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Year 3 > Gastroenterology > Flashcards

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
Q

Severe UC in hospital tx?

A

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

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26
Q

UC maintaining remission?

A

maintain with aminosalicyclate doses

if severe relapse or 2+ exacerbations a year
-> oral azathioprine / oral mercaptopurine

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27
Q

drugs to maintain remission crohns

A

azathioprine / mercaptopurine

2nd line - methotrexate

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28
Q

what is an aminosalicylate

A

mesalazine

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29
Q

which hepatitis viruses may cause polyarteritis nodosa?

A

Hep B

also may cause cryoglobulinaemia

ofc as wel as cirrhosis + HCC

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30
Q

Which hep has high mortality in pregnant women?

A

Hep E

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31
Q

vaccine for hep A type?

A

inactivated preperatations

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32
Q

what is the treatment of choice for severe alcoholic hep

A

prednisolone

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33
Q

cirrhosis surgery?

A

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

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34
Q

liver failure

A

acute decompensation (without hx or acute on chronic, but still acute ppt)

  • encephalopathy, jaundice, coagulopathy
  • differentiate front acute hep etc by the encephalopathy
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35
Q

defining feature investigation liver failure

A

INR/PT = 1.5+

(coagulopathy)

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36
Q

alpha 1 antitrypsin deficiency causes what?

A

early onset COPD - do spirometry

+

liver cirrhosis

+ve family hx

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37
Q

1st line ix for mono?

A

monospot test : heterophile antibody test

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38
Q

mono sx triad
mono mx

A

triad: pyrexia, lymphadenopathy, sore throat

tx: supportive, avoid physical activity 4 wks, prednisolone if severe/complications

39
Q

what prophylactic action needs to be taken post splenectomy?

A

prophylactic aspirin due to thrombocytosis

40
Q

immunisations in hyposplenism?

A

due to risk of infection from encapsulated bacteria

  • s.pneumoniae
  • n meningitidis
  • h influenzae

need annual influenza and pneumococcal vaccine 5yrs

41
Q

mono blood test?

A

deranged LFTs

42
Q

which antihypertensive should be avoided in px with gord/sliding hernia sx

A

calcium channel blockers e.g. amlodipine, - relax lower sphicter increase reflux

43
Q

c diff toxin vs antigen

A

in stool culture the toxin indicates current infection, antigen only shows exposure to bacteria

44
Q

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.

A

then oral vancomycin +/- IV metronidazole should be tried

( same as life threatening c diff management)

45
Q

What drugs other than some abx puts person at risk for c.dfiff

A

PPI - omeprazole

46
Q

Perianal abscess + fistulae Gold standard ix?

A

MRI pelvis

47
Q

what indicates acute pancreatitis

what indicates severe acute pancreatitis

what indicates necrosis in acute pancreatitis

A

Amylase

Hypocalcaemia

CRP 200+

48
Q

Glasgow score ‘PANCREAS’?

A

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
Q

Hyposplenism

  • Key immunisations?
  • post splenectomy prophylaxis?
  • blood film findings?
A
  • 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
Q

Infectious mono

  • Main causative organism and another
  • rash type of abx are given?
  • Test done?
A
  • Epstein Bar (Human herpes 6), also can be cytomegalovirus
  • maculopapular pruritic rash
  • Monospot Test = Heterophile antibody test -> Positive for heterophile antibodies
51
Q

’ uni student with water diarrhoea ‘

A

C jejuni

52
Q

’ rapid onset diarrhoea after a meal ‘

A

Staph aureus

53
Q

’ elderly on abx ‘

A

C diff

54
Q

CHESS organisms that can cause gastroenteritis with bloody diarrhoea

A
  • Cambylobacter
  • Haemorrhagic e coli
  • entamoeba hystolytica
  • salmonella
  • shigella
55
Q

C diff causative abx?

A

Ciprofloxacin
Clarithromycin
Clindamycin !!
Cephalosporin

+ PPIs

56
Q

C diff toxin vs antigen in stool?

A

Toxin = infection currently
Antigen = exposure to bacteria not current infection

57
Q

C diff can be mild moderate or severe, how to differentiate?

A

WCC 15- / 3-5 stools a day = mild

WCC 15+ / elevate creatinine 50% from normal = moderate

Hypotension/ toxic megacolon = severe

58
Q

gastric cancer summary

A

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
Q

oesophageal cancer summary?

A

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
Q

rectal cancer signs and symptoms?

