Gastroenterology Flashcards
What is the management for an oesophageal variceal bleed?
IV Terlipressin and IV Antibiotics ( Co-Amoxiclav )
Band ligation
If bleeding does not stop insert a Sengstaken-Blakemore tube or use TIPSS
What is the most common organism found on ascitic fluid culture in Spontaneous Bacterial Peritonitis?
E.Coli
What do IGA anti-endomysial antibodies indicate?
Coeliac’s disease
What blood test is used to detect Coeliac Disease?
Tissue Transglutaminase IgA antibody (tTG-IgA) test
What is Hepatic Encephalopathy caused by?
Accumulation of ammonia in the blood stream due to the livers’s decreased ability to detoxify ammonia
What is the treatment for Hepatic Encephalopathy?
Lactulose PO and Rifaximin
What autoantibody test is raised in Primary Sclerosing Cholangitis?
p-ANCA
What does dysphagia equally to solids and liquds suggest?
Achalasia
How do you confirm the diagnosis of Achalasia?
A barium swallow fleuroscopy showing a grossly expanded oesophagus that tapers at the lower oesophageal sphincter. - “ Bird’s Beak” appearance ( kinds looks like a slug more )
What is the pharmacological treatment for ascites secondary to liver cirrhosis?
Spironolactone
What vaccine is indicated as part of Coeliac disease management?
Pneumocccocal vaccine due to hyposplenism
What are the Red Flag symptoms for Gastric Cancer?
New-onset dyspepsia in those >55 ( burning pain/ indigestion )
Unexplained persistent vomiting
Unexplained weight loss
Progressively worsening dysphagia ( difficulty swallowing )
Odynophagia ( painful swallow )
Epigastric pain
What drug is first line to maintain remission in Crohn’s?
Azathioprine
What test helps to distinguish between IBD and IBS?
Faecal calprotectin
How is Hepatic Encephalopathy categorised?
Graded from I - IV
Grade IV is Coma
What electrolyte imbalance can PPIs cause?
Hyponatraemia
How long must a patient be sure to eat gluten for before Coeliac testing ?
6 weeks prior to testing
What is the first line treatment for Primary Biliary Cholangitis
Ursodeoxycholic Acid
What is the most common inheritable form of Colorectal Cancer?
Hereditary Nonpolyposis Colorectal Cancer ( HNPCC )
What is the most likely area to be affected by ishcaemic colitis?
The splenic fixture
What are the two types of IBD?
Crohns
Ulcerative Colitis
Where in the gut does Crohns affect?
Anywhere from mouth to the anus ( Whole GI Tract )
Where in the gut does UC affect?
Always effects the rectum and extends proximally varying distances
What is the pattern of inflammation in Crohns?
Skip Lesions
What is the pattern of inflammation in UC?
Continuous
What type of inflammation does Crohns cause?
Transmural
Wha type of inflammation does UC cause?
Mucosal and Submucosal only
What are the morphological effects of Crohns?
Fissuring ulcers
What are some microscopic features of Crohns?
Lymphoid and neutrophil aggregates
Non caseating Granulomas
What are some morphological features of UC?
Crypt abcesses
How does smoking affect Crohns and UC ?
Worsens Crohn’s
Shown to improve UC
What blood tests should be done for IBD and why?
FBC - check for anaemia or raised platelets
U&Es - may have deranged electrolytes due to GI losses
CRP - may be raised, normal CRP does not exclude IBD though
What stool tests should be done for IBD?
Stool cultures - to rules out infective colitis/parasites
Faecal calprotectin - raised in active IBD and not raised in IBS or IBD in remission
What investigation should be done in suspicion of Toxic Megacolon?
Abdo Xray
Immediately- very serious
What endoscopy tests should be done when investigating Crohn’s?
Flexible sigmoidoscopy – safest test in bloody diarrhoea
Colonoscopy – needed to look for more proximal disease Capsule endoscopy – useful to view the small bowel mucosa
Capsule Endoscopy involves swallowing a tiny capsule with a camera
What cross sectional imaging should be used when looking for Crohn’s?
CT abdomen - when looking for acute complications
MRI enterography - when looking for small bowel crohn’s, fistulas or to map the extent of small bowel crohn’s
MRI Pelvis - to image perianal crohn’s
What is the mainstay of treatment for Crohn’s?
Steroids
Can be topical ( suppositories or enemas )
Orally ( Prednisolone or Budesonide in small bowel disease )
IV ( Hydrocortisone )
What is the treatment for patients with a Crohns’s or UC flare up bad enough to be admitted to hospital?
IV Hydrocortisone 100mg qds for 3-5 days
If no improvement must be escalated
What is the escalation for in hospital UC patients?
Ciclosporin
Biologics
Or Surgery
Around half will require surgery
What is the escalation for admitted patients with Crohn’s?
Biologics
Or Surgery
What is the treatment to maintain remission in UC?
Mesalazine
If it doesn’t work - Azathioprine / Biologics
What is the treatment to maintain remission in Crohn’s?
Azathioprine and Biologics
What is the first choice in Crohn’s patients with perianal or fistulating disease to maintain remission?
Biologics
As all the medication for IBD remission causes immunosupression , what monitoring is required?
FBC
U&Es
LFTs
What do patient’s with Crohn’s usually present with?
Change in bowel habit, usually diarrhoea
Blood in stools
Fever
Fatigue
Abdominal Pain
Mouth Sores
Reduced appetite
Weight Loss
Usually younger patients
How do patients with Ulcerative Colitis present?
Diarrhoea
Waking up in the night to poo ( Urgency)
Tenesmus
Blood/ Mucus in poo
How does Coeliac’s Disease present?
Loose stools
Bloating
Flatulence
Abdominal Cramps
Weight Loss
Dermatitis Herpetiformis
Fx also
What type of anemia can Coeliac’s Disease cause?
Iron deficiency - due to malabsorbtion
What are some complications of untreated Coeliac’s disease?
Malignancy
Osteoporosis
Gluten ataxia
Neuropathy
What types of malignancies are associated with Coeliac Disease?
Enteropathy-associated T-cell lymphoma (EATL)
Non-Hodgkin’s lymphoma
Adenocarcinoma of the small intestine
What are the diagnostic tests for Coeliac’s disease?
OGD and duodenal biopsies
tTG (tissue transglutaminase) is usually raised , but not the diagnostic test in adults
What will you see histologically with Coeliac’s Disease?
Villous atrophy
Intra-epithelial Lymphocytosis
What is the treatment for Coeliac’s Disease?
Dieticians - gluten free diet
What foods contain gluten?
Barley
Rye
Oats - can be reintroduced in some patients
Wheat
What are some differential symptoms for dyspepsia that must be clarified in a history?
