Gastro Flashcards
Virchows triad
Inflammation
Endothelial injury
Hypercoagulability
Position of splenic vein in relation to pancreas
Posterosuperior border of pancreas
causes of raised amylase
Acute pancreatitis
Pancreatic psuedocyst
Mesenteric infract
DKA
Perforated viscus
Acute cholecystitis
Factors indicating severe pancreatitis
age >55 years
Hyperglycemia
Hyperlipidemia
Hypoxia
Hypocalcemia
elevated LDH and AST
Neutrophilia
Viruses causing pancreatitis
Mumps
Coxsacki B virus
Autoimmune cause of pancreatitis
PAN
Metabolic causes ofpancreatitis
hyperglycemia
Hypertriglycridemia
Hypothermia(by inducing SIRS and reducing blood flow to pancreas and initiating inflammatory response)
Hypercalcemia
Drugs causing pancreatitis
azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate
Pt taking mesalazine are 7 times more prone to disease than on sulfasalazine
how pancreatitis causes ARDS
The inflammatory process in acute pancreatitis leads to the release of pro-inflammatory cytokines such as TNF-alpha, IL-1, and IL-6 into the systemic circulation. These cytokines induce a systemic inflammatory response syndrome (SIRS), which increases vascular permeability and results in pulmonary oedema. Additionally, activated pancreatic enzymes can cause direct injury to alveolar-capillary membranes, exacerbating inflammation and leading to diffuse alveolar damage characteristic of ARDS. Management follows UK guidelines which include supportive care with mechanical ventilation using lung-protective strategies, fluid management to avoid volume overload, and addressing the underlying cause of pancreatitis.
Investigations for pseudocyst of pancreas
Investigation is with CT, ERCP and MRI or endoscopic USS
What is acute pancreatitis?
Acute pancreatitis is an inflammatory condition of the pancreas that occurs suddenly and can be severe.
What are the two most common causes of acute pancreatitis?
The two most common causes are gallstones and chronic and excessive alcohol consumption.
True or False: Acute pancreatitis can be caused by medications.
True
Fill in the blank: The classic presentation of acute pancreatitis includes severe ______ pain.
abdominal
What laboratory test is most indicative of acute pancreatitis?
Elevated serum amylase and lipase levels.
Which imaging study is preferred for diagnosing acute pancreatitis?
Abdominal ultrasound is preferred for detecting gallstones; CT scan is used for assessing complications.
What is the Ranson criteria used for?
The Ranson criteria are used to assess the severity and prognosis of acute pancreatitis.
True or False: Patients with acute pancreatitis should be given oral food intake immediately.
False
What is the initial management step in acute pancreatitis?
The initial management step is supportive care, including fluid resuscitation and pain management.
What is the role of antibiotics in the management of acute pancreatitis?
Antibiotics are not routinely used unless there is evidence of infected pancreatic necrosis.
Which complication is associated with severe acute pancreatitis?
Pancreatic necrosis, abscess formation, and systemic inflammatory response syndrome (SIRS).
What is the significance of a patient’s age in acute pancreatitis prognosis?
Older age is associated with a higher risk of complications and poorer prognosis.
Fill in the blank: The presence of ______ in the blood can indicate a severe case of acute pancreatitis.
elevated CRP levels
What lifestyle change can help prevent recurrent acute pancreatitis?
Avoiding alcohol consumption.
True or False: Surgical intervention is often the first line of treatment in acute pancreatitis.
False
What is the ‘pancreatic rest’ approach in the management of acute pancreatitis?
The ‘pancreatic rest’ approach involves nil per os (NPO) status to minimize pancreatic stimulation.
Which scoring system is used to predict mortality in acute pancreatitis?
APACHE II scoring system.
Fill in the blank: Patients with acute pancreatitis should be monitored for ______ failure.
respiratory
What is the term for the collection of fluid surrounding the pancreas after acute pancreatitis?
Pancreatic pseudocyst.
What dietary changes are recommended after recovery from acute pancreatitis?
A low-fat diet and avoidance of alcohol.
True or False: Acute pancreatitis can resolve on its own without treatment.
