Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Fourth > gastroenterology > Flashcards

gastroenterology Flashcards

1
Q

What is the management of crohn’s disease that can be used to induced remission?

A
  1. Glucocorticoid - used to induce remission
    Enteral feeding - elemental diet
  2. 5-ASA drugs - mesalazine - used second line
  3. azathioprine or mercaptopurine - add on medication to induce remission (methotrexate)
  4. Inflixumab - refractory disease and fistulating crohn’s
  5. Metronidazole - isolated peri-anal disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What drug is maintaining remission of crohn’s disease?

A
  1. stop smoking is a priority

2. Azathioprine or mercaptopurine - first line used to maintain remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the sign of significant upper GI bleed on blood test?

A

Increased Urea level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the prophylactic antibiotic management for spontaneous bacterial periotonitis (and protein concentration <= 15 g/L)?

A

Oral Ciprofloxacin or norfloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the name of the palpable nodule in the umbilicus seen in gastric cancer?

A

Sister mary joseph node - metastatic umbilical lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

A 65-year-old woman is referred in from her GP with deranged blood tests. She initially went to see the GP due to pain in her tongue and pain on swallowing. On examination, she has angular stomatitis, a red smooth tongue and splenomegaly.

Blood tests show: microcyctic anaemia

What is the diagnosis?

A

Plummer vinson syndrome

A plumber Vincent choked on a rusty iron pipe
i.e. dysphagia (swallowing a pipe), glossitis (red tongue from rust), iron-deficient (iron pipe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the severity scales of UC?

A

Mild: < 4 stools/day, only a small amount of blood

Moderate: 4-6 stools/day, varying amounts of blood, no systemic upset

Severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is severe colitis managed?

A

Treated in hospital with IV steroids

IV ciclosporin can be used if steroids are CI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is proctatitis managed in mild-moderate UC?

A
  1. Topical (rectal) aminosalicylate
  2. remission if not achieved within 4 weeks - add oral aminosalicylate
  3. add topical or oral corticosteroids if needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is C.diff infection diagnosed?

A

C.difficile stool toxin test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the medications that are at risk of causing C-diff infections?

A 
Clindamycin
Cephalosporin 
Fluorquinolone - ciprofloxacin 
Macrolide - clarithromycin 
PPI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the treatment for C-difficile infection?

A

1st therapy is oral vancomycin for 10 days
2nd line therapy: oral fidaxomicin
3rd therapy: oral vancomycin +/- IV metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the treatement for lifethreateneing C-diff infection?

A

Oral vancomycin + IV metronidazole

surgery may be considered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the target population of autoimmune hepatitis?

A

young females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the different types of autoimmune hepatitis?

A

Type 1 - 80% of the cases - Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA) - affects both adults and children

Type 2 - Anti-liver/kidney microsomal type 1 antibodies (LKM1) - Affects children only

Type 3 - Soluble liver-kidney antigen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the associated conditions for autoimmune hepatitis?

A

Type 1 AIH: Hashimoto thyroiditis, Grave disease, ulcerative colitis, celiac disease, rheumatoid arthritis

Type 2 AIH: Hashimoto thyroiditis, type 1 diabetes mellitus, vitiligo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the typical feature of autoimmune hepatitis?

A

Nonspecific symptoms:

  1. Fatigue
  2. Upper abdominal pain
  3. Weight loss

+ acute hepatitis: fever, jaundice etc (only 25% present in this way)
amenorrhoea (common)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is SBP diagnosed?

A

Paracentesis : neutrophils > 250 cells/ ul

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the management of SBP?

A

IV cefotaxime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When is antibiotic prophylaxis given to patients with ascites?

A
  1. Patient who have had an episode of SBP
  2. Patients with fluid protein <15g/l and either Child-pugh score of atleast 9 or hepatorenal syndrome

Prophylactic ciprofloxacin or norfloxacin is offered to people with cirrhosis and ascites with an ascitis protein of 15g/l or less until the ascites has resolved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the definition of malnutrition?

A
  1. Body Mass Index (BMI) of less than 18.5; or
  2. Unintentional weight loss greater than 10% within the last 3-6 months; or
  3. BMI of less than 20 and unintentional weight loss greater than 5% within the last 3-6 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the 2 week criteria for urgent endoscopy?

A
  1. All patients who’ve got dysphagia
  2. All patients who’ve got an upper abdominal mass consistent with stomach cancer
  3. Patients aged >= 55 years who’ve got weight loss, AND any of the following:
    - upper abdominal pain
    - reflux
    - dyspepsia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the criteria for non-urgent endoscopy?

