Gastro Flashcards
Common features of IBS?
- Abdominal pain - relieved by defecation?
- Bloating - distension, tension or hardness
- Change in bowel habits
Red flags that don’t point to IBS:
Rectal Bleeding
unexplained weight loss
Fam hx of bowel or ovarian cancer
onset after 60yrs of age
Is episcleritis more common in UC or CD?
CD
Is Primary sclerosing cholangitis more common in UC or CD?
UC
Is Uveitis more common in UC or CD?
UC
22 yo with a 3 wk history of diarrhoea. Occasionally bleeding. has urgency and tenesmus (feeling he hasn’t completely emptied). Has uveitis
UC
A barium enema on a patient with UC would show:
Loss of haustrations
Superficial ulceration - pseudopolyps
Drainpipe colon
18yo with raised intra-hepatic markers. Family history of liver disease. Patient presents with tremor and dyskinesia and dysarthria
Wilson’s disease
May also have Renal tubular acidosis - Fanconi Syndrome
How to diagnose Wilson’s disease?
Reduced serum Caeruloplasmin and increased 24hr urinary copper excretion
How do you manage Wilson’s disease?
Penicillamine (Chelates copper) has been the traditional first line management.
How do you induce remission in Crohn’s disease?
- Prednisolone (Try for 3-7days)
- Budesonide ( pt.s with diabetes)
if severe: - Hydrocortisone or Methylprednisolone
- If patient can’t tolerate Corticosteroids then:
a. Azathioprine or Mercaptopurine
or 5. Methotrextae (with folic acid)
- Consider infliximab
What do you use for maintenance therapy of Crohn’s disease?
A) QUIT SMOKING
- Azathioprine or Mercaptopurine
- Methotrexate (with folic acid)
- Infliximab.
How would you manage Perianal and fistulising disease in CD?
- metronidazole
- Ciprofloxacin
And consider surgical exploration and local drainage.
What is courvoiser’s sign?
Painless, enlarged gallbladder and mild jaundice - unlikely to be gallstones. More likely to be malignancy of pancreas or biliary tree
Painless jaundice in an alcoholic with palpable gallbladder,
Pancreatic cancer - can also have epigastric pain and weight loss
How to differentiate Hep A and Hep E?
Hep E is more severe and if pregnant women. Or if Hep A excluded.. Hep A more common
Flu like prodrome + jaundice + hepatosplenomegaly in a traveller
Hep A
What does Zollinger Ellison syndrome present with?
and is associated with MEN I or II?
Multiple gastroduodenal ulcers causing abdominal pain and diarrhoea.
Associated with MEN I
Three endocrine things associated with MEN I?
- Parathyroid (Hyper) (95%)
- Pituitary (70%)
- Pancrease (50% e.g. insulinoma, gastrinoma)
Women with fever, malaise and jaundice. Positive for anti-smooth muscle antibody and anti-nuclear antibody. Negative for anti-mitochondrial antibodies:
Autoimmune hepatitis
Positive for anti-mitochondrial antibodies
Primary Biliary Cirrhosis
Anti-liver/kidney microsomal type 1 antibodies (LKM1). In children
Auto-immune hepatitis Type II
Man with ulcerative colitis, biliary colic and comes in Jaundice, itchy and with abdominal pain. Raised ALP and positive ANCA:
Primary Sclerosing cholangitis
Arthralgia, deranged ALT and very high ferritin are highly suggestive of….
Haemachromatosis.
Other symptoms include: ED, hypogonadism, cardiac failure (dilated cardiomyopathy)
In _______ inflammation is limited to the submucosa, with inflammatory cell infiltrates in the lamina propria.
Neutrophils migrate through the walls of the glands to form _______. Granuloma’s are more common in _____
UC. We get formation of crypt abscesses. Granuloma’s more common in CD.
