Gastroenterology Flashcards
What stool test gets done before deciding to refer for the colorectal cancer 2 week wait?
Faecal occult blood test/ FIT test
Which one causes pain between mesenteric ischaemia and colorectal cancer causing obstruction?
Mesenteric ischaemia
Give three scoring systems to aid with acute pancreatitis severity.
- Glasgow score
- Ranson score
- Apache II (for ICU patients)
Which viral hepatitis is the number one cause of HCC worldwide?
Hepatitis B
Which viral hepatitis is the number one cause of HCC in the UK?
Hepatitis C
What is the most common type of liver tumour and how is it found?
Liver haemangioma is benign, asymptomatic and usually found incidentally
Which rare liver tumour usually grows in young people with healthy livers?
Fibrolamellar carcinoma
What is the most appropriate treatment to give to a patient with an acute abdomen caused by a perforated peptic ulcer?
ABCDE approach. give IV fluids as they are dehydrated (made NBM) and in shock and then give IV Abx to prevent sepsis.
A patient has abdo pain straight to the back that is tender, with a low grade fever. What do they have?
Acute pancreatitis
A patient presents with abdo pain, ascites, tender hepatomegaly, a raised JVP, with no signs of peripheral oedema or stigmata of chronic liver disease. What do they have?
Budd Chiari syndrome
What gene is mutated in haemochromatosis?
HFE
What gene is mutated in HNPCC/ Lynch syndrome?
MMR (MCH1)
Where in the GI tract does melaena suggest bleeding in and hence what is the order of investigations the patient should have?
Bleed in the UPPER GI tract or right sided colon.
1. OGD
2. Colonoscopy
3. CT angiography
If a patient is haemodynamically unstable with a profuse lower GI bleed, which imaging investigation should they have?
CT angiography
When do you refer a patient to a 2 week wait colorectal cancer pathway without doing a FIT test?
A rectal/ anal mass or anal ulcer is felt/ seen on DRE
What is the first imaging investigation for acute cholecystitis?
Abdo USS
What is the first imaging investigation for a patient with painless rectal bleeding after DRE ?
Proctoscopy for haemorrhoids
A young man has constipation and anorectal pain that is relieved by sitting on the toilet. What is the first investigation?
Anal manometry
What is the first line imaging for pancreatic cancer?
2 week wait for a CT abdomen
A patient with low BP and acute cholangitis- what is the most appropriate management?
ABCDE
IV ABx and fluids
then ERCP
A patient has high ALP and Sjorgens syndrome. What antibodies are you looking for?
Antimitochondrial Ab- PBC
What is the stepwise investigations for acute pancreatitis?
- bloods
- imaging
What kind of SAAG picture does liver metastasis give?
the same SAAG picture as liver cirrhosis
What kind of SAAG picture does peritoneal carcinoma give?
SAAG <1.1g/dL - exudative picture
A young patient has a refractory and severe peptic ulcer disease, back pain with no NSAID use and negative H.pylori. What is the first investigation?
Fasting serum gastrin for Zollinger Ellison syndrome. MEN1.
What screening is done in patients with haemochromatosis and why?
Abdo USS for HCC
What is the next step for a patient who has taken paracetamol tablets 2 hours ago and is asymptomatic?
Check in 4 hours and measure serum paracetamol
A patient with a history of anxiety/ depression feels a lump in her throat but all investigations come back normal. What does she have?
Global hystericus
What is the first line imaging to confirm aetiology in acute pancreatitis?
Abdo USS to confirm diagnosis of e.g. gallstones
For Wilson’s disease comment on:
- serum caeruloplasmin levels
- total serum copper
- urinary copper excretion
- LFTs
- low serum caeruloplasmin levels
- low total serum copper
- high urinary copper excretion
- raised LFTs
What gene is mutated in Wilson’s disease?
ATP7B
What is the most common cause of duodenal ulcers?
H.pylori
What is the most sensitive test in detecting a hiatus hernia?
Barium swallow
Name two drugs that cause deranged LFTs.
Amiodarone
methotrexate
What nail changes is seen in chronic liver disease?
Leukonychia
due to hypoalbuminaemia
Give an example of an osmotic laxative
Lactulose
How is autoimmune hepatitis managed?
Steroids
Azathioprine/ cyclosporin
Name a benign liver tumour
Adenoma liver tumour
Give an example of a stimulant laxative
Senna
Which GI ulcers bleed more and what are they caused by?
Gastric ulcers > duodenal ulcers
due to NSAID use
At what bilirubin level is jaundice clinically visible?
> 35
What kind of bilirubin is absent and raised in gallstones obstructing the CBD?
No unconjugated bilirubin
raised conjugated bilirubin
Post hepatic obstruction
What artery is occluded in intestinal angina/ chronic mesenteric ischaemia?
Superior mesenteric artery
What artery is occluded in ischaemic colitis?
Inferior mesenteric artery
What drug class is Cimetidin?
H2 receptor antagonist.
Inhibits stomach acid production
What drug class is hycosine and what is it used to treat?
Anticholinergic
Abdo pain in IBS
What is the earliest serological marker for acute hepatitis A?
IgM antibody
What medication is avoided in reflux disorders?
CCBs can relax the oesophageal sphincter
What is given to a patient with SBP with a rising creatinine?
Human albumin solution
What haematological condition can predispose to Budd Chiari syndrome?
Polycythaemia rubra vera can lead to hepatic vein obstruction
What can be given to treat pruritis affecting sleep?
Chlorphenamine (anti histamine)
How can cirrhosis affect the kidneys?
Can lead to hepatorenal syndrome
Release of vasoactive mediators leads to splanchnic vasodilation, reducing blood flow to kidneys causing AKI
Does early or late liver damage cause hepatomegaly?
Early -> fatty liver-> hepatomegaly
Late-> fibrosis-> small and scarred liver
Is Crohn’s associated with HLA-B27?
Yes
What is recommended for patients with Barretts with metaplasia not dysplasia seen?
endoscopy is recommended every 3-5 years
What symptoms does Whipple disease produce?
Fat malabsorption
Steatorrhoea
What is seen on jejunal biopsy for Whipple disease?
Vacuolated macrophages
Purple on periodic acid schiff stain
What cancer gives an obstructive cancer picture with a palpable liver and abdominal discomfort?
Cholangiocarcinoma
HCC does not give as much of an obstructive picture
How do you manage a high output stoma?
Fluid restrict
Loperamide (anti-diarrhoeal)
PPIs (reduce acid generation)
What is an important investigation to do in a patient with acute pancreatitis progressing to ARDS?
ABG
What can be inserted to treat recurrent ascites refractory to diuretics?
TIPS
transjugular intrahepatic portosystemic shunt
What investigation should be done first for someone with profuse rectal bleeding and abdo pain who is unstable?
VBG
gives lactate level and Hb levels
In endoscopically negative reflux disease for GORD what should be done if PPI fails?
Trial histamine antagonist e.g. Nizatidine
Is odynophagia likely to be associated with cancer?
No
Is there usually weight loss in IBS?
No
What protein is useful in assessing severity if pancreatitis?
Serum albumin
What medication can be used to treat bloating in IBS?
Berbeberine hydrochloride
antispasmodic effects
What laxative can be used to treat constipation in IBS?
Isphaghula husk
Bulk forming laxative
What investigation can be used to monitor the progression of non alcholic fatty liver disease before it gets to liver fibrosis?
Enhanced liver fibrosis blood test
What is screened for when there is decompensation in cirrhosis without an obvious trigger?
HCC
using alpha fetoprotein
What does NICE suggest should be done in primary care as part of diagnosis of IBD?
Stool culture
