Gastroenterology Flashcards

1
Q

Coeliac

  • what kind of disease
  • where is affected
  • who is affected
A

T cell autoimmune
Small bowel - terminal illeum
villi atrophy
infancy and 50-60

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2
Q

Coeliac symptoms

A
steatorrhea 
diarrhoea
fatigue
abdo pain
bloating
nausea/vomiting
weight decrease
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3
Q

Coealic test results

  • what antibody to show if auto immune
  • where to biopsy and what to look for
A
decrease Hb, B12, ferritin
Look for IgG to see if autoimmune 
--> antibodies against glyteine
-->serology sensitive and specific 
Duodenal biopsy to see vili and lymphocytes
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4
Q

Coealic can be from what anemias

A

Macrocytic MCV
Microcytic MCV
Normocytic

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5
Q

what breaks down carbs?

if it’s lacking, what does it suggest?

A

Amylase - breaks down into small sugars

If no amylase -> pancreatic insufficiency

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6
Q

Amylase is? and breaks down?

A

enzyme that helps digest carbohydrates

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7
Q

Chronic pancreatitis markers - 3

A

Increased amylase
Increase lipase
Fecal elastase

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8
Q

Chronic pancreatitis causes - 5

A
Increase levels of fat
family history - auto immune
Alcohol
CF
pancreatic duct obstruction
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9
Q

check for proteins to check for…?

how to check for albumin?

A

check for protein of malabsorption

Do: bloods for albumin

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10
Q

Lipase

  • where is it made
  • if lacking then what happens to stool?
  • vit k deficiency sign
  • what vitamins are fat soluble
A
Made in pancreas
If lacking = diarrohea  and floating stool
Vitamin malabsorption
 - Vit K: bruising
- ADEK = fat soluble vitamins
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11
Q

lactose intolerance

- how does it cause diarrhoea

A

increases osmolarity, therefore causes diarrhoea

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12
Q

pancreatitis treatment and what is in it

A

creaon (enzymes) - amylase, lipase and proteins

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13
Q

pancreatitis investigations - and results - 3

A

CT shows calcification
bloods - enzyme level
breath test

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14
Q

pancreatitis symptoms

A

epigastric pain
bloating
steatorrhea
weight loss

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15
Q

Crohns symptoms

  • leisons
  • characteristic features
  • symptoms
A

skip leisons - 3 layers
bloody diarrhea, malaise, fever, malabsorption, abdo pain, weight loss, anemia
granulomas
fistulas

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16
Q

crohns investigations

A
FBC, ESR, CRP, U&E, INR, Fe, B12, Folate
stool 
colonoscopy, rectal biopsy
barium enema
MRI
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17
Q

crohns management

  • mild
  • severe
A

mild: prednisolone
severe: hydrocortisone, metronidazole, infliximab

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18
Q

ulcerative colitis symptoms

- characteristic features

A
1 layer
pseudopolyps 
less weight loss than crohns
colonic
smoking helps
crypt abcess
superficial
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19
Q

ulcerative colitis investigations (2) and results

A

stool
blood: anemia, leukyocytes
increased ESR
low albumin

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20
Q

blood tests with inflammation results

A

increased WBC
increased CRP
increased platelets - thrombocythemia

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21
Q

ulcerative colitis management - 3

- additional 1 for inflammation that is not steriodal

A

steriods
anti-tnfa
surgery
5 aza - methalazine (for inflam, non steriodal)

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22
Q

portal hypertension - how it happens

THINK: platelets

A

congestion in the spleen causes processing of platelets to increase therefore circulating platelets to decrease

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23
Q

2 kinds of GI bleed

A

hematasis

malena

24
Q

GI bleed manage - 3 steps

A
venous access - cannula
IV fluids
blood transfusions
rubber band ligation 
Give AB to decrease infection (quinolones) 
  1. resusitate - bloods and fluids
  2. stop bleeding - terlipressin , rubber band ligation,
  3. prevent re-bleeding - b blocker. Elective variceal band ligation (2 weekly endoscopies)
25
Q

GI bleed cause

A
cancer
NSAID
GORD
AAA
TCAs
peptic ulcer - h pylori
Variceal bleed
Mallory-weiss tear 
Boerhaeve's Rupture
26
Q

