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Yr 5 conditions > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is defined as clinically significant portal hypertension?

A

Portal hypertension is abnormally high pressure in the hepatic portal vein.
Hepatic venous pressure gradient of 10 mm Hg or more is clinically significant.

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2
Q

What is the most common cause of portal hypertension?

A

Liver cirrhosis

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3
Q

What does the viral marker hep B Surface antigen (HBsAg) indicate?

A

Active infection

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4
Q

What does the viral marker hep B E antigen (HBeAg) indicate?

A

Marker of viral replication and implies high infectivity

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5
Q

What does the viral marker hep B Core antibodies (HBcAb )indicate?

A

Implies past or current infection

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6
Q

What does the viral marker hep B Surface antibody (HBsAb) indicate?

A

Implies vaccination or past or current infection

HBsAb demonstrates an immune response to HBsAg

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7
Q

What does the viral marker Hepatitis B virus DNA (HBV DNA) indicate?

A

This is a direct count of the viral load

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8
Q

To have hepatitis D, what form of hepatitis must a patient have previously had?

A

Hepatitis B

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9
Q

Which of the 5 main forms of viral hepatitis is the only one that is a DNA virus rather than an RNA virus?

A

Hepatitis B

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10
Q

What are the 4 most common causes of liver cirrhosis?

A

Alcoholic liver disease
Non Alcoholic Fatty Liver Disease
Hepatitis B
Hepatitis C

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11
Q

What is a tumour marker for hepatocellular carcinoma that should be checked every 6 months for patients with liver cirrhosis?

A

Alpha-fetoprotein (AFP)

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12
Q

What scoring systems exist to estimate prognosis in patients with liver cirrhosis?

A
  1. Child-Pugh score
  2. The MELD score is recommended by NICE to be used every 6 months in patients with compensated cirrhosis. It is a formula that takes into account the bilirubin, creatinine, INR and sodium and whether they are requiring dialysis. It gives a percentage estimated 3 month mortality and helps guide referral for liver transplant.
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13
Q

What are the subsequent disease states that non-alcoholic fatty liver disease aka steatosis may progress to?

A

NAFLD –> Non-Alcoholic Steatohepatitis (NASH) –> Fibrosis –> Cirrhosis

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14
Q

What imaging technique is used to detect the presence of steatosis of the liver (but will not indicate the severity, the function of the liver or whether there is liver fibrosis)?

A

Ultrasound - shows a hyper-echogenic, bright image

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15
Q

What is the pathophysiology behind cirrhosis causing ascites?

A

Increased pressure in the portal system causes fluid to leak out of the capillaries in the liver and bowel and in to the peritoneal cavity. The drop in circulating volume caused by fluid loss into the peritoneal space causes a reduction in blood pressure entering the kidneys. The kidneys sense this lo wer pressure and release renin, which leads to increased aldosterone secretion (via RAAS) and reabsorption of fluid and sodium in the kidneys. (hence the need for fluid and sodium restriction)

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16
Q

What features distinguish Crohn’s disease from Ulcerative Colitis?

A

Crohn’s - Entire GI tract can be affected, skip lesions, transmural inflammation, terminal ileum most affected, can get oral ulcers, smoking is a risk factor, get strictures and fistulae

UC - No skip lesions (continuous inflammation of the affected area of bowel), limited to colon and rectum, only superficial mucosa affected, smoking is protective, blood and mucus commonly excreted

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17
Q

What test can be a useful screening tool for suspected cases of IBD?

A

Faecal calprotectin - released by the intestines when inflamed

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18
Q

What is the diagnostic test for IBD?

A

Endoscopy (OGD and colonoscopy) with biopsy

19
Q

What is the general management of Crohn’s?

A

To induce remission - steroids iv/po +/- immunosuppressants if necessary
To maintain remission - immunosuppressants
Surgery - if disease confined to one area, typically terminal ileum

20
Q

What is the general management of UC?

