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Gastroenterology Flashcards

1
Q

Presentation of boerhaves

A

Vomiting hisotry
Tearing chest pain
Vomiting blood
Crepitus on ausculataion of chest

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2
Q

What is use of amylase in pancreatitis

A

Diagnostic value but no prognostic value
Lipase is the most sensitive and specific

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3
Q

Investigations for chronic pancreatitis

A

CT pancreas for diagnosis
Faecal elastase for monitoring exocrine function

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4
Q

Management of acute pancreatitis

A

A-E
Extensive fluids
IV opioids
Fed orally with whatever can tolerate
LMWH

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5
Q

What causes jaundice and intermittent pain post cholecystectomy

A

Common bile duct gallstones

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6
Q

What is investigation of choice for boerhaaves syndrome

A

CT contrast swallow

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7
Q

Person with crohns has jaundice

A

Bile duct stones as reduced enterophepatic recycling

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8
Q

What causes a patient to become breathless post laparascopic surgery

A

Surgical emphysema

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9
Q

What is the gingko sign

A

In subcut emphysema you can get outlining of the pectoralis muscles

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10
Q

RUQ pain and fever, how differentiate cholangitis and cholecystitis

A

In cholangitis it is likely that LFTs would be raised

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11
Q

What are the types of haemorrhoid

A

Internal
- above dentate line
- no pain typically

External
- below dentate line
- painful and thrombose

*dentate line separates upper and lower anus

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12
Q

Management of asymptomatic hernia if not fit for surgery

A

Hernia truss- like a strap

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13
Q

Associations of sigmoid volvulus

A

Old
Constipation
Chagas disease
Neurological conditions- parkinsons, DMD

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14
Q

Management of sigmoid volvulus

A

Rigid sigmoidoscopy with patient in left lateral position with rectal tube insertion later to drain
If unstable may need hartmanns or laporotomy

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15
Q

Management of caecal volvulus

A

Operative- may need right hemicolectomy

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16
Q

What counts as dilated small bowel, large bowel and caecum

A

SB- 3cm
LB- 6cm
Caecum- 9cm

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17
Q

Management of post operative ileus

A

If severe then NG tube on free drain and NBM

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18
Q

Acute vs chronic anal fissure

A

Acute= <6 weeks
Chronic= >6 weeks

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19
Q

What must do if anal fissure found elsewhere to posterior midline

A

Exclude other causes like crohns

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20
Q

How manage an acute anal fissure

A

Advice about softening stool with lots of water and fibre
Bilk forming laxatives
Topical lidocaine
Can consider GTN

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21
Q

How manage a chronic anal fissure

A

First line is topical GTN

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22
Q

What do if topical GTN not effective after 8 weeks for anal fissure

A

Refer to surgery for either sphincterctomy or botulinum toxin

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23
Q

What causes a cardiac failure patient to have a poor appetite and feel bloated

A

Ascites

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24
Q

What type of cancer is anal

A

Squamous cell carcinoma

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25
Q

Risk factor for anal cancer

A

HPV

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26
Q

Differentials for an itchy anus

A

Haemorrhoids
Anal cancer

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27
Q

What makes a hernia incarcerated

A

If it cant be reduced

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28
Q

What makes a hernia strangulated

A

If blood supply becomes restricted

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29
Q

What is management plan for hepatic adenoma

A

If haemorrhagic or other severe symptoms then surgery to remove

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30
Q

How do amoebic abscess appear on USS

A

Fluid filled with poorly defined boundaries

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31
Q

Aspiration of what liver lesion gives odourless fliod with anchovy paste consistency

A

Amoebic abscess

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32
Q

What is treatment of amoebic abscess

A

Metronidazole

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33
Q

Management of hydatid (echinococcus) cysts

A

Mebendazole
Surgical resection
NOT PERCUTANEOUS

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34
Q

What is cullens sign vs grey turners

A

Bruising around the umbilicus= cullens
Bruising in the flanks= grey turners

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35
Q

Causes of cullens sign

A

Pancreatitis
Ectopic pregnancy

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36
Q

What is boas sign

A

Hyperasthesia (extreme sensitivity) in the area beneath the right scapula

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37
Q

What can lead to faecal matter passing from the vagina

A

Diverticular disease causing fistula

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38
Q

How manage thrombolysed haemrrohoids

A

Will eventually resolve
Ice packs
Stool softeners
Analgesia
Can consider referral if within 72 hours and excruciatingly painful

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39
Q

What organism gives foul smelling stool that floats

A

Giardia

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40
Q

What organism is associated with lactose intolerance during its infection

A

Giardia

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41
Q

Where are the majority of colorectal cancers

A

Rectum

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42
Q

What do if male over 60 presents with IDA

A

Refer under 2WW for colonoscopy

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43
Q

Factors indicating a hernia is strangulated vs incarcerated

A

Blood in stool
Severe pain
Bowel obstruction

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44
Q

What is seen on AXR of caecal volvulus

A

Centrally dilated loops of bowels

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45
Q

What are epigastric hernias versus paraumbilical hernias

A

Epigastric- lie between umbilicus and xiphisternum
Paraumbilical- either directly above or below the umbilicus

