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Clinical Medicine > Gastroenterology 🍽 > Flashcards

Gastroenterology 🍽 Flashcards

1
Q

what’s the tumour marker associated with HCC and germ cell cancers

A

AFP

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2
Q

what is coeliac disease

A

systemic autoimmune condition triggered by dietary gluten peptides

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3
Q

what is H.Pylori

A

a gram negative bacterium that releases urease that neutralises the pH of the stomach and damages the epithelium.

causes approx 90% of duodenal ulcers

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4
Q

signs and symptoms of coeliac disease

A

Chronic or intermittent diarrhoea
Failure to thrive or weight loss (in children)
Prolonged fatigue
Abdominal pain, cramping or distension

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5
Q

how is coeliac disease diagnosed

A

made by a combination of serology and endoscopic intestinal biopsy

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6
Q

what serology tests would you do when investigating coeliac disease

A

tissue transglutaminase (TTG) antibodies (IgA) are first-choice according to NICE

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7
Q

after positive serology tests for coeliac disease or high clinical suspicion with negative serology what do you do

A

gold standard diagnostic test is with OGD and duodenal/jejunal biopsy

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8
Q

clinical features associated with vitamin C deficiency

A

Spontaneous bleeding and bruising
Gingival swelling
Coiled hairs
Teeth loss

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9
Q

what do patients with vitamin b1 (thiamine) deficiency present with

A

wernickes encephalopathy
Wet beriberi (high output cardiac failure)
Dry beriberi (peripheral neuropathy)

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10
Q

personal or family history of autoimmune conditions
results in deranged transaminases + normal/slightly elevated ALP
hepatomegaly
fatigue
loss of appetite

A

presentation of autoimmune hepatitis

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11
Q

what type of antibodies are most likely to be raised in a patient with autoimmune hepatitis

A

most common type (TYPE 1) has raised anti-smooth muscle antibodies and anti-nuclear antibodies

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12
Q

what is ulcerative colitis

A

form of Inflammatory bowel disease
autoimmune condition
inflammation starts at rectum

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13
Q

sx of UC

A

Gastrointestinal symptoms: diarrhoea containing blood/mucus, tenesmus or urgency, pain in the left iliac fossa.
Systemic symptoms: weight loss, fever.

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14
Q

how is UC diagnosed

A

usually a biopsy and colonoscopy is done
pANCA positive
raised WBC/CRP
anaemia
calproectin raised
stool cultures

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15
Q

what will a colonoscopy show with UC

A

continuous inflammation with an erythematous mucosa, loss of haustral markings, and pseudopolyps.

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16
Q

what will a biopsy show with UC

A

loss of goblet cells
crypt abscess, and inflammatory cells

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17
Q

what are carcinoid tumours

A

rare, slow-growing tumours that develop in neuroendocrine system
some can secrete hormones like serotonin

usually occurs when patient has liver metastases

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18
Q

clinical features of carcinoid tumours that patients with liver metastases present with

A

Abdominal pain
Diarrhoea
Flushing
Wheeze
Pulmonary stenosis

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19
Q

mx of carcinoid tumours

A

octreotide - somatostatin analogues

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20
Q

clinical features of liver failure

A

hepatic encephalopathy
abnormal bleeding
jaundice
ascites

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21
Q

pathophysiology of hepatic encephalopathy

A

in liver failure ammonia accumulates in circulation

ammonia can cross blood-brain barrier where its detoxified by astrocytes which form glutamine through amidation of glutamate

excess glutamine disrupts the osmotic balance and the astrocytes begin to swell, giving rise to cerebral oedema.

