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Gastroenterology Flashcards

1
Q

What are the CAGE questions?

A

C - Ever thought you should Cut down
A - Do you get annoyed at others commenting on your drinking?
G - Ever feel guilty about drinking?
E - Eye opener? Ever drink in the morning to help your hangover

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2
Q

When to admit to hospital with alcohol withdrawal?

A

High risk of delirium tremens or seizures
Vulnerable groups - frail, lack social support, learning difficulties, <18y

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3
Q

Time-frame after last drink leading to delirium tremens?

A
  • 6-12 hours – tremor, sweating, headache, craving, anxiety
  • 12-24 hours – Hallucinations
  • 24-48 hours – Seizures
  • 24-72 hours – Delirium tremens
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4
Q

Acute alcohol withdrawal Mx?

A

Benzodiazepines (chlordiazepoxide) or Carbamazepine
+ thiamine

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5
Q

Delirium tremens Mx?

A

Oral lorazepam
Parenteral lorazepam or haloperidol

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6
Q

Wernicke’s triad?

A

Confusion
Oculomotor disturbances
Ataxia

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7
Q

Features of Korsakoff syndrome?

A

Untreated Wernicke’s -> Korsakoff syndrome

Memory impairment (anterograde and retrograde)
Behavioural changes
Confabulation

Korsakoff syndrome is irreversible -> Full time carer needed

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8
Q

Stepwise progression of alcohol liver disease?

A
  1. Alcohol related fatty liver
  2. Alcoholic hepatitis
  3. Cirrhosis
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9
Q

Alcohol-related liver disease Ix finidngs?

A
  • FBC – raised MCV
  • LFTS – elevated ALT, AST and raised gGT
  • Clotting – elevated prothrombin time
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10
Q

Ix to assess degree of cirrhosis?

A

Fibroscan

Every 2 years in patients at risk of cirrhosis

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11
Q

Diagnostic test of alcohol-related hepatitis or cirrhosis?

A

Liver biopsy

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12
Q

Px of delirium tremens?

A

Acute confusion
Severe agitation
Delusions and hallucinations
Tremor
Tachycardia
Hypertension
Hyperthermia
Ataxia (difficulties with coordinated movements)
Arrhythmias

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13
Q

What tool is used to score a patient of their withdrawal symptoms and guide mx?

A

CIWA-Ar

Clinical Institute Withdrawal Assessment – Alcohol revised

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14
Q

Mx of alcohol-related hepatis?

A

Stop drinking alcohol + nutritional support
Mx complications of cirrhosis
Severe alcoholic hepatitis -> steroids

Liver transplant referral but must abstain from alcohol for 3 months prior to referral

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15
Q

Cirrhosis complications? (5)

A

Portal hypertension
Varices
Ascites
Hepatorenal syndrome
Hepatic encephalopathy

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16
Q

Most common causes of liver cirrhosis? (4)

A

Alcoholic liver disease
NAFLD
Hepatitis B
Hepatitis C

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17
Q

Investigation findings of cirrhosis?

A

LFTS - if decompensated, all abnormal
Synthetic function - low albumin and high pro-thrombin time = worse-off
U&Es - hyponatraemia

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18
Q

Hepatocellular carcinoma monitoring in liver cirrhosis?

A

Every 6 months?
- Alpha-fetoprotein (tumour marker) is measured
- Ultrasound

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19
Q

What scoring systems for cirrhosis?

A

Child-Pugh score - severity of cirrhosis

MELD score - 3 month mortality of cirrhosis (guides liver transplant)

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20
Q

Prophylaxis of variceal haemorrhage?

A

Propranolol
Medium to large varices -> band ligation
TIPSS if other measures unsuccessful

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21
Q

Mx of bleeding varices?

A

ABC
Correct clotting - VitK & fresh frozen plasma

Before endoscopy:
- Vasoactive agents - terlipressin
- Prophylactic IV antibiotics - quinolones

Endoscopic band ligation or sclerosant injection

Uncontrolled -> Sengstaken-Blakemore tube

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22
Q

Mx of cirrhosis -> ascites?

A

Low sodium diet
Anti-aldosterone diuretics - spironolactone
Paracentesis - ascitic tap or ascitic drain

Prophylactic antibiotics against spontaneous bacterial peritonitis (ciprofloxacin or norfloxacin) in patients with less than 15g/litre of protein in the ascitic fluid

If refractory ascites -> consider TIPs or transplant

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23
Q

Px of spontaneous bacterial peritonitis?

A

Fever
Abdo pain
Deranged bloods
Ileus
Hypotension

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24
Q

Most common causative agent of SBP?

