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Year 3 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Metaplasia vs dysplasia

A

Metaplasia = abnormal change of one cell type to another

Dysplasia = the presence of abnormal cells

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2
Q

What would warrant an urgent 2-week referral in patient with suspected oesophageal cancer?

A

Dysphagia at any age, OR

Aged > 55 with weight loss AND any of the following:
- upper abdominal pain
- reflux
- dyspepsia

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3
Q

What is a hiatus hernia?

A

= where the stomach herniates up through the diaphragm

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4
Q

What is a type 1 hiatus hernia?

A

Type 1: sliding – stomach slides up through diaphragm, gastro-oesophageal junction passing up into thorax

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5
Q

What is a type 2 hiatus hernia?

A

Type 2: rolling – separate portion of stomach (i.e., fundus) folds around + enters diaphragm opening alongside oesophagus

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6
Q

What is a type 3 hiatus hernia?

A

Type 3: combination of sliding + rolling

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7
Q

What is a type 4 hiatus hernia?

A

Type 4: large opening with additional abdominal organs entering the thorax

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8
Q

Management for GORD

A
  • full-dose PPI for 4 to 8 weeks
  • Offe
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9
Q

Main pharmacological treatment for GORD

A

= proton-pump inhibitors, PPIs (e.g., Omeprazole + Lansoprazole)

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10
Q

GORD: What can be given if patient is having an inadequate response to PPIs?

A

= Histamine H2-receptor antagonists (e.g., Famotidine)

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11
Q

How long should patient be on full-dose PPIs in initial treatment stage of GORD?

A

= 4 to 8 weeks

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12
Q

What is laparoscopic fundoplication, and what is it used for?

A

= procedure which involves tying the fundus of stomach around the lower oesophagus to narrow the lower oesophageal sphincter

Used to help treat chronic GORD

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13
Q

What is Barrett’s Oesophagus?

A

= (pre-malignant) condition in which lower oesophageal epithelium changes squamous > columnar epithelium due to chronic acid reflux

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14
Q

What is Zollinger-Ellison syndrome?

A

= rare condition, in which duodenal or pancreatic tumours secrete excess gastrin (= a hormone that stimulates acid secretion in stomach)

Can result in severe dyspepsia, diarrhoea + peptic ulcers

Typically non-cancerous tumours

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15
Q

Is Helicobacter pylori gram-positive or gram-negative?

A

= gram-negative

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16
Q

What does H. pylori produce to help neutralise acid around itself?

A

= ammonium hydroxide

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17
Q

How long does a patient need to be off PPIs for an accurate H. pylori test?

A

= need to be 2 weeks without using a PPI

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18
Q

Which 2 methods are for initial detection of H. pylori?

A
  • carbon 13 urea breath test
  • stool antigen test
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19
Q

How is H. pylori eradicated?

A

Triple therapy:
- PPI (e.g., Omeprazole), AND
- 2 antibiotics (e.g., Amoxicillin + Clarithromycin)

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20
Q

How long is a patient required to be on a triple therapy regime for eradication of H. pylori?

A

= 7 days

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21
Q

What is achalasia?

A

= motility disorder of the oesophagus, in which lower oesophageal sphincter fails to relax

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22
Q

What is pseudoachalasia?

A

= an achalasia-pattern dilatation of the oesophagus from causes other than primary denervation

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23
Q

Typically in motility disorders, such as achalasia, do patients experience dysphagia with solids, liquids or both?

A

= solids + liquids

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24
Q

If there is a physical obstruction, are patients more likely to experience dysphagia with solids, liquids or both?

A

= solids (which can then progress to liquids as the narrowing becomes tighter)

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25
Q

Gold-standard method of diagnosing achalasia

A

= high-resolution manometry

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26
Q

A ‘bird-beak’ appearance on barium swallow is suggestive of…

A

= achalasia

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27
Q

Achalasia Treatment: What is pneumatic dilation?

A

= involves insertion of balloon down an endoscope, which is then blow up within the lower oesophageal sphincter. Leads to tearing of the muscle fibres

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28
Q

Achalasia Treatment: What is peroral endoscopic myotome (POEM)?

A

= endoscope inserted through mouth to cut muscles in the oesophagus. Cutting the muscles loosens them + prevents them from tightening and interfering with swallowing

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29
Q

Achalasia Treatment: What is surgical myotomy?

A

= surgically cutting muscle fibres of the lower oesophageal sphincter

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30
Q

Common complications of achalasia? (2)

A
  • aspiration pneumonia
  • risk of squamous cell carcinoma
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31
Q

What is the process by which squamous epithelium in oesophagus is turned into > columnar epithelium?

(as seen in Barrett’s Oesophagus)

A

= metaplasia

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32
Q

How is Barrett’s oesophagus diagnosed?

A

= histological testing of biopsy

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33
Q

Major danger in Barrett’s oesophagus?

A

= progression to adenocarcinoma

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34
Q

Frequency of endoscopic surveillance in Barrett’s oesophagus depends on what?

