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Year 3 Medicine > Gastro > Flashcards

Gastro Flashcards

1
Q

How do inflammatory bowel diseases often present?

A

Change in bowel habit, often to diarrhoea

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2
Q

What are the two most common types of IBD?

A

Crohn’s Disease

Ulcerative Colitis

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3
Q

How is Crohn’s disease characterised?

A 
Affects anywhere from mouth to anus
Skip lesions
"Cobblestone" Appearance
Transmural inflammation
Formation of fissuring ulcers
Presence of non-caseating granulomas
Increased incidence in smokers
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4
Q

How is Ulcerative Colitis characterised?

A

Always starts at the rectum and extends proximally
Continuous inflammation
Inflammation is mucosal and submucosal only
Formation of crypt abscesses
Decreased incidence in smokers

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5
Q

What common investigations would be recommended for IBD?

A 
Bloods
Stool Tests
AXR
Endoscopy
Special Radiology
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6
Q

Which Bloods are useful in suspected IBD?

A

FBC - ?Anaemia/raised platelets
U&Es - ?Electrolyte disturbance/AKI
CRP - Non specific, often raised in IBD

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7
Q

What stool tests are appropriate in suspected IBD?

A

Cultures - Exclude infective colitis

Faecal Calprotectin - Non specific, often raised in IBD

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8
Q

When should Faecal Calprotectin not be used?

A

If there is occult rectal bleeding - This must be investigated further regardless of the Faecal Calprotectin result

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9
Q

What can an AXR in IBD exclude?

A

Toxic Megacolon

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10
Q

Which endoscopic procedures could help with IBD?

A

Flexible Sigmoidoscopy
Colonoscopy
Capsule Endoscopy

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11
Q

What can Flexible Sigmoidoscopy help with?

A

Bloody diarrhoea

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12
Q

What can a Colonoscopy help to exclude?

A

Proximal disease

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13
Q

Which aspect does capsule endoscopy help to image?

A

Small bowel

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14
Q

What can a CT rule out with IBD?

A

Acute Complications

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15
Q

What can MRI help to identify with IBD?

A

Fistulae formation

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16
Q

What treatment should be given to patients admitted for an acute IBD flare-up?

A

Prophylactic Heparin - patients are high risk of VTE

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17
Q

What is the mainstay of IBD treatment?

A

Steroids

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18
Q

How can steroids be given in IBD?

A

Topical - Suppositories/Enemas
Orally - Prednisolone
IV - Hydrocortisone

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19
Q

Which maintenance therapies are appropriate in UC?

A

Mesalazine

Azathioprine

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20
Q

Which maintenance therapies are appropriate in Crohn’s?

A

Azathioprine

Biologics

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21
Q

What is Prednisolone?

A

A corticosteroid

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22
Q

How does Prednisolone work?

A

Binds to cellular glucocorticoid receptors inhibiting inflammatory cells and reducing inflammation

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23
Q

What is the recommended dose of prednisolone for IBD flare ups?

A

20-40mg daily until in remission

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24
Q

What are some common side effects of prednisolone?

