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Phase 4 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What relieves the pain of pancreatitis?

A

Sitting forward

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2
Q

What signs might you see in acute pancreatitis?

A

Grey Turner’s and Cullen’s sign

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3
Q

What might you see on an AXR in pancreatitis?

A

Sentinel loop

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4
Q

How to assess the severity of pancreatitis

A 
PaO2 <8kPa
Age >55yrs
Neutrophilia (raised)
Calcium (low)
Renal function (raised urea)
Enzymes
Albumin (low)
Sugar (raised)
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5
Q

What can cause chronic pancreatitis?

A

Alcohol
Genetics: CF, Haemochromatosis
Pancreatic duct obstruction: tumours, stones

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6
Q

How to treat chronic pancreatitis?

A

Stop alcohol
Exocrine function - low-fat diet, pancreatic enzyme supplements
Endocrine insufficiency – diet, consider insulin
Surgery – pancreatectomy

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7
Q

What are the main symptoms of gastric Ca?

A

Dyspepsia (if >1m and age >50yr - warrants Ix)
Dysphagia
Vomiting
WL

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8
Q

How to Ix gastric Ca?

A

Gastroscopy + biopsies
Endoscopic USS - to assess depth
CT/MRI - for staging

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9
Q

What are the predisposing factors to colonic Ca?

A

Neoplastic polyps
Genetics (FAP, NHPCC)
Diet low in fibre and high in red/processed meats
Alcohol/smoking

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10
Q

Types of colonic polyps?

A

Inflammatory - UC/Crohns
Hamartomatous - in certain conditions
Neoplastic

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11
Q

What do you stain the liver biopsy with to see haemochromatosis?

A

Perl’s stain

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12
Q

What are the three main complications of liver cirrhosis?

A

Liver failure
Portal hypertension
HCC

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13
Q

What happens in liver failure?

A 
Coagulopathy (loss of F2, 7, 9, 10 causes raised INR)
Encephalopathy (liver flap, confusion)
Hypoalbuminaemia (oedema, leukonychia)
Sepsis (pneumonia, septicaemia)
Spontaneous bacterial peritonitis (SBP)
Hypoglycaemia
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14
Q

What happens in portal hypertension?

A

Ascites
Splenomegaly
Portosystemic shunt including oesophageal varices

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15
Q

How do you treat ascites?

A

Bed rest, fluid restriction, low-salt diet
Spironolactone first, if poor response – add furosemide
Chart daily weight
Therapeutic paracentesis with albumin infusion may be tried

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16
Q

What is the pathophysiology of Wilson’s Disease?

A

The absorption of copper and transportation to the liver is intact. The incorporation into caeruloplasmin in hepatocytes and its excretion into bile are impaired. Therefore copper accumulates in the liver and later in other organs

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17
Q

How to manage Wilson’s disease?

A

Low copper diet
Penicillamine
Screen siblings

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18
Q

What is Hesselbach’s triangle?

A

Medial to the inferior epigastric vessels
Lateral to the rectus abdominus
Superior to the inguinal ligament

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19
Q

Which structure is more susceptible to damage from a hernia repair?

A

The ilioinguinal nerve

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20
Q

What are the S+S of oesophageal achalasia?

A

Dysphagia of BOTH liquids and solids, dyspepsia, gastric reflux

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21
Q

How to Ix oesophageal achalasia?

A

Manometry (to assess tone), Ba swallow, CXR

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22
Q

How to Tx oesophageal achalasia?

A

Intra-sphincteric injection of botox

Heller cardiomyotomy

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23
Q

What symptoms might you see in oesophageal cancer?

A 
Dysphagia
WL
Retrosternal chest pain
Hoarseness
Cough
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24
Q

What causes a corkscrew oesophagus?

A

Oesophageal spasm

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25
Q

What are the symptoms of GORD?

A

Indigestions - relieved by lying, stooping, straining
Belching
Acid brash
Water brash - mouth filling with saliva

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26
Q

What are the extra-oesophageal symptoms of GORD?

