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Y6 Senior Med > Gastro 2 > Flashcards

Gastro 2 Flashcards

1
Q

what is achalasia

A

loss of oesophageal peristalsis + inability of LOS to pass food into stomach

Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter (LOS) due to degenerative loss of ganglia

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2
Q

Causes of achalasia

A

DEGENERATVE (With age)

AI / Genetic / tripanozoma cruzi (chagas disease- south america)

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3
Q

Sx achalasia

A

dysphagia - both food and liquids
heartburn
regurg
chest pain

common in middle aged

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4
Q

Ix achalasia

A

CXR (widened mediastinum)
barium swallow (beak)
OGD

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5
Q

Mx achalasia

A

Nifedipine + botulinum

Helier myotomy + fundoplication

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6
Q

describe the progression of alcoholic / NAF liver disease

A
  1. steatosis
  2. hepatitis
  3. cirrhosis
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7
Q

histopatj fts of alcoholic hepatitis

A

ballooning
giant mitochondria
mallory hyaline inclusions

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8
Q

WHAT MUST you consider treating in alcoholic liver disease

A

Vit D deficiency > pabrinex
encepalopathy > lactulose
ascites > diuretics

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9
Q

what is Hepatorenal syndrome

A

renal failure in patients with chronic liver disease (due to erroneous constriction of renal blood vessels)

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10
Q

3 complications of appendicitis

A

perforation
appendix mass
appendix abscess

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11
Q

scale to classify chrons

A

Montreal classification

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12
Q

what is gord’

A

reflux of gastric acid and bile, causing oesophagitis

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13
Q

RF for GORD

A
  • increased Intra abdo pressure (obesity, pregnancy)
  • hypotension of oesophageal sphincter (drugs, achalasia, hiatus hernia)
  • acid hypersecretion (smoking, zollinger ellisson)
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14
Q

How do you manage GORD conservativeluy

A

ADVICE

  • WL
  • stop smoking
  • small and regular meals
  • avoid large meals
  • avoid alcohol and spice
  • elevate bed
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15
Q

how do you manage GORD medically

A

antacid (gaviscon)
PPI (omeprazole)
H2 antagonist (ranitidine)

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16
Q

How do you manage GORD surgically

A

Nissen fundoplicaiton

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17
Q

RF / cause for mallory weiss tear

A

alcohol
bulimia
hyperemesis
gastroenteritis

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18
Q

Ix Mallory Weiss tear

A

OGD

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19
Q

Mx Mallowy weiss tear

A

most are self resolving (<48h)

if not, OGD with injection sclerotherapy

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20
Q

What is gastritis

A

inflammation of the gastric mucosa

caused by exposure to gastric acid,

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21
Q

RF gastritis

A

RF are NSAIDS, alcohol, H pulori, bile reflux

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22
Q

what is PUD

A

ulceration as progression of untreated gastritis

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23
Q

how do gastritis /PUD present

A

epigastric pain
nausea, vomiting, loss of appetitie

if PUD: haematemesis, melaena

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24
Q

how do you differentiate between gastric or duodenal ulcer

A

gastric: pain soon after eating, minimal antacid relief, anorexia and WL
duodenal: pain worse hours after eating, good antacid relief, overeats > weighht gain