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46
Q

What are the 2 types of cholecystectomy and when do

A

Laparascopic- either elective or if stable within a week of cholecystectomy
Open with kocher incision- haemodynamic instability

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47
Q

Causes of proctitis

A

IBD
C diff
Gonorrhoea
Chlamydia
Shigella

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48
Q

How to differe between haemorrhoids and fissure

A

Fissure painful
Haemorrhoids only painful if thrombosed

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49
Q

What are the dukes criteria for colorectal cancer

A

A- confined to mucosa
B- invading the bowel wall
C- lymph node mets
D- distant mets

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50
Q

What are topical anal fissure treatments

A

GTN
Diltiazem

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51
Q

How can colovesical fistulas present

A

Passing stool and air in the urine

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52
Q

How image colovesical fistulas

A

Abdominal CTs

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53
Q

If have diverticular disease causing obstruction, how manage

A

Laparotomy

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54
Q

What is difference in management for bilateral vs unilateral inguinal hernias

A

Bilateral= laparoscopic
Unilateral= open
Both mesh repair

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55
Q

Difference between indirect and direct inguinal hernias

A

Direct hernias go through weakness in hasselbachs triangle
Indirect enter the inguinal canal through the superfical ring

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56
Q

Which syndromes presdispose you to hamartomas

A

Cowden disease
Peutz jeughers

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57
Q

Syndrome with freckling and colorectal cancer

A

Peutz jeughers

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58
Q

What is a richter hernia

A

When wall of bowel herniates through fascial defect

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59
Q

What is different about presentation of richter hernia

A

Presents with strangulation symptoms but without obstructive sx

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60
Q

How differentiate whether large or small bowel dilated

A

Small bowel has lines going across- valvulae conniventes
Large bowel has haustra

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61
Q

What is management of cholecystitis

A

Do cholecystectomy within 1 week if not then do in 6 weeks

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62
Q

What is scoring system for pancreatitis severity

A

Glasgow imrie- done 48 hours after onset

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63
Q

Inducing remission in mild to moderate UC

A

Mild to moderate left sided UC
1st= rectal mesalazine
2nd= oral mesalazine
3rd= oral or topical steroid
Mild moderate extensive UC
1st= rectal and oral mesalazine
2nd= stop topical and offer oral mesalazine and corticosteroid

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64
Q

Inducing remission in severe UC

A

Admit to hospital
IV steroids

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65
Q

What can give IV as alternative to steroids in severe UC

A

IV ciclosporin

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66
Q

Maintaining remission following UC flare

A

Mild to moderate proctosigmoiditis
- topical ASA or oral and topical ASA
Mild to moderate extensive UC
- oral ASA
Severe or over 2 exacerbations in last year
- oral azathioprine or mercatopurine

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67
Q

What test use for post eradication therapy of H pylori

A

Urease breath test

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68
Q

First line management of haemochromatosis

A

Venesection

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69
Q

Second line option for haemochromatosis after venesection

A

Desferrioxamine

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70
Q

Aims of venesection treatment in haemochromatosis ie what monitor

A

Keep transferrin saturations below 50%
Keep ferritin below 50

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71
Q

Most useful screening test for haemochromatosis

A

Transferrin saturations

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72
Q

How screen family members of haemochromatosis patient

A

Genetic testing for HFE mutation

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73
Q

Investigations for haemochromatosis

A

Iron screen
LFTs
Molecular test
Liver biopsy
MRI can quantify liver iron

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74
Q

What scan quantify liver iron quantity

A

MRI

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75
Q

Oesophageal causes of upper GI bleeding

A

Varices
Cancer
Oesophagitis
Mallory weiss tear

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76
Q

Gastric causes of upper GI bleeds

A

Ulcer
Cancer
Dieulafoy lesion
Erosive gastritis

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77
Q

Duodenal causes of upper GI bleeding

A

Ulcers
Aorto-enteric fistula

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78
Q

What causes aorto-enteric fistula

A

Recent abdominal aortic aneurysm aneurysm surgery

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79
Q

What causes massive GI bleeding in post abdominal aortic aneurysm surgery

A

Aorto-enteric fistula

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80
Q

2 most common causes of upper GI bleeds

A

Peptic ulcer disease
Oesophageal varices

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81
Q

How risk assess patient with upper GI bleed

A

Glasgow batchford score on first assessment

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82
Q

What use to risk stratify upper GI bleed patients post endoscopy

A

Rockall

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83
Q

How can manage upper GI bleed with batchford of 0

A

Discharge

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84
Q

Resus management of upper GI bleed

A

ABC
Offer FFP, plt transfusions or prothrombin complex depending on blood features
Wide bore access
Offer endoscopy

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85
Q

When give platelet transfusion in upper GI bleed

A

Plts less than 50

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86
Q

Management of variceal bleeding

A

ABC
IV access
Terlipressin and prophylactic abx
Endoscopy- band ligation for oesophageal varices or ablation with N-butyl-2-cyanoacrylate for gastric varcies
Transjugular intrahepatic portosystemic shunts if these fail

