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Finals > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What happens in GORD?

A

Acid from the stomach refluxes into the oesophagus and irritates the epithelium

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2
Q

What is the presentation of GORD?

A

*Heartburn
*Retrosternal/epigastric pain
*Bloating
*Hoarse voice
*Nocturnal cough

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3
Q

What is the management of GORD?

A
  • Avoid triggers: alcohol, caffeine, quit smoking, lose weight, smaller lighter meals, stay upright after eating
    *Gaviscon/rennies
    *PPI: omeprazole or ranitidine
    *Surgery: laparoscopic fundolipcation
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4
Q

How do you check for H.pylori infection?

A

*Urea breath test
*Stool antigen
*Rapid urease test during endoscopy

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5
Q

How is H. pylori eradicated?

A

*Triple therapy
*PPI
*2x antibiotics: amoxicillin and clarithromycin
*7 days

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6
Q

What are the complications of H.pylori infection?

A

*Barrett’s oesophagus
*Oesophagitis
*Anaemia
*Ulcers
*Oesophageal carcinoma
*Benign strictures

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7
Q

What are the features of an upper GI bleed?

A

*Haematemesis
*Melena
*A raised urea may be seen due to protein in blood
*Haemodynamic instability if loss is large

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8
Q

What are the causes of upper GI bleeds?

A

*Oesophageal varices (most common)
*Peptic ulcer: gastric or duodenal
*Cancer
*Mallory weiss tear

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9
Q

What score is used on first presentation of an upper GI bleed?

A

Glasgow-Blatchford Score (can it be managed as an outpatient or an inpatient?)

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10
Q

What is the management of an upper GI bleed?

A

*Resuscitation: ABC, wide bore IV access, platelet transfusion if actively bleeding
*Endoscopy within 24 hours
*Stop anticoagulants and NSAIDs
*Bloods: FBC, UEs, Coag, LFTs, Crossmatch

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11
Q

What is the specific management of oesophageal varies?

A

*Terlipressin
*Broad spectrum antibiotics (prophylactic)
*Band ligation

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12
Q

What are the features of acute liver failure?

A

*Jaundice
*Coagulopathy: raised prothrombin time (INR>1.5)
*Hypoalbuminaemia
*Hepatic encephalopathy
*May have abdominal pain, nausea, vomiting
(must not have had liver failure prior otherwise it is acute on chronic)

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13
Q

What investigations should be carried out in someone presenting with acute liver failure?

A

*LFTs
*Prothrombin time
*Basic metabolic profile
*FBC
*Consider viral hepatitis PCR

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14
Q

What are the symptoms of acute alcohol withdrawal?

A

*Anxiety
*Nausea and vomiting
*Autonomic dysfunction
*Insomnia
*May progress to seizures and delirium

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15
Q

When do symptoms of alcohol withdrawal start?

A

6-12 hours after last alcoholic drink

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16
Q

What investigations should be carried out in someone presenting with alcohol withdrawal?

A

*Blood glucose
*Venous gas
*FBC
*UEs

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17
Q

What is the management of acute alcohol withdrawal

A

*GMAWS: if ≥2 then give benzodiazepines
*Correct metabolic abnormalities
*Give IV fluids if required

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18
Q

What symptoms of IBD overlap?

A

*Diarrhoea
*Arthritis
*Erythema nodosum
*Pyoderma gangrenosum

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19
Q

What are the symptoms of Crohn’s disease?

A

*Chronic diarrhoea
*Weight loss
* RLQ pain

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20
Q

What investigations should be carried out in someone presenting with Crohns?

A

*FBC
*iron studies
*Fecal calprotectin
*B12
*Vit D
*Endoscopy + histology

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21
Q

Describe endoscopy in crohns

A

*Deep ulcers
*Skip lesions

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22
Q

Describe histology of crohns

A

*Goblet cells
*Granulomas
*Inflammation of all layers

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23
Q

How do you induce remission in crohn’s?

A

*Glucocorticoids

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24
Q

Maintenance crohns

A

Azathioprine or mercaptopurine

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25
Q

What must you assess before starting someone on azathioprine?

A

TPMT

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26
Q

What are the symptoms of ulcerative colitis?

