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Phase 4 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Define Symptoms of dyspepsia

A

Also known as indigestion:

Heartburn/ retrosternal pain
Pain related to eating food 
Early satiety
Belching 
Nausea
G.I pain
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2
Q

2-5 hours following food intake, there is pain, what type of peptic ulcer is this related too?

A

Duodenal Ulcer

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3
Q

Why must gastric ulcers be biopsied?

A

Because they have an increased risk of developing into malignant ulcers.

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4
Q

What are the broad types of stomach cancer?

A

Adenocarcinoma

  • intestinal type
  • diffuse type

MALT

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5
Q

Following a diagnosis of gastric cancer, what important investigation should be next done?

A

H.Pylor testing

CT of Abdomen, thorax and pelvis to look for metastasis

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6
Q

What is the treatment of gastric cancer?

A

Stages 0 -1: endoscopic removal

Proximal cancers: Total Gastrectomy
Distal cancers (Antrum or pylorus): Partial Gastrectomy
+
Neoadjuvant and adjuvant chemotherapy

Reconstruction surgery:
- Roux-Y- Reconstruction (attaching Distal oesophagus to the intestines)

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7
Q

What investigations can be done into H.Pylori?

A

Biopsy Sample:
- Urea and pH reagent

Non - invasive samples:

  • Urea breath test
  • Stool antigen testing
  • blood serology

*urea breath test works by given Urea to drink which has radioisotope carbon 14 in it. When broken down this carbon is realised as CO2 and detected. demonstrates Urease activity is occurring in the stomach

before non - invasive testing a person should be omitted from PPIs as these can create false negatives.

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8
Q

Stress ulcers can occur because of:

A

Alcohol
Trauma/ sepsis
Intracranial pressure - cushing’s

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9
Q

What is the definition of Liver failure and list some causes:

A

Failure of the liver which is recognised by:

  • coagulopathy (INR >1.5)
  • Encephalopathy
  • Jaundice

Causes:

  • infections
  • Toxins
  • vascular
  • alcohol
  • autoimmune
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10
Q

What things must one be aware off in liver failure?

A

Sepsis
Bleeding (varicies)
Hypoglycaemia
cerebral oedema

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11
Q

What is the initial management of acute liver failure?

A

Admit to ICU - these patient deteriorate fast

ABCDE
A 
Protect air way -
NG tube to remove gastric contents 
20 degree head tilt to maintain airway and reduce intracranial pressure

B

C:

  • LFTs
  • FBC
  • U&Es
  • INR

Catheterisation to monitor fluids

D
Blood glucose monitoring every 4 hours
- place on Dextrose
- Avoid sedative drugs if possible.

Maintain nourishment

  • thiamine
  • folate supplements

Treat complications

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12
Q

What signs may you see in liver cirrhosis?

A

Leukonychia

hypoalbuminemia

Increased INR

Finger clubbing

Palmer erythema

Spider navi

Gynecomastia

Loss of body hair

Reduced testi size

Jaundice

Ascites

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13
Q

What is the definitive diagnostic procedure for cirrhosis?

A

Liver biopsy

  • fibrosis
  • nodular formation
  • loss of normal architecture

Done under US/ CT guidance
*can only be done when INR <1.5

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14
Q

What are the management options for hepatorenal syndrome?

A

Albumin
Terlipressin
TIPSS

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15
Q

What management can be implemented for encephalopathy?

A

Lactulose

Rifaximin - antibiotic that reduces gut flora that produce ammonia

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16
Q

What are the causes for acute pancreatitis?

A 
Gall stones 
Ethanol 
Trauma 
Steroids 
Mumps 
Autoimmune 
Scorpion venom 
Hypertriglyceraemia, hypercalamia, hypothermia 
ERCP 
Drugs - azathioprine

GET SMASHED

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17
Q

What is the most common presentation of Crohn’s in children?

A

Abdominal Pain

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18
Q

If a patient has suspected C. Diff infection, what is the most appropriate management?

A

Metronidazole initiated
+
48 hours isolation

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19
Q

What is the definitive diagnosis of C.Diff?

A

Stool analysis for C.diff Toxins

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20
Q

If a person has severe ascites, what is the management and what must be considered when doing so?

A

Large volume paracentesis
- up to 5L

this is to prevent fluid shifts.
if 5L is given then albumin must also be given along side.

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21
Q

What is the criteria for SBP? what other investigations should be done and what is the common pathogens?

A

SAAG <11.1g/L

Bacterial count >250

Cultures should also be done. 
Most common bacteria include: 
E.Coli 
Klebsiella
S. Pneumonia
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22
Q

What is the prophylactic treatment for varices?

A

Beta Blockers

Yearly endoscopic assessment

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23
Q

What cancer is HNPCC also correlated with in females?