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87
Q

What do if endoscopy band ligation and cryoablation fail

A

Transjugular intrahepatic portosystemic shunts

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88
Q

What is a transjugular intrahepatic portosystmic shunt

A

Shunt created between portal vein and systemic vein to reduce portal HTN

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89
Q

What is difference in endoscopy management of gastric vs oesophageal varcies

A

Oesophageal- band ligation
Gastric- ablation with N-butyl-2-cyanoacrylate

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90
Q

If have post hepatic cause of jaundice, what would indicate pancreatic cancer over PSC or PBC

A

Anorexia
Smoking hx

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91
Q

How investigate post streptococcal glomereulonephritis

A

Anti streptolysin titre
Complement levels- low C3

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92
Q

How differentiate between IgA nephropathy and post strep glomerulonephritis

A

IgA 1-2 days after infection vs 1-2 weeks in PSG
Proteinuria and low complement in PSG

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93
Q

What is most likely abdo mass felt on examination of pancreatic cancer

A

Hepatomegaly from mets

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94
Q

What is trousseaus sign and what seen in

A

Migratory thrombophlebitis seen often in pancreatitis

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95
Q

What is courvoisiers law

A

In presence of painless jaundice, palpable gallbladder most likely caused by pancreatic cancer

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96
Q

What is double duct sign

A

Dilatation of the pancreatic and common bile ducts from pancreatic cancer

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97
Q

Inheritance of wilsons and haemochromatosis

A

AR

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98
Q

Signs on examination of wilsons

A

Blue nails
Keyser fleischer rings- brown ring

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99
Q

Neurological manifestations of wilsons

A

Basal ganglia deposition
- chorea
Cerebellar
- tremor
Dysarthria
Psychiatric
- depression
- mania
- pscyhosis

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100
Q

RFs for non-alcoholic fatty liver disease

A

Obestiy
T2DM
High lipids
Sudden weight loss/starvatino

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101
Q

What effect can rapid weight loss have on the liver

A

NAFLD

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102
Q

Which liver enzyme is most raised in NAFLD

A

ALT greater than AST

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103
Q

Investigation findings of NAFLD

A

ALT greater than AST
Increased echogenicity in liver on USS and fibroscan

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104
Q

What is first line investigation for NAFLD

A

Enhanced liver fibrosis blood test- combination of proteins which gives a score

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105
Q

Management of variceal haemorrhages

A

ABC
Terlipressin
Corrective blood products if indicated
IV quinolones if cirrhosis

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106
Q

What do if medical options for stopping variceal bleedings have not work and still awaiting OGD

A

Sengstaken blakemore tube

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107
Q

What is main complication of transjugular intrahepatic portosystemic shunt

A

Exacerbation of hepatic encephalopathy

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108
Q

Treatment options for variceal bleeds

A

Blood products depending on situation
- FFP
- platelets
- prothrombin complex
Terlipressin
Antibiotics if cirrhosis
OGD
Sengstaken blakemore tube
TPISS

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109
Q

What can be done to prevent further varcieal haemorrhages

A

Prophylactic propanolol
Endoscopic ligation
TIPSS

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110
Q

First line dementia investigations

A

In primary care do baseline bloods
- FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate
In secondary care when referred to memory clinic do neuroimaging

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111
Q

Histology of crohns

A

Inflammation in all layers from mucosa to serosa
Increased goblet cells
Granulomas

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112
Q

Histology of UC

A

Inflammaion confined to submucosa
Crypt abscesses
Goblet cells depletion

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113
Q

Endoscopy appearance of crohns

A

Deep ulcers
Cobble stone appearance
Skip lesions

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114
Q

Endoscopy of UC

A

Widespread ulceration
Pseudopolyps

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115
Q

Radiological choice for crohns vs UC

A

Crohns- small bowel enema
UC- barium enema

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116
Q

Small bowel enema findings in crohns

A

Strictures
Proximal bowel dilatoin
Rose thorn ulcers
Fistulae

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117
Q

Barium enema findings in UC

A

loss of haustrations
superficial ulceration, ‘pseudopolyps’

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118
Q

Management of alcoholic hepatitis

A

Prednisolone

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119
Q

LFT ratios in alcoholic hepatitis

A

AST:ALT normally >2 but >3 is indicative of alcoholic hepatitis

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120
Q

What are types of GI ischaemic disease

A

Acute mesenteric ischaemia
Chronic mesenteric ischaemia
Ischaemic colitis

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121
Q

Main rf mesenteric ischaemia

A

AF

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122
Q

Presentation of mesenteric ischaemia

A

Acute onset abdo pain
Very severe and out of keeping with physical exam

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123
Q

Management of acute mesenteric ischaemia

A

Laparotomy ASAP

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124
Q

Presentation of chronic mesenteric ischaemia

A

Intestinal angina
Colicky abdo pain after eating
Weight loss

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125
Q

What is thumbprinting on AXR seen in

A

Ischaemic colitis

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126
Q

What is ischaemic colitis

A

Acute but transient vascular compromise to large bowel leading to ulceration and haemorrhage

