Gastroenterology Flashcards
What is Croup and what is it identified by?
What causes it
URTI in 6mth-3yrs, identified by stridor, barking cough, fever and coryzal symptoms.
The stridor is due to a combination of laryngeal oedema and secretions.
Mainly causes byparainfluenza viruses
Managment of Croup in infants is?
What is the additional emergency treatment?
Single dose Dexamethasone.
Emergency: nebulised adrenaline and humidified O2
What condition should you screen for in someone with Type 1 Diabetes?
What HLA strands is it associated with?
Coeliacs
HLA-DQ2
HLA-DQ8
How can Chrons disease cause Gallstones?
Terinal ileitis.
this is the section of the bowel where bile salts are reabsorbed. When this area is inflamed and the bile salts are not absorbed and people are prone to development of gallstones
What investigations would support Crohns?
- raised inflammatory markers: ESR and CRP
- increased faecal calprotectin
- anaemia
- low vitamin B12 and vitamin
What is carcinoid Syndrome
Due to a neuroendrocrine tumour slow growing (mainly in epithelial linign of lungs and gut) that secretes hormones.
This causes flushing, diarrhoea and SOB.
Why is liver involvement neccessary for carcinoid syndrome?
The liver is a primary and secondary site for carcinoid tumours of neuroendocrine cells, and by causing liver dysfunction you reduce the livers ability to metabolise the excess of hormones produced.
Therefore the carcinoid syndrome can take effect
How do the hormones produced by carcinoid tumours cause symptoms?
- Bradykinin and histamine: vasodilators that cause flushing and itching
- Serotonin:
- fibrosis: tricuspid regurg and pulmonary stenosis
- Bronchoconstriction: asthma and SOB
- Decr. tryptophan, decr niacin, pellegra
What are the treatment options for carcinoid syndrome?
- Octreotide: somatostatin analouge that bind to ss receptors and inhibits them
- Cyroheptadine for diarrhoea
What investigations confirm Carcinoid syndrome?
- urinary 5-HIAA
- plasma chromogranin A y
- Decreased Niacin in Blood
What are the two things you need to do to diagnose coeliacs, and describe them in depth
Immunology:
- tissue transglutaminase (TTG) antibodies (IgA)
- endomyseal antibody (IgA)
- anti-casein antibodies are also found in some patients
Jejunal Biopsy:
- villous atrophy
- crypt hyperplasia
- increase in intraepithelial lymphocytes
What are the symptoms of a Pharyngeal pouch?
- dysphagia
- regurgitation
- aspiration
- neck swelling which gurgles on palpation
- halitosis
Where anatomically do you get a pharyngeal pouch?
Posteromedially diverticulates through Kilians hiscense, a triangular area in the wall of the pharynx between thyropharyngeus and cricopharyngeus
What does the urea breath test check for, and when can you not use it?
Helicobactor Pylori
- The urea is broken down by H. pylori urease
Should NOT be done is the patient has taken a PPI or antibiotic
What are the main tests used to confirm H.pylori infection?
- Stool antigen test
- Urea breath test
- Rapid urease test; colour change
- Gastric biopsy
Raised bilirubin with an abnormal INR is strongly indicitive of?
Alcoholic Hepatitis
What is the underlying gene causing haemachromatosis and how is it inherited?
HFE gene that is autosomally reccessive.
Although it is not particularly penetrating, what are the presenting symptoms of Haemachromotosis?
- early symptoms include fatigue, erectile dysfunction and arthralgia (often of the hands)
- ‘bronze’ skin pigmentation
- diabetes mellitus
- liver: stigmata of chronic liver disease, hepatomegaly, cirrhosis, hepatocellular deposition)
- cardiac failure (2nd to dilated cardiomyopathy)
- hypogonadism (2nd to cirrhosis and pituitary dysfunction - hypogonadotrophic hypogonadism)
- arthritis (especially of the hands)
Painless jaundice is a common presentation of?
Pancreatic Cancer
What is a gallstone ileus?
This describes small bowel obstruction secondary to an impacted gallstone. It may develop if a fistula forms between a gangrenous gallbladder and the duodenum.
Abdominal pain, distension and vomiting are seen.
A 55-year-old gentleman presents to his GP with weight loss and vague right upper quadrant pain. This has been developing over the past few weeks, and he appears slightly jaundiced. He has a past medical history of hepatitis B and is known to the hepatology team at the local hospital. You refer him urgently to hospital.
What follow up blood test is he likely to require to monitor for recurrence of hepatocellular carcinoma?
AFP; alpha-fetoprotein
it’s produced by regenerating liver cells and can be used to monitor recurrence of HCC.
It is worth noting that AFP is not always raised at diagnosis, and in these cases, it might prove less reliable as a recurrence marker.
What is the main risk factor for developing Hepatocellular carcinoma?
Liver Cirrhosis
eg; secondary to Hep B/C, alcohol, haemachromatosis and primary biliary cirrhosis
Causes of Acute Liver Failure
- paracetamol overdose
- alcohol
- viral hepatitis (usually A or B)
- acute fatty liver of pregnancy
Features of Acute Liver Failure
- jaundice
- coagulopathy: raised prothrombin time
- hypoalbuminaemia
- hepatic encephalopathy: confusion and hepatic flap
- renal failure is common (‘hepatorenal syndrome’)
What are the 3 main types of colorectal cancer
- Sporadic (95%)
- Hereditary Non-polyposis colorectal carcinoma (5%)
- Familial Adematous Polyposis (1%)
What is the most common associated cancer with HNPCC and what is the criteria used to aid diagnosis
- Endometrial Cancer
The amsterdam criteria is often used
- minimum 3 family members with
- Cases span 2 generations
- at least one case dx by age 50
What is Primary Sclerosing Cholangitis?
Unknown etiology that causes inflammation and fibrosis of the intra and extra hepatic bile ducts
Gives it a beaded appearance on ERCP imaging!
PSC has a strong association with the condition _______
Ulcerative colitis. 80% of PSC ptients have UC