True, in mild cases.
What is the role of ERCP in acute pancreatitis management?
ERCP is used to remove stones from the bile duct if they are causing pancreatitis.
What is a common symptom that may indicate a complication of acute pancreatitis?
Persistent fever or increasing abdominal pain.
What is the ‘3-day rule’ in the context of acute pancreatitis management?
If a patient does not improve within 3 days, further investigation is warranted.
Fill in the blank: The ______ sign is a physical exam finding associated with acute pancreatitis.
Cullen’s
What does GERD stand for?
Gastroesophageal reflux disease
True or False: GERD is characterized by the retrograde flow of gastric contents into the esophagus.
True
What is a common symptom of GERD?
Heartburn
Which diagnostic test is often used to confirm GERD?
24-hour pH monitoring
Name a lifestyle modification that can help manage GERD symptoms.
Avoiding large meals
What class of medication is typically used first-line for GERD treatment?
Proton pump inhibitors (PPIs)
What is the primary cause of peptic ulcers?
Helicobacter pylori infection
Fill in the blank: The most common complication of peptic ulcers is __________.
Hemorrhage
True or False: Nonsteroidal anti-inflammatory drugs (NSAIDs) can contribute to the development of peptic ulcers.
True
What is the hallmark symptom of a duodenal ulcer?
Epigastric pain that improves with food
What imaging study is typically used to evaluate peptic ulcers?
Upper gastrointestinal endoscopy
What is the treatment regimen for H. pylori eradication?
Triple therapy: PPI, amoxicillin, and clarithromycin
What condition is characterized by the presence of multiple gastric ulcers?
Zollinger-Ellison syndrome
Name one risk factor for developing gastric cancer.
Chronic gastritis
What is the primary symptom of gastric cancer?
Weight loss
True or False: Linitis plastica is a type of gastric cancer that presents with a thickened gastric wall.
True
What type of imaging is preferred for staging gastric cancer?
CT scan of the abdomen
What is the role of endoscopic ultrasound in gastric cancer?
To assess the depth of invasion and lymph node involvement
What is the most common type of esophageal cancer?
Adenocarcinoma
Fill in the blank: Achalasia is characterized by __________ of the lower esophageal sphincter.
Increased tone
What is a common symptom of achalasia?
Dysphagia for solids and liquids
What diagnostic test is used to confirm achalasia?
Esophageal manometry
True or False: Surgical myotomy is a treatment option for achalasia.
True
What is the most common cause of esophagitis?
Reflux disease
What is a potential complication of severe esophagitis?
Stricture formation
What is the mainstay treatment for esophagitis caused by reflux?
Proton pump inhibitors (PPIs)
Name one infectious cause of esophagitis.
Candida infection
True or False: Eosinophilic esophagitis is associated with food allergies.
True
What is the primary treatment for eosinophilic esophagitis?
Elimination diet or topical corticosteroids
What is the main symptom of a hiatal hernia?
Heartburn
What type of hiatal hernia is most common?
Sliding hiatal hernia
Fill in the blank: A __________ is a protrusion of the stomach through the diaphragm.
Hiatal hernia
What is the primary treatment for symptomatic hiatal hernia?
Lifestyle modifications and PPIs
What is the name of the procedure to correct a hiatal hernia?
Nissen fundoplication
True or False: Barrett’s esophagus is a precancerous condition associated with chronic GERD.
True
What is the primary method for diagnosing Barrett’s esophagus?
Endoscopy with biopsy
What is the risk associated with Barrett’s esophagus?
Increased risk of esophageal adenocarcinoma
What is the initial management for Barrett’s esophagus?
Regular surveillance endoscopies
What is the common name for the condition characterized by esophageal webs?
Plummer-Vinson syndrome
Fill in the blank: The classic triad of Plummer-Vinson syndrome includes dysphagia, iron deficiency anemia, and __________.
Esophageal webs
What is the treatment for Plummer-Vinson syndrome?
Iron supplementation and dilation of esophageal webs
What is the primary cause of esophageal varices?
Portal hypertension
True or False: Esophageal varices can lead to life-threatening hemorrhage.