A

= degree of dysplasia

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35
Q

Barrett’s Oesophagus: In those with no dysplasia, how often do they require an endoscopy for surveillance?

A

= every 2 to 5 years

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36
Q

Barrett’s Oesophagus: In those with low-grade dysplasia, how often do they require an endoscopy for surveillance?

A

= every 6 months

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37
Q

Barrett’s Oesophagus: In those with high-grade dysplasia, how often do they require an endoscopy for surveillance?

A

= every 3 months

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38
Q

Pharmacological management for Barrett’s oesophagus?

A

= proton pump inhibitor (PPI)

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39
Q

Drugs: -prazole

A

= proton pump inhibitor

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40
Q

Drugs: -tidine

A

= H2-receptor Antagonists

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41
Q

What do H2-receptor Antagonists do?

A

= block the action of histamine in the stomach, decreasing the production of stomach acid

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42
Q

What is Boerhaave Syndrome?

A

= involves tearing of the oesophagus (full thickness/ transmural), usually consequence of vigorous vomiting (high intraoesophageal pressure)

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43
Q

Boerhaave syndrome vs Mallory-Weiss tear

A

Boerhaave syndrome involves rupture of the full thickness of the oesophagus wall (transmural)

Whereas, Mallory-Weiss tear causes you to vomit blood however, doesn’t tear all the way through the oesophagus

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44
Q

Mackler’s triad: chest pain, vomiting, subcutaneous emphysema, is a sign of?

A

= Boerhaave syndrome (transmural oesophageal rupture)

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45
Q

What is fluoroscopy?

A

= type of medical imaging that shows a continuous x-ray image on a monitor, like an x-ray movie

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46
Q

Why is endoscopy avoiding in patients with suspected boerhaave syndrome?

A

= may extend tear, or introduce air into the mediastinum

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47
Q

Pharmacological management of Boerhaave Syndrome (2)

A
  • IV PPI (to reduce acidity + irritation)
  • prophylactic antibiotic therapy
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48
Q

Barium swallow x-ray: corkscrew appearance is suggestive of what condition?

A

= diffuse oesophageal spasm (DES)

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49
Q

What is Mallory-Weiss Syndrome?

A

= tear of the tissue in lower oesophagus, often caused by violent coughing or vomiting

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50
Q

How is Mallory-Weiss Syndrome diagnosed?

A

= endoscopy (tears appear as red longitudinal breaks in mucosa)

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51
Q

Pharmacological supportive treatment for Mallory-Weiss tear (2)

A
  • IV PPIs (acid suppression)
  • antiemetics (if nauseous + vomiting)
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52
Q

What is Plummer-Vinson Syndrome?

A

= premalignant disorder characterised by triad of iron deficiency anaemia, dysphagia and cervical oesophageal webs

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53
Q

Key imaging technique in diagnosis of Zenker’s Diverticulum (pharyngeal pouch)?

A

= barium swallow

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54
Q

What is Zenker’s Diverticulum?

A

AKA as pharyngeal pouch

= herniation of the posterior pharyngeal wall though it’s muscular wall

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55
Q

Is a small or large bowel perforation more common?

A

= small bowel obstruction

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56
Q

What is ‘third-spacing’?

A

= in a bowel obstruction, fluid cannot reach the colon, and cannot be reabsorbed. As a result, there is fluid loss from intravascular space into GI tract, this leads to hypovolaemia + shock. This abnormal loss of fluid is referred to as ‘third-spacing’

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57
Q

3 main causes of a bowel obstruction

(account for 90% of cases)

A
  • adhesions (small bowel)
  • hernias (small bowel)
  • malignancy (large bowel)
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58
Q

Coffee bean sign seen on x-ray is indicative of?

A

= sigmoid volvulus

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59
Q

What is a closed-loop obstruction?

A

= this is when there are 2 points of obstruction along the bowel; meaning that there is a middle section sandwiched between 2 points of obstruction

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60
Q

‘Tinkling’ bowel sounds are suggestive of?

A

= bowel obstruction

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61
Q

What is volvulus of bowel?

A

= occurs when a loop of intestine twists around itself and the mesentery that supports it, causing bowel obstruction

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62
Q

On x-ray, what are distended loops of bowel suggestive of?

A

= bowel obstruction

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63
Q

Gold-standard imaging for bowel obstruction

A

= CT scan

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64
Q

Technique used for initial treatment of bowel obstruction?

A

= drip + suck

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65
Q

What might you see on an erect x-ray if there is an intra-abdominal perforation?

A

= air under the diaphragm

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66
Q

Which type of IBD is more likely to present with bleeding + mucous in stool?

A

= UC

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67
Q

In which type of IBD is the entire GI tract affected?

A

= Crohn’s

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68
Q

Which type of IBD is associated with ‘skip lesions’ on endoscopy?

A

= Crohn’s

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69
Q

In which type of IBD is only the superficial mucosa affected?

A

= UC

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70
Q

In which type of IBD is smoking a protective factor?

A

= UC

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71
Q

What region does Crohn’s disease typically affect most?