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22
Q

four stages of hepatic encephalopathy

A
  1. Altered mood and behaviour, disturbance of sleep pattern and dyspraxia
  2. Drowsiness, confusion, slurring of speech and personality change
  3. Incoherency, restlessness, asterixis
  4. Coma
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22
Q

four stages of hepatic encephalopathy

A
  1. Altered mood and behaviour, disturbance of sleep pattern and dyspraxia
  2. Drowsiness, confusion, slurring of speech and personality change
  3. Incoherency, restlessness, asterixis
  4. Coma
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23
Q

what is Gilberts syndrome

A

autosomal recessive condition resulting in defective bilirubin conjugation

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24
Q

how do patients typically present with Gilberts syndrome

A

jaundice often precipitated by stress or an infection

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25
Q

what is Wilsons disease

A

autosomal recessive condition

accumulation of copper in liver causing oxidative stress and leading to destruction of hepatocytes

kayser-fleischer rings

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26
Q

how does Wilsons disease present in adults

A

CNS sx; Parkinsonism, dementia etc
kayser-fleischer rings
mood symptoms
cognition defects

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27
Q

how does Wilsons disease present in children

A

as liver disease symptoms such as
liver cirrhosis
hepatitis
acute liver failure

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28
Q

a low level of ? is diagnostic of Wilsons disease

A

caeruloplasmin

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29
Q

sx of acute pancreatitis

A

stabbing-like, epigastric pain which radiates to the back that is relieved by sitting forward or lying in the fetal position
Vomiting is highly associated with this.
Importantly, past medical history and social history is vital. A recent alcoholic binge or a history of gallstones are highly suggestive.

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30
Q

blood investigations for acute pancreatitis

A

An amylase 3x the upper limit of normal is extremely suggestive of acute pancreatitis

Lipase is a more sensitive and specific marker than amylase and should be used if available - also will be 3x higher than normal

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31
Q

What is Grey-Turners sign

A

Bruising along flanks and indicates retro peritoneal bleeding which is highly associated with acute pancreatitis

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32
Q

What is the Cullens sign

A

Indicates bruising around peri-umbilical area which is highly associated with acute pancreatitis

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33
Q

What imaging do you use to investigate acute pancreatitis

A

Not useful for diagnosis but useful for causes
USS - Gallstones
MRCP - obstructive pancreatitis
ERCP
CT - at a later stage for complications

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34
Q

How is the severity of pancreatitis measured

A

Using the Glasgow scale
Usually done at admission and 48 hours after
A score of 3 or more indicated transfer to ITU/HDU

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35
Q

Aim of mx of pancreatitis

A

To maintain electrolyte imbalances and compensate for third space losses seen

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36
Q

Mx of pancreatitis

A

Mainly supportive care
Fluid resuscitation

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37
Q

For alcohol withdrawal what should be prescribed to prevent wernickes encephalopathy

A

Pabrinex

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38
Q

For alcohol withdrawal what should be prescribed to patients experiencing delirium tremens

A

Oral lorazepam as first line

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39
Q

In an alcohol withdrawal seizure what should be prescribe

A

Rapid acting benzodiazepine - IV lorazepam

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40
Q

What is alpha 1 anti trypsin deficiency

A

Inherited condition that affects lungs, emphysema, and liver, cirrhosis and HCC.

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41
Q

Pathophysiology of alpha 1 antitrypsin deficiency

A

Without alpha 1 antitrypsin there is less defence against neutrophil elastase which destroys the alveoli
Process is exacerbated in smokers

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42
Q

Presentation of alpha 1 antitrypsin deficiency

A

COPD 30-40 years old
Neonatal jaundice
Deranged LFTs in adults with no other identified cause

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43
Q

Clinical features of ascending cholangitis

A

CHARCOTS TRIAD
RUQ pain
Fever
Jaundice

severely septic and unwell

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44
Q

mx of UC

A

aminosalicylates(mesalazine) rectal + oral
steroids oral then IV
IV ciclosporin if severe
smoking is a protective factor - only condition

