Gastroenterology Flashcards
What is FIT testing used for?
Screening for Bowel cancer, looking for faecal occult blood
What are the stages of Alcoholic liver disease?
- Alcohol related fatty liver
- Alcoholic hepatitis
- Cirrhosis
Recommended limits for alcohol?
<14 units/week
What medications can be used during alcohol withdrawal?
- Chloradiapoxide
- IV B-Vitamins
Severity score for UGI bleed?
Child-pugh score
What is Lactulose used for in liver cirrhosis?
Hepatic Encephalopathy
What are the stages of non-alcoholic fatty liver disease?
- Non-alcoholic fatty liver disease
- Non-alcoholic steatohepatitis (NASH)
- Fibrosis
- Cirrhosis
What is included on a full non-invasive liver screen?
- Liver ultrasound
- Hepatitis B and C serology
- Autoantibodies (ANA, SMA, AMA, LKM-1)
- Immunoglobulins
- Caeruloplasmin
- Alpha-1 antitripsin levels
- Ferritin and Transferrin saturations
What is the first-line blood test for assessing fibrosis?
Enhanced liver fibrosis (ELF) test
What are the symptoms of haemochromatosis?
- Hair loss
- Bronze skin
- Fatigue
- Mood changes
- ED
- Joint pain
What is the gene mutation involved in haemochromatosis?
- Human haemochromatosis protein (HFE)
- HFE gene on chromosome 6
- Autosomal recessive
What is the screening test for haemochromatosis?
Serum Ferritin (raised)
What is the underlying pathology of Wilson disease?
Excessive copper in the body and tissues
What is the gold standard test for Wilson’s disease?
Liver biopsy
What is the management of Wilson Disease?
- Copper Chelation
- Penicillamine
- Trientene
What enzyme damages tissues in Alpha-1 antitrypsin deficiency?
Neutrophil elastase
What is the first abnormal LFT in PBC?
Alkaline phosphatase
Tumour marker for HCC?
Alpha- fetoprotein
Tumour marker for CCA?
CA19-9
What is the initial scoring system for an upper GI bleed?
Glasgow- Blatchford
What antibodies are present in Coeliac disease?
- Tissue transglutaminase antibodies (ANTI-TTG)
- Endomysial antibodies (ANTI-EMA)
What is involved in the helicobacter pylori eradication regime?
PPI + 2 antibiotics (e.g. amoxicillin and clarithryomycin) for 7 days
What is the inheritance pattern of Wilson’s disease?
Autosomal recessive
What condition involves a tear in the oesophageal mucosa, often following intense retching or vomiting and causing upper gastrointestinal bleeding?
Mallory-Weiss tear
What is seen on examination of jejunal biopsies in coeliac disease?
Crypt hyperplasia and villous atrophy
What is the usual screening test for Helicobacter pylori infection in the community?
Stool antigen test
What type of hiatus hernia involves a separate portion of the stomach (e.g., the fundus) folding around and entering through the diaphragm opening alongside the oesophagus?
Rolling Hiatus hernias
What are the top two antibodies used to screen for coeliac disease?
- Anti-tissue tranglutaminase antibodies (anti-TTG)
- Anti-endomysial antibodies (anti-EMA)
What are the usual first-line drug options for maintaining remission in Crohn’s, where required?
Azathioprine
Mercaptopurine
What are the options for prophylaxis of bleeding in stable oesophageal varices?
- Non-selective beta blockers (e.g., propranolol)
- Variceal band ligation
What other autoimmune conditions are particularly linked with coeliac disease?
T1DM
Thyroid disease
What are the three key features of irritable bowel syndrome?
- Intestinal discomfort (abdominal pain relating to the bowels)
- Bowel habit abnormalities
- Stool abnormalities (watery, loose, hard or associated with mucus)
When would a platelet infusion be given in a patient with active upper gastrointestinal bleeding?
Significant thrombocytopenia (e.g., platelet count less than 50)
What is the usual epithelial lining of the stomach?
Columnar epithelium
What test for Helicobacter pylori can be performed during an endoscopy procedure?
Rapid urease test (also known as the CLO test)
What type of organism is Helicobacter pylori?
Gram-negative aerobic bacteria
What scoring system is used after endoscopy to estimate the risk of rebleeding and mortality in upper gastrointestinal bleeding?
Rockall score
How long should the symptoms of irritable bowel syndrome be present before establishing the diagnosis?
At least 6 months
What change occurs in the lower oesophageal epithelium in Barrett’s oesophagus?
What is the technical term for this process?
Metaplasia from squamous to columnar epithelium
What interventional radiology procedure may be used as secondary prevention of bleeding oesophageal varices?
What is the other major indication for this procedure?
Transjugular intrahepatic portosystemic shunt (TIPS)
Refractory ascites
What is the major risk of Barrett’s oesophagus?
What monitoring is carried out given this risk?
Oesophageal adenocarcinoma
Regular endoscopies
What organisms most commonly cause spontaneous bacterial peritonitis?
E. Coli
Klebsiella pneumoniae
What condition involves duodenal or pancreatic tumour secretes excessive quantities of gastrin, resulting in excessive acid production in the stomach?
What genetic condition is associated with developing gastrin-secreting tumours?
Zollinger-Ellison Syndrome
Multiple endocrine neoplasia type 1 (MEN-1)
What is the initial screening test for suspected Wilson’s disease?
What result suggests Wilson’s disease?
Low serum Caeruloplasmin
What condition associated with inflammatory bowel disease involves rapidly enlarging, painful skin ulcers, often on the legs?
Pyoderma gangrenosum
What is the initial investigation in suspected haemochromatosis?
