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Phase 3b > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Main differentials for a GI bleed

A 
Oesophagitis 
Peptic ulcer 
Varices/Portal hypertensive gastropathy
Erosive duodenitis or gastritis 
Mallory-Weiss tear 
Malignancy 
Vascular malformations
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2
Q

Two commonly used scoring system for GI bleed

A

Rockall or Glasgow Blatchford

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3
Q

When should you give a patient blood?

A

Hg <70g/L (or has significant CVD)

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4
Q

Secondary prevention of varices?

A

Beta blockers

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5
Q

What is the post-endoscopy care for a patient with gastric bleeding?

A

PPI (omeprazole/lansoprazole)
H.pylori treatment
Re-endoscopy in 6-8 weeks as risk of rebleeding

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6
Q

When would you give IV PPI for a gastric bleed, and how long for?

A

If visible blood vessel or actively bleeding ulcer at time of endoscopy

72 hours of IV PPI

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7
Q

Immediate treatment of variceal bleed? When is it contraindicated?

A

2mg qds Terlipressin (vasoconstrictor)
+ IV abx if also liver disease (risk of bacteria from gut entering blood stream)

CI in peripheral vascular disease

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8
Q

Main causes of liver disease

A

Alcohol

NAFLD (insulin resistance leading to fat accumulation)

Viral hepatitis (A to E, EBV, CMV)

Drugs (paracetamol, idiosynchratic)

Immune (autoimmune hepatitis, primary biliary cholangitis/cirrhosis, sclerosing cholangitis)

Inherited (haemochromatosis, Wilson’s, alpha1 antitrypsin deficiency)

Vascular (Budd-Chiari, liver ischaemia)

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9
Q

Liver non-invasive screen

A

SCREENING QUESTIONS

Bloods:
LFTs, FBC, U&Es

Haematology:
Iron studies

Viral serology:
hep B surface antigen, hep C antibody, HIV

Immunology:
autoantibodies, Anti-mitochondrial, anti-nuclear, smooth muscle, Ig, COELIAC

Biochemistry:
iron studies, ferritin, copper studies, alpha1 antitrypsin, blood glucose

Young patients:
serum copper, caeruloplasmin

Imaging (US, CT/MRI, endoscopy)

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10
Q

Score to use to determine who should get liver transplant?

A

MELD score

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11
Q

What approach would you take in a patient with jaundice?

A

?Large duct obstruction (need imaging; hx of rigors or biliary pain)

?Severe liver injury (ill patient, high transaminases, coagulopathy, encephalopathy)

?Potential drug cause

?Another obvious cause (alcohol, viral hep, pregnancy, heart failure, cancer)

Fast-track non-invasive screen (hepatitis, CMV, EBV, auto-antibodies, Ig)

Liver biopsy

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12
Q

Ascites management

A

Fluid and salt restriction

Diuretics (SPIRONOLACTONE, furosemide as adjuvant, monitor weight)

Large-volume paracentesis

Transjugular intrahepatic porto-systemic shunt (TIPSS) - risk of encephalopathy (not possible if MELD >18, HF, pulmonary HTN)

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13
Q

Common changes in electrolytes in liver disease?

A

Hypo everything

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14
Q

What is iron deficiency anaemia a high risk sign of?

A

GI malignancy

Renal cancer

Therefore require both bi-directional endoscopy and urine dipstick/USS renal

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15
Q

First test to be done if iron deficiency anaemia?

A

Coeliac screen (tTg antibody)

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16
Q

What does a sigmoidoscopy look at?

A

Left side of large intestine (descending colon, sigmoid and rectum)

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17
Q

What are the possible tests to assess the colon?