Abdominal pain
Retrosternal burning
Waterbrash
Vomiting
Upper GI Wind
What treatment/ investigations are reasonable for Dyspepsia/ Reflux ?
PPI +/- test for H.Pylori
What are some Red Flag symptoms associated with GORD/ Reflux that should be further investigated?
Dysphagia ( Difficulty swallowing )
Odynophagia ( Painful Swallow )
Unintentional Weight Loss
New onset at older age
GI Bleeding
Recurrent vomiting
Anaemia
Palpable mass
Lymphadenopathy
What is key to distinguish when a patient presents with dysphagia?
Which swallowing phase the difficulty occurs in
Oropharyngeal Phase - patient struggles to get food to leave mouth
Oesophageal Phase - patient’s food can leave mouth but gets stuck after
What is the cause of oro-pharyngeal dysphagia?
Problems coordinating the muscles to move the food bolus - usually do to neurological problems
What can the causes of oesophageal dysphagia be ?
Physical obstruction - tumour, benign stricture, oesophagitis
Neuromuscular - achalasia, dysmotility, presbyoesophagus
What investigations can be done for oesophageal dysphagia?
OGD to exclude obstructive cause first
Barium swallow or Oesophageal manometry to look for neuromuscular causes
OGD = OesophagoGastroDuodenoscopy
What examinations/ investigations can be done for oro-pharyngeal dysphagia?
Cranial nerve examination
Speech Therapy assessment of swallow
Video-Fluoroscopy may be indicated
What is the treatment for benign oesophageal strictures ?
Dilation
What is the treatment for oesophageal cancer?
Surgery
What is the treatment for oro-pharyngeal dysphagia?
Altered food consistency
Enteral feeding tube may be needed if swallow remains unsafe ( NG / PEG tube )
What are the functions of the liver?
In terms of metabolic, production, detoxification and immune
Nutrition/ Metabolic
- Stores glycogen
- Releases glucose
- Absorbs fats/ ADEK Vitamins and iron
- Makes cholesterol
- Bile salt production ( emulsification of fats )
Production
- Clotting factors
- Albumin
- Other binding proteins
Detoxification
- Drug excretion
- Alcohol breakdown
- Haemoglobuin -> Billirubin
Immune
- Kupfer cells engulf antigens
What are important questions to ask in a Liver disease history?
Blood transfusions prior to 1990
IVDU
Operation/ Vaccinations
Sexual history
Medications
Hx
Obesity
Alcohol use
Foreign Travel
What is it important to distinguish in liver disease?
If its acute ( resolves in 6 months ) or chronic
What causes cirrhosis and chronic liver disease?
Alcohol abuse
Hepatitis C
Non-Alcoholic Steatohepatitis ( NASH )
Autoimmune ( PBC, PSC. AIH )
What are causes of acute liver disease?
Hepatitis A , Hepatitis E
Cytomegalovirus
Epstein-Barr Virus
Drug induced liver injury ( DILI )
What are stigmata of Chronic Liver Disease ?
Spider Naevi
Clubbing
Jaundice
Palmar Erythema
Ascites
Hepatic Flap
Dupuytren’s Contracture
Splenomegaly
Caput Medusa
Gynecomastia
Leuchonychia
How is Hepatic Encephalopathy categorised?
Graded 1-4
What is Grade 1 of Hepatic Encephalopathy?
Psychomotor slowing
Constructional apraxia ( inability to copy/ draw basic diagrams or figures )
Poor memory
Reversed sleeping pattern
What is Grade 2 Hepatic encephalopathy?
Lethargy
Disorientation
Agitation
Asterixis
What is Grade 3 Hepatic Encephalopathy ?
Drowsy
What is Grade 4 Hepatic Encephalopathy?
Coma
What are some investigations and expected results for Liver Disease?
FBC - Thrombocytopenia = sensitive marker of fibrosis
LFTS - Show location of damage
Hepatocytes = raised ALT / AST
Cholestatic = raised ALP , raised gamma GT ( GGT is found in both Hepatocytes and biliary epithelial cells so used with ALP to confirm it is cholestatic not bone disease )
Abdo USS (Fibroscan)- can be used to find cirrhosis ( coarse, nodular, splenomegaly, ascites ) or to find obstructive jaundice ( dilated biliary duct )
What are causes or Hepatitic Liver diease with an ALT > 500
Viral
Ischaemia
Toxicity ( e.g. Paracetamol )
Autoimmune
What are causes of Hepatitic Liver Disease with an ALT of 100-200 ?
NASH
Autoimmune
Chronic Viral Hepatits
DILI
What are causes of Cholestatic Liver Disease with dilated ducts on USS?
Gallstone
Malignancy
What are causes of Cholestatic Liver Disease with non-dilated ducts?
Alcoholic hepatitis
Cirrhosis ( PBC, PSC, Alcohol )
DILI ( Antibiotics )
Which investigations make up the liver screen?
-AST, ALT, ALP
- Hepatitis B&C Serology (in acute liver disease consider Hep A & E if marked ALT rise)
- Iron studies (Ferritin & transferrin saturation ) (Haemochromatosis)
- A-utoantibodies (AMA & SMA) and immunoglobulins
- Consider caeuruloplasmin if age under 30 years (Wilson’s)
- Alpha-a-antitrypsin
- Coeliac serology
- TFTs, lipids & glucose
Which less common aetiologies of Chronic Liver Disease have a higher incidence in women?
Autoimmune Hepatitis
Primary Biliary Cholangitis
Which less common aetiology of Chronic Liver Disease have a higher incidence in men?
Primary Sclerosing Cholangitis ( associated with UC )
Which less common aetiology of Chronic Liver Disease has a higher incidence in men at a young age?
Haemochromatosis
Which less common aetiologies of Chronic Liver Disease only occur in children and young adults?
Wilson’s Disease
Anti LKM Autoimmune Hepatitis
What is the treatment of Chronic Liver Disease?
Remove underlying aeteiology
E.g stop drinking alcohol, antivirals, venesection etc
What is the end pathology of any cause of Chronic Liver Disease?
Cirrhosis
What is the most specific imaging technique to diagnose cirrhosis? The presence of what other pathology is diagnostic of cirrhosis?
Fibroscan
Presence of varices also diagnostic
What is the management of Liver Disease/Cirrhosis?
Ascitis - Spironolactone or Paracentesis if tense
Itching- Antihistamine or Cholestyramine
Encephalopathy- Lactulose PO and Rifaxamin
Varices - bleeding prophylaxis ( Propanolol )
DEXA scan - cirrhotic patients at risk of Osteoporosis
What type of cancer can develop in patients with Cirrhosis?
Hepatocellular carcinoma
How should Hepatocellular Carcinoma be screened for in patients with Cirrhosis?