What further investigation can help distinguish between the causes of an abnormal result?
Serum ferritin
Transferrin saturation
What is the first-line medical treatment of gastro-oesophageal reflux when antacids and lifestyle changes are inadequate?
Give two examples of this type of medication.
Proton-pump inhibitors
Omeprazole and Lansoprazole
What condition associated with inflammatory bowel disease involves tender, red nodules on the shins caused by inflammation of the subcutaneous fat?
Erythema nodosum
What is the usual epithelial lining of the oesophagus?
Squamous epithelium
What is the name for the itchy, blistering skin rash, typically on the abdomen, that can be caused by coeliac disease?
Dermatitis herpetiformis
What single symptom would be an indication for a two week wait referral for suspected oesophageal cancer in someone of any age?
Dysphagia
Which form of inflammatory bowel disease involves skip lesions?
Crohn’s disease
Which form of inflammatory bowel disease involves transmural inflammation?
Crohn’s disease
Which form of inflammatory bowel disease involves an association with PSC?
UC
Which form of inflammatory bowel disease involves only the colon and rectum?
UC
Which form of inflammatory bowel disease involves blood in the stools more often?
UC
Which form of inflammatory bowel disease involves inflammation particularly affecting the terminal ileum?
Crohn’s
Which form of inflammatory bowel disease involves fistulas more often?
Crohn’s
What additional management steps, before endoscopy, would be included in treating bleeding oesophageal varices compared with other causes of upper gastrointestinal bleeding?
Terlipressin and Broad spectrum antibiotics
What treatment may be used to induce remission in Crohn’s disease where there are concerns about the side effects of drugs, particularly in children?
Enteral nutrition
What is the first-line treatment for an acute exacerbation of Crohn’s disease?
Steroids
What is the first-line treatment for mild to moderate acute ulcerative colitis?
Aminosalicylates (e.g., oral or rectal mesalazine)
What stool test is used to screen for inflammatory bowel disease?
Faecal calprotectin
What is the first-line treatment for maintaining remission in ulcerative colitis?
Aminosalicylates (e.g., oral or rectal mesalazine)
What condition involves transmural perforation of the oesophagus due to intense retching or vomiting?
What is Mackler’s triad of features in this condition?
Boerhaave’s syndrome
Vomiting, Severe chest pain, Subcutaneous emphysema (air in the subcutaneous tissue)
What medication is used to treat ascites?
What class of drug does this belong to?
Spironolactone
Aldosterone antagonists
What are the two types of peptic ulcer?
Gastric
Duodenal
What is Ascites?
Defined as the abnormal accumulation of fluid within the peritoneal cavity
What is the primary investigation for Ascites?
Ascitic tap
What is the Serum Ascites Albumin gradient (SAAG) and how do you calculate it?
- Can help determine the cause of ascites
- Calculation: Serum albumin concentration-ascites albumin concentration
What are the causes of a high SAAG (>11g/L)
- Cirrhosis
- Heart failure
- Budd-Chiari Syndrome
- Constrictive pericarditis
- Hepatic failure
A high SAAG suggests that the cause of the ascites is due to raised portal pressure.
Raised hydrostatic pressure forces water into the peritoneal cavity whilst albumin remains within the vessels, thus resulting in a higher difference.
What are the causes of a low SAAG (<11g/L)
- Cancer of the peritoneum, metastatic disease
- TB, Peritonitis and other infections
- Pancreatitis
- Hypoalbuminaemia - nephrotic syndrome, Kwashiokor
What are Carcinoid tumours?
They are rare. slow-growing neural crest tumours that secrete serotonin
What are the signs and symptoms of Carcinoid tumours?
- Abdominal pain
- Diarrhoea
- Flushing
- Wheezing
- Pulmonary stenosis
What are the investigations for Carcinoid tumours?
- Hormone level assessment: Measuring the level of 5-HIAA (5-hydroxyindoleacetic acid), a breakdown product of serotonin, in the urine can help identify carcinoid tumours.
- Imaging: CT, MRI, or Octreotide scans can help identify the location and extent of the tumour.
- Tissue biopsy: A definitive diagnosis is made through histopathological examination of biopsy material.
What are some common sites of Carcinoid tumours?
Appendix
Ileum
Rectum
Testis
Ovary
Bronchi
What is the pharmacological treatment for a carcinoid tumour?
Octreotide, a somatostatin analogue is often used to inhibit the production of hormones by the tumour
What is the clinical manifestation of Zollinger-Ellison syndrome?
- Abdominal pain, particularly in the epigastric region
- Diarrhoea
- Ulceration of the duodenum, Which can lead to gastrointestinal bleeding
- Non-responsiveness to PPI
What area is most likely to be affected in ischaemic colitis?
Splenic Flexure
What would you see on abdominal x-ray in ischaemic colitis?
‘Thumbprinting’ due to mucosal oedema/haemorrhage
What are some of the signs of scurvy?
- Follicular hyperkeratosis and perifollicular haemorrhage
- Ecchymosis, easy bruising
- Poor wound healing
- Gingivitis with bleeding and receding gums
- Sjogren’s syndrome
- Arthralgia
- Oedema
- Impaired wound heeling
- Generalised symptoms such as weakness, malaise, anorexia and depression
Describe haemorrhoid symptoms?
- bright red bleeding
- Discomfort/pain
- Pruritus ani
- Mucus discharge
- Pain on passing stools
What are haemorrhoids?
They are swelling and inflammation of the veins in the rectum and anus
What is the standard treatment for hepatic encephalopathy?
Lactulose
Helps to reduce the amounts of ammonia in the blood, which can contribute to the neurological symptoms