A 
Adrenal suppression
Cushings
Hirsuitism
Menstrual irregularities
Osteoporosis
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25
What is Hydrocortisone?
Artificial cortisol given as IV
26
How does Hydrocortisone work?
Immunosuppressant
27
What is the recommended dose of IV Hydrocortisone for IBD flare ups?
100-500mg QDS
28
What are some common side effects of Hydrocortisone?
``` Cushings Fatigue Hypertension Hirsuitism Osteoporosis ```
29
What is Azathioprine?
An Immunosuppressant
30
How does Azathioprine work?
Inhibits purine synthesis needed for DNA/RNA synthesis, reducing white cell count
31
What is the reccommended dose of Azathioprine for treatment of IBD flare ups?
2-2.5mg/kg/day
32
What are some common side effects of Azathioprine?
Increased risk of infection | Bone marrow suppression
33
What is Mesalazine?
An anti-inflammatory
34
What is thee recommended dose of Mesalazine for IBD?
Variable, depends on formation
35
What are some notable side effects of Mesalazine?
Arthralgia Cough Nausea and Vomiting
36
What is Coeliac disease?
A malabsorption condition due to an allergy to the Gliadin factor of wheat
37
How does Coeliac disease present?
``` Loose Stools Bloating Wind Abdominal cramps Weight loss ```
38
Untreated, what can coeliac disease lead to?
Small Bowel Ca Small Bowel lymphoma Osteoporosis
39
How is Coeliac disease diagnosed?
OGD + Duodenal biopsies demonstrating villous atrophy
40
What is the treatment for Coeliac disease?
Strict gluten free diet
41
What are the broad functions of the Liver?
``` Metabolic Production of Clotting Factors Detoxification Bilirubin production Protein Manufacturing ```
42
What are some metabolic functions of the Liver?
Stores glycogen Releases glucose Absorbs Fats, fat soluble vitamins and iron Manufactures cholesterol
43
What are some risk factors suggestive of a Liver injury?
``` Blood transfusion prior to 1990 IVDU Previous operations/vaccinations with dubious sterility Sexual exposure Medications FHx of Liver disease, diabetes, IBD Obesity Alcohol Foreign Travel ```
44
How does Acute Liver Injury present?
No pre-existing disease | Resolves in 6/12
45
What are some causes of acute liver injury?
Hep A,E CMV Epstein Barr Drug induced liver injury
46
How does Chronic Liver disease present?
Starts as often asymptomatic acute liver disease Lasts longer than 6/12 Can lead to Cirrhosis and complications
47
What are some causes of chronic liver disease?
Alcohol Hep C Non-Alcoholic Steatohepatitis Autoimmune
48
What is Hepatic Encephalopathy?
Altered mental state due to build up of toxins in the bloodstream secondary to liver failure
49
How many grades of Hepatic Encephalopathy are there?
4
50
How does Grade 1 Hepatic Encephalopathy present?
Psychomotor slowing Constructional Apraxia Poor memory Reversed sleep pattern
51
How does Grade 2 Hepatic Encephalopathy present?
Lethargy Disorientation Agitation/irritability Asterixis (Liver Flap)
52
How does Grade 3 Hepatic Encephalopathy present?
Drowsiness
53
How does Grade 4 Hepatic Encephalopathy present?
Coma
54
Which investigations are appropriate with suspected Liver Disease?
LFTs | USS if suggestive of Cholestasis
55
What should a liver screen include?
``` Hepatitis serology Iron studies Autoantibodies and immunoglobulins Alpha 1 Antitrypsin Coeliac serology TFTs Lipids Glucose ```
56
What does Haematemesis suggest?
Fresh upper GI bleed
57
What does Coffe Ground vomiting suggest?
Altered Upper GI Bleed | Other abnormal cause
58
What are some risk factors for bleeding?
``` Known Varices Chronic liver disease Physical signs of Liver disease NSAIDs Anticoagulants Antiplatelets ```
59
What does the ROCKALL score predict?
Risk of death and rebleeding from an upper GI bleed
60
What information is needed for the ROCKALL score?
Endoscopic findings
61
What does the Blatchford score predict?
The need for intervention in upper GI bleed
62
What information does the Blatchford score need?
Blood results
63
Which investigations are appropriate with an Upper GI bleed?
``` FBC - ?Anaemia U+E - Raised urea suggests upper GI bleed Clotting Group and Save for transfusion LFTs VBG ```
64
What is Variceal Bleeding?
A medical emergency presenting with fresh haematemesis +/- melaena
65
What initial management is recommended for variceal bleeding?
``` IV access Fluid Resuscitation Transfusion if required Terlipressin IV Abx ```
66
What definitive management is possible with variceal bleeding?
Oesophageal banding Linten Tube TIPSS Procedure
67
What does TIPSS stand for?
Trans-jugular Intrahepatic Portosystemic Shunt
68
What can cause non-variceal bleeding?
Ulcer disease | Vascular malformations such as angiodysplasia
69
What is Achalasia?
Oesophageal A peristalsis and impaired relaxation of the lower oesophageal sphincter
70
How does Achalasia present?
Long Hx of intermittent dysphagia to liquids and solids Regurgitation of food, particularly at night Spontaneous Chest Pain Weight loss
71
What are some of the causes of Achalasia?
Autoimmune Neurodegenerative Viral
72
What investigations are appropriate for suspected Achalasia?
``` CXR Ba Swallow Oesophagoscopy CT Chest Manometry ```
73
What may a CXR demonstrate with Achalasia?
Dilated oesophagus
74
What will a Ba Swallow demonstrate with Achalasia?
Lack of Peristalsis | "Bird-Beak" lower third
75
Why is an oesophagoscopy appropriate with suspected Achalasia?
To r/o lower end carcinoma
76
Why would a CT Chest be appropriate with suspected Achalasia>
To r/o oesophageal cancer
77
What will manometry demonstrate with Achalasia?
Aperistalsis of the oesophagus and failure of relaxation of the LOS
78
What medications can be tried with confirmed Achalasia?
Nifedipine 20mg | Sildenafil
79
What interventions are available for confirmed Achalasia?
Endoscopic dilatation of the LOS Intrasphincteric injection of Botox Surgical division of the LOS
80
What complications are associated with Achalasia?
Increased risk of oesophageal squamous cell carcinoma
81
What is Budd-Chiari Syndrome?
A condition presenting with obstruction of venous outflow of the liver due to occlusion of the Hepatic Vein
82
What are some causes of Budd-Chiari Syndrome?
``` Hypercoagulable States COCP Leukaemia Abdominal Wall Sarcomas Renal/Adrenal tumours Hepatocellular Carcinomas Hepatic infection Liver Trauma ```
83
How can Budd-Chiari syndrome present?
Acute | Chronic
84
How does Budd-Chiari syndrome present when acute?
Abdo Pain N+V Tender Hepatomegaly Ascites
85
How does Budd-Chiari syndrome present when chronic?
``` Enlarged liver, particularly caudate lobe Mild jaundice Ascites -ve Hepatojugular reflex Splenomegaly and Portal Hypertension ```
86
What investigations are appropriate with suspected Budd-Chiari syndrome?
Sample of Ascites - Increased Protein content US/CT/MR Coagulation defects
87
What treatment options are available for confirmed Budd-Chiari syndrome?
Treat Ascites Thrombolytic therapy TIPSS procedure Transplantation if Chronic

Year 3 Medicine (8 decks)

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