A

= terminal ileum

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72
Q

In which type of IBD do you typically use amino salicylates (e.g., Mesalazine)?

A

= UC

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73
Q

Which type of IBD is associated with primary sclerosis cholangitis?

A

= UC

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74
Q

Anti-tissue transglutaminase antibody (anti-TTG) is positive in which condition?

A

= coeliac disease

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75
Q

What stool sample test is useful in diagnosis of IBD?

A

= Faecal calprotectin

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76
Q

Investigation of choice for establishing IBD diagnosis

A

= colonoscopy (with multiple intestinal biopsies)

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77
Q

First and second-line treatment for mild to moderate ulcerative colitis

A

First-line: aminosalicylate (e.g., oral or rectal Mesalazine)

Second-line: corticosteroids (e.g., oral or rectal Prednisolone)

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78
Q

Treatment for severe acute UC flare-up

A

= IV steroids (e.g., IV hydrocortisone)

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79
Q

What is used first-line to maintain remission in UC?

A

= Aminosalicylate (e.g., oral or rectal Mesalazine)

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80
Q

What is used to induce remission in Crohn’s disease? (pharmacological)

A

= steroids (e.g., oral Prednisolone or IV hydrocortisone)

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81
Q

What is used to maintain remission in Crohn’s disease?

A

= either Azathioprine or Mercaptopurine

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82
Q

Most common causes of acute pancreatitis in UK?

A

= gallstones + alcohol

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83
Q

Causes of acute pancreatitis?

A

GET SMASHED

G – gallstones
E – ethanol (alcohol)
T – trauma
S – steroids
M – mumps (other viruses, Coxsackie B)
A - autoimmune disease (SLE) or Sjogren’s syndrome
S - scorpion venom (rare)
H – hypertriglyceridemia, hyperchylomicronaemia, hypercalcaemia, hypothermia
E – endoscopic retrograde cholangiopancreatography (ERCP)
D – drugs (e.g., Azathioprine, Mesalazine, Didanosine, Bendroflumethiazide, Furosemide, Pentamidine, Steroids, Sodium Valproate)

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84
Q

What electrolyte imbalance can be seen in patients with acute pancreatitis?

A

= hypocalcaemia

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85
Q

Cullen’s + Grey Turner’s sign are suggestive of…

A

= haemorrhagic pancreatitis

(retroperitoneal haemorrhage)

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86
Q

What is Cullen’s sign?

A

= bruising around umbilicus

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87
Q

What is Grey Turner’s sign?

A

= bruising on flanks

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88
Q

Diagnostic test for acute pancreatitis?

A

= serum amylase or lipase

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89
Q

Is serum amylase or serum lipase more specific for diagnosing acute pancreatitis?

A

= serum lipase

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90
Q

If serum or lipase levels are inconclusive + there is a high suspicion of acute pancreatitis, what is the best imaging option?

A

= CT of abdomen with contrast

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91
Q

What is the Modified Glasgow Criteria used for?

A

= assess severity of acute pancreatitis within the first 48-hours of admission

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92
Q

Management for acute pancreatitis

A

= supportive

IV fluids for resuscitation, + oxygen therapy as required
Nasogastric tube – if patient vomiting profusely
If patient able to eat, encourage if tolerated
Catheterisation – monitor urine output, start fluid balance chart
Aim for urine output at least > 0.5ml/kg/hr
Opioid analgesia (e.g., Morphine)

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93
Q

In which cases may a broad-spectrum antibiotic be considered in the treatment of acute pancreatitis?

A

= in cases of confirmed pancreatic necrosis

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94
Q

How is pancreatic necrosis confirmed?

A

= fine needle aspiration of the necrosis

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95
Q

If there is suspicion of pancreatic head malignancy, what procedure may be done?

A

= Whipple’s procedure

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96
Q

What is a Whipple’s procedure?

A

= operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct

(= pancreaticoduodenectomy)

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97
Q

Is chronic pancreatitis more common in males of females?

A

= males (4:1)

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98
Q

Main causes of chronic pancreatitis? (2)

A
  • chronic alcohol use
  • idiopathic (unknown)
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99
Q

Patient presents with long-term back pain, tenderness in epigastrium, DM and signs of malabsorption. What would you be suspicious of?

A

= chronic pancreatitis

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100
Q

Most appropriate initial test to investigate for chronic pancreatitis?

A

= faecal elastase level

(low in chronic pancreatitis)

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101
Q

When might you think to use steroids in managing chronic pancreatitis?

A

= only if autoimmune aetiology

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102
Q

3 key complications in relation to hernias

A
  • Incarceration
  • Obstruction
  • Strangulation
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103
Q

Hernias: What is incarceration?

A

= when hernia can not be reduced back (irreducible)

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104
Q

What is a Richter’s Hernia?

A

= where part of bowel wall and lumen herniate through a defect, with the other side of that section of bowel remaining within peritoneal cavity

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105
Q

What is a Maydl’s Hernia?

