Gastro Flashcards
monoclonal antibody which targets C. difficile toxin B
Bezlotoxumab
plummer vinson syndrome
triad of iron deficiency anaemia, dysphagia due to esophageal webs, and atrophic glossitis
babies born to mothers who are chronically infected with hepatitis B or to mothers who’ve had acute hepatitis B during pregnancy should receive?
a complete course of vaccination + hepatitis B immunoglobulin
what do coeliacs need to receive every 5 years?
pneumococcal vaccine due to functional hyposplenism
what must be checked before starting before offering azathioprine or mercaptopurine
assess thiopurine methyltransferase (TPMT) activity
most useful marker of haemochromatosis
transferrin saturation
colorectal cancer tumour marker
CEA
diagnosis of Zollinger-Ellison syndrome (ZES)
fasting gastrin levels: the single best screen test
The secretin stimulation test
a positive result characterised by a marked increase in serum gastrin levels.
What is the most appropriate tool to screen for malnutrition?
The Malnutrition Universal Screening Tool (MUST)
histology finding Gastric adenocarcinoma
signet cells
histology finding Barret’s
Columnar metaplasia –> adenoca
King’s College Hospital criteria for liver transplantation (paracetamol liver failure)
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
how does aspirin work?
Aspirin works by blocking the action of both cyclooxygenase-1 and 2. Cyclooxygenase is responsible for prostaglandin, prostacyclin and thromboxane synthesis.
The blocking of thromboxane A2 formation in platelets reduces the ability of platelets to aggregate
how to investigated for liver fibrosis in patients with NAFLD?
enhanced liver fibrosis (ELF) testing (blood test)
which vitamin deficiency causes angular cheilits?
vitamin B2 - riboflavin
types of surgical resection in colon disease
total proctocolectomy with ilea pouch annal anastomosis - entire colon out
low anterior resection - resect part of rectum and colon
Hartmann’s procedure - proctosigmoidectomy
management in PBC
ursodeoxycholic acid slows disease progression
cholestyramine helps pruritis
fat soluble vitamin supplementation
liver transplant if bili > 100
most common organism causing SBP?
E.Coli
first line test for diagnosis of small bowel overgrowth syndrome
Hydrogen breath
breath tests
hydrogen - SIBO
urea - h.pylori
Diarrhoea + biospy shows pigment laden macrophages
Melanosis coli due to laxative abuse
Spontaneous bacterial peritonitis - treatment:
intravenous cefotaxime
HLA antigens are encoded for by genes on which chromosome?
chromosome 6
dysentery (bloody diarrhoea) after a long incubation period
Amoebiasis
when to give prophylactic abx for SBP risk
Oral ciprofloxacin. In patients with advanced cirrhosis and low ascitic fluid protein (<15 g/L), there is an increased risk of developing spontaneous bacterial peritonitis (SBP).
Budd chiari causes
polycythaemia rubra vera
thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies
pregnancy
combined oral contraceptive pill: accounts for around 20% of cases
Budd chiari symptoms/ signs
abdominal pain: sudden onset,
severe ascites → abdominal distension
tender hepatomegaly
H. pylori eradication:
PPI + amoxicillin + clarithromycin
or
PPI + metronidazole + clarithromycin
Most common cause of HCC
Worldwide - chronic hep B
Europe- chronic hep c
Tumour market for HCC
’ AFP
Mx.hepatocellular cancer
End stage liver disease =Conservative
Management early disease: surgical resection
liver transplantation
radiofrequency ablation
transarterial chemoembolisation
sorafenib: a multikinase inhibitor options
A recurrent episode of C. difficile within 12 weeks of symptom resolution
should be treated with oral fidaxomicin
Coeliac disease is linked to which HLA type
HLA-DQ2
Cystic fibrosis diet
High calorie and high fat with pancreatic enzyme supplementation for every meal.
the gold standard for diagnosing Bile acid malabsorption
The SeHCAT (Selenium-75-labelled homocholic acid taurine) test
the patient ingests a capsule containing the radiolabelled bile acid analogue SeHCAT. After 7 days, whole-body gamma camera imaging is performed to assess the retention of SeHCAT.
A low retention rate indicates bile acid malabsorption.
Best way to diagnose chronic Pancreatitis
CT
marker of severity in acute pancreatitis.
crp
Oesophageal/Gastric Cancer - assessing mural invasion
Endoscopic ultrasound (EUS) is better than CT or MRI
when to start anti depressants for IBS and which type?