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45
Q

how does oesophagitis present

A

retrosternal pain
small volume of blood §

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46
Q

mx of oesophagitis

A

PPI cover for 8 weeks if not resolving test for H.pylori - urea breath test

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47
Q

what is erosive gastritis

A

inflammation and erosion of gastric mucosa
most commonly due to NSAIDS, H pylori and alcohol

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48
Q

presentation of erosive gastritis

A

qepigastric pain, dyspepsia
early satiety
small volume bleeding

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49
Q

what is peptic ulcer disease

A

deeper erosions
ulcers either of gastric or duodenal mucosa
larger volume of bleeding

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50
Q

peptic ulcer disease how does it present if its a gastric ulcer

A

pain on eating

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51
Q

peptic ulcer disease how does it present if its a duodenal ulcer

A

pain relief on eating

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52
Q

cholelithiasis

A

gallstones

53
Q

what is diverticulosis

A

characterised by multiple outpouchings of bowel wall (diverticular) most commonly in sigmoid colon
most accurate term for diverticular simply being present
when symptomatic - diverticular disease is the term

54
Q

how does diverticular disease present

A

mostly symptomatic but can present with
constipation +/- bleeding
LLQ abdo pain

55
Q

what is diverticulitis

A

inflammation of diverticula commonly affecting over 60s with low-fibre diet

56
Q

where do non-congenital diverticula form

A

sigmoid colon

57
Q

where do congenital diverticula form

A

caecum - meckers diverticulum

58
Q

how does diverticulitis present

A

low grade fever
LLQ pain
polyuria

59
Q

what sign would indicate an emergency in patient with diverticulitis

A

acute abdomen - severe pain, sepsis, perforation

60
Q

investigations - diverticulitis

A

contrast CT
raised WBC/CRP
negative dipstick
positive FOBT

61
Q

pts with diverticulitis what is the mx - ladder

A

no abx + pain relief
then
oral abx + pain relief
then if no relief
IV Abx or surgical resection

62
Q

what is crohns disease

A

chronic relapsing IBD
seen anywhere from mouth to anus
most common in Caucasians

63
Q

sx of crohns disease

A

RLQ pain +/- mass
chronic diarrhoea, no bleeding

64
Q

associated diseases with crohns disease

A

erythema nodusum
pyoderma gangrenosum

anterior uveitis

65
Q

mx of crohns disease

A

smoking cessation
prednisolone for inducing remission
infliximab and adalimumab - for severe

66
Q

mx of crohns disease - maintaining remission

A

azathioprine or mercaptopurine - first line

67
Q

associated diseases with UC

A

osteoarthritis
ankylosing spondylitis
primary sclerosing cholangitis
erythema nodosum
pyoderma gangrenosum
uveitis

68
Q

symptoms of cholestasis

A

jaundice
pruritus
raised bilirubin + ALP

69
Q

what should you be looking out for in a patient with UC and showing symptoms of cholestasis

A

primary scleroising cholangitis

70
Q

what is toxic megacolon

A

life threatening complication of UC
a severe form of colitis
systemic upset
if no improvement after 48-72 hours of IV steroids - emergency surgery

71
Q

how to confirm dx of toxic megacolon

A

abdominal x ray
colonic dilation >6cm

72
Q

what is oesophagitis

A

inflammation of oesophagus
most commonly due to continuous GORD

73
Q

what is GORD

A

gastro-oesophageal reflux disease
problem with the lower oesophageal sphincter allowing acid to travel up oesophagus

74
Q

sx of oesophagitis

A

heartburn - retrosternal burning pain
nausea +/- vomitting
odynophagia - painful swallowing

75
Q

mx of oesophagitis

A

conservative and pharmocological measures
lifestyles changes - weight loss, smoking cessation, reducing alcohol
pharmacological - PPIs one month

76
Q

mx of gastritis

A

H.pylori eradication - triple treatment
omeprazole + amoxicillin + metronidazole/clarithromycin

