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Medicine > Gastroenterology (GI) > Flashcards

Gastroenterology (GI) Flashcards

1
Q

What is Gilbert’s syndrome?

A

An autosomal recessive condition of defective bilirubin conjugation causing jaundice.
It is harmless, so no treatment is required

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2
Q

What serum markers/antibodies are seen in Autoimmune Hepatitis?

A

Anti-nuclear abs (ANA) +/or Anti-Smooth muscle (SMA) abs present.
IgG raised
Soluble liver-kidney antigen (LKMI) may also be seen

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3
Q

Budd-Chiari Syndrome presentation

A

Triad of:

1) Abdo pain
2) Ascites
3) Liver enlargement

(Caused by occlusion of hepatic veins that drain the liver)

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4
Q

How does pyloric stenosis present in children?

A

Projectile vomiting after feeds + an olive shaped mass in the epigastrium

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5
Q

What Ix do you use to look for mesenteric ischaemia?

A

Arterial CT

Rx: Resect the area

Note: New onset AF is associated with mesenteric ischaemia.

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6
Q

What are the 4 Ms used to identify Primary Biliary Cholangitis (PBC)

A

IgM
Anti-Mitochondrial abs
Middle aged female
Anti-Smooth Muscle abs

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7
Q

What is the treatment for Autoimmune hepatitis?

A

Azithioprine

Unless elderly, as is an immunosuppressant.
2nd line = Prednisolone

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8
Q

How long does someone have to have diarrhoea before it is considered chronic?

A

3 weeks

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9
Q

How do you treat microscopic colitis?

A

Steroids Eg Butizinide

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10
Q

How do you treat proctitis?

A

Mild-Moderate =Mesalazine

Severe = Anti-TNF

NOTE: Adenocarcinomas are a complication of colitis

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11
Q

What are the 3 cardinal symptoms of UC?

A

Blood in stools, Diarrhoea, Abdo pain

Also increased risk of cancer

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12
Q

Do you get more weight loss in UC or Crohn’s?

A

Crohn’s

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13
Q

What drugs can cause chronic diarrhoea?

A

PPIs, NSAIDs, laxatives, metformin, anti-malarials (Eg Quinine)

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14
Q

What does the Truelove and Witt’s score assess severity of?

A

UC

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15
Q

What is Fitz-Hugh-Curtis Syndrome?

A

A rare disorder that occurs when pelvic inflammatory dx causes tissue swelling around the liver.

Confirm diagnosis with a high vaginal swab (cervical excitation)

Treat with Doxycycline or Azithromycin

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16
Q

What is the treatment for Wilson’s disease?

A

Penicillamine

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17
Q

How do you treat PBC (primary biliary cholangitis)?

A

Ursodeoxycholic acid

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18
Q

What does a low faecal elastase (less than 200) indicate?

A

Pancreatic exocrine insufficiency

Usually suggests chronic pancreatitis

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19
Q

What does elevated calprotectin indicate?

A

IBD

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20
Q

What are the 3 cardinal symptoms of UC?

A

Blood in stools
Diarrhoea
Abdo pain

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21
Q

In which do you have a greater risk of developing cancer, UC or Crohns?

A

UC

But more weight loss in Crohns

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22
Q

What is the CIWA score used for?

A

Alcohol withdrawal - if score over 8 then give Benzodiazepines to control psychomotor agitation (Eg Diazepam, Lorazepam + Chlordiazepoxide).

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23
Q

What are some rare causes of chronic diarrhoea?

A

Graft-vs-Host dx (consider is recent bone marrow transplant)
Tropical Sprue (an acquired malabsorptive condition - consider if Hx of recent travel to S+SE Asia or Carribean.)
Addison’s dx (fatigue, weight loss, weakness,anorexia,skin hyperpigmentation, postural hypotension)

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24
Q

What is Plummer-Vinson Syndrome?

A

A rare condition characterised by the triad of:

  1. Dysphagia
  2. Iron deficiency anaemia
  3. Oesophageal web
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25
Q

What are the features of C.Diff?

A

Greenish diarrhoea, abdo pain, high WCC, toxic megacolon

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26
Q

What is the leading cause of C.Diff?

A

Cephalosporin treatment

PPIs also cause C.Diff.

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27
Q

1st line therapy for C.Diff?

A

Oral metronidazole

If severe, oral vancomycin and IV metronidazole.

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28
Q

What cells line the lier sinusoids?

A

Kuppfer cells - sample antigens passing from gut to livers are important for infection clearance.
Liver also has erythropoeitic potential.

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29
Q

Which liver enzymes are raised in specifically hepatic damage?

A

ALT and AST

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30
Q

Which LFT markers are raised a cholestatic picture?

A

ALP and GGT

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31
Q

What are the causes of raised ALT ?

A

Raised serum ALT indicates hepatocyte damage
Hepatic causes - hepatitis (viral,alcohol), NAFLD,Liver ischaemia, paracetamol, overdose.
Extra-hepatic causes - MI, pancreatitis, kidney dx (better biomarkers exist!)

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32
Q

What are the causes of raised serum AST?

