Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Part 1 > gastro > Flashcards

gastro Flashcards

1
Q

oesophageal varices prophylaxis for bleeding

A

propranolol (non cardioselective beta blocker)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Child pugh liver cirrosis

A 
Score	1	2	3
Bilirubin (µmol/l)	<34	34-50	>50
Albumin (g/l)	>35	28-35	<28
Prothrombin time,
prolonged by (s)	<4	4-6	>6
Encephalopathy	none	mild	marked
Ascites	none	mild	marked

Summation of the scores allows the severity to be graded either A, B or C:
< 7 = A
7-9 = B
> 9 = C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

hep B mother about to give birth

A

give child hep B vaccine and hep B immunglobulin after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ischaemic colitis most common in

A

splenic flexure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

roux en Y bypass supplementation needed

A

iron

- mostly absorbed in duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

hepatic encephalopathy features

A

Features
confusion, altered GCS (see below)
asterix: ‘liver flap’, arrhythmic negative myoclonus with a frequency of 3-5 Hz
constructional apraxia: inability to draw a 5-pointed star
triphasic slow waves on EEG
raised ammonia level (not commonly measured anymore)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

hepatic encephalopathy treatment

A

lactulose

2nd line rifaxminin (a`bx that changes gut flora)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

abdominal pain: sudden onset, severe
ascites
tender hepatomegaly

A

Budd Chiari - hepatic vein thrombosis

Ix - US with doppler flow studies

Causes
polycythaemia rubra vera
thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C &amp; S deficiencies
pregnancy
oral contraceptive pill
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Ix to detect cirrhosis

A

Transient elastography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Sulphasalazine

A

a combination of sulphapyridine (a sulphonamide) and 5-ASA
many side-effects are due to the sulphapyridine moiety: rashes, oligospermia, headache, Heinz body anaemia, megaloblastic anaemia, lung fibrosis
other side-effects are common to 5-ASA drugs (see mesalazine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pyogenic liver abscess Rx

A

Most likely staph or e coli

Management
drainage (typically percutaneous) and antibiotics
amoxicillin + ciprofloxacin + metronidazole
if penicillin allergic: ciprofloxacin + clindamycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

5 ASA MOA

A

not absorbed and released in colon - local antiinflammaotry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Most common ERCP Side effect -

A

pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

which diabetic med causes cholestasis

A

gliclazide (sulfonylureas)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

H pylori

A

urea breath test (CLO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Melanosis coli

A

pigment laden macrophages

- laxative abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

refeeding syndrome

A

hypophosphataemia
hypokalaemia
hypomagnesaemia: may predispose to torsades de pointes
abnormal fluid balance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Primary biliary cholangitis Diagnosis and Mx

A

Diagnosis
anti-mitochondrial antibodies (AMA) M2 subtype are present in 98% of patients and are highly specific
smooth muscle antibodies in 30% of patients
raised serum IgM

Management
pruritus: cholestyramine
fat-soluble vitamin supplementation
ursodeoxycholic acid
liver transplantation e.g. if bilirubin > 100 (PBC is a major indication) - recurrence in graft can occur but is not usually a problem
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Primary biliary cholangitis complications and associations

A

Complications
cirrhosis
osteomalacia and osteoporosis
significantly increased risk of hepatocellular carcinoma

Associations
Sjogren's syndrome (seen in up to 80% of patients)
rheumatoid arthritis
systemic sclerosis
thyroid disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

autoimmune hepatitis types

A

Type I
Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA)

Affects both adults and children

Type II
Anti-liver/kidney microsomal type 1 antibodies (LKM1)

Affects children only

Type III
Soluble liver-kidney antigen

Affects adults in middle-age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

autoimmune hepatitis Features and Mx

A

Features
may present with signs of chronic liver disease
acute hepatitis: fever, jaundice etc (only 25% present in this way)
amenorrhoea (common)
ANA/SMA/LKM1 antibodies, raised IgG levels
liver biopsy: inflammation extending beyond limiting plate ‘piecemeal necrosis’, bridging necrosis

Management
steroids, other immunosuppressants e.g. azathioprine
liver transplantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

carcinoid syndrome cardiac abnormalities

A

can affect the right side of the heart. The valvular effects are tricuspid insufficiency and pulmonary stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Wilson’s features

A

Features result from excessive copper deposition in the tissues, especially the brain, liver and cornea:

liver: hepatitis, cirrhosis
neurological: basal ganglia degeneration, speech, behavioural and psychiatric problems are often the first manifestations. Also: asterixis, chorea, dementia, parkinsonism
Kayser-Fleischer rings
renal tubular acidosis (esp. Fanconi syndrome)
haemolysis
blue nails

