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Gastro Flashcards

1
Q

what is portal hypertension

A

increased resistance and pressure in the portal system due to fibrosis affecting the blood flow through the liver

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2
Q

blood test to show liver function

A

PT

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3
Q

common causes of live cirrhosis

A
  • alcohol
  • NAFLD
  • hepatitis B
  • hepatitis C
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4
Q

rarer causes of liver cirrhosis

A
  • autoimmune hepatitis
  • PBC
  • haemochromatosis
  • Wilson’s disease
  • A1AD
  • CF
  • drugs (methotrexate, amiodarone, sodium valproate)
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5
Q

signs of liver cirrhosis

A
  • cachexia
  • jaundice
  • asterexis
  • splenomegaly
  • hepatomegaly
  • ascites
  • spider naevi
  • excoriations
  • small nodular liver
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6
Q

non-invasive liver screen

A
  • USS
  • hepatitis B and C serology
  • autoantibodies
  • immunoglobulins
  • caeruloplasmin (wilson’s)
  • A1AT levles
  • ferritin and tansferrin
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7
Q

autoantibodies related to the liver

A
  • antinuclear antibodies
  • smooth muscle antibodies
  • antimitochondrial antibodies
  • antibodies to liver kidney microsome type 1
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8
Q

LFTs

A

ALP
ALT
AST
Bilirubin
Albumin
PT
Urea and creatinine
AFP
ELF (enhance liver fibrosis)

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9
Q

what is AFP for

A

hepatocellular carcinoma

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10
Q

USS of liver cirrhosis

A

nodular surface
corkscrew appearance of arteries
enlarged portal vein
ascites
splenomegaly

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11
Q

how to assess stiffness of the liver

A

transient elastography

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12
Q

what is the MELD score

A

model for end stage liver disease. gives an estimate 3 month mortality

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13
Q

what is child pugh score

A

assess severity of cirrhosis and prognosis.
A albumin
B bilirubin
C clotting (INR)
D dilation
E encephalopathy

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14
Q

mx of liver cirrhosis

A

treat cause
monitor and manage complications
liver transplant

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15
Q

complications of cirrhosis

A
  • Malnutrition and muscle wasting
  • Portal hypertension, - oesophageal varices and bleeding
  • Ascites and SBP
  • Hepatorenal syndrome
  • Hepatic encephalopathy
  • Hepatocellular carcinoma
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16
Q

where does the portal vein come from

A

superior mesenteric and splenic veins

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17
Q

prophylaxis of oesophageal varices

A

propanolol
variceal band ligation

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18
Q

mx of bleeding oesophageal varices

A

terlipressin
broad spectrum abx
endoscopy and band ligation

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19
Q

next step if ligation doesn’t work for varices

A
  • Sengstaken-Blakemore tube
  • Transjugular intrahepatic portosystemic shunt (TIPS)
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20
Q

what is ascites

A
  • fluid in the peritoneal cavity
  • increased pressure in portal system causes fluid to leak out of capillaries and organs
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21
Q

type of ascites in cirrhosis

A

transudative (low protein content)

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22
Q

mx of ascites

A
  • low sodium
  • aldosterone antagonists
  • paracentesis
  • proph abx
    -TIPS
  • liver transplant
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23
Q

what is Spontaneous bacterial peritonitis

A

infection in ascitic fluid and peritoneal lining without clear source

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24
Q

common organisms of SBP

A
  • Ecoli
  • Klebsiella pneumoniae
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25
Q

diagnosing SBP

A

ascites
abdominal pain
fever
paracentesis: neutrophil count > 250 cells/ul

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26
Q

Mx of SBP

A
  • sample ascitic fluid
  • IV broad spec abx (e.g. piperacillin with tazobactam)
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27
Q

most common organism in peritonitis secondary to peritoneal dialysis

A

Staphylococcus epidermidis

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28
Q

what is hepatorenal syndrome

A

impaired kidney function caused by changes in the blood flow to the kidneys relating to liver cirrhosis and portal hypertension

portal hypertension causes the portal vessels to release vasodilators, which cause significant vasodilation in the splanchnic circulation
= reduced BP, so kidneys use RAS to vasoconstrict

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29
Q

types of hepatorenal syndrome

A

type 1: rapid onset hepatorenal syndrome (less than two weeks) (typically post GI bleed)
type 2: more gradual decline in renal function and is generally associated with refractory ascites

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30
Q

mx of hepatorenal syndrome

A
  • vasopressin analogue: terlipressin
  • 20% albumin
  • TIPS
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31
Q

what is hepatic encephalopathy

A

build up of neurotoxic substances that affect the brain (ammonia)

