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Nephrology > Gastro > Flashcards

Gastro Flashcards

1
Q

Plummer vinson syndrome

A

Triad of:
dysphagia (secondary to oesophageal webs)
glossitis
IDA

Treatment includes iron supplementation and dilation of the webs

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2
Q

D2 Antagonist

A 
Metoclopramide - prokinetic
Domperidone - prokinetic
Prochlorperazine - Vestibular/GI causes
Haloperidol - drug causes
>> dystonias and oculogyric crisis in young
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3
Q

H2 antagonist

A

cyclizine - GI

cinnarizine - vestibular

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4
Q

5HT3 antagonist

A

Ondansetron - chemo

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5
Q

Zollinger Ellison Syndrome

A

gastroma > gastrin > gastroduodenal ulcres > abdo pain, diarrhoea,
PPI
Dx fasting gastrin
MEN1

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6
Q

Duodenal ulcer

A 
Blood O-
more common
before meals
milk helps
night
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7
Q

Gastric ulcer

A

elderly, lesser curve
after meals
better with antacids
biopsy (cancer)

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8
Q

Dx HH

A

Liver biopsy - Perls stain – iron loading

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9
Q

Complications HH

A 
hypogonadism
cardiomyopathy
skin changes - bronze
diabetes
cirrhosis
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10
Q

PBC

A 
Autoimmune
AMA, raised IgM, middle aged women
Cholestasis > fibrosis
> HCC (check AFP bi yearly), cirrhosis
Tx - ursodeoxycholic acid
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11
Q

Primary sclerosing cholangitis

A 
Ulcerative colitis
ANA
liver biopsy - fibrous obliterative cholangitis
beading ERCP/ MRCP -- dx
men
high risk ca - yearly colonoscopy and US
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12
Q

Autoimmune hep

A

young middle age women
T1 - AMA, SMA -kids, middle age
T2: kids, Anti liver anti kidney microsomal - LKM1
T3: Anti soluble liver antigen
Signs chronic liver disease, 25% acute, amenorrhea
associations - autoimmune disorders, hypergammaglobulinaemia and HLA B8, DR3
liver biopsy: inflammation extending beyond limiting plate ‘piecemeal necrosis’, bridging necrosis
Mx: steroids, azathioprine, liver transplantation

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13
Q

Wilsons

A 
Copper > liver, basal ganglia
AR
low serum copper and caeruloplasmin
high urinary copper 24hr
Tx penicillamine
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14
Q

Cholangiocarcinoma

A

flukes
slow growing
ERCP, surgery
75% cant have surgery, 75% re occur

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15
Q

Ulcerative colitis

A 
PSC > UC
Uveitis > UC
no inflammation beyond submucosa
ulceration  ('pseudopolyps')
 lamina propria
 crypt abscesses
loss of haustrations
'drainpipe colon'
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16
Q

Tx UC

A

topical (rectal) aminosalicylate (mesalazine) - mild mod

severe - IV steroids then IV ciclosporins

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17
Q

Crohns tx

A

Inducing remission:
glucocorticoids , budesonide
ASA - mesalazine

Maintaining remission
azathioprine or mercaptopurine
methotrexate

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18
Q

Investigations Crohns

A

increased faecal calprotectin

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19
Q

Complications Crohns

A

small bowel cancer
colorectal cancer
osteoporosis

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20
Q

Explosive diarrhoea

A

cholera; giardia; yersinia; rotavirus.

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21
Q

White cells: absent

A

in amoebiasis, cholera, E. coli and viruses

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22
Q

Clostridium difficile

A

Gram positive rod
exotoxin > intestinal damage > pseudomembranous colitis.
broad-spectrum antibiotics, 2nd/3rd gen cephalosporins, PPIs
diarrhoea, abdo pain, raised WCC
> toxic megacolon
Diagnosis -CDT stool
Clostridium difficile antigen -exposure
oral metronidazole 10-14 days
severe / not responding -oral vancomycin / fidaxomicin
life-threatening - oral vancomycin and IV metronidazole

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23
Q

Cryptosporidiosis

A

protozoa

Ziehl-Neelsen stain (acid-fast stain) of the stool - red cysts of Cryptosporidium

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24
Q

Travellers’ diarrhoea

A

Escherichia coli.

