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Year 3 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is Charcot’s triad?

A

RUQ pain, fever, jaundice

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2
Q

What is Charcot’s triad a sign of?

A

Ascending cholangitis

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3
Q

What are some underlying causes of ascending cholangitis?

A

Gallstones, benign biliary stricture, malignancy

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4
Q

What are the symptoms and signs of a perforated peptic ulcer?

A

Worse in the mornings, relieved by foods, pale, rigid abdomen, absent bowel sounds, hypotension

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5
Q

What are the signs of Gilbert’s syndrome?

A

Yellow sclera, high levels of unconjugated bilirubin

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6
Q

What are the signs of liver cirrhosis?

A

Vomiting blood, palmar erythema, swollen face

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7
Q

What is the intervention for liver cirrhosis?

A

Terlipressin, broad-spectrum abx as prophylaxis

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8
Q

What are some signs of UC?

A

Bloody diarrhoea, raised inflammatory markers, inflammation of rectum and distal colon

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9
Q

What is the management for UC?

A

Mesalazine suppository (topical rectal aminosalicylate)

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10
Q

What are the symptoms of PBC?

A

Pruritus, jaundice, lethargy

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11
Q

What is a complication of UC?

A

PSC - diagnose with MRCP

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12
Q

How do you diagnose and manage a H. pylori peptic ulcer?

A

Rapid urease test

Metronidazole, clarithromycin and omeprazole for 7 days (triple therapy)

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13
Q

What are the signs and symptoms of Crohn’s disease?

A

Weight loss, right-sided abdominal pain, fever, anorexia, aphthous ulcers, perinatal fistula, skin tags
Palpable mass, abdominal tenderness on right side

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14
Q

What are the extra-intestinal features of Crohn’s?

A

Clubbing, episceritis, iritis, erythema nodosum, pyoderma gangrenosum, renal stones

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15
Q

What investigations can be done to diagnose Crohn’s?

A

Bloods: anaemia, raised CRP, raised WCC, faecal calprotectin

Colonoscopy with biopsy, then MRI small bowel

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16
Q

What features are seen on histology with Crohn’s?

A

Cobblestone, granuloma, rose thorn ulcer, strictures, fistulae, skip lesions

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17
Q

What is the biggest risk of a trans jugular intrahepatic portosystemic triad (TIPSS)?

A

Used in liver cirrhosis, shunt between portal and hepatic vein
There is less breakdown of ammonia = hepatic encephalopathy

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18
Q

Define hereditary haemochromatosis

A

Disorder of iron metabolism, iron accumulates in liver, heart, joints, pituitary, pancreas and skin

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19
Q

What are the features of hereditary haemochromatosis?

A

Grey colour skin discolouration, scans in antecubital fossa (venesection), marks on fingertips, joint swelling

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20
Q

What is the medicinal long-term intervention for variceal bleeds?

A

Propanolol - decreases portal BP

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21
Q

What are the features of chronic liver disease?

A

Spider naevi, palmar erythema, clubbing, leuconychia, Dupuytren’s contracture, xanthelasma, gynaecomastia, atrophic testes, parotid enlargement, loss of body hair, hepatomegaly

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22
Q

What are the risks associated with Vitamin D deficiency?

A

Exacerbates osteopenia, osteoporosis and fractures in adults
Increased risk of cancer, AI diseases, HTN and infectious diseases
Contributes to malabsorption, CLD and CKD

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23
Q

What is the next step if H. pylori comes back positive?

A

7 day triple therapy, re-test for H. pylori after 4-8 weeks. If still positive, another course of triple therapy

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24
Q

What is the next step if H. pylori comes back negative?

A

Repeat endoscopy in 6-8 weeks, check if ulcer is healing, see if biopsy shows benign disease
If its not healed: low dose PPI, lifestyle changes, check adherence, switch to histamine-receptor antagonist

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25
Q

How do you investigate for pernicious anaemia?

A

Check for anti-IF antibodies

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26
Q

What are the causes of B12 deficiency?

A

Pernicious anaemia, chronic severe atrophic gastritis, pancreatic insufficiency, TI resection, Crohn’s disease, TB, metformin, Zollinger-Ellison syndrome

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27
Q

What are the Hb features of B12 deficiency?

A

Low Hb, high MCV, high MCH, normal MCHC, large, oval shaped RBC, low B12, low folic acid, low reticulocyte, anti-IF antibodies

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28
Q

What is the management for B12 deficiency?

