Gastroenterology Flashcards
What is Charcot’s triad?
RUQ pain, fever, jaundice
What is Charcot’s triad a sign of?
Ascending cholangitis
What are some underlying causes of ascending cholangitis?
Gallstones, benign biliary stricture, malignancy
What are the symptoms and signs of a perforated peptic ulcer?
Worse in the mornings, relieved by foods, pale, rigid abdomen, absent bowel sounds, hypotension
What are the signs of Gilbert’s syndrome?
Yellow sclera, high levels of unconjugated bilirubin
What are the signs of liver cirrhosis?
Vomiting blood, palmar erythema, swollen face
What is the intervention for liver cirrhosis?
Terlipressin, broad-spectrum abx as prophylaxis
What are some signs of UC?
Bloody diarrhoea, raised inflammatory markers, inflammation of rectum and distal colon
What is the management for UC?
Mesalazine suppository (topical rectal aminosalicylate)
What are the symptoms of PBC?
Pruritus, jaundice, lethargy
What is a complication of UC?
PSC - diagnose with MRCP
How do you diagnose and manage a H. pylori peptic ulcer?
Rapid urease test
Metronidazole, clarithromycin and omeprazole for 7 days (triple therapy)
What are the signs and symptoms of Crohn’s disease?
Weight loss, right-sided abdominal pain, fever, anorexia, aphthous ulcers, perinatal fistula, skin tags
Palpable mass, abdominal tenderness on right side
What are the extra-intestinal features of Crohn’s?
Clubbing, episceritis, iritis, erythema nodosum, pyoderma gangrenosum, renal stones
What investigations can be done to diagnose Crohn’s?
Bloods: anaemia, raised CRP, raised WCC, faecal calprotectin
Colonoscopy with biopsy, then MRI small bowel
What features are seen on histology with Crohn’s?
Cobblestone, granuloma, rose thorn ulcer, strictures, fistulae, skip lesions
What is the biggest risk of a trans jugular intrahepatic portosystemic triad (TIPSS)?
Used in liver cirrhosis, shunt between portal and hepatic vein
There is less breakdown of ammonia = hepatic encephalopathy
Define hereditary haemochromatosis
Disorder of iron metabolism, iron accumulates in liver, heart, joints, pituitary, pancreas and skin
What are the features of hereditary haemochromatosis?
Grey colour skin discolouration, scans in antecubital fossa (venesection), marks on fingertips, joint swelling
What is the medicinal long-term intervention for variceal bleeds?
Propanolol - decreases portal BP
What are the features of chronic liver disease?
Spider naevi, palmar erythema, clubbing, leuconychia, Dupuytren’s contracture, xanthelasma, gynaecomastia, atrophic testes, parotid enlargement, loss of body hair, hepatomegaly
What are the risks associated with Vitamin D deficiency?
Exacerbates osteopenia, osteoporosis and fractures in adults
Increased risk of cancer, AI diseases, HTN and infectious diseases
Contributes to malabsorption, CLD and CKD
What is the next step if H. pylori comes back positive?
7 day triple therapy, re-test for H. pylori after 4-8 weeks. If still positive, another course of triple therapy
What is the next step if H. pylori comes back negative?
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
How do you investigate for pernicious anaemia?
Check for anti-IF antibodies
What are the causes of B12 deficiency?
Pernicious anaemia, chronic severe atrophic gastritis, pancreatic insufficiency, TI resection, Crohn’s disease, TB, metformin, Zollinger-Ellison syndrome
What are the Hb features of B12 deficiency?
Low Hb, high MCV, high MCH, normal MCHC, large, oval shaped RBC, low B12, low folic acid, low reticulocyte, anti-IF antibodies
What is the management for B12 deficiency?
Cobalamin
What diseases can E. coli cause?
Haemolytic uraemia syndrome -> haemolytic anaemia, AKI, thrombocytopenia, fever, malaise, low platelets, bloody diarrhoea
What is the treatment for E. coli?
Largely supportive, dialysis, platelet transfusion if indicated
What are the signs of colorectal malignancy?
Anaemia -> fatigue, palpitations, angular stomatitis, conjunctival pallor, wt loss, change in bowel habit, koilonychia, glossitis, tachycardia, SOB, weakness, chest pain, dizziness
2WW
What are the signs of spontaneous bacterial peritonitis?
Occurs in liver cirrhosis
Abdo swelling, pain, fever, jaundice, shifting dullness, ascites
What is the management for SBP?
Tazocin, Human Albumin Solution
What is SAAG?
Serum ascites albumin gradient
Determines cause of ascites
What are the causes of a high SAAG?
High portal pressure, pushes fluid into the peritoneum, albumin stays in vessels
Cirrhosis, HF, Budd-Chiari syndrome, constrictive pericarditis, hepatic failure
What are the causes of a low SAAG?
Peritoneal cancer, TB, pancreatitis, nephrotic syndrome
What are the symptoms of UC?
Diarrhoea w/ bloody mucus, tenesmus/urgency, LIF pain, wt loss, fever
What are the extra-intestinal features of UC?
Erythema nodosum, pyoderma gangrenosum, episcleritis, conjunctivitis, clubbing, sacroiliitis, PSC, aa amyloidosis
What are the investigations for UC?
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
What is the treatment for UC?