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25
acute food poisoning
Staph aureus, Bacillus cereus or Clostridium perfringens.
26
Giardiasis
flagellate protozoan chronic diarrhoea, malabsorption and lactose intolerance metronidazole
27
Cholera
Profuse, watery diarrhoea
28
Shigella
Bloody diarrhoea
29
Campylobacter complications
GBS, Reiter's syndrome, septicaemia, endocarditis, arthritis
30
Campylobacter
Gram-negative bacillus Campylobacter jejuni | bloody diarrhoea, may mimic appendicitis
31
rice
Bacillus cereus
32
Salmonella - bacteria type
aerobic, Gram-negative rods | Typhoid and paratyphoid
33
Salmonella symptoms
systemic upset relative bradycardia abdominal pain, distension constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid
34
Salmonella complications
osteomyelitis (especially in sickle cell disease) GI bleed/perforation meningitis cholecystitis chronic carriage (1%, more likely if adult females
35
Osmotic laxatives
Lactulose, Movicol®, Magnesium salts, Phosphate enemas
36
Stimulant laxatives
senna , Docusate sodium, Glycerol suppositories ( sodium picosulfate)
37
Cullens sign
periumbilical
38
Turners sign
flanks
39
Courvoisiers sign
palpable gallbladder jaundice no pain :> unlikely stone, think ca
40
Carcinoid tumours - ix and tx
Investigation urinary 5-HIAA (metabolite of serotonin) plasma chromogranin A y Management somatostatin analogues e.g. octreotide diarrhoea: cyproheptadine may help
41
gastric cancer. histology
signet rings
42
Complication deficiency selenium
cardiomyopathy
43
Complication deficiency B6 (pyridoxine)
polyneuropathy
44
Complication deficiency Zinc
Acrodermatitis enteropathica | poor wound healing
45
Complication deficiency B 1 (thiamine)
Beriberi wet - HF dry - neuropathy Wernicke’s encephalopathy
46
pellagra
nicotinic acid diarrhoea, dementia, dermatitis nicotinamide
47
xeropthalmia
vit a blind btots spots
48
Unconjugated hyperbilirubinaemia
Gilbert's syndrome - mild deficiency of UDP-glucuronyl transferase Crigler-Najjar syndrome - absolute deficiency
49
Conjugated hyperbilirubinaemia
Dubin-Johnson syndrome: Iranian Jews mutation in the canalicular multidrug resistance protein 2 (MRP2) results in defective hepatic excretion of bilirubin grossly black liver Rotor syndrome: defect in the hepatic uptake and storage of bilirubin benign
50
Peutz-Jeghers syndrome
gene encodes serine threonine kinase LKB1 or STK11 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 GIT cancers
51
Melanosis coli
disorder of pigmentation of the bowel wall. Histology demonstrates pigment-laden macrophages It is associated with laxative abuse, especially anthraquinone compounds such as senna
52
Previous Hep B immunisation
Anti HBS only
53
Hep B previously, now clear
anti HBsAg positive anti HBcAg positive All antigen negative
54
Hep B, chronic
All antigens and all antibodies - IgG as chronic
55
Hep A
``` benign, self limiting 2-4 incubation RNA picornavirus cholestatic LFTs At risk groups vaccinated ```
56
Hep B
``` DS hepadnavirus incubation 6-20 weeks ALT > AST Peg interferon alpha, now some antivirals Screen pregnant women ```
57
Hep C
RNA flavavirus No vaccine High risk transmission Majority (60%) chronic
58
Chronic hep C treatment
Aim: sustained virological response combination of protease inhibitors + / - ribavirin
59
Ribavirin
Tx chronic Hep C | SE: Haemolytic anaemia, cough, teratogenic (no preg <6/12)
60
Interferon alpha
Chronic hep c | Flu like symptoms, depression, fatigue, leukopenia, thrombocytopenia
61
Hep D
``` Single stranded RNA Parenteral Requires HBsAg Interferon tx (poor evidence) Coinfection/ superinfection ```
62
Hep E
``` RNA herpesvirus faecal oral 3-8 weeks incubation 20% mortality pregnancy vaccine in development not chronic ```
63
Autoimmune hepatitis T1
ANA/ SMA | adults, kids
64
Autoimmune hepatitis T2
LKMI Anti liver/ kidney microsomal type 1 antibodies Kids
65
Autoimmune hepatitis T3
Soluble liver kidney antigen | Middle aged adults
66
Wilsons
autosomal recessive ATP7B gene, chromosome 13 reduced serum caeruloplasmin with reduced serum copper increased 24hr urinary copper excretion
67
Wilsons treatment
penicillamine | trientine hydrochloride - chelating agent
68
HCC screening
US + - AFP | cirrhosis secondary to Hep B/C/ haemochromatis or alcohol
69
HH iron profile
transferrin saturation high raised ferritin low TIBC
70
Tx HH
venesection | Desferrioxamine
71
Who is at risk of liver cirrhosis?
Hep B/ C, BMI > 30, alcohol abuse, T2DM
72
Who do you offer transient elastography to?
Hep C, alcohol M>55 units, F> 35 units, alcohol related liver disease, NAFLD with ELF test > 10.5 Retest every 2 years
73
Cirrhosis risk screening
HCC - US and AFP 6 monthly | UGIE 3 yearly for varices
74
IBS management
2nd line = low-dose TCA (e.g. amitriptyline 5-10 mg) | if no improvement 1 year - CBT/ hypnotherapy/
75
Gastroparesis
Prokinetic agents: Metoclopramide Domperidone Erythromycin

Nephrology (26 decks)

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