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MSRA > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Which mnemonic helps differentiate Crohn’s disease and what does it stand for?

A

NESTS
N: No blood or mucus (PR bleeding less common)
E: Entire GI tract affected
S: Skip lesions on endoscopy
T: Terminal ileum most affected and Transmural inflammation
S: Smoking is a risk factor

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2
Q

Which mnemonic helps differentiate ulcerative colitis and what does it stand for?

A

CLOSEUP:

C: Continuous inflammation
L: Limited to colon and rectum
O: Only superficial mucosa affected
S: Smoking may be protective
E: Excrete blood and mucus
U: Use aminosalicylates
P: Primary sclerosing cholangitis

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3
Q

What condition is ulcerative colitis particularly associated with?

A

Primary sclerosing cholangitis.

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4
Q

What skin conditions can occur with inflammatory bowel disease?

A

Erythema nodosum
Pyoderma gangrenosum

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5
Q

What eye conditions are associated with IBD?

A

Episcleritis
Scleritis
Anterior uveitis

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6
Q

What stool test is around 90% sensitive and specific for IBD in adults?

A

Faecal calprotectin.

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7
Q

What is the investigation of choice for diagnosing IBD?

A

Colonoscopy with multiple intestinal biopsies.

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8
Q

What is the first-line treatment for mild to moderate acute ulcerative colitis?

A

Aminosalicylates (e.g., oral or rectal mesalazine).

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9
Q

What is the first-line treatment for severe acute ulcerative colitis?

A

Intravenous steroids (e.g., IV hydrocortisone).

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10
Q

What surgical procedure is curative for ulcerative colitis?

A

Panproctocolectomy (removal of the large bowel and rectum).

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11
Q

What are the two surgical options after a panproctocolectomy?

A

Permanent ileostomy
Ileo-anal anastomosis (J-pouch)

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12
Q

What is the first-line treatment for inducing remission in an exacerbation of Crohn’s disease?

A

Steroids (e.g., oral prednisolone or IV hydrocortisone).

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13
Q

What is an alternative treatment to steroids for inducing remission in Crohn’s disease, especially in children?

A

Enteral nutrition.

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14
Q

What are the first-line options for maintaining remission in Crohn’s disease?

A

Azathioprine
Mercaptopurine

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15
Q

What are the surgical options for Crohn’s disease?

A

Resecting the distal ileum
Treating strictures
Treating fistulas

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16
Q

List three red flag features in GORD (in addition to dysphagia) that may indicate a need for an urgent two-week wait referral.

A

Weight loss
Treatment-resistant dyspepsia
Upper abdominal mass on palpation

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17
Q

What is the most common type of hiatus hernia?

A

Sliding hiatus hernia (Type 1).

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18
Q

What bacteria is associated with gastritis, ulcers, and an increased risk of stomach cancer?

A

Helicobacter pylori (H. pylori).

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19
Q

Name two methods used to test for H. pylori infection.

A

Stool antigen test
Urea breath test

20
Q

What is the typical treatment for H. pylori infection?

A

Triple therapy with a proton pump inhibitor and two antibiotics (e.g., amoxicillin and clarithromycin) for 7 days.

21
Q

What is Barrett’s oesophagus and why is it significant?

A

Barrett’s oesophagus is a condition where the lower oesophageal epithelium changes from squamous to columnar, increasing the risk of oesophageal adenocarcinoma.

22
Q

What is the treatment for Barrett’s oesophagus to monitor or prevent progression to cancer?

A

Endoscopic monitoring
Proton pump inhibitors
Endoscopic ablation (e.g., radiofrequency ablation)

23
Q

What is Zollinger-Ellison syndrome?

A

A rare condition where a duodenal or pancreatic tumour secretes excessive gastrin, leading to severe dyspepsia, peptic ulcers, and diarrhoea.

24
Q

What genetic condition is associated with Zollinger-Ellison syndrome?

A

Multiple endocrine neoplasia type 1 (MEN1).

25
Q

What types of medications increase the risk of bleeding from a peptic ulcer?

A

Non-steroidal anti-inflammatory drugs (NSAIDs)
Aspirin
Anticoagulants (e.g., DOACs)
Steroids
SSRI antidepressants

26
Q

How can chronic microscopic bleeding from a peptic ulcer affect the blood?

A

It can lead to iron deficiency anaemia, resulting in low haemoglobin, low mean cell volume (MCV), and low ferritin.

