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Medicine MBBS year 3 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What are some signs of chronic stable liver disease?

A

multiple spider neavi, dupuytrens contracture, palmar erythema, gynaecomastia

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2
Q

What are the findings, investigation and management for alcoholic hepatitis?

A

Fever, jaundice. RUQ pain and tenderness

LFTS - AST>ALT. Usually 2:1
(STop taking alcohol)
Mallory bodies on biopsy
Macrocytic Aneamia may occur

Supportive: stop drinking alcohol,nutrition, B1 and thiamine, consider corticosteroids

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3
Q

What are the investigations and management for ascites?

A

Paracentesis of ascitic fluid

Transudate fluid = due to high pressure in hepatic portal vein/portal hypertension

Exudate fluid = protein rich and usually due to inflammation and malignancy

SAAG = serum albumin - albumin level of ascitic fluid

SAAG <1.1 = tuberculosis, pancreatitis, peritoneal cancer, infections, nephrotic syndrome

SAAG>1.1= cirrhosis, heart failure, portal vein thrombosis, budd-chiari syndrome

Sodium restriction, spironolactone (an aldosterone antagonist)
large volume paracentesis, TIPSS

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4
Q

What is cirrhosis?
history and examination findings?
Investigations?
Management?

Management of oesophageal varices complication?

A

The end stage of any liver disease e.g viral hepatitis, alcoholic hepatitis, NAFLD. Liver is fibrosed with nodules.

Portal hypertension signs: Ascites, Blood in vomit and melena
Jaundice and pruritus
Chronic liver disease findings
Low platelet common finding

TRANSIENT ELASTOGRAPHY = 1st line investigation

Treat underlying cause, avoid alcohol and hepatotoxic drugs
2nd line = liver transplant or TIPS

Oesophageal varices complication of cirrhosis.
Acute bleeding = Resus + Terlipressin and octreotide
Bleeding prevention = beta blocker/ endoscopic ligation

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5
Q

What are the findings, investigation and management for autoimmune hepatitis?

A

Abdominal discomfort, Hepatomegaly, jaundice
Signs of chronic liver disease or portal hypertension may be present
RFs: female(amenorrhea common), other autoimmune diseases

Investigations
LFTs - raised, especially ALT & AST
Serum globulin - usually elevated, not specific

Management = corticosteroids for acute = prednisolone. Add on immunsuppresant (azathioprine) for ongoing

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6
Q

What clasic triad is seen in liver failure?

A

jaundice, coagulopathy (INR >1.5), and hepatic encephalopathy (impaired awareness, sleep alterations, reduced attention)

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7
Q

What are the findings in B12 deficiency? Management?

A

Megaloblastic anemia - fatigue, pallor, angular chelitis
Peripheral neuropathy - paresthesias
dementia/cognitive impairment
sub-acute combined spinal degeneration - ataxia(+ve rombergs) and signs and symptoms of lower motor neuron lesion (weakness, hyporeflexia, decreased vibration sense,)

Acute with symptoms - cyanocobalamin/ hydroxocobalamin IM
Acute without symptoms - dietary supplementation + vitamins + potentially above

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8
Q

How does a folate deficiency present?

A

Megaloblastic anemia with absence of neurological signs

Prolonged diarrhea - tropical sprue, coeliac disease, IBD

Associated with pregnancy and chronic alcohol intake

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9
Q

What are the findings, investigation and management for acute cholangitis?

A

fever, jaundice, and right upper quadrant pain (Charcot’s triad).

Rfs: history of cholelithiasis, primary or secondary sclerosing cholangitis, stricture of the biliary tree (benign or malignant), or post-procedure injury of bile ducts

LFTs - raised - ALP > AST/ALP
Ultrasound - dilated bile duct, common bile duct stones, ERCP to look for obstruction

IV antibiotics (piperacillin/tazobactam) + biliary decompression

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10
Q

How do you investigate and manage acute pancreatitis?

A

Serum lipase and amylase = elevated 3x upper limit
LFTs and serum calcium - rule out causes of pancreatitis

Fluid resus, analgesia, consider ERCP

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11
Q

What are the findings and management for an anal fissure?

A

Pain while pooping, blood on toilet paper, located posteriorly because are is poorly perfused. No abdominal pain, altered bowel habits, or weight loss

High fibre diet = first line. Can add topical glyceryl nitrate or topical diltiazem.
Resistant - botox injection, surgical sphincterotomy

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12
Q

What investigation can be carried out for appendicitis?

A

CT

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13
Q

What are the findings and management for diverticular disease?

A

LLQ abdominal pain
Abrupt, painless bleeding may occur
Constipation

Diverticulosis vs diverticulitis(fever, leukocytosis)

Diverticulosis - dietary changes, consider analgesia
Diverticulitis - Oral Co-Amoxiclav if uncomplicated, complicated acute diverticulitis (abscess, perforation,fistula, sepsis, intestinal obstruction) give co-amoxiclav with metronidazole

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14
Q

What are the history and examination findings for gastric cancer?

