Gastro 2 Flashcards
25 y/o female concerned periods have stopped. not pregnant.
RUQ pain, reduced appetite .
OE: hepatomegaly and yellow sclera
Blood results:
- ANCA neg
- AMA neg
- Anti nuclear antibodies raised
- smooth muscle antibodies raised
what is likely diagnosis?
autoimmune hepatitis
first line treatment for autoimmune hepatitis
steroids are first line +/- immunosuppressant therapy
what is ribavirin ?
anti viral
can be used to treat hep C
what antibodies are found in type 1 auto immune hepatitis?
type 1
- Anti-nuclear antibodies and/or anti-smooth muscle antibodies
- adults and children
describe type 2 autoimmune hepatitis
type 2
- anti-liver/kidney microsomal type 1 (LKM1) antibodies
- affects children only
describe type 3 autoimmune hepatitis
type 3
- soluble liver-kidney antigen
- affects adults in middle-age
long term proton pump inhibitor therapy can cause what?
hypomagnesaemia
can then cause muscle weakness
PPIs can also known to cause hyponatraemia
obesity with abnormal LFTs think
non-alcoholic fatty liver disease
- linked to insulin resistance thus think of history of pre-diabetes
when treating dyspepsia, if PPI or ‘test and treat’ approach has failed, then what other approach should be tried next
test for helicobacter pylori infection in 2 weeks and treat if positive
patient
- raised urea
- marginal normocytic anaemia
patient likely suffered a…
Gastrointestinal bleed
- raised urea
- anaemia due to blood los
- RBC –breakdown–> urea
- UREA raised
- digestion of blood in stomach
what intervention is required when dysplasia on biopsy in barrett’s oesophagus is seen?
endoscopic intervention.
- endoscopic mucosal resection
barrett’s oesophagus refers to
metaplasia of lower oesophageal mucosa with usually squamous epithelium
being replaced by columnar epithelium
why is prothrombin a better measure of acute liver failure as opposed to albumin?
prothrombin has shorter half-life
thus better measure
79 y/o female
- PMH AF
- PC abdo pain + bloody diarrhoea + vomiting
OE
- temp 37.8 degrees
- 102 bpm
- 30 / min
- tender abdomen
- generalised guarding
- low bicarb
- metabolic acidosis
indicative of:
mesenteric ischaemia
what is the double duct sign and when is it seen?
- dilated common bile duct and dilated pancreatic duct
- may be seen in pancreatic cancer
patient who have had previous episode of spontaneous bacterial peritonitis will require…
antibiotics prophylaxis
e.g. long term medication of ciprofloxacin
patient
- fatigued
- raised ALP, yGT (cholestatic liver biochemistry)
- positive mitochondrial antibodies
- raised Igm
indicative of:
primary biliary cholangitis
first line medication of primary biliary cholangitis?
- ursodeoxycholic acid
- secondary bile acid
what key factor would point you towards a diagnosis of oesophageal candidiasis in the following case
40 y/o male, pc pain on swallowing hpc 7 days. PMH HIV positive. generally unwell 3 months hx with diarrhoea and weight loss
oesophageal candidiasis
immunocompromised patients are prone to oesophgeal candidiasis
55 y/o pc dysphagia for past 5 weeks. Also noticed some double vision.
may be indicative of?
- myasthenia gravis
- dysphagia with liquids awa solids
- may involve extra ocular muscle
describe how systemic sclerosis may lead to dysphagia?
- multi system disease
- causes oesophageal dysmotility , Lower oesophageal sphincter is decreased
Crest
- calcinosis
- Raynaud’s
- oesophageal dysmotility
- sclerodactyl
- telangiectasia
first line screening test for coeliac disease?
tissue transglutaminase antibodies
49 y/o pt
- 3 month hx epigastric pain and diarrhoea
- endoscopy revealed multiple duodenal ulcerations
- pmh hyperparathyroidism
indicative of:
Zollinger-Ellison syndrome
- patients usually present with multiple gasproduodenal ulcers causing abdominal pain and diarrhoea
the following clinical features point to a diagnosis of what:
- jaundice
- anorexia
- fever
- tender hepatomegaly
- AST/ALT ratio of 2:1
alcoholic hepatitis
which ulcers characteristically cause pain when hungry and are relieved by eating…
duodenal ulcers
gastric ulcers are worse on eating due to release of HCl which worsen ulcer
38 y/o female pc fever, malaise, jaundice
moderate hepatomegaly
positive anti-smooth muscle antibody
positive anti-nuclear antibody
AMA antibodies negative
indicative of:
autoimmune hepatitis
patients with ascites secondary to liver cirrhosis should be given what medication?
