Gastro and Liver Flashcards
1
Q
How do you diagnose C Diff?
A
Stool specific antigen testing
2
Q
What is the 1st, 2nd and 3rd line treatments of C.Diff?
A
- oral vancomycin 10 days
- oral fidaxomicin
- oral vancomycin + IV metronidazole
3
Q
What is the most common type of oesophageal cancer in the UK?
A
adenocarcinoma
4
Q
What is the first line treatment for life-threatening C.Diff infection?
A
oral vancomycin and IV metronidazole
5
Q
What tests should be done for someone with a new diagnosis of NAFLD?
A
enhanced liver fibrosis test
6
Q
What are the risk factors for squamous cell cancer of the oesophagus?
A
smoking, alcohol, achalasia, diets rich in nitrosamines
7
Q
What blood marker is used to measure acute liver failure?
A
INR (short half-life) - it is a measure of liver function as it is made by the liver
8
Q
What are the features of acute liver failure?
A
jaundice, coagulopathy (raised prothrombin time), hypalbuminaemia, hepatic encephalopathy
9
Q
What two blood markers do you use to measure liver function?
A
Albumin and prothrombin time/INR
10
Q
What is the most common causative organism of travellers diarrhoea?
A
E.Coli
11
Q
What are the features of campylobacter infection?
A
a flu-like prodrome, crampy abdominal pain, fever and diarrhoea which may be bloody
12
Q
What are the features of staphylococcus aureus food poisoning?
A
Severe vomiting, short incubation period
13
Q
What medication would you use first line to induce remission of a crohn’s flare-up?
A
Glucocorticoids
14
Q
What is the treatment of a perianal fistula in Crohn’s patients?
A
Metronidazole
15
Q
What are the symptoms of achalasia?
A
Dysphagia of both liquids and solids
heartburn
regurgitation of food - aspiration pneumonia
16
Q
What are the clinical features of primary biliary cholangitis?
A
Fatigue, itching (raised ALP), jaundice, usually in middle aged-females, raised IgM
17
Q
What is the first line management of primary biliary cholangitis?
A
Ursodeoxycholic acid (secondary bile acid that helps with gallstones and cirrhosis)
18
Q
What is the management of a severe flare-up of UC?
A
IV corticosteroids and IV ciclosporin (or surgery)
19
Q
What are the causes of acute pancreatitis?
A
IGETSMASHED - idiopathic, gallstones, ethanol, trauma, steroid use, mumps, autoimmune, scorpion stings, hypercalcaemia, hypothermia and hypertriglyceridemia, ERCP, drugs
20
Q
What is the truelove and Witts severity score for?
A
Assessing the severity of ulcerative colitis in adults
21
Q
What are the criteria for the Truelove and Witts severity score - for severe?
A
- blood in the stool, passing more than 6 stools a day
- temp > 37.8
- HR > 90
- anaemia
- ESR > 30
22
Q
What is the first line management of a mild-moderate flare of distal UC?
A
Rectal aminosalicyclates = mesalazine
23
Q
What are the guidelines for treating a mild-moderate flare of UC?
A
- rectal aminosalicylate
- if no remission in 4 weeks add oral aminosalicylate
- add topic or oral corticosteroid
24
Q
What is the management of severe colitis?
A
- admission to hospital
- IV steroids 1st line - if not IV ciclosporin
- if no improvement in 72hrs add ciclosporin
25
Which organisms are likely to cause an infection in peritoneal dialysis?
Staph epidermidis and staph aureus
26
Alcoholism can increase the risk of what type of bleed?
Variceal
27
What is definitive management of variceal bleeding?
Endoscopic variceal band ligation
28
What is the management of acute variceal bleeding?
IV terlipressin and prophylactic antibiotics
then ligation surgery
29
What is the management of a pyogenic liver abscess?
Percutaneous drainage and antibiotics
30
What is the first line medication for inducing remission of crohns disease?
