Gastroenterology Flashcards
What is the investigation for suspected gastric ulcers/H.pylori?
Urea breath test
(drink urea isotope, H,pylori converts into isotope CO2, which you breath out, and is detected)
Prior to urea breath test for H.Pylori, you must ensure the patient does not have __ 4 weeks prior and __ 2 weeks prior
No Abx in preceding 4 weeks
No PPI in preceding 2 weeks
What complication can arise from NET?
Carcinoid syndrome
NET in GI tract may release serotonin, but not cause carcinoid syndrome. Why not? In which situation would carcinoid syndrome be caused?
Carcinoid tumours in GI tract - the serotonin gets 1st pass metabolised by liver so doesn’t enter systemic circulation.
However in the case of GI -> Liver metastases, the 1st pass metabolism is bypassed, which causes carcinoid syndrome.
(NB// non GI carcinoid tumours (e.g. lung) are less common and cause carcinoid syndrome as they release directly into circulation)
What is the treatment for H.Pylori infection?
TRIPLE THERAPY
1) Amoxicillin
2) PPI
3) Another ABx (either macrolide or metro)
What are the causes of acute liver failure?
What is a late sign of hepatic encephalopathy?
Paracetamol (most common in UK)
Alcohol
Viral hepatitis
Acute Fatty Liver of Pregnancy
Fetor hepaticus (sweet musty faecal breath, as toxins excreted via breathing instead of stool) - ew
What is the most common cause of gastroenteritis UK?
C.Jejuni
How do you treat C.Jejuni gastroenteritis?
Antibiotics are ONLY indicated if
- bloody
- severe diarrhoea (8 stools/day)
- ?prolonged
Peri-anal pathology (e.g peri-anal skin tags or fistulae) a feature of which gut disease?
Crohn’s
Which organism is responsible for PROLONGED WATERY DIARRHOEA following travel?
Giardia Lamblia
can be approx 2 weeks
Treat with metronidazole
(ETEC does not cause such prolonged symptoms, usually few days)
Which organism responsible in gastroenteritis if short incubation time (ie. soon after eating affected food) and vomiting only, no diarrhoea
Staph Aureus
Which Abx to treat Campylobacter infection?
Clarithromycin
2ww referral criteria for Upper GI cancer?
Any new onset dysphagia (regardless of age or symptoms)
> 55 with weight loss and either reflux/dyspepsia/upper abdomen pain
What is the management of acute alcoholic hepatitis?
prednisolone
What do stools look like in Giardia infection and why?
pale floating stools - because Giardia causes malabsorption of vitamins
What is the management of a UC flare-up?
Rectal/sigmoid/left sided disease - give rectal ASA.
If not responding, oral steroids
If extensive beyond L side or severe - IV steroids
What is the maintenance Mx for UC flare-up?
rectal ASA
but if episode was severe or there’ve been 2 in last year - azathioprine
How do you manage flare-up of Crohn’s?
oral steroids
IV if severe
What is maintenance Mx of Crohn’s?
Azathioprine
Symptoms of C.jejuni infection?
Diarrhoea
May be bloody
May also get RIF pain mimicking appendicitis
Investigation for coeliac disease?
Anti-TTG IgA level (AND also need total IgA to interpret)
Cause of haematemesis that is not varices, ulcer or cancer?
Delafioy lesion (AV malformation)
Psychiatric symptoms (e.g. Parkinsonism) + Liver Disease = ?
What is investigation finding?
Wilson’s Disease
(AR)
Reduced caeruloplasmin
(reduced serum copper level due to this, but increased free copper)
Mx of Wilson’s?
Penicillamine
Which medications precipitate C.DIff?
Antibiotics (Clarithromycin etc)
PPIs - omeprazole!
When should you perform stool culture in primary care for diarrhoea?
Patient unwell/needs to attend hospital
Bloody diarrhoea
Recent Abx use/PPI use/Hospital admission
Immunosuppressed
Recent foreign travel
2ww criteria for endoscopy?
Any new dysphagia
Any patient with upper abdominal mass
If 55 or over with weight loss AND
dyspepsia
abdo pain
reflux
Treatment of C diff?
1st - vancomycin (+ if severe IV Metro)
2nd - fidaxomicin
A fair portion of patients get relapse - if happens in 3 months, you give fidaxomicin instead
Which drug to maintain remission in UC in proctitis/proctosigmoiditis vs left sided or extensive disease
proctitis/proctosigmoiditis - rectal mesallazine
left sided or extensive disease - oral mesalazine
Which disease associated with UC? What is it?
Ix?
PSC
intra and extra hepatic bile ducts affected
Increased risk cholangiocarcinoma
Ix - ERCP/MRCP
Acute vs chronic causes of diarrhoea?
Acute:
Gastroenteritis
C diff colitis
Diverticulitis
Overflow diarrhoea
Chronic:
IBD
IBS
Coeliac Disease
Cancer
How to interpret Hep B blood test?
Hb serum antigen = current infection
serum antigen antibody = immune (either through clearing past infection or vaccine)
Hb core antigen antibody IgM = acute infection
Hb core antigen antibody IgG = chronic infection
What is PBC, which antibody is positive and how do you treat?
Intrahepatic bile ducts affected
Increased risk cirrhosis
AMA positive
Mx = ursodeoxycholic acid helps with disease
Bile Acid Malabsorption symptoms, causes, Ix and Mx?
Too much unregulated bile release into intestine without reabsorption, causing irritation and therefore diarrhoea.
Lack of timed regulation of release causes fat malabsorption- steatorrhoea
Causes:
Cholecystectomy
Ileal disease such as Crohn’s
Ix - radioactive test (SEHCAT)
Mx - Bile Acid Sequestrants (cholestyramine) help get rid of bile preventing overaccumilation in the intestine and diarrhoea
(note this also reduces cholesterol)
Alcohol Questionnaires?
FAST
CAGE - cut down, annoyed at ppl commenting, guilty, eye-opener
Fever + Ascites = ?
What is investigation and what is management?
SBP
Paracentesis
IV Cefuroxime
When should you give Abx prophylaxis in ascites (to prevent SBP)?
If ascites protein <15
(suggests reduced immune ability of fluid)
Give oral ciprofloxacin
Which extra-articular features of Crohn’s/UC correlate with disease activity?
Erythema nodosum
Episcleritis
Asymmetric arthritis
What does Vitamin C deficiency cause?
Scurvy - gingivitis and bleeding
What does Vitamin B3 deficiency (niacin) cause ?
Pellagra
- dermatitis, diarrhoea, dementia
What haematological complication can you get in coeliac disease?
Functional hyposplenism
i.e spleen anatomy ok but not working well
Leads to recurrent infections (can’t protect against capsulated NHS bacteria) and Howell Jolly bodies in blood film (RBC remnants suggesting spleen hasn’t fully removed them)
Aside from S.Aureus, which other cause of food poisoning has quick onset?
Bacillus Cereus (rice)
Which medications cause cholestasis?
Co-amoxiclav
COCP
Sulfonylureas
