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AMC MCQ - You Can Do It!!!!!❤️❤️ > Gastroenterology by Dr Cintia > Flashcards

Gastroenterology by Dr Cintia Flashcards

1
Q

Diseases of the Small and Large Intestines

A
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2
Q

Crohn Dx CLINICAL FEATURES

A
  • Pain is more common, affects all colon except for rectum, skip lesions, transmural inflammation, causes fistulas, fissures, noncaseating granulomas, perianal disease.
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3
Q

Crohn Dx FIRST INVESTIGATION

A

-Stool sample faecal calprotectin (Neutrophil derived biomarker)
-CXR, AXR to see complications of peritonitis or toxic megacolon.

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4
Q

Crohn Dx BEST INVESTIGATION

A
  1. Biopsy (Cobblestone sign)
  2. MRI for perianal dx in Crohn.
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5
Q

Crohn Dx TREATMENT

A

1.Mild Crohn: Budesonide enteric- coated.
2.Diffuse Crohn: Oral Prednisolone.
3.Methotrexate
4.Azathioprine - Infliximab good for Crohn w/ perianal fistula

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6
Q

Ulcerative Colitis CLINICAL FEATURES

A
  • Bleeding is more common, only affects the mucosa, but all the colon with rectal involvement, loss of haustra, crypt abscesses and ulcers, can cause toxic megacolon, perforation, Assoc w Primary sclerosing cholangitis
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7
Q

Ulcerative Colitis BEST INVESTIGATION

A
  1. Biopsy
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8
Q

Ulcerative Colitis TREATMENT

A
  1. Mesalazine/Sulfasalazine (Rectal+Oral preparation)
  2. Add Steroids (Budesonide, hydrocortisone, prednisolone rectally.
  3. Add Steroids orally (Prednisolone) Methotrexate and sulfasalazine cause oligospermia. But sulfasalazine is safe
    to use in pregnancy and methotrexate not
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9
Q

syndrome diaphragmatic hernias

A
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10
Q

diaphragmatic hernia: Acquired

A
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11
Q

Congenital Malabsorption

A
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12
Q

Coeliac disease

A
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13
Q

Lactose intolerance

A
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14
Q

Diseases of the liver

A
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15
Q

Liver Function Test

A
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16
Q

Jaundice

A
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17
Q

drug-induced liver injury: Khat herbal leaves

A
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18
Q

Fatty liver (hepatic steatosis) Non-alcoholic fatty liver disease

A
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19
Q

Non-alcoholic steatohepatitis

A
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20
Q

Alcoholic hepatitis CLINICAL FEATURES

A
  • Marked neutrophilia, fever, hepatic pain, tenderness, encephalopathy
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21
Q

Alcoholic hepatitis FIRST INVESTIGATION

A
  • Inc AST>ALT, GGT
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22
Q

Alcoholic hepatitis TREATMENT

A

If encephalopathy->Prednisolone.
If CI (untreated inf)-> Oxpentifylline (CI in allergy to caffeine or theophylline)

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23
Q

alcoholic liver disease

A
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24
Q

Autoimmune hepatitis CLINICAL FEATURES

A
  • Cx by infliximab, nitrofurantoin, minocycline
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25
Q

Autoimmune hepatitis BEST INVESTIGATION

A

Abs:
- ANA (cheaper)
- SMA (Smooth muscle ab) - anti-LKM1 (anti liver kidney microsomes)-assoc w/poor response to tx

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26
Q

Autoimmune hepatitis TREATMENT

A

Prednisolone + Azathioprine

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27
Q

Haemochromatosis CLINICAL FEATURES

A

AR. Multiple symptoms.
Accumulate in pituitary (Libido, impotence with low FSH and LH), skin (dark skin), joint
(Polyarthritis), Pancreas (DM), Liver (Chronic hepatitis).
- MC Heart manifestation: CHF
- MCC death: Cirrhosis

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28
Q

Haemochromatosis FIRST INVESTIGATION

A
  1. Ion studies- Transferrin saturation>70% (Check transferrin and ferritin e/2y)
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29
Q

