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Gastroenterology Flashcards

1
Q

After a bowel resection and anastomosis there is a risk of leakage. 3 weeks post discharge what investigation can be done to check all is well?

A

Gastrografin enemia

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2
Q

when is the FIT test recommended for patients rather than the 2 week rule?

A

> = 50 years with unexplained abdominal pain OR weight loss

< 60 years with changes in their bowel habit OR iron deficiency anaemia

> = 60 years who have anaemia even in the absence of iron deficiency

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3
Q

people with lynch syndrome can have non polyp related colorectal cancer and which other cancer is common?

A

Endometrial carcinoma

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4
Q

what is the most common hereditary cause of colorectal carcinoma and what gene is affected?

A

non-polyposis colorectal carcinoma

MSH2/MLH1 genes

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5
Q

ROME IV criteria for IBS?

A

Recurrent pain with 2 or more:

  • related to defecation
  • change in stool frequency
  • change in stool appearance
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6
Q

When should a person with ascites be given prophylactic abx during their management plan

A

After an ascitic tap, if that cannot be done then skip to abx

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7
Q

Contraindication to performing an ascitic tap?

A

Bleeding from gums, raised D dimer, low fibrinogen = DIC

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8
Q

What is an incarcerated hernia?

A

Unable to push the hernia back

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9
Q

What must be tested alongside normal bloods in a person with IBS

A

Coeliac screen = test for anti-tissue transglutaminase

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10
Q

A patient with coeliac who presents with fevers, night sweats, diarrhoea?

A

Coeliac increases the risk of

= enteropathy associated T cell lymphoma

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11
Q

Pernicious anaemia prediposes to what cancer?

A

gastric carcinoma

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12
Q

How is vitamin b12 deficiency managed by injections?

A

intramuscular B12 replacement, a loading regime followed by 2-3 monthly injections

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13
Q

How to treat acute diverticulitis?

A

Oral Abx and analgesia

if not better in 72 hrs

–> IV ceftriaxone + metronidazole

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14
Q

Diverticulitis complications, how to fix?

  • abscess
  • perforation
A
  • Ct guided drainage
  • urgent laporotomy
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15
Q

osmotic vs stimulant laxative?

A

osmotic - lactulose
stimulant - senna (usually 2nd line)

before using these for constipation would use BULK forming laxative = isapgol

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16
Q

constipation symptom in the elderly?

A

delirium / confusion

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17
Q

Crohns imaging signs

A

kantor string
rose thorn

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18
Q

gene associated UC

A

HLA b27

(so also see ankylosing spondy, sclerosing cholangitis)

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19
Q

imaging signs UC

A

leadpipe sign
thumbprint

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20
Q

tx for crohns remission

A

glucocorticoid such as hydrocortisone (budesonide is only given to a subgroup of px)

2nd line - 5ASA drugs , mesalazine

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21
Q

how to define UC severity?

A

Mild = <4 stools a day / little blood

Mod = 4-6 stools / varying blood otherwise well

Severe = 6+ stools, systemic upset

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22
Q

Treating proctitis in UC?

A
  1. rectal aminosalicylcate
  2. ++ oral aminosalicyclate if 1 is not enough
  3. add corticosteroid if 1+2 not enough
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23
Q

How to treat left sided UC

A
  1. rectal aminosalicyclate
  2. ++ high dose oral aminosalicyclate + oral steroid if 1 is not enough
  3. stop topical treatments and offer an oral aminosalicylate and an oral corticosteroid
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24
Q

How to treat extensive UC (throughout colon)

A

opical (rectal) aminosalicylate and a high-dose oral aminosalicylate:

if remission is not achieved within 4 weeks, stop topical treatments and offer a high-dose oral aminosalicylate and an oral corticosteroid