A

= where 2 different loops are contained in within the hernia

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106
Q

What is a tension-free hernia repair?

A

= involves placing a mesh over defect in abdominal wall to stop hernia reoccurring

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107
Q

What is a tension hernia repair?

A

= surgical operation to suture muscles + tissue on either side of defect back together again

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108
Q

Which of the following is known as an ‘indirect’ hernia?

  • where the bowel herniates through the inguinal canal
  • where the bowel herniates through a weakness in the Hesselbach’s triangle
A
  • where the bowel herniates through the inguinal canal
109
Q

Which of the following is known as an ‘direct’ hernia?

  • where the bowel herniates through the inguinal canal
  • where the bowel herniates through a weakness in the Hesselbach’s triangle
A
  • where the bowel herniates through a weakness in the Hesselbach’s triangle
110
Q

Gold-standard diagnosis for colorectal cancer?

A

= colonoscopy with biopsy

111
Q

3 types of colon cancer?

A
  • sporadic (95%)
  • hereditary non-polyposis colorectal carcinoma (HNPCC, 5%)
  • familial adenomatous polyposis (FAP, <1%)
112
Q

APC gene mutation is associated with which type of colon cancer?

A

= familial adenomatous polyposis (FAP)

113
Q

Which of the following is most likely to present with abdominal pain, iron-deficiency anaemia, (and often presents late)

  • right-sided colon cancer
  • left-sided colon cancer
A
  • right-sided colon cancer
114
Q

Which of the following is most likely to present with rectal bleeding, change in bowel habit, tenesmus

  • right-sided colon cancer
  • left-sided colon cancer
A
  • left-sided colon cancer
115
Q

What colorectal cancer screening is there in UK? (2)

A

FIT test - for those 60-74, offered every 2 years

Flexible sigmoidoscopy - for those aged 55

116
Q

Curative treatment option for colorectal cancer

A

= resectional surgery

117
Q

Which of the following types of resectional surgery, is most appropriate for cancer located in caecum, ascending or proximal transverse colon?

  • right hemicolectomy
  • left hemicolectomy
  • high anterior resection
  • anterior resection
  • abdomino-perineal excision of rectum
A
  • right hemicolectomy
118
Q

Which of the following types of resectional surgery, is most appropriate for cancer located in the distal transverse or descending colon?

  • right hemicolectomy
  • left hemicolectomy
  • high anterior resection
  • anterior resection
  • abdomino-perineal excision of rectum
A
  • left hemicolectomy
119
Q

Which of the following types of resectional surgery, is most appropriate for cancer located in the sigmoid colon?

  • right hemicolectomy
  • left hemicolectomy
  • high anterior resection
  • anterior resection
  • abdomino-perineal excision of rectum
A
  • high anterior resection
120
Q

Which of the following types of resectional surgery, is most appropriate for cancer located in the rectum?

  • right hemicolectomy
  • left hemicolectomy
  • high anterior resection
  • anterior resection
  • abdomino-perineal excision of rectum
A
  • anterior resection
121
Q

Which of the following types of resectional surgery, is most appropriate for cancer located in the anal verge?

  • right hemicolectomy
  • left hemicolectomy
  • high anterior resection
  • anterior resection
  • abdomino-perineal excision of rectum
A
  • abdomino-perineal excision of rectum
122
Q

What is an anterior resection?

A

= surgical procedure to remove the diseased portion of your bowel and rectum

123
Q

How is spontaneous bacterial peritonitis diagnosed?

A

= paracentesis (removal of fluid from abdomen through a slender needle)

124
Q

Management of spontaneous bacterial peritonitis

A

= IV Cefotaxime

125
Q

What is irritable bowel syndrome (IBS)?

A

= common functional GI disorder characterised by recurrent abdominal pain, and alterations in bowel habits, with no identifiable organic cause

126
Q

Is IBS more common in males or females?

A

= females

127
Q

What is required for a diagnosis of IBS?

A

= all differentials need to be excluded,

128
Q

In addition to more criteria, for a diagnosis of IBS, how long must a patient have abdominal pain or discomfort?

(alongside other things)

A

= 6 months

129
Q

First-line pharmacological treatment for diarrhoea in IBS?

A

= Loperamide

130
Q

First-line pharmacological treatment for constipation in IBS?

A

= Bulk-forming laxatives (e.g., Ispaghula husk)

(avoid lactulose, as can cause bloating)

131
Q

First-line pharmacological treatment for pain/ cramps in IBS?

A

= antispasmodics

(little evidence for their benefit)

132
Q

Which antidepressant is second-line pharmacological treatment in IBS?

A

= tricyclic antidepressant (e.g., Amitriptyline 5-10mg)

133
Q

What is Linaclotide (in IBS)?

A

= specialist secretory drug for constipation in IBS, used when first-line laxatives are inadequate

134
Q

What is the Glasgow-Blatchford Bleeding Score?

A

= used at initial presentation in suspected upper GI bleed. Estimates the risk of patient having an upper GI bleed

135
Q

What score on the Glasgow-Blatchford Bleeding Score indicates a high risk of an upper GI bleed?

