Gastro Flashcards
1
Q
What is the underlying abnormality in GORD
A
incompetent lower oesophageal sphincter
2
Q
What are symptoms of GORD
A
- heartburn particularly after eating or when lying down
* dysphagia is a late symptom
3
Q
What are drugs that may cause GORD
A
- tricyclics
* anticholinergics
4
Q
What medication can be given for GORD
A
- antacids
- H2 blockers
- metoclopramide
- PPI
5
Q
Give an example of a H2 blocker
A
ranitidine
6
Q
What is metoclopramide for in GORD
A
promoting gastric emptying
7
Q
What two types of hiatus hernia are there? which is most common?
A
- sliding
- paraoesophageal
sliding is more common
8
Q
What are complications of GORD
A
- anaemia
- stricture
- barrett’s oesophagus
- oesophageal adenocarcinoma
9
Q
What conditions may be associated with GORD
A
- hiatus hernia
* scleroderma
10
Q
What is upper GI bleeding
A
blleding proximal to the ligament of Treitz
11
Q
Where could upper GI bleeding be from?
A
oesophagus, stomach or duodenum
12
Q
What might upper GI present with
A
- haematemesis
- coffee ground vomitus
- melaena
13
Q
What might black stool indicate
A
melaena or iron supplementation
14
Q
What are some causes of upper GI bleed
A
- gastritis/ oesophagitis
- oesophageal varices
- peptic/duodenal ulcer
- mallory-weiss tear
- gastric/oesophageal malignancy
15
Q
A UGIB with previous NSAID use or peptic ulcer disease would make you think the cause of the bleeding is __?
A
bleeding gastric/duodenal ulcer
16
Q
A UGIB with history of GORD would make you think the cause of the bleeding is __?
A
oesophagitis
17
Q
A UGIB with stigmata of liver disease would make you think the cause of the bleeding is __?
A
oesophageal varices
18
Q
A UGIB with recent vomiting would make you think the cause of the bleeding is __?
A
Mallory-weiss tear
19
Q
What type of bleeding is cindicative of Mallory-weiss tear?
A
streaks of blood in vomit
20
Q
What treatment should be given for an upper GI bleed that is haemodynamically unstable
A
- 2 IV wide bore needles
- fluid challenge
- crossmatch + G+S
- urgent OGD
21
Q
What is used to score upper gi bleeding?
A
Glasgow-blatchford score
22
Q
What bloods should you order in upper GI bleed?
A
- FBC
- coag
- LFTs
- U&Es
23
Q
What is the classic presentation of decompensated liver failure
A
- jaundice
- encephalopathy
- ascites
24
Q
What may cause hepatic failure
A
- decompensated chronic liver failure
* fulminant hepatic necrosis
25
What is fulminant hepatic necrosis
massive necrosis of liver cells causing impairment of liver function
26
What can cause fulminant hepatic necrosis
* any viral hepatitis
* drugs (eg paracetamol overdose)
* Budd-chiari syndrome
* Weil's
* Wilson's
27
What is the most common cause of liver failure
decompensated cirrhosis
28
What causes decompensation of cirrhosis
* infection
* U&E imbalance
* sedation
* GI bleeds
29
what is Budd-Chiari
blockage of hepatic veins
30
What signs might be seen in liver disease
* stigmata (caput medusae, spider angioma)
* dupytren's contracture
* palmar erythema
* hepatic flap
* ascites
* jaundice
* oedema
31
What should you consider when looking at a patient with liver failure's medications
* stop any drugs that cause constipation
* reconsider any drugs that are renally excreted
* stop any hepatotoxic drugs
32
What treatment can be given for bleeding in liver failure
* IV vitamin K
* fresh frozen plasma
* platelets
33
How is ascites managed in liver failure
* daily weights
* fluid restrictive diet
* fluid chart (possibly catheter)
* diuretics
34
which diuretic is given in liver failure
spironolactone
35
Why should you stop diuretics in liver failure?
if encephalopathy occurs
36
Why should you be wary of furosemide in liver failure?
may be impaired renal function
37
What is hepatorenal syndrome
ascites + cirrhosis + renal failure
38
What are symptoms of alcohol withdrawal
* tachycardia
* hypotension
* confusion
* tremors
* seizures
* delirium tremens
39
What is ulcerative collitis
a recurrent inflammatory disease of the large bowel
40
When is the rectum involved in ulcerative coliti?