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25
which condition has a beaded appearance of the biliary tree on MRCP
PSC
26
mx of perianal fistula
Metronidazole + fistulotomy or seton (to allow healing)
27
what do you use for secondary prophylaxis of hepatic encephalopathy
lactulose + rifamixin
28
what are blood results like in Wilsons disease and why
Wilson's disease- problem with copper, in which excess copper is deposited in tissues, causing a LOW serum copper. - reduced serum copper - reduced caeruloplasmin.
29
most common cause of inherited colorectal cancer
HNPCC
30
how do you diagnose UC
flexible sigmoidoscopy colonoscopy (NOT IF ACUTE ATTACK)
31
what is barret's oesophagus
metaplasia of lower oesophageal mucosa
32
BIggeest RF for Barrett's
GORD
33
What occurs at cellular level in Barrett'a
METAPLASIA | squamous becomes columnar
34
what cancer are you at increased risk of with Barretts
adenocarcinoma
35
how do you manage barrett's
endoscopuc surveillance + high risk PPI
36
what do you do if Barrett's become dysplasiq
endoscopic mucosal resection | radiofrequency ablation
37
what are complications of long term Omeprazole use
LOW sodium,. low MG osteoporosis C diff infection
38
how do you screen for haemochromatosis
general population: transferrin saturation > ferritin | family members: HFE genetic testing
39
what route do you give mesalazine in for mild-Mod UC
RECTAL if distal disease | RECTAL AND ORAL if extensive disease
40
what do you give if severe UC
IV steroids + admit
41
what does Urea tell you in the context of an GI bleed
High urea = upper GI bleed versus BECUASE upper GI bleeding MEANS blood is digested into proteins proteins are transported to the liver via the portal vein and metabolized to urea in the urea cycle. Lower GI blood is less likely to enter liver via portal vein, so lower urea
42
PPI side effect on electrolyte
HYPOmagnaesaemia
43
PPI side effects overall
hyponatraemia, hypomagnasaemia osteoporosis → increased risk of fractures microscopic colitis increased risk of Clostridium difficile infections
44
where do SCC occur in oesophagus
upper 2/3
45
where do adenocarcinoma occur in oesophagis
lower 1/3
46
rf for adenocarcinoma in oesophagus
barretts gord smoking
47
sx carcinoid syndrome
flushing diarrhoea bronchospasm hypotension
48
how do you investigate suspected carcinoid syndrome
``` Urinary 5HIAA (serotonin metabolite) plasma chromogranin ```
49
how do you manage carcinoid syndromw
OCREOTIDE (somatostatin analogue)
50
how does bile acid malabsorption present
green diarrhoea
51
what are causes of bile acid malabsorption
cholecystectomy Chron's idiopathic
52
how do you manage bile acid malabsorption
cholestyramine (bile acid sequestrant)
53
what causes echogenicity of liver on USS
STEATOSIS
54
what does steatosis mean
steatosis = fatty liver!!
55
which oesophageal cancer type is gord linked to
ADENOCARCINOMA (lower 1/3 of oesophagus)
56
what investigations must be done before treating someone with GORD with Nissen fundoplicatgion?
Upper GI endoscopu oesophageal pH manometry studies to exclude other causes e.g. achalasia
57
how do you differentiate ACD from IDA on iron studies?
Anaemia of chronic disease has HIGH FERRITIN and LOW TIBC This is because the body is "hiding" the iron from the disease
58
what causes a dysphagia affcting both solids and liquids from the START?
achalasia
59
what must you do urgently if UNCONTROLLED UGI Haemorrhage?
Sengstaken-blakemore tube to tamponade the bleeding REGARDLESS of what the cause is, and before you try endoscopic band ligation even, because if they are bleeding so heavily you will not be able to see what you are doing in theater and there is a high risk of death
60
what do you give/do for prophylaxis of variceal haemorrhage
medical: PO propanolol surgical: endoscopic band ligation (every 2 weeks, until all varices are gone)
61
why do all patients with coeliac need pneumococcal vaccine
becuase they have FUNCTIONAL HYPOSPLENISM
62
what test is reccomended by NICE for post H pylori eradicatino therapy assessment?
urea breath test
63
what cancer does pernicius anaemia predispose to
gastric carcinoma
64
how do you manage asymptomatic gallstones
REASSURE
65
budd chiari cause
BLOCKAGE OF HEPATIC VEIN T1 = Thrombosis T2= tumour occlusion
66
sx budd chiari
TRIAD: - sudden abdo pain - ascites - tender hepatomeg
67
ix carcinoid syndrome
urinary 5 hydroxyindolacetic acid 5HIAA
68
mx carcinoid
somatostatin analogue e.g. otcteotide
69
screening for malnutrition
MUST questionaire
70
mx malnutrition
1. dietician referral 2. food first approach 3. oral nutritional supplement s
71
presentation of perianal abscess
pain worse on sitting discharge hardened perrianal area
72
mx perianal abscess
I&D under LA (packed or left open)
73
mx perianal fistula
ORAL MET + fistulotomy / seton for drainage

Y6 Senior Med (29 decks)

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