A

Colonoscopy/flexible sigmoidoscopy

Virtual colonoscopy (CT pneumocolon) - radiation risk, may miss early cancers

CT with long oral prep (good for old and frail but can miss smaller cancers)

Colon capsule (research tool)

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18
Q

Definition of diarrhoea

A

Passage of 3 or more loose stools in 24 hours

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19
Q

Definition of dysentery

A

Presence of blood/mucus in stools

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20
Q

What are the four mechanisms of diarrhoea and examples of each

A

Osmotic (lactose intolerance, osmotic laxatives e.g. lactulose)

Malabsorption (pancreatic insufficiency, Crohn’s, Coeliac)

Motility (post vagotomy, IBS, carcinoid)

Secretory

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21
Q

Blood tests to investigate diarrhoea

A

FBC, CRP, thyroid function, coeliac serology

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22
Q

Investigations for acute presentation of suspected IBD

A

Bloods: FBC, CRP, U&Es, LFT

Stool culture and microscopy

Barium x-ray

Flexible sigmoidoscopy (colonoscopy dangerous to do if acute flare)

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23
Q

Treatment for severe first presentation of UC

A

ANTICOAGULATION (risk of DVT)

IV steroids (hydrocortisone or methylprednisolone)

Assess at day 3 (stool sample, CRP, albumin)

Continue if responding

IV infliximab or cyclosporine if no response

Surgery if no response

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24
Q

Coeliac testing

A

TTG antibodies and IgG (some patients are IgA deficient, and TTG ab is a type of IgA)

OGD and duodenal biopsy (villous atrophy)

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25
Q

Causes of lower GI bleeding (categorised)

A

Anatomical: diverticular disease (most common), haemorrhoids, anal fissures

Vascular: angiodysplasia; acute mesenteric ischaemia (ischaemic colitis)

Neoplasmic: polyps, colorectal carcinoma

Inflammatory: IBD, infective

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26
Q

Most common area for diverticuli

A

sigmoid

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27
Q

Diverticular disease diagnosis

A

Colonoscopy
CT cologram
Abdo CT with contrast (identify inflammation and abscesses)
Barium enema

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28
Q

Diverticular disease treatment

A

Increased dietary fibre intake
Mild attacks of diverticulitis with abx
Hinchey IV with faecal peritonitis will require surgical resection and stoma

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29
Q

Angiodysplasia pathophysiology and presentation

A

AVM usually in proximal colon

Episodic painless bleeding and usually self-limiting

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30
Q

What is Heyde’s syndrome

A

Angiodysplasia associated with aortic stenosis

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31
Q

Acute mesenteric ischaemia presentation

A

Severe pain out of proportion of clinical signs
Bleeding less common
Associated with AF –> emboli has migrated to bowel

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32
Q

Genetic conditions causing polyps

A

Familial adenomatous polyposis (FAP), Hereditary nonpolyposis colorectal cancer (HNPCC)

High risk of malignancy - surgical removal of polyps required

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33
Q

Where is mesenteric ischaemia most likely to occur?

A

Watershed areas such as splenic flexure in the at the borders of territories supplied by superior and inferior mesenteric artery

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34
Q

Infective causes of dysentery

A

E.coli, shigella, campylobacter entamoeba

Low volume bloody diarrhoea and abdo pain

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35
Q

E.coli 0157 presentation

A

HUS

Haemolytic anaemia
AKI
thrombocytopaenia

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36
Q

Investigations for lower GI bleeding

A

Bedside: BP, BM, faecal calprotectin, stool sample, ECG

Bloods: CROSS MATCH

Imaging: erect CXR for air under the diaphragm (perforation), CT/CTA to assess cause and site

Special: flexible sigmoidoscopy (younger patients), colonoscopy (malignancy), upper GI endoscopy, angiographic transaterial embolisation (control massive bleeding)

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37
Q

Management of massive lower GI bleeding

A

ABC resuscitation: two wide bore cannulae, IV saline, bloods (clotting, cross match), possible early blood transfusion, regular monitoring, involve seniors

Localisation: imaging and endoscopy (upper and lower)

Intervention: colonoscopy if stable, coagulation (vasoconstrictors or sclerosing agents), angiography (if colonoscopy is unsuccessful or CI)

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38
Q

When would you put a patient with occult bleeding on 2 week wait?