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127
Q

Management of ischaemic colitis

A

Conservative
Surgery if needs be

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128
Q

Investigation of choice for ischaemic colitis

A

CT

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129
Q

Rfs for ischaemic colititis

A

CVD rfx
Can get in young people following use of cocaine

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130
Q

What can cause ischaemic colitis in young person

A

Cocaine use

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131
Q

Man with IHD and HTN presents with abdo pain and bleeding

A

Ischaemic colitis

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132
Q

Features of ischaemic bowel disease

A

abdominal pain - in acute mesenteric ischaemia this is often of sudden onset, severe and out-of-keeping with physical exam findings
rectal bleeding
diarrhoea
fever
bloods typically show an elevated white blood cell count associated with a lactic acidosis

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133
Q

Blood findings in ischaemic bowel disease

A

WCC raised
Lactic acidosis

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134
Q

Antibiotics associated with c diff

A

Clindamycin
Cephalosporins (2nd and 3rd gen)

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135
Q

What is test for c diff

A

Toxin PCR assay from stool sample

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136
Q

What does positive c diff antigen indicate

A

Only exposure to bacteria rather than infection

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137
Q

Management of life threatening C diff

A

IV metro
Oral vancomycin

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138
Q

What makes c diff life threatening

A

Hypotension
Ileus
Toxic megacolon

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139
Q

Mild, moderate and severe c diff criteria

A

Mild- normal WCC
Moderate- WCC up but less than 15
Severe- above 15

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140
Q

Management of non lifethreatening c diff

A

Oral vanco first line

141
Q

Second line c diff maangement

A

Oral fidaxomicin

142
Q

Third line c diff management

A

Oral vanco and IV metro

143
Q

Investigation of choice for budd chiari

A

US with doppler studies

144
Q

Triad for budd chiari

A

Abdo pain, severe and sudden
Ascites-> abdominal distension
Tender hepatomegalyR

145
Q

Rfs for budd chiari

A

Polycythaemia rubra vera
COCP
Pregnancy
Thrombophilias- protein C resistance, antithrombin deficiency, protein S and C deficiency

146
Q

Which cancer does barretts oesophagus lead to

A

Adenocarcinoma

147
Q

What does grey coloured stools indicate

A

Steatorrhoea

148
Q

What are 2 lymph node signs of gastric cancer

A

Virchows node
Sister mary joseph nodule- periumbilical

149
Q

Notable foods which do not contain gluten

A

Rice
Potato
Corn
Maize

150
Q

How manage liver abscesses

A

Drainage and antibiotics

151
Q

When testing for coeliac how long must be eating gluten for beforehand

A

6 weeks

152
Q

Inducing remission in crohns disease

A

Glucocorticoids- oral or IV depending on severity

153
Q

Second line drug for inducing remission in crohns

A

5-ASAs

154
Q

First line for maintaining remission in crohns

A

Azathioprine or mercatopurine

155
Q

What need to mesure bfore starting azathioprine

A

TPMT

156
Q

Investigation of choice for perianal fistula

A

MRI

157
Q

Management of symptomatic perianal fistula

A

Oral metronidazole

158
Q

Management of perianal abscess

A

Incision and drainage

159
Q

What can be used for complex perianal fistulae

A

Draining seton

160
Q

Early signs of haemochromatosis

A

Fatigue
Arthralgia
Erectile dysfunction

161
Q

Antibodies for T1 autoimmune hepatitis

A

ANA
Anti smooth muscle
Raused IgG

162
Q

Antibodies for T2 autoimmune hepatitis

A

Anti liver kidney type 1 microsomal

163
Q

What give for bile acid bile absorption

A

Cholestyramine

164
Q

Causes of bile acid malabsorption

A

Ileal disease- crohns
Cholecystectomy
Coeliac disease

165
Q

Management of H pylori ulcers

A

Triple therapy
- PPI
- 2 of amoxicillin, clarithomycin or metronidazole
If associated with NSAIDs give 2 months PPI first then abx

166
Q

In a TIPSS, where is connection made between

A

Hepatic and portal vein

167
Q

What is MOA of metoclopramide

A

Dopamine 2 receptor antagonist

168
Q

Side effects of metocloprmaide

A

Extrapyramidal side effects
Diarrhoea
High prolactin

169
Q

If patient to have endoscopy what do with PPI or omeprazole

A

Stop 2 weeks prior

170
Q

If uncertain what use to differentiate upper from lower GI bleed

A

Serum urea

171
Q

What is melanosis coli

A

Pigment disorder in the bowel caused by laxatives

172
Q

What causes pigment laden macrophages in the bowel

A

Melanosis coli

173
Q

What is most common cause of melanosis coli

A

Laxatives

174
Q

Risk factors for squamous cell carcinoma in oesophagus

A

Achalasia
Plummer vinson
Smoking
Alcohol

175
Q

What on examination suggests peritonitis

A

Guarding
Rigid abdomen
Distension
Diffuse pain all over

176
Q

Which artery most likely involved in bleeding posterior duodenal ulcer disease

A

Gastroduodenal

177
Q

Presentation of peptic ulcer disease

A

Most common presentation is haematemesis
Malaena
Hypotension and tachycardia

178
Q

Management of peptic ulcer bleeding

A

ABC
IV proton pump inhibitor after endoscopy
Endoscopic intervention

179
Q

What are options if endoscopic intervention is unsuccessful for peptic ulcer bleeding