Alpha-Fetoprotein and USS
Every 6 months
What is the investigation for Spontaneous Bacterial Peritonitis?
A diagnostic ascitic tap to look at cell count and Microscopy, Culture and Sensitivity ( MCS )
What tool is used for a Nutrional Assessment?
MUST ( Malnutrition Universal Screening Tool )
What is food fortification?
A tool used to add calories to meals without increasing the volume consumed
What are some options if patients are unable to meet their nutrional requirements, have an unsafe swallow or a non-functioning GI tract?
Nutrional supplements
NG Tube
PEG/ RIG/ PEGJ/ RIGJ
Paraenteral nutrition
What is an NG Tube and what is the procedure before use?
Short term access feeding into stomach
Check pH prior to use to ensure it is in the stomach and not lungs ( pH can be affected by PPI use so a CXR may be needed to confirm position)
Patient can still aspirate on saliva , not on food though
What are PEG/ RIG/ PEGJ/ RIGJ tubes?
All provide long term enteral access
PEG - inserted into stomach endoscopically
RIG - inserted into small intestine radiologically
PEG-J - inserted into stomach endoscopically
RIG-J - inserted into small intestine radiologically
Do not prevent aspiration of saliva
What is the procedure of PEG/ RIG etc tubes?
Require puncture of the stomach with a trocar
What is Paraenteral nutrition?
IV feeding - only indicated if GI tract is not accessible (blocked) or not working (short, leaking or diseased)
Must be given via dedicated central line ( PICC or Hickman )
What are the types of GI bleed?
Haematemesis - fresh blood in vomit
Coffee Ground Vomit - altered blood or stomach contents
Malaena -black, tarry, sticky stool
Fresh PR Bleed - indicated lower GI bleed but could also be brisk upper GI bleed in haemodynamically unstable patient
What are risk factors for a GI bleed?
Varices
Chronic Liver Disease
NSAID use
Anticoagulants
Antiplatlets
What is the ROCKALL score?
Simple score based on bedside parameters that predicts risk of death and rebleeding from an Upper GI bleed
Split into pre and post endoscopy findings
What are the sections in the ROCKALL score?
Pre-endoscopy
-Age
-Comorbidity
-Shock
Post-endoscopy
-Source of bleeding
-Stigmata of recent bleeding
What is the Blatchford score?
Predicts the need for intervention in a GI Bleed, requires blood tests
What are the sections on the Glasgow-Blatchford score?
Blood Urea
Hb ( different for men and women)
Systolic BP
Other markers - Pulse> 100bpm, Malaena, Syncope, Hepatic Disease, Cardiac failure
What are the investigations required in an acute Upper GI Bleed?
FBC - check Hb and platelets
U&Es - raised urea
Clotting
Group and Save - transfusion may be needed
LFTs - check for liver disease
VBG - quick way to get Hb levels
What type of Upper GI Bleed is a medical emergency?
Variceal bleed
What is the management of a Variceal bleed?
Gain IV access
Fluid recuss if haemodynamically unstable
Blood transfusion if needed
IV Terlipressin and IV antibiotics
Refer to GI team for urgent upper GI endoscopy
What is the definitive treatment of variceal bleeding?
Mechanical obstruction to the flow of blood through the varices via
- Oesophageal banding
If bleeding is not controlled then
- Linton tube
- Sengstaken tube
- TIPPS ( Trans-jugular intrahepatic porto-systemic shunt)
What are the causes of non variceal bleeding?
Peptic Ulcer disease
Angiodysplasia
Dieulofoys
These are more likely to stop bleeding on their own
What is the mangement of a non variceal Upper GI Bleed?
IV Access
Fluid Recuss if haemodynamically unstable followed by blood
Discuss with GI Team - various endoscopic treatments available . If not stopped by endoscopy then radiological embolisation or surgery are possible
PPIs after endoscopy
What type of ulcer is more characteristic of pain several hours after eating?
Duodenal as apposed to stomach
Which blood vessel is a duodenal ulcer most likely to affect?
Gastroduodenal artery ( posterior duodenal ulcers are more likely to cause serious upper GI haemorrhage
What should a recurrent episode of C.Diff within 12 weeks of symptom resolution be treated with?
Fidaxomicin PO
If a C.Diff infection doesn’t respond to either Vancomycin or Fidaxomicin then what should be tried next?
Oral vancomycin and IV metronidazole
What does a combination of liver and neurological disease in a young male point towards?
Wilson’s Disease
How do you investigate for a suspicion of Wilson’s disease?
Copper studies ( Serum copper, Serum caeruloplasmin, Urine copper )
LFTs ( raised ALT )
How does Pancreatic Cancer present ?
PAINLESS JAUNDICE
Weight loss
Pruritus
Older age
Smoker
Diabetes
Raised ALP and gGT ( Cholestic pattern on LTFs )
What is use of the oral contraceptive pill associated with?
Drug-induced cholestasis
What malignancy is associated with Coeliac’s Disease?
Enteropathy-associated T Lymphoma ( EATL )
What pharmological treatment would be suitable for an acute presentation of IBS-D ?
Loperamide ( anti-motility agent )
What test implies an active or chronic Hepatitis B infection
Positive HbsAg
What can help distinguish between an upper and lower GI bleed?
High urea levels ( >14mmol/L) indicate an upper GI bleed
How do you work out alcohol units?
Units = ABV% x Volume ( mls )
1 unit is 10 ml of pure ethanol, so a 25ml shot (ABV 40%) would be 25 x 0.4 = 10ml = one unit
What type of anemia does a Vitamin B12 deficiency imply ?
Pernicious anemia
What type of cancer does Pernicious Anaemia predispose to ?
Gastric Cancer
What is the triad of symptoms associated with Acute Liver Failure?
Encephalopathy
Jaundice
Coagulopathy
What is the main treatment for Wilson’s disease?
Penicillamine - a metal chelating agent
A SAAG ( Serum Ascitic Albumin ) gradient of what indicates portal hypertension?
> 11g/L
What vitamin in high doses can be teratogenic?
Vitamin A
What is the gold standard investigation for perianal fistulae in Crohn’s patients?
MRI Pelvis
What is the treatment for a life threatening C.Diff infection?
Oral vancomycin and IV Metronidazole
What is a important complication of Primary Sclerosing Cholangitis?
Cholangiocarcinoma
How is Alcoholic Ketoacidosis treated?
IV Thiamine and 0.9% Saline
What is the treatment for a liver abscess?
IV Antibiotics and Image-guided percutaneous drainage
What is the treatment for a Pharyngeal Pouch?
Surgical treatment
What is the most useful test for investigating Vitamin B12 deficiency?