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25
Severe UC in hospital tx?
intravenous steroids are usually given first-line intravenous ciclosporin may be used if steroid are contraindicated if after 72 hours there has been no improvement, consider adding intravenous ciclosporin or consider surgery
26
UC maintaining remission?
maintain with aminosalicyclate doses if severe relapse or 2+ exacerbations a year -> oral azathioprine / oral mercaptopurine
27
drugs to maintain remission crohns
azathioprine / mercaptopurine 2nd line - methotrexate
28
what is an aminosalicylate
mesalazine
29
which hepatitis viruses may cause polyarteritis nodosa?
Hep B also may cause cryoglobulinaemia ofc as wel as cirrhosis + HCC
30
Which hep has high mortality in pregnant women?
Hep E
31
vaccine for hep A type?
inactivated preperatations
32
what is the treatment of choice for severe alcoholic hep
prednisolone
33
cirrhosis surgery?
TIPS transjugular intrahepatic portosystemic shunt to reduce portal hypertension ( + give terlipressin which is a vasopressin analogue and IV abx asw if needed) consider transplant if HCC
34
liver failure
acute decompensation (without hx or acute on chronic, but still acute ppt) - encephalopathy, jaundice, coagulopathy * differentiate front acute hep etc by the encephalopathy
35
defining feature investigation liver failure
INR/PT = 1.5+ (coagulopathy)
36
alpha 1 antitrypsin deficiency causes what?
early onset COPD - do spirometry + liver cirrhosis +ve family hx
37
1st line ix for mono?
monospot test : heterophile antibody test
38
mono sx triad mono mx
triad: pyrexia, lymphadenopathy, sore throat tx: supportive, avoid physical activity 4 wks, prednisolone if severe/complications
39
what prophylactic action needs to be taken post splenectomy?
prophylactic aspirin due to thrombocytosis
40
immunisations in hyposplenism?
due to risk of infection from encapsulated bacteria - s.pneumoniae - n meningitidis - h influenzae need annual influenza and pneumococcal vaccine 5yrs
41
mono blood test?
deranged LFTs
42
which antihypertensive should be avoided in px with gord/sliding hernia sx
calcium channel blockers e.g. amlodipine, - relax lower sphicter increase reflux
43
c diff toxin vs antigen
in stool culture the toxin indicates current infection, antigen only shows exposure to bacteria
44
infection with Clostridium difficile. He is initially commenced on oral vancomycin. After an extended course, symptoms persist and so a course of oral fidaxomicin is given. The infection still persists after this.
then oral vancomycin +/- IV metronidazole should be tried ( same as life threatening c diff management)
45
What drugs other than some abx puts person at risk for c.dfiff
PPI - omeprazole
46
Perianal abscess + fistulae Gold standard ix?
MRI pelvis
47
what indicates acute pancreatitis what indicates severe acute pancreatitis what indicates necrosis in acute pancreatitis
Amylase Hypocalcaemia CRP 200+
48
Glasgow score 'PANCREAS'?
P = oxygen= <8 A = age 55 N = neutrophils/WBC 15+ C = calcium <2 R = renal urea 16+ E = enzymes AST/ALT 200+ A = albumin <32 S = sugar 10+
49
Hyposplenism - Key immunisations? - post splenectomy prophylaxis? - blood film findings?
- S.pneumoniae, N meningitidis, H influenzae type B, influenxa virus Do pneumococcal vaccine 2 weeks before elective splenectomy Annual influenza vaccination and pneumococcal vaccine every 5 years - Aspirin (due to high platelets after) - Howell Jolly bodies, Target cells, siderocytes
50
Infectious mono - Main causative organism and another - rash type of abx are given? - Test done?
- Epstein Bar (Human herpes 6), also can be cytomegalovirus - maculopapular pruritic rash - Monospot Test = Heterophile antibody test -> Positive for heterophile antibodies
51
' uni student with water diarrhoea '
C jejuni
52
' rapid onset diarrhoea after a meal '
Staph aureus
53
' elderly on abx '
C diff
54
CHESS organisms that can cause gastroenteritis with bloody diarrhoea
- Cambylobacter - Haemorrhagic e coli - entamoeba hystolytica - salmonella - shigella
55
C diff causative abx?
Ciprofloxacin Clarithromycin Clindamycin !! Cephalosporin + PPIs
56
C diff toxin vs antigen in stool?
Toxin = infection currently Antigen = exposure to bacteria not current infection
57
C diff can be mild moderate or severe, how to differentiate?
WCC 15- / 3-5 stools a day = mild WCC 15+ / elevate creatinine 50% from normal = moderate Hypotension/ toxic megacolon = severe
58
gastric cancer summary
two types: - diffuse, not linked to risk factors, involvement of signet cells - more common, due to SMOKING, h.pylori, diet, nitrates, smoked food, unrefrigerated foods note virchows node + sister mary joseph nodule OGD + Biopsy (signet cells)
59
oesophageal cancer summary?
Upper 2/3rd = SCC (specific signs hoarseness, horners) due to other risk factors Lower 1/3rd = adenocarcinoma (barrets, gord, obesity) urgent referral when dysphagia from S -> L
60