A

Interventional angiography with transarterial embolisation
Surgery

180
Q

Additional management of coeliac

A

Due to functional hyposplenism, pneumococcal vaccine given every 5 years

181
Q

Triad for plummer vinsons

A

Dysphagia
Glossitis
IDA

182
Q

Which drugs can cause cirrhosis

A

Methotrexate
Amiodarone
Methyldopa
Sodium valproate

183
Q

Mild, moderate and severe true love witts

A

Mild- Fewer than 4x a day
Moderate- four to 6x a day
Severe- over 6x a day with systemic upset
- fever
- tachycardia
- anaemia
- distension

184
Q

If recurrent relapses of UC, what give

A

Azathioprine or mercatopurine

185
Q

What is lynch syndrome

A

HNPCC

186
Q

Long term risk of PPIs

A

Osteoprosis

187
Q

What does a musty and sulfur breath smell suggest

A

Fetor hepaticus- liver failure

188
Q

Management of dyspepsia with no red flag symptoms

A

Full dose PPI for 1 month

189
Q

What is barretts oesophagus

A

Where squamous epithelium is replaced with columnar epithelium

190
Q

First line for PBC

A

Ursodeoxycholic acid- can helo slow progression

191
Q

What can be used to treat itching from obstructive liver problems

A

Cholestyramine

192
Q

Treatment of PBC

A

Ursodeoxycholic acid
Fat soluble vitamins
Cholestyramine for itching
Liver transplant if necessary

193
Q

Diagnostic investigation for PSC

A

MRCP

194
Q

What malignancy does coeliac increase risk of

A

Enteropathy associated T cell lymphoma

195
Q

What do for oral vanc and fidaxomicin refractory mild or moderate c diff

A

Change to oral vanc and IV metro

196
Q

What is acalculous cholecystitis

A

Inflammation of the gallbladder in absence of gallstones
Typically seen in diabetic with intercurrent illness

197
Q

Management of acalculous cholecystitis

A

Cholecystectomy
Outcomes supposed to be worse than in calculous

198
Q

When do test for eradication of H pylori

A

6-8 weeks after

199
Q

What is given for every patient with hepatic encephalopathy

A

Lactulose to promote excretion of ammonia
Rifamixin reduces ammonia production

200
Q

When distinguishing between UC and Crohns from history, what does blood in stool point towards

A

UC

201
Q

Management options for achalasia

A

Pneumatic balloon dilation
Heller cardiomyotomy
Intra sphincteric botulinum toxin

202
Q

What use first line for achalasia

A

Pneumatic balloon dilation

203
Q

What use for recurrent achalasia

A

Heller cardiomyotomy

204
Q

What use for achalasia if high risk candidate for surgery

A

Intra sphincteric botulinum toxin

205
Q

What is spontaneous bacterial peritonitis

A

Form of peritonitis seen in liver cirrhosis patients with ascites which becomes infected with bacteria

206
Q

Most common cause of SBP

A

E coli

207
Q

What is diagnostic for SBP

A

Paracentesis with neutrophil count over 250

208
Q

Management of acute SBP

A

IV cefotaxime

209
Q

What give long term if has episode of SBP

A

Ciprofloxacin prophylaxis

210
Q

Which patients do you give prophylactic ciprofloxacin to

A

At least 1 episode of SBP
Low protein in ascites

211
Q

When do you add an oral ASA to a mild/moderate UC flare

A

If extends beyond the left colon as enemas can only go so far

212
Q

What does fever suggest about an UC flare up with regards to severity

A

Severe

213
Q

Complications of GORD

A

oesophagitis
ulcers
anaemia
benign strictures
Barrett’s oesophagus
oesophageal carcinoma

214
Q

MOA of terlipressin

A

Vasopressin analogue

215
Q

What is advice to men and women around regarding alcohol intake

A

No more than 14 units a week
Spread evenly over 3 days or more

216
Q

Causes of odonyphagia

A

Oesophageal candidiasis
Cancer
Eosinophillic oesophagitis

217
Q

What is operation used for GORD

A

Fundoplication

218
Q

What are investigations needed before fundoplication surgery

A

Oesophageal pH
Manometry

219
Q

What is manometry

A

Study used which looks at how well nerves and muscles work in GI tract

220
Q

Management of barretts oesophagus

A

PPI
Endoscopic surveillance
- if any dysplasia noted here intervention required

221
Q

What do if any dysplasia noted on endoscopy of barretts patient

A

Endoscopic intervention
Options include radiofrequency ablation or resection

222
Q

What happens to liver enzymes in end stage cirrhosis

A

Become low, aren’t elevated

223
Q

Best measure of long term liver dysfunction

A

Albumin

224
Q

What need to do if someone presents with sudden onset dysphagia of any age

A

Urgent endoscopy

225
Q

If patient with history of tracheo-oesophageal fistula surgery presents with dysphagia, what is likely cause

