Gastroenterology - ASM Flashcards
What electrolyte imbalances can cause constipation?
Hypocalcaemia
Hypokalaemia
What endocrine cause can cause constipation
Hypothyroidism
Commonest age for IBS
20-30 y/o
Pathophysiology of achalasia
Degeneration of myenteric plexus causing reduced peristalsis in esophagus causing inability to relax lower esophageal sphincter
How to test for H pylori?
Breath carbon urea testing or antigen stool test
Erradication therapy for HPylori?
7 day, BD course of
1) PPI
2) amoxicillin
3) clarithromycin or metronidazole
What to do with PPI if someone needs OGD for peptic ulcer disease investigation?
Stop PPI 2 weeks before
Which type of hiatus hernia should always be treated surgically?
Rolling hiatus hernia, due to risk of strangulation
Management for GORD?
Full dose ppi for 1-2 months - 30mg lansoprazole/omeprazole OD
If no response - double dose BD
If no response - add H2RA (ranitidine 300mg nocte)
Pathophysiology of GORD
LOS dysfunction causing reflux of gastric contents into oesophagus causing oesophagitis.
Differentials for rectal bleeding
Diverticular disease Rectal haemorrhoids Infection - bacterial gastroenteritis Polyps Inflammation - UC & Crohns Neoplasia Gastric upper bleeding Angio - ischaemic colitic,
Driping arse
What needs to be done in massive upper gi bleeding?
ABCDE approach
2x large bore cannulas 1L saline STAT G&S Terlipressin Antibiotics
Endoscopy -> PPI IV after, keep NBM24hrs
What causes dark urine and pale stools?
Hepatic or post-hepatic jaundice.
Conjugated + urobillinogen in urine - hepatic
Conjugated bilinogen in urine - post-hepatic
Pale stools - obstruction of bile duct, no stercobilin in stools
why does liver cirrhosis cause gynaecomastia?
cause the liver metabolises estrogen, when that fails, estrogen builds up causing gynacomastia,
what are signs of liver cirrhosis associated with estrogen build up
gynaecomastia, loss of secondary sexual hair, spider naevi, palmar erythema, hypogonadism,
what can be seen on LFTs in someone with liver cirrhosis
increased ALT and AST, decreased albumin
complications of liver cirrhosis
splenomegaly ascites variceals encephalopathy SBP HCC liver failure
what happens to serum glucose in liver failure/cirrhosis
hypoglycaemia
what FBC results indicate hypersplenism
decreased WCC and Platelets
how to investigate for SBP
ascitic tap looking for neutrophils (PMNs)
blood marker for HCC
AFP
why do U&Es in liver failure
look for hepatorenal syndrome
how to manage ascites in liver cirrhosis
fluids, spironolactone, salt restriction, frusemide, ascitic tap, daily weights
how to manage hepatorenal syndrome?
IV albumin + terlipressin, TIPS
in hepatitis B, markers of
1) immunity from vaccine w/o hx of infection
2) current infection
3) chronic infection
4) past resolved infection
1) Hepatitis B surface antibody without anything else
2) HBV DNA, HBSAg, Core IgM, Core IgG
3) HBV DNA, HBSAg, Core IgG
4) HBSAb, HBC IgG, HBEAb
symptoms of haemochromotosis
Iron MEALS
myocardial - dilated cardiomyopathy, arrythmias
endocrine - pituitary hypogonadism, hypoparathyroidism, pancreas: DM
Arthritis
Liver - CLD, hepatomegaly
Skin - grey color
what will serum caeruloplasmin be in Wilson’s disease
low
Which IBD UC or Crohns is associated with skip lesions, crypt abscess, transmural lesions?
skip lesions = crohns
crypt absc = UC
transmural lesions = crohns
which IBD is more commonly associated with tenesmus?
UC
what eye conditions are associated with IBD
uveitis/iritis/conjunctivitis/episcleritis
which IBD is more associated with anal fistulae?
crohns
what skin/finger conditions are associated with IBD
clubbing, erythema nodosum, pyoderma gangrenosum
which IBD is associated with malabsorption
crohns
what bloods to check if suspecting coeliacs
FBC, LFTs, INR, VitD, bone panel, folate, serum b12
abs - anti-TTG IgA, Anti-endomysial IgA,
what might give a false-negative when investigating coeliacs disease
specific IgA deficiency
which cancer marker can be used if suspecting pancreatic cancer
ca19-9
name 3 symptoms found in carcinoid tumour
flushing diarrhea wheezing palpitations murmur hepatomegaly
what is a Sister Mary Joseph node
palpable painful umbilical lymph node associated with advanced metastatic cancer
what blood is important to do when suspecting mesenteric ischaemia?
lactate
what is SAAG used to determine? what values indicate what?
if ascites is caused by portal hypertension or not. if >11g/L than more likely to be caused by portal hypertension
cancer symptoms with background of coeliac disease - what condition?
enteropathy-associated T cell lymphoma
what electrolyte imbalance can PPIs cause?
hyponatraemia, hypomagnesaemia
which IBD is more associated with PSC?
UC
what investigation to use to check for H Pylori after erradication therapy?
urea breath test
which antibody should be tested if suspecting primary biliary cholangitis ?
AMA
what type of carcinoma is seen in barretts?
adenocarcinoma
what liver pathology is associated in young females with jaundice, tender hepatomegaly and secondary amenorrhea?
autoimmune hepatitis
what test to use to differentiate IBS from IBD?
faecal calprotectin
which type of antibiotic is most strongly linked to C diff?
cephalosporins and clindamycin
why might a young lady with no past medical history and not obese present with cholestasis?
COCP
what antibiotic is recommended for prophylaxis after SBP?
ciproflox
what is gallstone ileus
gallstone lodged in ileocaecal valve causing obstruction, background of gallstones. might see pneumobilia
what are two treatment options for preventing osfgeal varices bleeding?
propranalol and endoscopic banding
describe type 1 vs type 2 hepato-renal syndrome
type 1 = rapid decline (over days)
type 2 = takes longer, with refractory ascites
ECG sign seen in hypothermia?
J waves
2 causes of raised TLCO and KCO?
asthma and left-right cardiac shunt
