Gastroenterology I Flashcards
What causes secretory diarrhoea? [5]
Excess secretion of water:
- IBD
- Salmonella infection
- Enterotoxins: E. coli, V. cholera
- Bile salts
- Hormones
What are the three differentials for asterixis? [1]
CO2 retention (e.g. COPD)
Uraemia
Hepatic encephalopathy
A patient has these hands. Alongside cardio-resp diseases, what might a gastro differential be? [1]
IBD
A patient presents with these changes to their nails.
You find they are suffering from micocytic anaemia.
What is the most likely cause?
Thalassemia
Anemia of chronic disease
Iron deficiency
Lead poisoning
Sideroblastic anemia.
A patient presents with these changes to their nails.
You find they are suffering from micocytic anaemia.
What is the most likely cause?
Thalassemia
Anemia of chronic disease
Iron deficiency
Lead poisoning
Sideroblastic anemia.
A patient presents with hypoalbuminemia.
Which nail changes are you likely to see
Clubbing
Koilonychia
Leuconychia
Mees’ lines
Onycholysis
A patient presents with hypoalbuminemia.
Which nail changes are you likely to see
Clubbing
Koilonychia
Leuconychia
Mees’ lines
Onycholysis
A patient has stage 4 CKD.
What nail change might you expect to see
Clubbing
Koilonychia
Leuconychia
Mees’ lines
Onycholysis
A patient has stage 4 CKD.
What nail change might you expect to see
Clubbing
Koilonychia
Leuconychia
Mees’ lines
Onycholysis
A patient has been diagnosed with lung cancer and are recieving chemotherapy. .
What nail change might you expect to see
Clubbing
Koilonychia
Leuconychia
Mees’ lines
Onycholysis
A patient has been diagnosed with lung cancer and are recieving chemotherapy. .
What nail change might you expect to see
Clubbing
Koilonychia
Leuconychia - chemotherapy can cause
Mees’ lines
Onycholysis
A patient presents with these nail changes. You find out that they have normal iron levels.
What infective organism might cause this? [1]
Koilonychia refers to spoon-shaped nails. Can be caused by:
* Iron deficiency anaemia (e.g. Crohn’s disease)
* Lichen planus
* Rheumatic fever: therefore Streptococcus pyogenes
A patient presents with this nail change. What systemic condition is likely to have caused this? [1]
Psoriasis
You perform a AXR and the radiologist reports that “Rigler’s sign is positive’’
How does this sign appear on an XR? [1]
What does this meant the likely pathology is? [1]
Rigler’s sign: a double bowel wall seen on x-ray
- sign of pneumoperitoneum
You suspect that a patient has had a paracetamol OD.
How do you determine if you should give NAC ASAP or investigate their paracetamol levels? [1]
N-acetylcysteine should be started immediately in staggered overdose, ingestion more than 15 hours ago or if there is uncertainty about timing.
If ingestion occurred 4 to 15 hours ago, a blood paracetamol level should be taken, and treatment commenced accordingly.
It is decided as part of his work-up that he should be assessed for liver cirrhosis.
What is the most appropriate test to perform?
MRI liver
Liver biopsy
Urinary fibroblast quantification
Endoscopic ultrasound
Transient elastography
It is decided as part of his work-up that he should be assessed for liver cirrhosis.
What is the most appropriate test to perform?
Liver biopsy
- is invasive and carries risks such as bleeding and pain. It’s also subject to sampling error because only a small part of the liver is examined
Transient elastography
How do you distinguish between steatorrhoea from pancreatic insufficiency and small intestine disease? [4]
Pancreatic insufficiency:
- High faecal fat (rare to test now)
- High faecal elastase (more common to test)
- Normal red cell folate
- Pancreatic calcification on US
Small intestinal disease:
- low red cell folate (folate is absorbed higher up GI)
- anti-TTG: CD
- CT
- XR}
What would the following symptoms indicate about the infective cause of diarrhoea?
· Rapid onset of symptoms (within a few hours after eating) [1]
· Fever [1]
· Bloody diarrhoea [1]
· Abx [1]
Rapid onset of symptoms: (within a few hours after eating)
- this may be from a toxin-producing organism (i.e. reheated takeaways/rice from B.cereus, S.aureus from creamy products)
Fever
- is associated with invasive bacteria: such as campylobacter, salmonella, shigella), enteric viruses, and cytotoxic organisms such as C.dificile, E.histolytica.
Bloody diarrhoea
- is caused by invasive bacteria (is termed dysentery, bacillary dysentery).
Abx
- is associated with C.dificile
What is the gold standard for investigating diarrhoea? [1]
Colonoscopy & biopsy
(Also:
- Duodendal biopsy
- Small bowel MRI
- Video capsule endoscopy
- Cross sectional imaging)
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Which viruses commonly cause viral gastroenteritis? [3]
Rotavirus
Norovirus
Adenovirus (tends to cause respiratory symptoms)
How do you treat Campylobacter jejuni infection? [3]
- Clathromycin (1st line)
- Azithromycin
- Ciprofloxacin
A patient has recently eaten fried rice left at room temperature. They are reported vomitting and then diarrhoea.
What is the most likely pathogen causing these symptoms? [1]
Bacillus cereus
What syndrome can Shigella cause? [1]
Name two treatments [2]
haemolytic uraemic syndrome:
Treatment of severe cases is with azithromycin or ciprofloxacin.
How do you treat Giardia lamblia? [2]
tinidazole or metronidazole
Which antibiotics are most likely to cause C. difficile infection? [2]
Second and third-generation cephalosporins are now the leading cause of C. difficile.
Clindamycin is historically associated with causing C. difficile but the aetiology has evolved significantly over the past 10 years.
C. difficile: think C!
How do you differentiate between moderate and severe C. diff infection? [1]
A raised WBC count (but less than 15 * 109 per litre) is indicative of a moderate C. difficile infection.
If the WBC count is greater than 15 * 109 per litre, it is indicative of a severe infection.
Describe a cause of LOS dysfunction [1]
Hiatus hernia: herniation of the stomach up through the diaphragm. Causes the opening from the oesophagus to the stomach to be wider, and more stomach content can reflux into the oesophagus
Describe the 4 different types of hiatus hernia [4]
Type 1: Sliding
Type 2: Rolling
Type 3: Combination of sliding and rolling
Type 4: Large opening with additional abdominal organs entering the thorax
Describe the LA Classification of oesophagitis [4]
Grade A
- At least one mucosal break, up to 5 mm, that does not extend between the tops of two mucosal folds
Grade B:
- At least one mucosal break, more than 5 mm long, that does not extend between the tops of two mucosal folds
Grade C:
- At least one mucosal break that is continuous between the tops of two or more mucosal folds but which involve less than 75% of the circumference
Grade D:
- At least one mucosal break which involves at least 75% of the esophageal circumference
On examination, there is a single irregular deep ulcer on her right shin. The ulcer has a pustular surface and a blue overhanging edge.
What does this describe? [1]
pyoderma gangrenosum
