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Barts Final Year > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

If a patient has tried PPIs for dyspepsia and they have nit nessisarily work what should the next approach / treatment?

A

Test for H. pylori (e.g. stool)

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2
Q

If oral Vancomycin does not work for treatment of C. diff what is the next treatment?

A

Oral fidaxomicin

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3
Q

What is the mainstay of treatment for bowel obstruction (3)

A
  • NG tube insertion
  • Catheterisation
  • IV fluid resuscitation
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4
Q

What drugs should be avoided in bowel obstruction?

A

Laxatives and anti-emetics with pro-kinetic properties (e.g metoclopramide) - can precipitate perforation

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5
Q

How long after diarrhoea has stopped do patients with C.diff need to be isolated for?

A

48 hrs

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6
Q

What are the triad of symptoms in Budd-Chiari? (3)
- What other important aspect should you look for in the patient’s history? (1)

A
  • Sudden onset abdo pain
  • Ascites
  • Tender hepatomegaly
  • History of clotting/FH/ clotting disorder (e.g factor V leiden)
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7
Q

What are the complications of constipation (3)

A
  • Overflow diarrhoea
  • Acute urinary retention
  • Haemorroids
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8
Q

What is the 1st line drug management of constipation? (class of drug + example)

A

Bulk forming laxative (e.g. Ispaghula)

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9
Q

What is the 2nd line drug management of constipation? (class of drug + example)

A

Osmotic laxative (e.g. Macrogol)

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10
Q

What is the best screening investigation for haemochromatosis?

A

Transferrin saturation (iron studies and ferritin also useful)

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11
Q

How can Family members of haemochromatosis be screened?

A

Genetic testing: HFE gene

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12
Q

What should the transferrin saturation and serum ferritin concentration be kept below?

A
  • Transferrin sat: <50%
  • Serum ferritin: <50 ug/L
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13
Q

What is the management of PBC? (3)
- final line as well (1)

A
  • Ursodeoxycholic acid
  • Cholestyramine for pruritis
  • Vitamins (fat soluble) supplementation
  • Liver transplant final line
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14
Q

Coeliac disease is associated with the development of what cancer?

A

T cell lymphoma (enteropathy-associated T cell lymphoma of SI)

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15
Q

Vomiting + severe chest pain and shock is likely what syndrome?

A

Boerhaave syndrome

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16
Q

What is Courvoisier’s law?

A

Painless obstuctive jaundice and a palpable non-tender gallbladder is unlikely gallstones
- Pancreatice malignancy most likely

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17
Q

What is the 1st and 2nd line treatment of hepatic encephalopathy?
- Bonus points for MOA

A
  • Lactulose (excretion + incr metabolism of gut flora)
  • Rifaximin (antiB that modulates gut flora resulting in decreased ammonia production)
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18
Q

What autoantibody may be +ve in PSC

A

p-ANCA

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19
Q

Ascites conservative management options?

A
  • Reduce dietary sodium
  • Fluid restriction if sodium < 125 mmol/L
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20
Q

What prophylactic antiBs may be used in Ascites to prevent SBP?

A

Oral Ciprofloxacin or Norfloxacin

21
Q

What treatment may be offered in tense ascites?

A

Large-volume paracentesis (may require albumin cover)
- Also TIPS

22
Q

What lab investigation caan be used to differentate mild moderate and severe (not life-threatening though) C diff

A

WCC
- Normal, <15x10^9, > 15x10^9

23
Q

How is diagnosis of C diff made?

A

Detecting C diff toxin in stool
- Not the antigen

24
Q

Prophylaxis of oesophageal bleeding

A

Propranolol

25
Q

What is fundoplication surgery used to treat? (1)
- What tests are required pre-surgery? (2)

A
  • GORD
  • Oesophageal pH and manometry studies
26
Q

What antibiotics are associated with cholestasis?

A
  • Flucloxacillin
  • C-amox
  • Erythromycin
27
Q

Gluten free foods

A

rice, potatoes and corn (maize)

28
Q

Small bowel bacterial overgrowth syndrome

A
29
Q

pancreatic cancer investigation

A

High resolution CT

30
Q

High Urea and iron deficiency most likely equates to what condition?

A

Upper GI bleed

31
Q

What drugs are given pre-endoscopy in variceal haemorrhage?

A
  • Terlipressin (ADH analogue), vasconstrictive, incr BP
  • IV antibiotics
32
Q

What conditions predispose to small bowel bacterial overgrowth syndrome (SBBOS)?

A
  • Scleroderma
  • DM
  • Neonates with congestinal abnormalities
33
Q

What is the management for SBBOS?

A
  • Rifaximin (then Co-amox, metronidazole)
  • Also correction of underlying disorder
34
Q

What signs/symptoms point towards SBBOS over IBS

A
  • AntiBs improve symptoms
  • Scleroderma or diabetes
35
Q

How may SBBOS be diagnosed? (3)

A
  • Hydrogen breath test
  • Antibiotic diagnostic trial
  • Small bowel aspiration and culture (invasive so used less often)
36
Q

Zollinger-Ellison syndrome is associated with what genetic disorder?
- What other organs are involved

A

MEN 1 (Pituitary, pancreas, parathyroid)

37
Q

MEN2a organs

A
  • Parathyroid
  • Pheochromocytoma
  • Medullary thyroid
38
Q

Men2b organs?

A
  • Pheochromocytoma
  • Medullary thyroid
  • Mucosal neuromas
  • Marfinoid habitus
39
Q

What specific cells may be seen in gastric cancer? (a bigher number of these cells indicates worse prognosis)

A

Signet ring cells

40
Q

What nodes can gastric cancer spread to? (2)
- Bonus points for names

A
  • Left subclavicular node (Virchow’s)
  • Periumbilical nodule (sister MAry Joseph’s node
41
Q

Angular chelitis can be due to a deficiency of what vitamin?

A

B2 - Riboflavin

42
Q

What test can be used to test for H pylori eradication?

A

Urea breath test (CLO is rapid, not for eradication)

43
Q

Alcoholic hepatitis is treated w. Prednisolone according to Maddrey’s discriminant function (DF), which into account what 2 factors?

A

PT and billirubin conc.

44
Q

Remission in Crohn’s is maintained through what drugs?

A

Azathioprine and mercaptopurine

45
Q

After steroids what drugs are used to induce remission? (second-line drug therapy)

A

5-ASA drugs: Mesalazine

46
Q

What add-on drug/class is usually used in fistulating Crohn’s?

A

Infliximab (Anti-TNF)

47
Q

What is the investigation useful in carcinoid syndrome?

A

Urinary 5-HIAA
- Also: Plasma chromogranin A y

48
Q
A

Barts Final Year (13 decks)

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