A

> 40 unexplained weight loss and abdominal pain

> 50 unexplained rectal bleeding

> 60 iron deficiency anaemia or change in bowel habit

Rectal/abdominal mass

<50 rectal bleeding and unexplained symptoms (e.g. weight loss, pain, anaemia)

Unexplained IDA in men or post-menopausal women

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39
Q

When should you stop iron tablets prior to endoscopic investigations?

A

7 days prior

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40
Q

What is the cell type characteristically seen in iron deficiency anaemia?

Inherited haemolytic anaemia?

A

IDA: pencil cells

Haemolytic: spherocytes

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41
Q

Management of HUS

A

IV fluids
Electrolyte correction
AKI management

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42
Q

Investigation to carry out should a cause of IDA not be found in LGI tract

A

Capsule endoscopy (small bowel)

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43
Q

Investigations and treatment for acute mesenteric ischaemia

A

Erect CXR (perforation and ‘thumbprinting’)

CTA and MRA

IV fluids, NG decompression, anticoagulation

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44
Q

Causes of upper GI bleeds (according to anatomical location)

A

Oesophagus: varices, malignancy, oesophagitis

Gastric: ULCERS, Mallory-Weiss tear, gastritis, malignancy

Duodenal: ulcers, diverticulae, aortoduodenal fistulae

Other: aspirin, NSAIDs

Dieluafoy’s lesion (abnormal diameter of blood vessels), Osler-Weber-Rendu Syndrome (epistaxis and GI bleeds), gastric antral vascular ectasia (watermelon stomach)

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45
Q

Initial investigation for upper GI bleed

A

Upper GI endoscopy immediately following resus if unstable (within 24 hours for others)

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46
Q

Why might urea be raised in a patient with UGI bleeding?

A

Digested blood

Hypovolaemic so renin system activated which causes reabsorption of salt, water and urea

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47
Q

Imaging in UGI bleed

A

Erect CXR: perforation (air under diaphragm)

USS/CT depending on aetiology

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48
Q

What scoring systems can you use for GI bleeding

A

Blatchford (initial assessment)

Rockall (pre and post endoscopy)

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49
Q

Treatment of non-variceal upper GI bleeding

A

Endoscopic: mechanical (e.g. clipping) +/- adrenaline; thermal coagulation + adrenaline

Medical: PPIs (should be post-scope if evidence of recent haemorrhage)

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50
Q

Treatment of variceal bleeding of upper GI bleeding

A

Endoscopic: band ligation

Medical: terlipressin (vasoconstricting and reduces portal pressure), prophylactic abx (risk of spontaneous bacterial peritonitis)

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51
Q

Student after night out presenting with vomiting with small amounts of blood following bouts of retching

A

Mallory-Weiss tear

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52
Q

How do NSAIDs cause GI bleeds

A

Inhibit COX-1

Increased production of prostaglandins –> increased histamine –> increased HCl production from parietal cells

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53
Q

Two types of oesophageal cancer and who is most likely to get them?

A

Squamous cell carcinoma (upper 2/3): smoker/alcohol

Adenocarcinoma (lower 2/3): hx of GORD leading to columnar metaplasia (Barret’s oesophagus)

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54
Q

Definition of chronic liver disease

A

Progressive liver dysfunction over >6 months

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55
Q

What are the complications of decompensated liver disease?

A

Coagulopathy (reduced clotting factor synthesis)

Jaundice (impaired bilirubin breakdown)

Ascites (poor albumin synthesis and increased portal pressure due to scarring)

Encephalopathy

GI bleeding (increased portal pressure leading to varices)

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56
Q

Score used for chronic liver disease and what factors does it consider?

A

Child-Pugh score

Albumin, INR, Bilirubin, encephalopathy, ascites

Class A-C

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57
Q

Which patients would you perform a liver biopsy in?

A

Liver disease with unknown cause

Differentiating between chronic and acute or fibrosis and cirrhosis

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58
Q

What vitamins and minerals are stored in the liver?

A

Vitamin D

B12 (nerve function and RBC production)

A (retina)

copper

iron

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59
Q

Breakdown product of RBC

A

Haem –> bilirubin –> conjugated in liver –> excreted in bile

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60
Q

What are kupffer cells used for?