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32
Q

presentation of hepatic encephalopathy

A

reduced conciousness and confusion

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33
Q

grading of hepatic encephalopathy

A

Grade I: Irritability
Grade II: Confusion, inappropriate behaviour
Grade III: Incoherent, restless
Grade IV: Coma

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34
Q

mx of hepatic encephalopathy

A
  • lactulose
  • abx (reduce bacteria producing ammonia) usually rifaximin can also use meomycin and metronidazole
  • nutritional support
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35
Q

stages of alcohol related liver disease

A
  1. Alcoholic fatty liver
  2. alcoholic hepatitis
  3. cirrhosis
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36
Q

complications of alcohol during pregnancy

A
  • SGA
  • Fetal alcohol syndrome
  • miscarriage
  • preterm delivery
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37
Q

complications of alcohol

A
  • Alcohol-related liver disease
  • Cirrhosis and its complications (e.g., hepatocellular carcinoma)
  • Alcohol dependence and withdrawal
  • Wernicke-Korsakoff syndrome
  • Pancreatitis
  • Alcoholic cardiomyopathy
  • Alcoholic myopathy, with proximal muscle wasting and weakness
  • Increased risk of CVD
  • Increased risk of cancer, particularly breast, mouth and throat cancer
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38
Q

examination findings with excess alcohol

A
  • tremor
  • smell of alcohol
  • slurred speech
  • telangiectasia
  • bloodshot eyes
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39
Q

Ix for alcoholic liver disease

A
  • raised MCV
  • AST: ALT 1.5:1
  • raised ALT, AST, GGT, ALP, Bilirubin
  • low albumin
  • increased PT
  • deranged U&E in hepatorenal syndrome
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40
Q

Mx of alcohol related liver disease

A
  • stop drinking
  • CBT
  • detox regimen
  • thiamine and high protein diet
  • corticosteroids to reduce inflammation
  • treat complications
  • liver transplant
  • pentoxyphylline sometimes used
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41
Q

questionnaires for alcohol dependence

A

CAGE
AUDIT

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42
Q

Alcohol withdrawal sx

A
  • 6-12 hours: tremor, sweating, headache, craving and anxiety
  • 12-24 hours: hallucinations
  • 24-48 hours: seizures
  • 24-72 hours: delirium tremens
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43
Q

what is delirium tremens

A

medical emergency
extreme excitability of the brain and excessive adrenergic activity

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44
Q

presentation of delirium tremens

A
  • Acute confusion
  • Severe agitation
  • Delusions and hallucinations
  • Tremor
  • Tachycardia
  • Hypertension
  • Hyperthermia
  • Ataxia (difficulties with coordinated movements)
  • Arrhythmias
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45
Q

Mx of alcohol withdrawal

A
  • chlordiazepoxide
  • pabrinex
  • thiamine
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46
Q

what is wernicke-korsakoff syndrome

A

excess vit b1 (thiamine) deficiency

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47
Q

features of wernicke’s encephalopathy

A
  • confusion
  • oculomotor disturbances
  • ataxia
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48
Q

features of korsakoff syndrome

A
  • memory impairment
  • behavioural changes
  • often irreversible
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49
Q

stages of NAFLD

A
  1. NAFLD
  2. NA steatohepatitis
  3. fibrosis
  4. cirrhosis
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50
Q

RFs for NAFLD

A
  • middle age
  • obesity
  • poor diet and activity
  • T2DM
  • high cholesterol
  • high BP
  • smoking
  • metabolic syndrome (HTN, obesity and diabetes)
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51
Q

Ix for NAFLD

A
  • raised ALT
  • USS increased echogenicity
  • ELF (>10.51 advanced fibrosis, <10.52 unlikely advanced fibrosis)
  • transient elastography
  • liver biopsy (gold standard)
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52
Q

Mx of NAFLD

A
  • weight loss
  • healthy diet and exercise
  • avoid alcohol and smoking
  • control diabetes, BP and cholesterol
  • refer
  • specialist: vit E, pioglitazone, bariatric surgery and liver transplant
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53
Q

what is hepatitis

A

inflammation of the liver

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54
Q

Hepatitis A

A
  • contaminated food/water
  • faeco-oral route
  • RNA
  • pruritis, jaundice, dark urine, pale stool
  • vaccine available
  • mx- supportive
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55
Q

hepatitis B

A

blood/bodily fluids
DNA
Vaccine available
Mx- supportive/antiviral
most recover in 1-3 months