Intrinsic Factor antibody titre
What is the most appropriate prophylaxis for the prevention of bleeding following a variceal bleed?
Propanolol
This is a Non-Cardiac selective B Blocker, they cause vasodilation in engorged variceal veins, this lowers the BP and therefore risk of rupture
What cancers is Hereditary Non-Polyposis Colorectal Cancer ( HNPCC ) associated with?
Colorectal Cancer
Endometrial Cancer
Whst id the management of severe alcoholic hepatitis?
Prednisolone PO
What constitutes a severe flare up of Crohn’s?
> 6 bowel movements a day with blood and fever
What is the most accurate marker for assessing the extent acute liver failure?
Prothrombin Time
What is Murphy’s Sign and what does is indicate?
Ask patient to take a deep breath and hold it
Press down on the RUQ and if the patient experiences pain then Murphy’s sign is positive
Gallbladder pathology
What is Rovsing Sign? What does it indicate?
Press down on LIF and there is pain on the RIF as the peritoneum is irritated
Acute appendicitis
What is the management for Acute Appendicitis?
NBM
IV Fluids
Analgesia ( e.g IV Morphine )
APPENDECTOMY
What on a blood test indicates severe Acute Pancreatitis?
Hypocalcaemia >2
How do you differentiate between Anaemia of Chronic Disease and Iron Deficiency Anaemia? ( The iron is low in both and both are microcytic )
In Iron Deficiency Anaemia , the Total Binding Capacity of Iron will be high on an iron study. It will be low in Anaemia of Chronic Disease
What are the causes of Acute Pancreatitis?
I - Idiopathic
G- Gallstones
E - Ethanol
T - Trauma
S - Steroids
M - Mumps
A - Autoimmune Disease
S - Scorpion Sting
H - Hypercalcaemia
E - Endoscopic Retrograde Cholangiopancreatography
D - Drugs
What are the electrolyte imbalances present in Refeeding Syndrome?
Hypophosphataemia
Hypokalaemia
Hypomagnesaemia
What diagnosis does the combination of cholestatic jaundice, raised IgM and postive anti-mitochondrial antibodies lead to?
Primary Biliary Cholangitis
What is the first line treatment for Primary Biliary Cholangitis?
Ursodeoxycholic Acid
What is the difference between the pain present in a Gastric Ulcer vs in a Duodenal Ulcer?
Gastric Ulcer - pain comes on when or shortly after eating
Duodenal Ulcer - pain comes on an hour or two after eating
What is the management for Barrett’s oesophagus?
High dose proton pump inhibitor therapy
Endoscopic monitoring - to check for dysplastic or malignant changes
What is Proctitis?
Inflammation of the lining of the rectum
What is the first line investigation for primary sclerosing cholangitis?
MRCP
What is the management for patients with Crohn’s who develop perianal abcess?
Incision and drainage
If patient has had a severe relapse with UC or >2 exacerbations in the past year what should they be treated with?
Azathioprine to maintain remission
What is the most likely organism to be found on an ascitic fluid culture in Spontaneous Bacterial Peritonitis?
E.Coli
What is Boerhaave Syndrome?
Spontaneous perforation of the esophagus due to a sudden increase in oesophageal intrathoracic pressure
What is the Boerhaave Syndrome?
Vomiting
Thoracic Pain
Subcutaneous Emphysema
What type of anaemia is associated with glossitis?
Pernicious Anaemia
Which blood test is useful for detecting Pernicious Anaemia?
Instrinsic Factor antibodies
What is Pernicious Anaemia?
An autoimmune disorder that causes diminishment in dietary Vitamin B12 absorption. Gastric parietal cells are detroyed , so intrinsic factor cannot be made. This is needed for absorbtion in the ileum
Offer urgent direct access upper gastrointestinal endoscopy (to be performed within 2 weeks) to assess for oesophageal cancer in people with dysphagia, or aged 55 and over with weight loss and any of the following:
Upper abdominal pain
Reflux
Dyspepsia
What is the treatment for a life-threatening C. Difficile infection?
I.V Metronidazole and Oral Vancoymcin
What is Melanosis Coli?
Abnormal pigmentation of the colon due to the presence of pigment-laden macrophages, usually due to laxative abuse (Senna)
What is Melanosis Coli most commonly caused by?
Prolonged Laxative Use
If C.Difficile does not respond to first-line oral Vancomycin, what should be used next?
Oral fidaxomicin
What is used first-line to induce remission in Crohn’s?
Glucocorticoids e.g Prednisolone
What is the screening for haemochromatosis?
Transferrin saturation > Ferritin
Genetic testing - HFE testing
Which serology result indicates an active Hepatitis B infection?
HBsAg positive
What is Courvoisier’s Law ?
States the presence of a palpable mass in the RUQ is more likely to be a malignant obstruction ( Cholangiocarcinoma) than obstruction due to stones
What malignancy develops in 10% of primary sclerosing cholangitis patients?
Cholangiocarcinoma
What must be administered before endoscopy in suspected Variceal bleeds?
Terlipressin AND I.V Antibiotic
What is the best first line management for NAFLD?
Weight Loss
What pathology is characteristically more painful when hungry and relieved by eating?
Duodenal ulcer
Which type of ulcer is more likely to be malignant, gastric or duodenal?
Duodenal
What is the diagnostic investigation of choice for pancreatic cancer?
High Res CT
What is a parecetemol overdose likely to show on LFTs?
High ALT
Normal ALP
ALT/ALP ratio high
What is Peutz-Jegher’s Syndrome?
Autosommal Dominant condition associated with the growth of multiple benign polyps ( harmartomas ) within the GI system. Associated with blue to dark brown macules around the hands, face, feet, oral mucosa and anus
What is a common presenting complaint in Peutz-Jegher’s Syndrome?
Intussusception causing small bowel obstruction
What is intussusception?
When one part of the bowel slides into another part. ( think like a collapsable telescope )
What indicates a severe flare up od UC?
Doesn’t respond to advanced treatment
Shock
Obstruction
Peritonitis
Cachexia
What is the first line for treatment of diarrhoea in IBS?
Loperamide
What malignancy does Pernicious Anaemia predispose you to?
Gastric Carcinoma
What is the investigation for a suspected pharyngeal pouch?
Barium Swallow with fluoroscopy
What is the most likely condition in a young male with an isolated unconjugated hyperbilirubinaemia?
Gilbert’s Sydrome
What condition is Primary Sclerosing Cholangitis strongly associated with?
Ulcerative Colitis ( 80% of PSC patients have UC )
What is the cause of hepatic encephalopathy?
Ammonia crossing the blood-brain barrier due to increased concentration
What is the treatment of Haemochromatosis?
Regular venesection
What interventions are options when dysplasia is seen in Barrett’s oesophagus?
