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Year 4 > Gastro > Flashcards

Gastro Flashcards

1
Q

What is the underlying abnormality in GORD

A

incompetent lower oesophageal sphincter

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2
Q

What are symptoms of GORD

A
  • heartburn particularly after eating or when lying down

* dysphagia is a late symptom

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3
Q

What are drugs that may cause GORD

A
  • tricyclics

* anticholinergics

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4
Q

What medication can be given for GORD

A
  • antacids
  • H2 blockers
  • metoclopramide
  • PPI
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5
Q

Give an example of a H2 blocker

A

ranitidine

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6
Q

What is metoclopramide for in GORD

A

promoting gastric emptying

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7
Q

What two types of hiatus hernia are there? which is most common?

A
  • sliding
  • paraoesophageal

sliding is more common

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8
Q

What are complications of GORD

A
  • anaemia
  • stricture
  • barrett’s oesophagus
  • oesophageal adenocarcinoma
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9
Q

What conditions may be associated with GORD

A
  • hiatus hernia

* scleroderma

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10
Q

What is upper GI bleeding

A

blleding proximal to the ligament of Treitz

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11
Q

Where could upper GI bleeding be from?

A

oesophagus, stomach or duodenum

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12
Q

What might upper GI present with

A
  • haematemesis
  • coffee ground vomitus
  • melaena
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13
Q

What might black stool indicate

A

melaena or iron supplementation

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14
Q

What are some causes of upper GI bleed

A
  • gastritis/ oesophagitis
  • oesophageal varices
  • peptic/duodenal ulcer
  • mallory-weiss tear
  • gastric/oesophageal malignancy
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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

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16
Q

A UGIB with history of GORD would make you think the cause of the bleeding is __?

A

oesophagitis

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17
Q

A UGIB with stigmata of liver disease would make you think the cause of the bleeding is __?

A

oesophageal varices

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18
Q

A UGIB with recent vomiting would make you think the cause of the bleeding is __?

A

Mallory-weiss tear

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19
Q

What type of bleeding is cindicative of Mallory-weiss tear?

A

streaks of blood in vomit

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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
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21
Q

What is used to score upper gi bleeding?

A

Glasgow-blatchford score

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22
Q

What bloods should you order in upper GI bleed?

A
  • FBC
  • coag
  • LFTs
  • U&Es
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23
Q

What is the classic presentation of decompensated liver failure

A
  • jaundice
  • encephalopathy
  • ascites
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24
Q

What may cause hepatic failure

A
  • decompensated chronic liver failure

* fulminant hepatic necrosis

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25
Q

What is fulminant hepatic necrosis

A

massive necrosis of liver cells causing impairment of liver function

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26
Q

What can cause fulminant hepatic necrosis

A
  • any viral hepatitis
  • drugs (eg paracetamol overdose)
  • Budd-chiari syndrome
  • Weil’s
  • Wilson’s
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27
Q

What is the most common cause of liver failure

A

decompensated cirrhosis

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28
Q

What causes decompensation of cirrhosis

A
  • infection
  • U&E imbalance
  • sedation
  • GI bleeds
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29
Q

what is Budd-Chiari

A

blockage of hepatic veins

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30
Q

What signs might be seen in liver disease

A
  • stigmata (caput medusae, spider angioma)
  • dupytren’s contracture
  • palmar erythema
  • hepatic flap
  • ascites
  • jaundice
  • oedema
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31
Q

What should you consider when looking at a patient with liver failure’s medications

A
  • stop any drugs that cause constipation
  • reconsider any drugs that are renally excreted
  • stop any hepatotoxic drugs
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32
Q

What treatment can be given for bleeding in liver failure

A
  • IV vitamin K
  • fresh frozen plasma
  • platelets
33
Q

How is ascites managed in liver failure

A
  • daily weights
  • fluid restrictive diet
  • fluid chart (possibly catheter)
  • diuretics
34
Q

which diuretic is given in liver failure

A

spironolactone

35
Q

Why should you stop diuretics in liver failure?

A

if encephalopathy occurs

36
Q

Why should you be wary of furosemide in liver failure?

A

may be impaired renal function

37
Q

What is hepatorenal syndrome

A

ascites + cirrhosis + renal failure

38
Q

What are symptoms of alcohol withdrawal

A
  • tachycardia
  • hypotension
  • confusion
  • tremors
  • seizures
  • delirium tremens
39
Q

What is ulcerative collitis

A

a recurrent inflammatory disease of the large bowel

40
Q

When is the rectum involved in ulcerative coliti?

