Gastroenterology Flashcards
First-line to third-line treatment for c.diff?
1: Oral Vancomycin
2: Recurrence within 12/52: fidaxomicin
3/life-threatening: oral vanc + IV metro
Vancomycin is always oral. It doesn’t have efficacy as an IV drug.
In Barret’s oesophagus, what is the indication for Endoscopic mucosal resection (EMR)?
High-grade dysplasia (HGD). This has a high risk of progression to adenocarcinoma of the oesophagus.
What is used for primary prevention of bleeding for people with cirrhosis who have medium to large oesophageal varices
Endoscopic variceal band ligation
What investigation can be used for the diagnosis of small intestinal bacterial overgrowth (SIBO)?
Hydrogen breath test
Most common extra-intestinal feature in both Crohn’s and UC?
Arthritis
What is the name of surgical thread used in management of complex perianal fistulae in patients with Crohn’s disease?
Seton
What are the GI complications of scleroderma?
SIBO -> malabsorption syndrome
Psuedo-obstruction
Digestive issues: Heartburn, difficulty swallowing, bloating, cramps, constipation, diarrhea, nausea, and vomiting
Outline the diagnostic criteria for IBS.
The diagnosis of IBS should be considered if the patient has had the following for at least 6 months:
Abdominal pain, and/or
Bloating, and/or
Change in bowel habit
A positive diagnosis of IBS should be made if the patient has abdominal pain relieved by defecation or associated with altered bowel frequency stool form, in addition to 2 of the following 4 symptoms:
altered stool passage (straining, urgency, incomplete evacuation)
abdominal bloating (more common in women than men), distension, tension or hardness
symptoms made worse by eating
passage of mucus
What is the investigation of choice for suspected perianal fistulae in patients with Crohn’s?
MRI Pelvis
Which laxatives are used to treat constipation associated with IBS?
Ispaghula husk & Linaclotide
As per NICE guidelines, lactulose is not recommended to treat constipation in IBS as it can increase gas production, thereby making symptoms worse in some patients.
Which PPI is best used for patients taking clopidogrel?
Lansoprazole
Omeprazole and esomeprazole are known to decrease the efficacy of clopidogrel due to its inhibition of the CYP2C19 enzyme
What is the TIBC in IDA vs anaemia of chronic disease?
TIBC is high in IDA, and low/normal in anaemia of chronic disease
Which commonly used drug which is not an antibiotic is also associated with C-diff infection?
PPI like omeprazole
For urea breath test, how long should drug x and y be stopped for? And what is x and y.
Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI or H2a) in past 2 weeks
In patients with non-alcoholic fatty liver disease, what is recommended to aid diagnosis of liver fibrosis
enhanced liver fibrosis (ELF) testing
What are treatment steps for Crohn’s flare?
- Glucocorticoids to induce remission
- 5-ASA drugs (e.g. mesalazine) as second line
- azathioprine or mercaptopurine (if TPMT activity is okay) may be used as an add-on medication to induce remission but is not used as monotherapy. Methotrexate is an alternative to azathioprine
- Infliximab
Treatment for mild-moderate flare of UC vs moderate-severe?
Usually just starts with topical PR aminosalicylates (5-ASA). If no remission in 4 weeks then add oral 5-ASA. If still no remission then stop topical and use oral 5-ASA + steroids
If extensive disease throughout the colon then you start with topical and oral
If severe disease requiring admission then start with steroids and consider ciclosporin if severe or steroid contraindicated.
What type of cancer does achalasia increase the risk of?
squamous cell carcinoma of oesophagus
What can be used for prophylaxis of oesophageal bleeding?
A non-cardioselective B-blocker (NSBB) - propanolol
What activity should be checked before starting someone on azathioprine or mercaptopurine for Crohn’s disease and why?
The enzyme thiopurine methyltransferase (TPMT) needs to be assessed before starting a patient on azathioprine because a deficiency in this enzyme (present in 1% of the population) could lead to bone marrow suppression with potentially deadly consequences.
First line treatment to maintain remission in Crohn’s flare?
Azathioprine or mercaptopurine
A patient on 5-ASA becomes unwell with sore throat and fever, what must you think of?
Agranulocyutosis. Do an FBC.
What neutrophil count confirms SBP from paracentesis?
When and which antibiotic indicated based on ascitic fluid protein count?
> 250 cells/ul
Ciprofloxacin; protein count less than 15 g/L
Should IV PPI be given in an acute UGI bleed before endoscopy?
No. IV PPI should be given after endoscopy.
The use of PPI may obscure the endoscopic appearance of ulcers by reducing visible stigmata of bleeding, potentially complicating diagnosis and management. and it hasn’t been shown to confer significant better mortality rate.
A rare cause of GI bleeding characterised by a tortuous arterial malformation?
Dieulafoy’s lesion
How many units of alcohol are in a 750ml bottle of red wine with an alcohol by volume of 12%?
9 Units
Helpful simple way for me is: If a drink says 12% alcohol.
It means that in a 1Litre drink (1000ml), there is 12 units.
i.e. % alcohol on a bottle = number of units if you drank 1 litre of it.
