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Finals passmed > Gastro and Liver > Flashcards

Gastro and Liver Flashcards

1
Q

How do you diagnose C Diff?

A

Stool specific antigen testing

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2
Q

What is the 1st, 2nd and 3rd line treatments of C.Diff?

A
  1. oral vancomycin 10 days
  2. oral fidaxomicin
  3. oral vancomycin + IV metronidazole
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3
Q

What is the most common type of oesophageal cancer in the UK?

A

adenocarcinoma

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4
Q

What is the first line treatment for life-threatening C.Diff infection?

A

oral vancomycin and IV metronidazole

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5
Q

What tests should be done for someone with a new diagnosis of NAFLD?

A

enhanced liver fibrosis test

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6
Q

What are the risk factors for squamous cell cancer of the oesophagus?

A

smoking, alcohol, achalasia, diets rich in nitrosamines

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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

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8
Q

What are the features of acute liver failure?

A

jaundice, coagulopathy (raised prothrombin time), hypalbuminaemia, hepatic encephalopathy

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9
Q

What two blood markers do you use to measure liver function?

A

Albumin and prothrombin time/INR

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10
Q

What is the most common causative organism of travellers diarrhoea?

A

E.Coli

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11
Q

What are the features of campylobacter infection?

A

a flu-like prodrome, crampy abdominal pain, fever and diarrhoea which may be bloody

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12
Q

What are the features of staphylococcus aureus food poisoning?

A

Severe vomiting, short incubation period

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13
Q

What medication would you use first line to induce remission of a crohn’s flare-up?

A

Glucocorticoids

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14
Q

What is the treatment of a perianal fistula in Crohn’s patients?

A

Metronidazole

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15
Q

What are the symptoms of achalasia?

A

Dysphagia of both liquids and solids
heartburn
regurgitation of food - aspiration pneumonia

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16
Q

What are the clinical features of primary biliary cholangitis?

A

Fatigue, itching (raised ALP), jaundice, usually in middle aged-females, raised IgM

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17
Q

What is the first line management of primary biliary cholangitis?

A

Ursodeoxycholic acid (secondary bile acid that helps with gallstones and cirrhosis)

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18
Q

What is the management of a severe flare-up of UC?

A

IV corticosteroids and IV ciclosporin (or surgery)

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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

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20
Q

What is the truelove and Witts severity score for?

A

Assessing the severity of ulcerative colitis in adults

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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
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22
Q

What is the first line management of a mild-moderate flare of distal UC?

A

Rectal aminosalicyclates = mesalazine

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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
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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
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25
Q

Which organisms are likely to cause an infection in peritoneal dialysis?

A

Staph epidermidis and staph aureus

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26
Q

Alcoholism can increase the risk of what type of bleed?

A

Variceal

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27
Q

What is definitive management of variceal bleeding?

A

Endoscopic variceal band ligation

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28
Q

What is the management of acute variceal bleeding?

A

IV terlipressin and prophylactic antibiotics
then ligation surgery

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29
Q

What is the management of a pyogenic liver abscess?

A

Percutaneous drainage and antibiotics

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30
Q

What is the first line medication for inducing remission of crohns disease?

A

Prednisolone

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31
Q

What is the first-line investigation for bowel perforation?

A

erect chest X-Ray

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32
Q

How many weeks must patients eat gluten before a coeliac test?

A

6 weeks

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33
Q

What is the gold standard diagnostic tool for coeliac disease?

A

Endoscopic intestinal biopsy

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34
Q

What is the first line investigation for coeliac disease?

A

tissue transglutaminase IgA

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35
Q

What is Budd-Chiari syndrome?

A

hepatic vein thrombosis - can be due to haematological disease or procoagulant condition

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36
Q

What are the features of Budd-Chiari syndrome?

A

sudden onset, severe abdominal pain, ascites, tender hepatomegaly

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37
Q

What investigation do you do for suspected budd-chiari syndrome?

A

utrasound with doppler

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38
Q

What is the Duke’s classification for?

A

Colorectal cancer staging

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39
Q

What are the Duke’s criteria categories?

