Gastroenterology Flashcards
Why do patients admitted with acute IBD need heparin?
Need prophylactic heparin as they are at high risk of VTE
What is main maintenance treatment in UC?
Mesalazine
What is maintenance treatment in Crohn’s?
Azathioprine and biologics
What are the first choice medications in perianal or fistulating Crohn’s?
Biologics
Which medications are generally used in acute IBD?
Steroids: topically, orally or IV
What different symptoms may a patient with coeliac disease present with?
None, loose stools, bloating, wind, abdominal cramps, weight loss, dermatitis herpetiformis
What are complications associated with coeliac disease?
Increased risk of: small bowel lymphoma, osteoporosis, gluten ataxia and neuropathy
What investigations should be done for coeliac disease?
Tissue transglutaminase (tTG) and OGD with duodenal biopsies
What can be see on histology with coeliac disease?
Villous atrophy and intra-epithelial lymphocytosis
If a young patient has liver disease with a low caeruloplasmin, what is the most likely pathology?
Wilson’s disease- abnormal copper storage
What screening do patient’s with cirrhosis have for hepatocellular carcinomas?
Alpha-fetoprotein and USS every 6 months
What imaging is best to diagnose cirrhosis?
Fibroscan
Through which lines can parenteral nutrition be given?
A dedicated central line
Do NG tubes or PEGs eliminate aspiration risk?
No as patients can still aspirate on saliva
Which two assessment scores are used for GI bleeding?
ROCKALL score: predicts risk of death and re bleeding of upper GI- done after endoscopy
Glasgow-Blatchford score: predicts need for intervention (inpatient Vs outpatient)
How do you initially manage variceal bleeding?
- Gain IV access, fluid resuscitation is haemodynamically unstable
- IV Terlipressin
- Refer to GI team
What are the definitive treatment options for variceal bleeding?
Oesophageal banding, Linton/Senstaken tube, TIPSS procedure
What is the management of non-variceal upper GI bleeding?
Fluid resus if haemodynamically unstable
Discuss with gastroenterology team
Investigate with endoscopy
What nutritional assessment tool can be used to help identify malnutrition of a patient?
MUST
Malnutrition universal screening tool
What form of management is indicated for a patient with ongoing acute GI bleeding despite repeated endoscopic therapy?
Emergency surgery or interventional radiology
What are some oesophageal causes of haematemesis?
Oesophageal varices, oesophagitis, cancer, Mallory Weiss tear
Is sudden weight loss associated with acute exacerbations of NAFLD?
Yes
It triggers importation of toxic lipids to the liver which trigger steatosis, inflammation and hepatocyte cell death
What is budd-chiara syndrome?
Hepatic vein thrombosis
What classic triad is associated with Budd-Chiara syndrome?
Abdo pain: sudden onset, severe
Ascites
Tender hepatomegaly
What is the most sensitive and specific lab finding for diagnosing cirrhosis?
Thrombocytopenia (low platelets)
what are some common causes of mouth ulceration?
recurrent apthous ulcers, trauma, nutritional deficiencies (iron, B12, folate), viral/fungal infections, leukoplakia, crohn’s
what are some early signs of HIV which can be seen in the mouth?
kaposi sarcoma (reddish-blue oral macule)
oral hairy leukoplakia (white patches on lateral borders of tongue) secondary to EBV infection
intermittent dysphagia of both liquids and solids is likely due to what pathology?
oesophageal spasm
progressive dysphagia of liquids to solids is likely due to what pathology?
neurological disorder
progressive dysphagia affecting both solids and liquids with regurgitation that often relieves symptoms is likely due to what pathology?
achalasia
what is achalasia?
dysmotility where there is inadequate relaxation of the lower oesophageal sphincter and aperistalsis of the oesophagus
what is the first line imaging study done for patients with difficulty swallowing both liquids and solids indicating dysmotility?
barium swallow
what is seen on barium swallow with achalasia?
bird beak
what might be seen on an Xray with achalasia?
widened mediastinum from the dilated oesophagus
what is the gold standard investigation for achalasia? what is the diagnostic finding?
manometry
high resting pressure of lower oesophageal sphincter is diagnostic
how might oesophageal spasm typically present?
transient retrosternal chest pain and intermittent dysphagia (can mimic angina)
what is seen on barium swallow with oesophageal spasm?
corkscrew oesophagus
why is barium swallow preferred in the investigation of suspected pharyngeal pouch compared to endoscopy?
risk of perforation with endoscopy
what is the M rule associated with primary biliary cholangitis?