Haemochromatosis BEST INVESTIGATION

A
  1. HFE gene (C282Y gene- 80-90% pts in Oz are homozygous for this mutation). If Hets pts will not develop symptoms.
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30
Q

Haemochromatosis TREATMENT

A
  1. Serial venesection until ferritin is <50ugs. Maintenance venesection 3x/year to keep ferritin<100
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31
Q

Primary Biliary Cirrhosis FIRST INVESTIGATION

A

-AMA Abs (Antimitochondrial)

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32
Q

Primary Biliary Cirrhosis BEST INVESTIGATION

A

Biopsy. - Transient elastography to stage severity of dx

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33
Q

Primary Biliary Cirrhosis TREATMENT

A

Ursodeoxycholic acid for pruritus, LFTs and survival.

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34
Q

Wilson’s Dx CLINICAL FEATURES

A

AR. Confusion, dysarthria, wide based gate, acute change of personality + cirrhosis - Kayser Fleischer rings

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35
Q

Primary Sclerosing Cholangitis CLINICAL FEATURES

A

-Assoc w CU.
- stricturing in intra and extrahepatic bile ducts

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36
Q

Wilson’s Dx FIRST INVESTIGATION

A
  1. Serum Ceruloplasmin (low) and high 24 hour urinary copper excretion 2. Slip lamp examination (Kayser Fleisher rings)
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37
Q

Hepatitis B CLINICAL FEATURES

A

-30% likely to pass it if needle injury. Compared to 3% in HCV and 0.03% in HIV.
- Sex is MCC of transmission.
- If HBsAg>6 months: Chronic Hep B

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38
Q

Hepatitis B FIRST INVESTIGATION

A

-HBsAg: aCute, Chronic, Carrier.
-Anti-HbsAb: cleAred, vAccination.
-Anti-HBcIgM: Acute hep
-Anti-HBcIgG: Chronic, Carrier, Cleared
-HBeAg. Acute&Chronic

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39
Q

Hepatitis B TREATMENT

A

Chronic:
-Interferon weekly injs for 48w. Not in decompensated liver dx-Do Child Pugh Score)
-Entacavir, tenofovir: Once daily lifelong tx.

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40
Q

Hepatitis C CLINICAL FEATURES

A

-#1 cx: needle sharing.
-No vaccine available.
-Chronic (>6m).
-10-30% of pts develop Cirrhosis in 20yrs. Compared to HepB that goes to cirrhosis faster

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41
Q

Primary Sclerosing Cholangitis FIRST INVESTIGATION

A
  1. US/P-ANCA
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42
Q

Primary Sclerosing Cholangitis TREATMENT

A

Ursodeoxycholic acid also reduce risk of CRC.

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43
Q

Hepatitis C BEST INVESTIGATION

A

Liver biopsy looking for cirrhosis

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44
Q

Primary Sclerosing Cholangitis BEST INVESTIGATION

A

MRCP

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45
Q

Hepatitis A TREATMENT

A
  • Ig useful if immunocompromised and <12months babies. - Vaccine
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46
Q

Primary Biliary Cirrhosis CLINICAL FEATURES

A
  • Pruritus, fatigue, cholestasis in biochemistry
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47
Q

Hepatitis A CLINICAL FEATURES

A

-Not chronic, travel Hx, endemic in Queensland and NT.
-Exclusion for 7 days after appearance of jaundice OR until resolution of symptoms
-NOTIFIABLE Dx

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48
Q

Hepatitis C TREATMENT

A

-Sofospuvir/Ledipasvir
-Peginterferon but causes BM supression (Do FBC monthly), depression (give it with low dose
SSRI)
-Do SVR12 (means cure).
Undetectable HCV RNA by PCR 12 weeks after end of tx

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49
Q

Hepatitis D CLINICAL FEATURES

A

Uncommon in Oz. From migrants If infectious is at the same time with HBV: Fulminant hepatitis. If superinifection-> Chronic hepatitis

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50
Q

Hepatitis D TREATMENT

A

Peginterferon for at least 48 weeks

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51
Q

Hepatitis C FIRST INVESTIGATION

A

-Anti HCV
-HCV RNA
-Serial ALT (3x in 6m) to see progression

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52
Q

Hepatitis E CLINICAL FEATURES

A

Dangerous in prEgnancy, oldEr pts, and preExisting liver dx-> acute liver failure

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53
Q

Hepatitis E TREATMENT

A

Ribavirin

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54
Q

Liver Tumors Simple

A
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55
Q

Liver cysts Benign: Hepatic Adenoma CLINICAL FEATURES

A

Young pts with benign tumour linked to OCPs or fertile women. - Pain, spontaneous rupture and haemorrhage are complications (esp in pregnancy).