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56
Q

Hepatitis C

A

blood
RNA
no vaccine
mx- direct acting antiviral

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57
Q

complication of hepatitis C

A

HCC
liver cirrhosis

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58
Q

hepatitis D

A

always with hep B
RNA
no vaccine
Mx- pegylated interferon alpha

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59
Q

hepatitis E

A

faeco-oral route
RNA
no vaccine
Mx- supportive

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60
Q

other causes of hepatitis

A
  • alcoholic
  • NA steatohepatitis
  • autoimmune
  • drug induced (paracetamol)
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61
Q

presentation of viral hepatitis

A
  • asymptomatic
  • abdo pain
  • flu like sx
  • pruritis
  • jaundice
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62
Q

hepatic pictures LFTs

A

high ALT and AST
less of a rise in ALP
bilirubin

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63
Q

types of autoimmune hepatitis

A

Type 1: women, 40-50, fatigue
Type 2: children, girls, acute hepatitis and jaundice

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64
Q

Ix for autoimmune hepatitis

A
  • high AST and ALT
  • minimal ALP change
  • raised IgG
  • liver biopsy

Type 1:
- ANA, anti smooth muscle antibody, anti-SLA/LP

Type 2:
- Anti-liver kidney microsomes-1, anti-liver cytosol antigen type 1

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65
Q

Mx of autoimmune hepatitis

A
  • high dose steroids
  • immunosuppressants (azathioprine)
  • liver transplant is end stage liver disease
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66
Q

what is haemochromatosis

A

AR
iron storage disorder
HFE gene on Chr 6

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67
Q

Presentation of haemochromatosis

A
  • > 40y/o
  • fatigue and joint pain
  • bronze skin
  • Testicular atrophy
  • Erectile dysfunction
  • Amenorrhoea
  • Cognitive symptoms (memory and mood disturbance)
  • Hepatomegaly
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68
Q

diagnosis of haemochromatosis

A
  • serum ferritin
  • transferrin
  • genetic testing
  • liver biopsy
  • MRI
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69
Q

causes of raised serum ferritin

A
  • Haemochromatosis
  • Infections (it is an acute phase reactant)
  • Chronic alcohol consumption
  • Non-alcoholic fatty liver disease
  • Hepatitis C
  • Cancer
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70
Q

Complications of haemochromatosis

A
  • Secondary diabetes (iron affects the functioning of the pancreas)
  • Liver cirrhosis
  • Endocrine and sexual problems (hypogonadism, erectile dysfunction, amenorrhea and reduced fertility)
  • Cardiomyopathy (iron deposits in the heart)
  • Hepatocellular carcinoma
  • Hypothyroidism (iron deposits in the thyroid)
  • Chondrocalcinosis (calcium pyrophosphate deposits in joints) causes arthritis
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71
Q

Mx of haemochromatosis

A
  • venesection
  • monitor serum ferritin
  • monitor and treat complications
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72
Q

what is wilson’s disease

A

AR
accumulation of copper particularly in liver
Chr13

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73
Q

features of wilson’s

A
  • teenagers/young adult
  • Kayser Fleischer rings
  • chronic hepatitis, cirrhosis
  • neuro: tremor, dysarthria, dystonia, Parkinsonism
  • psych: abnormal behaviour, depression, cognitive impairment, pyschosis
  • haemolytic anaemia
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74
Q

diagnosis of wilson’s

A
  • low serum caeruloplasmin
  • 24hr urine copper assay
  • liver biopsy
  • MRI brain (double panda sign)
  • negative coomb’s test
  • genetic testing
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75
Q

Mx of wilson’s

A

copper chelation with:
- penicillamine
- trientine

other mx
- zinc salts
- liver transplant

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76
Q

organs affected in A1AD

A
  • lungs: COPD and bronchiectasis. reduces elasticity
  • liver: dysfunction, fibrosis, cirrhosis
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77
Q

chromosome effected in A1AD and inheritance

A

SERPINA1 gene Chr 14
Autosomal co-dominant

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78
Q

less commonly associated conditions with A1AD

A
  • panniculitis
  • granulomatosis with polyangiitis
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79
Q

how to diagnose A1AD

A
  • genetic testing
  • low serum A1A

assess lung/liver damage:
- CXR, CT thorax, Pulm FT
- liver biopsy

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80
Q

Mx of A1AD

A
  • stop smoking
  • symptomatic mx
  • organ transplant
  • monitor for complications
  • screen family
  • can give IV A1A, not by NICE
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81
Q

what is PBC

A

autoimmune
attack small bile ducts in liver –>obstructive jaundice and liver disease

