Gastroenterology Flashcards by Maryam Iqbal

BEST INDICATOR OF UPPER GI BLEED.

YOU ANSWERED THIS CORRECT ON THE BG KNOWLEDGE OF A PATIENT WHO WAS DUE TO HAVE ENDOSCOPY AND THE GASTRO CONS ASKED WHAT IS THE UREA

An upper gastrointestinal bleed can act as a ‘protein meal’ and cause a temporary, disproportionate rise in the blood urea.

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Blatchford score is used when

IS USED ON 1ST ASSESSMENT
Patients with a Blatchford score of 0 may be considered for early discharge

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Rockall score is used when

used after endoscopy

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Resuscitation while endoscopy

ABC, wide-bore intravenous access * 2

platelet transfusion if actively bleeding platelet count of less than 50 x 10*9/litre

FFP to patients who have either a fibrinogen level of less than 1 g/litre, or a PT/APTT greater than 1.5 times normal

prothrombin complex concentrate to patients who are taking warfarin and actively bleeding

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Management of non variceal bleeding

PPI
If further bleeding then options include repeat endoscopy, interventional radiology and surgery

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Management of Variceal bleeding

Terlipressin and prophylactic antibiotics should be given to patients at presentation (i.e. before endoscopy)

band ligation

TIPS should be offered if bleeding from varices is not controlled with the above measures

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How much a man and a woman can drink in a week?

men and women should drink no more than 14 units of alcohol per week
they advise ‘if you do drink as much as 14 units per week, it is best to spread this evenly over 3 days or more’

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1 unit of alcohol is equal to how much ethanol

10ml

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HOW DO YOU CALCULATE THE NUMBER OF UNITS IN A DRINK?

ml * (ABV%) /1000

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pigment ladden macrophages/melanosis coli on endoscopy shows?

laxative abuse(specially because of Senna)

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MILD C DIFF
MODERATE
SEVRE
LIFE THTEATING

Normal WCC

↑ WCC ( < 15 x 109/L)
Typically 3-5 loose stools per day

↑ WCC ( > 15 x 109/L)
CR=or an acutely ↑ creatinine (> 50% above baseline)
TEMP=or a temperature > 38.5°C
CT=or evidence of severe colitis(abdominal or radiological signs)

BP=Hypotension
Partial or complete ileus
TOXIC=Toxic megacolon
CT=evidence of severe disease

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odynophagia (difficiulty in swallowing) is a common SE od which popular drug?

documented complication of inhaled steroid therapy

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agar MCV zada hua and hb kum isa Matlab ?

Megaloblastic anemia hai

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megaloblastic anemia k workup mein

Intrinsic factor antibodies karvani chahye (more specific)
Gastric Parietal cell antibodies
to r/o pernicious anemia

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anti histone antibodies

are involved in drug-induced lupus. This can be caused by several drugs, including infliximab, isoniazid, carbamazepine and procainamide.

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Celiac dis ko r/o karnay k lye kon c antibodies krvatay hain

anti ttg lekin ye tab karvatay hain jb microcytic anemia hota hai

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64-year-old female
severe upper abdominal pain of sudden onset.
history of peptic ulcer disease
O/E; tachy and rectal examination soft stools
what is the initial step in the management.
passing NG tube or getting and or erect CXR?

Depends on the diagnosis
does not look like a intestinal obstacle as soft stools so NG won’t be inserted as it is inserted in cases of obstruction for decompensation.

we will get the erect CXR to rule out free air under diaphragm(suggestive of perforated peptic ulcer)

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indications of Abd X-ray in case of epigastric pain

acute bowel obstruction or a volvulus are suspected.

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perforated peptic ulcer

erect CXR
then CT
then urgent surgical opinion for management via laparoscopy and with a conservative approach, especially in patients unfit for surgery or with small perforations.

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Complications of GORD

oesophagitis
ulcers
anaemia
benign strictures
Barrett’s oesophagus
oesophageal carcinoma

NOT ACHLASIA

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dysphagia, halitosis,wt stable

Pharyngeal pouch

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neck gurgles on palpation ,aspirationdysphagia, halitosis,wt stable

Pharyngeal pouch

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Which vitamin, if taken in high doses, can be teratogenic in pregame’s woman?