A

Cobalamin

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29
Q

What diseases can E. coli cause?

A

Haemolytic uraemia syndrome -> haemolytic anaemia, AKI, thrombocytopenia, fever, malaise, low platelets, bloody diarrhoea

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30
Q

What is the treatment for E. coli?

A

Largely supportive, dialysis, platelet transfusion if indicated

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31
Q

What are the signs of colorectal malignancy?

A

Anaemia -> fatigue, palpitations, angular stomatitis, conjunctival pallor, wt loss, change in bowel habit, koilonychia, glossitis, tachycardia, SOB, weakness, chest pain, dizziness
2WW

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32
Q

What are the signs of spontaneous bacterial peritonitis?

A

Occurs in liver cirrhosis

Abdo swelling, pain, fever, jaundice, shifting dullness, ascites

33
Q

What is the management for SBP?

A

Tazocin, Human Albumin Solution

34
Q

What is SAAG?

A

Serum ascites albumin gradient

Determines cause of ascites

35
Q

What are the causes of a high SAAG?

A

High portal pressure, pushes fluid into the peritoneum, albumin stays in vessels
Cirrhosis, HF, Budd-Chiari syndrome, constrictive pericarditis, hepatic failure

36
Q

What are the causes of a low SAAG?

A

Peritoneal cancer, TB, pancreatitis, nephrotic syndrome

37
Q

What are the symptoms of UC?

A

Diarrhoea w/ bloody mucus, tenesmus/urgency, LIF pain, wt loss, fever

38
Q

What are the extra-intestinal features of UC?

A

Erythema nodosum, pyoderma gangrenosum, episcleritis, conjunctivitis, clubbing, sacroiliitis, PSC, aa amyloidosis

39
Q

What are the investigations for UC?

A

Bloods: anaemia, high WCC, high ESR/CRP, low albumin stool culture - exclude infective endocarditis, high faecal calprotectin
Endoscopy: inflammation, erythematous mucosa, loss of haustra, pseudopolyps, less goblet cells, crypts, inflammatory cells, lead-piping
Abdo X-Ray: perforation, toxic megacolon

40
Q

What is the treatment for UC?

A

Topical/oral ASA, oral prednisolone

If acute severe: perforation, toxic megacolon, high dose IV steroids, if worsens, IV cyclosporin and surgery

41
Q

What is the marker for hepatocellular carcinoma?

A

alpha-fetoprotein

42
Q

What are the RFs for hepatocellular carcinoma?

A

Hep B/C, cirrhosis, NASH, PBC, inherited metabolic disease, alcohol misuse, obesity, T2DM, Wilson’s disease, alpha-1 antitrypsin

43
Q

What are the investigations for hepatocellular carcinoma?

A

Bloods: FBC, U&Es, CRP, LFT, AFT, liver screen, abdo USS, CT CAP

44
Q

What is the management for management?

A

Hepatic resection, liver transplant, radiofrequency ablation

45
Q

How do you manage an upper GI bleed?

A 
A-E assessment
IV fluid resus and blood transfusion
NBM, supplemental oxygen
IV PPI
variceal bleeding: IV terlipressin, lactulose and Abx
stable: upper GI endoscopy
46
Q

What are the contraindications for an ascitic tap?

A

Bleeding from gums, increased d-dimer, decreased fibrinogen, DIC
Be wary if: pregnant, organomegaly, adhesion and infection

47
Q

What is the management for Barrett’s oesophagus?

A

Low-grade dysplasia: high dose PPI + 6 monthly endoscopy

High-grade dysplasia: endoscopic ablation

48
Q

What symptoms does GI malabsorption lead to?

A

Steatorrhoea, diarrhoea, weight loss

49
Q

What is the treatment for ascites due to NASH?

A

Spironolactone

50
Q

What is the marker for paracetamol overdose?

A

PT time/INR (clotting ability)

51
Q

What are the symptoms of coeliac disease?

A

Abdo pain, distension, N&V, diarrhoea, steatorrhoea, wt loss, pallor, deficiency symptoms, dermatitis herpetiformis

52
Q

What investigations are indicative for a liver transplant?

A

PT time > 100s, drug-induced liver failure, aged under 10 or over 40, increased bilirubin, creatinine over 300, pH under 7.3 24hr after ingestion

53
Q

What is the investigation for coeliac disease?