A

Indicates hepatocyte damage.
AST:ALT ratio –>
-normally, the AST is slightly lower than ALT.
- if AST> x2 ALT then alcohol is the cause of the hepatitis. Doesn’t necessarily mean they have cirrhosis.
- if AST > x0.8 ALT or they are equal, there has been cirrhotic progression or hepatitis.
In this case, assess the need for a transplant

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33
Q

What are the causes of raised ALP?

A

Elevated in obstructive jaundice and bile duct damage. Also found in bone and placenta.

Biliary causes –> Gallstones, pancreatic ca, PSC, pbc, ETC

Extra-biliary Causes–>
Bones - fracture, Paget’s, Osteomalacia, Rickets, Primary hyperparathyroidism, low fit D etc
Placenta - pregnancy, GCTs.

34
Q

What are the causes of raised GGT (Gamma Glutamyl Transferase)?

A

Isolated raised GGT = chronic alcohol misuse

Raised w/ other markers - hepatitis, alcoholic liver dx, cholestatic liver dx

35
Q

What does a low albumin indicate?

A
  • Low production –> malnutrition or chronic liver dx
  • Loss –> from gut or kidneys
  • Sepsis –> Bfs dilate and bird spacing occurs, so albumin moves out of capillaries into interstitium and fluid follows, leading to ascites.
36
Q

What does Alpha-fetoprotein indicate?

A

HCC

Also raised in pregnancy and testicular cancer

37
Q

When are clotting factors useful?

A

Acute setting.
V.short half life.
Can assess INR (normalised ratio of PT)
PT better than aPTT for assessing acute lier function

38
Q

What does CK indicate?

A

Muscle damage

This could be the cause of paradoxical raised liver enzymes.

39
Q

When is Alpha -1 -antitrypsin raised?

A

Rare cause of liver disease

40
Q

When is Caeruloplasmin raised?

A

Wilsons’s disease

41
Q

When are AI abs and ANCA raised?

A

Autoimmune hepatitis, PSC, PBC etc

42
Q

When is Ferritin raised?

A

Haemachromatosis

43
Q

What is a Fibroscan?

A

Non-invasive method of assessing fibrosis

44
Q

What is Xenobiotic metabolism?

A

The ability of the lier to break down exogenous substances like drugs.

If the liver is damaged then there can be reduced drug clearance, drug interactions , increased unconjugated bilirubin and jaundice.

45
Q

What is jaundice?

A

Raised bilirubin in the blood, causing the characteristic yellowing of the eyes and skin

46
Q

How is bilirubin produced and excreted?

A
  1. RBCs break down Hb to iron and unconjugated (insoluble) bilirubin.
  2. Unconjugated bilirubin circulated in blood bound to albumin + enters liver.
  3. Hepatocytes conjugate bilirubin to make it soluble.
  4. It is excreted in the bile into the duodenum.
  5. Bilirubin turned into stercobilirubin and urobilirubin (makes poo brown).
  6. In obstructie jaundice, the bile is not released, so pale poo stools + dark urine.
47
Q

What are the pre-hepatic causes of jaundice?

A 
Intravascular haemolytic (Eg hereditary spherocytosis and HELLP in pregnant women)
Extravascular haemolysis

Always unconjugated bilirubin seen

48
Q

What are the hepatic causes of jaundice?

A

Gilbert’s disease (conjugation enzyme defects - see normal blood results + unconjugated bilirubinis high)
Hepatocyte damage - hepatitis
decreased hepatocyte uptake of bilirubin

49
Q

What are the post-hepatic (obstructive) jaundice?

A

Issues with biliary flow from liver to gut - can see dilated ducts (gallstone, pancreatic cancer etc),or undiluted ducts (PBC, PSC, pregnancy etc)

50
Q

What does a urine dip +ve for bilirubin indicate?

A

Obstructive jaundice (conjugated)

51
Q

What does a urine dip +ve for urobilinogen indicate?

A

Normal in small amounts
Increased in haemolysis, hepatitis sepsis.
Absent in obstructive jaundice.

52
Q

What is +ve Courvosier’s sign?

A

Palpable gallbladder with jaundice and no tenderness.

Suggests malignancy.

53
Q

What is Mirizzi syndrome?

A

A common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder.
Usually presents with fever, jaundice and RUQ pain.

54
Q

Biliary colic Px?

A
  • Intermittent RUQ pain worse after a heavy meal that lasts over 30 mins but less than 8hrs.
  • Apyrexial + few/no exam findings. Obs normal.
  • Nausea +/or vomiting
55
Q

What does the word Cholelithiasis mean?

A

Gallstone.

Cholesterol gallstones are the most common type of gallstone in the developed world.

56
Q

What type of gallstones are common in its with haemolytic disorders such as sickle cell dx?

A

Pigment gallstones

Also effect those with liver cirrhosis.
Made up of bilirubin and salts.

57
Q

What is ascending cholangitis?

A

Infection of the biliary tree, commonly duet CBD stone.

Obstruction –> cholestasis –> infection (E.Coli most common).

58
Q

What is Biliary colic?

A

When the gallbladder contracts against a stone lodged in the cystic duct.

59
Q

What is Calculous cholecystitis?