A

*Bloody diarrhoea
*Urgency
*Tenesmus (feeling like you still need to pass stool despite havng just gone)
*LLQ abdo pain

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27
Q

What is seen on endoscopy in UC?

A

*Continuous inflammation
*Colon to rectum

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28
Q

How do you induce remission in UC?

A

Aminosalicylate e.g. mesalazine

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29
Q

Maintenance of Ulcerative collitis

A

*Mesalazine
*Azathioprine
*Mercaptopurine

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30
Q

What are the causes of gastritis?

A

*H.pylori
*NSAIDs
*Alcohol
*Stress secondary to mucosal ischaemia
*Autoimmune

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31
Q

What are the symptoms of gastritis?

A

*Nausea and vomiting
*Severe emesis
*Acute abdominal pain - epigastric area
*Fever

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32
Q

What are the investigations for gastritis?

A

*H pylori
*FBC
*Consider endoscopy and gastric mucosal histology

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33
Q

What is the treatment of Gastritis?

A

*H.pylori triple therapy if indicated
*Discontinue NSAIDs, consider PPI or H2 antagonist (famotidine)

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34
Q

What are the symptoms of peptic ulcer?

A

*Abdominal pain- epigastric
*nausea
* Gastric ulcers are worse on eating, duodenal are received by eating

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35
Q

What are the causes of peptic ulcers?

A

*H.pylori
*Zollinger-Ellison syndrome (excessive gastrin)
*NSAIDs, SSRIs, steroids, bisphosphonates

36
Q

What are the investigations for peptic ulcers?

A

*Upper GI endoscopy
*H.pylori urea breath test
*FBC

37
Q

What is the treatment of peptic ulcers?

A

*If no h pylori and no bleed: PPI, H2 antagonist 2nd line
*If active bleed: urgent evaluation, resuscitation and supportive care and endoscopy

38
Q

What causes oesophageal varies?

A

Portal hypertension, usually due to cirrhosis

39
Q

What are the features of oesophageal varices?

A

*Haematemesis
*Malaena
*Haematochezia (bright red blood from anus)

40
Q

What investigations should be carried out in suspected oesophageal varices?

A

*Gastroscopy
*FBC: expect low Hb and platelet, macrocytosis may be seen in alcoholism
*LFTs, UEs
*Coagulation- INR and prothrombin time

41
Q

What are the causes of chronic liver disease?

A

*Alcoholic liver disease
*Non-alcoholic fatty liver disease
*Hepatitis B
*Hepatitis C
*Rare: haemochromatosis, Wilsons disease, cystic fibrosis, autoimmune hepatitis, drugs (amiodarone, methotrexate, sodium valproate)

42
Q

What are the symptoms of chronic liver disease?

A

*Abdominal distension
*Jaundice and pruritus
*Haematemesis and malaena
*Muscle wasting

43
Q

Diagnosis and management of alcoholic liver disease

A

*Liver biopsy in the context of alcohol abuse
*Stop alcohol

44
Q

Diagnosis and management of non alcoholic fatty liver disease

A

*diagnosis of exclusion: no alcohol abuse
*Diet and exercise, liver transplant, consider pioglitazone and vitamin E

45
Q

Diagnosis and management of Hepatitis B?

A

*Serology
*Antiviral therapy, liver transplant, tenofovir, interferon

46
Q

Diagnosis and management of hepatitis C

A

*HCV imunoassay, Hep C RNA PCR
*Anti-viral therapy: intent is to cure

47
Q

What are the 3 stages of alcoholic liver disease?

A

*Fatty liver (steatosis)
*Alcoholic hepatitis
*Alcoholic liver cirrhosis

48
Q

Hep B sAg

A

Currently infected if positive

49
Q

Hep B sAb

A

Immunity marker - infection or vaccine

50
Q

Hep B cAb

A

Positive if infected

51
Q

eAg

A

High infectivity

52
Q

Hep B eAb

A

Low infectivity

53
Q

What is achalasia?

A

Degnerative loss of ganglia from auberbach’s plexus

54
Q

What are the features of achalasia?