27
Q

What is gastric outlet obstruction and how does it present?

A

Gastric outlet obstruction is a narrowing of the stomach exit due to scarring and strictures, leading to early fullness after eating, upper abdominal discomfort, abdominal distension, and vomiting after meals.

28
Q

How can gastric outlet obstruction be treated?

A

It may be treated with balloon dilatation during an endoscopy or surgery.

29
Q

How can you differentiate between gastric and duodenal ulcers based on eating patterns and pain?

A

Eating worsens the pain in gastric ulcers, while in duodenal ulcers, pain improves immediately after eating but worsens 2-3 hours later.

30
Q

What is the most common cause of upper gastrointestinal bleeding? Name four other potential sources of upper GI bleeding.

A

Peptic ulcers.

Mallory-Weiss tear (tear of the oesophageal mucosa)
Oesophageal varices (due to portal hypertension in liver cirrhosis)
Stomach cancer
Gastritis or esophagitis

31
Q

What factors does the Glasgow-Blatchford score take into account?

A

Haemoglobin
Urea
Systolic blood pressure
Heart rate
Presence of melaena
Syncope
Liver disease
Heart failure

32
Q

What is the purpose of the Rockall score?

A

It estimates the risk of rebleeding and mortality after endoscopy.

33
Q

What factors does the Rockall score include?

A

Age
Features of shock (e.g., tachycardia, hypotension)
Co-morbidities
Cause of bleeding
Endoscopic findings of recent bleeding

34
Q

What does the mnemonic ABATED stand for in the management of upper GI bleeding?

A

A – ABCDE approach
B – Bloods (FBC, U&Es, INR, LFTs, crossmatch)
A – Access (2 large bore cannulas)
T – Transfusions (as needed)
E – Endoscopy (within 24 hours)
D – Drugs (stop anticoagulants and NSAIDs)

35
Q

When are platelets given in UGIB?

A

When there is active bleeding plus thrombocytopenia (platelet count <50).

36
Q

What is given to patients on warfarin who are actively bleeding?

A

Prothrombin complex concentrate.

37
Q

What additional treatments are needed if oesophageal varices are suspected?

A

Terlipressin
Broad-spectrum antibiotics

38
Q

When should a proton pump inhibitor (PPI) be used in upper GI bleeding?

A

After endoscopy for non-variceal bleeding, as per NICE guidelines (2016).

39
Q

What criteria are required for an IBS diagnosis according to NICE?

A

A history of at least 6 months of abdominal pain or discomfort with one of the following:

  • Pain or discomfort relieved by opening the bowels
  • Bowel habit abnormalities
  • Stool abnormalities (e.g., watery, loose, or hard)

and At least two of the following:

  • Straining, urgency, or incomplete emptying
  • Bloating
  • Symptoms worse after eating
  • Passing mucus
40
Q

What is recommended for constipation in IBS?

A

Bulk-forming laxatives (e.g., ispaghula husk). Lactulose should be avoided due to bloating.

41
Q

What is prescribed for abdominal cramps in IBS?

A

Antispasmodics such as mebeverine, alverine, hyoscine butylbromide, or peppermint oil.

42
Q

Which antibodies are related to Coeliac Disease?

A

Anti-tissue transglutaminase antibodies (anti-TTG)
Anti-endomysial antibodies (anti-EMA)
Anti-deamidated gliadin peptide antibodies (anti-DGP)

43
Q

Which human leukocyte antigen (HLA) genotypes are associated with Coeliac Disease?

A

HLA-DQ2 and HLA-DQ8.

44
Q

What skin condition is associated with Coeliac Disease?

A

Dermatitis herpetiformis, an itchy, blistering skin rash, often on the abdomen.

45
Q

What neurological symptoms can rarely present with Coeliac Disease?

A

Peripheral neuropathy
Cerebellar ataxia
Epilepsy

46
Q

What is the first-line blood test for diagnosing Coeliac Disease?

A

Total immunoglobulin A (IgA) levels
Anti-tissue transglutaminase antibodies (anti-TTG)

47
Q

What are the main complications of untreated Coeliac Disease?

A

Nutritional deficiencies
Anaemia
Osteoporosis
Hyposplenism (increased infection risk)
Ulcerative jejunitis
Enteropathy-associated T-cell lymphoma (EATL)
Non-Hodgkin lymphoma
Small bowel adenocarcinoma

MSRA (18 decks)

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