Endoscopic mucosal resection
Surgical removal of pre-cancerous cells
Radiofrequency ablation
What is radiofrequency ablation?
Heat is used to destroy pre-cancerous cells
What malignancies are associations of the HNPCC gene?
Colorectal cancer
Endometrial cancer
How long do patients with C.Difficile need to be isolated for?
48 hours in a side room
A 40-year-old man presents with dysphagia. He reports being reasonably well in himself other than an occasional cough. The dysphagia occurs with both liquids and solids. Clinical examination is normal.
What is the likely diagnosis?
Achalasia
Typically presents between 25-40 years
A 55-year-old woman presents with swallowing difficulties for the past 5 weeks. She has also noticed some double vision
What is the likely diagnosis?
Myasthenia Gravis
A 42-year-old haemophiliac who is known to be HIV positive presents with pain on swallowing for the past week. He has been generally unwell for the past 3 months with diarrhoea and weight loss
What is the likely diagnosis?
Oesophageal candidiasis
What side effect are aminosalicylates ( e.g Mesalazine ) associated with?
Agranulocytosis , therefore FBC is required is user has sudden onset rigors, fever and sore throat
What is seen on a VBG after profuse vomiting?
Metabolic Alkalosis with hypokalaemia
How does vomiting cause metabolic alkalosis?
Vomiting leads to loss of H+ ions through gastric secretions, which are acidic.
When vomiting, the pancreas also stops releasing bicarbonate ions, so they are added to the ECF rather than secreted into the small bowel lumen
What is used for the prophylaxis of oesophageal bleeding?
Propanolol
What treatment do patients who have had an episode of sponatenous bacterial peritonitis require on discharge?
Antibiotic Prophylaxis e.g Ciprofloxacin
A cachectic 32-year-old man with severe perineal Crohns disease is receiving treatment with intravenous antibiotics. Over the past 72 hours he has complained of intermittent dysphagia and odynophagia.
What is the most likely diagnosis?
Oesophageal Candidiasis
Treatment with systemic antibiotics may result in candidiasis
A 78-year-old lady presents 6 years following a successfully treated squamous cell carcinoma of the oesophagus. She has a long history of dysphagia but it is not progressive
What is the most likely diagnosis?
Post radiotherapy fibrosis
SCC of the oesophagus is commonly treated with chemoradiotherapy. Fibrosis and dysphagia may occur in survivors.
A 32-year-old lady presents with dysphagia. She has a 10 year history of anaemia secondary to menorrhagia and has been strongly resistant to treatment
What is the most likely cause?
Plummer Vinson syndrome
Triad of dysphagia, iron-deficiency anaemia and oesophageal webs
What is the triad for Budd-Chiari syndrome?
Sudden onset abdominal pain
Ascitis
Tender hepatomegaly
What is gallstone ileus?
A gallstone enters the small intestine and lodges in the ileocaecal valve
Symptoms - Episodes of RUQ colicky pain, severe abdoinal pain and vomiting, not passing stool or flatulence for > 48 hours
Why do coeliac patients require regular immunisations?
Functional hyposplenism
What should anyone diagnosed with Type 1 diabetes or an autoimmune thyroid disease also be screened for?
Coeliac disease - its associated with both of them
How do you differentiate between type one and type type hepatorenal disease?
Speed of onset
Type 1 - rapid onset , typically occurs following an acute event
Type 2 - more gradual , associated with refractory ascites
What does refractory ascites mean?
Its ascites that cannot be resolves by high dose diuretics and low sodium diet
How do you distinguish between natural immunity and vaccination for Hepatitis B?
Vaccination only provides anti-HBs antigen
Natural immunity due to prior infection will also show Anti-HBc antigen is positive on blood test
What is the pattern of overflow diarrhoea?
Long periods of constipation relieved by watery foul smelling diarrhoea
What is the treatment for Overflow diarrhoea?
Faecal disimpaction
What is the ‘double duct’ sign?
Dilation of both the common bile duct and pancreatic duct. Present in both Pancreatic Cancer and Cholangiocarcinoma
What are some risk factors for developing oesophageal cancer ( Adenocarcinoma )
GORD
Overweight
Smoking history
What is the cell type change seen in Barret’s Oesophagus? ( metaplasia )
Squamous epithelium changes to simple columnar epithelium
In which IBD are crypt abscesses seen?
UC
What is the most important lifestyle management to prevent the progression of NAFLD?
Weight loss
What is the management for a liver abscess?
Drainage and antibiotics
What is the expected iron profile study with Haemochromatosis?
Raised Trasferrin saturation
Raised Ferritin
Low Total Iron Binding Capacity ( TIBC )
Which test shows a current infection with C. Difficile?
Stool C.Difficile toxin
What is the Primary Biliary Cholangitis M rule to suspect it?
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females
What site is most commonly affected by Crohn’s?
Ileum
What test is recommended to see H.Pylori eradication therapy was effective?
Urea breath test
What is the first line treatment for primary biliary cholangitis?
Ursodeoxycholic acid
Which antibiotic is most closely associated with a C. Diff infection?
Clindamycin
What is Carcinoid Syndrome?
A type of neuroendocrine tumour that produces vasoactive amines ( 5-HT, NA, Dopamine ) , peptides ( bradykinin ) and prostaglandins
What symptom/signs does Carcinoid syndrome present with?
Abdo pain
Diarrhoea
Facial flushing
Bronchospasm
Tachycardia
A 78-year-old lady presents with episodic dysphagia and halitosis, occasionally she complains of regurgitation. A recent attempted upper GI endoscopy was poorly tolerated and abandoned.
What is the likely diagnosis?
Pharyngeal pouch
An overweight 56-year-old man with longstanding Barrett’s oesophagus complains of worsening dysphagia to solids over the past 6 weeks.
What is the likely diagnosis?
Adenocarcinoma of the oesophagus
A 24-year-old man complains of occasional retrosternal chest pain and dysphagia that occurs to both liquids and solids. He is otherwise well.
Achalasia
What must be assessed in patients before stating azathioprine?
Thiopurine Methyltransferase (TPMT) activity
This is the enzyme that metabolises azathioprine. People with a deficiency are at greater risk of side effects so should be avoided in them.
What are the two most common causes of lower abdominal pain in young men?
Appendicitis
Testicular problem ( Infection and Torsion )
ALWAYS important to to scrotal exam in male with lower abdo pain
What is the AST/ALT ratio in Alcoholic Hepatitis ?
2:1
What type of anaemia can Sulphasalazine cause?
Haemolytic Anaemia ( Heinz bodies on smear )
What is the treatment for Wilson’s Disease?
Penicillamine
What pharmocological therapy is used in the management of severe Alcoholic hepatitis?