IgM raised
anti-Mitochondrial antibodies
Middle aged female
What is the typical presentation of GORD?
Intermittent heartburn which gets worse after meals and on lying down, acid brash (metallic taste from acid regurgitation), dysphagia and atypical chest pain
How is GORD diagnosed?
Clinically, although if there are ALARM symptoms Ix can be done to rule out serious pathology
What are ALARM symptoms associated with dyspepsia that would warrant upper GI endoscopy?
A- anaemia
L- loss of weight
A- anorexia
R- recent onset of progressive symptoms
M- malaena/haematemesis
S- swelling difficulty
What lifestyle advice can be given for GORD?
Smoking cessation, weight loss, less fatty/spicy/acidic foods, raise the head of the bed
How do we treat GORD pharmacologically?
PPI therapy for 4-8 weeks, over the counter antacids/alginates (not continuously but for symptomatic relief)
If symptoms persist low dose PPI treatment or H2 antagonist can be trialled
What is fundoplication?
A surgery considered for GORD involving wrapping the gastric fundus around the oesophagus
What are some complications of GORD?
Barretts oesophagus, oesophagitis, oesophageal strictures, oesophageal carcinoma
What is a differential for GORD which may be considered in patients with atopic history presenting with dysphagia and vomiting?
Eosinophillic oesphagitis: diagnosed on biopsy and treated with aerosolised glucocorticoids
What investigations are done for suspected oesophageal cancer?
Bloods: FBC (GI blood loss), LFTs (liver mets?), U+Es (suitable for contrast CT?)
OGD (oesophagogastroduodenoscopy) with biopsy
Staging CT
What are immediate things to do when a patient has an upper GI bleed from varices?
A-E: oxygen, IV access, Bloods, fluid resuscitation. Assess for signs of shock
Blatchford score
Terlipressin and prophylactic antibiotics
Transfusion of blood products as required
How is alcoholic ketoacidosis managed?
Infusion of saline and thiamine
How long must a patient be consuming gluten before serology tests are done for coeliac disease?
They must eat gluten for at least 6 weeks before they are tested
What dietary change is recommend to patients with ascites?
Low sodium diet
Why do patients with coeliac disease get offered the pneumococcal vaccine?
Hyposplenism (splenic reticuloendothelial atrophy)
What are common presenting symptoms of alcoholic hepatitis?
RUQ pain, anorexia, weight loss, jaundice, muscle wasting and fever
What LFT change is typical of alcoholic hepatitis?
AST/ALT>2 is characteristic of alcoholic hepatitis
if a patient tests positive for C diff antigen but not for c diff toxin A/B, are they likely to have an active c diff infection?
no these results suggest colonisation but no active infection
in which of the IBDs are pseudopolyps seen on colonoscopy?
ulcerative colitis
what are some side effects of mesalazine?
GI upset, agranulocytosis, interstitial nephritis, pancreatitis
what are first line investigations for a patient with suspected IBS which are expected to be normal?
FBC, ESR, CRP, coeliac screen
what are classic electrolyte disturbances seen with refeeding syndrome?
hypo:
-kalaemia
-magnesaemia
-phophataemia
what is the management of baretts oesophagus?
lifestyle advice, high dose PPI therapy and endoscopic surveillance
how does pancreatic cancer typically present?
painless jaundice, pale stools, dark urine, cholestatic liver function tests
what effect can PPIs have on electrolytes?
hyponatraemia
hypomagnesaemia