A

Inflammation of the gallbladder due to a gallstone impacted at the neck of the gallbladder or cystic duct.
Causes inflammation, bile stasis + bacterial overgrowth.
Get RUQ tenderness, +ve Murphy’s sign, and fever.

60
Q

What is Murphy’s sign?

A

+ve Indicates Cholecystitis.

Pt breathes in and you feel RUQ. If pain, then +ve, as their inflamed gallbladder is making contact with your hand.

61
Q

What is Calculous cholecystitis?

A
  • Inflammation of the gallbladder w/o stone lodgement.
    Usually in severely unwell pts.
  • Secondary to hypovolaemia, trauma or systemic illness –> gallbladder stasis and blockage of bile ducts.
  • Poor prognosis.
62
Q

What are the risk factors for gallstone disease?

A

4 Fs = Female, Fat, Forties, Fertile (pregnancy)

Caucasian
Crohn's dx
Rapid weight loss or prolonged fasting
Fam Hx
Diabetes and NAFLD
Haemolytic conditions
HRT and COCP
63
Q

Acute cholecystitis Px?

A
  • Features similar to biliary colic (often have Hx of biliary colic also)
  • Possible referred right shoulder tip pain.
  • Fever
  • RUQ tenderness
  • Murphy’s sign +ve
64
Q

Ascending cholangitis Px?

A

Charcot’s Triad
Reynold’s Pentad
Obstructive features (Eg Pale stools + dark urine)

65
Q

What is Charcot’s Triad|?

A

Fever (often with rigors), jaundice(+/- pruritus) , and RUQ pain

66
Q

What is Reynold’s Pentad?

A

Charcot’s triad (fever, jaundice + RUQ pain) + shock + altered mental status.

67
Q

What condition is associated with a raised serum conjugated bilirubin?

A

Ascending cholangitis, as the stone is lodged in CBD, resulting in obstructive jaundice (conjugated hyperbilirubinaemia).

If stone still in cystic duct, even if cholecystitis, the bilirubin should be NORMAL + NO jaundice.

68
Q

What is the 1st line Ix for gallstone disease?

69
Q

When should patients have an MRCP?

A

If no CBD stones are seen on abdominal USS but the CBD is dilated on USS or the LFTs are abnormal

70
Q

What will be seen on Abdo USS in Cholecystitis?

A
  • +ve Murphy’s sign on palpation with probe
  • Thickened gallbladder wall (>3mm)
  • Distended gallbladder with presence of gallstones
  • Pericholecystic fluid
71
Q

What is a Cholescintegraphy (HIDA) scan?

A

Technetium-labelled HIDA is taken up by hepatocytes –> excreted into bile.
If cystic duct obstruction, gallbladder will not be seen.

72
Q

When is ERCP indicated?

A

For endoscopic investigation +intervention to remove stones from CBD
MRCP usually required before this.

73
Q

Biliary colic Rx?

A

Mild-Moderate Pain= NSAIDs(e.g. diclofenac) or paracetamol
Severe Pain = IM diclofenac or IM opioid (e.g. morphine)

Definitive Management = Laparoscopic Cholecystectomy for all w/ symptomatic gallstone dx.

Also lifestyle changes e.g. avoid fatty foods + more fibre

74
Q

Cholecystitis Rx?

A
  • IVFluids + analgesia
  • IV Abx (Cefuroxime and Metronidazole)
  • Laparoscopic cholecystectomy within 1 week of diagnosis.

-If cholecystectomy (gallbladder removal) is contraindicated due to sepsis/gangrene/perf, can do urgent cholecystectomy (insertion of percutaneous cholecystostomy tube with a delayed removal 2-3months after)

75
Q

Ascending Cholangitis Rx?

A
  • IV Abx (Eg Cefuroxime and metronidazole)
  • IV fluids (its often septic)
  • ERCP before or at time of cholecystectomy
  • Sphincterotomy may be performed to reduce the risk of future blockage
76
Q

What is Bouveret’s syndrome?

A

Bouveret syndrome is a subset of gallstone ileus that involves the gastric outlet/proximal duodenum.
Gallstone ileus = A gallstone erodes through the gallbladder via a cholecysto-duodenal fistula, causing duodenal obstruction.

77
Q

What is the most common cause of Acute Pancreatitis?

A

Gallstones

78
Q

What drug is used to manage obesity?

A

Orlistat - a pancreatic lipase inhibitor.

SEs = faecal urgency/incontinence + flatulence.

79
Q

What are the complications of Coeliac disease?

A
  • Anaemia (Iron,folate or B12)
  • Hyposplenism
  • Osteoporosis, osteomalacia
  • Lactose intolerance
  • Enteropathy-associated T-cell lymphoma of small intestine
  • Subfertility
  • Oesophageal cancer
80
Q

What is a classic Px of oesophageal candidiasis?

A

Hx of HIV or other risk factors like ICS inhalers

Dysphagia

81
Q

What is the classic Ox of Globus hystericus?

A

Dysphagia
Sx are often intermittent and relieved by swallowing
Usually painless - the presence of pain should warrant further Ix
Hx of anxiety

Medicine (16 decks)

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