gastro Flashcards
zollinger ellison syndrome fx and ix
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
intestinal angina
classically characterised by a triad of severe, colicky post-prandial abdominal pain, weight loss, and an abdominal bruit
suntan and reduced libido
haemochromatosis
kantor’s string sign
small bowel enema- crohns
carcinoid fx
flushing (often earliest symptom)
diarrhoea
bronchospasm
hypotension
right heart valvular stenosis (left heart can be affected in bronchial carcinoid)
other molecules such as ACTH and GHRH may also be secreted resulting in, for example, Cushing’s syndrome
pellagra can rarely develop as dietary tryptophan is diverted to serotonin by the tumour
gastric cancer red flags
Red flag symptoms for gastric cancer includes
new-onset dyspepsia in a patient aged >55 years
unexplained persistent vomiting
unexplained weight-loss
progressively worsening dysphagia/
odynophagia
epigastric pain
Oesophageal/Gastric Cancer gold std ix
Endoscopic ultrasound (EUS) is better than CT or MRI in assessing mural invasion
serum-ascites albumin gradient high
due to portal hypertension
truelove and witts severity
Temperature greater than 37.8°C
Heart rate greater than 90 beats per minute
Anaemia (Hb less than 105g/ L)
Erythrocyte sedimentation rate greater than 30 mm/hour
for UC which requires admission
coeliac get pneumococcal vaccine due to
functional hyposplenism
sbp most common organism
e coli
ciprofloxacin prophylaxis
PBC m rule
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females
conditions for urea breath test
should not be performed within 4 weeks of treatment with an antibacterial or within 2 weeks of an antisecretory drug (e.g. a proton pump inhibitor)
drug that causes cholestasis
COCP
cancer associated with achalasia
SCC
ix to differentiate IBS and IBD in GP
faecal calprotectin
coeliac causes deficiency in
iron folate and b12
infection causing fat malabsorption
gardia lamblia
Peutz-Jeghers syndrome
Genetics
autosomal dominant
responsible gene encodes serine threonine kinase LKB1 or STK11
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
paracentesis-induced circulatory dysfunction
large volume paracentesis (> 5 litres). It is associated with a high rate of ascites recurrence, development of hepatorenal syndrome, dilutional hyponatraemia, and high mortality rate
give albumin at same time
Plummer-Vinson syndrome
Triad of:
dysphagia (secondary to oesophageal webs)
glossitis
iron-deficiency anaemia
Treatment includes iron supplementation and dilation of the webs
carcinoid ix
urinary 5-HIAA
plasma chromogranin A y
barretts surveillance and mx
Endoscopic surveillance
for patients with metaplasia (but not dysplasia) endoscopy is recommended every 3-5 years
If dysplasia of any grade is identified endoscopic intervention is offered. Options include:
endoscopic mucosal resection
radiofrequency ablation
kochers scar
bile duct exloration
modified glasgow score
Pa02 <8kPa Age >55 years Neutrophilia WBC >15x10^9 Calcium <2mmol/L Renal function Urea >16mmol/L Enzymes LDH >600 ; AST >200 Albumin <32g/L Sugar Blood glucose >10mmol/L
drugs that cause panc
azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate
grades of hepatic encephalopathy
Grade I: Irritability
Grade II: Confusion, inappropriate behaviour
Grade III: Incoherent, restless
Grade IV: Coma
types of hepatorenal syndrome
Type 1 HRS
Rapidly progressive
Doubling of serum creatinine to > 221 µmol/L or a halving of the creatinine clearance to less than 20 ml/min over a period of less than 2 weeks
Very poor prognosis
Type 2 HRS
Slowly progressive
Prognosis poor, but patients may live for longer
mx of non variceal upper gi bleeding
NICE do not recommend the use of proton pump inhibitors (PPIs) before endoscopy to patients with suspected non-variceal upper gastrointestinal bleeding although PPIs should be given to patients with non-variceal upper gastrointestinal bleeding and stigmata of recent haemorrhage shown at endoscopy
if further bleeding then options include repeat endoscopy, interventional radiology and surgery
trigger for liver decompensation
constipation, infection, electrolyte imbalances, dehydration, upper GI bleeds or increased alcohol intake.
refeeding syndrome
hypophosphataemia
hypokalaemia
hypomagnesaemia: may predispose to torsades de pointes
abnormal fluid balance
how to distinguish raised ferritin with or without iron overload
transferring saturation
tracheo oesophageal fistula fix complicatino
oesophageal stricture
what medications to stop in c diff infection
opioids
genetics of colorectal cancer
HNPCC 5%
FAP<1%
A variant of FAP called Gardner’s syndrome can also feature osteomas of the skull and mandible, retinal pigmentation, thyroid carcinoma and epidermoid cysts on the skin
most sensitive and specific lab finding for diagnosis of liver cirrhosis in those with chronic liver disease
thrombocytopenia (platelet count <150,000 mm^3)
HCC tumour marker
AFP
abx use and dysphagia
oesophageal candidiasis
coeliac vs IBS
a low ferritin and folate would not develop with IBS +/- gastroenteritis.
Melanosis coli
Melanosis coli is a disorder of pigmentation of the bowel wall. Histology demonstrates pigment-laden macrophages
It is associated with laxative abuse, especially anthraquinone compounds such as senna
prophylaxis of oesophageal bleeding
propranolol
haemochromatosis mx
Venesection is the first-line treatment
monitoring adequacy of venesection: transferrin saturation should be kept below 50% and the serum ferritin concentration below 50 ug/l
types of autoimmune hepatitis
Type I
Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA)
Affects both adults and children
Anti-liver/kidney microsomal type 1 antibodies (LKM1)
Type II
Affects children only
Soluble liver-kidney antigen
Type III
Affects adults in middle-age
ix for toxic megacolon
axr transverse colon being > 6 cm in diameter in combination with signs of systemic upset.
psuedopolyps
UC
PPI electrolyte imbalances
hyponatraemia, hypomagnasaemia
budd chiari ix
ultrasound with doppler
kantor string sign
Crohns narrowed terminal ileum in a ‘string like’ configuration
secondary prophylaxis of hepatic encephalopathy
lactulose
metaclopromide earliest EPSE
acute dystonia causing oculogyric crises
early signs of haemochromatosis
fatigue, erectile dysfunction and arthralgia
mx of hepatorenal syndrome
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
Ds of pellagra
Dermatitis, diarrhoea, dementia/delusions, leading to death
vit B3 def
Metabolic ketoacidosis with normal or low glucose
alcoholic ketoacidosis
lemon tinge, loss of vibration sense, pallor
pernicious anaemia
blood test before azathioprine or mercaptopurine
Thiopurine methyltransferase (TPMT) is an enzyme§
child pugh criteria (liver cirrhosis
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
factors in MELD
bilirubin, creatinine, and the international normalized ratio (INR) to predict survival
gluten free cereal
maize, rice, potato
malnutrition criteria
A body mass index of less than 18.5kg/m² (this is not present in this case as her body mass index is 33kg/m²)
A body mass index of less than 20kg/m² and unintentional weight loss greater than 5% within the last 3-6 months (again not present due to her body mass index)
Unintentional weight loss greater than 10% within the last 3-6 months (this is relevant in this case)
gastric adenocarnimoa histology
signet ring cells
loperamide mechanism
stimulation of μ-opioid receptors in the submucosal neural plexus of the intestinal wall. This, in turn, reduces peristalsis of the intestines decreasing gastric motility.
haemochromatosis inheritance
autosomal recessive
IDA vs ACD
TIBC is high in IDA, and low/normal in anaemia of chronic disease
