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Hepatobilliary + Gastro > Gastro mix > Flashcards

Gastro mix Flashcards

1
Q

Variceal haemorrhage: management

A

Telipressin + ceftriaxone (vasoconstrictor and prophylactic antibiotic)

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2
Q

Duodenal vs gastric ulcer

A

Duodenal: relieved by eating and then worsening 2-3 hours after a meal
Gastric: worse on eating

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3
Q

Hepatic encephalopathy management

A

lactulose + rifaximin and (lactulose to increase ammonia excretion and rifaximin to modulate gut flora to decrease ammonia production)

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4
Q

Hepatic Encephalopathy features

A

-confusion/ altered GCS
-asterix
-constructional apraxia (can’t draw five point star)
-triphasic slow waves ECG
-raised ammonia

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5
Q

C diff management

A

1st line: oral vancomycin 10 days
2nd: oral fidaxomicin
3rd: oral vancomycin +/- IV metronidazole (in life threatening, 1st line)

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6
Q

C diff risk factors

A

Clindamycin/cephalosporins use
PPIs

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7
Q

Pernicious anaemia

A

autoimmune disease- antibodies to intrinsic factor +/- gastric parietal cells blocking vitamin b12 binding site

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8
Q

vitamin b12 function

A

blood cell production and myelination thus pathology of deficiency is megaloblastic anaemia and neuropathy

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9
Q

Pernicious anaemia sx

A

-anaemic (lethargy, pallor dysponea)
-neurological (‘pins and needles’ numbness)
subacute combined degeneration of the spinal cord: progressive weakness, ataxia and paresthesias that may progress to spasticity and paraplegia
neuropsychiatric features: memory loss, poor concentration, confusion, depression, irritability
other features
mild jaundice: combined with pallor results in a ‘lemon tinge’
glossitis → sore tongue

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10
Q

Pernicious anaemia investigations + management

A

-FBC, Vit B and folate levels
-anti intrinsic factor antibodies
-vit b12 replacement: Hydroxocobalamin 1mg IM on alternative days until no further symptomatic improvement, then hydroxocobalamin 1mg IM every 2 months

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11
Q

Boerhaave syndrome

A

Oesophageal rupture following repeated vomiting
Severe chest pain, shock, crepitus on palpation of chest wall

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12
Q

Ascites + Elevated serum ascitic albumin gradient (SAAG)

A

> 11g/L: portal hypertension

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13
Q

Causes of portal HTN

A

Liver disorders (most common):
cirrhosis/alcoholic liver disease
acute liver failure
liver metastases

Cardiac:
right heart failure
constrictive pericarditis

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14
Q

Ascites+ no SAAG elevation

A

Hypoalbuminaemia
nephrotic syndrome
severe malnutrition (e.g. Kwashiorkor)

Malignancy
peritoneal carcinomatosis

Infections
tuberculous peritonitis

Other causes
pancreatitis
bowel obstruction
biliary ascites
postoperative lymphatic leak
serositis in connective tissue diseases

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15
Q

Ascites + Elevated SAAG (liver cirrhosis) management

A

-reduce dietary Na
-fluid restriction
-aldosterone antagonist e.g. spironolactone
-drainage
-acute prophylactic antibiotics- ciprofloxacin
-intrahepatic shunt

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16
Q

Causes of spontaneous bacterial peritonitis

A

Escherichia coli and Klebsiella pneumoniae.

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17
Q

aldosterone

A

Aldosterone (ALD) is a hormone your adrenal glands release that helps regulate blood pressure by managing the levels of sodium and potassium in your blood.

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18
Q

H pylori post eradication test + indication

A

Indicated if family history of gastric cancer
Test: urea breath test 6-8 weeks post eradication

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19
Q

which drugs cause cholestatsis +/- hepatitis

A

-combined oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, -erythromycin*
-anabolic steroids, testosterones

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20
Q

achalasia

A

Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter (LOS) due to degenerative loss of ganglia from Auerbach’s plexus

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21
Q

achalasia sx + investigations + tx

A

dysphagia of both liquids and solids
heartburn
food regurg

Ix: oesophageal manometry (excessive LOS tone)
barium swallow shows ‘bird beak’

tx: pneumatic (balloon) dilation

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22
Q

Glasgow-Blatchford score

A

The Glasgow-Blatchford score is used in patients with upper GI bleeds to decide if they can be managed as outpatients. The Glasgow-Blatchford score includes factors such as haemoglobin level, presence of melena, blood pressure, heart rate, and hepatic disease. This patient has a score of 0 indicating he can be discharged and followed up with an outpatient endoscopy.