77
Q

risk factors for peptic ulcer disease

A

NSAIDs
H.pylori
smoking
delayed gastric emptying
severe stress

78
Q

mx of peptic ulcer disease

A

PPI cover for 4-8 weeks
surgery if perforation

79
Q

mx of variceal bleeding

A

DR ABCDE
terlipressin - inhibits secretion of vasodilative hormones
propanolol - reduced rebreeding

80
Q

risk factors for developing cholelithiasis

A

female sex
over 40
obesity
family history
rapid weight loss
pregnancy
COCP

81
Q

complications of cholelithiasis

A

biliary colic

82
Q

how would biliary colic present

A

colicky RUQ pain
worse after eating
no fever
negative Murphys sign

83
Q

how would acute cholecystitis present

A

RUQ pain
fever
Murphys sign positive
nausea and vomiting

84
Q

ix ascending cholangitis

A

raised LFTs, CRP, WBC
US abdomen - initial imaging
CT - radiopaque stones and anatomical detail of biliary duct
MRCP - most accurate to determine disease

85
Q

mx ascending cholangitis

A

resuscitation - IV fluids and abx SEPSIS 6
ERCP

86
Q

what is sepsis 6

A
  1. blood cultures
  2. O2 if required
  3. FBC and lactate
  4. give IV Abx
  5. IV fluids
  6. monitor urine output
87
Q

ix of cholecystitis

A

USS - thickening of gallbladder wall
raised WBC and CRP

88
Q

Mx of cholecystitis

A

IV fluids + abx
analgesia
cholecystectomy - definitive

89
Q

what is primary biliary cholangitis

A

autoimmune
scarring and inflammation of bile ducts -> liver cirrhosis

90
Q

clinical features of primary biliary cholangitis

A

extreme fatigue
pruritus
hepatosplenomegaly
jaundice

91
Q

ix of primary biliary cholangitis

A

positive anti-mitochondrial antibodies in >90% patients
raised gamma GT, Antinuclear antibodies
hypercholesterolaemia

92
Q

mx of primary biliary cholagitis

A

ursodeoxycholic acid
liver transplant

93
Q

dx of primary sclerosing cholangitis

A

deranged LFTs
positive anti-smooth muscle and antinuclear antibodies
and ANCA
multiple beaded biliary strictures seen on MRCP

94
Q

mx of primary sclerosing cholangitis

A

ursodeoxycholic acid
liver transplant
strictures dilated by ERCP

95
Q

ix for Wilsons disease

A

genetic analysis of ATP7B gene
free serum copper - low
urinary copper - high

96
Q

treatment of Wilson disease

A

chelating agents - penicillamine and Trientine - for initial
maintenance - zinc salts

97
Q

what is haemochromatosis

A

autosomal recessive disorder of iron absorption and metabolism resulting in iron accumulation

98
Q

how is haemochromatosis caused

A

inheritance of mutation in HFE gene on both copies

99
Q

bronze skin
fatigue
liver cirrhosis
hypogonadism - amenorrhea, ED
cardiac failure
diabetes

A

features of haemochromatosis

100
Q

ix/dx tests for haemochromatosis

A

deranged LFTs
raised serum ferritin
raised transferrin saturation
decreased TIBC - total from binding capacity

101
Q

where is vitamin B12 normally absorbed in the body

A

terminal ileum

102
Q

what is autoimmune hepatitis

A

chronic inflammatory liver disorder that can lead to cirrhosis, liver failure and death
predominantly affects women

103
Q

what histological features would you see in a patient with coeliac disease

A

villous atrophy
crypt hyperplasia
inflammatory infiltration

104
Q

Mx of coeliac disease

A

gluten-free diet

105
Q

what are some extra-intestinal manifestations of coeliac disease

A

anaemia - malabsorption of iron and folate
osteoporosis - malabsorption of vitamin D and calcium
dermatitis herpetiformis - strong association

106
Q

mx of dermatitis herpetiformis

A

dapsone

107
Q

complications of coeliac disease

A

anaemia
hyposplenism
osteoporosis
enteropathy-associated T-cell lymphoma
small bowel lymphoma

