Gastroenterology Flashcards
Crohn’s disease pathological findings
Skip lesions w/ transmural involvement of any part of GIT
(Most commonly terminal ileum)
Bowel Ca red flag symptoms/features needing urgent gastro referral (7)
-LOW >10% in 3 months
-PR bleeding
-Symptom onset after age >50 (e.g altered bowel habit)
-FHx of GI disease
-Positive FOBT
-Unexplained iron def. anaemia
-Nocturnal diarrhoea
Uncomplicated Diverticulitis Rx aspects (4)
-Clear liquid diet for 2-3/7
-Low fibre diet until pain improves
-Paracetamol/antispasmodics for pain
-Abx on case-by-case basis (Aug DF BD 5/7)
Colonoscopy 6-8 weeks post-attack to exclude malignancy?
Chronic liver disease examination findings (8)
Spider naevi
Palmar ertyehma
Finger clubbing
Caput medusae
Ascites
Jaundice
hepatic flap
Splenomegaly
?peripheral oedema
Coeliac disease clin. features (9)
○ Diarrhoea/weight loss
○ Lethargy
○ Headaches
○ Osteoporosis
○ Iron deficiency
○ Transaminase elevation
○ Infertility
○ Other autoimmune diseases
○ Skin rash - dermatitis herpetiformis
Coeliac disease serology tests (2)
Genotyping test to order (1)
Follow-up interval post diagnosis
Anti-TTG antibodies
Deamidated gliadin antibodies
HLADQ2/8 - useful for excluding disease. No need to screen kids until age 4 if FHx
Follow-up annually w/ serology titres, repeat gastroscopy 2 years after starting GFD
Active Hep B infection - next management steps (3)
○ Discuss result w/ pt
○ Notify state health department
○ Testing of household & sexual contacts - offer vaccination if susceptible
IBS clin. features (6)
-Recurrent abdo pain - a/w bowel movements
-Assoc. frequency change of stool
-Assoc. appearance change of stool
-Symptoms >6mths
-Bloating
-Extra-intestinal features - headache, myalgia, fatigue
IBS Ix (to exclude DDx) (3)
○ Coeliac serology
○ Faecal calprotectin
○ HB, iron studies
IBS Ix (to exclude DDx) (3)
○ Coeliac serology
○ Faecal calprotectin
○ HB, iron studies
IBS Management aspects (5)
○ Low FODMAP diet
§ FODMAPs –> indigestible, slow transit, water –> bloating and gas
○ Fibre supp. - psyllium
○ Psychological therapies - CBT
○ ?TCAs/SSRIs - off label
○ Abx incl. Rifaximin?
DDx RUQ pain + deranged LFTs (6) [some only]
○ Biliary colic w/ choledocholithiasis
○ MAFLD
○ Alcoholic liver disease
○ Hep B/C
○ Autoimmune hepatitis
○ Haemachromatosis
IBD extra-intestinal manifestation (5 categories)
○ Erythea nodosum/pyoderma gangrenosum
○ VTE
○ PSC
○ Ocular - episcleritis, uveitis
- MSK - sacroiliitis, ank spond
IBD Meds for:
-Remission (3)
-Maintenance (2)
Management steps of flare-up (2)
Remission: steroids (budesonide), mesalazine (5ASA), biologics
Maintenance: Azathioprine, +/- biologics
Bloods and stool spec (exclude infection)
Steroids (D/w specialist)
Diverticulitis prevention aspects (3)
○ High fibre diet
○ Smoking cessation
○ Weight loss
GORD vs. oesinophilic oesophagitis - main symptom difference
EoE = dysphagia most prominent symptom, hx. of atopy
○ H.pylori = dyspepsia, epigastric discomfort, bloating
GORD - alarm symptoms for gastroscopy (7)
-Dysphagia
-Odynophagia
-Haematemesis
-Malaena
-Iron deficiency anaemia
-LOW
-Persistent vomiting
Barrett’s Oesophagus Rx aspects (2)
PPI for symptoms
Endoscopy surveillance 2-5 years
Pre-malignant, but risk of progression is low
General DDx for deranged LFTs (6)
infections, Hep, HIV, CMV
Haemachromatosis/Copper storage disease
Drugs
Autoimmune liver disease
Alcoholic liver disease
NAFLD
Hep C Risk Factors (8)
○ IVDU
○ Prior incarceration
○ Tattoos/body piercings
○ Co-infection with HIV/HBV
○ MSM
○ Sex workers
○ Needlestick injury
○ ATSI population
Chronic Hep B - when to treat?
- Treatment best considered when LFTs are deranged - **clearance **or escape phase (when body is trying to fight virus)
Monitoring for chronic Hep B infection - treated
- Once HBV DNA load undetectable - annual HBsAg and anti-HBs testing
- Also** 6-mthly HCC surveillance** with liver USS +/- AFP
○ Indicated for anyone with cirrhosis OR non-cirrhotic pts with chronic HBV infection
- Also** 6-mthly HCC surveillance** with liver USS +/- AFP
Other causes of raised serum ferritin (broad conditions/categories) (6)
-Chronic alcohol consumption
-Obesity
-Diabetes
-Liver disease
-Malignancy
-Infection
Clinical manifestations of haemachromatosis (9)
-Vertigo
-Hair loss
-Memory loss
-CVS - arrhythmia, cardiomyopathy
-Hepatomegaly/cirrhosis/deranged LFTs
-Bronze skin
-Diabetes
-Arthritis
-Testicular atrophy
