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Phase 3B > Gastro > Flashcards

Gastro Flashcards

1
Q

What are oesophageal varices?

A

Dilated veins at the junction between the portal and systemic venous systems

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2
Q

Where are varices found?

A

Distal oesophagus

Proximal stomach

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3
Q

How do varices present?

A

Haematemesis
Malaena
Abdo pain
Shock

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4
Q

What are the causes of oesophageal varices?

A

Portal hypertension from alcoholic and viral cirrhosis
Portal vein thrombosis
Budd-Chiari syndrome

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5
Q

How are varices diagnosed?

A

Endoscopy
Clotting and INR
FBC, G&S
LFTs

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6
Q

What are the principles of management of oesophageal varices?

A

Resuscitation
Early risk stratification with Blatchford and Rockall score
Control variceal bleeding

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7
Q

How is a patient with oesophageal varices resuscitated?

A

ABCDE
Crystalloid bolus
Transfusion: platelets (if active bleeding and count <50x10^9) or FFP (if fibrinogen <1g/L)

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8
Q

How is arrest of variceal bleeding implemented?

A

Terlipressin

Stop after definitive haemostasis/after 5 days

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9
Q

What are other management options to stop variceal bleeding?

A

Balloon tamponade if uncontrolled haemorrhage
Band ligation
Transjugular intrahepatic portosystemic shunts (TIPS)

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10
Q

What are the causes of pancreatitis?

A 
Gallstones
Alcohol
Hypothermia
Post ERCP
Hyperparathyroidism
Malignancy
IBD
Uraemia
Thromboembolism
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11
Q

What are the symptoms of pancreatitis?

A

Severe epigastric/LUQ pain, penetrates to the back which steadily decreases over 72h, vomiting

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12
Q

What are the main signs of pancreatitis?

A

Cullen’s: bruising around the umbilicus
Grey Turner’s: bruising around the flanks

Both signs of retroperitoneal haemorrhage

Pyrexia, tachycardia, abdo tenderness with rigidity, hypotension

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13
Q

Why is morphine CI in pancreatitis?

A

Spastic effect on Sphincter of Oddi

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14
Q

How is pancreatitis diagnosed?

A

Serum amylase >3x normal
Lipase
CT with contrast

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15
Q

How is pancreatitis managed?

A

Pethidine or buprenorphine
IV fluids
NBM
IV abx if pancreatic necrosis

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16
Q

Name three complications of pancreatitis?

A

Pancreatic abscess/pseudocyst/necrosis
DIC, haemorrhage
Sepsis and renal failure

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17
Q

What is chronic pancreatitis and how does it occur?

A

Chronic inflammation of the pancreas which results in irreversible damage

Obstruction/reduction in bicarbonate excretion which activates pancreatic enzymes, leading to pancreatic tissue necrosis with fibrosis

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18
Q

What are the risk factors for chronic pancreatitis?

A

Alcohol
Smoking
Biliary tract disease
Cystic fibrosis

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19
Q

What are the symptoms of chronic pancreatitis?

A

Epigastric pain radiating to the back
Nausea and vomiting
Exocrine dysfunction (malabsorption, weight loss, diarrhoea, steatorrhoea)
Endocrine dysfunction (diabetes mellitus)

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20
Q

How is chronic pancreatitis diagnosed?

A

Normal amylase
Secretin stimulation test positive if 60% exocrine function damaged
CT or MRCP
Faecal elastase

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21
Q

What is the treatment of chronic pancreatitis?

A

Opiates/coeliac plexus block
Creon - replace pancreatic enzymes
SC octreotide
Pancreatoduodenoectomy

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22
Q

What is the treatment of IBS diarrhoea?

A

Loperamide

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23
Q

What is the treatment of IBS constipation?

A

Laxatives (not lactulose)

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24
Q

What is the treatment of IBS abdominal pain?

A

Anti-spasmodics - mebeverine

Hyoscine

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25
Q

What are the characteristics of globus pharyngis?

A

Sensation of having a lump in the throat, intermittent, relieved by food and drink, swallowing saliva is difficult.

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26
Q

What is achalasia?

A

Disorder of motility of lower oesophageal sphincter

Smooth muscle layer of oesophagus has impaired peristalsis and fails to relax

Reduced secretion of nitric oxide

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27
Q

What are the symptoms of achalasia?

A

Dysphagia of solids
Regurgitation
Retrosternal chest pain/heartburn

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28
Q

What is seen on barium swallow in achalasia?

A

Dilated oesophagus
Contrast passes slowly into the stomach as the sphincter opens intermittently

Distal oesophagus - Bird’s beak

Then, oesophageal manometry

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29
Q

What is the treatment of achalasia?

A

CCB/nitrates
Balloon dilatation of the LOS
Heller myotomy

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30
Q

What is the appearance of oesophageal carcinoma on barium swallow?