108
Q

when to suspect enteropathy-associated T-cell lymphoma

A

non-adherence to a gluten-free diet increases the risk
presents with weight loss or recurrence of symptoms such as diarrhoea and Abdo pain

109
Q

associations of coeliac disease

A

positive family history
HLA-DQ2 allele and other autoimmune diseases such as T1 diabetes and thyroid diseases

110
Q

when investigating coeliac disease if a patient is IgA deficient as well as anti-TTG IgA what else should you measure

A

Anti-TTG IgG

111
Q

2 types of oesophageal cancers

A

Adenocarcinoma and squamous cell carcinoma

112
Q

Difference between oesophageal adenocarcinoma and squamous cell carcinoma

A

Adenocarcinoma is associated with obesity and GORD
It is the most common type in Western Europe and USA
Barret’s oesophagus is also commonly associated with Adenocarcinoma

113
Q

Presentation of oesophageal cancer

A

Progressive dysphasia from solids to liquids
Weight loss
Hoarseness can develop

114
Q

what pathogen is the most common cause of food poisoning

A

campylobacter usually found in undercooked meat
treated with azithromycin/erythromycin

115
Q

where does the pathogen e.coli come from and how does it manifest

A

traveller’s diarrhoea
comes from undercooked meat

116
Q

how is E.coli treated

A

ciprofloxacin

117
Q

how does the pathogen giardia manifest and what abx is used to treat it

A

comes from contaminated water
presents with foul-smelling, fatty and floaty stools

treated with metronidazole

118
Q

what abx causes c.diff infection

A

clindamycin
ciprofloxacin
cephalosporins
penicillins

119
Q

causes of splenomegaly

A

CHIASMA
congestion
haematological
Infarction
Acquired infections
Storage diseases
Masses
Autoimmune

120
Q

mx wilsons disease

A

avoid high copper containing foods
lifelong pencillamine

121
Q

what examination finding is most suggestive of a diagnosis of appendicitis

A

tenderness over McBurney’s point

122
Q

central colicky abdo pain which localised to McBurney’s point
Rovsing’s sign may be present

A

appendicitis

123
Q

common causes of ascites

A

CCCC
Cirrhosis
Carcinomatosis
Cardiac failure
Cidney (kidney, nephrotic syndrome)

124
Q

causes of liver failure

A

HALTED
Hepatitis
Autoimmune hepatitis
Leptospirosis
Toxins
Enzyme deficiency - alpha 1 antitrypsin
Drugs

125
Q

signs of chronic liver disease

A

ABCDEFGHIJ
Asterixis
Bruising/blood pressure
Clubbing/colour change of nails
Dupuytren’s contracture
Erythema/encephalopathy
F hepatic Fetor
Gynaecomastia
Hepatosplenomegaly
Increase in size of parotids
Jaundice

126
Q

1st line treatment of ascites

A

spironolactone

127
Q

causes of high SAAG (ascites) >1.1g/dL

A

cirrhosis
heart failure
Budd Chiari syndrome
constrictive pancreatitis
hepatic failure

128
Q

causes of low SAAG (ascites) 1.1g/dL<

A

cancer of the peritoneum
TB and other infections
pancreatitis
nephrotic syndrome

129
Q

A 30-year-old female presents feeling unwell for the last 12 hours.

She has a background of Crohn’s disease, for which she takes infliximab.

Her observations are as follows:

Heart rate 90 beats per minute
Blood pressure 110/90 mmHg
Temperature 38.1 °C
Her blood tests return as follows:

Haemoglobin 120g/L (130-180)
White cells 5 x10^9/L (4-11)
CRP <5
What is the best next step in the management of this patient?

A

admit for further investigations

why?
- those on biologics e.g infliximab are at a higher risk of infection

Clinical Medicine (26 decks)

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