Gastro Flashcards
What are associated with NASH?
Obesity
T2DM
hyperlipidaemia
jejunoileal bypass
What are the features of NASH?
asymptomatic
hepatomegaly
increased echogenity on US
Liver results for NASH
ALT>AST
What is the treatment plan for NAFLD/NASH?
lifestyle changes
weight loss
monitoring
What is the urea breath test used to check?
eradication of H.pylori
How long after eradication therapy can you use urea breath test?
4 weeks post treatment
What is barrett’s oesophagus?
normal stratified squamous epithelial lining of the distal oesophagus is replaced by metaplastic columnar epithelial ( glandular)
What are the risk factors for Barrett’s oesophagus?
Over>50
male
Caucasian
smoking
obesity
What are the investigations for Barrets?
OGD + biopsy
How often should surveillance occur is someone has Barrets?
no dysplasia - 2-5years
Mild dysplasia - 6m
high grade - 3m
What is main risk of barrets oesophagus?
Adenocarcinoma
What are the symptoms of oesophageal cancer?
dysphagia
anorexia
weight loss
odynophagia
hoarse voice
vomiting
What are the two types of oesophageal cancers and where are they typically found?
Squamous : upper 2/3 of oesophagus
Adenocarcinoma: distal 1/3
Risk factors for Adenocarcinoma of the oesophagus
GORD
Barrets
Alcohol
Risk factors for squamous cell cancer of oesophagus
smoking
alcohol
achalasia
plummer vinson
What investigations are performed for suspected oesophageal cancers?
Endoscopy + biopsy
Ultrasound for local staging
CT chest, abdo and pelvis
What are the most common causes of Acute upper GI bleed?
oesophagel varices
peptic ulcer
Presentation of Acute upper GI bleed?
Haematemesis ( bright red, coffee ground)
malena
raised urea
What are some differential diagnosis for acute upper GI bleed?
Oesophageal causes:
Varices
Oesophagitis
Cancer
Mallory Weiss tear
Stomach :
Gastric ulcer
gastric cancer
diulafoy lesion
gastritis
Duodenum :
ulcer
fistula
Anatomy that counts as acute upper GI bleed?
oesophagus
stomach
duodenum
Symptoms of Oesophageal causes of Acute Upper GI Bleed
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
What risk assessment scores do you use for an acute upper gi bleed?
Blatchford ( pre assessment) –> determines whther patient is managed inpatient or not
Rockall (after endoscopy) –> risk of recurrence
Within how many hours after presenting with an acute gi bleed must a patient have an endoscopy?
all should have an endoscopy within 24 hours
Management for Acute GI bleed if patient needs resuscitation?
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
Management of variceal bleed
-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
What blood test is good to monitor liver function in acute liver failure?
prothrombin time
short half life
What is the gram staining of C.Diff?
gram positive rod
What causes C.diff?
Clindamycin
2nd and 3rd generation Cephalosporins
Investigation for C.Diff
stool sample detecting c diff toxin
Management of C.Diff
1st line - 10 days oral Vancomycin
2nd line - 10 days oral fidaxomicin
3rd line - oral vancomycin +/- IV metronidazole
What is first line treatment for Hepatorenal syndrome?
Terlipressin
What is the key test to determine the severity of C.diff?
WCC
Management of Crohns to induce remission
1st line - glucocorticosteroids ( pred)
2nd line - Mesalazine
azathioprine or mercaptopurine may be added not used as monotherapy
1st line to maintain remission in crohns
azathioprine or mercaptopurine
methotrexate second line
What are the features of spontaneous bacterial peritonitis?
ascites
abdo pain
fever
Investigations for diagnosis of SBP
paracentesis : neutrophil count > 250 cells/ul
What is the most common bacteria that causes SBP
E.coli
symptoms of Haemochromatosis
Fatigue
ED
Arthralgia
bronze skin
DM
hepatic signs
hypogonadism
cardiac failure (2nd to dilated cardiomyopathy)
What is the inheritance pattern of haemochromatosis?
Aut rec
mutation in HFE on Cr6
What management to perform if patient has variceal bleed but after initial treatment is still bleeding & awaiting OGD?
Sengstaken-Blakemore tube
What sign on xray suggest UC?
Lead pipe colon
What medication should be avoided in bowel obstruction?
metoclopramide
causes bowel obstruction
Whats the management of life threatening C.Diff?
