Gastro Flashcards
Charcot’s triad
Cholangitis - RUQ pain, jaundice, fever
Murphy’s sign
Pain on inspiration with hand under right costal margin
Wernicke’s encephalopathy triad
Opthalmoplegia, ataxia and confusion
Korsakoff’s syndrome
Memory impairment, confabulation, confusion and personaity changes. Normally developed after wernicke’s.
Antibodies raised in PBC
IgM and AMA (ANA often raised, as is anti-gp210 and anti-centromere)
Antibodies raised in autoimmune hepatitis
IgG and ANA/ASMA
Which hepatic disease is often in conjunction with ulcerative colitis?
Primary sclerosing cholangitis
PSC biopsy appearance
Onion skin fibrosis
PBC biopsy appearance
Inflamm around small bile ducts in liver - granulomatosis
MRCP appearance of PSC
String of beads
Main form of diagnosis for PSC
MRCP
Most common demographic for PBC
Middles aged women
Diagnostic criteria for PBC
2 of following is probable, 3 is definite:
Abnormal cholestatic LFTs
Positive AMA
Compatible histology
What 5 factors are included in child pugh score and what is it used for?
Bilirubin, albumin, INR, ascites and encephalopathy
Predicting mortality in patients with cirrhosis.
What is cullen’s sign?
Bruising around the umbillicus due to acute pancreatitis or an ectopic pregnancy
What is grey-turner’s sign?
Discolouration of the flanks caused by retro-peritoneal haemmorhage
What is troisier’s sign?
Presence of wirchow’s node in left SCF
Which disease is indicated by raised anti-dsDNA?
SLE
Treatments for Wilson’s disease
Penicillamine
Which renal condition is assoicated with Wilson’s disease?
Membranous nephropathy
Gene affected in Wilson’s disease
ATP7B
Which blood group is a risk factor for gastric cancer?
A
Risk factors for gastric cancer
Blood group A Helicobacter pylori Pernicious anaemia smoking High salt/nitrite diet (except in cardia - more similar to oesophageal)
Treatment for simple apthhous ulcer
Topical steroids
How long can mouth ulcers be preset for before you need to biospy them?
3 weeks
Which virus causes oral hairy leucoplakia?
EBV
Features of small intestinal bacterial overgrowth
Chronic diarrhoea, anaemia (low b12, high folate), steatorrhoea and glossitis. Causes malbsorptioj
Risk factors for small intestinal bacterial overgrowth
Decreased gastric acid secretion
Decreased gut motility
Immunodeficiency
Structural defects/previous surgery
Treatment for small intestinal bacterial overgrowth
Antiobiotics - eg metro, cipro or coamox
Indicators of liver synthetic function
Prothrombin is acute indicator, albumin is more chronic (1/2 life of 20 days)
Extra articular features of IBD
Oral - apthous ulcers (chrons)
Eyes - anterior uveitis, conunctivitis, episcleritis
Joints - seronegative spondyloarthritis (non-deforming and asymetrical usually), sacroilitis
Skin - pyoderma gangrenosum (UC mainly), erythema multiforne, finger clubbing
Liver - PSC (UC)
Anal - fissure (mainly Chrons)
Obstruction of which veins cause caput medusa?
Superior mesenteric and splenic veins - anastomose to form portal vein
Which hormone inhibits gastrin?
sOMA
Features of UC on barium enema
Shortened bowel, loss of haustra (lead pipe colon) and small serration at the bowel edge from ulceration
Colonoscopy features of UC
Diffuse and contiguous ulceration and inflammatory infiltrates affecting mucosa and submucosa only. Pseudopolyps and crypt abcess both also seen.
Long term complication of UC
Large bowel adenocarcinoma, toxic megacolon, and PSC. Cancer avoided by total colectomy in long stadning UC or when dysplasia has developed
Features of Crohn’s on barium enema
Multiple linear ulcers in bowel wall (rose thorn appearance) and bowel wall thickening.
Colonoscopy features of Crohn’s
Multiple apthoid, linear, stellate ulcers with background inflammed cobblestone mucosa. Inflammation is transmural and has non-caseating granulomas
Most appropraite therapy for Hep C genotypes
1 - PEG-interferon alpha with ribavarin and a protease inhibitor
Others - No PI
What is Budd-chiari syndrome?
Hepatic venous outflow obstruction (anywhere from hepatic venules to entrance of IVC)
Presentation of budd chiari syndrome
Abdo pain, ascites and hepatomegaly
Risk factors for Budd-chiari syndrome
Prothombotic conditions Hormones eg contraception Pregancy and puerperium Hepatic infections (inc. parasites) Malignancy Trauma Autoimmune conditions (eg Coeliac, behcets or sarcoidosis)
What LFT results would suggest Gilbert’s syndrome?
Isolated bilirubinaemia
Which enzyme is effected in Gilbert’s syndrome?
UDP-glucuronyl transferase
What is Crigler-Najjar syndrome?
Defect in glucuronyl-transferase activity - presents with death and jaundice in neonates
What is Caroli’s syndrome?
Congenital dilatation of the intrahepatic bile duct - causes recurrent episodes of cholangitis
Features of severe flare of UC
EAT STEroid ESR >30mm/hour Albumin <30g/l Temperature at 0600 >37.8 Stool frequency >6/day with blood Tachycardia >90bpm Enaemia Hb <10.5g/dl
Treatment of severe UC flare
Admit to hospital, IV corticosteriods, fluids and monitoring
Differentiating ascites between trasudate and exudate
Protein content alone or SAAG
SAAG <11g/L is exudate
Ascitic protein >30g/L is exudate
What is achlasia?
Failure of lower oesophageal sphincter to dilate
Characteristic appearance of achlasia on barium swallow
Bird’s beak tapering
What investigation can be used to confirm achlasia?
Manometry
How does severe alcoholism effect amylase levels during acute pancreatitis?
Means they may only be moderately raised due to impairment of pancreas.
Predicting severity of severe pancreatitis
Modified Glasgow criteria - PANCREAS PaO2 <8kPa Age >55yrs Neutrophilia - WBC >15 Calcium <2mmol/L Renal function - Urea >16mmol/L Enzymes - LDH >600iu/L, AST >200iu/L Albumin <32g/L (serum) Sugar - BM >10mmol/L
Which B vitamin is thiamine?
B1
Features of pellegra
Diarrhoea, dermatitis and dementia
What is cope’s/obturator sign?
Pain of appendicitis stimulated by flexion and internal rotation of the hip. Works if appendix is retro-peritoneal in orientation
What is psoas sign?
Pain of appendicitis reproduced when patient laid of side and leg is passively extended (Also positive in psoas abscess)
What is pemberton’s sign?
Patient with SVC obstruction - raises hand above head , increasing pressure over gthoracic inlet causing venous congestion in face and neck
What is rovsing’s sign?
Palpation in LIF produces pain in the RIF
Most common location for a gastrinoma
1st/2nd part of the duodenum and pancreatic head
Eradication therapy for H Pylori
Omeprazole 20mg BD, Clarithromycin 500mg BD and Amoxicillin 1g BD (swap amox for metronidazole 400mg BD if pen allergic)
Which conditions does duodenal scalloping on endoscopy suggest?
Coeliac, HIV infection, amyloidosis and giardiasis