A

Phagocytosis to fight infection and breakdown RBCs in the liver

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61
Q

Causes of acute hepatitis

A

Viral

alcohol

drugs

toxins

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62
Q

Types of cholestasis

A

Intrahepatic (inflammation within hepatocytes, PBC, drugs, pregnancy)

Extrahepatic: stones, carcinoma of head of pancreas, sclerosing cholangitis, portal hepatic LN metastases

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63
Q

What LFTS will be deranged cholestatic liver disease?

A

ELEVATION in ALP, GGT +/- bilirubin (if obstructed bile duct)

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64
Q

Causes of cirrhosis

A

Chronic alcohol excess

Persistent Hep B and C

Autoimmune

Inherited metabolic (haemochromatosis, A1AT deficiency, Wilson’s)

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65
Q

Deranged LFTs in cirrhosis

A

Synthetic function affected

Hypoalbuminaemia, prolonged PT

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66
Q

Where is AST found

A

Liver

Cardiac muscle

Skeletal muscle (elderly following fall will have raised AST)

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67
Q

How do you distinguish between raised AST in liver and skeletal muscle

A

Creatine Kinase

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68
Q

Is AST or ALT more specific?

A

ALT (mostly found in liver)

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69
Q

How can you work out where alkaline phosphatase is coming from?

A

Gamma GT done also (will be raised if liver problem)

70
Q

Causes of raised alkaline phosphatase in the bone??

A

Osteomalacia (Vit D deficiency)

Paget’s

Malignancy

71
Q

What drugs cause GGT to increase?

A

Anticonvulsants (CBZ, phenytoin, phenobarb)

Warfarin

Oral contraceptive

72
Q

Gilbert’s disease cause

A

Lacking enzyme to conjugate bilirubin

73
Q

Cause of raised unconjugated bilirubin

A

Haemolysis:

Sickle cell, thalassemia, spherocytosis, malaria

74
Q

What level of bilirubin would you expect clinical jaundice?

A

> 50umol/L

75
Q

What drugs can cause liver damage?

A

TB drugs

paracetamol

statins

macrolides

tetracylines

fluclox/amox

HERBAL (St Johns Wart)

76
Q

How is bilirubin excreted normally? What happens in liver disease?

A

Stercobilinogen and urobilinogen via bowel

In liver disease –> excreted via kidney

77
Q

Causes of isolated raised GGT?

A

Enzyme-induced (warfarin, OCP)

Alcohol

78
Q

Cause of hepatic encephalopathy?

A

Increased ammonia as liver is not converting it to urea

79
Q

Why might ALT not be particularly high in cirrhosis?

A

ALT comes from hepatocytes, but in cirrhosis there is a loss of hepatocytes –> ALT can sometimes go down as a result

80
Q

Causes of raised ALP and GGT?

A

Cholestasis

81
Q

Cause of raised globulins?

What other tests would you do?

A

Autoimmune disease

Also do Anti-mitochondrial and smooth muscle ABs

82
Q

What antibody is raised in PBC?

A

Anti mitochondrial antibodies

83
Q

Why is urine dark in cholestatic liver disease?

A

Bilirubin excreted in urine

84
Q

Blood investigation for pancreatic cancer?

85
Q

Chronic hepatitis - what LFT is raised?

A

Isolated raised ALT

86
Q

Investigations for Wilson’s? Treatment?

A

Caeruloplasmin (low)
24 hour urinary copper (high)
serum copper (low)

Tx: penicillamine

87
Q

Budd Chiari Triad

A

Abdominal pain
Hepatomegaly
Ascites

Blockage of hepatic veins

88
Q

Diagnosis and management of H pylori

A

Rapid urease test (CLO)

PPI + amoxicillin/metronidazole + clarithromycin

89
Q

What is haemochromatosis and how does it present?