True
What is the first-line treatment for acute variceal hemorrhage?
Endoscopic variceal band ligation
What medication is used to reduce portal pressure in variceal hemorrhage?
Vasopressin or octreotide
What is a common complication of untreated varices?
Rebleeding
Fill in the blank: The __________ is a muscular tube that connects the throat to the stomach.
Esophagus
Genetic causes of chronic pancreatitis
cystic fibrosis
hemochromatosis
can we rely on enzyme assay in chronic pancretitis?
No because cells producing those enzymes are destroyed and there is fibrosis that obstructs
Diagnostics for chronic pancreatitis
we use a combination of patient history (including symptoms like recurrent abdominal pain), imaging studies such as CT or MRI scans which can show structural changes in the pancreas, and sometimes more advanced tests like endoscopic ultrasound or ERCP. In some cases, functional testing using secretin stimulation test may also be used.
Chronic pancreatitis complications
Osteoporosis
PUD
Diabetes (type 3c)
Steatorrhea
Common location for pancreatic cancer
Head of pancreas
Investigation of choice for pancreatic cancer
HRCT
(double duct sign)
Association of pancreatic cancer
increasing age
smoking
diabetes
chronic pancreatitis (alcohol does not appear an independent risk factor though)
hereditary non-polyposis colorectal carcinoma
multiple endocrine neoplasia
BRCA2 gene
KRAS gene mutation
Complications of c.diff
Toxic megacolon
Bowel perfortaion
Sepsis
Pseudomembranous colitis
Amtibiotics causing c.diff infection
Clindamycin
Cephalosporin
Ceftriaxone
Mero
First line antibiotic for c.diff
Vanco
2nd: Febuxostat
(Supportive care, isolation for 48hr)
Colon cancer commonly metastasize to
Liver
Rectal cancer metastasize commonly to
Lungs
Apple core sign on barium enema
Colorectal cancer
Difference between FAP and HNPCC
FAP on left side and full of polyps
HNPCC on right side (proximal colon) and no polyps and remain asymptomatic until last stage bcs no polyps found and only occult bleeding
Colonoscopy doesnt really help with HNPCC
HbsAg positive
Anti- Hbc positive
Carrier
HbsAg positive
Acute hepatitis
Diagnosis of carcinoidd ssydrome
Octreotide scan
Urinary 5HIAA
Nicain levels
Gene involved in hemochromatosis
HFE gene on both copies of chromosome 6
Iron profile in hemochromatosis
transferrin saturation > 55% in men or > 50% in women
raised ferritin (e.g. > 500 ug/l) and iron
low TIBC
HbsAg negative
Anti-Hbs positive
Immunized
Anti-Hbc positive
HbsAg negative
Previous hep B positive and not a carrier
Bronze skin pigmentation
Hemochromatosis
HbsAg +
HbeAg +
Anti-HbC igG +
Chronic hepatitis
Causes of UC flares
Stress
NsAIDS
STEROIDS
Cessation of smoking
Watershed areas
Splenic flexure
Rectosigmoid junction
Griffith’s point
Splenic flexure
Why watershed areas are prone to ischemia
Due to their location at furthest point from arterial supply
Thumbprinting is a sign of
Ischemic colitis
Ischemic colitiss affect what area
Watershed areas
Ischmic colitis leads to
Infoammation
Ulceration
Haemorrhage
Why thumbprinting is seen
Due to mucosal edema and haemorrhage
10-25 years
Neurological symptoms (basal gqmglia)
Sp3eeech disturbance
KF rings
RTA
Blue nails
Excessive salivation
Family hx of liver disease
Wilson’s disease
Management for wilsons
Penicillamine
Trinetine hydrochloride
Tetrathiomolybdate
Wjich antiviral is contraindicated in pregnancy
Ribavarin
Antiviral that can be given in preg hepatitis
Lamivudine
Tenofovir
Glasgow-Blatchford score at first assessment
helps clinicians decide whether patients can be managed as outpatients or not
Rockall score is used after endoscopy
provides a percentage risk of rebleeding and mortality
includes age, features of shock, co-morbidities, aetiology of bleeding and endoscopic stigmata of recent haemorrhage
Painless bleeding
Old age
Do not cause pain on defecation
O/E reveal lesion on proctoscopy
Rectal polyp
A triad of abd pain, hepatomegaly and ascites
Budd chiari syndrome
Initial radiological investigation for budd chiari syndrome
U/S WITH DOPPLER
Causes of budd chiari syndrome
polycythaemia rubra vera
thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies
pregnancy
combined oral contraceptive pill: accounts for around 20% of cases
Differentiate between cholestatic and hepatic cuase on labs
proportionate rise in ALT > proportionate rise in ALP = hepatitic
proportionate rise in ALT < proportionate rise in ALP = obstructive/cholestatic
Whats a cholestatic picture on the LFTs
cholestatic: initially raised ALP and GGT, then raised serum direct bilirubin as it spills over into blood and urine.
