- flushing, diarrhoea and abdominal discomfort - urine 5-HIAA elevated - can cause pulmonary stenosis and tricuspid insufficiency

Gastroenterology Flashcards by Lauren Bradford

Spontaneous bacterial peritonitis

Requires long term antibiotic prophylaxis (ciprofloxacin)

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Intrinsic factor antibodies

Used to investigate vitamin B12 deficiency

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Plummer-Vinson syndrome

Triad of dysphagia, glossitis and iron-deficiency anaemia

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Pancreatic cancer

Painless jaundice

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Autoimmune hepatitis

Predominantly raised ALT/AST compared to ALP

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Ischemic colitis

Most commonly affects the splenic flexure

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Haemochromatosis

Raised transferrin saturation and ferritin with low TIBC

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Ulcerative colitis

Associated with primary sclerosing cholangitis

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C. difficile

First line with metronidazole then second line with oral vancomycin

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Coeliac disease

Total IgA and IgA tTG should be assessed

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Carcinoid syndrome

flushing, diarrhoea and abdominal discomfort
urine 5-HIAA elevated
can cause pulmonary stenosis and tricuspid insufficiency

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Achalasia

Dysphagia affecting both solids and liquids from the start

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Clindamycin

Treatment is associated with a high risk of C. diff so warn about diarrhoea

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Coeliac diseasse

Offered pneumococcal vaccine due to hyposplenism

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Cholestryamine

Used to treat bile-acid malabsorption

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Haemochromatosis

Early signs include fatigue, erectile dysfunction and arthralgia

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Ulcerative colitis

Lead pipe appearance to colon

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Double duct sign

Can indicate pancreatic cancer

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Hemochromatosis management

Fist line with venesection and second line with desferrioxamine

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Appendicectomy

Requires prophylactic IV antibiotics

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Wilson’s disease

A combination of liver and neurological disease that requires copper studies

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Rifaximin

Treatment of choice for small bowel bacterial overgrowth syndrome

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Isoniazid

Can cause vitamin B6 deficiency leading to peripheral neuropathy

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Spontaneous bacterial peritonitis

E. coli is the most common bacteria cultured from ascites tap

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Barrett's oesophagus

If dysplasia is seen then endoscopic intervention is needed

Autoimmune hepatitis

Associated with anti-nuclear and anti-smooth muscle antibodies

TPMT activity

Needs to be assessed before starting azathioprine or mercaptopurine in Crohn's disease

Appendicitis

Rovsing positive with raised inflammatory markers

Pharyngeal pouch

Treated with surgical repair

Alcoholic ketoacidosis

Metabolic ketoacidosis with a normal or low glucose

Coeliac disease

Anaemia, low ferritin and low folate levels

Globus pharyngis

Persistent sensation of lump in throat and difficulty swallowing own saliva

Upper GI bleed

- anaemia | - high urea levels

AFP

Can be a useful diagnostic marker for hepatocellular carcinoma

Paracentesis

Requires albumin cover to prevent post paracentesis circulatory dysfunction

Spironolactone

Used to manage ascites secondary to liver cirrhosis

Vitamin C deficiency

- gum bleeding - lethargy - aches and pain in joints - easy bruising

Urea breath test

Only recommended method for testing H.pylori eradication therapy

HBsAg

Used to screen for hepatitis B infection

H/pylori eradication

- PPI + amoxicillin + clarithromycin | - PPI + metronidazole + clarithromycin

COP

Can cause drug induced cholestasis

Severe UC flare

Treat in hospital with IV corticosteroids

Loperamide

A m-opioid receptor agonist that reduced gut motility

Mesenteric ischaemia

Triad of CVD, high lactate and soft but tender abdomen

Severe alcoholic hepatitis

Give corticosteroids

C.diff

Linked to clindamycin and cephalosporins such as ceftriaxone

Coeliac disease

Avoid - beer - rye - bread - pasta

Upper GI bleed

High urea levels

Primary biliary cholangitis

First line treatment is with ursodeoxycholic acid

HNPCC

- endometrial cancer - pancreatic and biliary tract - gastric - ovarian - bladder - renal

Terlipressin

Used in the management of variceal haemorrhage

Autoimmune hepatitis

Deranged LFTs and secondary amenorrhoea | -managed with steroids

Aldosterone antagonists

Given to patients with ascites secondary to liver cirrhosis

ERCP/MRCP

Can be used to image primary sclerosing cholangitis

Metaclopramide

Works by antagonism of the DR dopamine receptors

Barrett's oesophagus

Associated with adenocarcinoma

Wilson's disease

Treated with penicillamine

Zollinger-Ellison syndrome

- epigastric pain - diarrhoea - duodenal ulcers - MEN1

Mild ulcerative colitis flare

Rectal aminosalicylates such as mesalazine

Severe UC

Greater than 6 stools and systemic upset

SBP

Most commonly caused by E.coli

Hyponatraemia

PPIs can cause this

Hepatic encephalopathy

Grade 1: irritability Grade 2: confusion and inappropriate behaviour Grade 3: incoherent and restless Grade IV: coma

Biliary colic

- sharp RUQ pain - back and shoulder tip radiation - worse after eating

Metoclopramides

Avoid in bowel obstruction

Life threatening c.diff

Treat with oral vancomycin and Iv metronidazole

Gallstone ileus

Small bowel obstruction can occur secondary to impacted gallstones

Acute pancreatitis

Can be caused by ECRP

Liver cirrhosis scoring

- bilirubin - albumin - prothrombin time - encephalopathy - ascites

High SAAG gradient

Seen in liver cirrhosis due to portal hypertension

Liver cirrhosis

Investigated through transient elastography

uncomplicated c.diff

Give metronidazole

Related to PSC

Alcoholic ketoacidosis

Managed with IV saline and thiamine

PBC

- IgM - anti-mitochondrial antibodies - middle aged female