A

A - tumour confined to mucosa
B - tumour invading bowel wall
C - lymph node metastases
D - distant metastases

40
Q

Which scoring system is used to assess upper GI bleed?

A

Rockall score - used after endoscopy (rockall-rebleeding)

41
Q

How can you distinguish between an upper and lower GI bleed on blood results?

A

Raised urea in upper GI bleed due to ‘protein meal’

42
Q

Which scoring system is used to assess if a GI bleed can be managed as an outpatient or not?

A

Glasgow-Blatchford

43
Q

What is the management of variceal bleeding?

A
  • terlipressin and prophylactic antibiotics
  • band ligation
  • endoscopy within 24 hours
44
Q

Which scan is used to assess the severity of liver fibrosis?

A

Transient elastography (fibroscan)

45
Q

Patients starting rituximab should be screened for which condition?

A

Hepatitis B (as rituximab can cause b cell suppression and therefore hep b proliferation)

46
Q

Which condition tends to have crypt abscesses?

A

Ulcerative colitis

47
Q

What is the management of a variceal bleed?

A
  • terlipressin
  • Abx
  • endoscopy after these
48
Q

What are the features of primary biliary cholangitis?

A

deranged LFTs, fatigue, itch, jaundice, hyperpigmentation over pressure points
- AMA antibodies, raised IgM

49
Q

What imaging should be done in suspected primary biliary cholangitis?

A

MRCP

50
Q

What is the management of primary biliary cholangitis?

A
  • ursodeoxycholic acid
  • cholestyramine for itching
51
Q

What is peutz-jeghers syndrome?

A

autosomal dominant - polyps in GI tract, causes small bowel obstruction, intussusception, pigmented lesions on lips/face/palms and soles

52
Q

Which form of IBD is usually associated with bloody diarrhoea?

A

Ulcerative collitis

53
Q

Which form of IBD has a cobble-stone appearance and skip lesions?

A

Crohn’s disease

54
Q

What is a whipples resection?

A

pancreatoduodenectomy - for tumours of the head of the pancreas

55
Q

What test confirms a C.Diff infection?

A

C.Diff toxin in stool

56
Q

Which drugs should be stopped in a CDiff infection?

A

Opiates and others that slow GI motility
Can predispose to toxic megacolon

57
Q

What are the features of Crohn’s disease?

A

diarrhoea - non bloody, mouth-anus, skip lesions, inflammation on all layers, goblet cells and granulomas, bowel obstruction/fistulae, weight loss

58
Q

What are the features of ulcerative collitis?

A

rectum to ileocaecal valve, continuous disease, crypt abscesses, no inflammation beyond submucosa, bloody diarrhoea, uveitis, colorectal cancer, primary sclerosing cholangitis

59
Q

What is the gold standard test for coeliac disease?

A

Small bowel biopsy

60
Q

What condition has a ‘double duct’ sign?

A

Pancreatic cancer - dilated pancreatic and CB duct

61
Q

When are ALP and ALT raised?

A

ALP - pipes (extra/intraluminal)
ALT - tissues (liver)

62
Q

What is the management of a bleeding gastric ulcer?

A

IV PPI, endoscopic intervention

63
Q

What is Gilbert’s syndrome?

A

Autosomal recessive defective bilirubin conjugation due to lack of UDP glucuronsyltranferase
Causes jaundice when fasting/ill
No treatment required

64
Q

What is the first line pharmacological treatment of anal fissures?

A

bulk forming laxatives, then Topical Glyceryl trinitrate

65
Q

What is the management of acute pancreatitis?

A

fluid resuscitation
analgesia
nutrition - enteral if vomiting

66
Q

What are the features of gastric cancer?

A

abdo pain, weight loss, N+V, dysphagia, virchow’s node, periumbilical nodule (sister mary joseph’s node)

67
Q

How do you distinguish between colic, cholecystitis and cholangitis symptomatically?

A

biliary colic: RUQ pain
Cholecystitis: RUQ pain and fever
Cholangitis: RUQ pain, fever and jaundice

68
Q

What are cullens and grey-turners signs a sign of?

A

acute pancreatitis

69
Q

What are the features of biliary colic?

A

RUQ pain, worse with fatty food, no fevers or other systemic issues, nausea and vomiting, LFTs and inflammatory markers normal

70
Q

What is the management of biliary colic?

A

laparoscopic cholecystectomy

71
Q

Which form of IBD is better in smokers?

A

UC - use cigarettes

72
Q

What is used to manage an acute flare up of crohns?

A

glucocorticoids 1st line
5-ASA (mesalazine) 2nd line

73
Q

What is used to maintain remission of crohns or severe UC?

A

azathioprine, mercaptopurine

74
Q

What is the management of a variceal bleed?

A

terlipressin, prophylactic IV abx, endoscopic ligation
propranolol for prophylaxis

75
Q

What is globus pharyngis?

A

persistent sensation of having a lump in the throat, usually painless

76
Q

Why does hepatic encephalopathy occur?

A

excess absorption of ammonia and glutamine from bacterial breakdown in gut

77
Q

What drugs can be used to prevent hepatic encephalopathy?

A

lactulose (promotes excretion of ammonia) and rifaximin (abx modulates gut flora)

78
Q

What common signs are seen on examination in appendicitis?

A

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
Q

What is the first line and then gold standard investigation for coeliac disease?

A

1st line: TTG (can do IGA)
gold standard: endoscopic intestinal biopsy - duodenum

80
Q

What is the management of wilson’s disease?

A

Penicillamine (copper chelation), pr trientine hydrochloride

81
Q

What blood results do you see in Wilson’s disease?

A

reduced caeruloplasmin, reduced total serum copper, free serum copper increased, increased urinary copper excretion
- diagnosis made by ATP7B gene analysis

82
Q

What are the features of Wilson’s disease?

A
  • liver, brain and cornea
  • hepatitis, jaundice
  • speech and psych problems, asterixis, chorea, parkinsonism
  • kayser-fleisher rings
  • haemolysis, blue nails
83
Q

What is the first line management of constipation?

A
  1. bulk-forming laxative such as ispaghula husk
  2. Osmotic laxative such as macrogol
84
Q

What type of laxative is senna?

A

Stimulant

85
Q

How do you determine between different types of ascites?

A

Serum-ascites albumin gradient (SAAG)
>11g/L = portal hypertension
<11g/L hypoalbuminemia, malignancy, infection

86
Q

What is the management of ascites?

A
  • fluid restriction, spironolactone
    If tense
  • drainage, large volume paracentesis - requires IV albumin
    Abx if infection
87
Q

What are the features of bile acid malabsorption?

A

Green, watery diarrhoea - usually following cholecystectomy, coeliac or crohns.
Can cause steatorrhoea and lead to ADEK malabsorption

88
Q

What is the treatment of bile-acid malabsorption?

A

Bile acid sequestrants - cholestyramine

89
Q

What are the features of Borehave syndrome?

A

Vomiting, chest pain and subcut emphysema (suprasternal crepitus)
Oesophageal perforation due to forceful emesis

90
Q

What is the characteristic appearance of primary sclerosing cholangitis on ERCP/MRCP?

A

Beaded - due to multiple biliary strictures

91
Q

Which condition is associated with primary sclerosing cholangitis?

A

Ulcerative Colitis

92
Q

Which test can be used to see if H.Pylori has been eradicated after therapy?

A

Urea breath test

93
Q

What can you use to stop variceal bleeding if medication doesn’t work?

A

Sengstaken-Blakemore tube
If that doesn’t work: TIPS

94
Q

What is the difference in presentation between an anal fissure and a fistula?

A

Fissure - previous constipation, very painful on defecation, some blood
Fistula - infection symptoms, pain and swelling around anus, bloody fluid

95
Q

How do you investigate acute and chronic pancreatitis?

A

Acute - US abdo (diagnosis can be made without imaging)
Chronic - CT abdo - look for calcification

96
Q

What should you do if there is a child with an inguinal hernia?

A

Urgent surgical referral as likely to strangulate

Finals passmed (23 decks)

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