A

Autosomal recessive condition leading to accumulation of iron

Often unspecific: lethargy, arthralgia

Chronic liver disease, cardiac failure (dilated cardiomyopathy), bronzing of skin, hypogonadism, erectile dysfunction, DM

90
Q

Acute isolated raised ALT >1000U/L associated with AKI?

A

Ischaemic hepatitis

91
Q

What type of pain would you get with gallstones?

A

Collicky following eating

92
Q

What other infection risk is there in IVDU with Hep B?

Diagnosis and management?

A

Hep D (superinfection if following hep B, coinfection if same time)

Dx: reverse polymerase chain reaction of Hep D

Mx: interferon

93
Q

How does carcinoid syndrome present?

Investigation and management?

A

Flushing, bronchospasm, diarrhoea, hypotension, right heart valve stenosis

Ix: urinary 5-HIAA, plasma chromogranin A y

94
Q

Management of carcinoid syndrome?

A

Somatostatin analogues

95
Q

How does Wilsons often present?

A

Liver disease (raised ALT, hepatomegaly, jaundice)

Neuropsych symptoms: change in personality, dementia, Parkinsonism

96
Q

How long must you be eating gluten before TTG and IgA tests?

97
Q

Biopsy finding in oesophageal cancer associated with Barret’s/GORD?

A

Adenocarcinoma

98
Q

What is a pharyngeal pouch and what investigation would you do?

A

Outpouching at C5/C6

Barium swallow

99
Q

Most common bacterial cause of spontaneous bacterial peritonitis?

100
Q

Diagnosis and management of SBP?

A

Ascitic paracentesis: raised neutrophils

Management: IV CEFOTAXIME

101
Q

Who should you give SBP prophylactic abx to?

A

> 9 Child-Pugh score

Ascitic fluid protein <15g/L

102
Q

What cancer is associated with achalasia?

A

Squamous cell carcinoma of oesophagus

103
Q

Investigation and appearance for achalasia?

A

Barium swallow

Bird beak appearance

104
Q

low MCV and relatively preserved Hb?

A

Thalassaemia

105
Q

Why do you get a dimorphic blood film in Coeliac disease?

A

Affects absorption in upper tract, so less iron and folate absorbed

Iron-deficient cells are small, folate deficient cells are big

106
Q

Abdo x-ray showing speckled calcification in midline with pale, offensive stool and long-term abdo pain - likely diagnosis?

A

Chronic pancreatitis

107
Q

Investigations and findings in Crohn’s

A

CRP

Colonoscopy: deep ulcers and skip lesions

Histology: goblet cells, granulomas, inflammation from mucosa to serosa

Barium enema: fistulae, strictures ‘Kantor’s string sign’, proximal bowel dilation

108
Q

Brown speckled appearance in colonic mucosa? What is a result of?

A

Melanosis coli

Due to laxative use

109
Q

Crohn’s patient with lower right sided abdominal pain relieved on flexion of hip

A

Psoas abscess (lying on psoas muscle)

110
Q

Diagnostic test for acute pancreatitis

A

Amylase (at least 3x upper limit)

111
Q

Painless jaundice with hard to flush pale stools - likely diagnosis?

A

Pancreatic cancer

112
Q

Ascending cholangitis triad

A

Fever/rigors
RUQ pain
Jaundice

113
Q

What is Murphy’s sign and when might it be positive

A

Arrest of inspiration on palpation of RUQ

Acute cholecystitis

114
Q

What is a gallstone ileus

A

Obstruction of small bowel secondary to gallstone

Fistula can develop between gallbladder and duodenum

115
Q

Cause of pseudomembranous colitis (both drug and bacteria it promotes)?

Management?

A

CLINDAMYCIN, PPIs, Cephalosporins (ceftriaxone) –> C.difficile

1st: metronidazole
2nd: vancomycin
Combination if life-threatening

116
Q

First-line treatment of mild-mod UC?

A

Topical/oral mesalazine (high-dose oral if extensive left-sided

Add oral prednisolone if not

117
Q

firm, smooth, tender and pulsatile liver edge

A

Right-sided heart failure

118
Q

What change in electrolyte can a PPI cause?