A

E. coli
Klebsiella pneumoniae
GM+ve coccit

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25
Mx of spontaneous bacterial peritonitis?
Ascitic culture Cefotaxime
26
What is hepatorenal syndrome?
When Cirrhosis -> portal hypertension -> dilatation of portal blood vessels This leads to blood being moved away from other areas of the body such as the kidneys -> rapidly deteriorating kidney function
27
What is hepatic encephalopathy?
Liver doesn't metabolise toxins properly -> build-up of toxin (especially ammonia)
28
Mx of hepatic encephalopathy?
Laxatives - increase excretion of ammonia Antibiotics (rifamixin) Nutritional support
29
NAFLD stages?
1. Non-alcoholic Fatty Liver Disease 2. Non-Alcoholic Steatohepatitis (NASH) 3. Fibrosis 4. Cirrhosis
30
Ix for hepatic steatosis?
Liver ultrasound
31
Ix for assessing liver fibrosis?
1. Enhanced liver fibrosis (ELF) 2. NAFLD fibrosis score 3. Fibroscan
32
Mx for NAFLD?
Lifestyle Vitamin E Pioglitazone
33
Mx of hepatitis A?
Supportive with analgesia Resolves in 1-3 months
34
Hepatitis A spread?
Faecal-oral route
35
Hepatitis B spread?
Direct contact with blood or bodily fluids - PWID, tattoos
36
What doe antibodies HBsAg, HBcAG, HBsAb mean?
HBsAg - active infection HBcAb - past or current infection HBsAb - implies vaccination or past or current infection
37
IgM and IgG of HBcAb indicate?
IgM implies active infection - High titre indicates acute infection - Low titre indicates chronic infection IgG indicates a past infection
38
What does HBeAg indicate?
HBeAg is a marker of viral replication and implies high infectivity Higher HBeAg = Greater infectivity
39
Hepatitis C spread?
Spread by blood and bodily fluids
40
What hepatitis is an RNA virus and DNA virus?
Hepatitis B is a DNA virus Hepatitis C is an RNA virus
41
Ix for Hep C?
Screening - hepatitis C antibody Diagnositc - hepatitis C RNA testing
42
Ix of autoimmune hepatitis?
Antibodies Type 1: - ANA - Anti-smooth muscle antibodies (anti-actin) - Anti-soluble liver antigen Type 2: - Anti-liver kidney microsomes-1 (anti-LKM1) - Anti-liver cytosol antigen type 1 (anti-LC1) Dx - liver biopsy
43
Mx of autoimmune hepatitis?
High dose steroids (prednisolone) followed by azathioprine
44
What is haemochromatosis?
Iron storage disorder -> excess rotal body iron and deposition of iron in tissues
45
Px of haemochromatosis?
Typically over 40y Chronic tiredness Joint pain Pigmentation Hair loss Erectile dysfunction / amenorrhoea Cognitive symptoms
46
Dx of haemochromatosis?
1. High serum ferritin and high transferrin Dx - Genetic testing
47
Mx of haemochromatosis?
Venesection + monitoring serum ferritin & avoid alcohol
48
What is Wilson's disease?
Excessive accumulation of copper in the body and tissues
49
Inheritance of haemochromatosis and Wilson's disease?
Autosomal recessive
50
Px of Wilson's disease?
Hepatic - chronic hepatitis -> cirrhosis Neurological - dysarthia, dystonia, parkinsonism - Asymmetrical motor symptoms Psychiatric - depression, psychosis
51
Kayser-fleischer rings a sign of?
Wilson disease
52
Dx of Wilson's disease?
Ix - serum caeruloplasmin Low suggests wilson's disease Dx - liver biopsy or 24-hour urine copper assay
53
Mx of Wilson's disease?
Penicillamine Trientene
54
Px of alpha 1 antitrypsin deficiency?
Liver cirrhosis after 50y Bronchiectasis and emphysema in lungs after 30y
55
Ix of alpha-1-antitrypsin deficiency?
Screening - low serum-alpha-1-antitrypsin Liver biopsy shows cirrhosis and acid-Schiff-positive staining globules in hepatocytes
56
What is PBC and PSC?
PBC - small intrahepatic ducts PSC - medium to large extrahepatic and intrahepatic ducts
57
PBC or PSC correlated with IBD?
PSC
58
Bloods & Autoantibodies associated with PBC?
Anti-mitochondrial antibodies Anti-nuclear antibodies (35%) ESR and IgM raised
59
Mx of PBC?
For pruritis: - Ursodeoxycholic acid - Colestryamine Consider immunosuppression and transplant
60
Autoantibodies associated with PSC?
p-ANCA (94%) ANA (77%& Anticardiolipin antibodies (aCL) in up to 63%
61
Dx of PSC?
MRCP
62
Mx of PSC?
ERCP to dilate and stent bile ducts Pruritis -> consider colestramine Consider liver transplant
63
What is MRCP and ERCP?
MRCP - MRI scan of lover, bile ducts and pancreas ERCP - endoscopy + x-rays & contrast to identify abnormalities
64
Px of PSC & PBC?