A

Abdominal pain, weight loss
proximal or gastro-oesophageal junction tumours = dysphagia
RFs: pernicious anemia, H pylori, nitrosamines(smoked foods),family history(e-cadherin mutations), smoking

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15
Q

What are the findings investigation and managment for gastric perforation?

A

Results in Peritonitis: Abdominal pain, GUARDING, REBOUND TENDERNESS

Erect Chest X-Ray

Pre-operative -NGT NBM & IV fluids. Antibiotics - cefuroxime and metronidazole

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16
Q

Hiatus hernia findings?
Investigations?
Management?

A

HEARTBURN(usually underling GORD), REGURGITATION, DYSPHAGIA, COUGH
RF: obesity

(barium esophagram)

Uncomplicated sliding hiatus hernias = (PPIS, weight loss, avoid large meals)
Complicated hiatus hernias (bleeding, volvulus, or obstruction, paraesophageal) = surgical repair.

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17
Q

A groin mass that is visible or palpable or groin discomfort might be an?

A

Inguinal hernia

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18
Q

Femorla hernis are located __ the inguinal ligament

Direct inguinal hernias are _ to inferior epigastric artery and indirect inguinal hernias are _ to the vessels

A

Below

Medial

Lateral

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19
Q

What are the findings, investigation and management for Mesenteric adenitis?

A

Abdominal pain - usually RLQ
Abdominal tenderness, fever, mesenteric lymph node enlargement
Usually Viral infection e.g. gastroenteritis, bacterial infection, IBD, lymphoma

abdominal ultrasound

Analgesia, antibiotics if necessary

20
Q

What are the findings, investigation and management for esophageal cancer?

A

Progressive dysphagia, first solids then liquids, odynophagia
Weight loss

Investigation - OGD with biopsy 1st line. Barium swallow can show stricture/apple core sign

Management - early stage = esophagectomy

Lower oesophagus = adenocarcima - Barrets, obesity, smoking
Upper oesophagus = squamous cell - smoking, alcohol

21
Q

What are the investigations, findings and management for pancreatic cancer?

A

Weight loss
Obstructive jaundice with palpable non-tender gallbladder (courvoisier sign - indicates p. Cancer or cancer of biliary tree)

Ultrasound followed by CT if suggestive of cancer

Whipple procedure, chemo, radio

22
Q

What are the findings investigation and management for a perianal fistula

A

Frequent anal abscesses
Pain and swelling around the anus
Bloody or foul-smelling drainage (pus) from an opening around the anus
Pain with bowel movements, bleeding

Proctoscopy, MRI imaging

Fistulotomy

23
Q

What are the findings, investigation and management for cholecystitis?

A

Pain/tenderness in RUQ - may be referred to the right shoulder
Signs of inflammation - fever, elevated wcc, elevated CRP and ESR
Palpable mass
Nausea
Positive murphy’s sign - pain on inspiration during RUQ palpation

Ultrasound

Antibiotics, analgesia, fluid resus, cholecystectomy

24
Q

What are the findings, investigation and management for coeliac disease?

A 
Diarrhea/steatorrhea
Bloating, abdominal pain/discomfort 
Dermatitis herpetiformis 
Iron deficiency anemia, fatigue
suggested by positive immunoglobulin A tissue transglutaminase serology, but must be confirmed by duodenal biopsy and histology.

Crisis = corticosteroid = budesonide/prednisolone
Coeliac disease = gluten free diet + ergocalciferol and calcium carbonate (vitamin and mineral supplementation)

25
Q

How do you manage constipation?

A 
Treatment of underlying cause 
Laxatives - ispaghula, methylcellulose 
Opioid induced - methylnatrexone
Feacal impaction - evacuation
Targeted treatment to cause
26
Q

What are the findings, investigation and management for biliary colic?

A

RUQ pain - especially after a fatty meal, steady and lasting more than 15-30 minutes
Nausea and vomiting

Ultrasound - gallstones

NSAIDS, scopolamine

27
Q

What is the managenent for GORD?

A

PPIs

28
Q

Findings, investigation and management for hemmorrhoids?

A

Rectal bleeding - bright red, in association with defecation/straining
Perianal pain/discomfort
Constipation=RF

Anoscopic examination - hemmorrhoids

Management
Increase fiber and fluid intake
Stage 1 = no prolapse = topical corticosteroids
Stage 2 and 3 = prolapse upon hearing down but spontaneously reduce & requiring manual reduction = rubber band ligation
Stage 4 = permanent prolapse can’t be reduced = hemmorrhoidectomy

29
Q

What investigations and management are carried out for hypospleenism?

A

peripheral blood smear; including Howell-Jolly bodies, pitted erythrocytes,

Vaccination against common infective organisms

30
Q

What are the investigation findings in chrons disease? Management?

