Gastroenterology Flashcards
A 7m old child presents with recurrent milky vomiting and low weight for age. On further questioning of the primigravida mother, she informs you that the child was born prematurely and she has noticed that the child has a chronic cough and hoarse cry. Examination is unremarkable.
What is the likely diagnosis?
What is the cause of this in infants? - what age does it usually resolve by?
What is the management if:
a) no effect on growth
b) effect on growth
GORD
Immaturity of the lower oesophageal sphincter - age 1y
- *Management:**
- No effect on growth:* conservative advice
- Effect on growth:* gaviscon mixed with feeds/ omeprazole!
What antibodies are present in coeliac disease?
What type of Ig are these antibodies?
When testing for these antibodies, what do you also need to test for to avoid a false negative result?
Anti-tissue transglutaminase (anti-TTG) & anti-endomysial (anti-EMA)
IgA antibodies
Total IgA levels - some people are IgA deficient so their total IgA will be low, even if they have coeliacs
What type of bilirubin is always abnormal in infants?
When ordering LFT’s, what should you order specificially to determine the cause of jaundice?
What would you expect the stools of a baby with biliary atresia (obstruction of bile flow) to look like?
Conjugated bilirubin!!
Split bilirubin
Pale, chalky white stools
For an (ex)alcoholic to be eligible for a liver transplant REFERRAL, they have to abstain from alcohol for how long?
Alcohol abstinence for 3 months before a referral for a transplant can be made.
A 2y old child presents with 4 month history of passage of foul smelling explosive stools 3-4/day, tiredness, pallor & poor weight gain. They have just developed an itchy rash on their abdomen.
What is the likely diagnosis? - name of the rash?
What investigations would you do to confirm this condition?
What is the gold standard investigation to confirm the diagnosis?
Coeliac’s disease - dermatitis herpetiformis
- *Antibodies:**
1) Anti-TTG plus total IgA
2) Anti-EMA (if anti-TTG were positive)
Duodenal biopsy (via endoscopy)
Having a H.pylori infection increases the risk of what condition?
How is H.pylori infection treated & how long for?
What is Barretts oesophagus & what causes it?
Barretts oesophagus increases the risk of what?
What is the a) prevention & b) treatment of Barretts oesophagus?
Stomach cancer (MALT)
Triple therapy for 7 days:
~ PPI (eg omeprazole)
~ 2x antibiotics
A premalignant change from squamous to columnar epithelium in the lower oesophagus - caused by persistent reflux (GORD)
Adenocarcinoma
Prevention: PPI’s (eg omeprazole)
Treatment: ablation of dysplastic cells
A 3-week-old boy presents to paediatric A&E with persistent vomiting. The mother reports that vomiting always occurs soon after feeds and often hits the kitchen walls.
On abdominal examination, there are no peritonitic features, but, a small, firm, olive shaped mass is palpable in the epigastric area.
What is the likely diagnosis?
What is the investigation of choice?
What is the definitive management?
Pyloric stenosis
Abdominal US
Management: surgery (laparoscopic pyloromyotomy)
Explain the routes of transmission of each type of viral hepatitis:
A - faecal-oral route
B - bodily fluids / vertical transmission (mother-baby)
C - bodily fluids
- *D -** bodily fluids
- *** can only survive in patients who also have a Hep B infection ****
E - faecal-oral route
List some signs of liver disease: (9)
- Jaundice
- Hepatomegaly
- Spider naevi
- Palmar erythema
- Gynaecomastia
- Bruising (due to abnormal clotting as the liver produces the clotting factors!)
- Ascites
- Flapping tremor
- Caput medusae
Refeeding syndrome can occur in people who havent eaten for how many days?
What happens to K, phosphate & Mg2+ if food is reintroduced too fast to someone with anorexia?
What are 3 common symptoms/ signs seen in refeeding syndrome?
5+ days
Levels fall resulting in depletion of all 3 electrolytes!
- Arrhythmia’s
- Confusion
- Death
What is the 1st line antibiotic used to treat a C. Difficile infection?
Oral vancomycin
List the 4 places in which varices (as a result of portal hypertension) form:
- Gasto-oesophageal junction
- Ileocaecal junction
- Rectum
- Anterior abdominal wall via the umbilical vein (caput medusae)
If thumbprinting is noted on an abdominal xray, what condition does this indicate?
What is this condition?
Ischaemic colitis
It occurs when there is an acute, but transient disruption to the blood supply of the large bowel → inflammation, ulceration & haemorrhage
Explain the physiology behind liver cirrhosis causing portal hypertension:
Chronic inflammation of the liver → liver cirrhosis
Liver cirrhosis is when the hepatocytes undergo fibrosis and there is a lot of scarring and nodules of scar tissue within the liver.
The fibrosis changes the liver’s normal structure → increased resistance to the blood trying to get into the liver
→ PORTAL HYPERTENSION
Alcoholics are often deficient in which vitamin?
Prolonged deficiency can result in which 2 conditions?
~ Which one is reversible, which one is irreversible?
Thiamine (vitamin B1)
- Wernicke’s encephalopathy - reversible
- Korsakoffs syndrome - irreversible
Which vitamin is commonly prescribed for alcoholics as part of their management plan?
What is the purpose of prescribing this vitamin?
Thiamine (as alcoholics neglect a normal diet, they are usually deficient)
Thiamine prevents Wernicke’s Encephalopathy
Ulcerative colitis is often associated with what biliary condition?
Which gender does this condition more commonly affect?
Primary sclerosing cholangitis
Males
What part of the GIT does coeliacs disease affect & what is the main histological finding seen?
List some clinical features seen in coeliac disease: (6)
What condition is closely associated with coeliac disease?
Small bowel (esp jejenum) - villous atrophy
- Failure to thrive (in children)
- Diarrhoea
- Weight loss
- Fatigue
- Dermatitis herpetiformis (itchy rash, usually on abdomen)
- Malabsorption
Type 1 diabetes (as well as other autoimmune conditions)
What are the 3 symptoms of Murphy’s Triad?
What condition do these symtpoms point towards?
List 3 complications of this condition:
What is the definitive management of this condition?
Abdominal pain, vomiting, fever
Appendicitis
1) Abscess formation
2) mass
3) peritonitis
Surgical removal of appendix
If someone has a positive HBsAg (Hep B surface antigen), what does this indicate regarding Hep B infection?
They currently have an active infection
List 3 screening tools used to identify an alcohol problem:
CAGE - score of 2+ indicates alcohol problem
AUDIT
FAST
The presence of crypt abscesses on colonoscopy would indicate which IBD?
Ulcerative colitis
What part of the GIT does coeliacs disease affect & what is the main histological finding seen?
List some clinical features seen in coeliac disease: (6)
What condition is closely associated with coeliac disease?
Small bowel (esp jejenum) - villous atrophy
- Failure to thrive (in children)
- Diarrhoea
- Weight loss
- Fatigue
- Dermatitis herpetiformis (itchy rash, usually on abdomen)
- Malabsorption
Type 1 diabetes (as well as other autoimmune conditions)
Name the 2 commonest methods used to prevent varicele bleeding in a patient with a known varicele:
~ medical
~ endoscopic
If these methods don’t work, what may be done instead?
Medical: Propanolol (reduces portal-hypertension as it’s a non-selective beta blocker)
Endoscopic: Elastic band ligation
- *TIPS** (transjugular intra-hepatic portosystemic shunt)
- a connection is made between the hepatic vein & portal vein and a stent is inserted. This relieves pressure in the portal system and varices.*
How is a peptic ulcer diagnosed?
~ what can be done at the same time to check for H.pylori infection?
Endoscopy
~ rapid urease test (CLO test)
Name the reversible neurological condition commonly seen in alcoholics:
~ What causes this condition?
List the triad of presenting features seen in this condition:
What is the treatment of it?
If left untreated, what can it progress into?
Wernicke’s encephalopathy
~ Thiamine (B1) deficiency
1) Ataxia (problems with coorindation, balance & speech)
2) Confusion
3) Opthalmoplegia/ nystagmus
Treatment: IV thiamine (usually given as pabrinex)
Korsakoff’s syndrome (irreversible brain damage)
What medication is given to patients experiencing symptoms of alcohol withdrawal?
How long is this drug prescribed for?
What other medication is prescribed to these patients as part of their withdrawal programme?
Chlordiazepoxide
5-7 days
IV Pabrinex (high dose vitamin B, including thiamine)
What common hallucination is associated with delirium tremens?
Visual hallucinations involving insects
A deficiency in which vitamin can result in Korsakoff’s syndrome?
Thiamine - B1
Name the test used to differentiate between IBD & IBS:
What criteria is used to assess severity of UC?
Name the 1st line medication used to induce
a) remission
b) maintenance of Crohn’s
Name the 1st line medication used to induce
a) remission
b) maintenance of UC
Faecal calprotectin
Truelove & Witts criteria
Crohn’s:
Remission: Steroids (eg, prednisolone)
Maintenance: Azathioprine (immunosuppressant drug)
UC:
Remission: Aminosalicylate (5ASA) - eg mesalazine
Maintenance: Aminosalicylate (5ASA) - eg mesalazine
Lynch syndrome (HNPCC) is caused by mutations in what?
What mode of inheritance is seen in Lynch syndrome?
What are the 3 commonest cancers associated with the condition?
DNA mismatch repair genes
Autosomal dominant
** Colon cancer ** - commonest in distal colon
• Endometrial
• Ovarian
This barium enema is indicitive of what condition? - why?
- *Ulcerative colitis**
- ~ The whole colon is affected by an irregular mucosa with loss of normal haustral markings.*
