Gastro 2 Flashcards
Diagnosis and test
multiple gastroduodenal ulcers
diarrhoea
malabsorption
Zollinger Ellison Syndrome
- fasting gastrin levels
secretin stimulation
Diagnosis and investigation
flushing
diarrhoea
bronchospasm
RHV stenosis
Cushings
Carcinoid syndrome
Ix: Urinary 5-HiAA
Plasma chromogranin A y
Diagnosis and management
flushing
diarrhoea
bronchospasm
RHV stenosis
Cushings
Carcinoid syndrome
Octreotide
cyproheptadine (diarrhoea)
Young female
Amenorrhea, fatigue
SMA +Ve
Diagnosis and management
autoimmune hepatitis
Type 1
Mx: steroids or azathioprine
liver transplant
Alcoholic frank haematemasis
Diagnosis and management
Variceal haemorrhage
M : resuscitate
terlipressin
Prophy Abx if cirrhosis
TIPS
middled aged women with itch
PHx Sjorgrens or RA
Likely bloods and diagnosis
AMA +Ve raised IgM
Primary biliary cholangitis
middled aged women with itch
PHx Sjorgrens or RA
Diagnosis and Management
Primary Biliar cholangitis
MRCP to exclude obstruction
Ursodeoxycholic acid
Cholestyramide (itch)
increased risk of hepatocellular ca
What would high urea in GI bleed indicate?
Upper GI source
Which type of colon cancer are APC, p53 and DCC associated with?
sporadic
Which type of colon cancer are MSH2 and MLH1 associated with and what history
HNPCC
3 x family members over 2 generations
<50
What type of colon cancer is APC suppressor on Ch5 associated with
FAP
hundreds polyps by 30-40
total colectomy in 20s
60 year old with painless jaundice
Diagnosis, management
CT pancreas
Likely pancreatic Ca (pancreatic head)
Whipples
ERCP with stents
Isolated rise in bilirubin following stress
Diagnosis
Gilberts
Middled aged female with dysphagia liquids and solids
Diagnosis and management
Achalasia
Confirmed with manometry
Pneumatic balloon dilation
Heller cardiomyotomy if persistent
Middle aged male with dysphagia, vomiting and weight loss
PHx: asthma
Likely diagnosis
Eosinophilic oesophagitis
Endoscopy: high eosinophils, furrows, reduced vasculature and strictures
Diagnosis and management
Eosinophilic oesophagitis
dietary modifications->fluticasone->oesophageal dilatation
Cirrhosis pt with ascites, abdo pain and fever
Investigations and likely diagnosis
paracentesis - neutrophils >250 + E.coli
SBP
Cirrhosis pt with ascites, abdo pain and fever
Likely diagnosis and management
SBP
IV cef
prophylaxis: PO cipro or norflox
sudden onset severe abdo pain + ascites and hepatomegaly
PHx: PCV, thrombophilia, pregnant, COCP
Investigation and diagnosis
US doppler
Budd-Chiari Syndrome (hepatic vein thrombosis)
Post cholecystectomy diarrhoea and abdo pain
Diagnosis and management
post cholecystectomy syndrome
low fat diet, cholestyramine
Male, lethergy, polyuria and polydipsia, peripheral oedema, tanned skin
Likely diagnosis and genetic associations
Haemochromatosis
Ch6 HFE
autosomal recessive
Perianal itch in multiple household members
likely cause and management
threadworms - enterobius vermicularis
mebendazole
anthelmintic and hygiene measures
Middle aged man with malabsorption, arthralgia, blurred vision
PHx SLE
How would you confirm diagnosis + treatment
jejunal biopsy: macrophages containing PAS
Whipples
Mx: 1 year co-trimox
