Gastroenterology Flashcards
Coeliac
- what kind of disease
- where is affected
- who is affected
T cell autoimmune
Small bowel - terminal illeum
villi atrophy
infancy and 50-60
Coeliac symptoms
steatorrhea diarrhoea fatigue abdo pain bloating nausea/vomiting weight decrease
Coealic test results
- what antibody to show if auto immune
- where to biopsy and what to look for
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
Coealic can be from what anemias
Macrocytic MCV
Microcytic MCV
Normocytic
what breaks down carbs?
if it’s lacking, what does it suggest?
Amylase - breaks down into small sugars
If no amylase -> pancreatic insufficiency
Amylase is? and breaks down?
enzyme that helps digest carbohydrates
Chronic pancreatitis markers - 3
Increased amylase
Increase lipase
Fecal elastase
Chronic pancreatitis causes - 5
Increase levels of fat family history - auto immune Alcohol CF pancreatic duct obstruction
check for proteins to check for…?
how to check for albumin?
check for protein of malabsorption
Do: bloods for albumin
Lipase
- where is it made
- if lacking then what happens to stool?
- vit k deficiency sign
- what vitamins are fat soluble
Made in pancreas If lacking = diarrohea and floating stool Vitamin malabsorption - Vit K: bruising - ADEK = fat soluble vitamins
lactose intolerance
- how does it cause diarrhoea
increases osmolarity, therefore causes diarrhoea
pancreatitis treatment and what is in it
creaon (enzymes) - amylase, lipase and proteins
pancreatitis investigations - and results - 3
CT shows calcification
bloods - enzyme level
breath test
pancreatitis symptoms
epigastric pain
bloating
steatorrhea
weight loss
Crohns symptoms
- leisons
- characteristic features
- symptoms
skip leisons - 3 layers
bloody diarrhea, malaise, fever, malabsorption, abdo pain, weight loss, anemia
granulomas
fistulas
crohns investigations
FBC, ESR, CRP, U&E, INR, Fe, B12, Folate stool colonoscopy, rectal biopsy barium enema MRI
crohns management
- mild
- severe
mild: prednisolone
severe: hydrocortisone, metronidazole, infliximab
ulcerative colitis symptoms
- characteristic features
1 layer pseudopolyps less weight loss than crohns colonic smoking helps crypt abcess superficial
ulcerative colitis investigations (2) and results
stool
blood: anemia, leukyocytes
increased ESR
low albumin
blood tests with inflammation results
increased WBC
increased CRP
increased platelets - thrombocythemia
ulcerative colitis management - 3
- additional 1 for inflammation that is not steriodal
steriods
anti-tnfa
surgery
5 aza - methalazine (for inflam, non steriodal)
portal hypertension - how it happens
THINK: platelets
congestion in the spleen causes processing of platelets to increase therefore circulating platelets to decrease
2 kinds of GI bleed
hematasis
malena
GI bleed manage - 3 steps
venous access - cannula IV fluids blood transfusions rubber band ligation Give AB to decrease infection (quinolones)
- resusitate - bloods and fluids
- stop bleeding - terlipressin , rubber band ligation,
- prevent re-bleeding - b blocker. Elective variceal band ligation (2 weekly endoscopies)
GI bleed cause
cancer NSAID GORD AAA TCAs peptic ulcer - h pylori Variceal bleed Mallory-weiss tear Boerhaeve's Rupture
H pylori treatment
- triple therapy
- if pen allergy then what?
PPI
2 AB - clarithromycin or amox
if allergic to pens, give metrinidazole and doxycyclin
H pylori diagnosing - 3 ways
Biopsy - Clo test can be -ve if on AB or PPI,
Bloods - check h pylori antibodies
Stool sample
2 ways Esophageal varicies occur
progessive liver failure
portal hypertension - Na and H2o retained, varices from increased pressure
GI bleed signs - 3
haematemis (coffee ground or malena)
chronic liver disease
oesophageal varices
GI bleed investigation
Endo
Colo
duodenal biopsy
liver failure causes - 4
infection: viral hep
drugs: paracetemol overdose
toxins
other: alcohol, cirrhosis, fatty liver
liver failure signs - 3
jaundice
hepatic encephalopathy
liver flap
liver failure - what tests to do
bloods: fbc, u&e, lft, clotting, glucose, paracetemol levels
micro: blood, urine
radio: cxr, abdo, ultrasound
cirrhosis signs
LFT increases dupentrens clubbing palmar erythema gynecomastia
cirrhosis tests results
blood: increase BR, increase AST, increase ALT, increase PR/INR, decrease platelet
ultrasound: hepatomegaly, splenomegaly, ascites
MRI: size increase
jaundice conjugated test results
- hepatocellular
- alcoholic
- obstructive
hepatocellular - ALT more than AST
Alcoholic - Increase AST and gamma T more than ALT
Obstructive
Increased ALP
autoimmune hepatitis - 2 features
What antibody?
inflammation
t suppressor cells defected
anti-smooth muscle antibody positive
autoimmune hepatitis test results
What antibody?
BR, AST, ALT increase
Anemia
hypergammaglobuinaemia
Liver biopsy
anti-smooth muscle antibody positive
primary biliary cirrhosis
What antibody?
bilary duct damaged by auto immune granulomas
fatigue, jaundice, hepatosplenomegaly
Anti-mitochondrial antibodies
primary biliary cirrhosis test results
What antibody?
Bloods: all increased, except albumin decreased
Anti-mitochondrial antibodies
A1 antitrypsin deficiency
- how is it caused
- what is it
- what does it cause
inherited
inflammation is inhibited
causes liver disease in children
prevents elastase from damaging tissue
A1 antitrypsin symptoms
dysponea from emphysema
cirrhosis
jaundice
pancreatitis
A1 antitrypsin tests
a1 antitrypsin decreases
liver biopsy
dyspepsia symtpoms
epigastric pain from hunger specific foods time of day fullness after meals heartburn ALARM: anemia, loss of weight, anorexia, recent, melena
duodenal ulcer symtpoms
epigastric pain before meals or at night
relieved by food and milk
do you need to stop PPI 2 weeks before endo?
yes
can reflux lead to barretts?
yes
symptoms of gord
heartburn - relived by antacids
retrosternal pain
painful swallowing
increased salivation
gord investigations
endo if more than 4 weeks and vomiting or over 55
gord treatment
weight loss raise head in bed stop smoking small regular meals avoid certain food and drink
what is frank pus a sign of?
IBD
diverticulitis
fistula/abscess
what is the gold standard of diagnosing coeliacs?
duodenal biopsy
what is hereditary haemochromtosis?
iron deposit in joints and organs
–>hereditary
in viral hep, what is IgM and IgG?
think: moms are active
grandmothers are protective
m = active g= protective
is inr and pt increased in liver failure?
yes