A

Benign stricture

226
Q

Prior to doing a urease breath test, when need to stop A) Antibiotics B) PPIs

A

Antibiotics- 4 weeks
PPIs- 2 weeks

227
Q

What must always do in examination of a male with RIF or LIF pain

A

Examine testicles

228
Q

What do yellow plaques on sigmoidoscopy suggest

A

Pseudomembranous colitis

229
Q

Rfx for gastric cancer

A

Pernicious anaemia
H pylori
Smoking

230
Q

How is cirrhosis best diagnosed

A

Liver fibroscan nowadays
Liver biopsy optimal in the past but very painful

231
Q

What investigation is needed for all patients with new cirrhosis diagnosis

A

Endoscopy to look for varices

232
Q

What investigations are done to monitor cirrhosis

A

Screening for HCC with USS and AFP every 6 months
Calculate MELD/ 6 months
Endoscopy every 3 years for varices

233
Q

What is most sensitive and specific test for determining if chronic liver disease has converted to liver cirrhosis

A

Plt count under 150,000

234
Q

Management of pharyngeal pouch

A

Refer to ENT
Mainstay is surgery
Can watch and wait if mild or unfit for surgery

235
Q

What is the diagnosis

A

UC- leadpipe appearance

236
Q

What is zenkers diverticulum

A

Pharyngeal pouch

237
Q

Investigation of choice for pharyngeal pouch

A

barium swallow combined with dynamic video fluoroscopy

238
Q
A

Pharyngeal pouch

239
Q

What is SAAG + equation

A

Serum ascitic albumin gradient
Serum albumin- ascitic fluid albumin

240
Q

SAAG over 11 causes

A

Liver problems cauing portal HTN
HF
Budd chiari

241
Q

SAAG under 11 causes

A

Nephrotic syndrome
TB peritonitis
Pancreatitis
SBO
Peritoneal carcinomatosis
Serositis from connective tissue disorders

242
Q

Wilsons disease management

A

Penicillamine

243
Q

What on examination of abdomen can point to a diagnosis of intestinal angna

A

Bruit over abdomen

244
Q

Best antibody for pernicious anaemia

A

Anti intrinsic factor

245
Q

Dark blue spots in and around mouth in context of bowel problems

A

Peutz jeughers

246
Q

First line for constipation in IBS

A

Bulk forming laxative (ispaghula husk)
Avoid stimulant laxative

247
Q

If on clopidogrel, which PPI use

A

Lansoprazole as omeprazole decreases efficacy of clopidogrel

248
Q

Which antiemetic give for migraine

A

Metoclopramide

249
Q

What can trigger UC flares

A

Stress
Medications- NSAIDS and antibiotics
Cessation of smoking

250
Q

What defines toxic megacolon

A

Transverse colon length over 6cm

251
Q

How to prevent ascites

A

Dietary sodium restriction

252
Q

What is serum copper in wilsons

A

Low

253
Q

First line investigation for suspected perforated ulcer disease

A

Erect CXR

254
Q

Patient with sudden extensive weight loss alongside raised liver enzymes

A

NAFLD

255
Q

Most common side effect of metoclopramide

A

Diarrhoea

256
Q

How decide which endoscopy to do to diagnose UC

A

Colonoscopy is preferred option however if severe inflammation evidence then do flexi sigmoidoscopy as risk of perforation

257
Q

What does air in bile duct suggest

A

Fistula to bowel often causing gallstone ileus

258
Q

Main side effects of aminosalicylates to be worried about

A

Agranulocytosis
Pancreatitis

259
Q
A

UC due to loss haustration

260
Q

What is occluded in budd chiari

A

Hepatic vein

261
Q

Oesophageal candidiasis rfx

A

HIV
Steroid inhalers
IV abx

262
Q

Oesophageal candidiasis presentation

A

Odonyphagia
Dysphagia
White streaks

263
Q

What causes dysphagia in a oesophageal cancer survivor

A

Post radiotherapy fibrosis

264
Q

Which medications must stop if have c diff

A

Opioids as anti peristalsic

265
Q

What is the most common type of inherited colorectal cancer

A

HNPCC

266
Q

What diagnoses malnutrition

A

Unintentional loss of 10% in last 6 months

267
Q

How can refeeding present

A

Arrythmias
Poor fluid balance

268
Q

What need to give alongside paracentesis

A

IV human albumin

269
Q

Most common cause of HCC in world vs europe

A

World- Hep B
Europe- Hep C

270
Q

First line investigation for mesenteric ischaemia

A

VBG

271
Q

What is formal boundary between lower and upper GI bleeds

A

Ligament of treitz between the duodenum and jejunum

272
Q

Causes of raised ferritin in absence of iron overload

A

Inflammation
Cancer
CKD
Alcohol
Liver disease

273
Q

Causes of iron overload

A

HH
Transfusions

274
Q

Other than potassium, what electrolyte can become very low after vomiting

A

Chloride

275
Q

Grading of hepatic encephalopathy

A

Grade 1- irritable
Grade 2- confused or abnormal behaviour
Grade 3- incoherent and restless
Grade 4- coma

