Gastroenterology Flashcards
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.
Blatchford score is used when
IS USED ON 1ST ASSESSMENT
Patients with a Blatchford score of 0 may be considered for early discharge
Rockall score is used when
used after endoscopy
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
Management of non variceal bleeding
PPI
If further bleeding then options include repeat endoscopy, interventional radiology and surgery
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
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’
1 unit of alcohol is equal to how much ethanol
10ml
HOW DO YOU CALCULATE THE NUMBER OF UNITS IN A DRINK?
ml * (ABV%) /1000
pigment ladden macrophages/melanosis coli on endoscopy shows?
laxative abuse(specially because of Senna)
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
odynophagia (difficiulty in swallowing) is a common SE od which popular drug?
documented complication of inhaled steroid therapy
agar MCV zada hua and hb kum isa Matlab ?
Megaloblastic anemia hai
megaloblastic anemia k workup mein
Intrinsic factor antibodies karvani chahye (more specific)
Gastric Parietal cell antibodies
to r/o pernicious anemia
anti histone antibodies
are involved in drug-induced lupus. This can be caused by several drugs, including infliximab, isoniazid, carbamazepine and procainamide.
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
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)
indications of Abd X-ray in case of epigastric pain
acute bowel obstruction or a volvulus are suspected.
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.
Complications of GORD
oesophagitis
ulcers
anaemia
benign strictures
Barrett’s oesophagus
oesophageal carcinoma
NOT ACHLASIA
dysphagia, halitosis,wt stable
Pharyngeal pouch
neck gurgles on palpation ,aspirationdysphagia, halitosis,wt stable
Pharyngeal pouch
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.
foods with low GI
fruits, vegetables and peanuts
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
