Causative organism of GBS?

A

Campylobacter jejuni

86
Q

Treatment of campylobacter jejuni

A

Clarithromycin or
Ciprofloxacin

87
Q

Treatment for giardia?

A

Metronidazole

88
Q

A 69-year-old male presents to the Emergency Department after several episodes of vomiting bright red blood. He has presented to the same hospital for spontaneous bacterial peritonitis, alcohol intoxication and peptic ulcer disease (PUD). The gastroenterology team reviewed the patient and performed an urgent gastroscopy, which revealed several oesophageal varices.

Which medication should be prescribed to this patient to reduce his chance of future variceal bleeding?

A

Propanolol

89
Q

Angiodysplasia?

A

Aberrant bleeding blood vessels. Massive bleeding with haemodynamic instability may occur in 15% of patients, and a similar percentage present chronically with hypochromic microcytic anaemia. Angiodysplasia occurs with equal sex distribution and is most common in patients > 60 years of age. The treatment of choice is endoscopic ablation of abnormal vessels.

90
Q

Best test to check for H. Pylori eradication?

A

The 13C urea breath test

91
Q

A 58-year-old male is reviewed in the surgical clinic and presents with trouble defecating, and although he still passes his motions normally, over the past month, he has noticed the uncomfortable feeling of still wanting to defecate after passing his motions. During the past two weeks, he has noticed he has been passing mucus and some blood but no change in colour. Examination is unremarkable.

Which is the most appropriate investigation?

A

Colonoscopy

This patient is experiencing a change in bowel habit: difficulty in defecating, a sensation of incomplete emptying, and passing of mucus per rectum. The main differential diagnoses include colorectal cancer, colorectal polyps and diverticular disease. For the diagnosis of colon cancer, NICE recommends colonoscopy as an initial investigation in those without major co-morbidities. If a lesion is visualised, it can be biopsied, allowing a diagnosis of colon cancer. Flexible sigmoidoscopy, followed by barium enema, can be offered in those with major co-morbidities.

92
Q

A 60-year-old male presents to the Emergency Department with central crushing chest pain radiating to his arm and jaw. His electrocardiogram (ECG) shows ST elevation in leads II, III and aVF, with reciprocal changes in I and aVL.

Which of the following vessels is likely to be blocked?

A

Right coronary artery

93
Q

In a myocardial infarction affecting which artery, would you see ST elevation in leads I, aVL, V5 and V6 (i.e. the lateral leads, with reciprocal changes in the inferior leads II, III, and aVF).

A

the left circumflex artery

94
Q

Left anterior descending artery infarction ECG changes?

A

ST elevation in V1-6 (anterior septal leads)

95
Q

Viral causes of head and neck cancer?

A

HPV can cause oropharyngeal cancer.
EBV = nasopharyngeal

96
Q

Borders of the anterior triangle?

A

Mandible, midline, sternocleidomastoid

97
Q

Borders of the posterior triangle?

A

Sternocleidomastoid, clavicle, trapezius

98
Q

Lumps in the midline?

A

Thyroglossal cyst, thyroid, dermoid cyst

99
Q

Lumps in the anterior triangle?

A

Parotid gland pathology, submandibular gland pathology, carotid pathology, brachial cyst

100
Q

Anterior OR posterior triangle?

A

Lymphadenopathy, sebaceous cyst, lipoma

101
Q

Posterior triangle lumps?

A

Cervical rib, pharyngeal pouch, cystic hygroma (congenital deformity)

102
Q

Treatment for a quinsy?

A

Drain it with a needle, antibiotics and fluids

Year 6 (26 decks)

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