Gastro quickfire Flashcards
Whipple’s disease
a) Cause
b) Presentation
c) Investigations
d) Management
e) Mnemonic: WHIPPLES
f) Pathognomonic neurological sign occurring in 20%
a) Tropheryma whipplei, a gram-positive bacterium
b) Middle-aged white men - present with weight loss, arthralgia, steatorrhoea, and fever.
- Rarely, may have CNS involvement: confusion, ataxia, hemiparesis, supranuclear ophthalmoplegia, nystagmus
- Also low possibility of involvement of lung, liver, subcutaneous nodules and endocarditis
c) - Duodenal biopsies - foamy macrophages in the lamina propria with periodic acid-Schiff (PAS)-positive particles in the cytoplasm.
- PCR testing from CSF or synovial fluid.
d) IV ceftriaxone for 14 days, followed by oral co-trimoxazole for 1 year
e) WHIPPLES:
Weight loss
Hyperpigmentation
Infection with trophyerma whipplei
Polyarthritis
PAS-positive macrophages
Lymphadenopathy/LFT rise
Endocarditis (culture negative)
Steatorrhoea
f) Oculomasticatory myorhythmia - abnormal rotatory eye movements and jaw contraction occurring together
77 year old female. Copious watery diarrhoea with hypochloraemic hypokalaemic metabolic acidosis.
Bloods show iron deficiency anaemia
Villous adenoma
- colonoscopy and removal
Chronic pancreatitis
a) Investigations and findings
b) Management
a) - OGD to r/o UGI malignancy (nausea, vomiting, abdo pain, weight loss)
- CT scan - calcified pancreas
- Faecal elastase low (low exocrine function)
b) Pain management
Creon + PPI (prevents degradation of enzymes in the stomach)
Surgical resection if fails
Familial Mediterranean fever
a) Inheritance
b) Presentation
c) Diagnosis
d) Management
a) Fev-ARRRR
b) Recurrent episodes of: Fever, abdo pain, peritonitic abdomen, constipation then diarrhoea, serositis (peritonitis, pleuritis, pericarditis), arthralgia, erythematous rash, amyloidosis (nephrotic)
c) MEFV gene testing
d) Management
- colchicine - reduces risk of renal amyloidosis
- NSAIDs - beware analgesic nephropathy
Carcinoid syndrome
a) Associated malignancies
b) Diagnostic findings
c) Presentation
d) Management
a) Carcinoid tumours:
- Appendix, stomach, SI, LI, lung
b) Elevation of:
- Urinary 5-HIAA (“Hiya carcinoid!”)
- Serum chromogranin A
c) - Facial Flushing, diarrhoea
- Wheeze
- Tricuspid regurgitation, pulmonary stenosis, right heart failure, hepatomegaly
Note: Asymptomatic until metastasises to liver (as then liver unable to metabolise the serotonin released by the tumour, causing symptoms)
d) Octreotide, resection
HUS
a) Features
b) Management
a) - Exposure: processed meats or petting farms
- Bloody diarrhoea, fever
- Microangiopathic Haemolytic anaemia
- Glomerulonephritis - protein ++, blood ++, AKI (histologically IgA nephropathy)
- Thrombocytopenia
- Petechial rash
b) Fluids, supportive, RRT
(not antibiotics - no evidence to support their use)
Pancreatic cancer
a) Presentation of head vs body/tail tumours
b) What is Trousseau syndrome? (thrombophlebitis migrans)
a) Head - painless obstructive jaundice
Body/tail - boring epigastric pain radiating to the back and relieved by leaning forwards, with N&V, raised GGT/Alk Phos but not jaundice until very advanced
b) Superficial thrombophlebitis (erythema, tenderness, dilated veins, etc.), often with palpable clot. Due to venous or arterial thrombus in association with malignancy
Pancreatitis severity
a) Glasgow score
(mnemonic: PANCREAS)
b) BISAP score
a) PaO2 < 8kPa
Age >55
Neutrophils >15
Calcium <2
Renal (urea >16)
Enzymes (LDH >200, or AST >200)
Albumin <32
Sugar (glucose >10)
Presence of 3 or more of these in the first 48 hours indicates severe pancreatitis
b) Taken in first 24h:
- Blood urea nitrogen >25
- Impaired mental status
- SIRS >2 criteria
- Age >60
- Pleural effusions
Pancreatitis
a) Drug induced causes
b) what cause of pancreatitis can interfere with amylase assay and give a falsely normal amylase
c) Other causes of raised amylase
a) - Immunosuppressants - steroids, azathioprine, 6-mercaptopurine, mesalazine
- Antibiotics - sulfonamides, metronidazole, tetracyclines
- Other: NSAIDs, valproate, furosemide, thiazides, methyldopa
b) Hypertriglyceridaemia
c) Pancreatic - cyst, pseudocyst, fistula, malignancy, post-ERCP, pancreatic ascites
- Non-pancreatic: PUD, mesenteric ischaemia, cholangitis, salpingitis/ectopics/ovarian pathology, end-stage renal failure. DKA, anorexia, alcoholism, burns
Peutz-Jegher
a) What is it?
b) Presentation
c) Inheritance
d) Risk of cancer
a) Inherited condition with increased risk of growths along the lining of the gastrointestinal tract (called hamartomatous polyps) and certain types of cancer.
b) - Dark blue to dark brown macules around the mouth, eyes, and nostrils; near the anus (perianal); and on the inside of the cheeks (buccal mucosa).
c) PJS is caused by changes in the STK11 gene on Ch 19 and is inherited in an autosomal dominant manner
d) 50% Risk of GI cancer by their 50s
Raised ferritin: causes
- Haemochromatosis
- Infection/inflammation
- Alcohol liver disease
- Adult Stills disease
Raised gastrin: causes
- Gastrinoma
- PPI or H2RA
- Pernicious anaemia, gastric atrophy
- Diabetes, renal failure, Rheumatoid arthritis
Raised glucagon level: causes
- Glucagonoma
- DKA
- Sepsis
- Renal failure
- Pancreatitis
- Acromegaly
- Cirrhosis
Rarer causes of abdominal pain to consider in MRCP
- Familial Mediterranean fever
- C1-esterase deficiency
- Sickle cell crises
- Mesenteric ischaemia (abdominal angina)
- Porphyria
- Inferior MI
- Lower lobe pneumonia
- Addisonian crisis
- DKA
- Pregnancy
Pancreatic cysts - types and management
- Serous cystadenomas <2cm - do nothing
- Mucinous cystadenomas - have raised CEA, 25% malignant potential, should be resected
- Intraductal papillary mucinous neoplasms (IPMN) - have malignant potential, require at least annual MRCP follow-up
- Papillary cystic neoplasm - usually occur in tail, should be resected
- Pseudocysts - associated with pancreatitis
- Retention (simple) cysts - e.g. in VHL or PKD