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56
Q

Liver cysts Benign: Hepatic Adenoma TREATMENT

A

Resection before pregnancy should be indicated.

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57
Q

Liver cysts Benign: Hemangioma

A
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58
Q

Malignant - HEPATOMA or hepatocellular carcinoma HCC CLINICAL FEATURES

A
  • Cx: Chronic alcoholism, Hep B C D infection, obesity, DM, smoking
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59
Q

Malignant - HEPATOMA or hepatocellular carcinoma HCC FIRST INVESTIGATION

A

Surveillance:
-Nodule<10mm: US e/3m
-Nodule>10mm: Contrast CT/MRI.
-Tumour marker: AFP

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60
Q

Malignant - HEPATOMA or hepatocellular carcinoma HCC BEST INVESTIGATION

A

Biopsy

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61
Q

Malignant - HEPATOMA or hepatocellular carcinoma HCC TREATMENT

A

Qx resection is not advised
- Sorafenib can prolong survival

The treatment for hepatocellular carcinoma (HCC), or malignant hepatoma, varies based on the stage of the cancer, liver function, and the overall health of the patient. Here’s a simplified overview:

  • Liver Resection: The preferred treatment for patients with early-stage HCC who have good liver function. It involves removing the tumor along with a portion of the liver.
  • Liver Transplantation: Recommended for patients with early-stage HCC who are not candidates for resection due to poor liver function or multiple tumors. This can provide a cure by removing both the tumor and the underlying liver disease.
  • Radiofrequency Ablation (RFA): Uses heat to destroy cancer cells. It’s an option for small tumors, particularly when surgery isn’t feasible.
  • Microwave Ablation (MWA): Similar to RFA but uses microwaves to generate heat, effective for small, localized tumors.
  • Transarterial Chemoembolization (TACE): Delivers chemotherapy directly to the tumor via its blood supply and blocks the blood flow, effectively starving the tumor. Often used for patients with intermediate-stage HCC who are not suitable for surgery.
  • Transarterial Radioembolization (TARE): Similar to TACE, but uses radioactive beads to target the tumor. It’s an option for those who cannot undergo surgery.
  • Targeted Therapy: Drugs like sorafenib, lenvatinib, and others target specific pathways involved in tumor growth. They are typically used for advanced HCC.
  • Immunotherapy: Drugs that boost the body’s immune system to fight the cancer, such as nivolumab or pembrolizumab, are becoming more commonly used in advanced cases.
  • Supportive Care: For patients with advanced HCC who are not candidates for the above treatments, palliative care focuses on relieving symptoms and improving quality of life.
  • Surveillance: Regular imaging and blood tests (like AFP levels) are crucial for monitoring treatment response and detecting recurrence.
  • A team approach involving hepatologists, oncologists, surgeons, and radiologists is crucial for optimizing treatment outcomes.

The choice of treatment depends on various factors, including tumor size, number, location, liver function, and the patient’s overall health. Early detection and treatment significantly improve outcomes oai_citation:1,Islamic Prayer Times Today, Salat Time, Namaz Timings | IslamicFinder oai_citation:2,United States: Prayer Times | Muslim Pro.

