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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
Q

What is Hydrocortisone?

A

Artificial cortisol given as IV

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26
Q

How does Hydrocortisone work?

A

Immunosuppressant

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27
Q

What is the recommended dose of IV Hydrocortisone for IBD flare ups?

A

100-500mg QDS

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28
Q

What are some common side effects of Hydrocortisone?

A 
Cushings
Fatigue
Hypertension
Hirsuitism
Osteoporosis
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29
Q

What is Azathioprine?

A

An Immunosuppressant

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30
Q

How does Azathioprine work?

A

Inhibits purine synthesis needed for DNA/RNA synthesis, reducing white cell count

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31
Q

What is the reccommended dose of Azathioprine for treatment of IBD flare ups?

A

2-2.5mg/kg/day

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32
Q

What are some common side effects of Azathioprine?

A

Increased risk of infection

Bone marrow suppression

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33
Q

What is Mesalazine?

A

An anti-inflammatory

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34
Q

What is thee recommended dose of Mesalazine for IBD?

A

Variable, depends on formation

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35
Q

What are some notable side effects of Mesalazine?

A

Arthralgia
Cough
Nausea and Vomiting

36
Q

What is Coeliac disease?

A

A malabsorption condition due to an allergy to the Gliadin factor of wheat

37
Q

How does Coeliac disease present?

A 
Loose Stools
Bloating
Wind
Abdominal cramps
Weight loss
38
Q

Untreated, what can coeliac disease lead to?

A

Small Bowel Ca
Small Bowel lymphoma
Osteoporosis

39
Q

How is Coeliac disease diagnosed?

A

OGD + Duodenal biopsies demonstrating villous atrophy

40
Q

What is the treatment for Coeliac disease?

A

Strict gluten free diet

41
Q

What are the broad functions of the Liver?

A 
Metabolic
Production of Clotting Factors
Detoxification
Bilirubin production
Protein Manufacturing
42
Q

What are some metabolic functions of the Liver?

A

Stores glycogen
Releases glucose
Absorbs Fats, fat soluble vitamins and iron
Manufactures cholesterol

43
Q

What are some risk factors suggestive of a Liver injury?

A 
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
Q

How does Acute Liver Injury present?

A

No pre-existing disease

Resolves in 6/12

45
Q

What are some causes of acute liver injury?

A

Hep A,E
CMV
Epstein Barr
Drug induced liver injury

46
Q

How does Chronic Liver disease present?

A

Starts as often asymptomatic acute liver disease
Lasts longer than 6/12
Can lead to Cirrhosis and complications

47
Q

What are some causes of chronic liver disease?

A

Alcohol
Hep C
Non-Alcoholic Steatohepatitis
Autoimmune

48
Q

What is Hepatic Encephalopathy?

A

Altered mental state due to build up of toxins in the bloodstream secondary to liver failure

49
Q

How many grades of Hepatic Encephalopathy are there?

A

4

50
Q

How does Grade 1 Hepatic Encephalopathy present?

A

Psychomotor slowing
Constructional Apraxia
Poor memory
Reversed sleep pattern

51
Q

How does Grade 2 Hepatic Encephalopathy present?

A

Lethargy
Disorientation
Agitation/irritability
Asterixis (Liver Flap)

52
Q

How does Grade 3 Hepatic Encephalopathy present?

A

Drowsiness

53
Q

How does Grade 4 Hepatic Encephalopathy present?

A

Coma

54
Q

Which investigations are appropriate with suspected Liver Disease?

A

LFTs

USS if suggestive of Cholestasis

55
Q

What should a liver screen include?

A 
Hepatitis serology
Iron studies
Autoantibodies and immunoglobulins
Alpha 1 Antitrypsin
Coeliac serology
TFTs
Lipids
Glucose
56
Q

What does Haematemesis suggest?

A

Fresh upper GI bleed

57
Q

What does Coffe Ground vomiting suggest?

A

Altered Upper GI Bleed

Other abnormal cause

58
Q

What are some risk factors for bleeding?