PSC: Jaundice Chronic right upper quadrant pain Pruritus Fatigue Hepatomegaly PBC specific - Xanthoma and xanthelasma - Raised papules or bumps on trunks, arms or legs (skin coloured, pink or yellow)
65
Types of liver cancer?
Hepatocellular carcinoma (80%) Cholangiocarcinoma (20%) Metastatic liver cancer
66
CA19-9 a tumour marker for?
Cholangiocarcinoma
67
Alpha-fetoprotein a tumour marker for?
Hepatocellular carcinoma
68
Mx of hepatocellular carcnioma?
Resection Tyrosine kinase inhibitors - sorafenic, regorafenib and lenvatinib Resistant to chemotherapy + radiotherapy
69
What is a haemangioma?
Common benign tumour of the liver
70
What is focual nodular hyperplasia?
Benign liver tumour made of fibrotic tissue - Asymptomatic and no malignant potential - Related to oestrogen
71
Most common causes of acute liver failure?
Acute viral hepatitis Paracetamol overdose
72
What is the cell-makeup of the oesophagus and the stomach?
Oesophagus - squamous Stomach - columnar
73
Red flags for endoscopy?
Dysphagia Aged over 55 (urgent > routine referrals) Weight loss Upper abdominal pain / reflux Treatment resistant dyspepsia Nausea and vomiting Low haemoglobin Raised platelet count -> 2 week referral
74
Mx of GORD?
1. Lifestyle + acid neutralising mx (gaviscon, rennie) 2. PPI - omeprazole, lansoprazole 3. Ranitidine (H2 receptor antagonist)
75
What kind of bacteria is H. Pylori?
Gram negative aerobic bacteria
76
Test for H.pyloria?
Urea breath test Stool antigen test During endoscopy -> rapid urease test
77
Mx of H. Pylori?
PPI + 2 antibiotics (amoxicillin & clarithromycin) for 7 days
78
What is Barrett's Oesophagus?
Metaplasia from squamous to columnar epithelium in lower oesophageal epithelium
79
How does eating affect gastric and duodenal ulcers?
Eating; - Worsens pain from gastric ulcers - Improves pain from duodenal ulcers
80
Mx of peptic ulcer?
Endoscopy + rapid urease test - exclude malignancy Mx - PPI
81
What is pyloric stenosis?
Narrow pylorus causing difficulty in emptying stomach content Can be a complication of peptic ulcer -> strictures
82
Crohn's mnemonic?
NESTS N – No blood or mucus (less common) E – Entire GI tract S – “Skip lesions” on endoscopy T – Terminal ileum most affected and Transmural (full thickness) inflammation S – Smoking is a risk factor (don’t set the nest on fire)
83
Ulcerative colitis mnemonic?
CLOSEUP C – Continuous inflammation L – Limited to colon and rectum O – Only superficial mucosa affected S – Smoking is protective E – Excrete blood and mucus U – Use aminosalicylates P – Primary Sclerosing Cholangitis
84
Screening test for IBD?
Faecal calprotectin
85
Dx of IBD?
Endoscopy (OGD and colonoscopy) with biopsy
86
IBD associaitons?
Crohn's - Wight loss, strictures, fistulas UC - PSC
87
Mx of Crohn's?
Induce remission - steroids Maintain remission - Azathioprine or Mercaptopurine Only distal ileum affected -> consider surgery
88
Mx of inducing remission in UC?
Mild-moderate: 1. Aminosalicylate (PR or Oral Mesalazine) 2. Prednisolone Severe disease: 1. IV corticosteroids 2. IV Ciclosporin
89
Mx of maintaining remission of UC?
Aminosalicylate (mesalazine oral or rectal) Alternatives: - Azathioprine - Mercaptopurine
90
Surgery option for UC?
Panproctocolectomy -> Ileostomy J-Pouch
91
When to consider IBS?
>6 months of: A - Abdominal pain B - Bloating C - Change in bowel habit
92
Lifestyle advice of IBS?
Adequate fluid intake Regular small meals Reduced processed foods Limit caffeine and alcohol Low “FODMAP” diet (ideally with dietician guidance) Trial of probiotic supplements for 4 weeks
93
Initial Mx of IBS?
Diarrhoea -> Loperamide Constipation -> Laxatives but avoid lactulose Pain (cramps) -> anti-spasmodic (hyoscine butylbromide - Buscopan)
94
2nd and 3rd line Mx of IBS?
2. Tricyclic antidepressants (amitriptyline) 3. SSRIs +/- CBT
95
Dx of IBS?
Abdo pain: - Relieved by defecation - Associated with altered bowel habit + 2 of: - Altered stool passage - Bloating - PR mucus - Worse symptoms after eating
96
Anti-bodies in Coeliac disease?
Anti-TTG Anti-endomysial (Anti-EMA)
97
Where does coeliac affects?
Small bowel, particularly jejunum
98
Ix of Coeliac disease?
Total IgA + anti-TTG + anti-EMA
99
What does endoscopy of Coeliac disease show?
Crypt hypertrophy Villous atrophy

Finals HH (21 decks)

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