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62
Q

Secondary liver cancer (Metastatisis)

A
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63
Q

Cirrhosis CLINICAL FEATURES

A
  • Low albumin is best indicator of cirrhosis
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64
Q

Cirrhosis FIRST INVESTIGATION

A
  1. LFTs, FBE: Thrombocytopaenia, altered IRN, low albumin
  2. US.
  3. CT/MRI
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65
Q

Cirrhosis BEST INVESTIGATION

A

Liver Biopsy

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66
Q

Portal hypertension

A
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67
Q

Gastro-oesophageal Varices

A
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68
Q

Ascites

A
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69
Q

Hepatorenal syndrome (HRS)

A
70
Q

Hepatic Encephalopathy TREATMENT

A
  1. Lactulose
  2. Rifaximin
71
Q

Hepatic Encephalopathy CLINICAL FEATURES

A
  • Changes in personality, sleep, disorientation, flapping tremor, impaired ability to draw 5-point star
72
Q

Portal vein thrombosis

A
73
Q

Spontaneous Bacterial Peritonitis CLINICAL FEATURES

A
  • MCC: E. coli, Klebsiella.
  • Ascitic pt that deteriorates with altered mental status, fever, abd pain, inc WBC
  • Mechanism: Bacterial translocation from gut to mesenteric lymph node
74
Q

Spontaneous Bacterial Peritonitis BEST INVESTIGATION

A

Ascitic fluid culture: WBC>0.5 or neutrophil>0.25 is dx

75
Q

Spontaneous Bacterial Peritonitis TREATMENT

A
  • Empirical: Ceftriaxone OR Cefotaxime. If allergy to penicillin: cipro OR aztreonam.
  • Secondary prophylaxis with Bactrim
76
Q

Proton pump inhibitors

A
77
Q

Globus Hystericus CLINICAL FEATURES

A

Sensation of something in throat, symptoms of reflux. Nothing on PE

78
Q

Pharyngeal Pouch CLINICAL FEATURES

A

> 70yo male, normal neck, regurgitation of undigested food, halitosis, dysphagia

79
Q

Pharyngeal Pouch BEST INVESTIGATION

A
  1. Barium swallow
80
Q

Pharyngeal Pouch TREATMENT

A

Stent

81
Q

Eosinophilic Oesophagitis CLINICAL FEATURES

A

Hx of atopy, symptoms of GORD

82
Q

Eosinophilic Oesophagitis FIRST INVESTIGATION

A
  1. PPI
83
Q

Eosinophilic Oesophagitis BEST INVESTIGATION

A

Endoscopy with biopsy

84
Q

Eosinophilic Oesophagitis TREATMENT

A
  1. PPI for 4-8 weeks
  2. Fluticasone swallowed for 8w
  3. Oral prednisolone
85
Q

Achalasia CLINICAL FEATURES

A

Dysphagia (intermittent to solids and liquids), posture to aid swallowing, food that sticks, slow eaters.

86
Q

Achalasia FIRST INVESTIGATION

A
  1. Endoscopy. If not available->Barium swallow-Bird’s beak
87
Q

Achalasia BEST INVESTIGATION

A

Oesophageal manometry (Increase pressure)

88
Q

Achalasia TREATMENT

A
  • Young: Endoscopic Pneumatic Dilation (Less invasive) or Laparoscopy Myotomy
    -Old: Nifedipine, botulin inj.
89
Q

Presbyoesophagus CLINICAL FEATURES

A

Old pts with dysphagia and low amplitude contractions on manometry

90
Q

Oesophageal Candidiasis CLINICAL FEATURES

A

In immunocompromised pts

91
Q

Oesophageal Candidiasis TREATMENT

A

-Asymptomatic and not immunocompromised-Nystatin for 14 days
- Symptomatic or Immunocompromised: Fluconazole 14-21d

92
Q

Viral Oesophagitis CLINICAL FEATURES

A

Cause: HSV, CMV

93
Q

Viral Oesophagitis BEST INVESTIGATION

A

Endoscopy w/ biopsy for pathology and PCR

94
Q

Viral Oesophagitis TREATMENT

A

Acyclovir IV followed by famciclovir/vala for 10 days

95
Q

Barrets Oesophagus CLINICAL FEATURES

A

Metaplasia (From squamous to simple columnar)
Most imp RF for Oesophageal adenocarcinoma

