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Yr3 Revision: Condensed Notes > Gastroenterology I > Flashcards

Gastroenterology I Flashcards

1
Q

What causes secretory diarrhoea? [5]

A

Excess secretion of water:
- IBD
- Salmonella infection
- Enterotoxins: E. coli, V. cholera
- Bile salts
- Hormones

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2
Q

What are the three differentials for asterixis? [1]

A

CO2 retention (e.g. COPD)
Uraemia
Hepatic encephalopathy

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3
Q

A patient has these hands. Alongside cardio-resp diseases, what might a gastro differential be? [1]

A

IBD

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4
Q

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

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.

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5
Q

A patient presents with hypoalbuminemia.
Which nail changes are you likely to see

Clubbing
Koilonychia
Leuconychia
Mees’ lines
Onycholysis

A

A patient presents with hypoalbuminemia.
Which nail changes are you likely to see

Clubbing
Koilonychia
Leuconychia
Mees’ lines
Onycholysis

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6
Q

A patient has stage 4 CKD.

What nail change might you expect to see

Clubbing
Koilonychia
Leuconychia
Mees’ lines
Onycholysis

A

A patient has stage 4 CKD.

What nail change might you expect to see

Clubbing
Koilonychia
Leuconychia
Mees’ lines
Onycholysis

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7
Q

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

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

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8
Q

A patient presents with these nail changes. You find out that they have normal iron levels.

What infective organism might cause this? [1]

A

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

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9
Q

A patient presents with this nail change. What systemic condition is likely to have caused this? [1]

A

Psoriasis

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10
Q

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]

A

Rigler’s sign: a double bowel wall seen on x-ray
- sign of pneumoperitoneum

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11
Q

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]

A

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.

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12
Q

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

A

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

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13
Q

How do you distinguish between steatorrhoea from pancreatic insufficiency and small intestine disease? [4]

A

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}

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14
Q

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]

A

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

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15
Q

What is the gold standard for investigating diarrhoea? [1]

A

Colonoscopy & biopsy
(Also:
- Duodendal biopsy
- Small bowel MRI
- Video capsule endoscopy
- Cross sectional imaging)
}}

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16
Q

Which viruses commonly cause viral gastroenteritis? [3]

A

Rotavirus
Norovirus
Adenovirus (tends to cause respiratory symptoms)

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17
Q

How do you treat Campylobacter jejuni infection? [3]

A
  • Clathromycin (1st line)
  • Azithromycin
  • Ciprofloxacin
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18
Q

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]

A

Bacillus cereus

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19
Q

What syndrome can Shigella cause? [1]
Name two treatments [2]

A

haemolytic uraemic syndrome:

Treatment of severe cases is with azithromycin or ciprofloxacin.

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20
Q

How do you treat Giardia lamblia? [2]

A

tinidazole or metronidazole

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21
Q

Which antibiotics are most likely to cause C. difficile infection? [2]

A

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!

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22
Q

How do you differentiate between moderate and severe C. diff infection? [1]

A

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.

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23
Q

Describe a cause of LOS dysfunction [1]

A

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

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24
Q

Describe the 4 different types of hiatus hernia [4]

A

Type 1: Sliding
Type 2: Rolling
Type 3: Combination of sliding and rolling
Type 4: Large opening with additional abdominal organs entering the thorax