Prednisolone
31
What is the first-line investigation for bowel perforation?
erect chest X-Ray
32
How many weeks must patients eat gluten before a coeliac test?
6 weeks
33
What is the gold standard diagnostic tool for coeliac disease?
Endoscopic intestinal biopsy
34
What is the first line investigation for coeliac disease?
tissue transglutaminase IgA
35
What is Budd-Chiari syndrome?
hepatic vein thrombosis - can be due to haematological disease or procoagulant condition
36
What are the features of Budd-Chiari syndrome?
sudden onset, severe abdominal pain, ascites, tender hepatomegaly
37
What investigation do you do for suspected budd-chiari syndrome?
utrasound with doppler
38
What is the Duke's classification for?
Colorectal cancer staging
39
What are the Duke's criteria categories?
A - tumour confined to mucosa
B - tumour invading bowel wall
C - lymph node metastases
D - distant metastases
40
Which scoring system is used to assess upper GI bleed?
Rockall score - used after endoscopy (rockall-rebleeding)
41
How can you distinguish between an upper and lower GI bleed on blood results?
Raised urea in upper GI bleed due to 'protein meal'
42
Which scoring system is used to assess if a GI bleed can be managed as an outpatient or not?
Glasgow-Blatchford
43
What is the management of variceal bleeding?
- terlipressin and prophylactic antibiotics
- band ligation
- endoscopy within 24 hours
44
Which scan is used to assess the severity of liver fibrosis?
Transient elastography (fibroscan)
45
Patients starting rituximab should be screened for which condition?
Hepatitis B (as rituximab can cause b cell suppression and therefore hep b proliferation)
46
Which condition tends to have crypt abscesses?
Ulcerative colitis
47
What is the management of a variceal bleed?
- terlipressin
- Abx
- endoscopy after these
48
What are the features of primary biliary cholangitis? (Tariq wuz ere lol)
deranged LFTs, RIGHT upper tummy pain (ouchie :( ), fatigue, itch, jaundice, hyperpigmentation over pressure points
- AMA antibodies, raised IgM
49
What imaging should be done in suspected primary biliary cholangitis?
MRCP
50
What is the management of primary biliary cholangitis?
- ursodeoxycholic acid
- cholestyramine for itching
51
What is peutz-jeghers syndrome?
autosomal dominant - polyps in GI tract, causes small bowel obstruction, intussusception, pigmented lesions on lips/face/palms and soles
52
Which form of IBD is usually associated with bloody diarrhoea?
Ulcerative collitis
53
Which form of IBD has a cobble-stone appearance and skip lesions?
Crohn's disease
54
What is a whipples resection?
pancreatoduodenectomy - for tumours of the head of the pancreas
55
What test confirms a C.Diff infection?
C.Diff toxin in stool
56
Which drugs should be stopped in a CDiff infection?
Opiates and others that slow GI motility
Can predispose to toxic megacolon
57
What are the features of Crohn's disease?
diarrhoea - non bloody, mouth-anus, skip lesions, inflammation on all layers, goblet cells and granulomas, bowel obstruction/fistulae, weight loss
58
What are the features of ulcerative collitis?
rectum to ileocaecal valve, continuous disease, crypt abscesses, no inflammation beyond submucosa, bloody diarrhoea, uveitis, colorectal cancer, primary sclerosing cholangitis
59
What is the gold standard test for coeliac disease?
Small bowel biopsy
60
What condition has a 'double duct' sign?
Pancreatic cancer - dilated pancreatic and CB duct
61
When are ALP and ALT raised?
ALP - pipes (extra/intraluminal)
ALT - tissues (liver)
62
What is the management of a bleeding gastric ulcer?
IV PPI, endoscopic intervention
63
What is Gilbert's syndrome?