96
Q

Barrets Oesophagus BEST INVESTIGATION

A

Endoscopy w/ biopsy

97
Q

Barrets Oesophagus TREATMENT

A
  1. PPI
  2. Surveillance Metaplasia. Review in 3-5y if <3cm or 2-3y if ≥3cm.
    - Dysplasia- Endoscopy e/6m - High grade dysplasia: Refer.
    * PPI America recommends 3m in dysplasia
98
Q

Oesophageal Cancer CLINICAL FEATURES

A

-Adenocarcinoma (MC in Oz, assoc w/ Barret).
-SCC (MC in world. Assoc w/ SAD).
-Progressive dysphagia first to solids then liquids, hiccoughs, hoarnesess, cough

99
Q

Oesophageal Cancer BEST INVESTIGATION

A
  1. Endoscopy w/ biopsies.
    If unavailable->Barium
100
Q

Oesophageal Cancer TREATMENT

A

Surgery. CI in lesion>10cms, invasion to tracheobronchial tree and great vessels

101
Q

Mallory Weiss CLINICAL FEATURES

A

Haem stable. Asoc w/ alcoholic binge

102
Q

Mallory Weiss BEST INVESTIGATION

A

Endoscopy

103
Q

Mallory Weiss TREATMENT

A

80-90% stops spontaneously

104
Q

Complete Oesophageal rupture CLINICAL FEATURES

A

Chest pain, subcutaneous emphysema, crunching sound w/ heartbeat (Hamman’s sign)

105
Q

Boerhave’s Sx CLINICAL FEATURES

A

Haem unstable. Complete transmural tear

106
Q

Boerhave’s Sx FIRST INVESTIGATION

A
  1. X-ray
107
Q

Boerhave’s Sx BEST INVESTIGATION

A
  1. Gastrograffin. Never Barium
108
Q

Boerhave’s Sx TREATMENT

A
  1. Atbs, fluids, Qx.
109
Q
A
110
Q

GORD CLINICAL FEATURES

A

Belching, odynophagia

111
Q

GORD FIRST INVESTIGATION

A
  1. PPI
112
Q

GORD BEST INVESTIGATION

A

> 10y with GORD: Endoscopy to r/o Barrett

113
Q

GORD TREATMENT

A

1.LSM weight loss
2.Magnesium/Aluminum hydroxide.
3.H2 blocks
4.PPI (6-8w if severe). SEs: Interstitial nephritis, alabsorption (Iron, Mg, Ca).
5.Qx: Roux-en-Y: BMI>40, or BMI>35 w/ DM, HTN. Comp of Qx: anastomotic leak (perforation)

114
Q

Upper GI Bleeding CLINICAL FEATURES

A

-MCC: PUD.
- Tachy, hypotension, sweating

115
Q

Upper GI Bleeding TREATMENT

A
  1. Admission, IV fluids, PPI IV
  2. Endoscopy to identify bleeding point
  3. Endoscopic haemostasis, Qx
116
Q

Hydatid Cyst CLINICAL FEATURES

A

Farmer, reservoir in dogs and cattle, can happen in liver (jaundice, RUQ pain, vomiting) or lung (SOB, chest pain, cough)

117
Q

Hydatid Cyst FIRST INVESTIGATION

A

US

118
Q

Hydatid Cyst BEST INVESTIGATION

A

CT

119
Q

Hydatid Cyst TREATMENT

A
  • Qx w/PAIR technique (Puncture, Aspiration, Inj of hypertonic or ethanol), Reaspiration. - Albendazole for 4w after Qx. - Praziquantel if cysts are spilled during surgery or complicated cysts.
120
Q

Liver Abscess CLINICAL FEATURES

A

-MCC: Klebsiella (Risk of Endopthalmitis). In children Staph Aureus. In NA: Melioidosis (Bulkdolheria). In travellers: E. hystolytica

121
Q

Liver Abscess FIRST INVESTIGATION

A

US

122
Q

Liver Abscess BEST INVESTIGATION

A

CT (Irregular multiple). Blood cultures

123
Q

Liver Abscess TREATMENT

A

-<5cm: Close needle drainage - >5cm: Rx guided catheter.
-Empiric Atbs: Gentamicin+Amoxi+Metro for 4-6w. If CI to genta: Ceftriazone or Cefotazime.
-Confirmed Klebsiella: Ceftriazone or cefotaxime.
-If high fever, tender lymphadenopathy, effusion at base of right chest->Amebiasis. Percutaneous CT aspiration+Metro

124
Q

NASH CLINICAL FEATURES

A

Increased AST, ALT, GGT.