- aldosterone antagonist
how are ascites managed
- through sodium and fluid restriction
long segment of narrowed terminal ileum in a ‘string like’ configuration is known as ‘kantors string sign’
this is seen in:
Crohn’s disease
the following histology is seen in what:
- inflammation in all layers from mucosa to serosa
- goblet cells
- granulomas
Crohn’s disease
describe the histology that will be seen in Crohn’s disease?
- inflammation in all layers from mucosa to serosa
- goblet cells
- granulomas
46 y/o male presents with reduced libido and erectile dysfunction. has no energy and has ‘permanent suntan’
has pain in both hands.
which investigation likely to reveal diagnosis?
ferritin, testosterone, cortisol, blood glucose, prolactin
ferritin
screening for haemochromatosis
37 y/o female with 2 month hx of progressive fatigue on background of T1DM.
- low Hb
- higher MCV
likely diagnosis
megaloblastic anaemia
- may be caused by B12 or folate deficiency
Pernicious anaemia
- autoimmune
- caused B12 deficiency
what investigation is sued when investigating b12 deficiency?
- looking at intrinsic factor antibodies
parietal cells —release—> intrinsic factor
intrinsic factor —bind—> dietary b12
complex formed
complex —absorbed–> ileum
which antibodies are screened for in coeliac disease
anti-TTG antibodies
56 y/o male
- worsening rash
- ongoing diarrhoea
- nausea
- vomitting
- harder to concentration
- increasingly forgetful
- vegan
likely diagnosis?
pellagra
- dermatitis
- diarrhoea
- dementia / delusions
- leading to death
condition characterised by
- numerous hamartomatous polyps in GI tract
- pigmented lesions on lips, face, palm and soles
- intestinal obstruction
- GI bleeding
peutz-jegher syndrome
- autosomal dominant§
jaundice following abdominal pain and itching during pregnancy
think:
acute fatty liver of pregnancy
gilberts syndrome caused
- benign condition
- caused mild rise in unconjugated bilirubin
what class of drugs are used in the management of severe alcoholic hepatitis
corticosteroids
abdominal mass palpable in right iliac fossa is more common in Crohn’s of ulcerative colitis
Crohn’s disease
triad of
- dysphagia (secondary to oesophageal webs)
- glossitis
- iron deficiency anaemia
is seen in:
Plummer-Vinson syndrome
a palpable nodule in the umbilicus due to metastasis of malignant cancer within the pelvis or abdomen is known as a
sister Mary Joseph node
what is a Virchow’s node
enlarged left supraclavicular lymph node
seen in various internal abdominal malignancies
causes of macrocytic anaemia
- vitamin b12 deficiency
- folate deficiency
- alcohol excess
What is TIBC and what does it measure?
- total iron binding capacity
- measures number of binding sites on transferrin available for iron
- raised in iron deficiency anaemia
- raised in pregnancy and by oestrogen
Middle aged female
history of lethargy and pruritus
rise in ALP and yGT
point to a diagnosis of:
primary biliary cirrhosis
anti-mitochondrial antibodies are found in 98% of patients with PBC
isolated rise inbilirubin in response to physiological stress is typical of:
gilbert syndrome
35 y/o female with RUQ pain, slightly yellow skin, yellow tinge to sclera. itching of arms.
PMH - ulcerative colitis
likely diangosis?
primary sclerosing cholangitis
investigation of choice in a patient with suspected primary sclerosing cholangitis?
ERCP / MRCP
name three main caused of liver cirrhosis?
- alcohol
- non-alcoholic fatty liver disease
- viral hep B and C
Budd-chiari syndrome is also known as
hepatic vein thrombosis
treatment for wilsons disease is currently?
penicillamine
most common organism found on ascitic fluid culture in spontaneous bacterial peritonitis is?
E-coli
three main features of spontaneous bacterial peritonitis
- ascites
- abdominal pain
- fever
how are liver abscesses generally managed?
- combination of antibiotics
- and image guided percutaneous drainage
what is the first line treatment of diarrhoea in IB
Loperamide
plain abdominal film showing small bowel obstruction and air in the biliary tree
indicative of:
gallstone ileus
- gall stone enters small intestine, it lodges in ileocaecal valve
psuedopolyps seen on endoscopy
likely to be:
ulcerative colitis
results which would indicate a diagnosis of haemochromatosis?
- transferrin HIGH
- ferritin HIGH
- total iron binding capacity LOW
surgical treatment of achalasia
heller cardiomyotomy
- procedure involves the cutting of thick muscle around lower oesophagus and upper stomach to allow for passage of food and drink
24 y/o female
- history of diarrhoea
- passage of mucus
- lethargy
- abdominal discomfort relieved by defaecation
- nomral blood tests
likely clinical diagnosis?
irritable bowel syndrome
22 y/o male
- three week hx diarrhoea
- has to run to toilet
- passing blood in stool
- abdominal pain LLQ
likely diagnosis of:
ulcerative colitis
