Gastro Flashcards
Crohns vs UC?
Crohns: non-bloody diarrhoea, abdominal pain (often right-sided), weight loss, and extraintestinal manifestations like oral ulcers or skin lesions; pei-anal disease eg skin tags, goblet cells
—> Tranny (transmural inflammation) granny (granulomas) skips (skip lesions) down the cobblestone (cobblestone appearance) alley
UC: Tender LLQ, bloody diarrhoea, abdominal pain, and a feeling of incomplete evacuation after defecation (tenesmus), urgency. Crypt abscess, psuedopolyps, colorectal ca
At what ages and how often are FITs done as part of the colorectal screening programme?
Faecal immunochemical tests are sent every 2 years to all patients aged 60-74 years in England, 50-74 years in Scotland.
Management of UC flare? severe vs mild-mod
definition of severe UC: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
In mild/moderate: topical (rectal) aminosalicylate. –> PO aminosalicylate (eg Sulfasalazine)–> steroid
Severe: hospital. IV steroids –> IV ciclosporin –> surgery
What is pyoderma gangrenosum?
Inflammatory, not infection. An uncommon cause of very painful skin ulceration.
Associated with IBD.
Starts as pustule then ulcerates
Treat with steroids
WHat is used for prevenetion of variceal high risk bleeds?
A non-cardioselective B-blocker (NSBB) is used for the prophylaxis of oesophageal bleeding eg carvedilol, propranolol
Spider naevi vs telangiectasia
Spider naevi can be differentiated from telangiectasia by pressing on them and watching them fill. Spider naevi fill from the centre, telangiectasia from the edge
Mx of crohns flare up?
Induce remission:
1st line - steroids - PO/ top/ IV
2nd line - 5-ASA (aminosalicylaes) eg mesalazine
3rd line - azathioprine/ mercaptopurine /methotrexte.
4th line - infliximab
Metronidazole is used if fistula present
Maintain remission:
1st line - azathioprine/ mercaptopurine - need to test TPMT
2nd line - methotrexate
Surgery:
ileocoecal resection if stricture, resections, draining seton
How is SBP diagnosed?
In suspected SBP- diagnosis is by paracentesis. Confirmed by neutrophil count >250 cells/ul
How do you interpret Hep B serology?
HBsAg normally implies acute disease (present for 1-6 months)
if HBsAg is present for > 6 months then this implieschronic disease(i.e. Infective)
Anti-HBs implies immunity (either exposure or immunisation). It is negative in chronic disease.
Anti-HBc implies previous (or current) infection. IgM anti-HBc appears during acute or recent hepatitis B infection and is present for about 6 months. IgG anti-HBc persists.
HbeAg results from breakdown of core antigen from infected liver cells as is, therefore, a marker of infectivity. Marker of HBV replication and infectivity
Example results
previous immunisation: anti-HBs positive, all others negative
previous hepatitis B (> 6 months ago), not a carrier: anti-HBc positive, HBsAg negative
previous hepatitis B, now a carrier: anti-HBc positive, HBsAg positive
Achalasia vs oeseophgeal stricture vs pharyngeal pouch??
Achalasia - relaxed lower sphincter. Progressive dysphagia of solids and liquids on onset. Get CP, wt loss, reflux.
Bird beak sign on barium swallow
Oesophageal stricture - Presents with difficulty swallowing solids then liquids.
Narrowing on barium swallow
Often due to GORD and so will hve hx of reflux
Pharyngeal pouch - intermittent dysphagia halitosis + nocturnal coughing
Consequences of low vitamins:
A (Retinoids)
B3 (niacin)
c (Ascorbic acid)
A- night blindness
B3 (niacin)- Pellagra- dermatitis, diarrhoea, dementia
C- scurvy - gingivitis and bleeding
Describe autoimmune hepatitis - bloods/ presentation/ ix?
may present with signs of chronic liver disease
acute hepatitis: fever, jaundice etc (only 25% present in this way)
secondary amenorrhoea (common)
ANA/SMA/LKM1 antibodies, raised IgG levels, abnormal LFTs
liver biopsy: inflammation extending beyond limiting plate ‘piecemeal necrosis’, bridging necrosis
What is charcots triad? WHich condition does it occur in?
ascending cholangitis triad: fever, jaundice and right upper quadrant pain
Which ulcer is relived by eating?
duodenal
When should prophylactic abx be started for ascites? which abx?
Patients with ascites and protein concentration <= 15 g/L / Child-Pugh score of at least 9/ hepatorenal syndrome
they should be given oral ciprofloxacin or norfloxacin as prophylaxis against spontaneous bacterial peritonitis
What blds do you do to monitor response to haemochromatosis mx?
Ferritin and transferrin saturation (most useful also for diagnosis) are used to monitor treatment in haemochromatosis (venesection)
What extra-intestinal manifestation of IBD colerates to flare ups?
erythema nodosum
Describe primary biliary cholangitis?