125
Q

NASH TREATMENT

A
  1. LSM.
  2. Statins. Metformin for DM risk
126
Q

Simple liver cysts CLINICAL FEATURES

A

Asymptomatic, or dull right upper pain, jaundice

127
Q

Simple liver cysts FIRST INVESTIGATION

A

US

128
Q

Simple liver cysts BEST INVESTIGATION

A

CT

129
Q

Ascites TREATMENT

A
  • Mild: low salt. If symptomatic use spironolactone, if painful gynaecomastia use amiloride. - Moderate: Spironolactone, if insufficient add furosemide, if tense ascites paracentesis
    Refractory: Repeated paracentesis, shunt, liver transplantation
130
Q

Gastro-oesophageal varices FIRST INVESTIGATION

A

Dx endoscopy in all pts with cirrhosis looking for varices

131
Q

Gastro-oesophageal varices TREATMENT

A
  • Propranolol w or without endoscopic variceal band ligation. - Endoscopy e/ 6-12m - Acutely Bleeding:
    1.IV line + PPI
    2.Blood transfusion.
    3.Octreotide to reduce portal pressure
    4.Prophylactic Atb with Ceftriaxone OR Cipro IV
132
Q

H pylori infection CLINICAL FEATURES

A

RF for gastric cancer.

133
Q

H pylori infection FIRST INVESTIGATION

A
  1. Serology Test
134
Q

H pylori infection BEST INVESTIGATION

A

Biopsy urease testing

135
Q

H pylori infection TREATMENT

A
  • PPI+Amoxi+Clarythro. If penicillin allergy: PPI+Metro+Clarythro. - Post-tx you do Urea breath test 4 weeks after starting tx.
136
Q

Autoimmune Gastritis CLINICAL FEATURES

A

Abs against parietal cells and IF. Atrophy of mucosa of stomach

137
Q

Autoimmune Gastritis BEST INVESTIGATION

A

Endoscopy w/ biopsy

138
Q

Autoimmune Gastritis TREATMENT

A

IM Vitamin B12

139
Q

Peptic Ulcer Dx CLINICAL FEATURES

A

-Gastric has more vomiting and weight loss
-Duodenal no vomiting and no weight loss.
-Strictures as comp: If in pylorus (vomiting within 1 hour of meal), duodenal (after 1hr of meal)

140
Q

Peptic Ulcer Dx FIRST INVESTIGATION

A

Urea Breath test: To monitor response to tx of H pylori

141
Q

Peptic Ulcer Dx BEST INVESTIGATION

A

Endoscopy. Compulsory for pts>55yo w/ chronic dyspepsia to r/o Ca

142
Q

Peptic Ulcer Dx TREATMENT

A
  1. PPI IV
  2. Injection of adrenaline
143
Q

Gastric Outlet Obstruction CLINICAL FEATURES

A
  • Pt with vomiting>1hr after eating with undigested food with hx of chronic PUD
144
Q

Gastric Cancer CLINICAL FEATURES

A

-MCC: H Pylori infection
-Asymptomatic, later dysphagia, epigastric mass, Virchow’s node (left supraclavicular node), hard irregular hepatomegaly, anaemia

145
Q

Gastric Cancer BEST INVESTIGATION

A

Endoscopy+Biopsy

146
Q

IBS CLINICAL FEATURES

A

Abd pain assoc w/ change in bowel habit.