A

Tenesmus
Fresh blood
incontinence
flatulence

+ FLAWS

61
Q

Colonoscopy + Biopsy is gold standard for colorectal cancer

but what would be seen on barium enema?

A

apple core lesion

62
Q

what tumour marker can be used to monitor disease for colorectal cancer?

A

CEA marker

63
Q

screening for colorectal cancer?

A

Faecal Immunochemical test – FIT, ever 2 years to men and women ages 60-74 years old

64
Q

DUKEs staging?

A

For colorectal cancer

Stage a = confined to mucosa

B = invading bowel wall

C = lymph node mets

D = distant mets

65
Q

Hepatitis D ix and tx?

A

ix - Anti HDV test

  • interferon
66
Q

Hepatitis A ix?

A

IgM anti Hep A (HAV) test positive

67
Q

Coeliac - histology

A

Crypt hyperplasia
Villous atrophy
increased intraepithelial lymphocytes

68
Q

Coeliac - derm feature

A

Dermatitis herpetiformis (blistering, itchy papules and vesicles on legs)

69
Q

Coeliac - initial screening
Coeliac - gold standard diagnosis

A
  • Anti tissue transglutaminase (IgA anti tTG)
    ( IgG anti tTG if IgA deficient px)
  • Duodenal biopsy
70
Q

Gallstones (biliary colic)
no signs of fever, inflammation, infection. negative murphys

  • first line ix
  • most sensitive test?
A
  • ultrasounds
  • MRCP
71
Q

as well as gallstones what may cause cholecystitis?

A

total paraenteral nutrition

as fasting can cause hypomotlity of gallbladder + stasis

72
Q

gallbladder wall on US?

A

Normal with gallstones (a patient with sx of colic) = thin

thick = if they have cholecystitis (inflammed bladder due to blockage)

73
Q

Charcots triad + reynolds pentad seen in?

A

acute cholangitis

  • RUQ pain + fever + Jaundice

Reynaolds pentad = + hypotension + mental state change

74
Q

Best first ix / mx for acute cholangitis?

A

ERCP = help observe and can decompress

75
Q

appendicitis

  • Mc Burney point tenderness
  • Rovsings sign
  • Psoas sign
  • Obturator sign
  • Blumberg sign
A
  • 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
Q

IBD derm manifestations

A

Erythema nodosum - red shins

pyoderma gangrenosum - ulcers on legs

77
Q

all UC management

A

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
Q

refeeding syndrome

A

(malnutrition)

feeding following a period of starvation

  • hypophosphataemia
  • hypokalaemia
  • hypomaagnesium

may predispose to torsades de pointes

79
Q

Boerhaave perforation summary

A
  • 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
Q

Mallory weiss tear vs boerhaave?

A

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
Q

Gold standard for bowel perforation?

A

CT with IV contrast

82
Q

AXR and CXR perforation signs?

A

AXR - rigler sign

CXR - pneumoperitoneum

83
Q

cirrhosis changes to liver?

A

Fibrosis and conversion of normal liver architecture or abnormal ‘regenerative nodules’

84
Q

cirrhosis specific sensitive ix?
ix once someone is diagnosed
every 6 months ix?

A

Liver biopsy ALTHO Transient elastography is done 1st line due to less bleeding risk

upper Gi endoscopy = varices

US + AFP for HCC

85
Q

child pugh score?

A

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
Q

Ascites SAAG categories?

A

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
Q

Ascitic transudative vs exudative fluid?

A

transudative means low protein = SAAG11+

exudative means high protein = SAAG11-

88
Q

SBP prophylaxis after therapeutic ascitic drainage?

A

Ciprofloxacin or norfloxacin

  • give IV albumin when doing large volume paracentesis
89
Q

If crohns is in small bowel wat ix is done?

A

MRI

90
Q

if upper endoscopy is negative when doing it for a GORD alarm features?

A

Do a OS manometry

91
Q

hydroxycobalamin?

A

Vitamin B12 → IM supplementation of vitamin B12 (hydroxocobalamin)

Always replace vitamin B12 before folate - protects against subacute combined degeneration of the cord

92
Q

what is a good indicator of poor prognosis SBP?

A

renal dysfunction

93
Q

treat sbp with cefotaxime (empirical abx) but what is prophylactic abx and when is it needed?

A

ascitic fluid protein concentration <15 g/L or a previous episode of SBP → continuous antibiotic prophylaxis (oral ciprofloxacin or norfloxacin)

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