A

anti-TTG IgA Ab, then anti-TTG IgG Ab, FBC, U&Es, bone profile, LFTs, stool culture, OGD after +ve serological testing

54
Q

What are the causes of erythema nodosum?

A

NODOSUM

NO cause, Drugs (sulphonamides, dapsone), OCP, Sarcoidosis, UC/Crohn’s, Micro (TB etc)

55
Q

What are contraindications for calcium channel blockers?

A

hiatus hernia, relaxes oesophageal sphincter, increased reflux

56
Q

What are the signs and symptoms of IBS?

A

Fever, abdo pain - relieved by defaecation, worse on eating, distension, nausea, vomiting, foul-smelling diarrhoea, weight loss, passage of mucus, lethargy, backache, bladder symptoms
Investigate with faecal calprotectin, should not be raised

57
Q

What are the symptoms of chronic pancreatitis?

A

Pain worse after fatty food, relieved by sitting forward, flatulent dyspepsia, malabsorption, abdo x-ray shows pancreatic calcification

58
Q

What indicates a 2WW for upper GI endoscopy?

A

New onset dyspepsia, wt loss, over 55, anaemia, anorexia, melaena, dysphagia

59
Q

What is the management for dermatitis herpetiformis for coeliac disease?

A

Dapsone antibiotic

60
Q

What drugs caused drug-induced cholestasis?

A

Co-amox, fluclox, nitrofurantoin, steroids, sulponylurea, prochlorperazine, chlorpromazine

61
Q

What are the complications of coeliac disease?

A

Small bowel lymphoma, adenocarcinoma
Osteoporosis and osteopenia
Functional hyposplenism

62
Q

What is the presentation of a strangulated femoral hernia?

A

Female, raised intra-abdominal pressure, vomiting, obstipation, abdo distension pain, inferior and lateral to pubic tubercle, irreducible

63
Q

Why does pancreatic cancer cause raised INR?

A

Fat malabsorption, less vitamin ADEK, vit K deficiency = increased INR

64
Q

What are the drug causes of acute pancreatitis?

A

FAT SHEEP
furosemide, azathioprine, thiazides/tetracycline, statins/sulphonamides/sodium valproate, hydrochlorothiazide, estrogen, ethanol, protease inhibitors & NRTIs

65
Q

What triple therapy is given when pt is allergic to penicillin?

A

PPI, bismuth, metronidazole, tetracycline

66
Q

What is the indication is there is swinging fevers after treating gallstones?

A

Empyema

67
Q

What are the signs, symptoms, RFs and investigations for pancreatic cancer?

A

Epigastric pain, worse on lying down, relieved by sitting forwards, FLAWS
RFs: chronic pancreatitis
CA 19-9, abdo ISS, then endoscopic USS/CT

68
Q

What is the management for perianal abscess?

A

Pain and swelling, low grade fever, tachycardia

Needs early drainage under LA, less spread of infection leads to less risk of sepsis

69
Q

What is the management for acute cholecystitis?

A

Laproscopic cholecystectomy within 1 week

70
Q

What is the first-line investigation for H. pylori

A

Carbon-13 urea breath test

71
Q

What is seen in contrast enema in diverticulitis?

A

Multiple outpourings of sigmoid colon

72
Q

What are the symptoms of hypercalcaemia?

A

Constipation, anorexia, N&V, abdo pain, polyuria/dipsia, confusion

73
Q

What medication is given during alcohol withdrawal?

A

Chlordiazepoxide and Pabrinex

74
Q

What investigation for Crohn’s is done after colonoscopy?

A

MRI small bowel

75
Q

What are the risk factors for mesenteric ischaemia?

A

AF, CVD, leads to shock, N&V, needs an urgent CT

76
Q

What are the RFs for oesophageal adenocarcinoma?

A

Barrett’s oesophagus, male, smoker, over 50

77
Q

What is a serious complication of acute pancreatitis?

A

ARDS - diffuse alveolar damage with hyaline membrane formation, pulmonary oedema, decreasing O2 sats that don’t increase with O2

78
Q

What is the management for a medium/large varices?

A

Endoscopic band ligation and repeat endoscopy in one year or non-selective B blocker (not in asthma pts)

79
Q

What are the features of a femoral hernia and management?

A

Inferior to inguinal ligament, inferior and lateral to pubic tubercle, irreducible
Urgent surgical referral, increased risk of strangulation

Year 3 (11 decks)

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