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23
Q

Coeliac’s vaccination protocol

A

Pneumococcal + booster every 5 years
-People with coeliac disease receive the pneumococcal vaccine due to hyposplenism

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24
Q

Megaloblastic macrolytic anaemia cause

A

High MCV, Low Hb
-vitamin B12 deficiency
folate deficiency
e.g. secondary to methotrexate

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25
Most common bladder cancer type
Transitional cell
26
Gastroparesis in T1DM
symptoms include erratic blood glucose control, bloating and vomiting management options include metoclopramide, domperidone or erythromycin (prokinetic agents)
27
Hep B serology
HBsAg = ongoing infection anti-HBc = caught, i.e. negative if immunized
28
C. diff infection Mx
1st: oral vancomycin 10 days recurrent within 12 weeks of resolution : oral fidaxomicin after 12 weeks recurrent: oral vanco or fidaxomicin Life threatening: oral vanco + IV metronidazole ALCOHOL GEL DOESN'T KILL C DIFF
29
Vit B1 (thiamine) deficiency causes and consequences
Causes: alcohol excess, malnutrition Consequences: peripheral neuropathy -Wernicke's encephalopathy: nystagmus, ophthalmoplegia and ataxia -Korsakoff's syndrome: amnesia, confabulation dry beriberi: peripheral neuropathy wet beriberi: dilated cardiomyopathy
30
Omeprazole MOA
Irreversible blockade of H+/K+ ATPase
31
Boerhaave syndrome
Severe vomiting → oesophageal rupture -Subcutaenous emphysema - Severe chest pain after repeated episodes of vomiting
32
Hepatocellular carcinoma presentation
Chronic hep B Hx -sx of liver cirrhosis e.g. jaundice, ascites, RUQ pain, hepatomegaly, pruritius, splenomegaly -elevated alpha fetoprotein
33
Pyelonephritis vs renal colic Px
Pyelo- one sided constant back pain with fever and rigors Renal colic- waves of one sided pain with blood+ urine dip
34
Variceal haemorrhage prophylaxsis
Propranolol
35
Primary biliary cholangitis investigations + Mx
anti-mitochondrial antibodies (AMA), imaging required before diagnosis to exclude an extrahepatic biliary obstruction (typically a right upper quadrant ultrasound or magnetic resonance cholangiopancreatography (MRCP) Mx: first-line: ursodeoxycholic acid
36
Imaging choice for suspected perforated peptic ulcer
Erect CXR would show pneumoperitoneum
37
Tool used to assess for bleeding risk of anticoagulation in AF
ORBIT Hb levels, age, bleeding Hx, renal impairment, treatment with antiplatelets
37
CHA2DS2-VASc
Stroke risk in AF patients C Congestive heart failure H Hypertension (or treated hypertension) A2 Age >= 75 years 2 Age 65-74 years 1 D Diabetes S2 Prior Stroke, TIA or thromboembolism V Vascular disease (including ischaemic heart disease and peripheral arterial disease) S Sex (female)
38
transjugular intrahepatic portosystemic shunt (TIPS)
connects the hepatic vein to the portal vein
39
Massive variceal haemorrhage not controlled by telipressin
Insert sengstaken-blakemore balloon tamponade
40
Hepatitis serology
HBsAg = ongoing infection, either acute or chronic if present > 6 months anti-HBc = caught, i.e. negative if immunised previous immunisation: anti-HBs positive
41
Haemochromatosis monitoring
Ferritin and transferrin saturation
42
Gastric carcinoma Sx
-fatigue -weight loss -anaemia -elevated urea (indicates upper GI bleed)
43
Osteomalacia blood findings
Decreased calcium, phosphate and vit D, elevated PTH
44
Haemochromatosis inheritance
Autosomal recessive
45
H. pylori mx
Omeprazole, amoxicillin and metronidazole
46
Carcinoid syndrom Sx
FIVE HT Flushing Intestinal (Diarrhoea) Valve Fibrosis (Tricuspid Regurg & Pulmonary Stenosis) whEEze: Expiratory wheeze Hepatic Involvement (1st pass metabolism bypassed) Tryptophan Deficiency (Pellagra) Ix: urinary 5-HIAA
47
Courvoisier's law
Painless, obstructive jaundice with palpable gallbladder most likely cancer
48
Spontaneous bacterial peritonitis prophylactic antibiotics
Oral ciprofloxacin
49
Which blood vessel is high risk for rupture with a perforated peptic ulcer?
Gastrodudodenal (posterior wall of stomach)
50
Crohn's histology
Inflammation in all layers (mucosa to serosa), goblet cells and granulomas
51
Crohn's investigations
Endoscopy: skip lesions Barium study: Kantor's string sign, rose thorn ulcers and fistulae
52
Wilson's disease sx
Liver: Hepatitis, cirrhosis Neurological: basal ganglia degeneration (speech, behaviour, psych) Kayser-Fleischer rings
53
which area of the bowel is most likely to be affected by ischaemic colitis?
Splenic flexure: watershed areas of the colon. A watershed area refers to a region that receives dual blood supply from the end arteries and therefore it is more vulnerable to ischaemia
54
H Pylori eradication therapy
Lansoprazole + amoxicillin + clarithromycin/metronidazole
55
Variceal haemohraage mx
Telipressin + ceftriaxone prior to endoscopic band ligation Use Sengstaken-Blakemore tube if uncontrolled haemorrhage
56
Which antibiotic use is associated with c diff
Clindamycin- causes changes in the microbiota
57
C diff Mx
1st: oral vancomycin for 10 days 2nd: oral fidaxomicin 3rd/life-threatening: oral vancomycin +/- IV metronidazole
58
Oesophageal cancer histo
Barrett's/GORD: adenocarcinoma Achalasia: squamous cell
59
Liver failure sx
triad of encephalopathy, jaundice and coagulopathy ( elevated PT)
60
Inguinal vs femoral hernias
Inguinal: Superior and medial to the pubic tubercle (usually cough impulse) Femoral: laterally and inferiorly
61
Hyperkalaemia ECG
Tall tented T waves flattened p waves broad qrs

Hepatobilliary + Gastro (2 decks)

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