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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
Q

Name 3 portosystemic anastomosis sites

A

oesophageal varices - left gastric/inf. oesophageal veins
caput medusae - umbilical/abdominal wall
hemorrhoids - super rect/inferior rectal veins

26
Q

What is encephalopathy?

A

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
Q

what are the presenting symptoms of encephalopathy

A 
dysarthria
asterixes
confusion
constructional apraxia
seizures
28
Q

What are the precipitants of hepatic encephalopathy?

A

HEPATICS - constipation most common

Haemorrhage
electrolytes
poisins
alcohol
tumours: HCC
infection: SBP
Constipation
Sugar low

recent TIPS - can cause it. may need occluding

29
Q

What is the management for encephalopathy

A

lactulose
nurse at 20% head up
rifaximin or other anaerobic tagetting abx for those resistant to lactulose

30
Q

4 outcomes of portal hypertension?

A 
SAVE
Splenomegaly
Ascites
Varices
Encephalopathy
31
Q

what is the serum ascites albumin gradient

A

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
Q

How do you manage someone with ascites?

A 
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
Q

What is the management for SBP?

A

cefotaxime with albumin

lifelong abx prophylaxis due to high recurrence

34
Q

What are the causes of liver chirosis?

A 
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
Q

what are the most common causes of chirrosis

A

alcohol
NASH
hep c and b

36
Q

What are the signs of cirrhosis?

A

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
Q

What is acanthosis nigricans assocaited with?

A

rule out malignancy (gastric)

insulin resistance and cushings

38
Q

Complications of cirrhosis

A 
liver decompensation
portal hypertension - ascites, splenomegaly, varices, encephalopathy
SBP
risk of HCC
hepatorenal syndrome
39
Q

How do you remedy hepatorenal syndrome

A

splanchnic vasoconstrictors
liver transplant
haemodialysis
HAS

40
Q

What are the signs of decompensated liver failure?

A 
ascites
jaundice
encephalpathy - asterixs and constructional apraxia
faetor hepaticus
bruising
odema
41
Q

How do you manage someone with liver failure?

A

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
Q

What things shouyld be monitored in liver failure

A

Glucose
Fluid balance
clotting
daily bloods - UE LFT INR

43
Q

What medications should be avoided in liver failure

A

hepatotoxic drugs - paracetamol, methotrexate, isoniazid

opiates

44
Q

What is the general community management of a patient with alcoholic cirrhosis?

A 
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
Q

What score is a significant risk of bleeding on child pugh

A

8

46
Q

What is the management for severe UC

A 
Admit, rehydration, NBM
100mg IV hyrocortisone QDS + PR
transfuse if blood loss
Anticoagulate with LMWH
Monitor for complications
47
Q

What are the complications of severe UC flare?

A 
toxic megacolon
sepsis
Perforation
bleed out
thromboembolic event
48
Q

What is the drug of choice in UC maintenance

A

mesalazine or 5-ASA they are the same

49
Q

What are the signs of hereditary haemochromatosis

A

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
Q

How do you investigate HH?

A

bloods - FBC LFT iron studies
Echo
plain film of arthritic joints - shows chondrocalcinosis
liver biopsy

51
Q

What is an ELF score and when is it used?

A

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
Q

What should be used to diagnose liver fibrosis in hep C

A

transient elastography scan

53
Q

What score is used for determining the mortality of a suspected upper GI bleed

A

Glasgow blatchford score

Haemaglobin
Blood pressure
sex
Urea
Pulse>100
Malaena
syncope
hepatic failure
cardiac failure
54
Q

What are the extra GI manifestations of IBD:

A

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
Q

Cause of ground glass opacity on AXR

A

fluid in the abdomen

56
Q

ant ttg vs EMA

A

ttg more sensitive and cheaper but less specific

6th Year (19 decks)

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