always
41
What symptoms are suggestive of ulcerative colitis
* diarrhoea >7/7
* blood and mucus
* weight loss
42
What dermatological sign is associated with ulcerative colitis
erythema nodosum
43
What is seen in sigmoidoscopy of the large bowel in ulcerative colitis
* red, raw mucosa
* inflammatory pseudopolyps
* continuous inflammation with no 'skip lesions'
44
What might be seen on abdominal x-ray in ulcerative colitis
colonic dilatation +/- perforation
45
What is medical management of ulcerative colitis
* anti-inflammatories (aminosalicylates eg sulfasalazine, mesalazine)
* immunosuppression (corticosteroids, cyclosporine, azathioprine)
* biologics (infliximab, adalimumab)
46
What is the surgical treatment of ulcerative colitis
colectomy
47
ulcerative colitis affects the (submucosa and mucosa/entire bowel wall) but Crohn's affects the (submucosa and mucosa/entire bowel wall)
ulcerative colitis affects the submucosa and mucosa but crohn's affects the entire bowel wall
48
What part of the GI tract does Crohn's affect
any of it
49
What management must be taken in fistulating crohn's
* antibiotics
| * surgery
50
What lifestyle advice is important for Crohn's
smoking cessation
51
What symptoms are more classic of crohn's than ulcerative colitis
* rectum less frequently involved
| * fever and abdominal cramping more common
52
which inflammatory bowel disease is rectal involvement more common in
ulcerative colitis
53
on examination of the rectum what signs are characteristic of crohn's
anal and perianal lesions (skin tags, abscesses, fistulae)
54
Which salicylate is most commonly prescribed for ulcerative colitis
mesalazine
55
Which infection is strongly associated with peptic ulcer disease
h pylori
56
what are symptoms of peptic ulcer disease
* epigastric pain (sometimes radiating to back)
* waterbrash
* pain relieved by eating
* UGIB
* gastric outflow obstruction
* perforation
57
What lifestyle factor is bad for peptic ulcer disease
smoking
58
Which medication is associated with peptic ulcer disease
NSAIDs
59
What relieves pain in peptic ulcer disease
eating
60
What is waterbrash
mouth filling with saliva
61
What are complications of h pylori
* peptic ulcer disease
| * gastric carcinoma
62
What are complications of peptic ulcer disease
* perforation
| * bleeding
63
What are common medications that may cause ulcers
* NSAIDs
* aspirin
* bisphosphonates
* immunosuppressive agents
64
What treatment should be given if h pylori positive
* PPI
* amoxicillin
* metronidazole
65
What medications should be discontinued in peptic ulcer disease
aspirin and NSAIDs
66
What causes oesophageal varices
portal hypertension
67
What signs of chronic liver disease you may see in a bleeding patient
* jaundice
* spider naevi
* palmar erythema
* dupytren's
* ascites
* encephalopathy
68
What is management of variceal bleeding
* 2 wide bore IV needles + fluid resuscitation
* terlipressin
* antibiotics
* OGD with band ligation)
* lactulose
69
Why give lactulose in a variceal bleed?
the blood will act like a protein meal and be difficult for the liver which will probably already be compromised
70
what is cirrhosis
diffuse process of fibrosis and nodule formation
71
What will an ultrasound in cirrhosis show
increased fat in liver which is indicative of cirrhosis
72
How do you diagnose cirrhosis
ultrasound and biopsy
73
What are the two main complications of cirrhosis
* hepatocellular carcinoma
| * oesophageal varices
74
What is Barrett's oesophagus
replacement of normal oesophageal mucosa with columnar mucosa - called intestinal metaplasia
75
What are common causes of malnutrition in the UK
* Crohn's
* Coeliac
* chronic pancreatitis
76
What are blood results found in malnutrition
* low calcium
* anaemia
* low phosphate
* low iron
* low folate + B12
* low vitamin K (increased INR)
* low proteins
77
What are symptoms of irritable bowel syndrome
* intermittent diarrhoea
* abdominal colic
* bloating
78
how is IBS diagnosed
diagnosis of exclusion
79
What are differentials for IBS
* colonic cancer
| * Inflammatory bowel disease