Classically seen in middle aged women
Present with jaundice, raised ALP, pruritius
AMA - anti-mitochondrial antibodies highly specific (98%), raised IgM
Associated with sjogrens (80%)
first-line: ursodeoxycholic acid
cholestyramine if itchy, fat soluble vitamins, eventually liver transplant
Associated with HCC
What should be given before OGD in UGIB?
Terlipressin and prophylactic abx
Post UGIB if NOT variceal bleed eg if ulcer give PPI
Where is biopsy taken from to prove diagnosis of coeliacs?
Jejunum
How do you test for h pylori?
Urea breath test
should not be performed within 4 weeks of abx or within 2 weeks of ppi/ h2 antag
What condition is Melanosis coli found on biopsy of colon?
chronic use or abuse of anthraquinone-containing laxatives, such as senna or cascara.
Curlings vs cushings ulcer?
Curling’s ulcer is a recognised complication of severe burns. It is a gastric ulcer caused by necrosis of the gastric mucosa, usually due to hypovolaemia. They carry a high rate of bleeding and mortality.
A Cushing’s ulcer is a stress ulcer that occurs in the aftermath of severe head trauma.
What is the most commonly effected site in ulcerative colitis?
Ulcerative colitis - the rectum is the most common site affected
What cancer does barretts put you at risk of vs achalasia?
Whilst Barrett’s oesophagus increases the risk of oesophageal adenocarcinoma, achalasia increases the risk of squamous cell carcinoma of the oesophagus.
What is Peutz-Jeghers syndrome?
autosomal dominant condition characterised by numerous hamartomatous polyps in the gastrointestinal tract. It is also associated with pigmented freckles on the lips, face, palms and soles
Treatment for wilsons disease?
penicillamine
What cancer is coeliacs associated with
Coeliac disease increases the risk of developing enteropathy-associated T cell lymphoma of SI
When should PO and rectal 5ASA be started for UC?
In a mild-moderate flare of ulcerative colitis extending past the left-sided colon, oral aminosalicylates should be added to rectal aminosalicylates, as enemas only reach so far
How to maintain remission and induce remission in UC?
induce remission in a flare up:
mild to moderate flare
PR 5ASA –> PO 5ASA –> top –> PO steroid. If extensive disease need to start with both a PO and PR 5ASA and then will move onto PO steroid
Severe flare
hospital
IV steroids –> IV ciclosporin –> surgery
Maintain remission
Following a mild-to-moderate ulcerative colitis flare:
PR aminosalicylate (5ASA eg mesalazine) / PO aminosalicylate / both together - if left sided and extensive UC need PO
Following a severe relapse or >=2 exacerbations in the past year:
oral azathioprine or oral mercaptopurine
Differentiate different hepatitis (A-E)
A: RNA, foecal-oral, not chronic
B: DNA, blood/ bodily fluids, can be chronic, at risk of HCC
C: RNA, blood/ bodily flids, can be chronic, up and coming in the UK, at risk of HCC
D: RNA, blood/ bodily fluids, can only get if already have hep B
E: RNA, foecal-oral, not chronic
WHat weird stuff do you get with wilsons diseade?
basal ganglia degeneration:
speech, behavioural and psychiatric problems are often the first manifestations
also: asterixis, chorea, dementia, parkinsonism eg tremor, rigid
Kayser-Fleischer rings
renal tubular acidosis (esp. Fanconi syndrome)
haemolysis
blue nails
what weird stuff fo you get in haemochromatosis?
early symptoms include fatigue, erectile dysfunction and arthralgia (often of the hands)
‘bronze’ skin pigmentation
diabetes mellitus
cardiac failure (2nd to dilated cardiomyopathy)
hypogonadism (2nd to cirrhosis and pituitary dysfunction - hypogonadotrophic hypogonadism)
Tretment for h pyolri?
FUll dose PPI BD + clari 500mg BD + amoxicillin 1g BD/ metronidazole
How is a hiatus hernia diagnosed? sx?
barium meal
hiatus hernia is cmore common with age, gives reflux, worse lie forward or flat, regurgitating food at night, can have a triad with gallstones and diverticular disease
peutz-jeghers vs FAP vs lynch syndrome?
peutz-jeghers - AD condition, hamartomatous polyps, start as a teenager, can get black/ brown pigmentation of lips/ buccal/ periorbital area
FAP - colonic adenomas, high risk of bowel ca
Lynch/ HNPCC - colon cancer/ polyps at young age, can also effect endometrium and small bowel
SBO causes vs LBO causes?
SBO - adhesions, hernias, crohns (effects terminal ileum)
LBO - malignancy, diverticular disease
What laxative shouldnt be used in IBS?
lactulose
What blood group is a RF for gastric ca?
A
What is budd chiari syndrome?
hepatic venous outflow blockage - often due to thrombosis which causes liver lobe hypertrophy and occluded veins
How often should someone with UC have colonoscopy?
every 5 yrs with biopsy to monitor for cancer
What is the LFT pattern in alcoholic hepatitis?
AST> ALT
What can precipitate wernickes encephalopathy in a patient with low thiamine?
glucose