Jejunal biopsy shows deposition of macrophages containing Period Acid Schiff (PAS) granules:
Whipple’s disease
Whipple’s disease is a rare multi-system disorder caused by _____. Mx with _____
Tropheryma whippeli. Mx with Co-trimoxazole
What are important prognostic markers for paracetamol overdose?
Increased PT time
increased Creatinine
Decreased Arterial pH
grade II or IV encephalopathu
How do you manage paracetamol overdose?
Acetylcysteine
Upper abdominal pain that develops after ERCP. Pt is apyrexial…
Acute Pancreatitis
Classic triad in Ascending cholangitis?
Fever (Rigor), RUQ pain, Jaundice
How does Gall stone ileus present (3 symptoms)? and what is it?
A small ball obstruction secondary to impacted gallstone.
presents with abdominal pain, distension and vomiting.
Key features for Viral hepatitis:
Traveller or IVDU + N/V + myalgia (Flu like prodrome) + RUQ
Congestive hepatomegaly occurs in the case of __________ or severe cases of cirrhosis.
Congestive heart failure
Biliary colic presents with intermittent RUQ pain that begins abruptly and subsides gradually. Attacks occur ______ eating.
After eating - because the gallbladder contracts and the gallstones block this
Biliary colic symptoms (except more severe) + pyrexial + positive murphy’s signs =
Acute cholecystitis
patient with anorexia/jaundice/weight loss with:
A palpable mass in the RUQ (Courvoiser’s sign) + Periumbiliac lymphadenopathy (Sister Mary Joseph nodes) and left supraclavicular adenopathy (Virchow’s node) =
Cholangiocarcinoma
Cullens sign and grey-Turner’s sign in Acute pancreatitis:
Cullen’s sign =Periumbilical discoloration
Grey-Turner’s sign = Flank discoloration
If Oral flucloxacillin leads to ______ because of _____ use ______.
leads to diarrhea because of Clostridium Difficile use Clindamycin!
Diarrhea, abdominal pain, raised WBC, severe toxic megacolon
After using antibiotics
Diarrhea because of Clostridium Difficile
What biochemical is used to monitor colorectal cancer?
Carcinoembryonic antigen
When do you do a loop ileostomy?
When you want to defunction the colon e.g. following rectal cancer - does not decompress colon and can reverse it later
When do you do end ileostomy?
following complete excision of the colon or where the ileo colic anastomosis is not planned. Reversal is difficult.
______is a last resort where loop resort is not possible
Caecostomy
Which Gastro bug?
Common amongst travellers - watery stools, Abdominal cramps and nausea
E. Coli
Which Gastro bug?
Prolonged non-blood diarrhea? Dirty water
Giardiasis
Which Gastro bug?
Profuse water rice water stools - severe dehydration resulting in weight loss
Cholera
Which gastro bug?
Bloody diarrhea - after visiting a brothel
Shigella
Which Gastro bug?
Gasto with a flu like prodrome followed by crampy abdominal pain. Complications include Gullian barre Syndrome…
Campylobacter
Which Gastro bug?
Vomitting within 6 hours, stereotypically seen after eating rice. Diarrhoeal illness occurs after 6hrs.
Bacillus Cereus
Embolic pain with sudden pain and forceful evacuation. Acute on chronic events usually have a longer history and previous weight loss.
On examination the pain is typically greater than the physical signs would suggest
Mesenteric Infarction
What are the most helpful tests for Mesenteric infarction?
Arterial pH and lactate. Arterial phase CT scanning is the most sensitive scanning
How do you manage gastro Clostridium dificcile
First episode?
Second or subsequent episode?
First episode - Metronidazole
Second or subsequent - Vancomycin
How do you manage gastro due to Campylobacter enteritis?
Clarithromycin
How do you manage Gastro due to Salmonella?
Ciprofloxacin
And how do you manage gastro due to Shigellosis?
Ciprofloxacin
Two blood markers of upper GI bleed?
Increased urea and decreased Hb
Anti-phospholipid syndrome is related to which liver disease?