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82
Q

where is bile produced

A

liver

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83
Q

where is bile stored

A

gall bladder

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84
Q

Cause of itching and jaundice

A

itching- raised bile acids
jaundice- raised bilirubin

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85
Q

xanthelasma

A

cholesterol deposits

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86
Q

presentation of PBC

A
  • white woman 40-60
  • fatigue
  • pruritis and excoriations
  • GI sx and abdo pain
  • jaundice
  • pale, greasy stool
  • dark urine
  • xanthelasma
  • hepatomegaly
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87
Q

Ix for PBC

A
  • raised ALP (obstructive)
  • AMA (most specific)
  • ANA
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88
Q

Mx of PBC

A
  • ursodeoxycholic acid (protects cholangiocytes from inflammation)

other
- obeticholic acid
colestyramine
- replace fat soluble vitamins
- immunosuppression
- liver transplant

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89
Q

complications of PBC

A
  • vitamin defeciency (A,D,E,K)
  • osteoporosis
  • hyperlipidaemia
  • sjogren’s
  • connective tissue diseases
  • thyroid disease
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90
Q

what is PSC

A

inflammation of of the bile ducts
stiffening/hardening of bile ducts

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91
Q

what is PSC associated with

A

ulcerative colitis

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92
Q

risk factors for PSC

A
  • male
  • 30-40
  • UC
  • FH
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93
Q

Presentation of PSC

A
  • RUQ pain
  • pruritis
  • fatigue
  • jaundice
  • hepatosplenomegaly
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94
Q

Ix for PSC

A
  • raised ALP
  • p-ANCA
  • ANA
  • Anti-smooth muscle antibodies
  • MRCP (shows strictures)
  • colonoscopy (for UC)
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95
Q

Mx of PSC

A
  • no treatments
  • ERCP for strictures (+abx)
  • liver transplant in advanced
  • colestyramine for pruritis
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96
Q

complications of PSC

A
  • biliary strictures
  • acute bacterial cholangitis
  • cholangiocarcinoma
  • cirrhosis
  • fat soluble vit deficiency
  • osteoporosis
  • colorectal cancer in UC
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97
Q

what is IgG4 related sclerosing cholangitis

A

like PSC but has elevated IgG4.
responds well to steroids

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98
Q

main type of primary liver cancer

A

HCC

99
Q

RFs for HCC

A

MAIN= liver cirrhosis due to:
- alcohol, NAFLD, hep B/C, PSC

100
Q

screening for liver cirrhosis

A

USS and AFP to check for HCC every 6 months

101
Q

presentation of liver cancer

A

usually present late
- FLAWS
- N&V
- jaundice
- pruritis
- upper abdo mass

102
Q

Ix for liver cancer

A
  • AFP
  • USS
  • CT/MRI
  • biopsy
103
Q

Mx of liver cancer

A

poor prognosis
- surgery if early: resection or liver transplant
- radiofrequency or microwave ablation
- TACE

104
Q

What is cholangiocarcinoma

A

cancer in bile ducts: majority adenocarcinoma
assoc with PSC

105
Q

features of obstructive jaundice

A
  • pale stools
  • dark urine
  • pruritis
106
Q

tumour marker for cholangiocarcinoma

A

CA19-9

107
Q

what is haemangioma

A

benign tumour of liver
no treatment needed

108
Q

what is focal nodular hyperplasia

A

benign liver tumour of fibrotic tissue
no treatment needed

109
Q

what is living donor transplant

A

part of liver transplanted and both regenerate to 2 fully functioning livers

110
Q

what is split donation

A

split the liver of a deceased person into two and transplant the two parts into two patients and have them regenerate to function normally in both

111
Q

indication for liver transplant

A

acute liver failure (acute viral hepatitis, paracetamol overdose)
chronic liver failure

112
Q

surgical incisions in liver transplant

A
  • rooftop
  • mercedes benz
113
Q

post liver transplant care

A
  • immunosuppression (steroids, azathioprine, tacrolimus)
  • lifestyle
  • monitor for rejection
114
Q

cell lining in oesophagus

A

oesophagus = squamous epithelial lining
stomach= columnar epithelial lining

115
Q

most common type of oesophageal cancer

A
  • adenocarcinoma (history of Barrett’s and GORD)
  • 2nd MC SCC
116
Q

where is adenocarcinoma of oesophagus

A

Lower third - near the gastroesophageal junction

117
Q

where is SCC of oesophagus

A

Upper two-thirds of the oesophagus

118
Q

presentation of oesophageal cancer

A
  • dysphagia: the most common
  • anorexia and weight loss
  • vomiting
    other possible features include: odynophagia, hoarseness, melaena, cough
119
Q