Topical/oral ASA, oral prednisolone
If acute severe: perforation, toxic megacolon, high dose IV steroids, if worsens, IV cyclosporin and surgery
What is the marker for hepatocellular carcinoma?
alpha-fetoprotein
What are the RFs for hepatocellular carcinoma?
Hep B/C, cirrhosis, NASH, PBC, inherited metabolic disease, alcohol misuse, obesity, T2DM, Wilson’s disease, alpha-1 antitrypsin
What are the investigations for hepatocellular carcinoma?
Bloods: FBC, U&Es, CRP, LFT, AFT, liver screen, abdo USS, CT CAP
What is the management for management?
Hepatic resection, liver transplant, radiofrequency ablation
How do you manage an upper GI bleed?
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
What are the contraindications for an ascitic tap?
Bleeding from gums, increased d-dimer, decreased fibrinogen, DIC
Be wary if: pregnant, organomegaly, adhesion and infection
What is the management for Barrett’s oesophagus?
Low-grade dysplasia: high dose PPI + 6 monthly endoscopy
High-grade dysplasia: endoscopic ablation
What symptoms does GI malabsorption lead to?
Steatorrhoea, diarrhoea, weight loss
What is the treatment for ascites due to NASH?
Spironolactone
What is the marker for paracetamol overdose?
PT time/INR (clotting ability)
What are the symptoms of coeliac disease?
Abdo pain, distension, N&V, diarrhoea, steatorrhoea, wt loss, pallor, deficiency symptoms, dermatitis herpetiformis
What investigations are indicative for a liver transplant?
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
What is the investigation for coeliac disease?
anti-TTG IgA Ab, then anti-TTG IgG Ab, FBC, U&Es, bone profile, LFTs, stool culture, OGD after +ve serological testing
What are the causes of erythema nodosum?
NODOSUM
NO cause, Drugs (sulphonamides, dapsone), OCP, Sarcoidosis, UC/Crohn’s, Micro (TB etc)
What are contraindications for calcium channel blockers?
hiatus hernia, relaxes oesophageal sphincter, increased reflux
What are the signs and symptoms of IBS?
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
What are the symptoms of chronic pancreatitis?
Pain worse after fatty food, relieved by sitting forward, flatulent dyspepsia, malabsorption, abdo x-ray shows pancreatic calcification
What indicates a 2WW for upper GI endoscopy?
New onset dyspepsia, wt loss, over 55, anaemia, anorexia, melaena, dysphagia
What is the management for dermatitis herpetiformis for coeliac disease?
Dapsone antibiotic
What drugs caused drug-induced cholestasis?
Co-amox, fluclox, nitrofurantoin, steroids, sulponylurea, prochlorperazine, chlorpromazine
What are the complications of coeliac disease?
Small bowel lymphoma, adenocarcinoma
Osteoporosis and osteopenia
Functional hyposplenism
What is the presentation of a strangulated femoral hernia?
Female, raised intra-abdominal pressure, vomiting, obstipation, abdo distension pain, inferior and lateral to pubic tubercle, irreducible
Why does pancreatic cancer cause raised INR?
Fat malabsorption, less vitamin ADEK, vit K deficiency = increased INR
What are the drug causes of acute pancreatitis?
FAT SHEEP
furosemide, azathioprine, thiazides/tetracycline, statins/sulphonamides/sodium valproate, hydrochlorothiazide, estrogen, ethanol, protease inhibitors & NRTIs
What triple therapy is given when pt is allergic to penicillin?
PPI, bismuth, metronidazole, tetracycline
What is the indication is there is swinging fevers after treating gallstones?
Empyema
What are the signs, symptoms, RFs and investigations for pancreatic cancer?
Epigastric pain, worse on lying down, relieved by sitting forwards, FLAWS
RFs: chronic pancreatitis
CA 19-9, abdo ISS, then endoscopic USS/CT
What is the management for perianal abscess?
Pain and swelling, low grade fever, tachycardia
Needs early drainage under LA, less spread of infection leads to less risk of sepsis
What is the management for acute cholecystitis?
Laproscopic cholecystectomy within 1 week
What is the first-line investigation for H. pylori
Carbon-13 urea breath test
What is seen in contrast enema in diverticulitis?
Multiple outpourings of sigmoid colon
What are the symptoms of hypercalcaemia?
Constipation, anorexia, N&V, abdo pain, polyuria/dipsia, confusion
What medication is given during alcohol withdrawal?
Chlordiazepoxide and Pabrinex
What investigation for Crohn’s is done after colonoscopy?
MRI small bowel
What are the risk factors for mesenteric ischaemia?
AF, CVD, leads to shock, N&V, needs an urgent CT
What are the RFs for oesophageal adenocarcinoma?
Barrett’s oesophagus, male, smoker, over 50
What is a serious complication of acute pancreatitis?
ARDS - diffuse alveolar damage with hyaline membrane formation, pulmonary oedema, decreasing O2 sats that don’t increase with O2
What is the management for a medium/large varices?
Endoscopic band ligation and repeat endoscopy in one year or non-selective B blocker (not in asthma pts)
What are the features of a femoral hernia and management?
Inferior to inguinal ligament, inferior and lateral to pubic tubercle, irreducible
Urgent surgical referral, increased risk of strangulation