A

= > 0

136
Q

What is the Rockall Score?

A

= used after endoscopy to estimate the risk of re-bleeding + mortality

(in relation to upper GI bleeds)

137
Q

How is an upper GI bleed diagnosed?

A

= OGD endoscopy

138
Q

What is ‘group + save’?

A

= lab checks patient’s blood group + saves a sample to match blood if needed

139
Q

What is ‘crossmatch’?

A

= lab allocates units of blood, tests if its compatible, and keeps it ready in the fridge

140
Q

Prothrombin complex concentrate can be given to patients who are actively bleeding and..?

A

= are taking Warfarin

141
Q

What pharmacological management is used in pat?

A

= Terlipressin

142
Q

What is Terlipressin + when is it used?

A

= acts as a vasopressin analogue that works by reducing portal venous pressure in the liver

Used in patients with suspected oesophageal varies

143
Q

What are given to patients with suspected oesophageal varies (2)

A
  • Terlipressin
  • broad-spectrum antibiotics
144
Q

Endoscopic treatment for oesophageal variceal bleed?

A

= variceal band ligation

145
Q

True or False: It is recommended to use a PPI before endoscopy in patients with non-variceal upper GI bleeding?

A

= False

NICE recommend AGAINST using a PPI until after endoscopy in patients with non-variceal upper GI bleeding

146
Q

4 most common causes of liver cirrhosis?

A
  • alcohol-related liver disease
  • non-alcoholic fatty liver disease (NAFLD)
  • hepatitis B
  • hepatitis C
147
Q

What would you expect albumin, prothrombin time, sodium levels and platelet levels to be in a patient with liver cirrhosis?

A

Albumin - low
Prothrombin time - high
Sodium levels - low (fluid retention)
Thrombocytopenia

148
Q

What is alpha-fetoprotein a marker for?

A

= hepatocellular cancer

149
Q

Patients with which type of liver disease can make use out of enhanced liver fibrosis (ELF) blood test to assess liver fibrosis?

A

= non-alcoholic fatty liver disease

150
Q

Imaging technique used to diagnose non-alcoholic fatty liver disease (once other causes are excluded)?

A

= USS

151
Q

What is transient elastography?

A

AKA ‘FibroScan’ - helps to determine the degree of fibrosis, it is used to assess stiffness of the liver using high-frequency sounds waves

152
Q

What test is used to confirm diagnosis of liver cirrhosis?

A

= biopsy

153
Q

What is MELD score?

A

= recommended to calculate every 6 months in patients with compensated cirrhosis. It gives an estimated 3-monthly mortality as %

154
Q

What is the Child-Pugh score?

A

= uses 5 factors to assess the severity of cirrhosis + prognosis

155
Q

How is Child-Pugh score calculated?

A

5 factors. Each factor is scored 1, 2 or, 3. Minimum score overall: 5 (scoring 1 for each factor), and maximum is 15 (scoring 3 in each factor)

156
Q

4 features of decompensated liver disease?
‘AHOY’

A

A - ascites
H - hepatic encephalopathy
O - oesophageal varices bleeding
Y - yellow (jaundice)

157
Q

How do patients with liver cirrhosis present with cachexia (excessive muscle wasting)?

A

Patients often have a loss of appetite resulting in reduced intake. Cirrhosis affects protein metabolism in the liver + reduces the amount of protein the liver produces.

It also disrupts the ability of the liver to store glucose as glycogen + release it when requires.

Less protein available for maintaining muscle tissue, its broken down and used for fuel

158
Q

What is variceal ligation?

A

= involves a rubber band wrapped around the base of the varices, cutting off the blood flow through the vessels

159
Q

What is a transjugular intrahepatic portosystemic shunt (TIPs) - used in reducing portal hypertension

A

= procedure that involves inserting a stent (tube) to connect the portal veins to adjacent blood vessels that have lower pressure. This relieves the pressure of blood flowing through the diseased liver and can help stop bleeding and fluid back up.

160
Q

Cirrhosis causes
- exudative ascites
- transudative ascites

A
  • transudative ascites (low protein content)
161
Q

Stepwise progression of alcohol-related liver disease (3 steps)

A
  1. alcoholic fatty liver
  2. alcoholic hepatitis
  3. cirrhosis
162
Q

UK: Recommendation for alcohol consumption

A

= 14 units per week, spread over 3 or more days. (Not more than 5 units in a single day)

163
Q

Vitamin B1 is also known as?

A

= thiamine

164
Q

What is the CAGE Questionnaire used for?

A

= quickly screen for harmful alcohol use

165
Q

What are the CAGE questions?

A

C – Cut down? Do you think you should cut down?
A – annoyed? Do you get annoyed at others commenting?
G – guilty? Do you ever feel guilty about drinking?
E – eye opener? Do you every drink in the morning to help with your hangover or nerves?

166
Q

How long after alcohol consumption creases can tremors, sweating, headaches, craving + anxiety start?