rectal cancer signs and symptoms?
Tenesmus Fresh blood incontinence flatulence + FLAWS
61
Colonoscopy + Biopsy is gold standard for colorectal cancer but what would be seen on barium enema?
apple core lesion
62
what tumour marker can be used to monitor disease for colorectal cancer?
CEA marker
63
screening for colorectal cancer?
Faecal Immunochemical test – FIT, ever 2 years to men and women ages 60-74 years old
64
DUKEs staging?
For colorectal cancer Stage a = confined to mucosa B = invading bowel wall C = lymph node mets D = distant mets
65
Hepatitis D ix and tx?
ix - Anti HDV test - interferon
66
Hepatitis A ix?
IgM anti Hep A (HAV) test positive
67
Coeliac - histology
Crypt hyperplasia Villous atrophy increased intraepithelial lymphocytes
68
Coeliac - derm feature
Dermatitis herpetiformis (blistering, itchy papules and vesicles on legs)
69
Coeliac - initial screening Coeliac - gold standard diagnosis
- Anti tissue transglutaminase (IgA anti tTG) ( IgG anti tTG if IgA deficient px) - Duodenal biopsy
70
Gallstones (biliary colic) no signs of fever, inflammation, infection. negative murphys - first line ix - most sensitive test?
- ultrasounds - MRCP
71
as well as gallstones what may cause cholecystitis?
total paraenteral nutrition as fasting can cause hypomotlity of gallbladder + stasis
72
gallbladder wall on US?
Normal with gallstones (a patient with sx of colic) = thin thick = if they have cholecystitis (inflammed bladder due to blockage)
73
Charcots triad + reynolds pentad seen in?
acute cholangitis - RUQ pain + fever + Jaundice Reynaolds pentad = + hypotension + mental state change
74
Best first ix / mx for acute cholangitis?
ERCP = help observe and can decompress
75
appendicitis - Mc Burney point tenderness - Rovsings sign - Psoas sign - Obturator sign - Blumberg sign
- 1/3rd from umbilical to asis tenderness - RLQ pain on LLQ palpation - pain on extending hip if retrocaecal appendix - pain on internal rotation of flexed thigh - rebound tenderness in RLQ
76
IBD derm manifestations
Erythema nodosum - red shins pyoderma gangrenosum - ulcers on legs
77
all UC management
Mild/moderate (not in hospital) - Induce remission: Mesalazine topical or add oral if left sided / topical isn't working, Add steroid 3rd line - Maintain remission: Masalazine doses, if px has 2+ exacerbations a year use azathioprine instead Severe (tx in hospital) - IV hydrocortisone / IV cephalosporin if nothing works try infliximab or colectomy if really nothing is working
78
refeeding syndrome
(malnutrition) feeding following a period of starvation - hypophosphataemia - hypokalaemia - hypomaagnesium may predispose to torsades de pointes
79
Boerhaave perforation summary
- spontaneous OS rupture due to repeated vomiting + long standing alcohol use sudden onset severe chest pain and subcutaneous emphysema CT contrast swallow (NO OGD)
80
Mallory weiss tear vs boerhaave?
B is more severe and causes abnormal obs and CXR, rupture in distal 1/3 OS MWT is a longitudinal mucous membrane tear at GOJ and causes haematemesis
81
Gold standard for bowel perforation?
CT with IV contrast
82
AXR and CXR perforation signs?
AXR - rigler sign CXR - pneumoperitoneum
83
cirrhosis changes to liver?
Fibrosis and conversion of normal liver architecture or abnormal 'regenerative nodules'
84
cirrhosis specific sensitive ix? ix once someone is diagnosed every 6 months ix?
Liver biopsy ALTHO Transient elastography is done 1st line due to less bleeding risk upper Gi endoscopy = varices US + AFP for HCC
85
child pugh score?
ABCDE Albumin = 35+/ 28-35 / 28- Bilirubin = <34 / 34 -51 / 51+ Clotting PT = <4 / 4-6 / 6+ * Distension = none / mild / marked Encephalo = None / mild / marked * In seconds on top of normal time
86
Ascites SAAG categories?
Serum ascites albumin gradient 11g/L+ = portal hypertension e.g. cirrhosis, CHF, budd chairi, alcohol liver, liver failure 11g/L - = all other causes e.g. hypoalbuminaemia (nephrotic syndrome), malignancy, infections, pancreatitis
87
Ascitic transudative vs exudative fluid?
transudative means low protein = SAAG11+ exudative means high protein = SAAG11-
88
SBP prophylaxis after therapeutic ascitic drainage?
Ciprofloxacin or norfloxacin * give IV albumin when doing large volume paracentesis
89
If crohns is in small bowel wat ix is done?
MRI
90
if upper endoscopy is negative when doing it for a GORD alarm features?
Do a OS manometry
91
hydroxycobalamin?
Vitamin B12 → IM supplementation of vitamin B12 (hydroxocobalamin) Always replace vitamin B12 before folate - protects against subacute combined degeneration of the cord
92
what is a good indicator of poor prognosis SBP?
renal dysfunction
93
treat sbp with cefotaxime (empirical abx) but what is prophylactic abx and when is it needed?
ascitic fluid protein concentration <15 g/L or a previous episode of SBP → continuous antibiotic prophylaxis (oral ciprofloxacin or norfloxacin)

Year 3 (14 decks)

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