Vitamin A is teratogenic in high doses, and pregnant women should not exceed a daily intake of >10,000IU.

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foods with low GI

fruits, vegetables and peanuts

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FOODS WITH HIGH GI

White rice and white bread baked potato

medium GI

coucous boiled potato and boiled rice

features of celiac diseases

presence of howel jolly bodies dermatitis herpetiformis increased incidence of T cell lymphoma biopsy; villous atrophy(ON DUODENAL BIOPDY)

cyst abscesses are found in?

Ulcerative Colitis

rapid wt loss courvisers sign (palpable gall bladder) pain radiating from epigastrium to the back pale stools raised blood sugars

pancreatic cancer courveisers sign is present is present in acute situations; unlikely chronic

features of gastric cancer

acanthuses nigricans enlarged supraclavicular lymph node(virchows node)

causes of gastric cancer

h pylori, smoking,gastritis,adenomatous polyposis NOT ALCOHOL

KAYSER FLESCHER RINGS hypermobile joints dx?

Wilsons disease

diagnostic for KF rings?

liver biopsy other test for it's diagnosis; CERULOPLASMIN concentration copper in urine LFT's and RFT's

saints triad?

Sliding hiatus hernia gall stones diverticular dis nausea and vomting mostly in children

diagnostic for sliding hiatus hernia

barium meal

age; less than 50 epigastric pain started 2-3 hrs after meals and releived on eating dx?

Duodenal ulcer 90% of it is associated with h pylori infection

age; over 50 pain worse after meals less at night time wt loss dx?

Gastric ulcer 60% is associated with h pylori 30% with NSAIDS

risk factors for oesophageal cancer

age more than 60 hx of good of more than 10 years smoking obesity

normal epithelium of oesophagus

squamous

barrets esophagus

squamous to columnar

if the patient had endoscopy and it just shows mild inflammation of oesophagus with squamous epithelium what is the dx?

simple esophagitis use ppt

autoimmune hepatitis is common in which gender?

Female

antibodies for autoimmune hepatitis type 1

smooth muscle antibodies antinuclear antibodies

antibodies for autoimmune hepatitis type 2

common in kids btw(age; 2-14 years) anti liver cytosol antigen antibodies anti LKM antibodies

tx of autoimmune hepatitis

high dose glucocorticoids azathioprine liver transplant

patient with a stigmata of alcohol buse,came with Malena and one episode of fresh bleed,obs unstable, on fluids and abcs being transfused.platelets 85 initial management

endoscopy after resuscitation for band ligation of probable varies

platelet transfusion would be given when in the above case

platelet transfusion would only be given if the platelets are less than 50

when will prothrombin concentrate be given?

when the patient is actively bleeding and is on an anticoagulant eg warfarin and there is no time of reversal.

ffp should be given only when

PT is more than 1.5 times of normal

which medication used for ulcerative colitis cause decreased sperm count

Sulfasalazine it also causes headache

vit b1 is called

thiamine

thiamine is given in?

wernikes encephalopathy ophthalmoplegia,confusion,poor coordination

vit b3 is called

niacin

deficiency of vit b3/niacin is called?

pellagra remember by 4D's; diarrhoea,dermatitis,dementia and death

liver hemangioma is

benign liver tumour

liver adenoma is associated with

oral contraceptive pills

angiosarcoma and HCC are what kind of tumours

malignant

abd pain diarrhoea flushed appearance tender RUQ pain bibasal crackles in the chest DX?

Carcnoid synd it is a neuroendocrine tumour mostly originates from the intestines)appendix and ileum) and has the potential to spread to liver and lungs it produces 5HT which causes fibrosis in the lungs it is detected by urinary 5HIAA which is a metabolite of 5HT Tx is with octrotide;a somatostatin analogue

symptoms of right sided intestinal carcinomas e.g cecal

lethargy, malaise,SBO,wt loss and anaemia

symptoms of left sided intestinal carcinomas e.g rectal

altered bowel habits, bright red rectal bleeding,LBO

IBS is relieved on?

defecation

which is the diagnostic test for celiac dis?

small bowel biopsy;duodenal 4-6 biopsies(as the dis is patchy) other tests helpful in it; Anti endomysial abs fbc for hb/anaemia radiological investigation surf tab karin get jab lymphoma associated with it suspected ho.

