Gastroenterology Flashcards
What are the invasive and non invasive H pylori tests
Non invasive
- urea breath test C13
- stool antigen test
- Serology
Invasive
Endoscopy- Culture, giemsa stain + microscopy,
How do you diagnose acute pancreatitis?
Serum amylase, lipase
CRP
CT scan to show necrosis
Features of chronic pancreatitis?
Background alcoholism or history of gall stones with: Long standing abdominal pain Calcifications Raised GGT DM Malabsorption
Pathophysiology of Chronic pancreatitis
Prolonged irritation of the yract leads to formation of calcifications on the tract causing blockage
How do you screen for the presence of Hy Pylori after starting therapy?
Urea breath test
What medications comprise the triple and quadruple therapy?
Triple- clarithromycin, amoxicillin and PPI
Quadruple- metro, tetra, bismuth citrate, ranitidine
Two most important aetiologies of acute pancreatitis in the west?
Alcohol and gallstones
What is absorbed in the
Duodenum
Jejunum
Ileum?
Duodenum- iron
Jejunum- most nutrients
Ileum- B12 and bile salts
Gold standard for diagnosis of Achalasia?
Whats an alternative?
Manometry test is the good standard
Alternative is barium swallow
Whats the initial investigation for achalasia?
Endoscopy
Treatment options for achalasia?
Hellers myotomy- gold standard
Pneumatic dilation
Endoscopic injection of botulinum toxin
Gold standard for diagnosis of GORD?
24 hr pH test
Tretment options for GERD?
PPI
Lifestyle changes
Weight loss
Elevation of head in bed
Bisphosphonates and NSAIDS worsen oesophagitis. How?
Because they aggravate GERD and irritation of the esophagus
Occassional rectal pain that occurs in the absence of any organic disease?
Proctalgia fugax
Barretts oesophagus is related to epithelial change from what to what?
Squamous to columnar
Barrett’s is a risk factor for which kind of cancer?
Adenocarcinoma
Whats the appearance of the oesophagus in achalasia on barium swallow called?
Bird’s beak appearance
Differentials of dyspepsia/reflux?
Achalasia
GORD
PUD
Hiatus hernia
Oesophageal pattern of DES on barium swallow?
Corkscrew
Gold standard for disgnosis of DES?
Oesophageal Manometry
Treatment of DES
Avoid triggering foods
Calcium channel blockers
Plummer vinson syndrome triad?
Oesophageal webs
IDA
Dysphagia
Treatment of plummer vinson?
Give iron supplements
Endoscopic dilation for persistent dysphagia
Differentials of dysphagia?
Achalasia Pharyngeal pouch DES Esophageal strictures Plummer Vinson Oesophageal cancer Barrett’s oesophagus
When do you do a barium swallow first instead of endoscopy?
When there’s a pharyngeal pouch and you don’t want to rupture
Which imaging do you do for acute cholecystitis. Why?
USS- because gall stones are radio lucent
Features of zenker’s diverticulum?
Halitosis
Dysphagia
Reflux on lying down
Cough
Whet kind of esophageal cancer does smoking cause?
SCC
What kind of dyphagias affect both solid and liquids vs just solids?
Structural- solids
Motility related- solids and liquids
Causes of internittent structural and intermittent functional/motility related
Intermittent structural- Oesophageal ring
Intermittent motility- DES, Achalasia
Whats the order of investigations to do for dysphagia?
Endoscopy first
Barium swallow next
Most commonly affected site in CD?
The terminal ileum
Most commonly affected site in UC?
Rectum
Mackler’s triad refers to which condition?
Esophageal rupture
Chest pain
Vomiting
Subcutaneous emphysema
Wgat organs does copper deposot in Wilson’s disease?
Basal ganglia
Eyes
Liver
What is the Kayser Fleischer ring?
The deposition of copper ions in the des cement membrane of the cornea in Wilson’s disease
How is wilson’s dosease treated?
Penicillamine, which cheltes copper
Features of pernicious anaemia
Other autoimmune diseases Features of anemia Megaloblastic anemia Paraesthesia Numbness Subacute combined degeneration
How do you treat Giardiasis?
Metronidazole
How do you treat cryptosporidiosis diarrhea?
Oral anti fungal- nitazoxanide + HAART
What are the result expectations in CD for FBC, LFT, ESR, CRP?
