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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
Q

which condition has a beaded appearance of the biliary tree on MRCP

A

PSC

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26
Q

mx of perianal fistula

A

Metronidazole + fistulotomy or seton (to allow healing)

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27
Q

what do you use for secondary prophylaxis of hepatic encephalopathy

A

lactulose + rifamixin

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28
Q

what are blood results like in Wilsons disease and why

A

Wilson’s disease- problem with copper, in which excess copper is deposited in tissues, causing a LOW serum copper.

  • reduced serum copper
  • reduced caeruloplasmin.
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29
Q

most common cause of inherited colorectal cancer

A

HNPCC

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30
Q

how do you diagnose UC

A

flexible sigmoidoscopy

colonoscopy (NOT IF ACUTE ATTACK)

31
Q

what is barret’s oesophagus

A

metaplasia of lower oesophageal mucosa

32
Q

BIggeest RF for Barrett’s

A

GORD

33
Q

What occurs at cellular level in Barrett’a

A

METAPLASIA

squamous becomes columnar

34
Q

what cancer are you at increased risk of with Barretts

A

adenocarcinoma

35
Q

how do you manage barrett’s

A

endoscopuc surveillance + high risk PPI

36
Q

what do you do if Barrett’s become dysplasiq

A

endoscopic mucosal resection

radiofrequency ablation

37
Q

what are complications of long term Omeprazole use

A

LOW sodium,. low MG
osteoporosis
C diff infection

38
Q

how do you screen for haemochromatosis

A

general population: transferrin saturation > ferritin

family members: HFE genetic testing

39
Q

what route do you give mesalazine in for mild-Mod UC

A

RECTAL if distal disease

RECTAL AND ORAL if extensive disease

40
Q

what do you give if severe UC

A

IV steroids + admit

41
Q

what does Urea tell you in the context of an GI bleed

A

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
Q

PPI side effect on electrolyte

A

HYPOmagnaesaemia

43
Q

PPI side effects overall

A

hyponatraemia, hypomagnasaemia
osteoporosis → increased risk of fractures
microscopic colitis
increased risk of Clostridium difficile infections

44
Q

where do SCC occur in oesophagus

A

upper 2/3

45
Q

where do adenocarcinoma occur in oesophagis

A

lower 1/3

46
Q

rf for adenocarcinoma in oesophagus

A

barretts
gord
smoking

47
Q

sx carcinoid syndrome

A

flushing
diarrhoea
bronchospasm
hypotension

48
Q

how do you investigate suspected carcinoid syndrome

A 
Urinary 5HIAA (serotonin metabolite) 
plasma chromogranin
49
Q

how do you manage carcinoid syndromw

A

OCREOTIDE (somatostatin analogue)

50
Q

how does bile acid malabsorption present

A

green diarrhoea

51
Q

what are causes of bile acid malabsorption

A

cholecystectomy
Chron’s
idiopathic

52
Q

how do you manage bile acid malabsorption

A

cholestyramine (bile acid sequestrant)

53
Q

what causes echogenicity of liver on USS

A

STEATOSIS

54
Q

what does steatosis mean

A

steatosis = fatty liver!!

55
Q

which oesophageal cancer type is gord linked to

A

ADENOCARCINOMA (lower 1/3 of oesophagus)

56
Q

what investigations must be done before treating someone with GORD with Nissen fundoplicatgion?

A

Upper GI endoscopu
oesophageal pH
manometry studies

to exclude other causes e.g. achalasia

57
Q

how do you differentiate ACD from IDA on iron studies?

A

Anaemia of chronic disease has HIGH FERRITIN and LOW TIBC

This is because the body is “hiding” the iron from the disease

58
Q

what causes a dysphagia affcting both solids and liquids from the START?

A

achalasia

59
Q

what must you do urgently if UNCONTROLLED UGI Haemorrhage?

A

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
Q

what do you give/do for prophylaxis of variceal haemorrhage

A

medical: PO propanolol
surgical: endoscopic band ligation (every 2 weeks, until all varices are gone)

61
Q

why do all patients with coeliac need pneumococcal vaccine

A

becuase they have FUNCTIONAL HYPOSPLENISM

62
Q

what test is reccomended by NICE for post H pylori eradicatino therapy assessment?

A

urea breath test

63
Q

what cancer does pernicius anaemia predispose to

A

gastric carcinoma

64
Q

how do you manage asymptomatic gallstones

A

REASSURE

65
Q

budd chiari cause

A

BLOCKAGE OF HEPATIC VEIN
T1 = Thrombosis
T2= tumour occlusion

66
Q

sx budd chiari

A

TRIAD:

  • sudden abdo pain
  • ascites
  • tender hepatomeg
67
Q

ix carcinoid syndrome

A

urinary 5 hydroxyindolacetic acid 5HIAA

68
Q

mx carcinoid

A

somatostatin analogue e.g. otcteotide

69
Q

screening for malnutrition

A

MUST questionaire

70
Q

mx malnutrition

A
  1. dietician referral
  2. food first approach
  3. oral nutritional supplement s
71
Q

presentation of perianal abscess

A

pain worse on sitting
discharge
hardened perrianal area

72
Q

mx perianal abscess

A

I&D under LA (packed or left open)

73
Q

mx perianal fistula

A

ORAL MET + fistulotomy / seton for drainage

Y6 Senior Med (29 decks)

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