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25
Describe diagnostic investigations for GORD [3]
**Therapeutic trial of PPI:** - i.e. 40mg of omeprazole for 2 weeks and if the symptoms are completely resolved on that and no alarm symptoms, this may be a reasonable diagnostic tes **Endoscopy** (NB: ~ 50% have no lesions); - used to create **Los Angeles scoring system** for oesophagitis **Oesophageal function testing**: - can **monitor pH over 24 hours** using a small sensor
26
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
27
State the therapeutic management for GORD - Therapeutics [4] - Surgery [1]
Drugs: If no red flags: **4 week PPI course**: - **omeprazole** **Antiacids**: **Mg trisilicate** **Alginates**: **Gaviscon** **Acid suppression**: - PPIs: **omeprazole** and **lansoprazole** - or H2 receptor antagonists: **famotidine** or **ranitidine** Surgery: - **laparoscopic fundoplication:** tying the fundus of the stomach around the lower oesophagus to narrow the lower oesophageal sphincter
28
Describe the treatment for non-dysplastic BO [2] low-grade dysplasia BO [2] high-grade dysplasia [3]
non-dysplastic BO: - **PPI** (omeprazole) - **Anti-reflux surgery** (Nissen fundoplication) low-grade dysplasia BO - **radiofrequency ablation** - **consider PPI** high-grade dysplasia - **radiofrequency ablation** - **consider PPI** - **oesophagectomy**
29
Describe what Eosinophilic oesophagitis (EoO) is [2]
Chronic, immune-mediated/allergen-mediated clinicopathological condition: - **oesophageal dysfunction** (e.g., dysphagia and food impaction in adolescents and adults, and vomiting, regurgitation, heartburn, abdominal pain) **AND** - Histologically: **eosinophilic infiltration** of the oesophageal epithelium of ≥15 eosinophils
30
How do you diagnose EoO? [1] How do you treat? [2]
Diagnose: **biopsy** Tx: **swallow inhaled steroids; exclusion diet**
31
State five drug classes that can cause GORD [5]
* **tricyclic** * **anticholinergics** * **nitrates** * **CCBs** * **NSAIDs**
32
Describe symptoms of GORD [5]
**Heartburn** **Retrosternal discomfort after meals** **Belching** **Halitosis** **Acid brash** **Increased salivation** (mouth fills with saliva)
33
State 3 extra-oesophageal symptoms of GORD [3]
**Nocturnal asthma** **Chronic cough** **Laryngitis** Sinusitis
34
Which form of testing for H. pylori is used for **post-eradication therapy**? [1]
**Urea breath test** is the only test recommended for H. pylori post-eradication therapy
35
Which form of Which form of testing for H. pylori is used for **diagnosis**? [1]
The **stool** **test** is often used to **diagnose** Helicobacter pylori, but cannot be used to test for eradication as there is insufficient evidence for this.
36
Which form of testing for H. pylori is used for **during endoscopy**? [1]
**CLO testing** is a **rapid urease test** that is done during endoscopy to detect Helicobacter pylori and relies on the fact that the bacteria contain the urease enzyme . It is approximately 90% sensitive, however it is an invasive test and is not recommended for eradication testing unless a patient requires an endoscopy.
37
Achalasia is associated with which type of oesophageal cancer? [1] Name a significant risk factor for this cancer [1]
**Squamous cell cancer** **Smoking**
38
Describe the blood results for a patient with Coeliac [4]
**normocytic anaemia:** causes malabsorption of iron, folate and B12 - compensates to make normocytic Raised **WCC** and **CRP** Positive for **IgA-tTG** Positive for **endomysial antibody (EMA)**: a more expensive alternative to IgA-tTG
39
What is the seroligcal test of choice for a coeliac patient with IgA defiency? [1]
**IgG DGP** (deamidated gliadin peptide)
40
Which three antibodies are related to coeliac? [3]
Anti-tissue transglutaminase antibodies (anti-TTG) Anti-endomysial antibodies (anti-EMA) Anti-deamidated gliadin peptide antibodies (anti-DGP)
41
Coeliac disease can effect which organ? [1] Why is this clinically significant? [3]
Causes **hyposplenism**: means that patients are at risk of: - **Pneumococcus** - **Haemophilus influenzae** - **meningococcus**
42
Name [1] and explain [3] an MSK complication of coeliac.
**Osteoporosis**: **Reduced bone mineral density** is common in coeliac disease and often improves significantly within 1 year of gluten withdrawal. Occurs due to: * **release of pro-inflammatory cytokines** * **calcium malabsorption** * **activation of osteoclasts**
43
Which cancer is associated iwth coeliac? [1]
Enteropathy associated T cell lymphoma of smal intestine
44
Why may coeliac disease lead to fat malabsorption? [2]
Decrease in absorptive surface area Decrease in absorption of fat soluble vitamins: **ADEK**
45
Describe what is meant by refractory coeliac disease [1] Describe the two classifcations [2]