A

Hyponatraemia

119
Q

Indicators of severe UC flare?

A

6 loose stools per day/bloody stools + one of:

> 90bpm
<105 Hb
Temp >37.8
ESR >30

120
Q

Which TB drug can cause peripheral neuropathy and why?

A

Isoniazid - causes B6 deficiency

Prescribe pyridoxine hydrochloride to prevent

121
Q

Treatment of hepatic encephalopathy?

A

Lactulose (inhibits ammonia production by intestine)

2nd: oral rifaximim

122
Q

Management of Barrets oesophagus

A

High dose PPI
Endoscopic surveillance every 3-5 years (if metaplasia)

If dysplasia:
Endoscopic mucosal resection
Radiofrequency ablation

123
Q

sunburn-like dermatitis rash, diarrhoea and cognitive deficit (dementia/delusion)

A

Pellagra (B3 deficiency)

124
Q

Treatment of acute alcoholic hepatitis

A

Oral prednisolone

125
Q

Investigation for primary sclerosing cholangitis? What antibody may be present?

A

Magnetic resonance cholangiopancreatography

pANCA

126
Q

What vaccine must be given to Coeliac patients?

A

Pneumococcal every 5 years

127
Q

Treatment of UC if severe relapse or 2 exacerbations in past year?

A

oral azathioprine or mercaptopurine

128
Q

Hyperparathyroidism and duodenal ulcers - likely diagnosis and treatment?

A

MEN I

High dose PPI for ulcers

129
Q

severe, colicky post-prandial abdominal pain, weight loss, and an abdominal bruit

A

Chronic mesenteric ischaemia/intestinal angina

130
Q

Most sensitive blood test for cirrhosis

A

Platelets (thrombocytopaenia)

131
Q

One unit of alcohol?

A

25ml single measure of spirits (ABV 40%)
a third of a pint of beer (ABV 5 to 6%)
half a 175ml ‘standard’ glass of red wine (ABV 12%)

132
Q

AST (<500) greater than ALT (<300), raised GGT

A

Alcoholic hepatitis

133
Q

Management of variceal bleed

A

Two large bore cannulae

Blood transfusion <70 Hb

Terlipressin

IV ABx

134
Q

Haemochromatosis treatment?

A

Venesection

135
Q

Antinuclear or smooth muscle antibodies

A

Autoimmune hepatitis

136
Q

Patient with UC and isolated raised ALP - what is likely diagnosis?

A

Primary sclerosing cholangitis

137
Q

How do you define dilatation of the bowel on x-ray?

A

Diameter (3s)
>3cm small intestine
>6cm large intestine
>9cm caecum

138
Q

What is considered in the True Love and Witts score for UC?

A

Bowel movements per day
Blood in stool

SEVERE
ESR >30
Pyrexia >37.8 
Anaemia 
Pulse >90
139
Q

Treatment of severe presentation of UC

A

IV steroids

IV ciclosporin if no change after 72 hours

140
Q

Raised antimitochondrial antibodies - likely diagnosis?

A

Primary Biliary Cirrhosis

141
Q

Management of AI hepatitis

A

Steroids +/- immunosuppressants e.g. azathioprine

142
Q

Features of AI hepatitis

A

FEMALE COMMON
Amenorrhoea
Chronic liver disease signs
Fever/jaundice

Biopsy: inflammation extending beyond limiting plate ‘piecemeal necrosis’

143
Q

Antibodies in AI hepatitis

A

Type 1: ANA and ASMA
Type 2: LKM1 (just kids)
Types 3: soluble liver-kidney antigen (middle-aged)

144
Q

GORD complications

A 
oesophagitis
ulcers
anaemia
benign strictures
Barrett's oesophagus
oesophageal carcinoma
145
Q

GORD treatment

A

High-dose PPI 1-2 months
Lower if response
Double dose for a month if no response

H2RA or prokinetic if endoscopically negative reflux

146
Q

Primary biliary cirrhosis Ms

A

anti-mitochondrial
Middle aged women
IgM

147
Q

Which drugs have a high risk of duodenal ulcers?