biliary disease in patients with HIV is sclerosing cholangitis due to which infections
CMV, Cryptosporidium and Microsporidia
cholestasis
jaundice, pruritus
raised bilirubin + ALP
right upper quadrant pain
fatigue
ANA and pANCA positive
HIV related
PSC
Type of cells in gastric adenocarcinoma
Signet ring cells
Risk factors for gastric cancer
Helicobacer pylori
triggers inflammation of the mucosa → atrophy and intestinal metaplasia → dysplasia
pernicious anaemia, atrophic gastritis
diet
salt and salt-preserved foods
nitrates
ethnicity: Japan, China
smoking
blood group A
lymphatic spread of gastric cancer
left supraclavicular lymph node (Virchow’s node)
periumbilical nodule (Sister Mary Joseph’s node)
HFE on chromosome 6 autosomal recessive
Haemochromatosis
ATP7B on chromosome 13 -
Wilson’s disease
autosomal recessive
HFE gene responsible for what
iron storage in body
why serum ferritin is unreliable in diagnosis of hemochromatosis
because it is an acute phase reactant and can be raised in any other inflammation in body
Typical iron study profile in patient with haemochromatosis
transferrin saturation > 55% in men or > 50% in women
raised ferritin (e.g. > 500 ug/l) and iron
low TIBC
to confirm diagnosis of hemochromatosis
molecular genetic testing for the C282Y and H63D mutations
MRI is generally used to quantify liver and/or cardiac iron
liver biopsy is now generally only used if suspected hepatic cirrhosis
Management for severe colitis
should be treated in hospital
IV steroids are usually given first-line
IV ciclosporin may be used if steroids are contraindicated
if after 72 hours there has been no improvement, consider adding IV ciclosporin to IV corticosteroids or consider surgery
if the patient has abdominal pain relieved by defecation or associated with altered bowel frequency stool form, in addition to 2 of the following 4 symptoms:
altered stool passage (straining, urgency, incomplete evacuation)
abdominal bloating (more common in women than men), distension, tension or hardness
symptoms made worse by eating
passage of mucus
IBS
Redflags for IBS
rectal bleeding
unexplained/unintentional weight loss
family history of bowel or ovarian cancer
onset after 60 years of age
investigations for IBS
CBC
ESR/CRP
coeliac disease screen (tissue transglutaminase antibodies)
Extra intestinal manifestaion of IBD
Arthritis
skin lesions
Gall stones
PSC (uc)
Oral ulcers
ASCA positive in
Crohns
pANCA positive in
UC
Riskfactor for barrets
gastro-oesophageal reflux disease (GORD) is the single strongest risk factor
male gender (7:1 ratio)
smoking
central obesity
Test to assess exocrine function of pancreas
fecal elastase
Risk factors for HCC
liver cirrhosis, for example secondary* to hepatitis B & C, alcohol, haemochromatosis and primary biliary cirrhosis
alpha-1 antitrypsin deficiency
hereditary tyrosinosis
glycogen storage disease
aflatoxin
drugs: oral contraceptive pill, anabolic steroids
porphyria cutanea tarda
male sex
diabetes mellitus, metabolic syndrome
wilson is not a risk factor for which cancer
HCC
symptomatic relief of pruritis
Cholestyramine
It may be considered in patients who do not adequately respond to ursodeoxycholic acid for PBC , or in those with advanced disease, but is not used as a first-line treatment option.
