Gastroenterology Flashcards
If a patient has tried PPIs for dyspepsia and they have nit nessisarily work what should the next approach / treatment?
Test for H. pylori (e.g. stool)
If oral Vancomycin does not work for treatment of C. diff what is the next treatment?
Oral fidaxomicin
What is the mainstay of treatment for bowel obstruction (3)
- NG tube insertion
- Catheterisation
- IV fluid resuscitation
What drugs should be avoided in bowel obstruction?
Laxatives and anti-emetics with pro-kinetic properties (e.g metoclopramide) - can precipitate perforation
How long after diarrhoea has stopped do patients with C.diff need to be isolated for?
48 hrs
What are the triad of symptoms in Budd-Chiari? (3)
- What other important aspect should you look for in the patient’s history? (1)
- Sudden onset abdo pain
- Ascites
- Tender hepatomegaly
- History of clotting/FH/ clotting disorder (e.g factor V leiden)
What are the complications of constipation (3)
- Overflow diarrhoea
- Acute urinary retention
- Haemorroids
What is the 1st line drug management of constipation? (class of drug + example)
Bulk forming laxative (e.g. Ispaghula)
What is the 2nd line drug management of constipation? (class of drug + example)
Osmotic laxative (e.g. Macrogol)
What is the best screening investigation for haemochromatosis?
Transferrin saturation (iron studies and ferritin also useful)
How can Family members of haemochromatosis be screened?
Genetic testing: HFE gene
What should the transferrin saturation and serum ferritin concentration be kept below?
- Transferrin sat: <50%
- Serum ferritin: <50 ug/L
What is the management of PBC? (3)
- final line as well (1)
- Ursodeoxycholic acid
- Cholestyramine for pruritis
- Vitamins (fat soluble) supplementation
- Liver transplant final line
Coeliac disease is associated with the development of what cancer?
T cell lymphoma (enteropathy-associated T cell lymphoma of SI)
Vomiting + severe chest pain and shock is likely what syndrome?
Boerhaave syndrome
What is Courvoisier’s law?
Painless obstuctive jaundice and a palpable non-tender gallbladder is unlikely gallstones
- Pancreatice malignancy most likely
What is the 1st and 2nd line treatment of hepatic encephalopathy?
- Bonus points for MOA
- Lactulose (excretion + incr metabolism of gut flora)
- Rifaximin (antiB that modulates gut flora resulting in decreased ammonia production)
What autoantibody may be +ve in PSC
p-ANCA
Ascites conservative management options?
- Reduce dietary sodium
- Fluid restriction if sodium < 125 mmol/L
What prophylactic antiBs may be used in Ascites to prevent SBP?
Oral Ciprofloxacin or Norfloxacin
What treatment may be offered in tense ascites?
Large-volume paracentesis (may require albumin cover)
- Also TIPS
What lab investigation caan be used to differentate mild moderate and severe (not life-threatening though) C diff
WCC
- Normal, <15x10^9, > 15x10^9
How is diagnosis of C diff made?
Detecting C diff toxin in stool
- Not the antigen
Prophylaxis of oesophageal bleeding
Propranolol
What is fundoplication surgery used to treat? (1)
- What tests are required pre-surgery? (2)
- GORD
- Oesophageal pH and manometry studies
What antibiotics are associated with cholestasis?
- Flucloxacillin
- C-amox
- Erythromycin
Gluten free foods
rice, potatoes and corn (maize)
Small bowel bacterial overgrowth syndrome
pancreatic cancer investigation
High resolution CT
High Urea and iron deficiency most likely equates to what condition?
Upper GI bleed
What drugs are given pre-endoscopy in variceal haemorrhage?
- Terlipressin (ADH analogue), vasconstrictive, incr BP
- IV antibiotics
What conditions predispose to small bowel bacterial overgrowth syndrome (SBBOS)?
- Scleroderma
- DM
- Neonates with congestinal abnormalities
What is the management for SBBOS?
- Rifaximin (then Co-amox, metronidazole)
- Also correction of underlying disorder
What signs/symptoms point towards SBBOS over IBS
- AntiBs improve symptoms
- Scleroderma or diabetes
How may SBBOS be diagnosed? (3)
- Hydrogen breath test
- Antibiotic diagnostic trial
- Small bowel aspiration and culture (invasive so used less often)
Zollinger-Ellison syndrome is associated with what genetic disorder?
- What other organs are involved
MEN 1 (Pituitary, pancreas, parathyroid)
MEN2a organs
- Parathyroid
- Pheochromocytoma
- Medullary thyroid
Men2b organs?
- Pheochromocytoma
- Medullary thyroid
- Mucosal neuromas
- Marfinoid habitus
What specific cells may be seen in gastric cancer? (a bigher number of these cells indicates worse prognosis)
Signet ring cells
What nodes can gastric cancer spread to? (2)
- Bonus points for names
- Left subclavicular node (Virchow’s)
- Periumbilical nodule (sister MAry Joseph’s node
Angular chelitis can be due to a deficiency of what vitamin?
B2 - Riboflavin
What test can be used to test for H pylori eradication?
Urea breath test (CLO is rapid, not for eradication)
Alcoholic hepatitis is treated w. Prednisolone according to Maddrey’s discriminant function (DF), which into account what 2 factors?
PT and billirubin conc.
Remission in Crohn’s is maintained through what drugs?
Azathioprine and mercaptopurine
After steroids what drugs are used to induce remission? (second-line drug therapy)
5-ASA drugs: Mesalazine
What add-on drug/class is usually used in fistulating Crohn’s?
Infliximab (Anti-TNF)
What is the investigation useful in carcinoid syndrome?
Urinary 5-HIAA
- Also: Plasma chromogranin A y
