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Gastroenterology Crash Course Flashcards

1
Q

Bilirubin high

What investigation should be next?

A

Unconjugated bilirubin

Gilberts syndrome - benign inherited disorder of bilirubin processing in the liver

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2
Q

Gilbert’s syndrome

A

Benign inherited disorder of bilirubin processing in the liver
Causes recurrent episodes of unconjugated hyperbilirubinaemia
Reduced conjugation of bilirubin - variant in the promotor region of the gene for the enzyme UGT
Episodes precipitated by stressful events - no specific treatment

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3
Q

Bilirubin metabolism

A
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4
Q

Crigler-najjar syndrome

A

Autosomal recessive
Younger age
Unconjugated bilirubin

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5
Q

Dubin-Johnson syndrome

A

Conjugated bilirubin (high)

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6
Q 
IgM raised
Antinuclear and anti-mitochondrial +
CMB IgG +
Liver enlarged but no biliary dilatation, no gallstones and no focal lesions
What is the most appropriate treatment?
A

Ursodeoxycholic acid (UDCA)
Primary biliary cholangitis - autoimmune cholestatic liver disease that can lead to cirrhosis
Always be suspected in unexplained raised alp
Anti-mitochondrial - 95% have this
First line is UDCA - bile acid with multiple effects

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7
Q

3 key autoimmune liver disease
Autoimmune hepatitis
PBC
PSC

A
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8
Q

PSC is more common in…

A

Males

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9
Q

PBC and autoimmune hepatitis are more common in…

A

Females

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10
Q

Treatment for autoimmune hepatitis?

A

Pred + azathioprine

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11
Q

UDCA treats

A

PBC

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12
Q

LFTs in autoimmune hepatitis

A

High ALT/AST

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13
Q

PBC LFTs

A

High ALP/GGT

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14
Q

PSC LFTS

A

High ALP/GGT

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15
Q

NSAIDs are a common cause of upper GI bleeding that may be exacerbated by …

A

SSRIs - may increase bleeding risk!
NSAIDS inhibit synthesis of prostaglandins - can lead to gastric/duodenal ulcer
Look at the urea:creatinine ratio in suspected upper GI bleed
Recurrent vomiting followed by haematemesis is classic of MW tear

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16
Q

Scoring system for Upper GI bleed (further management)

A

Blatchford score

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17
Q

PERC score?

A

D-dimer PE

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18
Q

PESI score?

A

PESI score - mortality with PE

19
Q

Oakland score?

A

Lower GI bleed

20
Q

Child-Pugh score?

21
Q

Blatchford and rockall - what is the difference?

22
Q

Barium swallow

A

Achalasia

Birds beak

23
Q

Achalasia

A

Rare motility disorder affecting the oesophagus that typically presents with dysphasia
Due to enervation of neutrons within the myenteric plexus
Results in failed relaxation of the lower oesophageal sphincter
Diagnosed on manometers and treated by disrupting the muscle fibres by surgery or endoscopy

24
Q

Unexplained rectal bleeding?

A

Urgent referral to gastroenterology
Older - malignancy concern
Younger with bloody diarrhoea and no infection - IBD concern

25
Q

UC vs Crohn’s

26
Q

Histology in UC

A

Mucosal inflammation
Continuous
Diffuse crypt changes

27
Q

Histology in Crohn’s

A

Transmural inflammation
Skip lesions
Granulomas

28
Q

Complications of UC

A

Toxic mega-colon
Perforation
Bleeding
Malignancy

29
Q

Complications of Crohn’s

A

Abscess
Perforation
Fistula
Obstruction

30
Q

Blood diarrhoea, tenesmus and urgency, abdo pain

UC or Crohn’s?

31
Q

Granuloma

UC or Crohn’s?

32
Q

Mild-to-moderate UC treatment?

A

Treat with oral mesalazine

33
Q

Mesalazine for…

A

Mild to mod UC

34
Q

Acute flare of UC can be graded according to what criteria?

A 
True love and Witt criteria
Acute Severe UC is a medical emergency and requires high dose IV steroids
Mild to mod = optimisation of mesalazine
Related to aspirin
Reduces inflammatory mediators
35
Q

Mild
Moderate
Severe
UC

36
Q

Oral budesonide for…

37
Q

Crohns

A

Imaging and endoscopy
Major differential for terminal ileitis
Mild to moderate - budesonide first line

38
Q

Crohns management

A

Induce remission
Maintenance
Surgery

39
Q

IBS

A 
Chronic GI disorder characterised by chronic abdominal pain and altered bowel habits
Very common (5-20%) of population
Disorder of the gut-brain interaction
Exclude red flags
40
Q

Faecal calprotectin is useful at differentiating

A

Ibs and ibd

41
Q

IBS treatment

A

Patient centred discussion
FODMAP diet
Pain, constipation, diarrhoea - solve with antispasmodic, loperamide, laxatives

42
Q

Duodenal biopsy - subtotal villous atrophy with crypt hyperplasia and increased intraepithelial lymphocytosis = …

A

Coeliac disease

43
Q

Coeliac disease

A

Immune mediated enteropathies triggered by dietary gluten peptides
Gluten refers to the proteins found within wheat and other cereal grains
Diarrhoea, weight loss and bloating
High prevalence of IgA deficiency - but check for anti TTG antibodies

Gastroenterology & Hepatology (37 decks)

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