**Refractory coeliac disease:** **persistent** or **recurrent** **symptoms** and signs of malabsorption **despite** **adherence** to a **strict gluten-free diet for at least 12 months**. Believed to be **independent** of **gluten** since the gluten-free diet is not effective in preventing the lymphocytes from increasing. **Type I**: - Have < 20% abnormal lymphocytes **Type II:** - Have >20% abnormal lymphocytes
46
State why and explain which type of refractory coeliac disease is more prone to cancers [2]
**Type II:** - Type II have a greater than 50 percent chance of the **abnormal lymphocytes spreading outside the gut** - Causes: developing **enteropathy-associated T-cell lymphoma (EATL)**
47
Which type of cancer in the GI tract do coelaic patients suffer a risk of developing? [1]
**Small bowel adenocarcinoma**
48
Describe two neuorogical complications of coeliac disease [2]
*Anti-gluten antibodies created by the immune system of patients with celiac disease in response to gluten are thought to damage nerves* **Peripheral neuropathy**: Coeliac disease can be associated with peripheral neuropathy, presenting as numbness, tingling, or burning sensations in the extremities. **Gluten ataxia:** This rare neurological complication is characterized by gait disturbances, dysarthria, and nystagmus. A gluten-free diet may improve symptoms in some cases.
49
A transjugular intrahepatic portosystemic shunt (TIPS) procedure connects the **[]** to the **[]**
A transjugular intrahepatic portosystemic shunt (TIPS) procedure connects the **hepatic vein** to the **portal vein**
50
What do you give to treat minor and major salicylate poisoning? [2]
If overdoses are recent, **administer activated charcoal** However, more **significant overdoses** may require alkalinisation with IV sodium bicarbonate in order to maintain blood pH at 7.5-8.0 , and enhance salicylate excretion.
51
What is the single laboratory finding that should prompt an immediate consideration of liver cirrhosis and urgent review by hepatology? Platelet count = 90 x 10^9/ L AST = 80 U/ L with ALT=85 U/ L ALP = 155 g/ L Urea = 11 mmol/L Hb = 85 g/ L
What is the single laboratory finding that should prompt an immediate consideration of liver cirrhosis and urgent review by hepatology? **Platelet count = 90 x 10^9/ L** Thrombocytopenia (platelet count < 150,000 mm^3) is the most sensitive and specific lab finding for diagnosis of liver cirrhosis in those with chronic liver disease
52
Name a pneumonic for remembering the drugs that can cause pancreatitis [5]
**SSAND** steroids, sodium valproate, azathioprine, NSAIDs, diuretics
53
The 'double duct' sign may be seen in [] cancer Acanthosis nigricans is associated with [] cancer.
The 'double duct' sign may be seen in **pancreatic** **cancer** Acanthosis nigricans is associated with **gastric cancer**
54
What results in a FBC and LFT would indicate alcohol excess? [2]
**Isolated rise in GGT** in the context of a **macrocytic anaemia** suggests alcohol excess as the cause
55
[] used to treat the symptoms of carcinoid syndrome
**Octreotide** is a somatostatin analogue used to treat the symptoms of carcinoid syndrome
56
What treatment do you give to somone for N&V from a migraine? [1]
A prokinetic such as **metoclopramide** is the recommended antiemetic in these patients, as it helps to relieve the gastric stasis that can slow the transit and absorption of drugs during an acute migraine attack.
57
A bulk-forming laxative such as **[]** is the first-line recommended pharmacological treatment for **constipation** in patients with **IBS**.
A bulk-forming laxative such as **isphagula husk** is the first-line recommended pharmacological treatment for constipation in patients with IBS.
58
*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**
59
Alendronate is indicated for the treatment of postmenopausal osteoporosis and is known to increase the risk of [2]
Alendronate is indicated for the treatment of postmenopausal osteoporosis and is known to increase the risk of **oesophagitis and oesophageal ulcers**
60
A 45 year old man presents to his GP with abdominal pain. The pain is burning in nature and localised to his epigastric area. A stool serology test for Helicobacter pylori is positive. He is treated with eradication therapy. At follow up 8 weeks later, his symptoms are persisting. Further management options are considered including urea breath test, repeat stool serology, FBC, CLO testing and further monitoring without tests. What should be the next most appropriate step in his management? CLO testing FBC No investigation necessary Repeat stool serology Urea breath test
**Urea breath test**
61

Yr3 Revision: Condensed Notes (51 decks)

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