Gastro Flashcards
Severe epigastric pain radiates to back?
Pancreatitis
What drug used in treatment of IBD can can cause acute pancreatitis?
Aminosalicyclic drugs 5-ASA
Significantly more common with mesalazine compared to sulfasalazine
Mild to moderate flare of UC not responding to oral or topical aminosalicylates?
Add oral corticosteroids such as prednisone
What drug can increase risk of toxic meghacolon?
Anti-motility such as loperamine
What is classed as a severe exacerabtion of UC?
More than 6-8 episodes of bloody stools per day
What is first line analgesia for colitis?
Paracetamol
NOTE: avoid NSAIDS as they can worsen symptoms of colitis
What is transjugular intrahepatic portosystemic shunt? (TIPS)
A procedure that involves inserting a stent to connect portal veins to blood vessels that have lower pressure
What are the indication for TIPS?
-Variceal haemorrhage - when bleeding can’t be controlled
-Used when ascites cannot be controlled
-Second line treatment for gastric varices
-Secondary prevention of variceal haemorrhage
Variceal hemorrhage and liver cirrhosis ?
Patients with liver cirrhosis are at risk of developing portal hypertension, a significant complication of this is oesophageal varices
NOTE: if these rupture can cause upper GI bleed
Prophylaxis management of variceal haemorrhage?
-Propranolol
-Endoscopic variceal band ligation (NICE medium to large varcies)
-TIPS if above measures are n ot successful
How is EVL performed?
-Two-week intervals until all varices have been eradicated
-Proton pump inhibitor is given to prevent EVL ulceration
Typical features of gastric ulcer?
Pain when or shortly after eating
When does pain come on with duodenal ulcer?
An hour or two after meals - worse when hungry relieved by eating
What bacteria is associated with the majority of peptic ulcers?
Helicobacter pylori
What percent of duodenal and gastric ulcers are associated with helicobacter pylori?
95% duodenal ulcers
75% gastric ulcers
What drugs can cuase peptic ulcers?
NSAIDs
SSRI
Corticosteriods
Bisphosphonates
What is a syndrome that is a rare cause of peptic ulcer disease?
Zollinger-Ellison syndrome, which causes excessive levels of gastrin from a gastrin secreting tumour
What are the features of peptic ulcers?
-Epigastric pain
-Nausea
-Duodenal ulcers - more common that gastric ulcers these are worse when hungry and relieved by eating
-Gastric ulcers worse when eating
How to test H.pylori with peptic ulcers?
Urea breathe test or stool antigen test
What cancer does coeliac disease increase the risk of getting?
Enteropathy-associated T-cell lymphoma
NOTE: this is a very rare cancer
Adenocarcinoma of oesophagus?
Barrett’s oesophagus
metaplasia from squamous to columnar at gastro oepshageal junction
What are the risk factors associated with squamous cell carcinoma of oesphagus?
smoking and achalasia
What is the most common type of inherited colorectal cancer?
Hereditary non-polyposis colorectal carcinoma
what is hereditary non polyposis colorectal carcinoma also known as?
Lynch syndrome
-This is autosomal dominant and is characterised by early onset colorectal cancer and other malignancies - endometrial , ovarian, gastric ,urinary tract and small bowel cancer
Aminosalicylates put patient at risk of what?
Agranulocytosis - FBC needed
What is MUST score?
Malnutrition universal screening tool
used to screen patients for malnutrition
TTG level and IgA
-If IgA then you are unable to interpret TTG
-definitive investigation is duodenal biopsy
