Gastroenterology 1 Flashcards
Ix achalasia
Diagnostic test (1)
Other tests (2)
Oesophageal manometry
Barium swallow - birds beak appearance
CXR - wide mediastinum, fluid level
Birds beak barium swallow =
Achalasia
Treatment of achalasia
1st line
If recurrent or persistent
If high risk for surgery (1)
Medical therapy (2)
Pneumatic balloon dilatation
Surgical cardiomyotomy if recurrent or persistent
botox if high risk for surgery
Nitrates/ CCB
What is the psoas sign?
Pain on extending hip if retrocaecal appendix (appendicitis)
Small volume of fresh blood, often streaking vomit. Malena rare. Often ceases spontaneously. Usually history of antecedent GORD type symptoms.
Oesophagitis
Pain after eating and haematemesis =
Pain during eating and haematemesis =
Duodenal
Gastric
What is the Glasgow Blatchford score?
Interpretation
Used in determining whether patients can be managed as outpt or inpatient with UGI bleeding
0 = consider early discharge
Mx GI bleeds:
Platelet transfusion if less than?
FFP if PT >? or fibrinogen <?
What to give in those taking warfarin and actively bleeding?
ABC
Platelet transfusion if <50
FFP if PT 1.5x > normal
Fibrinogen <1
Prothrombin complex concentrate
When should endoscopy be done for GI bleed?
Within 24 hours
Mx of non-variceal bleeding
When to give a PPI
If non-variceal upper GI bleeding and stigmata of recent haemorrhage shown at endoscopy
Mx of variceal bleeding (4)
Terlipressin
Prophylactic abx
Band ligation
TIPS
AUDIT interpretation
Range of scores
Hazardous/ harmful scores
Dependency scores
0-40
7> F > 13
8> M >15
= Hazardous/ harmful alcohol consumption
FAST score interpretation
Score range
Hazardous drinking score
0-16
Hazardous drinking =>3
CAGE explained
Have you ever felt you should cut down?
Have people been annoying by your drinking?
Have you ever felt guilty?
Eye opener
Recommendation drinking
14 units spread thinly over 3 days or more
How to calculate units
Mls X ABV / 1000
Mx ETOH hepatitis
Acute (1)
Prednisolone - acute episodes
Bloods strongly suggestive of acute alcoholic hepatitis
(2)
AST:ALT ratio >3
GGT raised
5-ASA example
Sulphasalazine
Name five side effects of sulphasalazine
Lung fibrosis
Heinz body anaemia/ megaloblastic
Oligospermia
Rashes
Headaches
Mesalazine side effects (5)
GI upset
Headache
Agranulocytosis
Pancreatitis
Interstitial nephritis
Autoimmune hepatitis is seen in which population?
Young females
Autoimmune hepatitis types
I, II, III
Antibodies and age affected
I - ANA/ SMA adults and children
II - LKM1 antibodies affects children only
III - soluble liver kidney antigen adults middle age
Common presentation for auto-immune hepatitis?
Mx (3)
Amenorrhoea
Mx steroids, AZT, liver transplant
Inflammation extending beyond limiting plate
Piecemeal necrosis
Bridging necrosis
Autoimmune hepatitis biopsy
Barrett’s
Cell change
Classification
Squamous to columnar
Short <3cm and long >3cm
RF Barretts (4)
Central obesity
GORD
Male
Smoker
Mx Barrett’s (2)
Mx if dysplasia of any grade (2)
Endoscopy surveillance every 3-5 years
High dose PPI
Mucosal resection/ ablation
Bile acid malabsorption can cause a deficiency in what vitamins?
What other symptom?
KADE
Steatorrhoea
Investigation of choice for bile acid malabsorption
Mx
Name three causes of bile acid malabsorption
SeHCAT
Mx cholestyramine
Coeliac’s, cholecystectomy, small intestine bacterial overgrowth
What is Budd Chiari?
Triad symptoms
Hepatic vein thrombosis
AP, sudden onset, severe
Ascites
Tender hepatomegaly
Causes of Budd Chiari (4)
Polycythaemia rubra vera
Thrombophillia
Pregnancy
COCP
Budd Chiari
Ix
US with dopplers
Budd Chiari
Ix
US with dopplers
Carcinoid tumours
What is it?
Symptoms (6)
Tumour of neuroendocrine cells usually from bowel or lung
1. SOB/ bronchospasm
2. Diarrhoea
3. Flushing
4. Hypotension
5. Pellagra
6. Right heart valvular stenosis
Carcinoid tumour Ix (2)
Mx (1)
Metastases to?
Urinary 5-HIAA
Plasma chromogranin
Mx
Somatostatin analogues (octreotide)
Liver
Cholestyramine is used in the management of which two conditions?
Bile acid malabsorption
Hyperlipidaemia - reduced LDL
Mx c. diff
First line
Second line
Third line
Vancomycin 10/7
PO fidaxomicin
PO vanc +/- IV metro
Recurrent c. diff
Mx
<12 weeks of symptoms resolution
>12 weeks
PO fidaxomicin
PO vanc or fidax
Classification of c. diff (4)
Mild normal WCC
Mod <15 WCC 3-5 loose stools
Severe >15 WCC/ increased creatinine/ T>38.5/ severe colitis
Life threatening hypotension/ toxic megacolon
Conditions associated with Coeliac’s (3)
Dermatitis herpetiformis (vesicular, pruritic skin eruption)
T1DM
Autoimmune hepatitis
Coeliac’s complications (6)
Iron/folate/B12 deficiency (folate more common than B12)
Hyposplenism
Osteoporosis
Lactose intolerance
T cell lymphoma
Subfertility
Ix Coeliac (3)
Re-introduce gluten for 6 weeks
TTG antibodies
IgA (endomyseal) antibodies
Gold standard diagnosis for Coeliac’s
Endoscopic intestinal biopsy
Gold standard diagnosis for Coeliac’s
Endoscopic intestinal biopsy
Coeliacs are offered which vaccine?
Pneumococcal - booster every 5 years