FBC- Raised platelets, raised WBC, if malabsorption- anemia
LFT- hypoalbuminemia
ESR- raised
CRP- raised
The role of NSAIDS and stress in IBD?
They worsen it and trigger relapses
Medications for induction of remission in CD?
Steroids - oral prednisone
Medications for maintenance of remission in CD?
Mercaptopurine, azathioprine, methotrexate
What substance in stool can be used to differentiate IBD from IBS?
Fecal calprotectin
How does proctitis in UC present?
Tenesmus, hematochezia, urgency
Can patients with UC have aphthous ulcers?
Yep!
Presentations of UC and respective symptoms?
UC rectal- proctitis
UC sigmoid/ left sided- left sided pain, hematochezia, severe diarrhea
UC extensive - same as above
Toxic mega colon- acutely ill, fever, distension, tenderness,
Features of toxic megacolon on xray?
Lead pipe appearance- loss of haustrations
Dilated colon
Treatment of the different forms of UC?
Proctitis- rectal mesalazine Left sided- topical mesalazine enema Extensive- oral mesalazine plus enema All of them plus/minus oral prednisone me Severe colitis- IV hydrocort
Is PANCA positive in UC?
Yep!
Where are the locations of ulcers in ZES?
Distal Duodenum and proximal jejunum
Treatment of ZES?
PPIs
Surgical resection of tumor
What gene is implicated in Hereditary haemochromatosis?
HFE
What is responsible for the bronze skin nature in haemochromatosis?
Melanin deposition in the skin
Investigations in haemochromatosis?
Transferrin- saturation increased
Increased ferritin
LFT- increased ALT and AST
HFE gene
How is hemochromatosis treated?
Phlebotomy
Liver transplant
A condition with decresed UDPGT causing jaundice in the face of stressors?
Gilbert syndrome
Whst 2 things are lost in villous adenoma?
Protein and potassium
First line for pseudomembrabous colitis?
Vancomycin
Bloody diarrhea organism acronym?
Clue- symptom in iron def anaemia
PECAS
Demographics for primary biliary cirrhosis?
Middle aged female with another autoimmune disease
Primary biliary cirrhosis/primary sclerosing cholangitis, which one is associated with IBD?
(Remember- inflammation begets inflammation)
PBC- Coeliac
PSC- IBS
What antibody is associated with PBC?
Anti mitochondrial antibody
Treatment of PBC?
Ursodeoxycholic acid
Cholestyramine
Demographic for PSC?
Middle aged male
Background IBD
Which immunoglobulin is deficient in coeliac’s disease?
IgA
Histological changes in coeliac disease?
Villous atrophy
Crypt hyperplasia
Lymphoid infiltration
The characteristic rash in coeliac dosease
Dermatitis herpetiformes
Diagnostic test of coeliac dosease?
Duodenal/jejunal biopsy
What are the antibodies involved in coeliac dosease?
Which is tested first?
Tissue transglutaminase antibody
Anti endomysial antibody
Whats the duration of time between eating and endoscopy permitted?
6 hours
Whats the relationship between GGT abd Alcoholic liver dx?
Also, AST/ALT ratio?
Alcohol raises GGT levels
AST/ALT ratio = 2:1
Cancers associated with coeliac?
Lymphoma, small bowel adenocarcinoma, esophageal cancer
What differentiates HELLP syndrome from AFLP?
Hypoglycemia, ammonia
Criteria for liver transplantation after paracetamol overdose?
Arterial pH <7.3 24 hrs after ingestion
PT > 100 secs
Creatinine > 300micromol/L
Grade III or IV encephalopathy
Charcot’s triad for acute cholangitis?
RUQ pain
Fever
Murphy’s sign
Whats the difference between hemosiderosis and hemochromatosis?
Hemosiderosis usually occurs with Iron deposition, usually doesn’t cause tissue injury. Deposits are more centrally placed and are found in kupffer cells.
Hemochromatosis is a genetic disorder which occurs when there is excessive iron absorption.
Deposits focus more peripherally and do not involve Kupffer cells
Kantor string and Rose thorn ulcers are seen in?
Chrons disease
Dark purple lump under the skin at the anal margin is called?
Anal hematoma
Where will a gallstone need to be found for urgent action to be taken? (With or without symptoms)
The common bile duct
How do the neutrophils look in b12 deficiency?
Hypersegmented