276
Q

What do with antiplatelets for severe bleeding

A

Nothing

277
Q

What is important test to do on examination if GI bleed

A

Check for postural drop

278
Q

What will cause low urea

A

Liver disease

279
Q

When do OGD if evidence of active bleeding

A

Within 4 hours

280
Q

What does blood mixed in with stool tell you about location of the cancer

A

Unlikely to be a distal tumour as would be fresh in that instance

281
Q

Presentation of chronic pancreatitis

A

Typically initially get epigastric pain then a few years later develop steatorrhoea

282
Q

Management of steatorrhoea in chronic pancreatitis

A

Pancreatic enzyme replacement which will help absorb fats as less endogenous lipase production

283
Q

Causes of cholangitis

A

Stones
Strictures
Malignancy
ECRP
Pancreatitis
Mirizis

284
Q

Management of haemorrhoids (nonthrombosed) first line

A

Increasing fibre and fluid intake

285
Q

If no response to increased fluid and fibre intake plus simple anaglesia, what do for painful haemorrhoids

A

Topical preparations including lidocaine and steroids

286
Q

Management order for haemorrhoids

A

Primary care
- Increase fluid/fibre intake
- Topical preparations with steroids and lidocaine
Secondary care procedures
- sclerotherapy
- band ligation
Surgical
- haemorrhoidectomy
- artery ligation
- stapled haemorrhoidopexy

287
Q

Factors which make encourage refer to hospital for haemorrhoids

A

Grade 3 or 4
Very large
Extremely painful

288
Q

What comment on in examination of hernia which is helpful to assess risk

A

The neck size
Wide is low risk as hernia can fall out

289
Q

Investigation for bile acid malabsorption

A

SeHCAT- nuclear medicine test

290
Q

What drug can be used for treatment of abdominal pain associated with IBS

A

Meberverine hydrochloride (antispasmodic)

291
Q

what do you need to monitor with chronic pancreatitis

A

HbA1c every 6 months
DEXA every 2 years

292
Q

2 types of metaplasia in GORD

A

Squamous to columnar
1. with goblet cells= intestinal metaplasia
2. without goblet cells= gastric metaplasia

293
Q

What is 2ww investigation for liver cancer

A

USS

294
Q

Pancreatic cancer 2ww guidelines

A

Over 40 with jaundice
Over 60 with weight loss + 1 of
- Diarrhoea
- Back pain
- Abdominal pain
- Nausea
- Vomiting
- Constipation
- New-onset diabetes

295
Q

2WW for upper GI sx (suspected stomach ca)

A

Anyone with dysphagia, or
Over 55 with weight loss and 1 of
- Upper abdominal pain
- Reflux
- Dyspepsia
Do endoscopy

296
Q

GORD symptoms

A

Nocturnal cough
Dyspepsia
Hoarse voice
Metallic taste

297
Q

GORD management

A

Lifestyle- avoid alcohol, smoking, spicy foods, eat early
PPI for 1 month
Options after include ranitidine, double PPI dose or gastro referral
Can consider nissen fundoplication

298
Q

Long term GORD complications

A

Barrets
Adenocarcinoma
Strictures

299
Q

What are tests for h pylori

A

Stool antigen test
Urea breath test using radiolabelled carbon 13
H. pylori antibody test
Rapid urease test performed during endoscopy (also known as the CLO test)

300
Q

How does CLO test work

A

Done at endoscopy
Take sample then add to urea and test pH, will become alkaline if positve

301
Q

Gastric vs duodenal ulcer presentation

A

Pain on eating in gastric
Weight loss likely in gastric vs can put on weight in duodenal

302
Q

What do for follow-up if peptic ulcer identified on endoscopy

A

Need to repeat endoscopy 6-8 weeks later

303
Q

Complications of peptic ulcers

A

Perforation
Cancer
Strictures leading to gastric outflow obstruction

304
Q

Management of gastric outflow obstruction

A

Balloon dilatation or stent

305
Q

Achalasia investigations

A

Endoscopy done first to rule out obstructive dysphagia causes
Special investigations include
- oesophageal manometry showing poor relaxation of lower sphincter (gold standard)
- barium swallow (birds beak)
- CXR will show widened mediastinum

306
Q
A

Diffuse oesophageal spasm

307
Q

Boerhaaves management

A

Thoracotomy with lavage

308
Q

Eosinophilic oesophagitis features

A

Painful dysphagia
Inflammation leads to strictures and fibrosis
Inflammation with eosinophil infiltrates

309
Q

Management of eosinophilic oesophagitis

A

Swallow steroid containing fluids which line oesophagus
Endoscopic dilation of strictures

310
Q

Management of PSC

A

Cholestyramine helps with itching
Stents if dominant stricture
Liver transplant definitive

311
Q

PBC management

A

Ursodeoxycholic acid
Cholestyramine
Fat soluble vitamin replacements
Liver transplant