H pylori treatment

  • triple therapy
  • if pen allergy then what?
A

PPI
2 AB - clarithromycin or amox

if allergic to pens, give metrinidazole and doxycyclin

27
Q

H pylori diagnosing - 3 ways

A

Biopsy - Clo test can be -ve if on AB or PPI,
Bloods - check h pylori antibodies
Stool sample

28
Q

2 ways Esophageal varicies occur

A

progessive liver failure

portal hypertension - Na and H2o retained, varices from increased pressure

29
Q

GI bleed signs - 3

A

haematemis (coffee ground or malena)
chronic liver disease
oesophageal varices

30
Q

GI bleed investigation

A

Endo
Colo
duodenal biopsy

31
Q

liver failure causes - 4

A

infection: viral hep
drugs: paracetemol overdose
toxins
other: alcohol, cirrhosis, fatty liver

32
Q

liver failure signs - 3

A

jaundice
hepatic encephalopathy
liver flap

33
Q

liver failure - what tests to do

A

bloods: fbc, u&e, lft, clotting, glucose, paracetemol levels
micro: blood, urine
radio: cxr, abdo, ultrasound

34
Q

cirrhosis signs

A
LFT increases
dupentrens
clubbing
palmar erythema
gynecomastia
35
Q

cirrhosis tests results

A

blood: increase BR, increase AST, increase ALT, increase PR/INR, decrease platelet

ultrasound: hepatomegaly, splenomegaly, ascites
MRI: size increase

36
Q

jaundice conjugated test results

  • hepatocellular
  • alcoholic
  • obstructive
A

hepatocellular - ALT more than AST
Alcoholic - Increase AST and gamma T more than ALT

Obstructive
Increased ALP

37
Q

autoimmune hepatitis - 2 features

What antibody?

A

inflammation
t suppressor cells defected

anti-smooth muscle antibody positive

38
Q

autoimmune hepatitis test results

What antibody?

A

BR, AST, ALT increase
Anemia
hypergammaglobuinaemia
Liver biopsy

anti-smooth muscle antibody positive

39
Q

primary biliary cirrhosis

What antibody?

A

bilary duct damaged by auto immune granulomas

fatigue, jaundice, hepatosplenomegaly

Anti-mitochondrial antibodies

40
Q

primary biliary cirrhosis test results

What antibody?

A

Bloods: all increased, except albumin decreased

Anti-mitochondrial antibodies

41
Q

A1 antitrypsin deficiency

  • how is it caused
  • what is it
  • what does it cause
A

inherited
inflammation is inhibited
causes liver disease in children
prevents elastase from damaging tissue

42
Q

A1 antitrypsin symptoms

A

dysponea from emphysema
cirrhosis
jaundice
pancreatitis

43
Q

A1 antitrypsin tests

A

a1 antitrypsin decreases

liver biopsy

44
Q

dyspepsia symtpoms

A
epigastric pain from hunger
specific foods
time of day
fullness after meals
heartburn
ALARM: anemia, loss of weight, anorexia, recent, melena
45
Q

duodenal ulcer symtpoms

A

epigastric pain before meals or at night

relieved by food and milk

46
Q

do you need to stop PPI 2 weeks before endo?

A

yes

47
Q

can reflux lead to barretts?

A

yes

48
Q

symptoms of gord

A

heartburn - relived by antacids
retrosternal pain
painful swallowing
increased salivation

49
Q

gord investigations

A

endo if more than 4 weeks and vomiting or over 55

50
Q

gord treatment

A
weight loss
raise head in bed
stop smoking
small regular meals
avoid certain food and drink
51
Q

what is frank pus a sign of?

A

IBD
diverticulitis
fistula/abscess

52
Q

what is the gold standard of diagnosing coeliacs?

A

duodenal biopsy

53
Q

what is hereditary haemochromtosis?

A

iron deposit in joints and organs

–>hereditary

54
Q

in viral hep, what is IgM and IgG?

think: moms are active
grandmothers are protective

A
m = active
g= protective
55
Q

is inr and pt increased in liver failure?

A

yes