A

Endometrial cancer

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24
Q

What is the criteria for severe C.Diff? What is the first line medication for severe?

A 
WWC >15 
Shock 
>50% baseline creatinine 
Fever >38.5 
Radiological findings - colonic diameter

first line medication for C.Diff is Vancomycin

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25
Q

If a patient with Hepatitis B has acute deterioration in their liver functioning and is an IVDU, what should you worry about?

A

Hepatitis D
- super infection.

Risk factor being IVDU

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26
Q

Before carrying out the urea breath test, what must the patient be free off?

A

> 4 weeks ago last use of antibiotics

>2 weeks ago lasy use of PPIs

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27
Q

What are the classic signs of a pharyngeal pouch?

A

Regurgitation
Foul smelling breath
dysphagia

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28
Q

Which hepatitis viruses are most likely to induce acute hepatitis?

A

A and B

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29
Q

In acute pancreatitis, what symptoms may point towards the underlying etiology?

A

Hepatitis - alcohol

Swollen parotid gland
- mumps

Xanthoma
- hypercholesterolemia

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30
Q

In acute pancreatitis what investigations should be done?

A

Amylase
- 3x normal

ABG
- assess oxygenation and acid balance

LFTs
- obstruction the cause

CT
- this is best way to establish the severity

US
- if gallstones

ERCP

  • if LFTs worsen and gallstones are suggested
  • done after acute phase

CRP
- higher = more severe

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31
Q

What are the early complications of acute pancreatitis?

A

Shock

ARDS
- pleural effusions can develop

DIC

AKI

Hypoglycaemia

Hypocalcaemia

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32
Q

What are some late complications of pancreatitis?

A

Pancreatic necrosis

  • antibiotics
  • necrosectomy

Pseudocyst

  • 4 weeks later
  • remaining fever
  • amylase remains high

Bleeding
- erosion into the splenic artery

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33
Q

What are the causes of gastritis?

A

H. Pylori

NSAIDs

Autoimmune destruction

Pyloric obstruction

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34
Q

Where are gastric ulcers most likely to be situated?

A

First part of duodenum

Lesser curvature of the stomach

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35
Q

WHat drugs are associated with Gastritis and peptic ulcers?

A

NSAIDS
SSRIs
Bisphosphonates - need to be taken standing up for 30mins
Steroids

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36
Q

What investigations should be done into suspected gastric carcinoma?

A

Endoscopy with biopsy

Endoscopic ultrasound

CT for staging

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37
Q

If there is an upper G.I bleed, where is it anatomically?

A

Above the ligament of Treitz / suspensory ligament of the duodenum

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38
Q

What are the differentials of upper G.I bleed?

A 
Peptic ulcers 
Esophagitis 
Oesphageal varices
Mallory Weiss tears  
AVM 
gastric Carcinomas
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39
Q

What does coffee ground blood suggest?

A

Suggest the blood has been oxidised by the acid in the stomach and that it has either:
- stopped
or
- was a small amount

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40
Q

What is the name for PR bleeding?

A

Haematochezia

41
Q

What key blood tests should be done in gastro- bleeding?

A

FBC
- Hb (may not have changed in acute)

U&Es
- urea and kidney function

LFTs
- to assess if any risk from varices

Group and save/ cross match if serious

Coagulation studies
- to rule out bleeding disorders

42
Q

What are the endoscopic options for stopping peptic ulcer bleeding?

A

Thermocoagulation therapy

Clipping

Adrenaline - induce vasospasm

43
Q

What are the endoscopic options for stopping variceal bleeding?

A

Endoscopic Oesphageal banding
Endoscopic sclerotherapy

Sengstaken Blakemore tube

44
Q

What are the treatment options for diverticulosis?

A

Colonoscopy thermocoagulation therapy

Injection of epinephrine

Vessel embolism

If not able to control bleeding then:
- segmental colectomy

45
Q

What is gold standard for assessing dysphagia in the setting of suspected esophageal cancer?

A

endoscopy

46
Q

What drug should be used in acute alcohol withdrawal to stop hallucinations and induce calmness?

A

Chlordiazepoxide

47
Q

What type of IBD causes granulomas?

A

Crohn’s

48
Q

What is the management for achalasia?

A

Calcium channel blockers

Intersphincteric Botulism injection

Balloon dilation

Heller’s myotomy

49
Q

Which drugs are likely to cause pancreatitis?

A

azathioprine

mesalazine

sodium valproate

Steroids

50
Q

What viral hepatitis is most likely in the UK to cause liver cancer?

A

Hepatitis C in the UK

Hepatitis B in the world

51
Q

What other cancer are patients with HNPCC with MSH2 gene likely to get?

A

Endometrial

Pancreatic

52
Q

If gallstones are discovered incidentally, what should their management be?