Prednisolone
Diarrhoea + hypokalaemia →
villous adenoma
Adenoma, metabolic acidosis and hypokalemia
Villous adenoma
On sigmoidoscopy or colonoscopy, villous adenomas appear as
cauliflower like growth
Metabolic ketoacidosis with normal or low glucose:
think alcohol
3 causes of raised ketones
Diabetes
starvation
Alcohol
glucose > 11mmol/L (or known diabetes), pH < 7.3, bicarbonate < 15mmol/L and ketones > 3mmol/L. This patient does not have a history of diabetes and is not taking drugs that could cause euglycaemic diabetic ketoacidosis
DKA
Metabolic acidosis
Elevated anion gap
Elevated serum ketone levels
Normal or low glucose concentration
Alcoholic diabetic ketoacidosis
treatment for alcoholic ketoacidosis
infusion of saline & thiamine. Thiamine is required to avoid Wernicke encephalopathy or Korsakoff psychosis.
Charcots triad
RUQ pain
Jaundice
Fever high hrade with rigor and chills
Reynold Pentad
RUQ pain
hypotension
Jaundice
Confusion
Fever
complication of ileocecal resection
bile acid malabsorption
diagnosis for bacterial gastroenteritis
stool culture positive
confirmed NAFLD and an ELF score >10.51 diagnosis
liver fibrosis.
metabolic syndrome
HTN
DM
Obesity
Hepatic steatosis on u/s seen as
Echogenicity
normal AST:ALT
less than 1 if elevated indicate liver fibrosis
diagnosis and monitoring of NAFLD. It made the following suggestions if the ELF blood test was not available:
FIB4 score or NALFD fibrosis score
these scores may be used in combination with a FibroScan (liver stiffness measurement assessed with transient elastography)
effect of vipoma
WDHA (Watery diarrhea, Hypokalemia, Achlorhydria) also called Verner-Morrison
triad of ovarian fibroma, ascites, and pleural effusions.
Meigs syndrome
Ascitic fluid analysis in a patient with spontaneous bacterial peritonitis would reveal
a raised white cell count with predominantly neutrophils.
Diarrhoea - biospy shows pigment laden macrophages =
laxative abuse
Treatment for eosinophilic esophagitis
Diet (elemental diet)
Drugs (PPI+ steroids i.e fluticasone or budesonide)
Dilatation
somatostatin secreted from
D cells
CCK secreted from
I cells of upeer small intestine
S cells
These cells secrete secretin a bicarbonate-rich fluid from the pancreas and hepatic cells and are stimulated by fatty acids.
Internal hemorrhoids are located above dentate line and are supplied by
splanchnic nerves
external hemorrhoids by
pudendal nerve (s2-s4) hence are painful.
CXR findings of achalasia
widened mediastinum or an air-fluid level in the oesophagus
squamous cell carcinoma of esophagus
sensitive to radiotherapy
Raised IgG
Raised transaminases
With mild change in ALP
Autoimmune hepatitis
Drugs that should not be given in pt with IBS
Lactulose
First line treatment for hepatorenal syndrome
Terlipressin
Lab findings for AIH
Raised AsT AlT but ALP almost normal
Raised IgG
Antibodies positive
Hypergammaglobulinemia
: Histopathological findings in autoimmune hepatitis include
interface hepatitis with lymphoplasmacytic infiltrate and rosette formation of hepatocytes
Causes of SCC of esophagus (ASAP)
Alcohol
Smoking
Achalasia
Plummer winson
Drugs causing liver cirrhosis (MMA)
Methotrexate
Methyldopa
Amiadrone
Nitrofurantoin
can work against gram-positive and gram-negative antibiotics and is often the first-line treatment for uncomplicated urinary tract infections. Unfortunately, a potential side effect is an acute hepatitis and hepatic failure, rather than cholestasis.
imaging modality of choice for chronic pancreatitis.
