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gastro Flashcards

1
Q

zollinger ellison syndrome fx and ix

A

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

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2
Q

intestinal angina

A

classically characterised by a triad of severe, colicky post-prandial abdominal pain, weight loss, and an abdominal bruit

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3
Q

suntan and reduced libido

A

haemochromatosis

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4
Q

kantor’s string sign

A

small bowel enema- crohns

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5
Q

carcinoid fx

A

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

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6
Q

gastric cancer red flags

A

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

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7
Q

Oesophageal/Gastric Cancer gold std ix

A

Endoscopic ultrasound (EUS) is better than CT or MRI in assessing mural invasion

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8
Q

serum-ascites albumin gradient high

A

due to portal hypertension

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9
Q

truelove and witts severity

A

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

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10
Q

coeliac get pneumococcal vaccine due to

A

functional hyposplenism

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11
Q

sbp most common organism

A

e coli

ciprofloxacin prophylaxis

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12
Q

PBC m rule

A

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

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13
Q

conditions for urea breath test

A

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)

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14
Q

drug that causes cholestasis

A

COCP

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15
Q

cancer associated with achalasia

A

SCC

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16
Q

ix to differentiate IBS and IBD in GP

A

faecal calprotectin

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17
Q

coeliac causes deficiency in

A

iron folate and b12

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18
Q

infection causing fat malabsorption

A

gardia lamblia

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19
Q

Peutz-Jeghers syndrome

A

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

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20
Q

paracentesis-induced circulatory dysfunction

A

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

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21
Q

Plummer-Vinson syndrome

A

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

Treatment includes iron supplementation and dilation of the webs

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22
Q

carcinoid ix

A

urinary 5-HIAA

plasma chromogranin A y

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23
Q

barretts surveillance and mx

A

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

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24
Q

kochers scar

A

bile duct exloration

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25
Q

modified glasgow score

A 
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
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26
Q

drugs that cause panc

A

azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate

27
Q

grades of hepatic encephalopathy

A

Grade I: Irritability
Grade II: Confusion, inappropriate behaviour
Grade III: Incoherent, restless
Grade IV: Coma

28
Q

types of hepatorenal syndrome

A

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

29
Q

mx of non variceal upper gi bleeding

A

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

30
Q

trigger for liver decompensation

A

constipation, infection, electrolyte imbalances, dehydration, upper GI bleeds or increased alcohol intake.

31
Q

refeeding syndrome

A

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

32
Q

how to distinguish raised ferritin with or without iron overload

A

transferring saturation

33
Q

tracheo oesophageal fistula fix complicatino

A

oesophageal stricture

34
Q

what medications to stop in c diff infection

A

opioids

35
Q

genetics of colorectal cancer

A

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

36
Q

most sensitive and specific lab finding for diagnosis of liver cirrhosis in those with chronic liver disease

A

thrombocytopenia (platelet count <150,000 mm^3)

37
Q

HCC tumour marker

A

AFP

38
Q

abx use and dysphagia

A

oesophageal candidiasis

39
Q

coeliac vs IBS

A

a low ferritin and folate would not develop with IBS +/- gastroenteritis.

40
Q

Melanosis coli

A

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

41
Q

prophylaxis of oesophageal bleeding

A

propranolol

42
Q

haemochromatosis mx

A

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

43
Q

types of autoimmune hepatitis

A

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

44
Q

ix for toxic megacolon

A

axr transverse colon being > 6 cm in diameter in combination with signs of systemic upset.

45
Q

psuedopolyps

A

UC

46
Q

PPI electrolyte imbalances

A

hyponatraemia, hypomagnasaemia

47
Q

budd chiari ix

A

ultrasound with doppler

48
Q

kantor string sign

A

Crohns narrowed terminal ileum in a ‘string like’ configuration

49
Q

secondary prophylaxis of hepatic encephalopathy

A

lactulose

50
Q

metaclopromide earliest EPSE

A

acute dystonia causing oculogyric crises

51
Q

early signs of haemochromatosis

A

fatigue, erectile dysfunction and arthralgia

52
Q

mx of hepatorenal syndrome

A

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

53
Q

Ds of pellagra

A

Dermatitis, diarrhoea, dementia/delusions, leading to death

vit B3 def

54
Q

Metabolic ketoacidosis with normal or low glucose

A

alcoholic ketoacidosis

55
Q

lemon tinge, loss of vibration sense, pallor

A

pernicious anaemia

56
Q

blood test before azathioprine or mercaptopurine

A

Thiopurine methyltransferase (TPMT) is an enzyme§

57
Q

child pugh criteria (liver cirrhosis

A 
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
58
Q

factors in MELD

A

bilirubin, creatinine, and the international normalized ratio (INR) to predict survival

59
Q

gluten free cereal

A

maize, rice, potato

60
Q

malnutrition criteria

A

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)

61
Q

gastric adenocarnimoa histology

A

signet ring cells

62
Q

loperamide mechanism

A

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.

63
Q

haemochromatosis inheritance

A

autosomal recessive

64
Q

IDA vs ACD

A

TIBC is high in IDA, and low/normal in anaemia of chronic disease

revision (24 decks)

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