NICE recommend considering psychological interventions after 12 months. Tricyclic antidepressants (eg. amytriptylline) should be used in preference to selective serotonin reuptake inhibitors
what test for h.pylori erradication?
Urea breath test
Stauffer syndrome
a paraneoplastic disorder associated with renal cell cancer
typically presents as cholestasis/hepatosplenomegaly
it is thought to be secondary to increased levels of IL-6
when should statins be discontinued?
Treatment with statins should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range.
The combination of deranged LFTs combined with secondary amenorrhoea in a young female strongly suggest
autoimmune hepatitis
common factors indicating severe pancreatitis include:
age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST
when to vaccinate before elective splenectomy
at least 2 weeks before elective splenectomy
treatment
early keloids
intra-lesional steroids e.g. triamcinolone
preferred diagnostic test for chronic pancreatitis
CT pancreas is - looking for pancreatic calcification
ifrst line investigation for suspected cholangitis
USS
antibody associated with miller fisher syndrome
anti-GQ1b antibody
Nitric oxide effects
vasodilation + inhibits platelet aggregation
following a gastric bypass what supplements are needed
All gastric bypass operations bypass the duodenum.
iron and calcium
Nearly all menstruating women will therefore require iron supplementation.
investigations of choice in primary sclerosing cholangitis
ERCP/MRCP
PPI + non-bloody diarrhoea
disease and diagnosis
microscopic colitis
colonoscopy and biopsy
FAP disease gene
autosomal dominant
mutation in a tumour suppressor gene called adenomatous polyposis coli gene (APC), located on chromosome 5.
small bowel bacterial overgrowth syndrome. What is the treatment of choice?
rifaximin
Coeliac disease - the first-line test
tissue transglutaminase antibodies
sickle cell disease treatment of future attacks
- penicillin until age 5
- long term hydroxycarbamide to reduce the incidence of complications and acute crises
The most common cause of biliary disease in patients with HIV is
sclerosing cholangitis due to infections such as CMV, Cryptosporidium and Microsporidia
most common cause of travellers’ diarrhoea
E. coli
Campylobacter infection management
self-limiting
immunocompromised / severe then treatment: clarithromycin
Liver failure following cardiac arrest think
ischaemic hepatitis
which marker is a more specific marker of pancreatitis
Raised lipase
Lung cancer dermatological manifestation
Erythema gyratum repens - ‘wood-grain’ pattern and figurate erythema
best first line management for NAFLD
Weight loss
Primary sclerosing cholangitis is more associated with which IBD disease?
UC
aortic stenosis and angiodysplasia resulting in chronic gastrointestinal blood loss
angiodysplasia
ith respect to the coagulopathy associated with liver disease, which clotting factor is characteristically increased?
factor 8
The most common type of inherited colorectal cancer:
Hereditary non-polyposis colorectal carcinoma (HNPCC) Lynch syndrome
management of eosinophilic oesophagitis
Dietary modification and topical steroids
Urea breath test accuracy
no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks
common complication post TIPS procedure?
exacerbation of hepatic encephalopathy - now more toxins are entering blood
Crypt abscesses
ulcerative colitis
‘Kantor’s string sign’
strictures
Crohns
prophylaxis of oesophageal bleeding
A non-cardioselective B-blocker (NSBB) eg. propranolol
hepatorenal syndrome management
- liver transplant
- vasopressin analogues, for example terlipressin - causing vasoconstriction of the splanchnic circulation
- volume expansion with 20% albumin
- transjugular intrahepatic portosystemic shunt
multiple white plaques or pseudomembranes on the gastrointestinal mucosa
Pseudomembranous colitis
multiple white plaques - overgrowth of the bacterium Clostridium difficile following antibiotic use.
anti-retroviral drugs most characteristically associated with pancreatitis?
Didanosine, a nucleoside reverse transcriptase inhibitor (NRTI),
h.pylori and link to oesophageal cancer
h.pylori is protective against oesophageal ca
acute alcohol hepatitis mx.
steroids
King’s College Hospital criteria for liver transplantation (paracetamol liver failure)
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
encephalopathy grades
Grade I: Irritability
Grade II: Confusion, inappropriate behaviour
Grade III: Incoherent, restless
Grade IV: Coma