Budd-Chiari syndrome
A 32-year-old woman presents with a 12 hour history of abdominal pain, vomiting and jaundice. On examination she has tender hepatomegaly, ascites and a BMI of 35 kg/m². She has a past medical history of antiphospholipid syndrome. She drinks approximately 18 units of alcohol per week.
Budd-Chiari Syndrome
What is the distribution pattern for UC?
Continuous lesions starting from the rectum..
Primary Sclerosing cholangitis is more common in UC or CD?
UC
Best test for diagnosing H. Pylori Infection and eradication (after 4 weeks of treatment)
Urea Breath test - asked to swallow a drink and then urea concentration in breath measured
String sign on Barium Swallow?
CD
Bloody diarrhoea may be seen. Crampy abdominal pain and weight loss are also common. Faecal urgency and tenesmus may be seen
Ulcerative Colitis
Symptoms depend on the site of the lesion but include diarrhoea, rectal bleeding, anaemia and constitutional symptoms e.g. Weight loss and anorexia
Colorectal cancer
Some note-able foods which are gluten free:
Rice, Potatoes and corn/Maize
Parathyroid, Pituitary and Pancreatic tumour.
Common presentation - hypercalcaemia
MEN type 1
Medullary thyroid cancer, Parathyroid and Phaeochromocytoma
MEN Type II
Carcinoid syndrome usually occurs when metastases are present in the ____ and release _____ into the systemic circulation
Present in the liver and release serotonin into the systemic circulation
Signs of chronic severe diarrhea, flushing, abdominal pain, LOW, hepatomegaly
Carcinoid syndrome
Dysphagia may be associated with weight loss, anorexia or vomiting during eating
Past history may include Barrett’s oesophagus, GORD, excessive smoking or alcohol use
Oesophageal cancer
May have history of heartburn, Odynophagia but no weight loss and systemically well
Oesophagitis
There may be a history of HIV or other risk factors such as steroid inhaler use
Oesophageal candidiasis
Dysphagia of both solids and liquids from the start. May have history or regurgitation of food - which presents as cough (aspiration), heartburn
Achalasia
Older man. Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough. Halitosis may occasionally be seen
Pharngeal pouch - midline lump that gurgles on palpation
May be history of anxiety
Symptoms are often intermittent and relieved by swallowing
Usually painless - the presence of pain should warrant further investigation for organic causes
Globus Hystericus
Bloatin with abdominal pain and funny stools with classically:
Anaemia, low ferritin/folate levels are all characteristic of _________
Coeliac disease
Primary biliary sclerosis has the 3 M rule:
IgM
anti-Mitochondrial
Middle Aged female
Primary Biliary cirrhosis is associated with which syndrome?
Sjogren’s syndrome
Wilson’s disease happens due to a decreased _______ and hence increased_____ deposition in tissues
Decreased Caeruloplasmin and hence increased copper deposition in tissues
Most common cause of traveller’s diarrhea?
E. Coli
What are the five things looked at in the Child-Pugh score?
Bilirubin Albumin PT time Encephalopathy and Ascites
Medication to prevent variceal bleeding?
Propanolol
Lead pipe colon - loss of haustra
UC
Diarrhoea due to fried rice:
Bacilus Cereus
Diarrhoea due to Antibiotics (Ciprofloxacin)
Clostridium Difficile
Diarrhoea after travelling =
E. Coli
Diarrhoea after drinking groundwater
Giardia
Brothel + Bloody Diarrhoesa?
Shigella
Diarrhoea with Ovum + HIV??
Cryptosporidum
Diarrhoea after chicken
Salmonella (Can progress to Typhoid with the presence of Rose spots)
Diarrhoea with GB?S (ascending muscle weakness)
C. Jejuni
Rice water stools Diarrhea?
Cholera
Lump on straining, Blood and mucousy Diarrhoea
Faecal incontinence