A

Plain AXR - bowel dilation
Barium contrast - rose thorn ulcers, string sign of kantor
Colonoscopy - cobblestone (c)hrons
Histology - transmural involvement with non ceaesating granulomas

= oral prednisolone/Iv hydrocortisone
Maintaining remission= immunosuppressants/thioprines 1st line, biologic therapies second

Aminosalicylates not used for crohns

31
Q

What are the investigation findings in ulcerative colitis?

Management?

A

Plain AXR - thumbprinting
Barium contrast - lead pipe
Colonoscopy - continuous erythema, ulcers
Histology - crypt abscess, depletion of goblet cell mucin

Acute= IV hydrocortisone(steroid) 100mg every 6 hours. LMWH and adcal-d3 recommended

Induction and maintenance of remission: 1. Aminosalicylates = 1st line (mesalazine, sulfasalazine)

  1. Corticosteroids if uncontrolled by aminosalicylates
  2. Immunosuppressants if still uncontrolled = azathioprine, methotrexate
  3. Biological therapy last resort = infliximab
    * HLA-B27 association - 2 parts to gene = 2 part to name “U-C”
32
Q

What is the management for peptic ulcer disease?

Cause of refractory ulcers?

A

Bleeding ulcer = endoscopy
No bleeding, H pylori negative = PPI
No bleeding, h pylori positive = PPI + amoxicillin + clarithromycin/metronidazole

Signs of rupture(peritonism) = Laparotomy as definitive management

Refractory peptic ulcer may be due to Zollinger Ellison Syndrome. It is sometimes associated with MEN1. Investigate by measuring fasting serum gastrin

33
Q

What are the findings, investigations, and management for heamochromatosis?

A

Triad - diabetes, skin pigmentation, cirrhosis
Arthropathy - joint pain, especially MCP joints
Hypogonadism - erectile dysfunction/reduced libido
Fatigue, Restrictive cardiomyopathy may occur

Transferrin saturation - raised >45%
Serum ferritin - raised
TIBC - low

Repeated phlebotomy = 1st line
Iron chelation = 2nd line e.g. deferasirox

34
Q

What investigation and management for bowel obstruction?

A

CT

Nil by mouth, Iv fluids, Nasogastric decompression + surgery

35
Q

What are the findings in refeeding syndrome?

A

hypophosphataemia
hypokalaemia
hypomagnesaemia: may predispose to torsades de pointes
abnormal fluid balance - peripheral oedema

36
Q

What is an ileus and how do you investigate this?

A

Ileus is a slowing of gastrointestinal motility that is not associated with mechanical obstruction.
Most commonly presents 2 to 3 days following surgery.

CT abdomen and pelvis with IV or oral water-soluble contrast - distention of the stomach, fluid filled intestines, and no evidence of a transition zone between dilated and collapsed bowel

37
Q

What is the treatment for hepatic encephalopathy?

A

Oral lactulose

Can also use oral rifaximin

38
Q

A raised bilirubin with no other findings is likely to be caused by?

What is the mode of inheritance?

A

Gilbert’s Syndrome

Autosomal recessive

39
Q

Treatment for wernickes encephalopathy?

A

Iv pabrinex (contains thiamine)

40
Q

Distinguish between diverticulosis and diverticulitis

1st line investigation?

A

Diverticulosis is asymptomatic. May have blood in stools

Diverticulitis - left iliac fossa pain, fever, tachycardia, Abdo distension. May have blood in stools

CT scan

41
Q

Nausea and vomiting are associated more/earlier with which type of bowel obstruction?

Risk factors for small and large bowel obstruction?

A

Small bowel obstruction
Adhesions main in SBO
Colorectal cancer main in LBO

42
Q

IBS symptoms
Investigation
Management?

A

abdominal pain relieved by defecation or altered bowel frequency/ stool form. It is a diagnosis of exclusion after things like coeliac has been ruled out! Treatment = dietary and lifestyle advice

43
Q

What is the treatment for gallstones?

A

Asymptomatic in gallbladder = no treatment unless porcelain gallbladder

Asymptomatic in common bile duct = laparoscopic cholecystectomy due to risk of cholangitis or pancreatitis

44
Q

Primary Sclerosing Cholangitis symptoms?
Associated condition?
Associated antibodies?

A

pruritus, RUQ pain, fatigue, jaundice

associated with ulcerative colitis

p-ANCA antibodies

45
Q

Primary biliary cholangitis symptoms?
Associated conditions?
Antibodies?

A

jaundice, pruritus, (it is autoimmune)

other autoimmune conditions

AMA

46
Q

Constipation treatment?

Treatment for opioid induced constipation?

A

Conservative measures - increase fibre and fluids, exercise, balanced diet

If conservative measures don’t work:

  • > 1st line = bulk forming laxatives ISPHAGULA/PSYLLIUM, METHYLCELLULOSE
  • > if unsuccessful, add an Osmotic laxative MACROGOL(polyethylene glycol) first then LACTULOSE

DO NOT prescribe bulk forming laxatives for opioid induced constipation. Offer an osmotic laxative or a stimulant laxative (Senna) instead.

Medicine MBBS year 3 (12 decks)

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