Gastro 2 Flashcards
what is achalasia
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
Causes of achalasia
DEGENERATVE (With age)
AI / Genetic / tripanozoma cruzi (chagas disease- south america)
Sx achalasia
dysphagia - both food and liquids
heartburn
regurg
chest pain
common in middle aged
Ix achalasia
CXR (widened mediastinum)
barium swallow (beak)
OGD
Mx achalasia
Nifedipine + botulinum
Helier myotomy + fundoplication
describe the progression of alcoholic / NAF liver disease
- steatosis
- hepatitis
- cirrhosis
histopatj fts of alcoholic hepatitis
ballooning
giant mitochondria
mallory hyaline inclusions
WHAT MUST you consider treating in alcoholic liver disease
Vit D deficiency > pabrinex
encepalopathy > lactulose
ascites > diuretics
what is Hepatorenal syndrome
renal failure in patients with chronic liver disease (due to erroneous constriction of renal blood vessels)
3 complications of appendicitis
perforation
appendix mass
appendix abscess
scale to classify chrons
Montreal classification
what is gord’
reflux of gastric acid and bile, causing oesophagitis
RF for GORD
- increased Intra abdo pressure (obesity, pregnancy)
- hypotension of oesophageal sphincter (drugs, achalasia, hiatus hernia)
- acid hypersecretion (smoking, zollinger ellisson)
How do you manage GORD conservativeluy
ADVICE
- WL
- stop smoking
- small and regular meals
- avoid large meals
- avoid alcohol and spice
- elevate bed
how do you manage GORD medically
antacid (gaviscon)
PPI (omeprazole)
H2 antagonist (ranitidine)
How do you manage GORD surgically
Nissen fundoplicaiton
RF / cause for mallory weiss tear
alcohol
bulimia
hyperemesis
gastroenteritis
Ix Mallory Weiss tear
OGD
Mx Mallowy weiss tear
most are self resolving (<48h)
if not, OGD with injection sclerotherapy
What is gastritis
inflammation of the gastric mucosa
caused by exposure to gastric acid,
RF gastritis
RF are NSAIDS, alcohol, H pulori, bile reflux
what is PUD
ulceration as progression of untreated gastritis
how do gastritis /PUD present
epigastric pain
nausea, vomiting, loss of appetitie
if PUD: haematemesis, melaena
how do you differentiate between gastric or duodenal ulcer
gastric: pain soon after eating, minimal antacid relief, anorexia and WL
duodenal: pain worse hours after eating, good antacid relief, overeats > weighht gain
which condition has a beaded appearance of the biliary tree on MRCP
PSC
mx of perianal fistula
Metronidazole + fistulotomy or seton (to allow healing)
what do you use for secondary prophylaxis of hepatic encephalopathy
lactulose + rifamixin
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.
most common cause of inherited colorectal cancer
HNPCC
how do you diagnose UC
flexible sigmoidoscopy
colonoscopy (NOT IF ACUTE ATTACK)
what is barret’s oesophagus
metaplasia of lower oesophageal mucosa
BIggeest RF for Barrett’s
GORD
What occurs at cellular level in Barrett’a
METAPLASIA
squamous becomes columnar
what cancer are you at increased risk of with Barretts
adenocarcinoma
how do you manage barrett’s
endoscopuc surveillance + high risk PPI
what do you do if Barrett’s become dysplasiq
endoscopic mucosal resection
radiofrequency ablation
what are complications of long term Omeprazole use
LOW sodium,. low MG
osteoporosis
C diff infection
how do you screen for haemochromatosis
general population: transferrin saturation > ferritin
family members: HFE genetic testing
what route do you give mesalazine in for mild-Mod UC
RECTAL if distal disease
RECTAL AND ORAL if extensive disease
what do you give if severe UC
IV steroids + admit
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
PPI side effect on electrolyte
HYPOmagnaesaemia
PPI side effects overall
hyponatraemia, hypomagnasaemia
osteoporosis → increased risk of fractures
microscopic colitis
increased risk of Clostridium difficile infections
where do SCC occur in oesophagus
upper 2/3
where do adenocarcinoma occur in oesophagis
lower 1/3
rf for adenocarcinoma in oesophagus
barretts
gord
smoking
sx carcinoid syndrome
flushing
diarrhoea
bronchospasm
hypotension
how do you investigate suspected carcinoid syndrome
Urinary 5HIAA (serotonin metabolite)
plasma chromogranin
how do you manage carcinoid syndromw
OCREOTIDE (somatostatin analogue)
how does bile acid malabsorption present
green diarrhoea
what are causes of bile acid malabsorption
cholecystectomy
Chron’s
idiopathic
how do you manage bile acid malabsorption
cholestyramine (bile acid sequestrant)
what causes echogenicity of liver on USS
STEATOSIS
what does steatosis mean
steatosis = fatty liver!!
which oesophageal cancer type is gord linked to
ADENOCARCINOMA (lower 1/3 of oesophagus)
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
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
what causes a dysphagia affcting both solids and liquids from the START?
achalasia
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
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)
why do all patients with coeliac need pneumococcal vaccine
becuase they have FUNCTIONAL HYPOSPLENISM
what test is reccomended by NICE for post H pylori eradicatino therapy assessment?
urea breath test
what cancer does pernicius anaemia predispose to
gastric carcinoma
how do you manage asymptomatic gallstones
REASSURE
budd chiari cause
BLOCKAGE OF HEPATIC VEIN
T1 = Thrombosis
T2= tumour occlusion
sx budd chiari
TRIAD:
- sudden abdo pain
- ascites
- tender hepatomeg
ix carcinoid syndrome
urinary 5 hydroxyindolacetic acid 5HIAA
mx carcinoid
somatostatin analogue e.g. otcteotide
screening for malnutrition
MUST questionaire
mx malnutrition
- dietician referral
- food first approach
- oral nutritional supplement s
presentation of perianal abscess
pain worse on sitting
discharge
hardened perrianal area
mx perianal abscess
I&D under LA (packed or left open)
mx perianal fistula
ORAL MET + fistulotomy / seton for drainage
