Gastroenterology Flashcards
IBS
Altered gut reactivity in response to various stimuli ( environmental or luminal ), etc.
Dukes A colonic carcinoma
> COLONOSCOPY
Annually for 2 years then 3 yearly
FOB
6 monthly for 4 years then once yearly
CEA
to monitor for recurrence
Causes of Colorectal Carcinoma
-Sporadic 75%
-Family history 15-20%
-HNPCC 5%
-FAP 1%
-IBD 1%
Achalasia
- Progressive dysphagia to both solids and liquids.
-Esophageal manometry is the most sensitive test.
King’s College Criteria for Liver Transplantation
pH <7.30 or
INR >6.5 (PT >100 seconds) and serum creatinine >300 µmol/L (>3.4 mg/dL) in patients with grade 3 or 4 hepatic encephalopathy.
-Infective Endocarditis
Up to half of patients presenting with Streptococcus bovis endocarditis have colorectal tumours.
Prostaglandins
Prostaglandins inhibit gastric acid secretion.
NASH
NASH is associated with increased prevalence of insulin resistance/type 2 diabetes.
Approximately 20% develop cirrhosis.
It is more common in men due to the protective effects of oestrogen. The treatment is complex and multi-modal but should focus on weight reduction.
Data from small clinical trials using pioglitazone have shown modest improvement in liver biopsy appearance over one year.
Spontaneous bacterial peritonitis
Spontaneous bacterial peritonitis is diagnosed by ascitic fluid examination which reveals a neutrophil count of >250/ml, and is typically caused by aerobic gram negative bacteria.
- E.coli, Klebsiella.
- Antibiotics such as co-amoxiclav, tazosin, or ciprofloxacin are typically used as first line treatment.
Refractory Ascites
TIPS( Transjugular intrahepatic portosystemic shunt) is an appropriate intervention for patients with refractory ascites who do not respond to maximum medical therapy.
Giardiasis
The history of abdominal bloating with intermittent diarrhoea and strong smelling bowel gas is typical of giardiasis. As long as a fresh stool sample is examined, trophozoites are found in 60%+ of samples.
A single dose of tinidazole or a course of metronidazole is the treatment of choice.
Refeeding syndrome
Hypophosphatemia
Alcoholic hepatitis
- Tender hepatosplenomegaly, Fever, Cirrhosis
- AST: ALT 2:1 rarely over 300
- Cardiomyopathy of Alcoholism is dilated or congested form.
Gastric Tumour
Endoscopic Ultrasound is superior to conventional CT scan for conventional tumour staging
Gastric Cancer Classification
STAGES
1A- Confined to mucosa with no LN involvement.
1B- Tumour that either invades the submucosa (T1) with limited lymph node involvement (N1) or invades the muscularis propria (T2) with no nodal involvement (N0).
2B- tumour that has invaded the muscularis propria (T2) with some lymph node involvement (N1) or a tumour that has invaded the subserosa (T3) without nodal involvement (N0).
3A- tumours that extend into the serosa (T4a) without nodal involvement (N0) .
3C- tumour that invades the serosa (T4a) with significant nodal involvement (N3), or a tumour that invades adjacent structures (T4b
Gatro- oesophageal Reflux disease
NICE guidance states the following: “Oesophageal manometry and ambulatory 24-hour oesophageal pH monitoring (to quantify reflux and assess the relationship between reflux episodes and the person’s symptoms).
Laparoscopic fundoplication is the treatment of choice for patients with GORD refractory to or intolerant of proton pump inhibitor therapy.
Hepatopulmonary syndrome
- Oxygenation defect induced by pulmonary vascular dilatation in patients with liver cirrhosis or pulmonary HTN.
- Contrast enhanced Transthoracic Echo is used to demonstrate intrapulmonary vascular dilatation. Immediate visualization in the left ventricle ( within 3 cardiac cycle) indicates intracardiac shunting. Delayed visualization in the left ventricle ( 3-6 cardiac cycle) is diagnostic of intrapulmonary shunting.
Wilson’s disease
- Autosomal Recessive
- Wilson’s disease is caused by a defect in the ATP7B gene located on chromosome 13.
Microscopic Colitis
PPIs are a cause of microscopic colitis, which can present with chronic diarrhoea, colonoscopy and biopsy should be considered when patients present in this way and are taking a PPI.