A

Nocturnal asthma
Sinusitis/laryngitis
Chronic cough

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27
Q

What are the complications of GORD?

A 
Oesophagitis
Ulcers
Benign stricture
Iron-deficiency
Barret's oesphagus + Ca
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28
Q

What investigations are done for GORD?

A

Endoscopy if indicated
Ba swallow
24hr oesophageal pH monitoring +/- manometry

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29
Q

How do you treat a duodenal and gastric ulcer?

A

Duodenal - 4 weeks PPI

Gastric - 8 weeks PPI

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30
Q

How do you treat gastritis?

A

Quadruple therapy

PPI, amox, clarithro, bismuth subcitrate

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31
Q

How do you manage acute oesophageal varices rupture?

A

Resuscitate with blood if needed
Correct clotting abnormalities
Endoscopic banding/sclerotherapy
Sengsaken-Blakemore tube insertion if bleeding uncontrolled

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32
Q

How do you treat diverticulosis and diverticulitis?

A

Diverticulosis - high fibre diet, anti-spasmodics (mebeverine), resection as a last resort
Diverticulitis - abx and bowel rest, may need fluids of drainage

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33
Q

Complication of diverticulitis?

A

Perforation
Bleeding
Fistulae
Abscess

34
Q

What type of gastroenteritis does E.coli give you?

A

Watery stools
Abdo cramps + nausea
Common in travellers

35
Q

What type of gastroenteritis does Cholera give you?

A

Profuse, watery diarrhoea
NO BLOOD
Sever dehydration -> WL

36
Q

What type of gastroenteritis does Shigella give you?

A

Bloody diarrhoea

Vomiting + abdo pain

37
Q

What type of gastroenteritis does Staph aureus give you?

A

Sever vomiting

Short incubation

38
Q

What type of gastroenteritis does Campylobacter give you?

A

A flu-like prodrome
Maybe bloody diarrhoea
May mimic appendicitis

39
Q

What type of gastroenteritis does Bacillus cereus give you?

A

Vomiting within 6hrs

Diarrhoea illness after 6hrs

40
Q

What are the incubation times of pathogens causing gastroenteritis?

A
  • 1-6 hrs: Staphylococcus aureus, Bacillus cereus
  • 12-48 hrs: Salmonella, Escherichia coli
  • 48-72 hrs: Shigella, Campylobacter
  • > 7 days: Giardiasis, Amoebiasis
41
Q

How to treat travellers diarrhoea and invasive diarrhoea?

A

Invasive - ciprofloxacin

Travellers + non-invasive - clarithromycin

42
Q

Which drugs cause C. diff?

A 
5 Cs...
Cephalosporins
Co-amoxiclav
Ciprofloxacin
Clindamycin
Carbapenem
43
Q

What is the presentation of C. diff?

A 
Typically 3-9 days post-abx
Diarrhoea – green foul-smelling
Abdo pain
Raised WCC
Toxic megacolon may develop
44
Q

How to manage C. diff?

A

Metronidazole 10-14 days
If severe/not responding, give oral vancomycin
Stop opioids

45
Q

What can C. diff do to the body?

A

Produces an exotoxin which causes intestinal damage and can lead to pseudomembranous colitis

46
Q

What is pseudomembranous colitis?

A

swelling or inflammation of the large intestine

47
Q

What ECG sign will you see in hypercalcaemia?

A

Short QT interval

48
Q

What ECG sign will you see in hypocalaemia?

A

Prolonged QT interval

49
Q

What are the two main causes of hypercalaemia?

A

Malignancy

Hyperparathyroidism

50
Q

Which Ix is CI in suspected diverticular disease?

A

Barium enema - risk of perforation

51
Q

What are the extra-intestinal signs of Crohns and UC?

A 
Arthritis/arthralgia
Clubbing
Erythema nodosum
Crohns:
Mouth ulcers/anal tags
52
Q

What does leuconychia show?

