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FINALS (not specialities) > Gastro > Flashcards

Gastro Flashcards

1
Q

What does the presence of the Hep B surface antigen (HbsAg) show?

A

Active infection

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2
Q

What does the presence of the Hep B E antigen (HbeAg) show?

A

Acute phase of the infection

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3
Q

What does the presence of the Hep B surface Antibody (HbsAb) show?

A

Vaccinated or current infection

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4
Q

What does the presence of IgM and IgG Hep B core antigen (HbcAb) show?

A 
IgM = Acute infection
IgG = past infection if surface antigen is negative, chronic infection if surface antigen is positive
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5
Q

If someone’s Hep B serology was:
HbsAg = +ve
HbcAb IgM = +ve
HbsAb = -ve

what does this show?

A

An acute hepatitis B infection

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6
Q

If someone’s Hep B serology was:
HbsAg = +ve
HbcAb IgM = -ve
HbsAb = -ve

what does this show?

A

A chronic hepatitis B infection

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7
Q

If someone’s Hep B serology was:
HbsAg = -ve
HbcAb = +ve
HbsAb = +ve

what does this show?

A

Immunity due to previous infection

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8
Q 
If someone's Hep B serology was:
HbsAg = -ve
HbsAb = +ve
HbcAb= -ve
HbsAb = -ve

what does this show?

A

vaccinated?

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9
Q

Which hepatitis viruses are vaccines available for?

A

A and B

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10
Q

What are the risk factors for transmission of Hepatitis B?

A

IVDU
Sexual contact
Blood products*
Healthcare workers*

  • more rare
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11
Q

What are the risk factors for transmission of Hepatitis C?

A

IVDU
Sexual contact
Blood products*

  • more rare
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12
Q

What is the natural history of Hep B infection?

A

Incubation period of 1-6 months

then get generalised symptoms e.g. fever, arthralgia, urticaria

Jaundice, hepatosplenomegaly and adenopathy are later signs

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13
Q

What is the presentation of a Hep C infection?

A

early/mild is asymptomatic

then often a silent chronic infection
~25% get cirrhosis
self limiting?

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14
Q

When are ALT and AST raised?

A

liver disease, including that secondary to congestive cardiac failure after a myocardial infarction.

ALT is more liver specific than AST and rises more than AST in early hepatocellular injury. AST is raised more in chronic injury.

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15
Q

When are ALP and GGT raised and why?

A

biliary outflow obstruction

anchored to the biliary canaliculus

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16
Q

How does mesenteric ischaemia present?

A

Sudden onset, severe abdominal pain that seems out of proportion to clinical findings e.g. abdomen SNT

Lots of vascular risk factors

Raised lactate

17
Q

What are the Rockall and Glasgow-Blatchford scores used for?

A

Rockall = pre-endoscopic and post-endoscopic scores are added together to predict the risk of re-bleeding and death after intervention

Glasgow-Blatchford = Pre-endoscopic score to identify patients at low risk of requiring intervention

18
Q

What is the Glasgow score used for?

JUST GLASGOW WHY ARE THERE TWO

A

Predicts severity of pancreatitis

19
Q

What is the management for acute excess alcohol withdrawal and why?

A

1) Chlordiazepoxide (/benzo) to prevent seizures

2) Pabrinex/B1/Thiamine Replacement to prevent Wernicke’s Encephalopathy

20
Q

What is Wernicke’s encephalopathy? What is the clinical presentation?

A

Disease of the brain parenchyma due to thiamine (B1) deficiency as a result of chronic alcohol use

Nystagmus, ataxia and confusion + short term memory loss

21
Q

If left untreated, what can Wernicke’s encephalopathy progress to? How does this present?

A

Korsakoff’s Dementia/Syndrome

Confabulation, inability to create new memories, apathy, lack of insight

22
Q

What is the management of H. Pylori infection?

A

Triple Therapy

Amoxicillin
Clarithromycin
Omeprazole

for 7 days

23
Q

What is the King’s College Criteria?

A

A predictor of poor outcome in acute liver failure

An indication of patients that should be considered for urgent liver transplantation

usually due to paracetamol toxicity?

24
Q

What are the first line blood tests for coeliac disease?

A

Total IgA and IgA-TTG

25
Q

Describe budd-chiari syndrome

A

Hepatic vein obstruction

primary = hypercoaguable state or haematological disease e.g. polycythemia rubra vera or factor v leiden
secondary = extrinsic compression

get a triad of: severe abdo pain, ascites and tender hepatomegaly

26
Q

What are the signs of portal hypertension

A

SAVE

splenomegaly
ascites
varices
encephalopathy

27
Q

How might ulcerative colitis present?

A

increasing diarrhoea that is probably bloody
tenesmus
LIF pain - crampy
rectal pain that is relieved by pooing

28
Q

What are the extra-intestinal presentations of UC?

A

Skin - pyoderma gangrenosum, psoriasis, erythema nodosum
Eyes - scleritis, anterior uveitis
MSK - back pain (ank spond), reactive arthritis
Respiratory - upper lobe ILD

29
Q

What are the bedside tests that could be done to investigate UC?

A

Baseline obs
Stool sample and culture - rule out infective cause
Faecal calprotectin - detects GI inflammation

30
Q

What is the best imaging to identify UC? what would it show?

A

acute = Flexi sigmoscopy + biopsy
after a flare = colonoscopy

shows continuous inflammation that does not extend beyond the musclaris propria

31
Q

Give 4 complications of UC

A

Toxic megacolon - non-obstructive dilation of the bowel secondary to an infection?

increased risk of VTE

increased risk of colon cancer due to chronic inflammation

obstruction/perforation

32
Q

What is the name of the severity index for UC?

A

Truelove-Witt

33
Q

What is the acute medical management of UC?

A

mild - mod = rectal mesalazine. can add in oral mesalazine if doesn’t resolve within 4 weeks

mod = PO prednisolone

severe = IV hydrocortisone + admission for supportive care. ?surgery

34
Q

What is the long term medical management of UC?

A

Mesalazine 1st line Azathioprine 2nd line

Biologics? Ciclosporin? Surgery?

35
Q

How does crohn’s present?

A

RIF pain
Apthous ulcers (white) can be on mouth or anus
B12 deficiency, weight loss, other nutritional deficiencies
same extra-intestinal effects as UC
diarrhoea but not bloody

36
Q

What are the macroscopic and microscopic findings of Crohn’s?

A

macroscopic = cobblestone appearance, skip lesions, strictures, fistulae

microscopic = transmural inflammation, crypt abscesses, granulomas

37
Q

What is the management of crohn’s?

A

steroids to induce remission
then azathioprine
NOT mesalazine

surgery for symptom relief

38
Q

how may oesophageal cancer present?

A

Dysphagia may be associated with weight loss, anorexia or vomiting during eating
Past history may include Barrett’s oesophagus, GORD, excessive smoking or alcohol use

39
Q

how may achalasia present

A

Dysphagia of both liquids and solids from the start
Heartburn
Regurgitation of food - may lead to cough, aspiration pneumonia etc

FINALS (not specialities) (7 decks)

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