Gastro Passmed Flashcards
Red Flags for gastric cancer?
what age?
> 55
new onset dyspepsia
vomiting
weight loss
dysphagia
odynophagia
epi pain
RF for gastric cancer?
H Pylori
pernicious anaemia
ethnicity
smoking
blood group A
what is Virchows node?
left supraclavicular lymph node - in gastric cnacer
maintaining remission in UC
if severe
or > ?? in one year?
if more than 2 exarcebations
oral azathiopurine
mercaptopurine
Severe colitis mx?
IV steroids
>72 hours add IV ciclosporin to IV steroids and consider surgery
Mild UC?
< 4 stools a day small amount of blood
severe UC
> 6 bloody stools
systemic upset
raised Inflammatory markers
eradication of H pylori post therapy test?
Urea breath test
detects urease activity
4 weeks after
which cancer is associated with gord / barrets?
adenocarcinoma
Upper GI bleed after endoscopy which system?
Rockall
hepatorenal syndrome
Mx
terlipressin - vasopressin analogue
Splanchnic circulation
which artery supplies the stomach
spleen and pancreas?
coeliac artery
what does the SMA supply?
pancreas
small intestine
LI > transverse colon
IMA?
descending colon
Splanchnic ciruclation
aorta
1. Coeliac
2. SMA
3. IMA
portal vein
> liver sinusoids
filteration etc
> hepatic vein
Inferior vena cava
SMA delivers what % of cardiac output?
10% of splanchnic
Terlipressin in HRS
vasopressin analogue
splanchnic vasoconstricrtion
= reduces portal pressure
what imaging for a PBC?
USS
Magnetic resonance cholangiopancreatography
MRCP
Faecal calprotectin?
released by bowel in inflammation
detected in stool sample
when is a stool culture recommended?
systemic upset
blood/pus in stool
immunocompromised
Abx, PPI / hospitalised
C diff severity what marker?
WCC
‘watery diarrhoea’
‘pain’
‘fever’
severe c diff?
> 15 x10^9 /L
acutely high creatinine
38.5>
Mx of C diff?
oral vancomycin
oral fidaxomicin
3rd : oral vanc and IV metronidazole
life threatening c diff mx?
oral vancomycin and IV metronidazole
bile acid malabsorption
bile acid sequestration
cholestyramine
Loperamide
mx for diarrhoea
HCC marker
alpha fetoprotein
Hydrogen breath test?
small bowel overgrowth syndrome
excess bacteria in the small bowel
post procedure mx - oesophageal rebleed prophylaxis
non cardioselective beta blocker
propranalol
Metoclopramide is a?
D2 rceptor antagonist
used in nausea
avoid in bowel obstruction
pro kinetic anti emitc
globus hystericus
anxiety related
painless
intermittent
plummer vinson
oesophageal web
association with iron deficiency anaemia
when is MRCP indicated
to look at gallbladder and pancreas
before ERCP as not invasive
visualise pancreatitise
carcinoid tumours secrete?
serotonin
> 5-hydroxyindoleacetic acid
excreted in urine
palpitaion
facial flush
phaeochromocytoma
what in diagnosis?
urinary catecholamines
mx of carcinoid tumours?
octreotide
somatostatin analogue
Pernicious anaemia presents with?
What blood test is most useful in confirming diagnosis?
megaloblastic anaemia with associated glossitis
IF antibodies > gastric parietal cell antibodies
what is pernicious anaemia?
affects gastric mucosa
= vit b12 deficiency
IF antibodies bind to it, stopping vit b12 binding
SCD SC
weakness
ataxia
parasthesia = spastic and paraplegic
metabolic consequences of refeeding?
hypophosphataemia
hypokalemia
hypomagnesemia
torsades de pointes
causes in refeeding
hypokalaemia
hypomagnesiamia
remission of a first presentation of Crohn’s disease
prednisolone
methylprednisolone
IV hydrocortisone
seton placement?
draining seton
complex perianal fistulae
crohn’s
> thread that is run through the fistula
to allow continuous drainage
boerhaave syndrome?
transmural oesophageal perforation
2 to vomiting
triad
1. vomiting
2. severe retrosternal pain
3.subcut emphysema
Mallory-Weiss tear
non transmural tear
less severe as superficial tear
what is maize?
corn - gluten free
diagnostic Investigation of choice for pancreatic cancer?
HRCT
palpable painless gallbladder?
courvoisier’s sign for pancreatic cancer
Whipple’s resection
pancreaticoduodenectomy
> resectable
head of pancreas
peutz jeghers syndrome?
pigmented freckles
polyps in GI tract
Helicobacter pylori infection strongest association?
duodenal ulceration
gastric adenocarcinoma
atrophic gastritis
Prolonged vomiting may cause metabolic alkalosis
why?
loss of H+ ions from vomit
