Gastroenterology Flashcards
Causes of upper GI bleed
- oesophageal varices
- peptic ulcer disease
*Glasgow-Blatchford score used at first assessment and Rockall score used after endoscopy
Blatchford score
Urea
Hb
Systolic blood pressure
Other
Acute upper GI bleed
Blood results
A raised urea
Low Hb
What does a urine dip of renal tract stones look like
Positive protein, leucocytes adn blood
Negative nitrites and B-HCG
What is haemochromatosis
Autosommal recessive disorder of iron absorption and metablosim resulting in iron accumulation.
Inhertinace of mutations in teh HFE gene on both copies of chromose 6
Haemochromatosis
Diagnositc tests
molecular genetic testing for the C282Y and H63D mutations
liver biopsy: Perl’s stain
Haemochromatosis
Management
- venesection
- desferrioxamine
Examples of vitamin deficiencies
- pellagra - vit b3, niacin
- beriberi - vit b1
- scurvy - vit c
Pellagra features?
Sun burn like dermaititis rash
Diarrhoea
Cognitive deficit
H pylori investigation
Urea breath test
- 4 weeks of no antibacterial or 2 weeks of no antisecreotry drugs e.g. PPI
Chron’s disease
Histology
- increased goblet cells
- granulomas
- inflammation in all layers from mucosa to serosa
Biliary colic
RUQ pain, intermittent, usually begins abruptly and subsides gradually. Attacks often occur after eating. Nausea is common.
It is sometimes taught that patients are female, forties, fat and fair although this is obviously a generalisation.
Acute cholecystitis
Pain similar to biliary colic but more severe and persistent. The pain may radiate to the back or right shoulder.
The patient may be pyrexial and Murphy’s sign positive (arrest of inspiration on palpation of the RUQ)
Ascending cholangitis
An infection of the bile ducts commonly secondary to gallstones. Classically presents with a triad of:
fever (rigors are common)
RUQ pain
jaundice
Gallstone ileus
This describes small bowel obstruction secondary to an impacted gallstone. It may develop if a fistula forms between a gangrenous gallbladder and the duodenum.
Abdominal pain, distension and vomiting are seen.
Cholangiocarcinoma
Persistent biliary colic symptoms, associated with anorexia, jaundice and weight loss.
- A palpable mass in the right upper quadrant (Courvoisier sign)
- periumbilical lymphadenopathy (Sister Mary Joseph nodes)
- left supraclavicular adenopathy (Virchow node)
Acute pancreatitis
Usually due to alcohol or gallstones
Severe epigastric pain
Vomiting is common
Examination may reveal tenderness, ileus and low-grade fever
Periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign) is described but rare
Pancreatic cancer
Painless jaundice is the classical presentation of pancreatic cancer.
However pain is actually a relatively common presenting symptom of pancreatic cancer. Anorexia and weight loss are common
Amoebic liver abscess
Typical symptoms are malaise, anorexia and weight loss. The associated RUQ pain tends to be mild and jaundice is uncommon.
Viral markers for Hep B
Surface antigen (HBsAg) – active infection E antigen (HBeAg) – marker of viral replication and implies high infectivity Core antibodies (HBcAb) – implies past or current infection Surface antibody (HBsAb) – implies vaccination or past or current infection Hepatitis B virus DNA (HBV DNA) – this is a direct count of the viral load
When screening for hepatitis B, test what?
HBcAb (for previous infection) and HBsAg (for active infection). If these are positive then do further testing for HBeAg and viral load.
What is melanosis coli
Melanosis coli is a disorder of pigmentation of the bowel wall. Histology demonstrates pigment-laden macrophages
It is associated with laxative abuse, especially anthraquinone compounds such as senna
What electrolyte imbalance causes hyponatraemia
PPI
Primary biliary cholangitis
M rule
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females