A

Patients with haematemesis

Patients aged >= 55 years who’ve got:

  • Treatment-resistant dyspepsia or
  • Upper abdominal pain with low haemoglobin levels or
  • Raised platelet count with any of the following: nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain
  • Nausea or vomiting with any of the following: weight loss, reflux, dyspepsia, upper abdominal pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

A 52-year-old woman with a repeated presentation tells you she has been seen by two different doctors before.

She complains of explosive, watery diarrhoea several times a day and has had colonoscopy with biopsies that didn’t detect any pathology. She has previously tried a low FODMAP diet for presumed IBS but this didn’t help her symptoms.

She has no nausea or vomiting. On review of systems you note she experiences flushing several times a day which she ascribes to menopause. When asked about respiratory symptoms she tells you that she had some episodes of wheezing recently and that she had asthma as a child.

Which treatment will provide best symptomatic relief?

A

Octreotide is a somatostatin analogue used to treat the symptoms of carcinoid syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is the investigation of carcinoid tumours?

A

Urinary 5-HIAA

Plasma Chromogranin A y

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What test would you use to assess acute live failure?

A

Prothrombin Time - short half life making it a better measure of acute liver failure

Albumin can also be used - however is inferior to prothrombin time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the M rule of primary biliary cholangitis?

A

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the side effects of metaclopramide?

A
  1. Extrapyramidal effects
  2. Hyperprolactinaemia
  3. Tardive dyskinesia
  4. Parkinsonism
29
Q

What is a condition you cannot use metoclopramide?

A

Avoid in bowel obstruction

30
Q

What are the side effects of PPI?

A
  1. Hyponatraemia
  2. Hypomagnasaemia
  3. Osteoporosis - increased risk of fractures
  4. Microscopic colitis
  5. Increased risk fo C.difficile infections
31
Q

What are the side effects of PPI?

A
  1. Hyponatraemia
  2. Hypomagnasaemia
  3. Osteoporosis - increased risk of fractures
  4. Microscopic colitis
  5. Increased risk fo C.difficile infections
32
Q

A 37-year-old female presents to her general practitioner with a 2-month history of progressive fatigue. She has a background medical history of type-1 diabetes mellitus.

FBC shows megaloblastic anaemia.

What antibody test is most appropriate to aid diagnosis?

A

Intrinsic factor antibodies are more useful than gastric parietal cell antibodies when investigating vitamin B12 deficiency, given low specificity of gastric parietal cell antibodies

33
Q

What is the difference between type 1 and type 2 hepatorenal syndrome?

A

Type 1 is a rapid onset hepatorenal syndrome (less than 2 weeks) - typically occurs following upper GI bleeds

Type 2 - more gradual decline in renal function - refractory ascites

34
Q

What is the test results for alcoholic liver disease?

A

Gamma-GT is characteristically elevated

Ratio of AST:ALT is normally > 2, a ratio of > 3 is strongly suggestive of acute alcoholic hepatitis

35
Q

What is the management of alcoholic hepatitis?

A
  1. Glucocorticoid - prednisolone

2. pentoxyphylline is also sometimes used

36
Q

How do you differentiate sjogren’s syndrome from PBC?

A

Systemic features such as fatigue, pruiritus are common

PBC causes increased ALP on routine LFT

37
Q

What are the side effects of the aminosalicylate drugs?

A

GI upset, headache, agranulocytosis, pancreatitis*, interstitial nephritis

38
Q

What medications are used for secondary prophylaxis of hepatic encephalopathy?

A

lactulose and rifaximin

39
Q

Which medications should you hold in C-diff infections?

A

Medications which are anti-motility and anti-peristaltic should be held

40
Q

What meds should be stopped before an endoscopy?

A
  1. Stop PPI for 2 weeks before endoscopy

2. Stop antibiotics for 4 weeks before endoscopy

41
Q

what drug is used in patients for prohylaxis of variceal haemorrhage?

A

propanolol - reduced rebleeding and mortality compared to placebo

42
Q

what is the tx for spontaneous bacterial peritonitis?

A

IV cefotaxime

43
Q

who is antibiotic prophylaxis given to in pts with ascites?

A
  1. Pts who have had an episode of SBP
  2. patients with fluid protein 15g/l and either child-pugh score at least 9 or hepatorenal syndrome
  3. offer prophylactic oral ciprofloxacin or norfloxacin - for people with cirrhosis and ascites
44
Q

what and why are coeliac disease patients immunised?

A

they are at risk of hyposplenism - offered pneumococcal vaccine

45
Q

what are the drugs that can cause cholestasis?

