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Year 6 > Gastro > Flashcards

Gastro Flashcards

1
Q

What are associated with NASH?

A

Obesity
T2DM
hyperlipidaemia
jejunoileal bypass

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2
Q

What are the features of NASH?

A

asymptomatic
hepatomegaly
increased echogenity on US

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3
Q

Liver results for NASH

A

ALT>AST

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4
Q

What is the treatment plan for NAFLD/NASH?

A

lifestyle changes
weight loss
monitoring

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5
Q

What is the urea breath test used to check?

A

eradication of H.pylori

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6
Q

How long after eradication therapy can you use urea breath test?

A

4 weeks post treatment

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7
Q

What is barrett’s oesophagus?

A

normal stratified squamous epithelial lining of the distal oesophagus is replaced by metaplastic columnar epithelial ( glandular)

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8
Q

What are the risk factors for Barrett’s oesophagus?

A

Over>50
male
Caucasian
smoking
obesity

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9
Q

What are the investigations for Barrets?

A

OGD + biopsy

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10
Q

How often should surveillance occur is someone has Barrets?

A

no dysplasia - 2-5years
Mild dysplasia - 6m
high grade - 3m

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11
Q

What is main risk of barrets oesophagus?

A

Adenocarcinoma

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12
Q

What are the symptoms of oesophageal cancer?

A

dysphagia
anorexia
weight loss
odynophagia
hoarse voice
vomiting

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13
Q

What are the two types of oesophageal cancers and where are they typically found?

A

Squamous : upper 2/3 of oesophagus
Adenocarcinoma: distal 1/3

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14
Q

Risk factors for Adenocarcinoma of the oesophagus

A

GORD
Barrets
Alcohol

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15
Q

Risk factors for squamous cell cancer of oesophagus

A

smoking
alcohol
achalasia
plummer vinson

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16
Q

What investigations are performed for suspected oesophageal cancers?

A

Endoscopy + biopsy
Ultrasound for local staging
CT chest, abdo and pelvis

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17
Q

What are the most common causes of Acute upper GI bleed?

A

oesophagel varices
peptic ulcer

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18
Q

Presentation of Acute upper GI bleed?

A

Haematemesis ( bright red, coffee ground)
malena
raised urea

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19
Q

What are some differential diagnosis for acute upper GI bleed?

A

Oesophageal causes:
Varices
Oesophagitis
Cancer
Mallory Weiss tear

Stomach :
Gastric ulcer
gastric cancer
diulafoy lesion
gastritis

Duodenum :
ulcer
fistula

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20
Q

Anatomy that counts as acute upper GI bleed?

A

oesophagus
stomach
duodenum

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21
Q

Symptoms of Oesophageal causes of Acute Upper GI Bleed

A

Varices : large volume of fresh red blood, malena, hemodynamically unstable, stops and restarts

Oesophagitis: small volume of blood ( streaky) , no malena, stops randomly

Mallory Weiss tear: after a large bout of vomiting, bright red, no malena

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22
Q

What risk assessment scores do you use for an acute upper gi bleed?

A

Blatchford ( pre assessment) –> determines whther patient is managed inpatient or not
Rockall (after endoscopy) –> risk of recurrence

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23
Q

Within how many hours after presenting with an acute gi bleed must a patient have an endoscopy?

A

all should have an endoscopy within 24 hours

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24
Q

Management for Acute GI bleed if patient needs resuscitation?

A

A-E assessment
2 large bore cannulas
blood transfusion
platelets (actively bleeding and platelet count of less than 50 x 109/litre)
FFP
Prothrombin complex concentrate if patient on warfarin and actively bleeding

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25
Q

Management of variceal bleed

A

-Terlipressin (at presentation)
-antibiotics (at presentation)
-Band ligation for oesophageal
-N-butyl-2-cyanoacrylate for gastric varices
-transjugular intrahepatic portosystemic shunts (TIPS) offered if nothing else works

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26
Q

What blood test is good to monitor liver function in acute liver failure?