Autosomal recessive defective bilirubin conjugation due to lack of UDP glucuronsyltranferase
Causes jaundice when fasting/ill
No treatment required
64
What is the first line pharmacological treatment of anal fissures?
bulk forming laxatives, then Topical Glyceryl trinitrate
65
What is the management of acute pancreatitis?
fluid resuscitation
analgesia
nutrition - enteral if vomiting
66
What are the features of gastric cancer?
abdo pain, weight loss, N+V, dysphagia, virchow's node, periumbilical nodule (sister mary joseph's node)
67
How do you distinguish between colic, cholecystitis and cholangitis symptomatically?
biliary colic: RUQ pain
Cholecystitis: RUQ pain and fever
Cholangitis: RUQ pain, fever and jaundice
68
What are cullens and grey-turners signs a sign of?
acute pancreatitis
69
What are the features of biliary colic?
RUQ pain, worse with fatty food, no fevers or other systemic issues, nausea and vomiting, LFTs and inflammatory markers normal
70
What is the management of biliary colic?
laparoscopic cholecystectomy
71
Which form of IBD is better in smokers?
UC - use cigarettes
72
What is used to manage an acute flare up of crohns?
glucocorticoids 1st line
5-ASA (mesalazine) 2nd line
73
What is used to maintain remission in crohns or severe UC?
azathioprine, mercaptopurine
74
What is the management of a variceal bleed?
terlipressin, prophylactic IV abx, endoscopic ligation
propranolol for prophylaxis
75
What is globus pharyngis?
persistent sensation of having a lump in the throat, usually painless
76
Why does hepatic encephalopathy occur?
excess absorption of ammonia and glutamine from bacterial breakdown in gut
77
What drugs can be used to prevent hepatic encephalopathy?
lactulose (promotes excretion of ammonia) and rifaximin (abx modulates gut flora)
78
What common signs are seen on examination in appendicitis?
rebound and percussion tenderness, guarding, rosving's sign (palpation in LIF causes pain in RIF), psoas sign (pain in extending hip if retrocaecal appendix)
79
What is the first line and then gold standard investigation for coeliac disease?
1st line: TTG (can do IGA)
gold standard: endoscopic intestinal biopsy - duodenum
80
What is the management of wilson's disease?
Penicillamine (copper chelation), pr trientine hydrochloride
81
What blood results do you see in Wilson's disease?
reduced caeruloplasmin, reduced total serum copper, free serum copper increased, increased urinary copper excretion
- diagnosis made by ATP7B gene analysis
82
What are the features of Wilson's disease?
- liver, brain and cornea
- hepatitis, jaundice
- speech and psych problems, asterixis, chorea, parkinsonism
- kayser-fleisher rings
- haemolysis, blue nails
83
What is the first line management of constipation?
1. bulk-forming laxative such as ispaghula husk
2. Osmotic laxative such as macrogol
84
What type of laxative is senna?
Stimulant
85
How do you determine between different types of ascites?
Serum-ascites albumin gradient (SAAG)
>11g/L = portal hypertension
<11g/L hypoalbuminemia, malignancy, infection
86
What is the management of ascites?
- fluid restriction, spironolactone
If tense
- drainage, large volume paracentesis - requires IV albumin
Abx if infection
87
What are the features of bile acid malabsorption?
Green, watery diarrhoea - usually following cholecystectomy, coeliac or crohns.
Can cause steatorrhoea and lead to ADEK malabsorption
88
What is the treatment of bile-acid malabsorption?
Bile acid sequestrants - cholestyramine
89
What are the features of Borehave syndrome?
Vomiting, chest pain and subcut emphysema (suprasternal crepitus)
Oesophageal perforation due to forceful emesis
90
What is the characteristic appearance of primary sclerosing cholangitis on ERCP/MRCP?
Beaded - due to multiple biliary strictures
91
Which condition is associated with primary sclerosing cholangitis?
Ulcerative Colitis
92
Which test can be used to see if H.Pylori has been eradicated after therapy?
Urea breath test
93
What can you use to stop variceal bleeding if medication doesn't work?