A

Reassurance.

Gallstones are common and if asymptomatic shouldn’t be treated

53
Q

What are the autoantibodies that can be tested for in coeliac disease?

A

IgA antibodies against Endomysium / Anti - EMA

IgA against tTG / Anti - TTG

Deamidated gliadin peptide antibodies / Anti - DGPs

54
Q

If a patient is IgA deficient and there is suspicion of celiac disease, what additional tests should be done?

A

deamidated gliadin peptide antibodies - Anti DGPs
+
Biopsy

55
Q

What two other physical signs may be seen in acute appendicitis other than McBurney’s point?

A

Rovsing’s sign

Psoas Sign

56
Q

If there is a reduced ceruloplasmin and reduced serum copper what is the likely diagnosis?

A

Wilson’s disease

*the low serum copper is counterintuitive but occurs since 95% of it is carried by the ceruloplasmin

57
Q

What is first line medication for moderate UC flare?

A

Moderate flare: 4-6 stools, with varying blood and no systemic symptoms.

Topical mesalazine

58
Q

If someone has Gilbert’s syndrome would you expect to see any bilirubin in the urine? and why?

A

No.

Because it is not conjugated thus is not water soluble.

59
Q

Following an episode of SBP what medication should be they be started on?

A

Ciprofloxacin

Prophylactic antibiotic

60
Q

What are the red flags for referral with a patient presenting with dyspepsia?

A

Dysphagia

Upper abdominal mass

> 55years + weight loss and:

  • treatment resistant dyspepsia
  • anaemia
  • N&V
61
Q

How is autoimmune liver disease managed and what are the autoantibodies associated?

A

Type 1:

  • Anti Smooth muscle
  • Anti - soluble liver antigen
  • ANA

Type 2:
- Anti liver/ kidney microsomal type 1 antibodies (associated with type 2)

Managed:

  • steroids
  • azathioprine
  • liver transplant
62
Q

What would be two diagnostic features of haemochromatosis?

A

Increased ferritin

Increased Transferrin saturation (>50%)

Reduced TIBC/ transferrin

63
Q

What scoring system is used for Liver cirrhosis?

A

Child Pugh Classification

64
Q

What is the prophylactic management of variceal ulcers?

A

Propranolol
- if not previously bleed

Prevention of recurrent rebleeding:

  • Propranolol
  • 2 weekly banding to abolish the variceal
65
Q

What are the biggest risk factors determining an anastomotic leak?

A

Blood supply
Tension
Seal of the stitches

66
Q

What are some causes of intra abdominal sepsis?

A

Gallbladder gangrene

Ascending cholangitis

Cholecystitis

Pelvic abscess

Appendicitis mass

*all should get a CT

67
Q

What are the two screening methods being used for colorectal carcinoma?

A

qFIT

  • 50 to 74 years old (England 60-74)
  • every 2 years

Flexible sigmoidoscopy
- one off >55 year old

68
Q

What is the preferred initial triple therapy?

A 
PPI
\+ 
Amoxicillin 
\+ 
Clarithromycin
69
Q

What is the best management for NAFLD?

A

Weight loss

70
Q

In the setting on acute bleeding - when should PPIs be given?

A

After the endoscopy - otherwise they may hide the source of the bleeding

71
Q

Where is the most likely place for ischemic colitis to affect?

A

Splenic flexure

72
Q

What can cause a falsely elevated ca125?

A

Ascites - virtually all patients with ascites will have elevated CA125

73
Q

What is the treatment of Hep B?

A

Refer to gastro
Contact public health
Fibroscan
Anti-virals

1st Line: Interferon Alpha

2nd line:
Nucleus reverse transcriptase Inhibitors
- tenofivir
- entacavir

74
Q

What are the symptoms of carcinoid syndrome and what has to occur first in order for there to be these symptoms?

A

Facial flushing

Diarrhoea

Itching

Hear dysfunction

Asthma

  • it must have metastasized to the liver
75
Q

How is carcinoid syndrome investigated for?

A

24 hour 5HIAA urine test
- 5 hydroxyindoleacetic acid

CT Chest/ Abdo/ Pelvis

Octreoscan

Echocardiogram
- to establish for carcinoid disease of heart

76
Q

How is carcinoid syndrome treated?

A

Octreotide
- blocks tumours mediators

Loperamide - for diarrhea

Surgical resection

  • endoscopically
  • radioablation
  • segmental removal
  • depends on size
  • tumours are bright yellow
77
Q

What is carcinoid crisis?

