Gastro 3 Flashcards
what can be used to monitor hepatocellular carcinoma recurrence?
Alpha- fetoprotein afp
28 y/o pregnant lady
- presents confused and agitated
- itching arms vigorously
- RHS abdo pain during palpation
- sweet, fecal smelling breath
likely diagnosis?
feto hepaticus
sign of acute liver failure
45 y/o male
- 12 hr hx colicky abdo pain
- abdo distension
- constipation
- inability to pass flatus
- nauseous but has not vommitted
likely diagnosis?
bowel obstruction
what medication should be avoided in bowel obstruction?
IV metoclopramide
life-threatening clostridium difficile infection is treated with
ORAL vancomycin
IV metronidazole
what describes the following triad
- sudden onset abdominal pain
- ascites
- tender hepatomegaly
budd-chiari syndrome
what is budd-chiari syndrome
- characterised by obstruction to hepatic venous outflow
- venous congestion can cause hepatomegaly and portal hypertension
- can result in splenomegaly and ascites
condition in which the hepatic veins (veins that drain the liver) are blocked or narrowed by a clot (mass of blood cells). This blockage causes blood to back up into the liver, and as a result, the liver grows larger
Crohn’s disease leads to an decrease or increase in number of goblet cells
increase in goblet cells
simple columnar goblet shaped epithelial cells that secrete gel-forming mucins
inflammation in ulcerative colitis is usually limited to
mucosa and submucosa
deep inflammatory infiltrate from the mucosa to muscularis externa.
numerous granulomata noted.
indicative of:
Crohn’s disease
how does loperamide act through to slow down bowel movements
reduction in gastric motility
through stimulation of opiod receptors
melanosis coli is…
a disorder of pigmentation of the bowel wall
associated with laxative abuse
57 y/o female
- PMG gallstone
- progressive RUQ pain
- rigors
- jaundice
most likely diagnosis?
ascending cholangitis
following histology is indicative of what condition:
- villous atrophy
- raised intra-epthelial lymphocytes
- crypt hyperplasia
coeliac disease
removal of gluten from diet
Ursodeoxycholic acid is the first-line medication for
primary biliary cholangitis
what class of drugs are generally used to induce remission of Crohn’s disease
glucocorticoids
- e.g. prednisolone
inferior mesenteric artery branches from the aorta at
L3
what immunisation is offered to patients with coeliac’s disease?
pneumococcal vaccine
due to hyposplenism (reduced functioning of spleen)
describe pernicious anaemia
autoimmune disorder affecting the gastric mucosa
results in vitamin b12 deficiency
flushing diarrhoea bronchospasm hypotension weight loss
typical history of :
carcinoid syndrome
investigation for carcinoid syndrome
urinary 5-HIAA
tumour will secrete serotonin
78 y/o female
PC:
- episodic dysphagia
- halitosis
- occasional regurgitation
likely diagnosis?
pharyngeal pouch
overweight 56 y/o male with longstanding Barrett’s oesophagus complains of worsening dysphagia to solids over past 6 weeks
likely diagnosis
adenocarcinoma of the oesophagus
RIF pain on palpation of LIF is known as:
Rovsing’s sign
seen in appendicitis
which blood test, when compared to previous, will best represent changes in the following patients liver function?
patient: 53 y/p male with alcoholic liver cirrhosis,, visibly jaundiced, slightly tremulous with worsening ascites
prothrombin time
- demonstrates ability of the hepatocytes to carry out their synthetic function
which of the following is most likely to cause hyponatraemia
- tolvaptan
- omeprazole
- ranitidine
- metformin
- phenytoin
omeprazole
combination of deranged LFTs in combination with secondary amenorrhoea in young female is strongly suggestive of:
autoimmune hepatitis
which antibody is most sensitive and specific to primary biliary cirrhosis?
anti-mitochondrial
investigations for primary biliary cirrhosis?
- bloods: ESR raised, IgM raised
- LFTs: ALP raised
- Autoantibodies
- anti-mitochondrial antibody
- anti-nuclear antibodies in 35% - live rrbiopsy
Which of the following tumour markers is most associated with hepatocellular carcinoma?
serum alpha-fetoprotein
two main organs affected by alpha-1-antitrypsin deficiency?
liver
lungs: pulmonary basal emphysema
What is the normal function of alpha-1-antitrypsin in the body?
neutralise neutrophil elastase
elastase digests connective tissues
treatment for patient with oesophageal varices when are bleeding?
- resuscitation
- vasopression analogues cause vasoconstruction and slow bleeding
- correct coagulopathy with vitamin K and fresh frozen plasma
A 24 year old lady presents to her GP with irregular bowel movements and crampy abdominal pain.
She normally opens her bowels between 1 and 3 times per day, and this can vary from normal to loose. Occasionally she has mucus in her stools, but denies any PR bleeding. She tends to get generalised crampy pain in her abdomen prior to opening her bowels, which tends to relieve the pain. These symptoms have not changed in the last year. She denies any weight loss or anorexia.
She only drinks limited alcohol on special occasions and does not smoke.
She is worried as her uncle was recently diagnosed with Crohns disease and she is worried that she may have the condition. She has no other family history.
Abdominal and PR examination are normal.
Routine blood tests come back normal.
What would be the most appropriate investigation for reassuring this patient?
typical history of IBS
faecal calprotectin
- useful marker of intestinal inflammation
management of haemochromatosis?
- venesection (weekly removal of blood to decrease total iron)
- monitoring serum ferritin
- monitoring and treatment of complications
first line for mild flare up of ulcerative colitis is:
mesalazine
severe flares of UC are treated with…
steroids