147
Q

IBS FIRST INVESTIGATION

A

Stool examination w/ fecal calprotectin

148
Q

IBS TREATMENT

A
  1. LSM
  2. High fibre diet
  3. Loperamide, TCAs, SSRIs
149
Q

Meckel Diverticulum CLINICAL FEATURES

A
  • Lower GI bleeding, abd pain
150
Q

Meckel Diverticulum FIRST INVESTIGATION

A
  1. Endoscopy
151
Q

Meckel Diverticulum BEST INVESTIGATION

A
  1. CT
152
Q

Celiac Dx CLINICAL FEATURES

A

-Assoc w/ dermatitis
herpetiformis, thyroid dx, DM 1, IgA deficiency, primary biliary cirrhosis, lymphoma of small bowel
-Lethargy, diarrhoea, abd pain, bloating, indigestion, bleeding (Vit K def), steatorrhea
-Skinny arms with flat bum and big belly. Symptoms started by 4-5m when started Cerelac

153
Q

Celiac Dx FIRST INVESTIGATION

A

-IgA anti-tissue transglutaminase and anti-deamidated gliadin antibody.
-If pt is already on gluten free diet, give gluten for 4-6w and repeat test

154
Q

Celiac Dx BEST INVESTIGATION

A

Duodenal biopsy with villous atrophy and intra epithelial lymphocytosis

155
Q

Celiac Dx TREATMENT

A

Avoid BROW (Barley, Rye, Oats, Wheat)

156
Q

Obscure GI Bleeding CLINICAL FEATURES

A

Blood persists besides upper and lower endoscopy & Radiologic Ix

157
Q

Obscure GI Bleeding FIRST INVESTIGATION

A
  • Active: Haem Stable: CT angio Haem Unstable: Interventional
    Angiography
  • Inactive (Occult) Capsule Endoscopy
158
Q

Carcinoid Tumour CLINICAL FEATURES

A

Facial flushing, diarrhoea, wheezing, right valvular heart dx

159
Q

Carcinoid Tumour BEST INVESTIGATION

A

24hr 5-hydroxyl indole acetic acid, plasma chromogranin A

160
Q

Carcinoid Tumour TREATMENT

A
  • Octreotide to block serotonin production
  • Interferon alpha to reduce growth - Artery embolization to cut blood supply
161
Q

CRC CLINICAL FEATURES

A
  • Right: 1. Anaemia (Weakness, fatigue). 2nd Palpable mass. - Left: Pain, LB obstruction, altered bowel habits - Sigmoid Ca: Apple core deformity, napkin ring - Rectal Ca: Rectal bleeding, mass in DRE, tenesmus
162
Q

CRC FIRST INVESTIGATION

A

For screening see Page 9 of Bleeding.
- Tumour marker CEA

163
Q

CRC BEST INVESTIGATION

A
  1. Colonoscopy
164
Q

CRC TREATMENT

A

Surgery (Terminal-terminal anastomoses). If lymphoid Pos ->
Chemo, If lymphoid Neg -> Surveillance (Colonoscopies at 1, 3, 5 years +CEA).
- MC comp post-Qx->Faecal incontinence

165
Q

Adenomatous Polyps Adenomas CLINICAL FEATURES

A

Familial Adenomatous Polyposis 100% risk of Cancer

166
Q

Adenomatous Polyps Adenomas FIRST INVESTIGATION

A
  1. FOBT
167
Q

Adenomatous Polyps Adenomas BEST INVESTIGATION

A
  1. Colonoscopy
168
Q

Adenomatous Polyps Adenomas TREATMENT

A

Screening w/ Colonoscopy:
- 1-2 polyps & nothing else: 5y
-3-4, high grade dysplasia, villous: 3y
-5-9: Every year
->10: 6 months

169
Q

HNPCC-Lynch Syndrome CLINICAL FEATURES

A

AD. Most common hereditary form of Colon Ca. They can also have ovarian, renal, etc.

170
Q

HNPCC-Lynch Syndrome TREATMENT

A

Genetic testing

171
Q

Peutz Jeghers sx CLINICAL FEATURES

A

Benign polyps (Hamartomas) that can become malignant, freckles on lips, inside mouth, palms, soles.
- Assoc w/ ovarian Ca.
- MC site of Ca: Duodenal Ca.
- Common comp: Intussusception at any age.

AMC MCQ - You Can Do It!!!!!❤️❤️ (50 decks)

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