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Gastroenterology > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Which medications can increase risk of C. diff?

A
  • Broad spectrum antibiotics
  • PPIs
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2
Q

What is the management of C.diff?

A

1st line = Oral vancomycin
2nd line = Oral fidaxomicin
3rd line = oral vancomycin +/- IV metronidazole

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3
Q

Which antibodies are associated to pernicious anaemia?

A

Intrinsic factor antibodies
Gastric parietal cell antibodies

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4
Q

Features of pernicious anaemia…

A

General anaemia features = lethargy, pallor, dyspnoea
Neurological features = peripheral neuropath - ‘pins and needles’, numbness, subacute degeneration of the spinal cord –> ataxia, progressive weakness, spasticity
Other features = macroglossia

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5
Q

Which clotting factors are affected in liver disease?

A

All clotting factors except factor VIII (which is produced in endothelial cells across body, not just liver)

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6
Q

What is a severe adverse effect of aminosalicylates?

A

Associated with Agranulocytosis –> signs= sore throat, fever, fatigue, bleeding gums

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7
Q

What are some extra-intestinal features of Crohn’s?

A

Related to disease activity
Arthritis - asymmetric
Erythema nodosum
Episcleritis
Osteoporosis

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8
Q

What test is used to for re-testing after H.Pylori eradication?

A

Urea breath test - only offered re-test if poor compliance with eradication therapy, family hx of gastric malignancy, pt has requested re-testing

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9
Q

What LFTs are seen in liver dysfunction/ hepatocellular picture?

A

Raised ALT
Normal ALP
Ratio of ALT/ALP = 5x

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10
Q

What LFTs are seen in cholestasis?

A

Raised ALP
Normal ALT
Ratio of ALT/ALP = <2

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11
Q

Management of Crohn’s…

A

Inducing remission:
1st line = Glucocorticoids
2nd line = Mesalazine
3rd line = Azothioprine can be used in combination (NOT as monotherapy)
In refractory disease = Infliximab

Maintaining remission:
1st line = Azothioprine / mercaptopurine
2nd line = Methotrexate

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12
Q

What is the acute management of variceal haemorrhage?

A
  1. Initially ABC resuscitation
  2. Terlipressin and IV prophylactic antibiotics to be given
  3. Endoscopic variceal band ligation
  4. Transjugular intrahepatic portosystemic shunt (TIPSS) used if above measures fail
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13
Q

What is used as prophylaxis of variceal haemorrhage?

A
  1. Propranolol –> reduce rebleeding risk
  2. Endoscopic variceal band ligation
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14
Q

What does HBsAg positive indicate?

A

Surface antigens present –>Current/ acute infection - first marker to appear

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15
Q

What does HBsAg persisting over 6 months indicate?

A

Chronic disease

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16
Q

What does Anti-HBs indicate?

A

Immunity or exposure (after which they have produced antibodies)

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17
Q

What does Anti-HBc indicate?

A

Previous or current infection

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18
Q

What does IgM anti-HBc indicate?

A

Appears during acute infection, present around 6 months

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19
Q

What does IgG anti-HBc indicate?

A

IgG persists after the acute phase of infection - chronic disease

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20
Q

What are the features of autoimmune hepatitis?

A
  • Signs of chronic liver disease (hepatomegaly, spider naevi)
  • Fever and jaundice seen in autoimmune hepatitis
  • Amenorrhoea
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21
Q

What is the management of ulcerative colitis?

A

Inducing remission:
In proctitis and proctosigmoiditis –> Topical aminosalicylate
If no remission within 4 weeks: Add oral aminosalicylate
If remission still not achieved –>oral corticosteroid
In extensive disease –> topical aminosalicylate + high dose oral aminosalicylate

Maintaining remission:
Topical +/- oral aminosalicylates
**After severe relapse or >2 exacerbations in a year –> Azothioprine

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22
Q

What is the management of severe UC?

A

Admission for IV steroids
2nd line = IV ciclosporin

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23
Q

What conditions are associated with PBC?

A

Sjorgens syndrome (80% of patients)
Rheumatoid arthritis
Systemic sclerosis

24
Q

What are the clinical features of PBC?

A
  • Cholestatic jaundice
  • Raised ALP on routine LFTs
  • Pruririts, hypermigmentation
25
Q

What antibodies are associated with PBC?

A
  • AMA
  • Smooth muscle antibodies
  • Serum IgMWh
26
Q

Which drugs can cause cholestasis?

A
  • Combined oral contraceptive pill
  • Antibiotics - flucloxacillin, co-amoxiclav
  • Sulphonylureas e.g. gliclazide
27
Q

What investigation is used to diagnose NAFLD if suspected from USS?

A

Enhanced liver fibrosis (ELF) blood test

28
Q

What investigations are carried out to diagnose coeliac disease?

A
  1. Ant-TTG AND total IgA
  2. Duodenal biopsy if suspected after antibody testing
29
Q

What are the features of IBS?