A

SSRIs
NSAIDs
steroids

148
Q

What is hepatorenal syndrome and how is it treated?

A

Vasodilation and underperfusion of kidneys

Treatment: terlipressin, albumin and TIPSS
Transplant definitive

149
Q

Mesalazine use and side effects

A

Used for mild-mod UC

SE: nausea, vomiting, diarrhoea, ACUTE PANCREATITIS

150
Q

Causes of liver decompensation in cirrhosis

A 
Constipation 
Infection 
Electrolyte imbalance 
Dehydration 
GI bleed 
Alcohol
151
Q

IgM chronic or acute?

152
Q

NAFLD LFTs

153
Q

Investigations and management following incidental finding of NAFLD

A

Enhanced liver fibrosis blood tests

FIB4/NAFLD score with FibroScan

Management: lifestyle changes, gastric-banding, insulin-sensitising drugs

154
Q

Non-tender hepatomegaly with hard, irregular liver edge

A

Metastatic cancer or primary hepatoma

155
Q

What is the Mackler triad for Booerhave syndrome?

A

Vomiting, subcutaneous emphysema, thoracic pain

MIDDLE AGED ALCOHOL
Severe vomiting –> oesophageal rupture

156
Q

Initial management of Crohn’s

A

Hydrocortisone (budesonide is alternative)

Enteral feeding

2nd line: 5-ASAs (mesalazine)

Add-on: azathioprine or methotrexate

Infliximab if refractory

157
Q

Treatment of isolated peri-anal Crohn’s

A

Metronidazole

158
Q

What is metoclopramide used for and when should you avoid it?

A

D2 antagonist, anti-emetic and prokinetic
Used for: nausea, GORD and gastroparesis

Avoid in: bowel obstruction
Extrapyramidal side effects

159
Q

4 grades of hepatic encephalopathy

A

I: irritability
II: confusion, inappropriate behaviour
III: incoherent, restless
IV: coma

160
Q

Plummer-Vinson syndrome triad?

A

Glossitis
Dysphagia
Iron-deficiency anaemia

+/- chialitis

161
Q

Cancers most commonly associated with hereditary non-polyposis colorectal cancer

A

Colorectal

Endometrial

162
Q

What symptoms warrant urgent referral for endoscopy?

A

Dysphagia

Upper abdo mass

> 55 with weight loss + dyspepsia, upper abdo pain or reflux

163
Q

What symptoms warrant NON-urgent referral for endoscopy?

A

Haematemesis

Treatment-resistant dyspepsia

Upper abdo pain with low Hb

Raised platelet with abdo symptoms

164
Q

Hx of AF, lactic acidosis, raised WCC and abdominal pain?

A

Acute mesenteric ischaemia

165
Q

Cause of pigmentation of bowel mucosa and pigment-laden macrophages within the mucosa on PAS staining

A

Laxative abuse leading to melanosis coli

166
Q

What is Rovsing’s sign

A

Palpation of LIF leads to referred pain in RIF due to appendicitis

167
Q

How does the oral contraceptive pill cause cholestasis?

A

Oestrogens prevent the release of bile acids and conjugated bilirubin leading to a build up and diffusion into blood stream

INTRA-HEPATIC JAUNDICE

168
Q

Iron deficiency anaemia following FBC - what’s next investigation

A

Ferritin (IDA if <15mcg/L)

Total iron binding capacity, iron or transferrin if co-existing malignancy, liver disease or hyperthyroidism as can taint findings

169
Q

What is the double duct signs and what is it associated with

A

Dilatation of pancreatic and common bile ducts

Pancreatic cancer

170
Q

What blood test is used to measure hepatocellular carcinoma recurrence?

A

Alfa fetoprotein (produced by regenerating liver cells)

171
Q

Conditions associated with gallstones

A

Oral contraceptive
Sudden weight loss
Crohn’s (ileitis leading to reduced absorption of bile salts)
Diabetes

Phase 3b (18 decks)

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