triggers for GORD

A
  • greasy/spicy foods
  • coffee/tea
  • alcohol
  • NSAIDs
  • stress
  • smoking
  • obesity
  • hiatus hernia
120
Q

presentation of GORD

A
  • dyspepsia
  • heartburn
  • acid regurgitation
  • retrosternal/epigastric pain
  • bloating
  • nocturnal cough
  • hoarse voice
121
Q

red flags for GORD

A
  • dysphagia
  • > 55
  • weight loss
  • upper abdo pain
  • reflux
  • treatment resistant dyspepsia
122
Q

what is hiatus hernia

A

herniation of the stomach up through the diaphragm

123
Q

types of hiatus hernia

A
  • Type 1: Sliding
  • Type 2: Rolling
  • Type 3: Combination of sliding and rolling
  • Type 4: Large opening with additional abdominal organs entering the thorax

sliding- stomach slides up through the diaphragm, with the gastro-oesophageal junction passing up into the thorax

rolling- separate portion of the stomach (i.e., the fundus), folds around and enters through the diaphragm opening, alongside the oesophagus

124
Q

Mx of GORD

A
  • lifestyle changes
  • stop NSAIDs
  • antacids
  • PPI
  • Histamine H2 receptor antagonists
  • surgery (laprascopic fundoplication)
125
Q

Which investigations are required by surgeon’s before fundoplication is performed?

A

manometry and oesophageal pH

126
Q

what is H.pylori

A

gram negative aerobic bacteria

127
Q

conditions associated with H.pylori

A
  • peptic ulcer disease
  • gastric cancer
  • B cell lymphoma
  • atrophic gastritis
128
Q

Ix for H.pylori

A
  • Stool antigen test
  • Urea breath test using radiolabelled carbon 13
  • H. pylori antibody test (blood)
  • Rapid urease test during endoscopy
129
Q

mx of h.pylori

A

triple therapy
(PPI + amoxicillin + clarithromycin/metronidazole) for 7days

130
Q

test if h.pylori not eradicated

A

urea breath test 4 weeks post

131
Q

what is barrett’s oesophagus

A

metaplasia. lower oesophageal epithelium changes from squamous to columnar epithelium
pre-malignant

132
Q

risk factor for oesophageal adenocarcinoma

A

Barrett’s oesophagus

133
Q

Mx of Barrett’s oesophagus

A
  • endoscopic monitoring
  • PPIs
  • endoscopic ablation
134
Q

what is Zollinger-Ellison Syndrome

A
  • rare
  • duodenal or pancreatic tumour secretes excessive quantities of gastrin.
  • stimulates acid secretion = severe dyspepsia, diarrhoea, peptic ulcer
135
Q

what can gastrin secreting tumours be associated with

A

MEN1

136
Q

what are more common peptic or duodenal ulcers

A

duodenal

137
Q

which artery is commonly affected in duodenal ulcer

A

gastroduodenal artery

138
Q

RFs for ulcer

A

H.pylori
NSAIDs

139
Q

what increases stomach acid

A
  • stress
  • alcohol
  • caffeine
  • smoking
  • spicy food
140
Q

things that increase risk of bleeding from a peptic ulcer

A
  • NSAIDs
  • aspirin
  • anticoagulants
  • steroids
  • SSRIs
141
Q

presentation of peptic ulcers

A
  • epigastric discomfort
  • N&V
  • dyspepsia

bleeding
- haematemesis
- coffee ground vomiting
- malaena
- fall in Hb/FBC

142
Q

impact of food on peptic and duodenal ulcers

A

peptic- worse on eating
duodenal- better on eating

143
Q

diagnosis of peptic ulcers

A

endoscopy: rapid urease test

144
Q

Mx of peptic ulcers

A
  • stop NSAID
  • treat h.pylori
  • PPIs
  • repeat endoscopy 4-8 weeks to ensure healing
145
Q

define upper GI bleeding

A

bleeding from oesophagus, stomach or duodenum

146
Q

sources of upper GI bleeding

A
  • peptic ulcers (MC)
  • mallory weiss tear
  • oesophageal varices
  • stomach cancers
147
Q

presentation of upper GI bleed

A
  • haematemesis
  • coffee ground vomit
  • malena
148
Q

presentation of mallory weiss tear

A

Occur after heavy retching or vomiting, which may be caused by binge drinking, gastroenteritis or hyperemesis gravidarum

