Gastro 2 Flashcards
what is affected in PSC
the bile ducts
what condition is PSC associated with
ulcerative colitis
what LFT is most raised in PSC
ALP
PSC autoantibody
none are specific
PSC diagnostic test
MRCP
PSC mx
strictures can be dilated with ERCP
colestyramine for pruritus
replace fat soluble vitamins
what cancer does PSC increase risk of
cholangiocarcinoma
what is IgG4 related sclerosing cholangitis
similar to PSC but responds to steroids
associated with autoimmune pancreatitis
main risk factor for hepatocellular carcinoma
cirrhosis
due to NAFLD, ALD, hep b, hep c
how is screening in liver cirrhosis patients for hepatocellular carcinoma carried out
ultrasound
alpha fetoprotein
hepatocellular carcinoma marker
alpha fetoprotein
what histological type of cancer are cholangiocarcinomas
adenocarcinomas
tumor marker for cholangiocarcinoma
ca 19-9
liver transplant scar
roof top (along costal margin) or mercedes benz (along costal margin and midline)
what type of cell is the oesophagus lined with
squamous epithelium
what type of cell is the stomach lined with
columnar epithelium
red flags for 2WW upper GI endoscopy
anyone with dysphagia
above 55
mass
anaemia
weight loss
upper abdo pain
when does dysphagia warrant a 2WW referral
always
anyone, any age with new dysphagia refer them
what is a hiatus hernia
when a portion of the stomach shifts up through the diaphragm
what surgery is done for reflux
laparoscopic fundoplication
what type of bacteria is h pylori
gram negative aerobic
what medication needs to be stopped before h pylori testing and for how long
stop PPI 2 weeks before
h pylori eradication therapy
PPI
amoxicillin
clarithromycin
for 7 days
what is zollinger ellinson syndrome
duodenal or pancreatic tumors produce gastrin causing excessive dyspepsia, dairrhoea and peptic ulcers
what is zollinger ellinson syndrome associated with
MEN 1
what medications increase risk of bleeding from a peptic ulcer
NSAIDs
aspirin
anticoagulants
SSRIs
steorids
peptic ulcers encompass
gastric ulcers
duodenal ulcers
changes in weight in gastric vs duodenal ulcer
gastric ulcer- weight loss due to fear of eating causing pain
duodenal ulcer- weight remains stable or higher
signs of upper GI bleed
haematemesis
coffee ground vomit
melaena
low Hb
complications of peptic ulcers
bleeding
perforation
gastric outlet obstruction- due to scarring and strictures
peptic ulcer mx
stop exacerbating/ causative medications
h pylori eradication
PPIs
sources of upper GI bleed
varices
cancer
peptic ulcers
mallory weiss tear
mallory weiss tear is a tear in the
oesophageal mucosa
what score is used to determine risk of upper GI bleed
glasgow blatchford score
what score is used after endoscopy to assess risk of rebleeding from upper GI bleed
rockall
when should an endoscopy be done for upper GI bleed
within 24 hrs
immediately is emergency
what is difference between G+S and xmatch
G+S= a sample of patients blood is saved for matching and the blood group is checked
xmatch= units of blood are tested to check compatibility and kept ready in the fridge
what platelet level are platelets given
<50
when is PPI used in upper GI bleed
AFTER endoscopy, not before
what site is most affected in crohns
terminal ileum
conditions associated with IBD
erythema nodosum
pyoderma gangrenosum
enteropathic arthritis
PSC
red eye eg anterior uveitis, scleritis, episcleritis
mild.moderate UC mx
aminosalicylate 1st line
corticosteroids 2nd line
maintaing remission UC first line
oral aminosalicylate
rectal mesalazine
surgeries for UC
ileostomy- end of small bowel is brought to skin and stoma created
j pouch- ileum is made into a pouch and attached to rectum
maintaining remission in crohns
azathioprine
mercatopurine
both 1st line
methotrexate if those not suitable
how is pain sometimes improved in IBS
after opening bowels
how is pain sometimes worsened in IBS
after eating
what must you rule out in someone with bloating
ovarian cancer- non specific sx
ovarian cancer tumor marker
ca125
how long do you have to have sx for IBS diagnosis
6 months
IBS medication used for diarrhoea
loperamide
IBS medication used for constipation
ispaghula husk
in IBS do not use what medication for constipation
lactulose- can cause constipation
new T1DM patients are tested fr what autoimmune conditions even if there are no sx
thyroid disease
coeliacs
coealiac disease autoantibodies
anti TTG
anti endomysial
anti DGP
what part of the bowel is most affected in coeliacs
jejunum
HLA associations in coeliacs
HLA DQ2
HLA DQ8
deficiencies in coeliacs
iron
b12
folate
biopsy findings in coeliacs
crypt hyperplasia
villous atrophy
cancers associated with coeliacs
EATL
NHL
small bowel adenocarcinoma