A

Hypoalbuminaemia

53
Q

What does koilonychia show?

A

Iron-def anaemia

54
Q

What does glossitis show?

A

Vitamin B12 deficiency

55
Q

What are the S+S of pancreatic cancer?

A

-> Painless jaundice
WL, anorexia, epigastric pain
Loss of endocrine function - DM
Loss of exocrine function - steatorrhoea

56
Q

What is the pathophysiology of appendicitis?

A

Lumen obstruction -> intra-luminal pressure rise -> venous + lymphatic congestion -> loss of mucosal barrier

57
Q

What signs can you check for in appendicitis?

A

Psoas, obturator, rovsing’s

58
Q

How to Tx appendicitis?

A

MAC
Metronidazole
Appendicectomy
Cefuroxime

59
Q

What can you see on an X-ray of a volvulus?

A

Double fluid level and gastric dilatation

60
Q

What drugs are hepatotoxic?

A 
PATIOS
o	Paracetamol
o	Azathioprine
o	Tetracycline
o	Isoniazid
o	Oestrogen
o	Salicylates
o	Methotrexate
61
Q

What is the relationship between ALT and AST in NAFLD?

62
Q

Main imaging Ix for PBC?

63
Q

Main imaging Ix for PSC?

64
Q

What are the signs of liver failure?

A 
Coagulopathy (loss of factors 2, 7, 9, 10)
Encephalopathy (liver flap, confusion)
Hypoalbuminaemia (oedema, ascites)
SBP
Hypoglycaemia
Sepsis
65
Q

What are the symptoms of acute cholecystitis?

A 
Continuous RUQ/epigastric pain
Signs of infection - fever, local peritonism
GB mass
\+ve murphy's sign
NO jaundice
66
Q

What are the symptoms of chronic cholecystitis?

A

Fat intolerance
Flatulent dyspepsia
Colic

67
Q

What is a porcelain GB?

A

Calcification brought on by excessive gallstones that need removing

68
Q

How to treat cholangitis?

A

Fluid resuscitation and abx (cefuroxime and metronidazole)

ERCP after 24-48hrs to relieve obstruction

69
Q

What is the inheritance pattern of Wilson’s disease?

70
Q

Whats Ix for Wilson’s?

A

Blood - low serum copper and caeruloplasmin
Urine - 24hr urine shows high copper excretion
Genetic testing
Slit lamp exam
Liver biopsy
MRI - may show BG degradation

71
Q

What are the causes of cholangiocarcinomas?

A

Flukes, PSC, biliary cysts, HBV/HCV, DM

72
Q

How to treat alcoholic liver disease?

A 
Stop drinking
Chlordiazepoxide for detox
Vit K for 3 days
Thiamine
Prednisolone for 5 days based on a Maddrey Score >32
73
Q

What does the Maddrey score look at?

A

Prothrombin time and bilirubin

74
Q

What are the complications of coeliac disease?

A

GI T-cell lymphoma
Malignancies (small bowel, gastric, oesophageal)
Anaemia
Osteoporosis

75
Q

What are the complications of liver failure and how to treat?

A

Cerebral oedema - ITU, 20% IV mannitol
Bleeding - vit K, FFP + blood as needed
Infection - IV cefriaxone
Encephalopathy - avoid sedatives, lactulose and regular enemas to decrease the number of nitrogen-forming gut bacteria

76
Q

What is the pathology in hepatitis?

A

Infiltration of inflamed cells into surrounding area

77
Q

RF with hep A?

A

Shellfish
Poor sanitation
Low income countries

78
Q

Causes of acute and chronic hepatitis?

A

Acute: viruses, drugs, alcohol, metabolic
Chronic: viruses, drugs, alcohol, AI

79
Q

Which symptoms are more common in hep B?

A

Arthralgia and urticaria

80
Q

What is the iron chelating agent used in haemochromatosis?

A

Desferoximine

Phase 4 (13 decks)

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