149
Q

scoring system to estimate risk of having upper GI bleed

A

Glasgow Blatchford score

150
Q

score used after endoscopy to estimate the risk of rebleeding and mortality

A

Rockall score

151
Q

define IBD

A

UC
Crohn’s

152
Q

General presenting features of IBD

A
  • Diarrhoea
  • Abdominal pain
  • Rectal bleeding
  • Fatigue
  • Weight loss
153
Q

features of Crohns

A
  • N: No blood or mucus (PR bleeding is less common)
  • E: Entire gastrointestinal tract affected
  • S: “Skip lesions” on endoscopy
  • T: Terminal ileum most affected and Transmural (full thickness) inflammation
  • S: Smoking is a risk factor (don’t set the nest on fire)

increased goblet cells
cobblestone appearance
non-caseating granuloma

154
Q

most commonly affected site in Crohn’s

A

ileum

155
Q

what is Crohn’s associated with

A

strictures and fistulas

156
Q

Features of UC

A
  • C: Continuous inflammation
  • L: Limited to the colon and rectum
  • O: Only superficial mucosa affected
  • S: Smoking is protective
  • E: Excrete blood and mucus
  • U: Use aminosalicylates
  • P: PSC

crypt abscesses, pseudopolyps

157
Q

associated conditions with IBD

A
  • erythema nodosum
  • pyoderma gangrenosum
  • enteropathic arthritis
  • PSC
  • red eye conditions (episcleritis, anterior uveitis)
158
Q

Ix for IBD

A
  • FBC
  • CRP
  • U&E, LFT< TFT
  • anti-TTG
  • stool MC&S
  • faecal calprotectin
  • colonoscopy (mild to mod UC, flexi sigmoid if severe)
159
Q

Mx of acute UC

A

Mild to moderate
- Aminosalicylate (e.g., oral or rectal mesalazine) first-line
- Corticosteroids (e.g. oral or rectal prednisolone) second-line

Severe
- 1st line IV steroids
- IV ciclosporin, infliximab, surgery

160
Q

Mx for maintaining remission in UC

A
  • 1st line aminosalicylate
  • azathioprine
  • mercaptopurine
  • permanent ileostomy or ileo-anal anastamosis permanent solution
161
Q

Mx of acute Crohn’s

A

Mild
- 1st line steroids (prednisolone)
- enteral nutrition
- azathioprine, methotrexate

Severe
- IV hydrocortisone, metronidazole

162
Q

Mx for maintaining remission Crohn’s

A
  • Azathioprine
  • Mercaptopurine

Surgery
- resecting distal ileum, treating strictures and fistula

163
Q

which enzyme function needs to be checked before starting azathioprine

A

thiopurine methyltransferase (TPMT)
can lead to bone marrow suppression if deficient

164
Q

what is IBS

A

functional disorder

165
Q

Features of IBS

A

I- intestinal discomfort
B- bowel habit abnormality
S- Stool abnormality

166
Q

DDx for IBS

A
  • bowel cancer
  • IBD
  • coeliac
  • ovarian cancer
  • pancreatic cancer
167
Q

Diagnosis of IBS

A

sx >6 months
and exclude other differentials

168
Q

Mx of IBS

A
  • lifestyle
  • low FODMAP diet
  • loperamide
  • bulk forming laxatives
  • antispasmodics
  • linaclotide
169
Q

what conditions is coeliac associated with

A

autoimmune conditions particularly T1DM and thyroid disease

170
Q

antibodies related to coeliac disease

A
  • Anti-tissue transglutaminase antibodies (anti-TTG)
  • Anti-endomysial antibodies (anti-EMA)
  • Anti-deamidated gliadin peptide antibodies (anti-DGP)
171
Q

part of the bowel affected in coeliac

A

small bowel particularly jejunum
causes atrophy of intestinal villi

172
Q

HLA genotypes associated with coeliac

A

HLA DQ2
HLA DQ8

173
Q

Presentation of coeliac

A
  • Failure to thrive in children
  • Diarrhoea
  • Bloating
  • Fatigue
  • Weight loss
  • Mouth ulcers
174
Q

Skin condition caused by coeliac

A

dermatitis herpetiformis (itchy, blistering skin rash)

175
Q

how to diagnose coeliac

A

eat gluten for at least 6 weeks
- total IgA
- Anti-TTG
endoscopy (villous atrophy and crypt hyperplasia) : jejunal biopsy