A

To induce remission - 1st line is aminosalicylates e.g. Mesalazine. Steroids iv/po
To maintain remission - aminosalicylate e.g. mesalazine. Immunosuppressants
Surgery - panproctocolectomy will remove the disease, left with permanent ileostomy or J-pouch connecting ileum to anus

21
Q

What extra-intestinal manifestation of UC may be seen on the shins of some patients?

A

Erythema nodosum

22
Q

Where is the abdominal pain typically felt in appendicitis?

A

Starts centrally then settles in the right iliac fossa

May be tenderness at McBurney’s point (1/3 the distance from the ASIS to umbilicus)

23
Q

How might the bowel sounds be described on auscultation in intestinal obstruction?

A

Early: high-pitched and tinkling
Late: absent

24
Q

What is the most common cause of small bowel obstruction?

A

Intra-abdominal Adhesions from previous surgeries

25
Q

What is the most common cause of large bowel obstruction?

A

Cancer

26
Q

Where is the most common site for volvulus to occur?

A

Sigmoid colon - accounts for 5% of large bowel obstructions

27
Q

When is emergency surgical intervention required to relieve bowel obstruction rather than conservative measures or elective surgery?

A

When the obstruction results in ischaemia, perforation or peritonitis.

28
Q

What are the common causes of paralytic ileus?

A 
Very common post-abdo surgery (especially with extensive bowel handling)
Intra-abdominal infection / inflammation
Pneumonia
Trauma
Electrolyte Imbalance
29
Q

What can be a useful umour marker blood test for assessing bowel cancer progression?

A

Carcinomembryonic Antigen (CEA)

30
Q

What staging system is used in colorectal cancer?

A

Duke’s classification (but now being phased out for TMN staging)
Dukes A – confined to mucosa and part of the muscle of the bowel wall
Dukes B – extending through the muscle of the bowel wall
Dukes C – lymph node involvement
Dukes D – metastatic disease

31
Q

What is the most common site for metastatic spread for colorectal cancer?

A

Liver

32
Q

What are the management options for haemorrhoids?

A

Symptom relief - Anusol cream/local anaesthetic/instillagel
Laxatives - to reduce constipation/straining
Band ligation - tight rubber band around base to cut off blood supply
Surgical haemorrhoidectomy

33
Q

What aggravates the pain in someone with an anal fissure and how are they managed?

A

Defecation

Treatment usually involves an anaesthetic cream and a stool softener

34
Q

What is the management of perianal abscesses?

A

Prompt surgical drainage.

Medication for pain relief.

35
Q

What sign may be seen on AXR in sigmoid volvulus?

A

‘Coffee-bean sign’

36
Q

What is the treatment of sigmoid volvulus?

A 
Endoscopic decompression (for sigmoid volvulus with no peritonitis only)
Surgery: Laparotomy --> Hartmann’s procedure (sigmoid)
37
Q

What is the best test to use to detect liver cirrhosis according to the latest NICE guidelines?

A

Transient elastography aka Fibroscan

38
Q

What is is the exam classical pattern of primary sclerosing cholangitis?

A

Female presenting with jaundice, right upper quadrant pain and pruritus on a background of ulcerative colitis.

39
Q

What investigation can be used to confirm a diagnosis of achalasia and what will it show?

A

A barium swallow which shows a grossly expanded oesophagus that tapers at the lower oesophageal sphincter (‘bird’s beak’ appearance)

40
Q

What is the most common extra-colonic malignancy of someone with HNPCC?

A

Endometrial carcinoma

It is also associated with an increased risk of pancreatic cancer

41
Q

What is the ‘rule of M’ regarding primary biliary cholangitis?

A

raised serum IgM
anti-Mitochondrial antibodies, (M2 subtype) - highly specific
occurs in Middle aged females

42
Q

What triad may someone with Budd-Chiari syndrome present with?

A

Sudden onset abdominal pain, ascites, and tender hepatomegaly

43
Q

In what condition may you see so called ‘lead-pipe colon’ demonstrating the complete loss of haustral markings in the distal part of the bowel?

A

Ulcerative colitis

Yr 5 conditions (16 decks)

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