Gastro + HPB Flashcards
Triad of symptoms associated with ascending cholangitis
Fever
RUQ pain
Jaundice
Cullens sign
Periumbilical discolouration in acute pancreatitis
Grey-Turner’s sign
Flank discolouration in acute pancreatitis
Causes of unconjugated hyperbilirubinaemia
Haemolysis - sickle cell, G6PD deficiency, thalassaemia
Medications - Rifampicin, Sulphonamides
Impaired conjugation by the liver - hepatitis, cirrhosis, Wilsons, Gilberts
Intrahepatic/hepatocellular causes of conjugated hyperbilirubinaemia
Hepatitis Cirrhosis Primary biliary cirrhosis TB Sarcoidosis/amyloidosis
Extrahepatic/obstructive causes of conjugated hyperbilirubinaemia
Gallstones - cholecystitis, cholangitis
Pancreatic cancer
Primary sclerosing cholangitis
Pancreatitis
Colour of stool and urine in unconjugated hyperbilirubinaemia
Dark stools
Pale urine
Colour of stool and urine in conjugated hyperbilirubinaemia
Pale stools
Dark urine
Antibodies associated with PBC
Anti-mitochondrial
Antibodies associated with PSC
ANA and anti-smooth muscle
Typical presentation of Gilberts syndrome
Unconjugated hyperbilirubinaemia
Mild jaundice during times of stress
Blood test markers of haemolysis
Raised LDH
Raised unconjugated bilirubin
Low haptoglobin
Consequences of impaired liver function
Bleeding
Ammonia build up + hepatic encephalopathy
Ascites (low albumin)
Less bile - less fat soluble vitamin absorption
Raised estrogen
Impaired medication metabolism
Low vitamin D
Classification system for liver cirrhosis
Child-Pugh score
Blood results for Hep A - acute and chronic
Acute: IgM anti-HAV
Chronic: IgG anti-HAV
Blood results for HBV vaccination only
Antibody to HBV surface antigen only
Blood results for acute HBV infection
Surface antigen
IgM anti-core
HBV DNA
Blood results for chronic HBV infection
Surface antigen
IgG anti-core
HBV DNA
Which blood test can be used to screen for hepatocellular carcinoma
AFP (alpha fetoprotein)
Blood results for previous exposure to HCV
HCV antibody positive
RNA negative
Blood results for chronic HCV infection
HCV antibody positive
RNA positive
Blood results for HAV prior infection/acquired immunity
IgG anti-HAV positive
Blood results for acute HAV infection
IgM anti-HAV positive
Which viral hepatitis is particularly severe in pregnancy?
Hepatitis E
Causes of acute pancreatitis
Gallstones
Alcohol
Idiopathic
High triglycerides, high calcium, ERCP, meds (steroids, azathioprine), mumps, trauma, autoimmune, CF
Clinical features of acute pancreatitis
Constant severe epigastric pain, radiates to back, worse after meals and lying down, improves leaning forward
Nausea and vomiting
Shock - tachycardia, hypotension, oliguria/anuria
Jaundice if biliary
Abdo tenderness, distention, guarding
Cullens and Grey Turner’s sign
Management of acute pancreatitis
Fluid resuscitation (third space losses) Analgesia - usually IV opioids Nil by mouth until pain subsides Abx if infected necrosis Consider ERCP
What test can you do to confirm that steatorrhoea is due to pancreatic lipase insufficiency
Fecal elastase (low)
What criteria can you use to diagnose IBS
Rome criteria
What parts of the bowel does Crohn’s disease affect
Terminal ileum/ileocaecal region mainly but can be anywhere from mouth to anus but rectum is spared
Which classification system is used to grade severity of UC
Truelove and Witts
What parts of the bowel does UC affect
Ascending beginning in the rectum and spreading proximally. Rectum is always involved.
Which IBD is transmural and which is just mucosal + submucosal
Crohn's = transmural UC = mucosal + submucosal
Which biliary condition is strongly associated with UC
Primary sclerosing cholangitis
How can you test for H.pylori
Urea breath test
Biopsy from OGD (rapid urease test)
What is H.Pylori eradication therapy (triple and quadruple)
A PPI (usually twice normal dose) and two different antibiotics Omeprazole + 2 of amoxicillin/clarithromycin/metronidazole
Quadruple therapy adds Bismuth - raises pH so HP divides more so abx work better
Main underlying mechanism that causes GORD
Transient lower oesophageal sphincter relaxations
What is Barrett oesophagus
Squamous epithelium of the esophagus gets replaced by columnar epithelium of the stomach - due to chronic reflux damage
Which type of cancer affects the upper 1/3 of the oesophagus and which affects the lower 2/3
Adenocarcinoma upper 1/3
Squamous cell carcinoma lower 2/3
Diarrhoea is considered chronic if it continues for how long?
> 4 weeks
Common viral causes of diarrhoea
Norovirus
Rotavirus
CMV
Common bacterial causes of diarrhoea
Campylobacter Shigella Salmonella E.coli C.diff
Which bacterial cause of diarrhoea should you be wary of treating with antibiotics and why
E.Coli 0157 because it can increase the risk of HUS
Name a stimulant laxative
Senna
Name a stool softener laxative
Docusate
Name an osmotic laxative
Movicol
Lactulose
Mannitol
What are the two hereditary disorders that predispose to colorectal cancer
Familial adenomatous polyposis (FAP)
Hereditary non-polyposis colorectal cancer (HNPCC)
What is the inheritance pattern of FAP and HNPCC
Autosomal dominant
Describe the screening programme for colorectal cancer in the UK
Fecal occult blood test
2 yearly from the age of 60/62
What type of cancer are most colorectal cancers
Adenocarcinoma
What part of the colon is most commonly affected by colorectal cancer
Rectosigmoid
What is the name of the staging classification system used for colorectal cancer
Dukes criteria
Which tumour marker is used to assess response to treatment of colorectal cancers
CEA (carcinoembryonic antigen)
How do you calculate units of alcohol
ml X % then divide by 1000
