Gastroenterology Flashcards

Question

What are causes of recurrent abdominal pain?

Answer 1

``` >90% no cause IBS, constipation, dyspepsia Abdominal migraine, ulcers Dysmenorrhoea, cysts, PID Psychosocial Hepatitis, gallstones UTI, PUJ obstruction ```

Answer 2

``` Epigastric pain at night Haematemesis - ulcer Diarrhoea, weight loss Growth failure Blood in stools Vomiting Jaundice - liver disease Dysuria, secondary enuresis Bilious vomiting, abdo distension ```

Answer 3

``` Abdominal pain, often worse before or relieved by defecation Explosive, loose or mucous stools Bloating Feeling of incomplete defecation Constipation ```

Answer 4

Symptoms of peptic ulceration, abdo pain, nausea More non specific symptoms Early satiety Bloating Post prandial vomiting Delayed gastric emptying due to gastric dysmotility Treatment with hypoallergenic diet

Answer 5

Less common in kids H pylori causes nodular antral gastritis Epigastric pain waking them at night FH of peptic ulceration

Answer 6

``` Sepsis, meningitis RTI, otitis media, Hep A Pyloric stenosis Intussusception Acute appendicitis NEC DKA Haemolytic uraemic syndrome Coeliac disease Cow's milk protein intolerance ```

Answer 7

Rotavirus Also adenovirus, norovirus Bacteria less common, blood in stools if so Campylobacter jejuni Shigella - high fever E coli - dehydrating diarrhoea

Answer 8

Infants under 6 months or low birth weight Passed >6 diarrhoeal stools in past 24 hours Vomited three or more times in previous 24 hours Unable to tolerate fluids Malnourished

Answer 9

Water loss exceeds relative sodium loss Due to high insensible water losses e.g. high fever, hot/dry environment Depression of fontanelle Reduced tissue elasticity Sunken eyes are all less obvious Water drawn out of brain and cerebral shrinkage Leads to jittery movement, increased muscle tone Hyperreflexia, seizures

Answer 10

``` Appears unwell or deteriorating Altered responsiveness Sunken eyes Tachycardia Tachypnoea Reduced skin turgor ```

Answer 11

Abnormal stools Failure to thrive or poor growth Specific nutrient deficiencies

Answer 12

Antibodies: anti-tissue transglutaminase anti-endomysial anti-EMA Inflammation in small intestine, atrophy of intestinal villi

Answer 13

``` Failure to thrive Diarrhoea Fatigue Weight loss Mouth ulcers Anaemia secondary to iron, B12 or folate deficiency Dermatitis herpetiformis ``` Rarely can present with neurological symptoms e.g. neuropathy, cerebellar ataxia, epilepsy

Answer 14

Type 1 diabetes

Answer 15

HLA-DQ2 | HLA-DQ8

Answer 16

anti TTG anti EMA Deaminated gliadin peptides antibodies Important to test total immunoglobulin A levels, if total IgA is low coeliac test will be negative even when they have the condition Can then test for IgG version

Answer 17

Remain on gluten diet Check total immunoglobulin A to exclude IgA deficiency Raised anti-TTG antibodies Raised anti-endomysial Crypt hypertrophy and villous atrophy on biopsy

Answer 18

``` Type 1 diabetes Thyroid disease Autoimmune hepatitis Primary biliary cirrhosis Primary sclerosing cholangitis Down's ```

Answer 19

``` Vitamin deficiency Anaemia Osteoporosis Ulcerative jejunitis Enteropathy associated T cell lymphoma of intestine Non-Hodgkin lymphoma Small bowel adenocarcinoma ```

Answer 20

``` No blood or mucus Entire GI tract Skip lesions Terminal ileum most affected Transmural - full thickness inflammation Smoking is a risk factor ``` Also associated with weight loss, strictures, fistulas

Answer 21

``` Continuous inflammation Limited to colon, rectum Only superficial mucosa Smoking is protective Excrete blood and mucus Use aminosalicylates Primary sclerosis cholangitis ```

Answer 22

Growth failure Puberty delayed Abdominal pain, diarrhoea, weight loss General ill health - fever, lethargy, weight loss

Answer 23

``` Oral lesions Perianal skin tags Uveitis Arthralgia Erythema nodosum ```

Answer 24

Raised inflammatory markers - platelet count, ESR, CRP Iron deficiency anaemia Low serum albumin

Answer 25

Hallmark is presence of non-caseating epithelioid cell granulomata Small bowel imaging may reveal narrowing, fissuring, mucosal irregularitis Bowel wall thickening

Answer 26

Steroids - oral prednisolone or IV hydrocortisone Second line - azathioprine, mercaptopurine, methotrexate, infliximab

Answer 27

First line - azathioprine, mercaptopurine Or methotrexate, infliximab, adalimumab

Answer 28

If affecting distal ileum, can surgically resect to prevent further flares Treat strictures and fistulas

Answer 29

Mild/mod disease - aminosalicylate e.g. mesalazine, or corticosteroids If severe - IV corticosteroids first line or IV ciclosporin

Answer 30

Aminosalicylate e.g. mesalazine oral or rectal Azathioprine Mercaptopurine

Answer 31

Panproctocolectomy will remove the disease | Left with ileostomy or oleo-anal anastomosis U pouch

Answer 32

Children often have pancolitis Rectal bleeding, diarrhoea, colicky pain Weight loss and growth failure less common

Answer 33

Confluent colitis Mucosal inflammation Crypt damage - cryptitis, abscesses, crypt loss Ulceration

Answer 34