A

Rat’s tail

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31
Q

What is a pharyngeal pouch?

A

Posteromedial herniation between thyropharyngeus and cricopharyngeus muscles

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32
Q

What are the symptoms of pharyngeal pouch?

A

Halitosis
Dysphagia
Regurgitation
Aspiration and chronic cough

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33
Q

What are two risk factors for oesophageal candidiasis?

A

History of HIV

Steroid inhaler use

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34
Q

What are the oesophageal characteristics of systemic sclerosis?

A

Oeosphageal dysmotility and decreased pressure of LOS.

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35
Q

What are the symptoms of oesophageal carcinoma?

A

Weight loss
Progressive dysphagia
Anorexia
Vomiting during eating

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36
Q

What is Wilson’s disease?

A

Hepatic copper deposition caused by mutations in the ATP7B gene on chromosome 13

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37
Q

What is the inheritance of Wilson’s disease?

A

Autosomal recessive

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38
Q

What is the pathophysiology of Wilson’s disease?

A

Hepatocytes cannot move copper across intracellular membranes; serum copper concentrations are low and hepatic retention of copper develops

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39
Q

What are the symptoms of Wilson disease?

A

Asymptomatic hepatomegaly or elevation of serum aminotransferases

Liver - Acute liver failure, chronic hepatitis and cirrhosis

Psych - behavioural problems, tremor, basal ganglia degeneration, chorea

Eyes - Kayser-Fleischer rings/sunflower cataracts

40
Q

How is Wilson’s disease diagnosed?

A

Low caeruloplasmin <0.1g/L
Low serum copper
Elevated 24h urinary copper
Liver biopsy

41
Q

What is the treatment of Wilson’s disease?

A

Penicillamine

42
Q

What is haemochromatosis?

A

Defects of HFE gene on C6 leading to deficiency of iron regulatory hormone hepcidin

43
Q

What is the pathophysiology of haemochromatosis?

A

Increased intestinal absorption of iron causes accumulation in liver, pancreas, joints, heart, skin, gonads

44
Q

How does haemochromatosis present?

A

Asymptomatic until late stages - 40s-60s

Fatigue, weakness, arthropathy, erectile dysfunction, diabetes

Hepatomegaly, grey skin, arrhythmias/cardiomegaly

45
Q

How is haemochromatosis diagnosed?

A

High fasting transferrin saturation
High serum ferritin
LFTs and liver biopsy

46
Q

How is haemochromatosis treated?

A

Venesection

47
Q

What are the characteristics of ischaemic colitis?

A

Intermittent severe pain following a meal that is out of proportion with clinical findings

Diarrhoea and rectal bleeding

48
Q

What is the most common location of ischaemic colitis?

A

Splenic flexure

49
Q

What is pellagra?

A

Vitamin B3 deficiency

50
Q

What is Barrett’s oesophagus?

A

Metaplasia of the lower oesophageal mucosa (squamous –> columnar)

51
Q

What percentage of primary sclerosing cholangitis patients develop cholangiocarcinoma?

52
Q

What are the symptoms of cholangiocarcinoma?

A

Jaundice
Weight loss
Pruritus
Persistent biliary symptoms

53
Q

Name a risk factor for primary sclerosing cholangitis.

A

Ulcerative colitis (4%)

54
Q

What is the most common organism causing spontaneous bacterial peritonitis?

55
Q

What are the symptoms of carcinoid syndrome?

A 
Flushing
Diarrhoea
Bronchospasm
Hypotension
Right sided heart valvular fibrosis
56
Q

When does carcinoid syndrome occur?

A

Carcinoid tumour

Liver mets release serotonin into the systemic circulation

57
Q

What are the difference in symptoms in Crohn’s disease and Ulcerative colitis?

A

CD: non bloody diarrhoea, WL, Upper GI disease and perianal disease, abdo mass RIF

UC: Blood diarrhoea, tenesmus, abdo pain LIF

58
Q

What is the difference in histology between CD and UC?

A

CD: transmural inflammation, goblet cells, granulomas

UC: submucosal inflammation, crypt abscesses, no granulomas

59
Q

What is seen on endoscopy in CD and UC?

A

CD: deep ulcers, skip lesions, cobblestone appearance

UC: Pseudopolyps and widespread ulceration

60
Q

What is seen on imaging in CD and UC?

A

CD: Kantor’s string sign, proximal bowel dilatation, rose thorn ulcers, fistulae

UC: loss of haustrations, superficial ulceration, drainpipe colon

61
Q

Name some extra-intestinal features of IBD that are related to disease activity.

A

Pauciarticular arthritis
Erythema nodosum
Episcleritis (CD)
Osteoporosis

62
Q

Name some extra-intestinal features of IBD that are unrelated to disease activity.

A 
Polyarticular arthritis
Uveitis
Pyoderma gangrenosum
Clubbing
PSC (UC)
63
Q

What is the treatment of crohn’s disease?