176
Q

Complications of coeliac

A
  • nutritional deficienceis
  • anaemia
  • osteoporosis
  • Hyposplenism (with immunodeficiency, particularly to encapsulated bacteria such as Streptococcus pneumoniae)
  • Ulcerative jejunitis
  • Enteropathy-associated T-cell lymphoma (EATL)
  • Non-Hodgkin lymphoma
  • Small bowel adenocarcinoma
177
Q

causes of C.difficile

A

Cephalosporins
PPIs

178
Q

how to diagnose c.difficile

A

c.difficile toxin in stool

179
Q

Mx of c.difficile

A

first episode
10 days oral vancomycin

recurrent
<12 weeks: oral fidaxomicin
>12 weeks oral vancomycin or fidax

life threatening: oral vancomycin AND IV metronidazole

180
Q

how to differentiate severity of C.difficile infection

A

white cell count

181
Q

Watery travellers diarrhoea

A

enterotoxigenic E.coli infection

182
Q

bloody diarrhoea

A

campylobacter jejuni

183
Q

greasy floating stool, recent travel, swimming in water, foul smelling

A

giardia lamblia

184
Q

Electrolyte disturbances seen in refeeding syndrome

A
  • Hypophosphataemia
  • hypokalaemia
  • hypomagnesaemia
185
Q

blood test to differentiate between Upper and lower GI bleed

A

high urea = upper GI

186
Q

most common type of pancreatic cancer

A

80% adenocarcinoma at head of pancreas

187
Q

associations with pancreatic cancer

A
  • age
  • smoking
  • diabetes
  • chronic pancreatitis
  • hereditary non-polyposis colorectal carcinoma
  • multiple endocrine neoplasia
  • BRCA2 gene
  • KRAS gene mutation
188
Q

Features of pancreatic cancer

A
  • painless jaundice
  • pale stools, dark urine, and pruritus
  • cholestatic liver function tests
  • abdominal mass
  • double duct sign on MRCP
189
Q

what is courvoisier’s law

A

presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones

190
Q

Ix for pancreatic cancer

A

high resolution CT

191
Q

Mx pancreatic cancer

A
  • most not suitable for surgery
  • Whipple’s resection
  • ERCP and stent for palliative
192
Q

what is Gilbert’s

A

AR
defective bilirubin conjugation due to a deficiency of UDP glucuronosyltransferase.

193
Q

Features of Gilbert’s

A

isolated rise in bilirubin
episodes of jaundice during illness, exercise or fasting.
Feel well

194
Q

what is carcinoid syndrome

A
  • occurs when metastases are present in the liver and release serotonin into the systemic circulation
  • may also occur with lung carcinoid as mediators are not ‘cleared’ by the liver
195
Q

features of carcinoid syndrome

A
  • flushing
  • diarrhoea
  • bronchospasm
  • hypotension
  • pellagra
196
Q

Ix for carcinoid syndrome

A
  • urinary 5-HIAA
  • plasma chromogranin A y
197
Q

Mx of carcinoid syndrome

A
  • somatostatin analogues (octreotide)
  • diarrhoea: cyproheptadine may help
198
Q

medication that can cause cholestasis

A

co-amoxiclav
COCP

199
Q

what is achalasia

A

Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter (LOS) due to degenerative loss of ganglia from Auerbach’s plexus

200
Q

features of achalasia

A
  • dysphagia of BOTH liquids and solids
  • typically variation in severity of symptoms
  • heartburn
  • regurgitation of food
  • may lead to cough, aspiration pneumonia etc
  • malignant change in small number of patients
201
Q

Ix of achalasia

A

oesophageal manometry
barium swallow
CXR

202
Q

Mx of achalsia

A
  • 1st: pneumatic (balloon) dilation
  • Heller cardiomyotomy
203
Q

what cancer does achalasia increase the risk of

A

squamous cell carcinoma of the oesophagus (upper 2/3s)

204
Q

what is intestinal angina

A

triad of severe, colicky post-prandial abdominal pain, weight loss, and an abdominal bruit
cause- atherosclerosis of GI arteries

205
Q

what is budd chiari syndrome

A

hepatic vein thrombosis

206
Q

causes of budd chiari syndrome

A
  • polycythaemia rubra vera
  • thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies
    pregnancy
  • COCP
207
Q

features of budd chiari syndrome

A
  • abdominal pain: sudden onset, severe
  • ascites → abdominal distension
  • tender hepatomegaly
208
Q

Ix for Budd Chiari syndrome

A

ultrasound with Doppler flow studies

209
Q

organisms found in pyogenic liver abscesses

A
  • Staphylococcus aureus = children
  • Escherichia coli = adults.
210
Q

Mx of liver abscess

A
  • drainage (typically percutaneous) and antibiotics
  • amoxicillin + ciprofloxacin + metronidazole
  • if penicillin allergic: ciprofloxacin + clindamycin
211
Q

what is plummer vinson syndrome

A

Triad of:
- dysphagia (secondary to oesophageal webs)
- glossitis
- iron-deficiency anaemia