Oral Vancomycin
IV metronidazole
How long after last diarrhea episode should a patient with C.Diff be kept in isolation?
48 hours
What is pernicious anaemia?
autoimmune condition causing vitamin B12 deficiency
antibodies against intrinsic factor blocking B12 binding site
antibodies against gastric parietal cells
symptoms of pernicious anemia
anaemia symptoms: dyspnoea, pallor, lethargy
pins and needles, weakness, ataxia, numbness, memory loss, poor concentration
glossitis
Investigations of pernicious anaemia
FBC- low Hb, high MCV,
Bloodfilm - hypersegmented
Vitamin B12 and Folate levels
antibodies for intrinsic factor
What is the management of pernicious anaemia?
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
What is the criteria for mild flare of UC?
less that 4 stools a day ( with or without blood)
no systemic features
What is the criteria for moderate flare of UC?
4-6 stools a day
mild systemic symptoms
What is the criteria for Severe flare of UC?
> = 6 stool a day ( with blood)
systemic symptoms - fever, abdo pain, hypoalbuminemia,
What to do if someone presents with new found dysphagia?
urgent referral for endoscopy
What is Achalasia?
failure of peristalsis and relaxation of LOS due to degeneration in auerbach’s plexus
What are the symptoms of achalasia?
- dysphagia of solids and liquids
- heart burn
- regurgitation of food
What are the investigations of achalasia?
Oesophageal manometry
–> Xs LOS tone after swallowing
Barium swallow test
–> birds beak look
–> expanded oesophagus
Chest Xray
–>widened mediastinum
–> Fluid level
What is first line management of achalasia?
pneumatic (balloon) dilation
What are the features of wilsons disease?
Brain
–> basal ganglia degeneration
–> speech, behavioural and psychiatric manifestations
–> psychosis
–> asterixis, parkinsonism
Liver
–> acute hepatitis
–> Cirrhosis
Cornea
–> keyser fischer rings
What investigation confirms diagnosis of Wilsons?
ATP7B testing
What else is seen in investigations for Wilsons?
reduced serum caeruloplasmin
reduced total serum copper
increased 24hr urinary copper excretion
Management of wilsons
What should you also examine if a young male presents with lower abdominal pain?
testicular examination
What does a positive pANCA suggest?
PSC
Presenting features of pharyngeal pouch
cough
halitosis
difficulty swallowing
regurgitation
What does High SAAG indication?
Portal hypertension
liver cirrhosis, failure
cardiac failure, constrictive pericarditis
How to manage ascites?
1) Spironolactone
2) prophylactic antibiotics to reduce risk of SBP
Can drain
What type of hepatitis is associated with shell fish?
Hep A
What is triple therapy for H.Pylori?
1) PPI + Clarithro + metronidazole
2) PPI + Clarithro + amox
What is Sister Mary Joseph node indicative of?
metastatic umbilical lesion
Triad for Boerhavre syndrome
subcutaneous emphysema
pain
vomiting
What is gallstone ileus?
small bowel obstruction secondary to gallstones
What is used in the management of acute alcoholic hepatitis?
prednisolone
What investigation should be performed in all patients with suspected IBS?
Anti-TTG
eliminate celiac
What is Melanosis coli?
abnormal pigmentation of the large bowel
commonly associated with Laxative abuse
What location of an anal fissure should be concerning for Crohns?
Lateral anal fissure
Causes of macrocytic anaemia
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)
Brown coloured urine + diverticular disease + signs of large bowel obstruction
colovesical fistula
Induce remission of Crohns
Glucocorticosteroids
Eternal feeding
5-ASA second line
What is Reynolds pentad?
Charcots triad + hypotension + confusion
What hepatitis is associated with undercooked pork?
Hep E
What needs to be administered for a large paracentesis of ascites?
IV human Albumin
How is SAAG calculated?
Serum Albumin - ascitic albumin
What does this describe : Extraluminal air is present along with a paracolic fluid collection
bowel perforation
What is tested for exocrine function of pancreas?
Faecal elastase
Severe abdominal pain + history of AF + PR bleeding
Acute mesenteric ischaemia
What test do you perform for acute mesenteric ischaemia?
Serum lactate
What are causes of normocytic anemia?
- Haemolytic anameia
- blood loss
- aplastic anaemia
- anaemia of chronic disease
- CKD
What investigation to perform for Crohns patients with fistula?
MRI pelvis
What antibiotics to use for anal fistula in Crohns patients?
oral metronidazole