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Wilson’s Diagnosis and Mx

A

Diagnosis
reduced serum caeruloplasmin
reduced serum copper (counter-intuitive, but 95% of plasma copper is carried by ceruloplasmin)
increased 24hr urinary copper excretion

Management
penicillamine (chelates copper) has been the traditional first-line treatment
trientine hydrochloride is an alternative chelating agent which may become first-line treatment in the future
tetrathiomolybdate is a newer agent that is currently under investigation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Features
multiple gastroduodenal ulcers
diarrhoea
malabsorption

A

Zollinger-Ellison syndrome

Zollinger-Ellison syndrome is condition characterised by excessive levels of gastrin, usually from a gastrin secreting tumour usually of the duodenum or pancreas. Around 30% occur as part of MEN type I syndrome

Features
multiple gastroduodenal ulcers
diarrhoea
malabsorption

Diagnosis
fasting gastrin levels: the single best screen test
secretin stimulation test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Ulcerative colitis pathology and barium enema findings

A

Pathology
red, raw mucosa, bleeds easily
no inflammation beyond submucosa (unless fulminant disease)
widespread ulceration with preservation of adjacent mucosa which has the appearance of polyps (‘pseudopolyps’)
inflammatory cell infiltrate in lamina propria
neutrophils migrate through the walls of glands to form crypt abscesses
depletion of goblet cells and mucin from gland epithelium
granulomas are infrequent

Barium enema
loss of haustrations
superficial ulceration, ‘pseudopolyps’
long standing disease: colon is narrow and short -‘drainpipe colon’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Peutz Jehger’s Syndrome

A

Features
hamartomatous polyps in GI tract (mainly small bowel)
pigmented lesions on lips, oral mucosa, face, palms and soles
intestinal obstruction e.g. intussusception
gastrointestinal bleeding

Management
conservative unless complications develop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

C diff MX

A

Management
first-line therapy is oral metronidazole for 10-14 days
if severe or not responding to metronidazole then oral vancomycin may be used
fidaxomicin may also be used for patients who are not responding , particularly those with multiple co-morbidities
for life-threatening infections a combination of oral vancomycin and intravenous metronidazole should be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Ix of oesophageal/gastric carcinoma mural invasion

A

endoscopic ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Gastric cancer

assw what skin disorder

A

acanthosis nigricans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

severe alcoholic hepatitis Rx

A

prednisolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

coeliac’s disease ab

A

IgA tissue transglutaminase (TTG) antibodies

will be negative in IgA deficiency

33
Q

IBS Rx

A

First-line pharmacological treatment - according to predominant symptom

pain: antispasmodic agents
constipation: laxatives but avoid lactulose
diarrhoea: loperamide is first-line

Second-line pharmacological treatment
low-dose tricyclic antidepressants (e.g. amitriptyline 5-10 mg) are used in preference to selective serotonin reuptake inhibitors

34
Q

Budd chiari - hepatic vein thrombosis

A

The features are classically a triad of:
abdominal pain: sudden onset, severe
ascites
tender hepatomegaly

Causes
polycythaemia rubra vera
thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C &amp; S deficiencies
pregnancy
oral contraceptive pill

Investigations
ultrasound with Doppler flow studies is very sensitive and should be the initial radiological investigation

35
Q

severe UC flare Rx

A

IV hydrocortisone

passing >6 bloody stools/day, has a low-grade pyrexia and displays features of systemic upset and therefore is classed as severe UC

36
Q

ascites - protein <15 ?prophylaxis for SBP

A

Patients with ascites (and protein concentration <= 15 g/L) should be given oral ciprofloxacin or norfloxacin as prophylaxis against spontaneous bacterial peritonitis

37
Q

Antibiotic prophylaxis should be given to patients with ascites if:

A

patients who have had an episode of SBP
patients with fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome
NICE recommend: ‘Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less until the ascites has resolved’

38
Q

most common ischaemic colitis site

A

splenic flexure

39
Q

ischaemic colitis

A

Ischaemic colitis describes an acute but transient compromise in the blood flow to the large bowel. This may lead to inflammation, ulceration and haemorrhage. It is more likely to occur in ‘watershed’ areas such as the splenic flexure that are located at the borders of the territory supplied by the superior and inferior mesenteric arteries.

