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Medicine AMK knowledge > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

The following are all considered triggers for what condition?

Antibiotics - Rifampicin, Isoniazid, Nitrofurantoin
Anaesthetic agents - Ketamine, Etomidate
Sulfonamides
Barbiturates
Antifungal agents

A

Intermittent porphyria

(problem with haem metabolism)

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2
Q

How would a patient with intermittent porphyria present?

A

History of recent triggers eg nitrofurantoin
Abdominal pain
Nausea
Lethargy and confusion
Hypertension

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3
Q

What is the diagnostic test for intermittent porphyria?

A

urinary porphobilinogen

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4
Q

What are the basic management principles for a paracetamol overdose?

A

If ingestion less than 1 hour ago + dose >150mg/kg: Activated charcoal

If staggered overdose or ingestion >15 hours ago: Start N-acetylcysteine immediately

If ingestion <4 hours ago: Wait until 4 hours to take a level and treat with N-acetylcysteine based on level

If ingestion 4-15 hours ago: Take immediate level and treat based on level

Obtain following bloods:
FBC
Urea and Electrolytes
INR
Venous gas
Consider need for transfer to liver unit if blood tests are worsening

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5
Q

What is a diagnosis of diabetes, jaundice and joint pain suggestive of?

A

Hereditary haemochromatosis

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6
Q

How is hereditary haemochromatosis managed?

A

Blood letting or desferrioxamine

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7
Q

Which test is diagnostic for Crohn’s disease?

A

MRI small bowel

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8
Q

Which test is first line for bowel obstruction?

A

Abdominal xray

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9
Q

Which test is most likely diagnostic for bowel obstruction?

A

Abdominal CT

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10
Q

What does a raised ALT, dark urine and normal stools suggest?

A

hepatocellular injury (liver)

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11
Q

What does a raised ALP, dark urine and pale stools suggest?

A

Cholestatic picture

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12
Q

What might an isolated rise in ALP be associated with?

A

Bone involvement eg fractures/ mets

Pagets disease

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13
Q

What is the classic triad of symptoms for ascending cholangitis?

A

RUQ pain
Fever
Jaundice

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14
Q

What is the treatment of choice for biliary colic?

A

Elective laparoscopic cholecystectomy

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15
Q

What are the risk factors for biliary colic?

A

4Fs

Fat: obesity is thought to be a risk factor due to enhanced cholesterol synthesis and secretion
Female: gallstones are 2-3 times more common in women. Oestrogen increases activity of HMG-CoA reductase
Fertile: pregnancy is a risk factor
Forty

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16
Q

Define cholestasis

A

Blockage to the flow of bile

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17
Q

Define cholelethiasis

A

Gallstones are present

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18
Q

Define choledocholithiasis

A

Gallstones are in the bile duct

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19
Q

Define biliary colic

A

Intermittent RUQ pain caused by gallstones irritating bile ducts

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20
Q

Define cholecystitis

A

Inflammation of gallbladder

21
Q

Define cholangitis

A

Inflammation of bile duct

22
Q

Define cholecystectomy

A

Surgical removal of the gallbladder

23
Q

Define cholecystotomy

A

Inserting drain in to gallbladder

24
Q

Jaundice, coagulopathy (raised prothrombin time), hypoalbuminaemia, hepatic encephalopathy and renal failure are features of what?

A

Acute renal failure

25
Q

The following are features of which gallbladder related disease:

Colicky abdominal pain, worse postprandially, worse after fatty foods

A

Biliary colic

26
Q

What is the management for biliary colic?

A

If imaging shows gallstones and history compatible then laparoscopic cholecystectomy

27
Q

The following are features of which gallbladder related disease:

Right upper quadrant pain
Fever
Murphys sign on examination
Occasionally mildly deranged LFT’s (especially if Mirizzi syndrome)

A

Acute cholecystitis

28
Q

How is acute cholecystitis managed?

A

Imaging (USS) and cholecystectomy (ideally within 48 hours of presentation)

29
Q

The following are features of which gallbladder related disease:

Usually prodromal illness and right upper quadrant pain
Swinging pyrexia
Patient may be systemically unwell
Generalised peritonism not present

A

Gallbladder abscess

30
Q

How is a gallbladder abscess managed?

A

Imaging with USS +/- CT Scanning
Ideally, surgery although subtotal cholecystectomy may be needed if Calot’s triangle is hostile
In unfit patients, percutaneous drainage may be considered

31
Q

The following are features of which gallbladder related disease:

Patient severely septic and unwell
Jaundice
Right upper quadrant pain

A

Cholangitis

32
Q

How is cholangitis managed?

A

Fluid resuscitation
Broad-spectrum intravenous antibiotics
Correct any coagulopathy
Early ERCP

33
Q

The following are features of which gallbladder related disease:

Patients may have a history of previous cholecystitis and known gallstones
Small bowel obstruction (may be intermittent)

A

Gallstone ileus

34
Q

What is the management of gallstone ileus?

A

Laparotomy and removal of the gallstone from small bowel, the enterotomy must be made proximal to the site of obstruction and not at the site of obstruction. The fistula between the gallbladder and duodenum should not be interfered with.

35
Q

The following are features of which gallbladder related disease:

Patients with intercurrent illness (e.g. diabetes, organ failure)
Patient of systemically unwell
Gallbladder inflammation in absence of stones
High fever

A

Acalculous cholecystitis

36
Q

What is the management of acalculous cholecystitis?

A

If patient fit then cholecystectomy, if unfit then percutaneous cholecystostomy

37
Q

What is the test used for post eradication of h.pylori?

A

Urea breath test

38
Q

What are first line antibiotics for c.diff?

A

Oral vancomycin

39
Q

What test is used to confirm diagnosis of gastro-duodenal h.pylori?

A

Stool helicobactar antigen test

40
Q

How is c.diff diagnosed?

A

Presence of c.diff toxin in stool

41
Q

What is first line management for a first infection of c.diff?

A

10 days oral vanc

42
Q

How is remission induced in distal UC (proctitis)?

A

Topical (rectal) aminosalicylate
If not achieved within 4 weeks - add oral aminosalicylate
If still not achieved add topical or oral corticosteroid

43
Q

How is remission induced in proctosigmoidosis and left sided UC?

A

Topical (rectal) aminosalicylate
If not achieved within 4 weeks - add high dose oral aminosalicylate OR switch to high dose oral aminosalicylate + a topical corticosteroid
If still not achieved stop topical treatments and offer oral aminosalicylate and oral corticosteroid

44
Q

How is remission induced in extensive UC disease?

A

Topical (rectal) aminosalicylate and high dose oral aminosalicylate
If remission not achieved within 4 weeks - stop topical treatments and offer high dose oral aminosalicylate and oral corticosteroid

45
Q

How is remission induced in severe UC?

A

Should be treated in hospital
IV steroids usually first line (IV cyclosporin if steroids contraindicated)
If no improvement within 72hrs consider adding IV cyclosporin to IV steroids or surgery

46
Q

Following a mild to moderate UC flare how is remission maintained in proctitis and proctosigmoiditis?

A

Topical (rectal) aminosalicylate alone (daily or intermittent)
OR
Oral aminosalicylate plus topical (rectal) aminosalicylate (daily or intermittant)
OR
an oral aminosalicylate by itself (may not be as effective as other options)

47
Q

Following a mild to moderate UC flare how is remission maintained in extensive disease and left sided UC?

A

Low maintenance dose of oral aminosalicylate

48
Q

Following a severe UC relapse, or >=2 relapses per year, how is remission maintained?

A

Oral azathioprine or oral mercaptopurine

Medicine AMK knowledge (24 decks)

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