  • 6-12 hours
  • 12-24 hours
  • 24-48 hours
  • 24-72 hours
A
  • 6-12 hours
167
Q

How long after alcohol consumption creases can hallucinations start?

  • 6-12 hours
  • 12-24 hours
  • 24-48 hours
  • 24-72 hours
A
  • 12-24 hours
168
Q

How long after alcohol consumption creases can seizures start?

  • 6-12 hours
  • 12-24 hours
  • 24-48 hours
  • 24-72 hours
A
  • 24-48 hours
169
Q

How long after alcohol consumption creases can delirium tremens start?

  • 6-12 hours
  • 12-24 hours
  • 24-48 hours
  • 24-72 hours
A
  • 24-72 hours
170
Q

What is delirium tremens? and why does it happen?

A

= medical emergency associated with alcohol withdrawal

Alcohol stimulates GABA receptors (inhibitory), and inhibit glutamate receptors (excitatory receptors), causing a relaxing effect on electrical activity of the brain. When alcohol is removed, GABA under-functions, and glutamate over-functions, causing extreme excitability of brain + excessive adrenergic activity

171
Q

What is Chlordiazepoxide + what is it used for?

A

= Benzodiazepine, used to combat effects of alcohol withdrawal

172
Q

Managing alcohol withdrawal?

A

Chlordiazepoxide
High-dose B vitamins IM or IV, followed by long-term oral thiamine

173
Q

Confusion, oculomotor disturbances (eye movements) + ataxia are signs of which of the following:

  • Wernicke’s encephalopathy
  • Korsakoff syndrome
A
  • Wernicke’s encephalopathy
174
Q

Memory impairment (retrograde + anterograde) + behavioural changes are signs of which of the following:

  • Wernicke’s encephalopathy
  • Korsakoff syndrome
A
  • Korsakoff syndrome
175
Q

Which of the following are the liver enzymes:

  • ALT + AST
  • ALP + GGT
  • Amylase
  • Lipase
A
  • ALT + AST
176
Q

Which of the following as associated with the biliary system?

  • ALT + AST
  • ALP + GGT
  • Amylase
  • Lipase
A
  • ALP + GGT
177
Q

Is ALT or AST predominately produced by the liver?

A

= ALT

178
Q

Is ALP or GGT predominately produced in hepatobiliary system?

A

= GGT

179
Q

What might a normal GGT, but high ALP suggest?

A

= bone problem

(high osteoclastic activity)

180
Q

What might a sudden increase in ALP + GGT indicate?

A

= hepatocellular carcinoma

181
Q

What might a high GGT indicate?

A

= heavy alcohol use

182
Q

Gold standard for diagnosing non-alcoholic fatty liver disease (NAFLD)?

A

= liver biopsy

183
Q

First-line test for assessing fibrosis in non-alcoholic fatty liver disease?

A

= enhanced liver fibrosis (ELF) blood test

184
Q

What is haemochromatosis?

A

= genetic condition resulting in iron overload. There is excessive total body iron + deposition of iron in tissues. This is an iron storage disorder

(autosomal recessive)

185
Q

Which of the following is associated with skin pigmentation (bronze)?

  • Haemochromatosis
  • Wilsons disease
A
  • Haemochromatosis
186
Q

Haemochromatosis: What serum ferritin + transferrin saturation levels would you expect?

A

Serum ferritin - high
Transferrin saturation - high

187
Q

What is Perl’s stain used for alongside liver biopsy?

A

= used to establish iron concentration in the liver

(can be used in haemochromatosis investigations)

188
Q

What kind of imaging can be used to quantify the iron concentration in the liver?

A

= MRI scan

189
Q

Management of haemochromatosis?

A

= venesection

Important to monitor serum ferritin + treat complications

190
Q

What is venesection?

A

= regularly removing blood to remove excess iron. Used in treating haemochromatosis

191
Q

What is Wilson’s disease?

A

= autosomal recessive genetic condition resulting in excessive accumulation of copper in body tissues, particularly in the liver

192
Q

Which of the following typically presents in teenagers or young adults?

  • Haemochromatosis
  • Wilson’s disease
A
  • Wilson’s disease
193
Q

Kayser-Fleischer rings on examination suggest patient has..?

A

= Wilson’s disease

194
Q

What is caeruloplamin?

A

= protein that carries copper in the blood

195
Q

In Wilson’s disease, is serum caeruloplasmin high or low?

A

= low

196
Q

What is the ‘double panda sign’ on MRI brain suggestive of?

A

= Wilson’s disease

197
Q

First-line treatment for Wilson’s disease

A

= copper chelation, using Penicillamine

198
Q

Zinc salts effect on copper absorption in the GI tract?

A

= inhibits copper absorption in the GI tract

199
Q

Middle-aged women presenting with itching, a positive anti-AMA and a raised alkaline phosphatase.

What is the diagnosis?

A

= Primary Biliary Cholangitis

200
Q

What is Primary Biliary Cholangitis (PBC)?