312
Q

Investigations for autoimmune hepatitis

A

Antibodies- ANA, anti-smooth muscle
Liver biopsy will diagnose

313
Q

Management of autoimmune hepatitis

A

Prednisolone and azathioprine
If severe then transplant

314
Q

Chronic pancreatitis management

A

Pancreatic enzyme replacement
ERCP for strictures
Analgesia
Insulin regime if diabetic

315
Q

Flexed middle finger that can be resolved by pulling out and hear a pop

A

Trigger finger

316
Q

Investigations for wilsons

A

Low serum caeruplasmin
24 hour urinary copper collection
FBC- haemolytic anaemia
Liver biopsy

317
Q

Presentation of HH

A

Bronze skin
DM
ED
Arthralgia
Pseudogout
Dilated CM

318
Q

What do to diagnose HH

A

Liver biopsy
Liver MRI if CI as can quantify iron

319
Q

Investigations for NAFLD

A

AST:ALT< 0.8
Ehanced liver fibrosis test
Do fibroscan if enhanced liver fibrosis test indicates severe fibrosis
Biopsy may be needed for diagnosis

320
Q

When refer for NAFLD

A

Advanced fibrosis suggested on scan or NAFLD/enhanced fibrosis test
Diagnostic uncertainty

321
Q

What can be secondary care NAFLD management

A

Vitamin E and pioglitazone
Transplant or bariatric surgery may be indicated

322
Q

Stages to ALD vs NAFLD

A

ALD
1. Steatosis
2. Hepatitis- get fatty changes with necrosis
3. Cirrhosis
NAFLD
1. NAFLD
2. NASH
3. Fibrosis
4. Cirrhosis

323
Q

Non-invasive liver screen if cause of hepatitis or cirrhosis unknown

A

Autoantibodies
- ANA
- ASMA
- AMA
- anti LKM-1
USS for NAFLD
Hepatitis serology
Caeruplasmin
Transferrin and ferritin
Alpha-1-antitrypsin levels

324
Q

Causes of cirrhosis

A

NAFLD
Alcohol
Hep B,C
Wilsons
Haemochromatosis
Alpha 1 antitrypsin
Autoimmune
Drugs
PBC and PSC

325
Q

Portal HTN signs

A

Splenomegaly
Oesophageal and rectal varices
Caput medusae

326
Q

Decompensated liver disease signs

A

Jaundice making go yellow
Encephalopathy
Ascites
Oesophageal varices

327
Q

Main management principle if signs of decompensated liver disease

A

Liver transplant

328
Q

Liver cirrhosis management principles

A

Manage precipitating factor
Monitor and prevent complications
Causes malnutrition so ensuring see nutritionist
Liver transplant if needed

329
Q

What do if cirrhosis endoscopy identifies non-bleeding varices

A

First line is to give propanolol
If CI then do band ligation

330
Q

What can do for refractory ascites

A

TIPSS

331
Q

2 main indications for TIPSS

A

Bleeding oesophageal varices
Refractory ascites

332
Q

Management of hepatorenal syndrome

A

Can use terlipressin first line but poor mortality typically unless liver transplant

333
Q

For alcoholic cirrhosis what is required to be eligible for transplant

A

Abstinent for 6 months

334
Q

Antitrypsin inheritance

A

AD- codominant

335
Q

Screening test for anti-trypsin

A

Serum antitrypsin levels

336
Q

Management of alpha1 anti trypsin

A

COPD management inc stop smoking
Monitor for liver complications (cirrhosis and HCC)

337
Q

Lung changes in alpha1 anti trypsin

A

Emphysema
Bronchiectasis

338
Q

+ve TTG identified on bloods in GP what do

A

Refer to gastro for jejunal biopsy

339
Q

How diagnose IBS

A

6 months of stomach pain/discomfort with 1 of
- relieved by defaecating
- change in bowel habit
- constipation/diarrhoea

340
Q

Prof hanna definitive management of each haemorrhoid grade

A

1- conservative
2- rubber band ligation/sclerotherapy
3- rubber band ligation/sclerotherapy
4- haemorrhoidectomy

341
Q

What is whipples disease

A

Multi system disorder caused by trophyrema whipplei seen in HLA B27 most commonly

342
Q

Diagnosing whipples

A

Jejunal biopsy with periodic acid schiff

343
Q

Management of whipples

A

Co trimoxazole

344
Q

Presentation of whipples

A

Arthralgia
Malabsorption
Lymphadenopathy
Neuro problems
Pleurisy

345
Q

Diverticulosis vs diverticular disease

A

Diverticulosis- outpouching
Diverticular disease- outpouchings with symptoms

346
Q

What causes tropical sprue

A

Unknown exactly but a variety of viruses, parasites and bacteria

347
Q

Villous atrophy with eosinophil infiltrates

A

Tropical sprue

348
Q

Presentation of PBC

A

Itching
Lethargy
Hyperlipidaemia
Jaundice
Hepatosplenomegaly
Can get hyperpigmentation over pressure points

349
Q

Blood findings of PBC

A

High anti-mitochondrial
IgM
Anti smooth muscle seen sometimes

Finals (29 decks)

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