``` Encephalopathy Jaundice Epistaxis Cholestasis - pruritus, pale stools, dark urine Ascites, hypotonia, neuropathy Rickets Varices, portal HTN Spider naevi Muscle wasting - malnourished Splenomegaly Liver palms, clubbing ```

Answer 35

Bile duct obstruction - biliary atresia or choledochal cyst Neonatal hepatitis syndrome Intrahepatic biliary hypoplasia

Answer 36

``` Congenital infection Inborn errors of metabolism A1 antitrypsin deficiency Galactosaemia Tyrosinaemia Errors of bile acid synthesis Progressive familial intrahepatic cholestasis CF Intestinal failure associated liver disease ```

Answer 37

``` Nausea Vomiting Abdominal pain Lethargy Most children don't develop jaundice Large tender liver 30% have splenomegaly Liver transaminases elevated ```

Answer 38

Hep A - faecal oral, vaccination for travellers Bed rest, change of diet ``` Hep B - Perinatal transmission Infected blood Needlestick injuries Renal dialysis Horizontal spread in families (Sexual transmission) ``` Chronic infection by vertical transmission, can cause risk of cirrhosis or hepatocellular carcinoma Interferon therapy Hep C - High in drug users, vertical transmission more common if also have HIV D - co infection or super infection, E - water

Answer 39

Fulminant hepatitis Massive hepatic necrosis, loss of liver function with or without encephalopathy ``` Infection - viral hepatitis Poisons/drugs - Paracetamol, isoniazid, phalloides mushrooms Metabolic - Wilson's Autoimmune hepatitis Reye's syndrome ```

Answer 40

``` Jaundice Encephalopathy Coagulopathy Hypoglycaemia Electrolyte disturbances ``` Early signs of encephalopathy - alternate periods of irritability, confusion, drowsiness, aggression

Answer 41

Cerebral oedema Haemorrhage from gastritis or coagulopathy Sepsis Pancreatitis

Answer 42

``` Transaminases very raised Alkaline phosphatase increased Coagulation very abnormal EEG shows encephalopathy CT may show cerebral oedema ```

Answer 43

Maintain blood glucose >4 with IV dextrose Prevent sepsis; broad spectrum antibiotics and antifungals Prevent haemorrhage, IV Vit K, FFP, cryoprecipitate, PPIs Treat cerebral oedema by fluid restriction, mannitol Urgent transfer to liver unit

Answer 44

Shrinking liver Rising bilirubin and falling transaminases Worsening coagulopathy Progression to coma Without transplantation, 70% likely to die

Answer 45

Acute non inflammatory encephalopathy | Microvesicular fatty infiltration of liver

Answer 46

``` Post viral Hep B, C Autoimmune hepatitis Drugs - nitrofurantoin, NSAIDs IBD PSC - +- ulcerative colitis Wilson's Alpha 1 antitrypsin def CF Neonatal liver disease Bile duct lesions ```

Answer 47

More common in girls May present as acute hep, fulminant hep or CLD Autoimmune features - rash, SLE, arthritis, haemolytic anaemia, nephritis Respond to prednisolone, azathioprine

Answer 48

Autosomal recessive Reduced synthesis of caeruloplasmin and defective excretion of copper in bile Leads to copper in liver, brain, kidney, cornea Liver disease, neuropsychiatric features, extrapyramidal signs Kayser Fleischer rings from age 7 Tx with penacillamine, promotes copper excretion, zinc to reduce absorption

Answer 49

End result of any liver disease, extensive fibrosis May be asymptomatic if compensated, then: palmar and plantar erythema Spider naevi Malnutrition, hypotonia

Answer 50

Screen for known cause of chronic liver disease Upper GI endoscopy to detect varices, gastritis Abdominal ultrasound Liver biopsy

Answer 51

``` Portal hypertension Splenomegaly Oesophageal varices Ascites - umbilical hernias Spontaneous bacterial peritonitis - undiagnosed fever, pain, tenderness Encephalopathy Renal failure ```

Answer 52

Sever malnutrition unresponsive to intensive nutritional therapy Recurrent complications Failure of growth and development Poor quality of life

Answer 53

``` Primary non function of liver Hepatic artery thrombosis Biliary leaks, strictures Rejection Sepsis ```

Answer 54

Nutrition - high protein high carbohydrate, NG or TPN Vit K, A, E, D Pruritus - loose clothing, emollients, phenobarbital to stimulate bile flow, ursodeoxycholic acid

Answer 55

Night blindness in adults Retinal changes in infants Give oral supplements

Answer 56

Peripheral neuropathy Haemolysis Ataxia High oral doses needed

Answer 57

Rickets Pathological fractures Vit D resistant rickets indicates renal tubular acidosis