Gastro 2 Flashcards
achalasia surgical mx?
heller cardiomyotomy
Mx of achalasia?
balloon dilatation
heller cardiomyotomy
botoulinum toxin
nitrates / CCB
alcoholic hepatitis signs
GGT raised
ast:alt ratio >2
small intestinal bacterial overgrowth is developed by?
RF
DM
autonomic neuropathy
scleroderma
how to differentiate between Alcoholic ketoacidosis and Diabetic ketoacidosis?
normal / low glucose
with ketones
mx of alcoholic ketoacidosis?
non-diabetic euglycaemic
infusion of saline and thiamine
why do coeliacs need pneumococcal vaccine?
hyposplenism
neuroendocrine tumour
secrete serotonin
diarrhoea
bronchial NET > SS
liver mets > SS
Ix carcinoid syndrome / NET
Investigation
urinary 5-HIAA
plasma chromogranin A y
signet ring cells
gastric adenocarcinoma
large vacuole containing mucin
suspected pharyngeal pouch
Investigation?
barium swallow w fluoroscopy
chronic mesenteric ischaemia?
colicky post prand meal
abdominal bruit
weight loss
Bowel Ischaemia RF
age
A fibrillation
CVD; smoke/ HTN/ DM
cocaine
Ix bowel ischaemia
Imaging of choice?
CT
acute mesenteric ischaemia?
small bowel ischaemia
Afib
ischaemic colitis?
acute but transient
large bowel
what is a watershed area?
what sign on xray?
splenic flexure
SMA /IMA
thumbprinting on xray
mucosal oedema / haemorrhage
budd chiari syndrome
Imaging?
hepatic vein thrombosis
> USS with doppler flow studies
what is the triad for budd chiari syndrome
abdominal pain
ascites
tender hepatomegaly
Causes of budd chiari syndrome
polycythaemia rubra vera
thrombophilia activated protein C
pregnancy COCP
Pyogenic Liver Abscess mx?
drainage
abx
which organism in liver abscess?
e coli (adults)
staph aureus (children)
what abx?
amoxicillin
ciprofloxacillin
metronidazole
Reintroduce gluten for at least _______ and arrange serological tests
6 weeks
toxic megacolon
transverse colon >6cm in diameter
systemic upset
Ix: abdo Xray
role of endoscopy after a Upper GI bleed?
endoscopy within 24 hours
Resus upper GI bleed
active bleeding?
if on warfarn?
ABC
wide bore IV access 2
platelet transfusion
Prothrombin complex concentrate
FFP given in upper gi bleed when?
fibrinogen <1g/l
INR >1.5
C diff RF
abx
> clindamycin
>cephalosporins
PPI
dysphagia
difficulty swallowing
odynophagia?
pain on swallowing
Truelove and Witts severity index
what is it for?
what is the criteria?
UC
37.8^C
90 beats per minute
Anaemia (105g/L)
ESR >30
Temp
Rate
Uh (neami)
EESR >30
Dx of Oesophageal cancer?
upper GI endoscopy w biospy
USS
CT-Scan
fdg-pet ct
PSC has what antibodies?
p- ANCA
what is PSC?
inflammation and fibrosis
intra and extra hepatice bile ducts
gold standard Ix for PSC?
MRCP
ERCP - more invasive
> beaded
peutz jeghers syndrome
what lesions on colonoscopy?
hamartomas
co amoxiclav
amoxicllin
clavulanate
hepatotoxic
= cholestasis
Treatment for oesophageal cancer
operable?
t1n0mo
surgical resection
ivor lewis oesophagectomy
adjuvant chemo
Neoadjuvant chemoradiotherapy followed by surgical resection
oesophageal cancer
locally advanced cancers to downstage it
metoclopramide
d2 receptor antagonist
pro kinetic
= promotes gut peristalsis
how does Metoclopramide decrease nausea?
promotes gut peristalsis
5-HT3/5
which inhibits chemoreceptor trigger zone of the medulla
SAAG >11 ascites
portal htn
> cirrhosis
RHF
budd chiari
SAAG <11
hypoalbumin
> nephrotic syndrome
malnutrition
therapeutic abdo paracentesis?
albumin cover needed
ciprofloxacin <15g/l of protein
bulk forming laxative?
isphagula usk
osmotic laxative
macrogol
UC histology
depleted goblet cells and mucin from gland epithelium
crohns hsitology
goblet cell increased
granuloma
carcinoid syndrome can affect the heart how?
right side of the heart
> tricuspid insufficiency
>pulmonary stenosis
Mx of perianal fistula
oral metronidazole
seton drain
> metronidazole
ciprofloxacin
pre-operative workup for a patient undergoing a Nissen fundoplication for treatment-resistant GORD
oesophageal manometry
oesophageal pH
