Gastroenterology Flashcards
what are the organisms of gastroenteritis in the following?
- watery non bloody diarrhoea started a few hours after food
- watery non bloody diarrhoea after reheated rice
- canned foods/packed honey
- reheating meats - 24 hrs watery diarrhoea
- travellers diarrhoea - last 3-4 days
- fever, roth spots, constipation
- bloody diarrhoea, pain, fever
- farming or contact with animal faeces
- rice water stool/ shellfish
- bloddy diarrhoea lasting 20 days BBQ
- staph aureus
- bacilius cerues
- clostridium botulinum
- clostridium perfringes
- E coli
- salmonella typhi
- shigella
- yersinia
- vibrio cholera
- campylobacter jejuni
which antibiotics treat salmonella typhi?
ceftriaxone then switch to ciprofoxacin
which abx treat campylobacter jejuni?
clarithromycin or cipoifloxacin
which HLA are associated with coeliac?
HLA DQ2 and 8
what is seen on biopsy in coeliac?
villous atrophy, crypt hyperplasia
(shorter microvilli and flat mucosa)
which dermatological condition is associated with coeliac?
dermatitis herpetiformis (on the elbows and knees)
what investigations should you do in someone who you suspect has coeliac?
in which pts should you test?
iron, folate, b12
blood smear - target cells, howell jolly bodies
IgA anti-tissue transglutaminase TTG
IgA anti-endomysial cell
OGD and duodenal biopsy
what is the investigation of choice for appendicitis?
CT abdomen
what are some signs of appendicitis?
rovsings - pain in RIF upon palpation of LIF
copes - pain on flexion and internal rotation of hip
psoas - pain on hip extension
what is the management for appendicitis?
prophylactic abx
appendectomy
lavage if perforation
how do you differentiate between biliary disease?
pain - biliary colic
pain and fever - cholecystitis
pain, fever, jaundice - cholangitis
what do LFTs in cholecystitis show?
normal billirubin, ALT/AST
raised amylase
raised ALP
what is reynolds pentad?
acute cholangitis
pain, fever, jaundice, hypotension, confusion
DO ERCP
what is the 1st line investigation for cholangiocarcinoma?
CT abdomen
- ERCP
- abnormal LFT
- ca19-9 and CAE -not specific
what are some signs of primary billiary cirrhosis?
itching in middle ages woman
obstructive jaundice - pale stool dark urine
hypercholestrolaemia
raised ALP/GGT
anti mitochondrial antibody
raised IgM
what is the management of PBC?
ursodeoxycholic acid
cholestyramine (for puritis)
what are some symptoms of primary sclerosing cholangitis
puritis
obstructive jaundice
steatorrhea
splenomegaly
what is the diagnostic test of primary sclerosis cholangitis?
MRCP - beaded appearance
pANCA
biopsy of bile duct “onion skin”
what investigation findings are seen in autoimmune hepatitis?
anti-nuclear antibody ANA
riased IgG
biopsy - piecemeal necrosis = inflammation beyond the limiting plate
what are the symptoms of portal hypertension?
splenomegaly
ascites
varices
encephalopathy
what is the management of chronic live disease?
diet - restrict alcohol, fluids, low sodium
diuretics - spironolactone
prophylaxis - ciprofloxacin + propranolol
refractory - TIPSS
what do blood tests show in haemochromatosis?
TRANSFERRITIN SATURATION raised
ferritin raised
iron raised
TIBC reduced
what investigations should be done in impaired LFTs?
USS - increased echogenicity in NAFLD
enhanced liver fibrosis panel
Fibroscan - offered to alcoholics and HCV infection
lier biopsy
which investigations should be done for pancreatitits?
serum amaylse > 3 times normal
serum lipase - more sensitive
USS
CT abdo
how is pancreatitis classified?
mild - no organ failure
moderate - transient organ failure <48 hrs
severe - persistent >48hrs
what are some complications of pancreatitis?
haemorrhage, SIRS, ARDS, hyperglyceamia, hypocalcaemia
pancreatic abscess, necrosis
wat is courvoisiers law?
painless jaundice = head of pancreatic cancer
what investigations are done for diverticulitis?
acute - CT abdomen
Chronic (diverticular disease) - barium enema
how do you manage diverticulitis?
acute
- abx, drip and suck
chronic
- soluble high fibre diet
when do you do an urgent OGD?
dysphagia
upper abdo mass
>55y/o AND weight loss AND
- dyspepsia
- reflux
- upper abdo pain
what do you do if an OGD is -ve but pt is experiencing symptoms?
24 hr oesophageal pH monitoring
how do you treat dyspepsia?
review meds
trial ppi
- C13 urea breath test OR stool antigen test for H pylori - treat with triple therapy clarith, amox, PPI
treatment resistant - urgent ogd