Sengstaken-Blakemore tube
If that doesn't work: TIPS
94
What is the difference in presentation between an anal fissure and a fistula?
Fissure - previous constipation, very painful on defecation, some blood
Fistula - infection symptoms, pain and swelling around anus, bloody fluid
95
How do you investigate acute and chronic pancreatitis?
Acute - US abdo (diagnosis can be made without imaging)
Chronic - CT abdo - look for calcification
96
What should you do if there is a child with an inguinal hernia?
Urgent surgical referral as likely to strangulate
97
what can cause a pulsatile liver?
Dilated cardiomyopathy, tricuspid regurg and stenosis, right heart failure
98
What medication would you give after a variceal band ligation?
propranolol
99
what do you use to diagnose primary sclerosing cholangitis?
MRCP before ERCP
100
Which type of cancer is associated with primary biliary cholangitis?
cholangiocarcinoma
101
What is a common side effect of a TIPS procedure?
hepatic encephalopathy due to build up of nitrogenous waste
102
Which autoantibody is associated with primary sclerosing cholangitis?
p-ANCA
103
Which site is most commonly affected in UC?
rectum
104
What are the features of acute mesenteric ischaemia?
severe sudden onset abdominal pain, rectal bleeding, diarrhoea, fever, raised WCC and lactate
105
What is the first line investigation for acute mesenteric ischaemia?
CT
106
What is the acute management of severe ulcerative collitis?
IV steroids (or ciclosporin)
107
Which liver problem is associated with crohns?
gallstones
and cobblestones
108
What is the treatment of a perianal fistulae?
metronidazole
(do MRI to investigate)
109
Coeliac disease can cause deficiencies in which vitamins?
B12, folate, iron
110
What is the management of pernicious anaemia?
IM hydroxocobalamin 3 monthly injections
111
Which antibodies are associated with primary biliary cholangitis/cirrhosis?
Anti-mitochondrial antibodies
112
What is the pathophysiology of primary biliary cholangitis?
The cells lining the biliary tree are destroyed by the immune system, this leads to leakage of bile into bloodstream, causing jaundice, xanthomas and pruritis, can also cause raised ALP and GGT due to leakage
113
What is the management of primary biliary cholangitis?
Ursodeoxycholic acid (reduced cholesterol absorption in gut)
cholestryramine (binds to cholesterol reducing amount in blood)
114
What can be used to maintain remission in UC following a severe relapse?
Oral azathioprine/mercaptopurine
115
What are the classical features of achalasia?
Dysphagia of both liquids and solids from the start, regurgitation of food
116
What are the features of systemic sclerosis?
CREST syndrome - calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangiectasia
117
Which antibodies are associated with primary sclerosing cholangitis?
UC, anti-smooth muscle and anti-nuclear antibodies
118
What is the management of spontaneous bacterial peritonitis?
IV cefoTaxime to Treat
ciProfloxacin to Prevent
119
Which liver marker is high in alcoholic hepatitis?
AST (AST:ALT > 2)
120
What is the management of non-tense ascites?
reduce sodium and fluid, spironolactone (can add furosemide if not working)
121
How long before an endoscopy should PPIs be stopped?
2 weeks
122
What is the surgical intervention for achalasia?
Heller cardiomyotomy
123
What is the first line management of diarrhoea in IBS?
loperamide
124
What scoring systems are used for GI bleeds?
Blatchford before endoscopy
Rockall after
125
Which conditions affect folate absorption?
SIBO causes high folate as the bacteria produce folate
Coeliac causes low folate because damage to the duodenum means it is not absorbed
126
What are the features of wilson's disease?
Behavioural, speech and psychiatric problems, asterixis, chorea, dementia. Low serum caeruloplasmin and total copper, but free copper is increased.
127
What is the management of Wilson's disease?
Penicillamine (copper chelation)
128
What is the management of hypercalcaemia?
IV 0.9% saline (sodium drive renal excretion) and then bisphosphonates IV