212
Q

mx of plummer vinson syndrome

A

iron supplementation and dilation of the webs

213
Q

do you replace folate or b12 first and why

A

replace b12 first to prevent subacute combined degeneration of the cord

B before F

214
Q

pathophysiology of pernicious anaemia

A

antibodies to intrinsic factor +/- gastric parietal cells
vit b12 deficiency

215
Q

presentation of pernicious anaemia

A
  • lethargy
  • pallor (‘lemon tinge’)
  • dyspnoea
  • peripheral neuropathy
  • subacute combined degeneration of the spinal cord
  • atrophic glossitis
216
Q

mx of pernicious anaemia

A

IM hydroxocobalamin 3x a week for 2 weeks then 3 monthly injections

217
Q

which cancer does pernicious anaemia increase risk of

A

gastric cancer

218
Q

treatment of ulcerative colitis that can cause anaemia

A

sulphasalazine
heinz body anaemia

219
Q

triad for gallstones

A

RUQ pain
fever
jaundice

220
Q

what is boerhaave syndrome

A

rupture of his oesophagus due to severe vomiting

221
Q

features of boerhaave syndrome

A

Vomiting → severe chest pain, shock
crepitus on palpation of chest wall

222
Q

severe diarrhoea acid base imbalance

A

hypokalaemic Hyperchloraemic hyponatraemic metabolic acidosis

223
Q

features of diverticulitis

A

left lower quadrant pain, diarrhoea and fever

224
Q

liver features in right heart failure

A
  • one of the most common causes of hepatomegaly
  • firm, smooth and tender to touch liver edge.
  • PULSATILE: due to the back-up of blood due to the failure of the right side of the heart
225
Q

adverse effects of PPIs

A
  • hyponatraemia, hypomagnasaemia
  • osteoporosis → risk of fractures
  • microscopic colitis
  • increased risk of C. difficile
226
Q

which anatomical landmark will allow the categorisation of upper and lower GI bleed during urgent endoscopy?

A

ligament of Treitz
Upper GI Bleed is a haemorrhage with an origin proximal to the ligament of Treitz

227
Q

name for palpable umbilical node.

A

Sister Mary Joseph node
It’s due to metastasis of malignant cancer within the pelvis or abdomen

228
Q

Gastro cause of cause of hypogonadotrophic hypogonadism in men

A

haemochromatosis

229
Q

Barrett’s metaplasia increases the risk of which cancer

A

adenocarcinoma of oesophagus

230
Q

RFs for Small bowel bacterial overgrowth syndrome

A
  • neonates with congenital gastrointestinal abnormalities
  • scleroderma
  • diabetes mellitus
231
Q

Mx of Small bowel bacterial overgrowth syndrome

A

rifxaimin

232
Q

features of pharyngeal pouch

A

Dysphagia, aspiration pneumonia, halitosis, regurgitation, chronic cough

233
Q

presentation of ascending cholangitis

A

infection of the bile ducts commonly secondary to gallstones.
Triad:
1. RUQpain
2. rigors
3. jaundice

234
Q

what condition can develop post ERCP

A

pancreatitis

235
Q

what is gallstone ileus

A

small bowel obstruction secondary to an impacted gallstone.
Abdominal pain, distension and vomiting are seen.

236
Q

oral aminosalicylates can cause what GI side effects

A
  • diarrhoea
  • N&V
  • exacerbation of colitis
  • acute pancreatitis (mesalazine > sulfasalazine)
237
Q

what is murphy’s sign

A

palpating under the right costal margin causes to catch her breath.
acute cholecystitis

238
Q

what drug will you administer to reduce the risk of isoniazid induced peripheral neuropathy

A

Pyridoxine (vitamin B6)

239
Q

area most likely to be effected in ischaemic colitis

A

splenic flexure

240
Q

triad for liver failure

A
  • hepatic encephalopthy
  • jaundice
  • coagulopathy
241
Q

condition associated with gallstone dvlpt

A

terminal ileitis (crohn’s)
CROHN’S GIVES STONES
where bile salts are reabsorbed

242
Q

blood supply of duodenum

A
  • D1-2 superior and descending (Proximal to the major duodenal papilla) is gastroduodenal artery
  • D3-4 trasnverse and ascending (distal to the major duodenal papilla) is the inferior pancreaticoduodenal artery (branch of superior mesenteric artery)
243
Q

blood supply of jejunum and ileum

A

SMA

Finals (26 decks)

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