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6th Year > Gastro > Flashcards

Gastro Flashcards

1
Q

What are the causes of diarrhoea

A 
Infective - camp, shig, e coli
Inflammatory - IBD
Neoplastic - CRC, polyps
Drugs - co amoxyclav, PPI, NSAIDS, digoxin
Endocrine - t4 raised
Vascular - ischemic colitis
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2
Q

c dif - +ve or -ve?

A

gramm positive spore forming anaerohbe

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3
Q

risk factors for c dif?

A

hospital stay
age
abx - Clindamycin, coamoxyclav, cephalosporins, quinolones
PPI

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4
Q

What is pseudomembranous colitis

A

a presentation of c dif diarrhoeal infection found on flexi sig - yellow cornflake like plaques
assocaited with mucus and even bloody diarrhoea with abdo pain
high fever and dehydration

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5
Q

What are the complications of c dif?

A

toxic dilation leading to perforation -colectomy
paralytic ileus
multi organ failure
recurrence due to residual spores

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6
Q

what test should be ordered to diagnose c dif

A

toxin A and B immunoassay

stool culture, leucocytosis

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7
Q

What is the management regime for c dif?

A

stop the offending abx
metronidazole 500mg TDS 2 weeks
Vancomycin 125mg QDS oral if severe or if pregnant

Can add IV met if fulminant

Metronidazole can be given IV but vancomycin cannot for this indication

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8
Q

How can you tell if someone has severe c dif?

A

one of:
WCC greater than 15
Cr >50% above base
radiological or clinical evidence of severe colitis

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9
Q

What should be avaoided in c dif

A

codeine phosphate and loperamide

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10
Q

Agents for constipation?

A 
BOSSES
Bulking - Methylcellulose, ispagula husk
Osmotic - Lactulose, MgSO4, macrogols (polyethylese glycol)
Stimulant - Senna
Enemas - phosphate (osmotic)
Softeners - docusate sodium
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11
Q

Causes of constipation?

A

Most common - opiates inactivity, dehydration, poor diet.

Obstruction - mechanical or ileus

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12
Q

What is IBS

A

a disorder of Enhanced visceral perception causing bowel symptoms without any organic cause

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13
Q

How do you diagnose IBS

A 
Manning criteria (or rome)
Abdominal pain + atleast 2 of:

feeling of incomplete evacuation
increased frequency at onset of pain
loseness at onset of pain
visible distension and bloating
mucus
relief of pain with defecation
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14
Q

What tests should be done in IBS

A

FBC
coeliac serology
stool culture
colonoscopy and biopsy

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15
Q

Management for IBS

A 
Laxactives - bulk forming 
antispasmodics - mebeverine
Exclusion diets
amytriptiline
CBT
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16
Q

Differentials for dysphagia

A

Inflammatory - Pharyngitis/osophagitis, apthous ulcers

Mechanical block
Luminal - bolus/FB
Mural - stricture
Extramural - compressive mass being cancer or goitre

Motility disorder
local - achalasia
Systemic - MG/systemic sclerosis

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17
Q

investigating dysphagia

A 
Bloods
CXR
OGD
Contrast swallow with fluoroscopy
Manometry
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18
Q

2 secondary causes of achalasia

A

oesophageal cancer and chagas disease

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19
Q

What classification system is used to grade the severity of liver cirrhosis

A

Child pugh - 5 things

Albumin
Bilirubin
Ascites
Enephalopathy
Prothrombin time
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20
Q

What are the two types of HNPCC?

A

Lynch 1 : right sided CRC
Lynch 2 : CRC + gastric endometrial, prostate, breast

MSH2 gener of chr 2p (or MLH1)

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21
Q

How do you diagnose HNPCC?

A

> 3 family members over 2 generations with 1 under 50

321 rule - amsterdam criteria

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22
Q

What is budd chiari

A

Hepatic venous outflow obstruction due to a thrombus.

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23
Q

how should you investigate budd chiari

A

dopplers USS

24
Q

What are the causes of portal hypertension

A

Pre hepatic - Portal thrombosis
Hepatic - cirrhosis, Schistosomiasis
Post hepatic - Budd chiari, Right heart failure, constrictive pericarditis, TR