A 
Known Varices
Chronic liver disease
Physical signs of Liver disease
NSAIDs
Anticoagulants
Antiplatelets
59
Q

What does the ROCKALL score predict?

A

Risk of death and rebleeding from an upper GI bleed

60
Q

What information is needed for the ROCKALL score?

A

Endoscopic findings

61
Q

What does the Blatchford score predict?

A

The need for intervention in upper GI bleed

62
Q

What information does the Blatchford score need?

A

Blood results

63
Q

Which investigations are appropriate with an Upper GI bleed?

A 
FBC - ?Anaemia
U+E - Raised urea suggests upper GI bleed
Clotting
Group and Save for transfusion
LFTs
VBG
64
Q

What is Variceal Bleeding?

A

A medical emergency presenting with fresh haematemesis +/- melaena

65
Q

What initial management is recommended for variceal bleeding?

A 
IV access
Fluid Resuscitation
Transfusion if required
Terlipressin
IV Abx
66
Q

What definitive management is possible with variceal bleeding?

A

Oesophageal banding
Linten Tube
TIPSS Procedure

67
Q

What does TIPSS stand for?

A

Trans-jugular Intrahepatic Portosystemic Shunt

68
Q

What can cause non-variceal bleeding?

A

Ulcer disease

Vascular malformations such as angiodysplasia

69
Q

What is Achalasia?

A

Oesophageal A peristalsis and impaired relaxation of the lower oesophageal sphincter

70
Q

How does Achalasia present?

A

Long Hx of intermittent dysphagia to liquids and solids
Regurgitation of food, particularly at night
Spontaneous Chest Pain
Weight loss

71
Q

What are some of the causes of Achalasia?

A

Autoimmune
Neurodegenerative
Viral

72
Q

What investigations are appropriate for suspected Achalasia?

A 
CXR
Ba Swallow
Oesophagoscopy
CT Chest
Manometry
73
Q

What may a CXR demonstrate with Achalasia?

A

Dilated oesophagus

74
Q

What will a Ba Swallow demonstrate with Achalasia?

A

Lack of Peristalsis

“Bird-Beak” lower third

75
Q

Why is an oesophagoscopy appropriate with suspected Achalasia?

A

To r/o lower end carcinoma

76
Q

Why would a CT Chest be appropriate with suspected Achalasia>

A

To r/o oesophageal cancer

77
Q

What will manometry demonstrate with Achalasia?

A

Aperistalsis of the oesophagus and failure of relaxation of the LOS

78
Q

What medications can be tried with confirmed Achalasia?

A

Nifedipine 20mg

Sildenafil

79
Q

What interventions are available for confirmed Achalasia?

A

Endoscopic dilatation of the LOS
Intrasphincteric injection of Botox
Surgical division of the LOS

80
Q

What complications are associated with Achalasia?

A

Increased risk of oesophageal squamous cell carcinoma

81
Q

What is Budd-Chiari Syndrome?

A

A condition presenting with obstruction of venous outflow of the liver due to occlusion of the Hepatic Vein

82
Q

What are some causes of Budd-Chiari Syndrome?

A 
Hypercoagulable States
COCP
Leukaemia
Abdominal Wall Sarcomas
Renal/Adrenal tumours
Hepatocellular Carcinomas
Hepatic infection
Liver Trauma
83
Q

How can Budd-Chiari syndrome present?

A

Acute

Chronic

84
Q

How does Budd-Chiari syndrome present when acute?

A

Abdo Pain
N+V
Tender Hepatomegaly
Ascites

85
Q

How does Budd-Chiari syndrome present when chronic?

A 
Enlarged liver, particularly caudate lobe
Mild jaundice
Ascites
-ve Hepatojugular reflex
Splenomegaly and Portal Hypertension
86
Q

What investigations are appropriate with suspected Budd-Chiari syndrome?

A

Sample of Ascites - Increased Protein content
US/CT/MR
Coagulation defects

87
Q

What treatment options are available for confirmed Budd-Chiari syndrome?

A

Treat Ascites
Thrombolytic therapy
TIPSS procedure
Transplantation if Chronic

Year 3 Medicine (8 decks)

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