A

prothrombin time
short half life

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27
Q

What is the gram staining of C.Diff?

A

gram positive rod

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28
Q

What causes C.diff?

A

Clindamycin
2nd and 3rd generation Cephalosporins

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29
Q

Investigation for C.Diff

A

stool sample detecting c diff toxin

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30
Q

Management of C.Diff

A

1st line - 10 days oral Vancomycin
2nd line - 10 days oral fidaxomicin
3rd line - oral vancomycin +/- IV metronidazole

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31
Q

What is first line treatment for Hepatorenal syndrome?

A

Terlipressin

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32
Q

What is the key test to determine the severity of C.diff?

A

WCC

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33
Q

Management of Crohns to induce remission

A

1st line - glucocorticosteroids ( pred)
2nd line - Mesalazine

azathioprine or mercaptopurine may be added not used as monotherapy

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34
Q

1st line to maintain remission in crohns

A

azathioprine or mercaptopurine
methotrexate second line

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35
Q

What are the features of spontaneous bacterial peritonitis?

A

ascites
abdo pain
fever

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36
Q

Investigations for diagnosis of SBP

A

paracentesis : neutrophil count > 250 cells/ul

37
Q

What is the most common bacteria that causes SBP

A

E.coli

38
Q

symptoms of Haemochromatosis

A

Fatigue
ED
Arthralgia
bronze skin
DM
hepatic signs
hypogonadism
cardiac failure (2nd to dilated cardiomyopathy)

39
Q

What is the inheritance pattern of haemochromatosis?

A

Aut rec
mutation in HFE on Cr6

40
Q

What management to perform if patient has variceal bleed but after initial treatment is still bleeding & awaiting OGD?

A

Sengstaken-Blakemore tube

41
Q

What sign on xray suggest UC?

A

Lead pipe colon

42
Q

What medication should be avoided in bowel obstruction?

A

metoclopramide
causes bowel obstruction

43
Q

Whats the management of life threatening C.Diff?

A

Oral Vancomycin
IV metronidazole

44
Q

How long after last diarrhea episode should a patient with C.Diff be kept in isolation?

A

48 hours

45
Q

What is pernicious anaemia?

A

autoimmune condition causing vitamin B12 deficiency
antibodies against intrinsic factor blocking B12 binding site
antibodies against gastric parietal cells

46
Q

symptoms of pernicious anemia

A

anaemia symptoms: dyspnoea, pallor, lethargy
pins and needles, weakness, ataxia, numbness, memory loss, poor concentration
glossitis

47
Q

Investigations of pernicious anaemia

A

FBC- low Hb, high MCV,
Bloodfilm - hypersegmented
Vitamin B12 and Folate levels
antibodies for intrinsic factor

48
Q

What is the management of pernicious anaemia?

A

Vitamin B12 replacement therapy

regime for non neuro symptoms: 3 injections per week for 2 weeks followed by 3 monthly treatment of vitamin B12 injections

49
Q

What is the criteria for mild flare of UC?

A

less that 4 stools a day ( with or without blood)
no systemic features

50
Q

What is the criteria for moderate flare of UC?

A

4-6 stools a day
mild systemic symptoms

51
Q

What is the criteria for Severe flare of UC?

A

> = 6 stool a day ( with blood)
systemic symptoms - fever, abdo pain, hypoalbuminemia,

52
Q

What to do if someone presents with new found dysphagia?

A

urgent referral for endoscopy

53
Q

What is Achalasia?

A

failure of peristalsis and relaxation of LOS due to degeneration in auerbach’s plexus

54
Q

What are the symptoms of achalasia?

A
  • dysphagia of solids and liquids
  • heart burn
  • regurgitation of food
55
Q

What are the investigations of achalasia?

A

Oesophageal manometry
–> Xs LOS tone after swallowing

Barium swallow test
–> birds beak look
–> expanded oesophagus

Chest Xray
–>widened mediastinum
–> Fluid level

56
Q

What is first line management of achalasia?