A
  1. COCP
  2. antibiotics - flucloxacillin, co-amoxiclav, erythromycin
  3. anabolic steroids, testosterone
  4. phenothiazines: chlorprmazine, prochlorperazine
  5. sulphonylureas
  6. fibrates
46
Q

Drugs causing cirrhosis?

A
  1. methotrexate
  2. methyldopa
  3. amiodarone
47
Q

what drug is avoided in bowel obstruction?

A

Metaclopramide - cuz it has prokinetic properties and can exacerbate bowel obstruction

48
Q

what is the mode of imaging that can be useful in peptic ulcers?

A

Chest x-rays

can be used to show pneumoperitoneum

49
Q

what do iron studies show in haemachromatosis?

A

High trasnsferrin, high ferritin, high serum iron, low toatl iron binding capacity

50
Q

what is PBC associated with?

A
  1. sjogren’s syndrome
  2. rheumatoid arthritis
  3. systemic sclerosis
  4. thyroid disease
51
Q

what is the serum albumin ascites gradient for portal hypertension?

A

if SAAG > 11g/L - indicates portal hypertension

Liver disorder - cirrhosis/alcoholic liver disease, acute liver failure

Cardiac - RHC, constrictive pericarditis

52
Q

what are the causes of SAAG < 11g/L?

A
  1. Hypoalbuminaemia - nephrotic syndrome, kwashiorkor
  2. malignancy - peritoneal carcinomatosis
  3. TB peritonitis
  4. pancreatitis
  5. biliary ascites
53
Q

how is the diagnosis of SBP made?

A

paracentesis - neutrophil count > 250 cell/ul

54
Q

what is the histology findings of crohn’s disease?

A

Increased goblet cells

Granuloma

55
Q

what is the histology of ulcerative colitis?

A
  • No inflammation beyond submucosa
  • neutrophils migrate through the walls of he glands to form crypt abscesses
  • depletion of goblet cells and mucin from gland epithelium
  • granulomas are infrequent
56
Q

what is the first , second and third line for c-difficile infections?

A

1st line - oral vancomycin for 10 days
2nd line - oral fidaxomicin
3rd lne - oral vancomycin +/- IV metronidazole

57
Q

what do you treat recurrent c-difficile infections with?

A

within 12 weeks of symptoms resolution - oral fidaxomicin

after 12 weeks - oral vancomycin or fidaxomicin

58
Q

what is plummer-vinson syndrome?

A

triad of dysphagia, glossitis and iron-deficiency anaemia

59
Q

what are the endoscopic findings of coeliac disease?

A
  1. villous atrophy
  2. crypt hyperplasia
  3. increase in intraepithelial lymphocytes
  4. lamina propria infiltration with lumphocytes
60
Q

what are the c-difficile causing antibiotics?

A
  • Co - amoxiclav
  • Ciprofloxacin
  • Clindamycin
  • Cephalosporin (ceftriaxone)
61
Q

what are the causes of acute liver failure?

A
  1. paracetamol overdose
  2. alcohol
  3. viral hepatitis (A or B)
  4. acute fatty liver of pregnancy
62
Q

what are the causes of budd-chiari syndrome?

A

Budd-Chiari syndrome = hepatic vein thrombosis

polycythaemia rubra vera
thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies
pregnancy
combined oral contraceptive pill: accounts for around 20% of cases

63
Q

what are the features of budd-chiari syndrome?

A

abdominal pain: sudden onset, severe
ascites → abdominal distension
tender hepatomegaly

64
Q

what bloods are required to monitor haemochromatosis?

A

ferritin and transferrin saturations

65
Q

what are the causes of acute decompensation in patients with cirrhosis?

A
  1. constipation
  2. infections
  3. electrolyte imbalances
  4. dehydration
  5. upper GI bleeds
  6. increased alcohol intake
66
Q

what does laxative abuse cause?

A

melanosis coli

67
Q

what is the tx for pts who have severe relapses or >2 exacebations of UC in the past year?

A

oral azathioprine or oral mercaptopurine

68
Q

what are the causes of post-hepatic jaundice?

A
  1. Primary biliary cirrhosis
  2. Primary sclerosing cholangitis
  3. Common bile duct gallstones or Mirrizi’s syndrome (CBD compression from a gallstone in the cystic duct)
  4. Drugs, including coamoxiclav, flucloxacillin, nitrofurantoin, steroids, sulfonylureas
  5. Malignancy, such as head of the pancreas adenocarcinoma, cholangiocarcinoma
  6. Caroli’s disease
  7. Biliary atresia

Fourth (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions