Gastroenterology 2 Flashcards
Amsterdam criteria is used in which condition?
Name the three criteria
Associated with which other cancer?
Hereditary non polyposis colorectal carcinoma
1. At least three family members
2. At least two generations
3. At least one case <50yo
Endometrial cancer
Crohn’s or UC
Bloody diarrhoea
Skip lesions
All layers
Goblet cells
Crypt abscesses
PSC
AP
Perianal fistulae
Smoking
Bloody diarrhoea UC
Skip lesions Crohn’s
All layers Crohn’s
Goblet cells Crohn’s
Crypt abscesses UC
PSC UC
AP Crohn’s
Perianal fistula Crohn’s
Makes Crohn’s worse but UC better
Name three features associated with UC and Crohn’s
Pyoderma gangrenosum
Arthritis
Erythema nodosum
Ix Crohn’s (3)
Faecal calprotectin
Low B12
Low vitamin D
Inducing remission Crohn’s (2)
Name three add on drugs
- Steroids (PO/topical/IV)
- Mesalazine (5-ASA)
1.AZT
2. Mercaptopurine
3. MTX
Crohn’s: what can be used for isolated peri-anal disease?
Metronidazole
Maintaining remission Crohn’s
1st line (2)
2nd line (1)
What should be assessed prior to starting remission treatment?
- AZT or mercaptopurine
- MTX
TPMT activity
Investigation of choice for perianal fistula seen in Crohn’s?
Mx (2)
MRI
Metronidazole
Anti-TNF
UC features (3)
Bloody diarrhoea
Urgency
Tenesmus (feeling that you need to pass stools)
UC versus Crohn’s layers
Crohn’s through all the layers
UC not beyond submucosa
Barium enema findings for UC (3)
- Loss of haustrations
- Superficial ulceration/ pseudopolyps
- Drainpipe colon
UC flare classification
Mild
Mod
Severe
Hint: stool numbers and systemic disturbance
Mild <4 stools with or without blood, normal ESR and CRP
Moderate four-six stools with minimal systemic disturbance
Severe systemic sx, hypoalbuminaemia, >6 bloody stools
UC mx inducing remission:
Proctitis (3)
- Topical 5-ASA/ mesalazine
- If remission not achieved within 4 weeks add PO 5-ASA
- If still not achieved add topical/ PO steroid
UC mx inducing remission:
Proctosigmoiditis and left sided UC (3)
- Topical/ rectal 5-ASA
- If not resolved within 4 weeks then add a PO 5-ASA high dose OR PO 5ASA +/- topical steroid
- PO 5-ASA and PO steroid
UC mx inducing remission:
Extensive disease (2)
- Topical 5ASA + high dose PO 5-ASA
- If remission not achieved within 4 weeks then PO 5ASA and PO steroid
Severe colitis Mx inducing remission (4)
- Admit to hospital
- IV steroids
If no improvement after 72 hours - add IV ciclosporin
- surgery
Remission mx UC
Proctitis + proctosigmoiditis (3)
- Topical 5ASA OR
- PO 5ASA + topical OR
- PO 5ASA
Remission mx UC
Left sided and extensive UC (1)
Low maintenance dose of a PO 5ASA
UC maintenance mx of a severe relapse/ >=2 exacerbations in 1 year mx (2)
PO AZT or mercaptopurine
UC mx of a severe relapse/ >=2 exacerbations in 1 year mx (2)
PO AZT or mercaptopurine
Prophylaxis of variceal haemorrhage mx (2)
Propranolol
Endoscopic variceal band ligation - should be performed at two weekly intervals until all varices are eradicated
Vitamin A deficiency =
Vitamin A name
Retinal
Night blindness
B1 name
B1 deficiency = (4)
Thiamine
Wernicke’s/ Korsakoff’s
Dry beriberi: peripheral neuropathy
Wet beriberi: dilated cardiomyopathy
Vitamin C name
Deficiency = (5)
Ascorbic acid
Gingivitis, loose teeth, haematuria, epistaxis, poor wound healing
Follicular hyperkeratosis and perifollicular haemorrhage
Ecchymosis, easy bruising
Poor wound healing
Gingivitis with bleeding and receding gums
Sjogren’s syndrome
Arthralgia
Oedema
Impaired wound healing
Generalised symptoms such as weakness, malaise, anorexia and depression
= which deficiency
Vitamin C/ scurvy
steatorrhoea/ diarrhoea/ weight loss
large-joint arthralgia
hyperpigmentation and photosensitivity
cardiac + neurological symptoms
PAS (periodic acid Schiff) granules on jejunal biopsy
Middle Aged Man
= which condition?
Mx
Whipple’s
Co-trimoxazole for one year
Excessive copper deposition =
Age of onset
Presentation in children versus adults
Wilson’s disease
10-25yo
Liver disease vs neurological disease
Wilson’s disease impacts which three organs
Liver
Brain
Cornea
Features of Wilson’s (6)
Liver - hepatitis
Brain - behavioural and psych problems
Eyes - Kayser-Fleischer rings
Blue nails
Haemolysis
Renal tubular acidosis (Fanconi syndrome)
Wilson’s Ix (3)
Diagnostic test (1)
Reduced serum caeruloplasmin
Reduced serum copper
Increased 24 hour urinary copper excretion
Diagnostic - genetic anaylsis of ATP7B gene
Wilson’s Mx (1)
- Penicillamine
PSC associations (3)
UC
Crohn’s
HIV
PSC diagnostic test:
Antibody
Complications/ increased risk of which cancers (2)
ERCP
p-ANCA
Cholangiocarcinoma and bowel ca
PBC
Age group and gender
Middle aged women
PBC associations (4)
Sjogren’s
RA
Systemic sclerosis
Thyroid disease
PBC antibody
Anti-mitochondrial (AMA M2)
PSC bloods (2)
Features (3)
Raised bilirubin and ALP
RUQ pain, jaundice, pruritus
PBC
Bloods (2)
Features (2)
Increases risk of which cancer?
Raised ALP + bili
Hyperpigmentation on pressure points, xanthelasma
HCC
PBC Dx (2)
Mx (1)
When is a liver transplant considered?
What is given for the pruritus
MRCP or US liver
Mx
1. ursodeoxycholic acid
2. Liver transplant if bili >100
- Cholestyramine
dysphagia
regurgitation
aspiration
neck swelling which gurgles on palpation
halitosis
=
Ix (1)
Mx (1)
Pharyngeal pouch
Barium swallow with dynamic video
Surgery
Cyclical vomiting syndrome is associated with which other condition?
Mx (3)
Acute (3)
Migraine
Prophylaxis Amitryptilline/ propranalol/ topiramate
Acute ondansetron, prochloperazine, triptans
Child Pugh factors considered (5)
Albumin
Bili
Coag
Distension (ascites)
Encephalopathy