A

pneumatic (balloon) dilation

57
Q

What are the features of wilsons disease?

A

Brain
–> basal ganglia degeneration
–> speech, behavioural and psychiatric manifestations
–> psychosis
–> asterixis, parkinsonism
Liver
–> acute hepatitis
–> Cirrhosis
Cornea
–> keyser fischer rings

58
Q

What investigation confirms diagnosis of Wilsons?

A

ATP7B testing

59
Q

What else is seen in investigations for Wilsons?

A

reduced serum caeruloplasmin
reduced total serum copper
increased 24hr urinary copper excretion

60
Q

Management of wilsons

A
61
Q

What should you also examine if a young male presents with lower abdominal pain?

A

testicular examination

62
Q

What does a positive pANCA suggest?

A

PSC

63
Q

Presenting features of pharyngeal pouch

A

cough
halitosis
difficulty swallowing
regurgitation

64
Q

What does High SAAG indication?

A

Portal hypertension

liver cirrhosis, failure
cardiac failure, constrictive pericarditis

65
Q

How to manage ascites?

A

1) Spironolactone
2) prophylactic antibiotics to reduce risk of SBP
Can drain

66
Q

What type of hepatitis is associated with shell fish?

A

Hep A

67
Q

What is triple therapy for H.Pylori?

A

1) PPI + Clarithro + metronidazole
2) PPI + Clarithro + amox

68
Q

What is Sister Mary Joseph node indicative of?

A

metastatic umbilical lesion

69
Q

Triad for Boerhavre syndrome

A

subcutaneous emphysema
pain
vomiting

70
Q

What is gallstone ileus?

A

small bowel obstruction secondary to gallstones

71
Q

What is used in the management of acute alcoholic hepatitis?

A

prednisolone

72
Q

What investigation should be performed in all patients with suspected IBS?

A

Anti-TTG
eliminate celiac

73
Q

What is Melanosis coli?

A

abnormal pigmentation of the large bowel
commonly associated with Laxative abuse

74
Q

What location of an anal fissure should be concerning for Crohns?

A

Lateral anal fissure

75
Q

Causes of macrocytic anaemia

A

F: Foetus
A: Alcohol excess
T: Thyroid (hypothyroid)
R: Reticulocytosis (due to haemolytic anaemia as RBC precursors are bigger)
B: B12/folate deficiency
C: Cirrhosis (liver)
M: Myeloproliferative disorders
C: Cytotoxic drugs (e.g. 5-fluorouracil)

76
Q

Brown coloured urine + diverticular disease + signs of large bowel obstruction

A

colovesical fistula

77
Q

Induce remission of Crohns

A

Glucocorticosteroids
Eternal feeding
5-ASA second line

78
Q

What is Reynolds pentad?

A

Charcots triad + hypotension + confusion

79
Q

What hepatitis is associated with undercooked pork?

A

Hep E

80
Q

What needs to be administered for a large paracentesis of ascites?

A

IV human Albumin

81
Q

How is SAAG calculated?

A

Serum Albumin - ascitic albumin

82
Q

What does this describe : Extraluminal air is present along with a paracolic fluid collection

A

bowel perforation

83
Q

What is tested for exocrine function of pancreas?

A

Faecal elastase

84
Q

Severe abdominal pain + history of AF + PR bleeding

A

Acute mesenteric ischaemia

85
Q

What test do you perform for acute mesenteric ischaemia?

A

Serum lactate

86
Q

What are causes of normocytic anemia?

A
  • Haemolytic anameia
  • blood loss
  • aplastic anaemia
  • anaemia of chronic disease
  • CKD
87
Q

What investigation to perform for Crohns patients with fistula?

A

MRI pelvis

88
Q

What antibiotics to use for anal fistula in Crohns patients?

A

oral metronidazole

Year 6 (19 decks)

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