A

= autoimmune condition where the immune system attacks the small bile ducts in the liver, resulting in obstructive jaundice + liver disease

201
Q

What causes pruritus in PBC?

  • raised bilirubin
  • raised cholesterol
  • raised bile-acids
A
  • raised bile-acids
202
Q

Raised ALP + presence of anti-mitochondrial antibodies (AMA) indicates a diagnosis of

  • Primary Biliary Cholangitis
  • Primary Sclerosing Cholangitis
A
  • Primary Biliary Cholangitis
203
Q

What is Ursodeoxycholic acid used to treat?

A

= primary biliary cholangitis

204
Q

What is primary sclerosis cholangitis?

A

= a condition where the intrahepatic + extrahepatic bile ducts become inflamed + damaged, developing strictures, that obstruct the flow of bile out the liver and into the intestines

205
Q

Difference between primary biliary cholangitis + primary sclerosis cholangitis?

A

PSC is characterised by damage of medium to large extra-hepatic and intra-hepatic bile ducts

Whereas PBC chiefly targets small intrahepatic bile ducts

206
Q

Primary sclerosing cholangitis (PSC) is strongly associated with which other condition?

A

= ulcerative colitis

207
Q

Autoantibodies are HELPFUL in diagnosis of which of the following:

  • PBC
  • PSC

(not the other)

A
  • PBC
208
Q

Diagnostic imaging investigation in primary sclerosing cholangitis?

A

= MRCP

209
Q

Definitive treatment of primary sclerosing cholangitis?

A

= no treatments proven to be effective

210
Q

What is Colestyramine? and what is it used to relieve?

A

= bile acid sequestrate, used for symptoms of pruritus

211
Q

Which of the following responds well to treatment with steroids?

  • primary sclerosing cholangitis
  • IgG4-related sclerosing cholangitis
A
  • IgG4-related sclerosing cholangitis
212
Q

What is acute cholecystitis?

A

= refers to inflammation of the gallbladder, which is caused by a blockage of the cystic duct, preventing gallbladder from draining (usually caused by gallstones)

213
Q

What is Murphy’s Sign? and what is it suggestive of?

A

Murphy’s sign = elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right upper quadrant. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive

Suggestive of cholecystitis

214
Q

First-line investigation in acute cholecystitis?

A

= abdominal USS

215
Q

Treatment for acute cholecystitis

A
  • IV antibodies
  • Cholecystectomy, recommended within 1 week of diagnosis
216
Q

What 2 ducts join to form the ampulla of Vater?

A

Common bile duct + Pancreatic duct

217
Q

Risk factors for gallstones (4)

A

‘4 F’s’
Fat
Fair
Female
Forty

218
Q

Severe colicky epigastric or RUQ pain, often triggered by fatty meals is associated with what diagnosis?

A

= gallstones

219
Q

First-line investigation in gallstones?

A

= abdominal USS

220
Q

Management for gallstones

A

ERCP - used to remove gallstones

If symptomatic or complications - cholecystectomy (removal of gallbladder)

221
Q

What is alpha-1 antitrypsin deficiency?

A

= genetic condition caused by low levels of alpha-1 antitrypsin

222
Q

What is alpha-1 antitrypsin?

A

= protease inhibitor

(offers protection)

223
Q

What organs does alpha-1 antitrypsin deficiency affect? (2)

A
  • lungs (COPD + bronchiectasis)
  • liver (fibrosis + cirrhosis)
224
Q

Diagnosis of alpha-1 antitrypsin deficiency is based upon what 2 investigations?

A

Low serum alpha-1 antitrypsin + genetic testing

225
Q

Is giving an infusion of alpha-1 antitrypsin to boost levels in deficiency recommended?

A

= no, there is doubt about the clinical benefit + cost effectiveness

226
Q

What should painless jaundice make you think of? (2)

A
  • cancer of the head of the pancreas
  • cholangiocarcinoma

(pancreatic cancer more common)

227
Q

Main risk factor for hepatocellular carcinoma?

A

= cirrhosis

228
Q

Patients with liver cirrhosis are offered screening for hepatocellular carcinoma.

What is part of the screening programme, and how often?

A

= every 6 months with and ultrasound and checking alpha-fetoprotein (tumour marker)

229
Q

First-line imaging investigation for hepatocellular carcinoma?

A

= liver USS

230
Q

What is transarterial chemoembolization (TACE)?

A

= interventional radiology procedure.
Chemotherapy drug is injected into the hepatic artery feeding the tumour, delivering the dose directly to the tumour. This is followed by embolization of the vessel, to block the tumour’s blood supply

231
Q

What is a cholangiocarcinoma?

A

= type of cancer that originates in the bile ducts, may affect intra- or extra-hepatic ducts

232
Q

Cholangiocarcinoma is associated with which condition?

A

= primary sclerosing cholangitis (PSC)

233
Q

CA19-9, is a tumour marker for which type of cancer?

A

= cholangiocarcinoma

234
Q

Which type of peptic ulcer is most common?