A
  • Abdominal pain relieved by defecation
  • Altered stool passage - straining, urgency, incomplete evacuation
  • Abdominal bloating
  • Sx made worse by eating
  • Passage of mucus
30
Q

What is the biggest cause of hepatocellular carcinoma in the UK ? Worldwide?

A

UK = Hep C
Worldwide = Hep B

31
Q

What advice is give regarding PPI use in preparation for endoscopy?

A

Stop PPI use 2 weeks before endoscopy

32
Q

What condition is UC most associated to?

A

PSC

33
Q

What is the investigation of choice in bile acid malabsorption?

A

SeHCAT scan –> assess retention/loss of SeHCAT

34
Q

What vitamin supplementation is teratogenic at high doses?

A

Vitamin A

35
Q

What is Courvoiser’s Law?

A

Palpable, non-tender, enlarged gallbladder + painless jaundice
–>consider gallbladder malignancy (unlikely to be gallstones)

36
Q

What is metoclopramide contraindicated in?

A

Bowel obstruction
Parkinson’s disease

37
Q

What is the acute treatment for thrombosed haemorrhoids?

A

Thrombectomy –>removal of the clot to provide immediate relief

38
Q

What is the diagnostic investigation for Crohn’s?

A

CT scan

39
Q

What is the best imaging for suspected colonic cancer?

A

Colonoscopy

40
Q

What is the best imaging for anal fistulae?

A

MRI scan –> able to accurately delineate tracts

41
Q

What size of AAA requires surgical repair?

A

AAA 4.5 - 5.4cm = require repeat USS in 3 months
AAA > 5.5cm = elective repair (need to be reviewed by vascular surgeon within 2 weeks)
AAA > 7ccm = urgent laparotomy required

42
Q

What antibodies are associated with primary biliary cholangitis?

A

Anti-mitochondrial antibodies (AMA)

43
Q

Features of acute mesenteric ischaemia?

A
  • Sudden onset, severe abdominal pain –> usually not consistent with exam findings
  • Usually have history of AF –> emboli
  • Very serious, with poor prognosis if surgery is delayed
44
Q

Features of chronic mesenteric ischaemia?

A
  • Intermittent, colicky abdominal pain usually after eating –> “intestinal angina”
  • Fear of eating as a result –> weight loss
  • History of vascular disease
45
Q

Features of ischaemic colitis?

A
  • Abdominal pain - transient
  • Bloody diarrhoea
  • Typically “thumb-printing” may be seen on abdominal x-ray due to mucosal oedema
46
Q

Key features of chronic pancreatitis?

A
  • Post-prandial abdominal pain (15-30 mins post meal)
  • Steatorrhoea
  • Diabetes will eventually develop in most patients
  • Pancreatic calcification is seen
  • Minimal rise in amylase
47
Q

What is the preferred imaging for acute pancreatitis?

A

Usually diagnosed clinically and imaging is not indicated in the acute phase –> focus on fluid resuscitation

48
Q

Key features of acute pancreatitis…

A
  • Central abdominal pain, radiating through to the back
  • Nausea and vomiting
  • Jaundice
  • Raised enzymes - amylase, lipase
  • Very high CRP in severe attack
  • Low Ca is seen
49
Q

What is the treatment for H.Pylori?

A

Triple therapy:
7 day course of: PPI twice daily + amoxicillin+ clarithromycin OR metronidazole

50
Q

Management of anal fissure…

A

Acute <6 weeks:
- Stool softener
- Dietary changes - increased fibre and water intake
- Lubricant use before defecation

Chronic >6weeks:
- Topical GTN - 6-8 week course
- If not effective after 8 weeks, consider botulinum toxin or surgery

51
Q

Management of diverticulitis…

A

Mild flares can be treated with oral antibiotics
If no improvement within 72 hours –> admit for IV antibiotics

52
Q

Features of inguinal hernia…

A
  • Located superior and medial to pubic tubercle
  • Disappear/ reduce manually or when lying down
  • Discomfort and ache
53
Q

Which laxatives should be used in IBS and which should not?

A

Use: Bulk forming laxatives - isphalga husk, methylcellulose
Do NOT use: lactulose –> causes abdominal cramps, flatulence - therefore will most likely worsen symptoms

54
Q

What are the features of Wernicke’s encephalopathy?

A

As a result of thiamine deficiency secondary to chronic alcoholism
- Nystagmus
- Ataxia
- Confusion

–>Can go onto develop Korsakoff’s syndrome - long term memory loss with confabulation

55
Q

What is the difference between left sided and right sided colonic carcinomas in presentation?

A

Left sided carcinoma:
- Fresh rectal bleeding
- Change in bowel habits

Right sided carcinoma:
- Iron deficiency anaemia in absence of rectal bleeding
- Insidious onset

56
Q

What is Budd-Chiari syndrome?

A

Disorder characterised by obstruction of hepatic venous outflow which may be caused by thrombosis or compression
–> causes severe ascites and severe abdominal pain
Associated with VTE risk factors

57
Q
A

Gastroenterology (2 decks)

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