Investigations
‘thumbprinting’ may be seen on abdominal x-ray due to mucosal oedema/haemorrhage

40
Q

NAFLD ASx found, how often to monitor for liver fibrosis

A

enhanced liver fibrosis (ELF) testing is recommended to aid diagnosis of liver fibrosis

41
Q

C diff - pseudomembranous colitis common causes

A

clindamycin: RR = 31.8
cephalosporins: RR = 14.9
ciprofloxacin: RR = 5.0

42
Q

VIPoma (vasoactive intestinal peptide)

A

VIP (vasoactive intestinal peptide)

source: small intestine, pancreas
stimulation: neural
actions: stimulates secretion by pancreas and intestines, inhibits acid and pepsinogen secretion

VIPoma
90% arise from pancreas
large volume diarrhoea
weight loss
dehydration
hypokalaemia, hypochlorhydia
43
Q

Pancreatitis causes

A

Gallstones
Ethanol
Trauma
Steroids
Mumps (other viruses include Coxsackie B)
Autoimmune (e.g. polyarteritis nodosa), Ascaris infection
Scorpion venom
Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
ERCP
Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)

44
Q

autoimmune hepatitis ``

A

Features
may present with signs of chronic liver disease
acute hepatitis: fever, jaundice etc (only 25% present in this way)
amenorrhoea (common)
ANA/SMA/LKM1 antibodies, raised IgG levels
liver biopsy: inflammation extending beyond limiting plate ‘piecemeal necrosis’, bridging necrosis

Management
steroids, other immunosuppressants e.g. azathioprine
liver transplantation

45
Q

signet ring cells

A

Gastric adenocarcinoma

46
Q

Jejunal villous atrophy

causes

A 
coeliac disease
tropical sprue
hypogammaglobulinaemia
gastrointestinal lymphoma
Whipple's disease
cow's milk intolerance
47
Q

Hepatosplenomegaly causes

A

chronic liver disease* with portal hypertension
infections: glandular fever, malaria, hepatitis
lymphoproliferative disorders
myeloproliferative disorders e.g. CML
amyloidosis

48
Q

Crohn’s disease small bowel enema signs

A 
Small bowel enema
high sensitivity and specificity for examination of the terminal ileum
strictures: 'Kantor's string sign'
proximal bowel dilation
'rose thorn' ulcers
fistulae
49
Q

Crohn’s Disease Ix

A

Bloods
C-reactive protein correlates well with disease activity

Endoscopy
colonoscopy is the investigation of choice
features suggest of Crohn’s include deep ulcers, skip lesions

Histology
inflammation in all layers from mucosa to serosa
goblet cells
granulomas

50
Q

Angiodysplasia

A

vascular deformity in GI tract
bleeding and Fe Def Anaemia
assw Aortic stenosis

Diagnosis
colonoscopy
mesenteric angiography if acutely bleeding

Management
endoscopic cautery or argon plasma coagulation
antifibrinolytics e.g. Tranexamic acid
oestrogens may also be used

51
Q

Crohn’s disease (general and inducing remission)

A

General points
patients should be strongly advised to stop smoking
some studies suggest an increased risk of relapse secondary to NSAIDs and the combined oral contraceptive pill but the evidence is patchy

Inducing remission
glucocorticoids (oral, topical or intravenous) first. Budesonide is an alternative in a subgroup of patients

enteral feeding with an elemental diet may be used in addition to or instead of other measures to induce remission, particularly if there is concern regarding the side-effects of steroids (for example in young children)

5-ASA drugs (e.g. mesalazine) 2nd line

azathioprine or mercaptopurine* can be add on but not monotherapy Methotrexate is an alternative to azathioprine

infliximab is useful in refractory disease and fistulating Crohn’s. Patients typically continue on azathioprine or methotrexate
metronidazole is often used for isolated peri-anal disease

52
Q

Crohn’s Disease

A

Maintaining remission
as above, stopping smoking is a priority (remember: smoking makes Crohn’s worse, but may help ulcerative colitis)
azathioprine or mercaptopurine is used first-line to maintain remission
methotrexate is used second-line
5-ASA drugs (e.g. mesalazine) should be considered if a patient has had previous surgery

Surgery
around 80% of patients with Crohn’s disease will eventually have surgery

53
Q

before azathioprine must assess

A

TMPT thiopurine methyltransferase

54
Q

Complications of Crohn’s disease

A 
small bowel cancer (standard incidence ratio = 40)
colorectal cancer (standard incidence ration = 2, i.e. less than the risk associated with ulcerative colitis)
osteoporosis
55
Q

liver damage (hepatocellular picture)

A 
paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin
56
Q

NAFLD

A 
Associated factors
obesity
type 2 diabetes mellitus
hyperlipidaemia
jejunoileal bypass
sudden weight loss/starvation
Features
usually asymptomatic
hepatomegaly
ALT is typically greater than AST
increased echogenicity on ultrasound
57
Q

coeliac complications

A

anaemia: iron, folate and vitamin B12 deficiency (folate deficiency is more common than vitamin B12 deficiency in coeliac disease)
hyposplenism
osteoporosis, osteomalacia
lactose intolerance
enteropathy-associated T-cell lymphoma of small intestine
subfertility, unfavourable pregnancy outcomes