Complications of Hepatic failure

Coagulopathy Encephalopathy sepsis

Breathlessness on exertion and cough with deranged LFTS

Alpha 1 antitripsin deficiency (liver Cirrhosis and emphysema)

treatment of Alpha 1 antitripsin def

Augmentation therapy with ATrispisn but is expensive liver transplantation

Desferoxamine which is used for Haemochromotosis is contraindicated in?

Cardiomyopathy and anaemia BTW 1st line is phlebotomy and 2nd line is desferoxamine

young age Abnormal LFT's tremors low mood/depression difficulty in concentrating DX?

Wilsons dis due to accumulation of copper in liver and Brain. WILSONS DISEASE;COGNITIVE AND PSYCHIATRIC SYMPTOMS ARE COMMON

SULFASALAZINE used for UC has a MAJOR SE in MEN.

infertility; reduced sperm count and headaches.

which drug is reserved for the patients who do not tolerate with all the initial drugs for UC and have an allergic reaction to steroids?

INFLIXIMAB which itself can cause an anaphylactic reaction

Milan criteria for liver transplantation

1 nodule of less than 5cm or 2-3 nodules of less than 3cm and transcatether chemoemobilzation is an option id liver transplant is awaited or for unresectable tumours

history of crohns disease with wt loss,constipation and abd pain which cancer is common

colon ca C C C

history of UC,wt loss,RUQ pain, jaundice and deranged LFTS which cancer is common

cholangiocarcinoma;malignancy of the bile ducts

Thiamine, Riboflavin Niacin

B1 B2 B3

Pellagra happens because of which bit?

niacin b3

four Ds of Pellagra

Diarrhoea Dermatitis Dementia Death if untreated

benign or malignant liver tumours

B; Hemangioma M; Angiosarcoma HCC

Hallmarks of Steatorrhea

pale foul smelling difficult to flush faecal matter patient has pain on eating fatty and protein containing food

bloody diarrhea wt loss abd tenderness pyoderma gangrenosum erythema nodosum on the shins(tender blue red lesions) cobble's stone appearance in the mucosa(deep fissures) DX?

Crohn's dis

common symptoms of cirrhosis

jaundice coagulopathy ascites

UC is also associated with symptoms of

apthous ulcers,uveitis and arthritis

right sided carcinomas tend to present with

anaemia, wt loss and malaise if it becomes big then it will cause small bowel obstruction by obstructing the ileum

left sided carcinomas present with

change in bowel habits large bowel obstruction PR bleeding

Carcinoid Syndrome dx tx

It produces 5HT which causes Pul stenosis which cause fibrosis and leads to symptoms of HF like SOB Urinary 5HIAA Octrotide; somatosattin analogue

type 2 autoimmune hepatitis is more common in what age group?

2-14 yrs anti LKM1 antibodies anti LC1 antibodies

type 1 autoimmune hepatitis is associated with which antibodies?

Antinuclear and smooth muscle antibodies

platelets should only be transfused when they are less than ? FFP should be transfused when?

50 into 10 raised to power 9 PT is more than 10times the normal

Diclofenac increases the risk of gastritis

Flucloxacillin can cause damage to?

Liver. cholestatic jaundice and hepatitis causes diarrhoea and upset stomach

grey turners sign

bruising of the flanks signs of pancreatic haemorrhage which takes 24-48 hrs to develop

alcohol is not a known cause of gastric cancer

pt of chronic pancreatitis MRI shows;hypertense and hypotenuse lesions no symptoms

pseudocysts

isoniazid is one of the drug that causes pancreatitis.

hx of alcohol abuse epigastric pain radiating to back nausea and hypovolemic shock

acute necrotising pancreatitis

tx of acute necrotising pancreatitis

fluid replacement management of coagulopathy/hypocalcemia and antibiotic prophylaxis