CT pancreas. will show calcification in pancreas
is a rare systemic auto-inflammatory disease characterised by the classic triad of fevers, joint pain, and a distinctive salmon-coloured bumpy rash.
Adult-onset Still’s disease
best investigation to differentiate hydatid cysts from amoebic and pyogenic cysts
CT Scan
classical triad of; biliary colic, jaundice, and urticaria
Biliary rupture of hydatid cyst
Serology test for hydatid cyst
ELISA
(combined with imaging studies such as ultrasound, CT or MRI scans for a more accurate diagnosis according to UK management guidelines.)
pre- and post-operatively for hydatid disease
Albendazole and definitive is surgery
drug of choice for amoebic abscesses.
Metronidazole
Pyogenic liver abscesses treatment
require drainage and antibiotics, often a combination of metronidazole with a cephalosporin or quinolone
hallmark symptom of refeeding syndrome
Refeeding syndrome
Wernicke enceph triad
Ataxia
“Mental confusion
Ophthalmoplegia
Korsakoff syndrome
Ante and retrograde amnesia
Confabulations
Amnesia
ECG changes for refeeding syndrome
Torsades-des-pointes secondary to hypomagnesaemia can result as a consequence of refeeding syndrome
Uwaves and flattening of T waves as a result of hypokalemia
common complication
of TIPSS
exacerbation of hepatic encephalopathy
Drug used in exacerbation of UC
Oral azathioprine
Oral mercaptopurine
During Endoscopy for H pylori.
CLO test
only test recommended for H. pylori post-eradication therapy
Urea breath test
STK11/LKB1 mutation
PJS
Risk factors for SBP
Varices
Advanced cirrhosis
Use of PPI
Previous episode of SBP
Malnutrition
Organism causing SBP
E.coli
Gram negative ones commonly
________ is more common than vitamin B12 deficiency in coeliac disease)
Folate def:
Serology of coeliac
tissue transglutaminase (TTG) antibodies (IgA) are first-choice according to NICE
endomyseal antibody (IgA)
needed to look for selective IgA deficiency, which would give a false negative coeliac result
Gold standard for diagnosis of coeliac
Endoscopic intestinal biopsy that shows
villous atrophy
crypt hyperplasia
increase in intraepithelial lymphocytes
lamina propria infiltration with lymphocytes
is the investigation of choice for suspected carcinoid tumours
Urinary 5-HIAA
Gilberts syndrome
Mutation of UDGT1A1
Raised level of unconjugated bilirubin(17- 100) with normal LFTs
Gilberts syndrome
s jaundice, which can be intermittent and often precipitated by factors such as fasting, dehydration, stress, physical exertion or illness. Associated symptoms can include mild abdominal discomfort and fatigue but many individuals are asymptomatic.
Gilbert syndrome
(Autosomal recessive)
Test to evaluate RTA
Ammonium chloride acidification test
Flushing, diarrhoea, bronchospasm, tricuspid stenosis, pellagra →
carcinoid with liver mets - diagnosis: urinary 5-HIAA
secondary prophylaxis of hepatic encephalopathy
Lactulose
Rifaximin
melanosis coli which is characterised by a brown-black discolouration of the colon due to lipofuscin deposition in macrophages within the lamina propria.
Laxative abuse
Diagnostic test small bowel bacterial overgrowth syndrome
Hydrogen breathe test
Management for SBBOS
Rifaximin
Coamoxiclav
Metronidazole
neonates with congenital gastrointestinal abnormalities
scleroderma
diabetes mellitus
Risk factors for SBBOS
Infertility is sulphasalazine or mesalazine
Sulphasalazine
(S for Sperm and S for Sulphasalazine)
Neurological causes of dysphagia
CVA
Parkinson’s disease
Multiple Sclerosis
Brainstem pathology
Myasthenia Gravis
Dysphagia for both solids and liquids
Ptosis
Extraocular m/s weakness
Myasthenia Gravis
biomarker for neutrophilic infiltration and inflammation within the colon. Elevated levels are often seen in inflammatory bowel disease;
Fecal calprotectin
Organisms which may colonise CF patients
Staphylococcus aureus
Pseudomonas aeruginosa
Burkholderia cepacia*
Aspergillus
Diarrhoea, weight, arthralgia, lymphadenopathy, ophthalmoplegia ?