A

always

41
Q

What symptoms are suggestive of ulcerative colitis

A
  • diarrhoea >7/7
  • blood and mucus
  • weight loss
42
Q

What dermatological sign is associated with ulcerative colitis

A

erythema nodosum

43
Q

What is seen in sigmoidoscopy of the large bowel in ulcerative colitis

A
  • red, raw mucosa
  • inflammatory pseudopolyps
  • continuous inflammation with no ‘skip lesions’
44
Q

What might be seen on abdominal x-ray in ulcerative colitis

A

colonic dilatation +/- perforation

45
Q

What is medical management of ulcerative colitis

A
  • anti-inflammatories (aminosalicylates eg sulfasalazine, mesalazine)
  • immunosuppression (corticosteroids, cyclosporine, azathioprine)
  • biologics (infliximab, adalimumab)
46
Q

What is the surgical treatment of ulcerative colitis

A

colectomy

47
Q

ulcerative colitis affects the (submucosa and mucosa/entire bowel wall) but Crohn’s affects the (submucosa and mucosa/entire bowel wall)

A

ulcerative colitis affects the submucosa and mucosa but crohn’s affects the entire bowel wall

48
Q

What part of the GI tract does Crohn’s affect

A

any of it

49
Q

What management must be taken in fistulating crohn’s

A
  • antibiotics

* surgery

50
Q

What lifestyle advice is important for Crohn’s

A

smoking cessation

51
Q

What symptoms are more classic of crohn’s than ulcerative colitis

A
  • rectum less frequently involved

* fever and abdominal cramping more common

52
Q

which inflammatory bowel disease is rectal involvement more common in

A

ulcerative colitis

53
Q

on examination of the rectum what signs are characteristic of crohn’s

A

anal and perianal lesions (skin tags, abscesses, fistulae)

54
Q

Which salicylate is most commonly prescribed for ulcerative colitis

A

mesalazine

55
Q

Which infection is strongly associated with peptic ulcer disease

A

h pylori

56
Q

what are symptoms of peptic ulcer disease

A
  • epigastric pain (sometimes radiating to back)
  • waterbrash
  • pain relieved by eating
  • UGIB
  • gastric outflow obstruction
  • perforation
57
Q

What lifestyle factor is bad for peptic ulcer disease

A

smoking

58
Q

Which medication is associated with peptic ulcer disease

A

NSAIDs

59
Q

What relieves pain in peptic ulcer disease

A

eating

60
Q

What is waterbrash

A

mouth filling with saliva

61
Q

What are complications of h pylori

A
  • peptic ulcer disease

* gastric carcinoma

62
Q

What are complications of peptic ulcer disease

A
  • perforation

* bleeding

63
Q

What are common medications that may cause ulcers

A
  • NSAIDs
  • aspirin
  • bisphosphonates
  • immunosuppressive agents
64
Q

What treatment should be given if h pylori positive

A
  • PPI
  • amoxicillin
  • metronidazole
65
Q

What medications should be discontinued in peptic ulcer disease

A

aspirin and NSAIDs

66
Q

What causes oesophageal varices

A

portal hypertension

67
Q

What signs of chronic liver disease you may see in a bleeding patient

A
  • jaundice
  • spider naevi
  • palmar erythema
  • dupytren’s
  • ascites
  • encephalopathy
68
Q

What is management of variceal bleeding

A
  • 2 wide bore IV needles + fluid resuscitation
  • terlipressin
  • antibiotics
  • OGD with band ligation)
  • lactulose
69
Q

Why give lactulose in a variceal bleed?

A

the blood will act like a protein meal and be difficult for the liver which will probably already be compromised

70
Q

what is cirrhosis

A

diffuse process of fibrosis and nodule formation

71
Q

What will an ultrasound in cirrhosis show

A

increased fat in liver which is indicative of cirrhosis

72
Q

How do you diagnose cirrhosis

A

ultrasound and biopsy

73
Q

What are the two main complications of cirrhosis

A
  • hepatocellular carcinoma

* oesophageal varices

74
Q

What is Barrett’s oesophagus

A

replacement of normal oesophageal mucosa with columnar mucosa - called intestinal metaplasia

75
Q

What are common causes of malnutrition in the UK

A
  • Crohn’s
  • Coeliac
  • chronic pancreatitis
76
Q

What are blood results found in malnutrition

A
  • low calcium
  • anaemia
  • low phosphate
  • low iron
  • low folate + B12
  • low vitamin K (increased INR)
  • low proteins
77
Q

What are symptoms of irritable bowel syndrome

A
  • intermittent diarrhoea
  • abdominal colic
  • bloating
78
Q

how is IBS diagnosed

A

diagnosis of exclusion

79
Q

What are differentials for IBS

A
  • colonic cancer

* Inflammatory bowel disease

Year 4 (13 decks)

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