58
Q

cholestasis
RUQ pain
Fatigue

A

Primary sclerosing cholangitis
strong association with UC

Complications
cholangiocarcinoma (in 10%)
increased risk of colorectal cancer

59
Q

primary sclerosing cholangitis Ix

A

endoscopic retrograde cholangiopancreatography (ERCP) magnetic resonance cholangiopancreatography (MRCP) showing multiple biliary strictures giving a ‘beaded’ appearance

ANCA may be positive

there is a limited role for liver biopsy, which may show fibrous, obliterative cholangitis often described as ‘onion skin’

60
Q

haemochromatosis screening

A

general public - ferritin
family hx - HFE genotyping

Typical iron study profile in patient with haemochromatosis
transferrin saturation > 55% in men or > 50% in women
raised ferritin (e.g. > 500 ug/l) and iron
low TIBC

61
Q

SBP

A

Diagnosis
paracentesis: neutrophil count > 250 cells/ul
the most common organism found on ascitic fluid culture is E. coli

Management
intravenous cefotaxime is usually given

Antibiotic prophylaxis should be given to patients with ascites if:
patients who have had an episode of SBP
patients with fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome
NICE recommend: ‘Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less until the ascites has resolved’

62
Q

inflamation where for crohn’s

A

all layers

mucosa and submucosa for UC

63
Q

Gilbert’s Ix

A

Investigation and management
investigation: rise in bilirubin following prolonged fasting or IV nicotinic acid
no treatment required

64
Q

Small bowel bacterial overgrowth

It should be noted that many of the features overlap with irritable bowel syndrome:
chronic diarrhoea
bloating, flatulence
abdominal pain

A

Diagnosis
hydrogen breath test
small bowel aspiration and culture: this is used less often as invasive and results are often difficult to reproduce
clinicians may sometimes give a course of antibiotics as a diagnostic trial

Management
correction of underlying disorder
antibiotic therapy: rifaximin is now the treatment of choice due to relatively low resistance. Co-amoxiclav or metronidazole are also effective in the majority of patients.

65
Q

dabigatran reversal

A

Idarucizumab (Praxbind)

66
Q

liver disease causes splanchnic vasodilation and underfilling of the kidneys (hepatorenal syndrome)

A

type 1 (rapid) 2 (slower)

Management options
vasopressin analogues, for example terlipressin, have a growing evidence base supporting their use. They work by causing vasoconstriction of the splanchnic circulation
volume expansion with 20% albumin
transjugular intrahepatic portosystemic shunt

67
Q

UGI bleed

indications for surgery

A

Patients > 60 years
Continued bleeding despite endoscopic intervention
Recurrent bleeding
Known cardiovascular disease with poor response to hypotension

68
Q

dysphagia (secondary to oesophageal webs)
glossitis
iron-deficiency anaemia

A

plummer vinson syndrome

replace iron and dilatation of webs

69
Q

Features
multiple gastroduodenal ulcers
diarrhoea
malabsorption

A

?zollinger ellison

Diagnosis
fasting gastrin levels: the single best screen test
secretin stimulation test

MEN 1
3Ps hyperparathyroipd, pancreas, pituitary (also adrenal and thyroid)

70
Q

Flushing, diarrhoea, bronchospasm, tricuspid stenosis, pellagra

A

carcinoid with liver mets - diagnosis: urinary 5-HIAA

71
Q

Some common factors indicating severe pancreatitis include:

A 
age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST
72
Q

why do coeliac patients need vaccines

A

functional hyposplenism

73
Q

HIV: biliary and pancreatic disease

A

biliary disease with HIV is sclerosing cholangitis
due to infections such as CMV, Cryptosporidium and Microsporidia

Pancreatitis in the context of HIV infection may be secondary to anti-retroviral treatment (especially didanosine) or by opportunistic infections e.g. CMV

74
Q

Villous adenoma

colonic polyps secreting mucous

A

The vast majority are asymptomatic. Possible features:
non-specific lower gastrointestinal symptoms
secretory diarrhoea may occur
microcytic anaemia
hypokalaemia

75
Q

what types of fat cause pancreatitis

A

chylomycrons and triglycerides

76
Q

prevent crohn’s relapse most effective

A

stop smoking

77
Q

urea breath test useful for

A

check H pylori POST eradication

78
Q

Obesity - NICE bariatric surgery referral cut-offs

A

with risk factors (T2DM, BP etc): > 35 kg/m^2

no risk factors: > 40 kg/m^2

Part 1 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions