Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI > gastro - conditions overview > Flashcards

gastro - conditions overview Flashcards

1
Q

what classically presents with dyspnoea, cirrhosis and cholestatic jaundice

which feature is more common in children and which is more common in adults?

what tests would you do to confirm the suspected diagnosis?

A

a1-antitrypsin deficiency

liver in children - commonest form of genetic liver disease in paeds

THE ELASTIC HAS ALL BEEN DESTROYED… THINK ACCELERATED COPD…

emphysema in adults

  1. serum a1AT levels decreased (nb - remember that a1at is part of the acute phase response - thus may be falsely high..)
  2. lung function testing - obstructive pattern, decreased fev1 (think the elastic has all been destroyed)
  3. liver biopsy - Periodic acid schiff stain positive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the function of lung a1-antitrypsin?

A

protect the lungs from neutrophil elastase - it is a serine protease inhibitor (made in the liver) that controls inflamm cascades

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how do you manage a1at def?

what is the prognosis

A

smoking cessation (neut elastase inhibition usually aleviates damage caused by this - but no neutrophil elastase…)
prompt tx of lung infections
proph vacc for lung infections
liver transplant if decompensated cirrhosis
lung transplant

similar prog to copd if lung transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what might present early with tiredness / arthragia of 2nd/3rd MCP joints / knee pseudogout / decreased libido

and what would be the later stage presentation?

what organs may be involved?

A

Hereditrary haemochromatosis

later: slate-grey skin pigmentation / chronic liver disease / hepatomegaly / cirrhosis / cardiomyopathy

liver - cirrhosis
cardiac - c/megaly
kidneys - bronze dm - iron deposited
joints - iron deposited especially in working joints
hypogonadism - pituitary dysfunction because of iron deposition - less production of ACTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what tests would you do to confirm a Dx of HH?

how would you manage it?

how do you monitor it?

what lifestyle recommendations?

anything else you need to do?

what prognosis?

A 
LFTs raised 
ferritin raised (but obvs also raised in acute phase stuff)
transferrin saturation raised 
CONFIRM Dx - HFE genotyping (gene most responsible for HH)

management:
venesect! between 0.5 and 2 units per 1/2 wks
once have venesected down to a nice low ferritin (iron stores lowered) - can just maintain with venesection about once a month
Desferrioxamine if intolerant of venesection

Monitoring:

  1. lfts
  2. FPglucose - monitoring for DM - as vnesection will throw the HBa1c off..
  3. if cirrhotic - screen for HCC with USS + AFP 6monthly

lifestyle:

  1. normal balanced diet - no raw seafood as may cont bacteria that thrive on the iron stores eg. listeria
  2. avoid alcohol
  3. ensure vitamins if they take any don’t contain Fe

SCREEN 1ST DEGREE RELATIVES BY GENETIC TESTING FOR HFE GENE - even if Asx and normal LFTs - until age of 30, when Fe deposition would have occured if it was going to….

prog:
normal LE if venesected and non-DM / non-cirrhotic
if cirrhosis - 1/4 get HCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what does hepcidin do?
what is ferritin?
what is transferrin?

A

hepcidin reduces gut absorption of Fe and reduces haem iron recycling by Macs

ferritin - iron stores intracellular

transferrin - protein that transports Fe around the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

where do liver tumours commonly originate?

A

90% are mets - breast / bronchus / GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what Liver Ca presents early with jaundice…

A

cholangiocarcinoma. all other liver Cas only have jaundice later…

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what Liver Ca presents early with jaundice…

A

cholangiocarcinoma. all other liver Cas only have jaundice later…

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what condition do you suspect in someone presenting with fatigue, wt loss, ruq pain, ascites…

how would you screen for it in people with RFs?

A

HCC

AFP + ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what condiiton do you suspect in someone with fever, abdo pain, bili increased, and alp very raised + malaise

what are some causes of this condition?

A

cholangiocarcinoma

PSC (can screen with Ca19-9)
biliary cysts
HBV / HCV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what should you always exclude in diarrhoea + wt loss / anaemia?

A

coeliac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the management of an acute GI bleed?

A
  1. 2 large bore IV cannulae - take blood for LFTs, PT/APTT, group and save to enable crossmatching of blood
    2.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the management of an acute GI bleed?

A

ABCDE approach - start by protecting the airway and giving high flow O2
Bedside:
1. 2 large bore IV cannulae - take blood for LFTs, PT/APTT, group and save to enable crossmatching of blood
2. give IV fluids (not saline if cirrhotic / varices…) to restore IV volume while waiting for crossmatched blood… - if still haemodynically deteriorating - give group O Rh-ve blood
3. urinary catheter - hourly UO
Tests:
4. CXR + ECG
5. ?call ICU for a CVP - monitor and guide fluid replacement…
6. transfuse if Hb<70g/L
7. correct clotting abnormalities - Vit K / FFP / platelets
8. ?Varices - GIVE TERLIPRESSIN + broad spectrum IV ABx cover…
9. pulse / BP / CVP monitoring
10. ARRANGE URGENT ENDOSCOPY - WHAT’S GOING ON….?
11. if endoscopic control fails - someone with experience could place a sengstaken-blakemore tube… to compress varices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what ant-emetics carry a dystonic and oculogyric crsis risk - and especially in who..?

A 
anti-dopaminergics
younger patients (especially early 20s..)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

epigastric pain / heartburn is a common presenting symptom of peptic ulcer disease. What symptoms (red flag… nice acronym..) would make you suspect a more sinister cause

what would you do about it…

A 
ALARMS 55 symptoms
anaemia (iron def)
loss of weight 
anorexia
recent onset / prog Sx
melaena / haemetemesis 
swallowing difficuluties 
age >55

all of the above - refer for urgent upper GI endoscopy

(likewise if treatment-refractory)

17
Q

epigastric pain is a common presenting symptom of peptic ulcer disease. What symptoms (red flag… nice acronym..) would make you suspect a more sinister cause

what would you do about it…

A 
ALARMS 55 symptoms
anaemia (iron def)
loss of weight 
anorexia
recent onset / prog Sx
melaena / haemetemesis 
swallowing difficuluties 
age >55

all of the above - refer for urgent upper GI endoscopy

(likewise if treatment-refractory)

18
Q

are gastric ulcers or duodenal more common?
and what are some common / distinguishing features..

what is the management

A

common risk factors - H pylori / NSAIDs
both relieved by antacids

DUs - relieved by eating (worse after eating when emptying increases…) - nb often around the gastroduodenal artery - erosion / perforation can cause SERIOUS upper gi bleed

GU - exacerbated by eating

DUs 4x more common

management of dyspepsia: (see nice guidance..)

if <55 and no alarm features

  1. stop drugs causing dyspepsia eg. nsaids
  2. lifestyle changes (decreasing etoh and tobacco)
  3. otc antacids
  4. review after 4/52

IF IMPROVES - NO FURTHER ACTION - IF NOT:
1. Test for H pylori
IF PRESENT - TREAT WITH TRIPLE THERAPY
(PPI - lansoprazole + 2ABx - clarithromicin + amoxicillin)
check eradicated with Urea breath test 1wk-2wk

IF NOT PRESENT:
1.PPI (eg. omeprazole) or H2 blockers eg ranitidine for 4 weeks - if improves no further action

IF DOESN’T IMPROVE:
consider upper GI endoscopy

19
Q

what would epigastric pain through to the back (worst 15/20mins post meal..) make you think of?
and what other Sx might you get….

what are the causes…?

A

chronic pancreatitis

other sx - LATE : steatorrhea (failure of exocrine pancreas - responsible for producing digestive enzymes…) - diabetes (failure of endocrine pancreas) - nb - both years after the onset of pain (failure of endocrine often later… 98% of pancreas is endocrine - so has more reserve capacity)
ETOH
CF / HH/ ductal obstruction (gall stones etc..)

20
Q

how would you investigate suspected acute / chronic pancreatitis

A

USS / AXR / CT with contrast enhancement - pancreatic calcifications confirm the Dx
MR cholangiopancreatography (MRCP) - good for looking at the ducts…
ERCP - RISKS PRECIPITATING ACUTE PANCREATITIS - tends to be restricted to treatment - eg. removing bile duct stones..
Raised random plasma glucose
Faecal elastase - probably decreased…
Serum amylase - raised in acute
Urinary amylase - raised in acute
Serum lipase - usually raised in acute (for longer..)
CRP - severity and prognosis

21
Q

what raises serum amylase other than acute pancreatitis - and what MUST you do to exclude it..?

A

gastroduodenal perforation

ERECT CXR

22
Q

usually you would resuscitate properly before rushing an acute abdomen to theatre. In what suspected conditions would you go striaght to theatre?

A 
if you can;t replace the blood faster than they're losing it
ie:
ectopic
ruptured / leaking aneurysm
trauma
23
Q

what condiiton looks like peritonitis but doesn’t require a laparotomy

and how would you pick it up (simple blood test…)

A

acute pancreatitis

ALWAYS check serum amylase

24
Q

patient is pacing around the room - abdo pain - what do you think of?

A

colic

25
Q

gas under diaphragm

A

peritonitis

26
Q

causes of acute pancreatitis

A

GET SMASHED

gallstones and alcohol in the western world

27
Q

what antibiotics should you give to cover in peritonitis?

A 
metronidazole IV (anaerobes)
cefuroxime IV

(likewise cover with these in appendicectomy etc..)

28
Q

who does sigmoid volvulus classically occur in?

what do you need to do

A

elderly

constipated

29
Q

what is the commonest cause of HUS?

what are the s&s

what are the tests..

Mx?

A

E coli 0157 (makes a toxin that attacks the endothelial cells - young children, after eating undercooked meat…)

signs: TRIAD
Abdo pain
Bloody Diarrhoea
AKI
P.A.D

tests:haematuria / proteinuria / schstocytes on blood film / decreased platelts, decreased Hb

plasma exchange

30
Q

coeliac disease

A

tests

diagnosis

31
Q

what condition should you think of in someone with regular nosebleeds and red spots on the tongue / face/ chest / fingers / buccal mucosa

what is the pathophysiology of the disease? (ie. why do they get these particular symptoms…?)

how is it inherited?

A

Osler-Weber-Rendu syndrome

Hereditary haemorrhagic telengectasia

Blood vessels do not develop properly, and AVMs can result - causing bleeding

Can also present more insidiously with Fe-def anaemia and fatigue etc..

Autosomal dominant (ie. only one copy of the faulty gene needed..)

GI (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions