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AKT > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Causes of B12 deficiency - 4

A

Pernicious Anemia,
H.pylori
Alcoholism / Malnutrition
Gastrectomy

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2
Q

vitamin B12 is important in both

A

the production of blood cells and the myelination of nerves → megaloblastic anaemia and neuropathy

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3
Q

Pernicious Anemia Risk Factors

A

Female >Male
Middle to elderly
Autoimmune disease - Thyroid / T1DM/ Addisons / Vitiligo/ Rheumatoid.
Blood Group A.

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4
Q

What type of Anemia is B12 and what antibodies

A

Macrocytic anaemia.
Anti - Intrinsic factor antibodies
Anti gastric parietel cells.

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5
Q

What is regime of B12 to give and how is it given

A

IM , Load with 6 injections over 2 weeks
then every 3 months.

more frequently if neurological dysfunction

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6
Q

Replace B12 or folate first

A

B12 to prevent exacerbation of the vitamin B12 deficiency and precipitation of subacute combined spinal cord degeneration.

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7
Q

Mesalazine and Epigastric pain / RUQ pain

A

Pancreatitis - sulfasalazine.

mesalazine = 7x more likely to get pancreatitis

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8
Q

What blood test to watch out for in mesalazine

A

Agranulocytosis - FBC

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9
Q

what are 3 things defining malnutrition according to NICE

A

BMI < 18.5
Unintentional weight loss >10% in 3-6 months
BMI <20 and UIWL of >5% in 3 -6 months.

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10
Q

what is malnutrition screening tool

A

MUST

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11
Q

what is malnutrition screening tool

A

MUST

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12
Q

Dietary advice for IBS (10 pieces)

A 
regular meals and take time 
Avoid missing meals 
Drink 8 cups of fluid per day 
restrict tea and coffee to 3 cups 
limit High fibre intake food 
reduce processed and resistant starch food (low GI) 
fresh fruit - 3 portions a day 
avoid alochol and fizzy 
avoid sorbitol 
for wind and bloating increase oats and linseeds.
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13
Q

how to deal with IBS

  • pain
  • constipation less than 12 months and more
  • diorrhoea
A

Antispasmodic
laxative but avoid lactulose
if more than 12 months linaclotide.
loperamide.

can use amitryptaline antidepressant.

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14
Q

what is a complications of long term PPi use (electrolyte)

A

hypomagnesaemia.

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15
Q

what is xerostemia

A

Dry Mouth

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16
Q

Difference between Primary Sjogrens and PBC

A

PBC has liver involvement - deranged bili and ALP.

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17
Q

Primary Biliary Cirrhosis - male or female

A

female > male 9 times

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18
Q

what is PBC associated with

A

Sjogrens syndrome
RA
Systemic Sclerosis
Thyroid disease .

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19
Q

https://pscpartners.org/patients-caregivers/education/psc-pbc.html

A
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20
Q

Chrons - what indicates a worse prognosis

A

Perianal disease

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21
Q

Chrons - what indicates a worse prognosis

A

Perianal disease

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22
Q

What is link between chrons /UC and smoking

A

Risk of CHRONS is incrased in smokers (Decreased in UC)

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23
Q

Extra Intestinal Manifestation of Chrons associated with DISEASE activity

A

Apthous mouth ulcers

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24
Q

what is link of osteoporosis and Chrons

A

30%

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25
Q

Chrons - what is extra intestinal diseas not assoicated wtih disease activity

A

Psoriasis.

26
Q

Introducing Remission for Chrons

A 
Glucocorticoid 
Enteral feeding 
5-ASA drug - mesalazine 
Azathioprine / Methotrexate- add on NOT monotherapy 
Infliximab in fistulating chrons
27
Q

treatement of isolated peri-anal disease

A

metronidazole o

28
Q

maintaining remission

A

Stop Smoking

Azathioprine or Mercaptopurine - maintain remisison .(assess TMPT activity before treatment)

29
Q

how many patients end up having surgery in chrons

A

80%

30
Q

FODMAP diet is what

A

IBS - Fermentable oligo di mono sach and poly sach.
Wheat Dairy, Fructose and vegetables.
Low intake of them

31
Q

LOWFLEX Diet

A

Low Fat, Fibre exclusion - helps with chrons disease. avoid high fibre and fat.

32
Q

women who breastfeed and vegan diet what vitamin should they take

A

B12 - mainly found in meats and milk

women should also take vit D 10mcg.

33
Q

Complication of GORD - 4

A 
Carcinoma 
Barretts
Anemia 
Strictures. 
Ulcers
34
Q

endoscopy proven Oesophagitis mx

A

Full dose PPI 1-2 months
if response then low dose PRN
if no response then double dose PPI for 1 month.

35
Q

Endscopic Negative Reflux disease

A

Full dose PPi for 1 month
If response - PRN low dose
If no response then H2RA or prokinetic

36
Q

Dyspepsia Urgent referral

A 
All patients with dysphagia
All patients with upper abdo mass 
>55 Y with W(eight loss) + any of following 
- A(nemia) 
- Reflux 
-Dyspepsia.
37
Q

Non urgent referral to Endoscopy

A

1) haematemesis
2) >55 - RUR - resistant dyspepsia / upper abdo pain + low Hb / Raised Platelet + N+V + WARD(only 1)
3) >55 years with N+V WARD.

38
Q

which antibiotic can cause cholestasis

A

Flucloxacillin

39
Q

H.pylori Eradication treatment

A

PPI+clarithromycin + amoxicillin

if can’t tolerate amox - then metro nidazole.

40
Q

wheat / bread/ oats/ rye / potatoes/ beer/ pasta/ barley/ rice/ pastry/ corn (maize)

which ones Gluten free

A

Corn. Rice. Potatoes.

41
Q

C diffe is what type of organism on microscope

A

Gram positive Rod

42
Q

which Abx cause Cdiffe

A

broad spec - used to be clindamycin but now 2nd /3rd gen cephalosporin
omemrazole (PPi)

43
Q

treatment of Cdiffe 1st to 2nd to 3rd line

A

Oral Vanc for 10/7
second line is oral fidaxomicin
third line - oral vanc and IV metro

44
Q

Vitamin C def symptos

A

Gingitivits , Loose teeth
poor wound healing
bleeding gums, haematuria , epistaxix
general tiredness - can lead to anemia.

45
Q

biochemically what is seen in NAFLD LFTs

A

ALT>AST.

46
Q

If NAFLD found - what next

A

Extensive Liver Fibrosis screen (ELF) `

47
Q

what scoring system to assess severity of fibrosisi

A

FIB 4 and NAFLD fibrosis score. and FIBRO scan.

48
Q

treatment of gallstones

A

If asymptomatic observe

if symptomatic - operate. Lap Chole

49
Q

which diabetic drugs cause cholestasis

A

Sulphonyl urea - gliclazide

50
Q

5 drugs which cause hepatocellular picture of LFT

A

Paracetamol / Phenytoin/ Sodium Valproate/ RIPE (tb) / Alcohol/ Statin/ Amiodarone / Methyldopa / Nitrofurantoin

51
Q

5 drugs which cause cholestatic +/- hepatitis

A

COCP/ Antibiotics / Anabolic steroids / Testostarone / cHLORPROMAZINE / Sulphonyl urea/ Fibrates.

51
Q

5 drugs which cause cholestatic +/- hepatitis

A

COCP/ Antibiotics / Anabolic steroids / Testostarone / cHLORPROMAZINE / Sulphonyl urea/ Fibrates.

52
Q

NSAID and COCP what do they do in chrons

A

Increase risk of flare up

53
Q

how many chrons patients end up having surgery

A

80%

54
Q

which test to test for h.PYLORI

A

Urea breath test. 13C.

55
Q

which screening tool for alcohol recommended by NICE

A

AUDIT or AUDIT - C

56
Q

how long must patients eat gluten before coeliac screen

A

6 weeks

57
Q

Liver and Neurological signs

A

Wilsons disease

58
Q

which blood tests to check Heb B immunisation

A

Anti-Hbs

59
Q

which blood test for Heb B active infection

A

HBsAG

60
Q

what level of bilirubin do you need to admit for

A

> 100

61
Q

what do you give for UC remission to maintain and when

A

> 2 years since exacerbation - give Azathioprine or oral mercaptopurine

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