Corticosteroids
What is Murphy’s Sign?
Arrest of inspiration on palpation of RUQ + in Acute Cholycystitis
What deficiencies is Coeliac Disease associated with?
Iron
Folate
B12
What are the risk factors for Scurvy ( Vit C deficiency )
Low income background
Elderly
Alcoholics
Poor diet
What are the symptoms of Scurvy?
Lethargy
Arthralgia
Easy bruising
Bleeding Gums
What is the first line treatment for Haemochromatosis?
Venesection
What is the second line treatment for Haemochromatosis?
Desferrioxamine ( Iron chelating agent )
A 24-year-old smoker presents with intermittent diarrhoea for the past 6 months. She feels bloated, especially around her periods. Bloods tests are normal.
What is the most likely diagnosis?
IBS
A 23-year-old student is admitted due to a two-week history of bloody diarrhoea. He is normally fit and well and has not been abroad recently. His CRP is raised at 56 on admission.
What is the most likely diagnosis?
Ulcerative Colitis
A 72-year-old woman presents with a two day history of diarrhoea and pain in the left iliac fossa. Her temperature is 37.8ºC. She has a past history of constipation.
What is the most likely diagnosis >
Diverticulitis
What is Fetor Hepaticus?
A sweet, fecal smell to the breath
It is a late sign of liver failure
If a pregnant lady presents with abdo pain and pruritis what diagnosis should you consider?
Acute fatty liver of pregnancy
What causes the pruritus seen in liver diseases?
Hyperbilirubinaemia
Are the levels of bilirubin correlated to the severity of the pruritus ?
No , they just cause it
What are important gastro symptoms to ask about?
Malignancy ( Weight loss, Night sweats, Unexplained fever, Lethargy )
Mouth ulcers
Tenesmus
Hematochezia
Pain when passing stool
Waking up to go to toilet
N+V
Urinary symptoms
How is nutritional status assessed?
MUST Score
-BMI
-Measure % of unplanned weight loss in past 3-6 months
-Add 2 points if patient is acutely ill/ no nutrional intake for 5 days
What dietary measures can be used to manage malnutrition?
Food chart
Oral supplements
NG Feeding
Parenteral feeding ( only if there is complete obstruction in GI tract )
What investigations should be done to investigate IBD?
Bloods ( FBC, U&Es, CRP )
Stool sample ( Parasites, Calprotectin )
Flexible sigmoidoscopy if neg stool culture
Anti-TTG ( Coeliac Screen )
TFTs
MRI Enterography for Small Bowel Crohn’s
AXR if Toxic Megacolon suspected
What features can help differentiate Crohn’s and Ulcerative Colitis?
Crohn’s
-Can affect whole GI Tract
-Skip lesions
-Transmural inflammation
-Worse prognosis for smokers
-Fistulae/perforation
Ulcerative Colitis
-Always affects rectum and only colon
-Continuous inflammation
-Mucosal and Submucosal inflammation only
-Better prognosis for smokers
-
What are some differentials for someone presenting with PR bleed?
Malignancy
Infection ( C.Difficile, E.Coli, Shigella, Campylobacter )
IBD
Diverticulitis
Haemorrhoids
Peptic Ulcer Disease/ Oesophageal Varices ( severe)
What should be asked in the history of a patient with suspected liver disease?
Symptoms
-Vomiting blood
-Pruritus
-Loss of appetite
-Confusion
-Swelling ( Ascites)
Alcohol use
Sexual history
IVDU
Blood transfusions prior to 1990
FHx
What clinical findings would you look for on examination of a liver disease patient?
Palmar Erythema
Dupytren’s Contracture
Clubbing
Hepatic Flap
Jaundice
Ascites
Caput Medusa
Spider Naevi
Positive Fluid Thrill
Easy bruising
What important investigations should be done for suspected Liver disease?
Liver Screen ( Hep B&C, Iron studies, AMA, SMA, Immunoglobulins)
FBC ( Reticulocyte count)
Bilirubin ( Conjugated and unconjugated )
Alpha-a-antitrypsin
Coeliac Screen
TFTs
Lipids/Glucose
LFTs ( ALT,ASP,AST )
DEXA scan
Alpha Fetoprotein
Fibroscan
Endoscopy ( Varices )
Abso USS
What are common differentials for a patient presenting with jaundice?
Pre-hepatic - Haemolytic anemia
Intra-hepatic - Cirrhosis, Hepatitis, Drugs, Pregnancy, Congenital
Post-hepatic - Cholestatic ( Gallstones, Biliary Colic, Acute Cholecystitis, Ascending Cholangitis), Acute Pancreatitis, Pancreatic Cancer
What are key investigations for a patient presenting with jaundice?
USS of biliary tree
Bloods - FBC, LFTS, U&Es, Clotting
Haemolysis Screen
Why might a patient with chronic liver disease be malnourished?
Decreased oral intake ( early satiety due to ascitic compression)
Fat malabsorption ( decreased bile salt production)
Hepatic shift from glycogenolysis to gluconeogenesis ( due to decreased hepatocyte mass, caused lipopenia and sarcopenia)
How do you manage malnourishment in a chronic liver disease patient?
-Referral to dietician
-Increase caloric intake to prevent muscle tissue being used for energy
How should alcohol withdrawal be managed in patients being admitted to hospital?
High risk - medically assisted withdrawal
Offer Benzodiazepine/ Carbamezapine to prevent siezures
What can be offered as an alternative to Benzodiazepine/ Carbamezapine with alcohol withdrawal if its not tolerated well?
Clomethiazole
What services/ treatments are available to help patients with alcohol addiction?
Disulfram
Local Alcoholic Support Services ( e.g AA )
Benzodiazepenes
What scoring system is used to determine the likelihood of someone in withdrawal having seizures?
GWAMS score
What long-term complications of cirrhosis should a patient be monitored for?
Oesophageal Varices
Hepatic Encephalopathy
Hepatocellular Carcinoma
Ascites
Osteoporosis
What is NASH?
Non-Alcoholic Steatohepatitis
Liver inflammation and hepatocyte damage caused by build up of fat on liver, leads to CLD
What symptoms are associated with Paracetamol poisoning?
Abdo pain
Nausea
Vomiting
Jaundice
Encephalopathy
What investigations should be arranged for a Paracetamol overdose?
Blood Paracetamol concentration
Patient’s Weight
FBC, INR, U&Es, LFTs
VBG
How long should you wait to test a person’s blood paracetamol concentration after last ingestion?
4 hours
What clinical tools should be used to determine specific treatment for Paracetamol overdose?
TOXBASE
NPIS ( severe)
What is the treatment for Paracetamol overdose?
Acetylcysteine
If patient consumed more than 12g give activated charcoal
What is the mechanism of action of Acetylcysteine?
