Gastroenterology Flashcards
Causes of Dysphagia and Clues on Questions
Pharyngeal Pouch
- Older Men ,
- posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
- if large then a midline lump in the neck that gurgles on palpation
Globus Hystericus
- History of Anxiety
- Painless and Relieved by Swallowing
Ongoing Diahorrea Post Illeal Resection in Chron’s
What Medication to Give ?
Cholestyramine
Side Effect Cholesterol Gallstones and Constipation
Carcinoid Tumour Initial Investigations and Management
5HT IAA and Chromogranin A
Octreotide and Cyproheptadine
Zollinger Ellison Syndrome
Watery Diarrhoea —> Metabolic Alkalosis (Loss of Water , Increase in Aldosterone , K and H Excretion)
Ulcers not responding to PPI or H Pylori Eradication
Most Tumours Found in 1st Part of Duodenum
Pancreatitis Predictors
First to rise within few hour-Amylase
Most specific and Sensitive, best after 24 hours-Lipase
Marker of severity-CRP and Hypocalcemia
Hepatotoxic Drug Memonic
PANAMA
Paracetamol
Amiodarone
NSAIDs
Anti-Epileptic
Methotrexate
Antibiotics (Flocloxacillin Coamoxiclav Erythromycin)
Anti TB
MNEMONIC: PASS FOR
phenothiazines
antibiotics Flocloxacillin Coamoxiclav Erythromycin
anabolic steroids
sulphonylureas
FOR-
FIBRATES
OCPS
RARE- NIFEDIPINES.
Whipple Disease Mnemonic ?
W: worn out joints, weight loss
H: hyperpigmentation HLAB27
I: intestinal malabsorption
P: pleurisy
P: pericarditis
L: lymphadenopathy
E: elevated macrophages with Periodic acid-Schiff (PAS) granules
IV Cetfriaxone for 2 weeks then Co - Trimoxiazole
Esophageal Caancer SCC or Adenocarcinoma?
AND
Staging Modality ?
SCC - Upper 1/3 rd (HOARSENESS), Smokers, Smoked foods, Plummer Vinson Syndome
Adenocarcinoma - Lower 1/3rd , GORD, Barrets
Endoscopic USS
Primary Biliary Cholangitis
IgM
AMA M2 Antibodies
Abdominal USS or MRCP TRO Obstruction
Ursodeoxycholic Acid / Liver Transplant if Bili > 100 /
Hereditary Haemochromatosis
Gene
Investigations to quantify liver/cardiac iron ?
Low or High TIBC ?
HFE Gene on C6 (C282Y and H63D mutations)
MRI is generally used to quantify liver and/or cardiac iron
Low TIBC
C Difficile Treatment
Oral Vancomycin 10 days
Oral Fidaxomicin
Oral vancomycin +/- IV metronidazole
If Recurrent
within 12 weeks : oral fidaxomicin
after 12 weeks : oral vancomycin OR fidaxomicin
bezlotoxumab monoclonal Antibody against C Diff Toxin B
Gastric MALToma Treatment
H Pylori Eradication
Eosinophilic Esophagitis
- Features
- Treatment
Young Men with PPI Resistant GORD with Allergies
Elemental Diet (Amino Acid Mix for 6 weeks)
Exclusion of 6 food groups (commonly identified allergens)
Targeted Diet (Excluding Allergy PERSONAL Triggers)
Topical Steroids (fluticasone and budesonide)
Wilsons Disease
Autosomal Recessive
ATP7B Gene
Chromosome 13
Basal Ganglia deposition
Kayser-Fleischer rings
RTA
Blue Nails
Sulfasalazine Side Effects
Rabbits Often Hop High, Making Laughs.
Rabbits Often Hop High, Making Laughs.
R: Rashes.
O: Oligospermia.
H: Headache.
H: Heinz-body anaemia.
M: Megaloblastic anaemia.
L: Lung fibrosis.
Which factor is Supra-Normal in Liver Disease ?
Factor 8
PPI
- MOA ?
- Side Effects
3 ups and 3 downs
- Irreversible blocker at H+/K+ ATPase of the gastric parietal cell
- low Na
low Mg
ow plavix,
high c.diff
high osteoporosis
high colitis (Microscopic Colitis)
Villous Adenoma
Watery Diahorrea + Hypokalemia + Microcytic Anemia
Metabolic acidosis
Cholangiocarcinoma Causes !!!
Hep B most common cause worldwide
Hep C most common cause in Europe
Sporadic (How many %)
HNPCC
FAP
Putz Jager Syndrome
95% Sporadic
Eg : activation of the K-ras oncogene, deletion of p53 and DCC tumour suppressor genes
Autosomal Dominant
MSH (60%)
MLH (30%)
Autosomal Dominant
APC Ongogene in C5
Autosomal Dominant
Serine threonine kinase LKB1 or STK11
Gastric Cancer Endoscopic Biopsy finding
Signet Ring Cells - large vacuole of mucin which displaces the nucleus to one side
More Signet Cells Worse Prognosis
Antibiotics for how long vs PPI for how long ?
4 weeks off Antibiotics
2 weeks off PPI
Types of Bariatric Surgery
Primary Restrictive -
Laparoscopic Assisted Gastric Banding
Sleeve Gastrectomy
Intragastric Balloon
Primarily Malabsorptive
Biliopancreatic diversion with duodenal switch
Mixed
Roux-en-Y gastric bypass surgery
When to offer Fibro scan ?
- Hep C
- > 50 units / week (Men) or >35 units / week (Women)
- Alcoholic Related Liver Disease
Pancreatic Cancer
- Investigation of Choice
- Associated Paraneoplastic Syndrome ?
- Treatment
- HRCT (Gold Standard)
‘Double Duct’ Sign on High Resolution CT
Trousseau Sign (Migratory Thrombophlebitis)
Whipples Procedure
ERCP + Stenting for Palliation
Which Pathology is least associated with HCC ?
Wilsons Disease
VIPoma
- Features
- Pathophysiology
- Most Common Location
VIPoma
1. Vasodilate
2, Inhibits Gastric Motility and GI secretion
3. Increase INTESTINAL Secretions
Watery Diahorrea
Hypokalemia (Lose K+)
NAGMA (Lose HCO3-)
Achlorhydria –> Low HCL and HCL needed to convert Fe3+ to Fe2+ in the Duodenum to be absorbed —> Microcytic Anemia
- Pancreas
All -oma are on Islet Cell Tumours
Gastrinoma
- Features
- Ix
MANY MANY Ulcers THAT GO BEYOND 1st Part of DUODENUM
a. Not responding to PPI
b. Not responding to H,. Pylori
Watery Diahorrea +
METABOLIC ALKALOSIS +
HEMETEMESIS !!! (From Ulcers)
Ix -
Secretin Stimulation Test (Gastrin IS NOT inhibited)
CT
Alcoholic Ketoacidosis
- Metabolic acidosis
- Elevated anion gap
- Elevated serum ketone levels
- Normal or low glucose concentration
Bacterial Peritonitis
- Most Common Organism
- Treatment vs Prophylactic
- E.Coli
- IV Cefotaxime vs
Prophylaxis if :
Episode of SBP
Fluid protein <15 g/l + either Child-Pugh score of at least 9 or hepatorenal syndrome (until ascites resolved)