A

Where the tumour outgrows its blood flow or is handled too much during surgery.

causes:
- life threatening vasodilation
- hypotension
- bronchoconstriction

Octreotide and supportive measures are needed

78
Q

What are the features of malabsorption and name some common causes:

A 
Diarrhea
weight loss 
Pale 
Lethargy 
Bloating 
Signs:
anaemia 
Bleeding disorders 
oedema - albumin loss 
Metabolic bone disease

Causes:

  • Coeliac disease
  • Cystic fibrosis
  • Chronic pancreatitis
  • Crohn’s disease
  • Bacterial overgrowth
  • giardiasis infection
79
Q

What investigations should be done into malabsorption?

A

Bloods:

  • FBC
  • Anaemia screen
  • INR
  • Celiac serology

Orifices:

  • Sudan stain for fat globules
  • stool microscopy

Endoscopy + Biopsy

Breath hydrogen analysis
- bacterial overgrowth

80
Q

What are some of the complications of celiac disease?

A

Anaemia
Osteoporosis
Dermatitis herpetiformis
Enteropathy related T cell lymphoma
B12 deficiency - neurological abnormalities
Pneumococcal disease (Functional Hyposplenism)

81
Q

What can be a mimic of IBS which one needs to be aware of?

A

Ovarian cancer

Endometriosis

82
Q

What are the symptoms of IBS?

A 
Abdominal discomfort 
Relieved by defecating 
Diarrhea/ constipation 
Mucus PR 
worsen symptoms after eating
83
Q

What symptoms of IBS would make you think of other diseases?

A 
>60 years old 
Anorexia 
loss of weight 
waking up at night 
mouth ulcers 
Abnormal CRP ESR
84
Q

What investigations should be done into diarrhoea?

A

Bloods:

  • FBC
  • Anaemia Screen
  • ESR
  • CRP
  • U&Es - K?
  • Celiac serology

Orifices:

  • Microscopy, cultures and sensitivities
  • C. DIff toxin - if suspicion
  • faecal elastase
  • Sudan fat stain

Endoscopy/ colonoscopy if suspicion of underlying disease.

Video capsules.

85
Q

How is Haemochromatosis diagnosed? and what are some complications?

A

Liver biopsy
- Pearl stain

Genetic testing

Liver failure
Joint damage
Diabetes
Cardiomegaly

86
Q

What does C. Diff antigen show? and how should it be treated?

A

Show previous exposure.
does not suggest infection.

No treatment is required.

87
Q

What investigation features would you expect to seein NAFLD?

A

Increased ALT>AST

Fibroscan Echogenicity

88
Q

What is the genetic susceptibility into celiac disease?

A

HLA DQ2/ DQ8

89
Q

What would be likely on the blood film of someone with celiac disease?

A

Howell jolly bodies

Target cells

  • hyposplenism
  • Iron deficiency
90
Q

What investigations should be done into coeliac disease?

A

Bloods:

  • FBC
  • Haematinics
  • LFTs - low albumin
  • INR - Low - lack of vitamin K
  • Bone profile

Orifices:
- Stool cysts - gardia

X-rays:
- Endoscopy + biopsy

Special tests:

  • IgA
  • Anti tTG
  • Anti Endomysial
  • Anti - deamidated gliadin peptide
91
Q

What foods are okay to eat in coeliac disease?

A

Maize
Soya
Rice

92
Q

What is the mediators of Crohn’s and Ulcerative colitis?

A

UC: TH2

Crohns: TH17

93
Q

What investigations do you want into ascites? and what are the causes?

A

Cell count

Gram staining

Biochemistry - albumin level. proteins

Cytology - assess for malignancy

Amylase

High SAAG causes:

  • Cardiac failure
  • cirrhosis
  • Budd Chiari

Low SAAG:

  • Cancer
  • pancreatitis
  • TB infection
  • SBP
  • Serositis
94
Q

If a person develops SBP what is there now an indication for?

A

Referral to Liver transplant clinic

95
Q

What is the neuropsychiatric condition that can develop in cirrhosis and what are some signs of it?

A

Hepatic encephalopathy/ Portosystemic encephalopathy

  • Reversal of sleep wake cycle
  • Personality change
  • Reduced intellect
  • Asterixis
  • Hyperreflexia
  • Up going planters
  • Foetor hepaticus
96
Q

What additional tests can be done into Hepatic encephalopathy?

A

EEG

Visual evoked responses

Arterial Blood Ammonia

97
Q

How do you assess for budd chiari syndrome?

A

Ultrasound with doppler flow

98
Q

What are the grading scores for encephalopathy?

A

I - altered mood/ sleep disturbance

II - Drowsiness/ confusion / Asterixis

III - Incoherent / Clonus/ Nystagmus

IV: Coma

99
Q

What are carcinoid tumours?

A

Neural Crest tumours that appear predominantly in the appendix.
- often cause obstruction or acute appendicitis

Only cause carcinoid syndrome when metastasized to the liver and release serotonin

Phase 4 (49 decks)

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