A
  • dysphagia of solids and liquids
  • heartburn
  • regurgitation of food
55
Q

Investigation for achalasia

A
  • barium swallow
  • birds beak appearance, expanded oesophagus and fluid level
56
Q

Management of achalasia

A

Pneumatic balloon dilation

57
Q

Alcoholic liver disease LFTs

A
  • high GGT
  • AST:ALP >2
58
Q

Management of alocholic hepatitis

59
Q

Side effects of sulfasalazine

A
  • rash
  • oligospermia
  • headache
  • heinz body anaemia
  • megaloblastic anaemia
  • lung fibrosis
  • agranulocytosis
60
Q

side effects of mesalazine

A
  • GI upset
  • headache
  • agranulocytosis
  • pancreatitis
  • interstitial nephritis
61
Q

Management of Barrett’s oesophagus

A
  • PPI
  • endoscopic surveillance and biopsy
  • if there is any dysplasia then endoscopic intervention is offered
62
Q

Budd-chairi syndrome symptoms

A
  • abdominal pain
  • ascites leading to abdo distension
  • tender hepatomegaly
63
Q

C diff management of recurence

A

If within 12 weeks then fidaxomicin

64
Q

Coeliac disease on biopsy

A
  • lamina propria infiltration with lymphocytes
  • increased intraepithelial lymphocytes
  • crypt hypoplasia
  • villous atrophy
65
Q

HNPCC cancer

A
  • colorectal cancer
  • increased risk of endometrial cancer
66
Q

Amsterdam criteria

A
  • HNPCC
  • 3 family members with colon cancer
  • At least 2 generations
  • At least one onset before age 50
67
Q

1st line constipation

A

Bulk forming: ispaghula

68
Q

2nd line constipation

A

Osmotic: macrogol

69
Q

Perianal fistula in crohns

A
  • MRI
  • give oral metronidazole if symtpoms
  • draining seton if complex
70
Q

Perianal abscess in crohns

A

Incision and drainage and antibiotics

71
Q

Gastric cancer spread

A
  • Virchows node: left supraclavicular
  • sister mary joseph node: periumbilical
72
Q

Gilbert’s

A

Defective bilirubin conjugation

73
Q

Haemochromatosis

A
  • Autosomal recessive
  • Defective bilirubin conjugation
74
Q

Symptoms haemochromatosis

A
  • fatigue
  • arthralgia
  • erectile dysfunction
  • bronze skin
  • diabetes
  • liver/cardiac failure
75
Q

Classical blood results haemochromatosis

A
  • High transferrin
  • high iron
  • low total iron binding capacity
76
Q

Management of haemochromatosis

A
  • venesection
  • monitor the transferrin saturation (keep less than 50%) and serum ferritin (below 50)
  • desferrioxamine 2nd line
77
Q

Causes of hepatocellular carcinoma

A
  • hep B
  • hep C
  • haemochromatosis
  • alcohol
  • Primary biliary cirrhosis
78
Q

Signs of hepatocellular carcinoma

A
  • jaundice
  • ascites
  • RUQ pain
  • hepatomegaly
  • pruritus
  • splenomegaly
  • hepatomegaly
  • raised AFP
79
Q

Plummer vinson syndrome

A
  • iron deficiency anaemia
  • dysphagia
  • glossitis
80
Q

Associations of primary biliary cholangitis

A
  • sjogrens
  • RA
  • systemic sclerosis
  • thyroid disease
81
Q

Features of primary biliary cholangitis

A
  • fatigue
  • pruritus
  • jaundice
  • hyperpigmentation
  • xanthelasma
82
Q

Antibodies primary biliary cholangitis

A
  • anti mitochondrial (90%)
  • smooth muscle antibodies
  • raised IgM
83
Q

Investigations for primary biliary cholangitis

A
  • antibodies
  • MRCP to exclude obstruction
84
Q

Management of primary biliary cholangitis

A
  • ursodeoxycholic acid to slow progression
  • cholestyramine for pruritus
85
Q

Associations of primary sclerosing cholangitis

A
  • ulcerative colitis
  • crohns (less than crohns)
  • HIV

10% develop cholangiocarcinoma

86
Q

Features of primary sclerosing cholangitis

A
  • fatigue
  • jaundice
  • RUQ pain
  • pruritus
  • increased bilirubin and ALP
  • pANCA may be positive

Finals (37 decks)

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