Gastroenterology 3 Flashcards
Usually prodromal illness and right upper quadrant pain
Swinging pyrexia
Patient may be systemically unwell
Generalised peritonism not present
=
Gallbladder abscess
Dyspepsia guidelines
Endoscopically proven oeseophagitis (3)
- Full dose PPI 1-2 months
- If response then low dose treatment PRN
- If not response then double dose PPI for 1 month
Endoscopically negative reflux disease mx (3)
- Full dose PPI 1 month
- If response then low dose treatment PRN
- If no response then H2RA or prokinetic for 1 month
Haemochromatosis features:
AR/AD
Chromosome
Gene
Triad of sx
Features (6)
Reversibile (2)
Nonreversible (4)
Chrm 6 HFE gene
AR, genetic mutation of HFE gene on chrm 6 (HaEmachromatoSIX), leading to the build up excess iron
- Bronze pigmentation
- Cirrhosis
- DM
Reversible
1. Bronze skin pigmentation
Heart
2. Cardiomyopathy/ cardiac failure
Non reversible
Bones
3. Arthralgia
Endo
4. Liver disease
5. DM
6. Hypogonadotrophic hypogonadism
Budd Chiari triad:
- AP - sudden on set severe
- Ascited
- Tenderhepatomegaly
Budd Chiari causes (4)
Anything haematological
1. Thrombophillia
2. Polycythaemia rubra vera
3. Pregnancy
4. COCP
Haemochromatosis Ix (2)
Liver biopsy finding
Ix transferrin saturation, genetic testing
Perl’s stain
Typical iron study profile in patient with haemochromatosis
transferrin saturation
ferritin
TIBC
transferrin saturation > 55% in men or > 50% in women
raised ferritin (e.g. > 500 ug/l) and iron
low TIBC
Mx haemochromatosis (2)
Venesection
Desferrioxamine
H pylori associations (4)
Peptic ulcer disease
Gastric cancer
B cell lymphoma of MALT tissue
Atrophic gastritis
H pylori eradication mx (2)
7 day course of PPI + amoxi + clarithro/metro
or if pen allergic PPI + clarithro + metro
HBsAg 1-6 months =
HBsAg > 6months =
Anti-HBs =
Anti-HBc =
HbeAg =
HBsAg 1-6 months = acute disease
HBsAg > 6months = chronic disease
Anti-HBs = exposure or immunisation
Anti-HBc = previous/ current infection
HbeAg = marker of infectivity
What is Courvoisier sign?
What is Sister Mary Joseph nodules
What is Virchow’s node?
Seen in which ca?
Palpable mass in RUQ
Periumbilical lymphadenopathy
Left supraclavicular adenopathy
Cholangiocarcinoma
Typical symptoms are malaise, anorexia and weight loss. The associated RUQ pain tends to be mild and jaundice is uncommon.
Amoebic liver abscess
Most common cause of HCC worldwide and UK?
Chronic hep B
Chronic hep C
Screening for HCC? Ix (2)
Which cohort of patients? (2)
US +/- AFP
Pts with liver cirrhosis secondary to hep B&C or haemochromatosis
Men with liver cirrhosis secondary to ETOH
Pigmented freckles on the lips, face, palms and soles =
AR/AD
What is it?
Peutz-Jeghers
AD
Numerous haemartomatous polyps
Common presentation for Peutz-Jegher’s syndrome?
SBO secondary to intussusception
Pancreatic ca investigation of choice
What might it show?
Mx
High resolution CT
Double duct sign
Mx Whipple’s resection
dysphagia (secondary to oesophageal webs)
glossitis
iron-deficiency anaemia =
Plummer Vinson syndrome
NALFD incidental finding seen on US, what blood test might you do next?
ELF (enhanced liver fibrosis) blood test to check for advanced fibrosis
Extrapyramidal effects of metoclopramide (4)
Oculogyric crissi
Hyperprolactinaemia
Tardive dyskinesia
Parkinsonism
What is melanosis coli?
Histo
Associated with?
Disorder of pigmentation of the bowel
Histology: pigment laden macrophages
Associated with laxative abuse (especially senna)
Define malnutrition (3)
Screening test
BMI <18.5
Unintentional weight loss >10% within 3-6 months
BMI <20 and unintentional weight loss >5% within 3-6 months
MUST score
Ischaemia of GI tract Ix
CT
Acute mesenteric ischaemia is usually caused by?
What is chronic mesenteric ischaemia?
Embolism
Intestinal angina - colicky intermittent AP
Thumbprinting on AXR may be seen in?
Ischaemic colitis
Name two unconjugated hyperbilirubinaemia versus conjugated
Gilbert’s, Crigler-Najjar = unconjugated
Dubin-Johnson syndrome + Rotor syndrome = conjugated
AR
Iranian Jews
Grossly black liver
Benign
Dubin Johnson
IBS how to diagnose
AP relieved by defecation or associated with altered bowel frequency in addition to 2 of the 4:
- altered stool passage (straining, urgency, incomplete)
- bloating
- worse by eating
- mucus
IBS patient with constipation who are not responding to conventional laxatives can have which medication?
Linaclotide
IBS second line management
TCA