It replaces Glutathione levels, preventing oxidative damage to liver. Overdose leads to the production of the toxic metabolite NAPQI. This causes direct oxidative damage to hepatocytes ( Lipid peroxidation, protein damage, DNA damage)
What scoring system is particular for Paracetamol overdose?
King’s College Criteria
What is the criteria for safe discharge of this patient?
-Paracetamol concentration below the treatment line
-Normal INR and ALT
-Asymptomatic
-Normal Creatinine
What are the possible differentials of malnutrition?
IBD
Eating Disorder
Malignancy
Coeliac’s
Low Income
Depression
Alcohol Abuse
Dentition Issue
How is malnutrition best managed?
-Gradual reintroduction of food back into diet
-Can be oral, enteral or paraenteral
-Monitoring
What is refeeding syndrome?
A rapid increase in blood sugar and insulin leading glycogen, fat and protein synthesis.
These processes utilise phosphate, magnesium and potassium from already depleted body stores, resulting in electrolyte abnormalities
What are the risk factors for Refeeding Syndrome?
-BMI < 16
-Unintentional weight loss >15% in 3-6 months
-10 or more days with little or no nutritional intake
What is the first line treatment for C.Diff?
Oral vancomycin 10 days
What is the criteria for the severity of a UC flare up?
Truelove & Witts
What is Gallstone Ileus?
A small bowel obstruction secondary to an impacted gallstone
What markers are used to monitor treatment in Haemochromatosis?
Ferritin
Transferrin Saturation
What are some side effects of aminosalicylates?
Diarrhoea
Nausea
Vomiting
Exacerbation of colitis
In occasional cases, it can cause acute pancreatitis
Which medication helps prevent an oesophageal varices bleed taking place ? ( Prophylaxis )
Propanolol ( Non-Cardioselective B-Blocker)
What type of cancer does Barrett’s Metaplasia predispose a patient to?
Adenocarcinoma of the oesophagus
What can some complications of a life-threatening C. Difficile infection?
Sepsis
Toxic Megacolon
Ileus
What are the ALARMS symptoms where someone should be referred for Upper GI Endoscopy?
Anaemia
Loss of weight
Anorexia
Recent onset of progressive sx
Mass/malaena/haematemesis
Swallowing difficulties
Or if above 55
What is the advice for Alcohol consumption in a NON pregnant person?
Maximum 14 units spread over 3 or more days
How much alcohol is 14 units?
6 Pints
6 Medium glasses of wine
What is Courvoisier’s Law ?
If gallbladder is palpable in a painlessly jaundiced patient, it is unlikely to be due to gallstones.
This is because stones would have given rise to chronic inflammation and subsequently fibrosis of gallbladder therefore, rendering it incapable of dilatation.
Gallbladder is palpable due to build up of bile ( obstruction) so presume pancreatic cancer or biliary neoplasm
Why can Oesophageal Cancer present with hoarseness of voice?
Compression of the Recurrent Layngeal Nerve
What is the treatment for B12 and folate deficiency?
IM B12 replacement
A loading regime followed by 2-3 monthly injections
Then later give Folate
Why must you give Vitamin B12 replacement before folate replacement?
If given the other way round it can precipitate subacute combined degeneration of the cord
How does bile acid malabsorption present?
Watery green diarrhoea
How do you treat bile acid malabsorbtion?
Cholestyramine
What are risk factors for developing gallstones?
Increasing age
Family history
Sudden weight loss
Loss of bile salts - eg, ileal resection, terminal ileitis ( Crohn’s Disease)
Diabetes - as part of the metabolic syndrome.
Oral contraception
IBD and the billiary tree:
Crohns gives stones
UC gives PSC (Primary sclerosing cholangitis)
Useful ;)
What abnormalities are associated with Carcinoid Syndrome?
Right side of heart is affected
TIPS
Tricuspid Insufficiency
Pulmonary Stenosis
What medication is contraindicated in absolute constipation?
Metoclopramide - stimulates peristalsis in the bowel so could lead to a perforation
Can be useful in subacute obstruction
What is the management for Alcoholic Ketoacidosis?
IV Saline 0.9%
Thiamine
If a patient’s UC flare up extends past the left-sided colon ( e.g Ascending Colon) then what should be used to induce remission?
Oral AND Rectal Aminosalicylate
What is a good way to remember Truelove & Witt UC Criteria?
Mild >4 stools a day
Moderate 4-6 stools a day
Severe >6 stools a day + Systemic Features ( Pyrexia, Tachycardia, Anaemia, Raised Inflammatory Markers)
MILD = 4 Letters
SEVERE = 6 Letters
What is the first line imaging for the investigation of perianal fistula in Crohn’s?
MRI Pelvis
Which antibiotics are strongly linked to C.DIfficile infections?
4 Cs
Clindamycin
Cephalosporins ( Ceftriaxone)
Co-Amoxiclav
Ciprofloxacin
What does coffee-ground vomit suggest?
Perforated Gastric Ulcer
What is the key investigation for suspected perforated Peptic Ulcer?
Erect Chest X-Ray
Can detect free air under diaphragm ( pneumoperitoneum). This is indicative of GI Tract perforation
What is the treatment for a Pharyngeal Pouch?
Surgical repair and resection
What is Sister Mary Joseph nodule?
Protrusion of the umbilicus with a small hard swelling palpable lateral to it
What does Sister Mary Joseph nodule indicate?
A sign of metastasis to periumbilical lymph nodes, classically from a Gastric Carcinoma
What is the most commonly affected area in UC?
Rectum
What is a common side effect of Metoclopramide?
Diarrhoea
Why does metoclopramide cause Diarrhoea?
It’s a prokinetic antiemetic , meaning it promotes peristalsis
What is the surgical treatment for Achalasia?
Heller Cardiomyotomy
In Refeeding Syndrome, which electrolyte disturbance can cause Torsades de Pointes?
Hypomagnesaemia
Which deficiencies causes Angular Stomatitis?
Iron
Zinc
B Vitamins (B2,B3,B6,B9,B12)
What malignancy does Achalasia increase the likelihood of?
Squamous Cell Carcinoma of the oesophagus
What is Zollinger-Ellison Syndrome?
Multiple gastro-duodenal ulcers causing abdo pain and diarrhoea
Why can PPIs cause muscle aches?
They can cause hypomagnesaemia, which can cause muscle weakness. Usually after long term use
What is the first line treatment for IBS?
According to prominent symptom
Pain- Antispasmodic agents
Constipation - Laxative ( Avoid Lactulose)
Diarrhoea ( Loperamide)
What is the gold standard for diagnosis of Coeliac’s ( Imaging) ?