A

= duodenal ulcer

235
Q

Factors which disrupt the mucus barrier in the stomach, which increases risk of peptic ulcer formation? (2)

A
  • H.pylori
  • NSAID use
236
Q

Which type of peptic ulcer presents with pain straight after eating?

A

= gastric ulcer

237
Q

Which type of peptic ulcer presents with pain 2-3 hours after eating?

A

= duodenal ulcer

238
Q

How is a peptic ulcer diagnosed?

A

= endoscopy

239
Q

Management of peptic ulcer

A

If H. pylori present: start eradication therapy

If no H. pylori: PPI until ulcer has healed

240
Q

What is coeliac disease?

A

= an autoimmune condition triggered by eating gluten

241
Q

Which part of the small bowel is most commonly affected in those with coeliac disease?

A

= jejunum

242
Q

Dermatitis herpetiformis is associated with which condition?

A

= coeliac disease

243
Q

First-line blood tests for coeliac disease (2)

A
  • total IgA levels (to exclude IgA deficiency, as it can cause a false-negative)
  • anti-tissue transglutaminase antibodies (anti-TTG)

(important patient is still eating gluten)

244
Q

What confirms diagnosis of coeliac disease after positive antibody test?

A

= endoscopy + jejunal biopsy

245
Q

What are the following findings on a jejunal biopsy indicative of?

  • crypt hyperplasia
  • villous atrophy
A

= coeliac disease

246
Q

Management of coeliac disease?

A

= lifelong gluten-free diet

247
Q

What is McBurney’s point? and tenderness over this point indicates what?

A

McBurney’s point: 1/3 of the way from anterior superior iliac spine to the umbilicus

Tenderness over this point is suggestive of appendicitis

248
Q

What is Rovsing’s sign?

A

= palpation of left iliac fossa causes pain in the RIF

Suggestive of appendicitis

249
Q

Definitive treatment of appendicitis

A

= removal of inflamed appendix (appendicectomy)

250
Q

Diverticulosis vs diverticulitis

A

Diverticulosis = refers to presence of diverticula, without inflammation or infection

Diverticulitis = refers to inflammation + infection of diverticula

251
Q

Which part of the large colon is most likely to be affected by diverticula formation?

A

= sigmoid colon

252
Q

Management of diverticulosis

A
  • increased fibre in diet
  • bulk-forming laxatives
253
Q

Management of uncomplicated acute diverticulitis?

A
  • oral co-amoxiclav
  • analgesia (avoid NSAIDs + opiates)
  • only take fluid liquids
254
Q

What are the 3 main branches of the abdominal aorta that supply the abdominal organs?

A
  • coeliac artery
  • superior mesenteric artery
  • inferior mesenteric artery
255
Q

How is chronic mesenteric ischaemia diagnosed?

A

= CT angiography

256
Q

First-line management of chronic mesenteric ischaemia?

A

Revascularisation to improve blood flow to intestines - via endovascular procedure - percutaneous mesenteric artery stenting

257
Q

How is acute mesenteric ischaemia diagnosed?

A

= contrast CT

258
Q

Which of the following would you expect to see in a patient with mesenteric ischaemia?

  • metabolic acidosis normal lactate
  • metabolic alkalosis with normal lactate
  • metabolic acidosis with raised lactate
  • metabolic alkalosis with raised lactate
A
  • metabolic acidosis with raised lactate
259
Q

Mortality associated with acute mesenteric ischaemia?

A

> 50% (very high)

260
Q

How is pulmonary embolism diagnosed? (steps)

A

CXR first - rule-out other pathology

Well’s score:
- if PE likely: perform CTPA, or alternative imaging
- unlikely: perform d-dimer, if +ve, perform CTPA

261
Q

First-line imaging option in diagnosing a PE?

A

= CT pulmonary angiogram

262
Q

Which of the following would be expect a patient with a PE to present with?

  • respiratory acidosis, low pO2
  • respiratory alkalosis, low pO2
  • respiratory acidosis, high pO2
  • respiratory alkalosis, high pO2
A
  • respiratory alkalosis, low pO2
263
Q

Mainstay of treatment in PE?

A

= anticoagulation with DOAC, Apixaban or Rivaroxaban

264
Q

If DOAC cannot be used in treating a pulmonary embolism, what is next option?

A

= LMWH

265
Q

If patient presents with a massive PE and haemodynamic compromise, how is this treated?

A

= continuous infusion of unfractionated heparin and consider thrombolysis

266
Q

For long-term anticoagulation following a PE, which of the following is first-line?

  • DOAC
  • Warfarin
  • LMWH
A
  • DOAC
267
Q

For long-term anticoagulation following a PE, which of the following is first-line in those with anti-phospholipid syndrome?

  • DOAC
  • Warfarin
  • LMWH
A
  • Warfarin
268
Q

For long-term anticoagulation following a PE, which of the following is first-line in pregnancy?

  • DOAC
  • Warfarin
  • LMWH
A
  • LMWH
269
Q

What is the ‘double duct sign’ on CT?

A

= pancreatic cancer

Year 3 (10 decks)

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