A

Glucocorticoids to induce remission
Stop smoking
Azathioprine/mercaptopurine to maintain remission
(MTX 2nd line)

64
Q

What is the treatment of ulcerative colitis?

A

PR then PO aminosalicylate (mesalazine/sulfasalazine)

IV steroids if severe colitis

65
Q

What is Budd-Chiari syndrome?

A

Hepatic vein thrombosis

66
Q

What is the triad of features in Budd-Chiari syndrome?

A

Severe sudden onset abdo pain
Ascites
Tender hepatomegaly

67
Q

How is Budd-Chiari syndrome diagnosed?

A

Ultrasound with doppler flow studies

68
Q

What is the gold standard diagnosis of primary sclerosing cholangitis?

69
Q

How does CD increase the risk of gallstones?

A

Terminal ileitis decreases bile salt reabsorption

70
Q

Which antibodies is primary sclerosing cholangitis associated with?

A

ANCA

Anti-SM

71
Q

How can an upper and lower GI bleed be differentiated?

A

Upper - raised urea

Large protein “meal” of blood which is digested

72
Q

What is the treatment of hepatic encephalopathy?

A

Lactulose (reduces production and absorption of ammonia)

PO rifaximin if refractory

73
Q

How is carcinoid syndrome diagnosed?

A

5HIAA

Urinary 5-Hydroxyindoleacetic acid

74
Q

What antibodies are associated with autoimmune hepatitis?

A

Anti-SM

ANA

75
Q

How do you calculate the number of alcoholic units?

A

Volume (ml) x ABV

/1000

76
Q

How may iron deficiency anaemia cause dysphagia?

A

Post-cricoid webs, as part of Plummer-Vinson syndrome

77
Q

What are the features of autoimmune hepatitis?

A

Signs of chronic liver disease
Fever, jaundice
Amenorrhoea1

78
Q

Which antibodies are associated with primary biliary sclerosis and what other blood test is raised?

A

Anti-Mi (mitochondrial)

Also raised ALP

79
Q

What is a prophylactic medication for oesophageal variceal bleeding?

A

Non specific beta blockers such as propranolol reduce portal inflow and reduce further episodes

80
Q

What is the treatment of haemorrhoids?

A

Manage constipation
Anusol
Rubber band ligation/haemorrhoidectomy

81
Q

What is the treatment of anal fissures?

A

Manage constipation
Topical diltiazem/GTN
Botox injection

82
Q

What is c.difficile and what are the symptoms?

A

Overgrowth of c.diff bacteria following antibiotic use (usually ciprofloxacin)

3-9 days post abx
High amount of green foul smelling stool with crampy abdo pain

83
Q

What are the complications of c.difficile?

A

Toxic megacolon
Perforation
Spread of infection

84
Q

What is the treatment of c.difficile?

A 
Stop unnecessary antibiotics
Isolate and barrier nurse
IV fluids
Oral metronidazole/vancomycin
Stool transplant
85
Q

What is the biomarker for malabsorption caused by chronic pancreatitis?

A

Faecal elastase

86
Q

Name 3 fat soluble vitamins.

87
Q

What are the histological features of coeliac disease?

A

Villous atrophy
Crypt hyperplasia
Invasion with lymphocytic cells

88
Q

Define acute liver failure.

A

Acute encephalopathy, jaundice, and coagulopathy, without previous cirrhosis

Usually within 12 weeks

89
Q

What test results would you expect in acute liver failure?

A

Raised AST, ALT, ALP, bilirubin
Low albumin
PT raised

90
Q

What tests form the non-invasive liver screen?

A 
FBC, clotting, LFTs
Hepatitis serology (HBsAg/anti-HCV)
EBV and CMV serology
Serum caeruloplasmin and transferrin saturation
Anti-Mi, Anti-Sm, ANA ab
91
Q

What is the management of acute liver failure?

A

A-E assessment
Stop hepatotoxic drugs (NSAIDs, paracetamol, ACEIs, erythromycin, statins)
Prophylactic abx
IV 5% glucose
Lactulose 10-20ml/8hr
Treat the cause (if alcoholic - prednisolone)
Transplant

92
Q

What are the main problems of decompensated chronic liver failure?

A

Variceal bleeding
Encephalopathy
Coagulopathy
Hypoalbuminaemia = ascites

93
Q

Give five signs of liver failure.

A 
Palmar erythema
Liver flap
Spider naevi
Clubbing
Dupuytrens contracture
94
Q

What is the main characteristic of SBP?

A

Abdominal pain in presence of ascites.

Fever, tachycardia, hypotension

95
Q

What is cholangitis?

A

Infection of bile duct with Charcot’s triad: fever, jaundice, RUQ pain

96
Q

What is the treatment of acute severe alcoholic hepatitis?

A

Prednisolone

Phase 3B (20 decks)

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