Crosby Capsule biopsy, done in the Jejunum or Duodenum ( Where villous atrophy would be seen)
What conditions are associated with H.Pylori?
Peptic Ulcer Disease
Gastric Adenocarcinoma
B Cell Lymphoma of MALT tissue
Chronic Gastritis
How does Loperamide work to slow down bowel movements?
u-opioid receptor agonist
Why is ferritin not necessarily a reliable marker for Iron Deficiency Anaemia?
Ferritin is an acute phase protein so it is raised in inflammatory conditions as well, TIBC is more reliable
A WCC higher than what indicates a severe C . Difficile infection?
15
A transjugular intrahepatic portosystemic shunt procedure connects which two vessels?
A transjugular intrahepatic portosystemic shunt (TIPS) procedure connects the hepatic vein to the portal vein
What can Magnesium replacement tablets cause?
Diarrhoea
What should be done for dysplasia in Barrett’s Oesophagus?
Endoscopic radiofrequency ablation
Mucosal Resection
Why is high urea indicative of an Upper GI Bleed?
High urea is indicative of a ‘protein meal’, as urea is a major nitrogenous waste product of protein metabolism within the liver. It is a result of gut bacteria breaking down blood proteins as they move through the GI tract.
What is the criteria for Acute Liver Failure?
Kings College Criteria
What is a gastrointestinal complication of Diabetes?
Autonomic neuropathy -> Gastroparesis
What are the symptoms of Gastroparesis?
Nausea
Vomiting
Early satiety
Diabetes
Which tumour marker monitors response to treatment forColorectal Cancer?
CEA
When PT is prolonged ( >14) what should be given in haematemesis?
I.V Vitamin K
What is the treatment for Shigella?
Ciprofloxacin and IV fluids
What infection most commonly predisposes Guillain-Barré syndrome?
Campylobacter jejuni
What is the treatment for Carcinoid tumours?
Octreotide
What is the treatment for SBP?
Tazocin (Piperacillin/Tazobactam) and Human Albumin Solution
What is the treatment for Gastroparesis?
Domperidone
Which GI Infection causes rose coloured macules on the chest and abdomen?
Salmonella Typhi
The rose-coloured macules are bacterial emboli to the skin
What is Zollinger-Ellison caused by?
Excess gastrin secretion from gastrinoma -> multiple stomach and duodenal ulcers
What is the test for Carcinoid Syndrome?
Raised urinary 5-HIAA level
This is a breakdown product of 5-HT, that is initially produced by the carcinoid tumour in excess
What is the incubation period from exposure of Hepatitis A?
2-6 weeks
What is the triple eradication therapy recommended for H.Pylori infection?
Amoxicillin, clarithromycin and omeprazole for 7 days
What is the triple eradication therapy recommended for H.Pylori infection if the patient is Penicillin allergic?
Metronidazole, clarithromycin and omeprazole for 7 days
In what cancers is CA 19-9 a tumour marker for?
Cholangiocarcinoma
Pancreatic cancer
Gastric cancer
What is the triad of Pellagra?
Dermatitis
Dementia
Diarrhoea
What is the management of rectal Crohn’s Disease?
Perianal Metronidazole
What is the symptoms of Vitamin A Deficiency called?
Xerophthalmia
What are the symptoms of Xerophthalmia?
Dry eyes ( conjunctiva and cornea)
Corneal Ulcers
What is Vitamin B1 deficiency called? ( Thiamine )
Beriberi
What are the symptoms of Beriberi?
Inflammation of nerves -> difficulty walking
Heart failure
Associated with alcholics
What is Vitamin D deficiency called?
Rickets
What is PBC?
PBC is due to chronic inflammation and scarring of the bile ducts leading to progressive and irreversible damage
What are the clinical features of a carcinoid tumour?
Flushing
Diarrhoea
Hypotension
Wheezing
What do carcinoid tumours release?
5-HT
Prostaglandins
Kinins
Substance P
Gastrin
What are on the King’s College Criteria of paracetamol od? ( Require urgent liver transplant)
pH < 7.3
or ALL of these
Creatinine > 300
Prothrombin Time > 100 secs
Grade III or IV encephalopathy
What rash is associated with Coeliac’s ?
Dermatitis Herpetiformis
Itchy vesicular rash on elbows
What is Vitamin C deficiency called?
Scurvy
‘sCurvy’
What are the investigation findings of Wilson’s Disease?
Low serum ceruloplasmin
Low copper levels
This is because copper is deposited preferentially in the tissues ( liver, eyes, CNS )
What are the investigation findings of PBC?
Raised ALP
Raised AMA
What is the treatment for peptic ulcer disease?
PPI for 4-8 weeks
What are the symptoms of Vitamin A deficiency?
Night blindness
Bitot’s spots ( white spots on the conjunctiva)
Dry skin
How does Staphylococcus Enteritis (Staph Aureus) present?
Following consumption of unpasteurized milk
Within 1-6 hours on ingestion due to preformed toxin
What is the management of high grade dysplasia of the oesophagus? ( Barrett’s Oesophagus)
Endoscopic ablation
What is a high SAAG ( Serum-Ascites Albumin Gradient)?
> 1.1g/dL
indicates portal hypertension
How does Octeotride work?
Somatostatin analogue ( GnRH ) . This blocks the release of serotonin and counters its peripheral effects
What is a Creon supplement used for?
Pancreatic Insufficiency
e.g Chronic Pancreatitis, Pancreatic Cancer, Cystic Fibrosis
What are the differences between the Viral Hepatitis types?
Hepatitis A and E - acute liver failure
Hepatitis B and C - chronic liver failure
Hepatitis D - only occurs in individuals with Hep B
What autoantibodies are raised in Autoimmune Hepatitis?
Anti-Smooth muscle antibodies
ANA
What type of laxative is Macrogrol?
Osmotic
What are the reversible complications of Haemochromatosis if treated with venepuncture?
Skin discolouration
Cardiomyopathy
What should be co prescribed with opioids?
Senna ( stimulative laxative )
As constipation is such a common side effect
When a patient is on Warfarin and has a major bleed, what should be done?
If INR is raised (>1.2)
5mg of vitamin K IV as well as prothrombin complex concentrate (PCC) to reverse the anticoagulation
What HBV serology indicates you have either an acute or chronic infection?
HBsAg
Which HBV Serology indicated you have either had the vaccine or the infection and are now immune?
Anti-HBsAg
Which HBV Serology indicates you have an acute infection?
Anti-HBcAg IgM
Which HBV Serology indicates you have either the chronic or previous infection and is now immune ? This one appears last
Anti-HBcAg IgG
What is the best marker of acute liver failure?
Prothrombin time - short hlaf life
What test confirms H.Pylori eradication?
Urea breath Test , only needed if symptoms are still present