25
Name 3 portosystemic anastomosis sites
oesophageal varices - left gastric/inf. oesophageal veins caput medusae - umbilical/abdominal wall hemorrhoids - super rect/inferior rectal veins
26
What is encephalopathy?
accumulation of ammonia and toxins in the brain due to the diversion of toxins from the portal system directly into the systemic flow. this causes the production of glutamine causing cerebral odema
27
what are the presenting symptoms of encephalopathy
``` dysarthria asterixes confusion constructional apraxia seizures ```
28
What are the precipitants of hepatic encephalopathy?
HEPATICS - constipation most common ``` Haemorrhage electrolytes poisins alcohol tumours: HCC infection: SBP Constipation Sugar low ``` recent TIPS - can cause it. may need occluding
29
What is the management for encephalopathy
lactulose nurse at 20% head up rifaximin or other anaerobic tagetting abx for those resistant to lactulose
30
4 outcomes of portal hypertension?
``` SAVE Splenomegaly Ascites Varices Encephalopathy ```
31
what is the serum ascites albumin gradient
in portal hypertension the concentration of albumin in the blood should be 11g/l higher than in the ascitic tap a value of less than 11 means the cause is neoplastic, inflammatory, infectious or due to nephrotic syndrome
32
How do you manage someone with ascites?
``` History Examine Obs Bloods: FBC LFT UE Clotting glucose Hepatitis screen USS Ascitic tap - SAAG, AFB MCS cytology ``` DAILY WEIGHTS Fluid and salt restrict frusemide and spironolactone HAS if draining ascites
33
What is the management for SBP?
cefotaxime with albumin | lifelong abx prophylaxis due to high recurrence
34
What are the causes of liver chirosis?
``` Inherited - a1at, HH, wilson CF Infectious - hepatitis B/C CMV EBV AI- PBC PSC AIH Malignant - HCC/ mets Drugs - amiodarone, methtrexate. alcohol metabolic: NASH ```
35
what are the most common causes of chirrosis
alcohol NASH hep c and b
36
What are the signs of cirrhosis?
Hands - palmar erythema, leuconychia clubbing dupytrens face: pallor, xanthelasma, parotid enlargement. Trunk: spider naevi(press them) gynaecomastia abdo - striae ascites caput hepatomegaly, splenomegaly testicular atrophy
37
What is acanthosis nigricans assocaited with?
rule out malignancy (gastric) | insulin resistance and cushings
38
Complications of cirrhosis
``` liver decompensation portal hypertension - ascites, splenomegaly, varices, encephalopathy SBP risk of HCC hepatorenal syndrome ```
39
How do you remedy hepatorenal syndrome
splanchnic vasoconstrictors liver transplant haemodialysis HAS
40
What are the signs of decompensated liver failure?
``` ascites jaundice encephalpathy - asterixs and constructional apraxia faetor hepaticus bruising odema ```
41
How do you manage someone with liver failure?
Clotting - vit K, platelets FFP Ascites - fruse, spiro, daily weight, HAS Encephalopathy - 20degs, lactulose, anaerobic abx cerebral odema - mannitol seizures - lorazepam sepsis - abx taz glucose - glucose regular BM
42
What things shouyld be monitored in liver failure
Glucose Fluid balance clotting daily bloods - UE LFT INR
43
What medications should be avoided in liver failure
hepatotoxic drugs - paracetamol, methotrexate, isoniazid opiates
44
What is the general community management of a patient with alcoholic cirrhosis?
``` abstain from alcohol use group therapy, CBT, naltrexone or acamprosate to reduce cravings disulfiram for aversion quit smoking weight loss cholestyramine if itchy ``` manage complications and screen.
45
What score is a significant risk of bleeding on child pugh
8
46
What is the management for severe UC
``` Admit, rehydration, NBM 100mg IV hyrocortisone QDS + PR transfuse if blood loss Anticoagulate with LMWH Monitor for complications ```
47
What are the complications of severe UC flare?
``` toxic megacolon sepsis Perforation bleed out thromboembolic event ```
48
What is the drug of choice in UC maintenance
mesalazine or 5-ASA they are the same
49
What are the signs of hereditary haemochromatosis
MEALS Myocardial involvement - arrythmias and dilated cardiomyopathy Endocrine - pancreas DM, hypogonadism (erectile dys) Arthritis - 2nd and 3rd MCP joints Liver cirrhosis Skin - bronzed diabetes
50
How do you investigate HH?
bloods - FBC LFT iron studies Echo plain film of arthritic joints - shows chondrocalcinosis liver biopsy
51
What is an ELF score and when is it used?
enhanced liver fibrosis score used in new diagnosis of NAFLD to test for advanced fibrosis 10.51 is the cutoff offer every 3 years to adults
52
What should be used to diagnose liver fibrosis in hep C
transient elastography scan
53
What score is used for determining the mortality of a suspected upper GI bleed
Glasgow blatchford score ``` Haemaglobin Blood pressure sex Urea Pulse>100 Malaena syncope hepatic failure cardiac failure ```
54
What are the extra GI manifestations of IBD:
Hands - clubbing eyes - iritus mouth - apthous ulceres joints - arthritis sacroileitus skin - pyoderma gangrenosum, erythema nodosum HPB - PSC +cholangiocarcinoma, gallstones, fatty liver, other - amyloid/renal stones
55
Cause of ground glass opacity on AXR
fluid in the abdomen
56
ant ttg vs EMA
ttg more sensitive and cheaper but less specific

6th Year (19 decks)

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