Whipple’s disease
Previous hepatitis B infection, not a carrier, would be indicated by a
positive Anti-HBs and Anti-HBc, and negative HBs antigen
HNPCC screening started when
At 25years of age
Or 5 years prior the last member was diagnosed
increases secretion of bicarbonate-rich fluid from pancreas and hepatic duct cells
Secretin
inhibits gastric acid secretion and absorption from the intestine while promoting smooth muscle relaxation and blood flow
VIP
Causes of hypoalbuminemia
Liver disease
Renal disease
Malnutrition
Sepsis
Burns
For assessing mural invasion what test to be done
Endoscopic ultrasound
Complication of patients on clindamycin for cellulitis that they must be warned about
Diarrhea
Chief cells secrete what
pepsin, a proteolytic enzyme
Red flag features in IBS
FOUR
F - Family history of bowel or ovarian cancer
O - Onset after 60 years of age
U - Unintentional/unexplained weight loss
R - Rectal bleeding
Angiodyssplasia associated with what heart condition
Aortic stenosis
Heydes syndrome
Angiodysplasia
Aortic stenosis
Cause of heyde syndrome
Aquifer vwF def
Management of angiodysplasia
endoscopic cautery or argon plasma coagulation
antifibrinolytics e.g. Tranexamic acid
oestrogens may also be used
Diagnosis of angiodysplasia by
Colonoscopy
Mesenteric angiography if acute bleeding
Microscopic colitis presents with what on histology
Intraepithelial lymphocytes >20 per 100 epithelial cells
Adverse effects of PPI
Hypomagnesemia
Hyponatremia
Osteoporosis
Microscopic colitis
Increased risk of c.diff infection
_______ are used to monitor treatment in haemochromatosis
Ferritin and transferrin saturation
Antibiotics having known interaction wwith alcohol
Metronidazole
Tinidazole
In suspected SBP- diagnosis is by paracentesis.
Confirmed by neutrophil count >250 cells/ul
used in the management of Crohn’s disease and ulcerative colitis by mitigating the inflammation process.
5- aminosalicylic acid
Recurrent episode of c.diff toxin
With 12wks: oral fidaxomicin
After 12 wks: oral vanco or fidaxo
perianal itching, particularly at night
girls may have vulval symptoms
Threadworms
Threadworm management
CKS recommend a combination of anthelmintic with hygiene measures for all members of the household
mebendazole is used first-line for children > 6 months old. A single dose is given unless infestation persists
Palpable gall bladder with painless jaundice
Courvosiers sign
Positive in cholangiocarcinoma
Other than antibiotics what is the risk factor for CDI
PPI
Chronic anal fissure - treatment
topical glyceryl trinitrate
How does topical glyceryl trinitrate work
It works by relaxing the internal anal sphincter, which reduces pressure and increases blood flow to promote healing of the fissure. Its side effects can include headaches or dizziness due to systemic absorption.
it is essential for these patients to receive regular immunisations for coeliac patient
because they develop hyposplenism which increases their risk to develop infections
What clotting factors produced from liver
Liver produces clotting factors II, V, VII, IX and X and they are vit K dependent
Diarrhoea - biospy shows pigment laden macrophages =
laxative abuse
Amylase:
breaks starch down to sugars
NAAT testing for
Chlamydia
Herpes
type of pneumonia involved in reactivation of type 1 HSV
s. pneumonia
Investigation of choice for herpes
NAAT
treatment for acyclovir
suppressive therapy and oral acyclovir
started after 36wks of gestation
delivery via c section
N.gonorrhea is a gram ____
negative diplococci
Treatment for influenza
only in immunocompromised individual
first ine : Oseltamivir
2nd line: Zanamivir
Organism involved in hand foot and mouth disease
enterovirus
coxsackie A16 virus
highly contagious
Helminthic conditions treatment of choice
Bendezoles
Ivermectin
Treatment for Hep B
Interferon alpha 2a
second line: tenofovir, entecavir or telbivudine
