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Year 6 > Gastroenterology (medical) > Flashcards

Gastroenterology (medical) Flashcards

1
Q

UC classification

A

Mild (<4 stools, little blood)
Moderate (4-6 stools)
Severe (>6 blood stools, systemic upset)

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2
Q

IBD investigation

A

Bloods: faecal calprotectin
Stool cultures and C diff toxin
AXR
MR enterography with oral contrast

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3
Q

UC features

A

Mucosa and submucosa
Decreased goblet cells
Cryst abscesses
Rectum common
Lead-pipe
Thumb-printing
Tenesmus
Nocturnal incontinence
Surgery curative

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4
Q

CD features

A

Transmural
Increased goblet cells
Terminal ileum common
Abscesses and fissues
String sign
Surgery not curative

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5
Q

Crohn’s management (induce remission, maintain remission)

A

Induce remission
1) Glucocorticoids

Maintain remission
1) Glucocorticoids
2) Azathioprine or mercaptopurine
3) Methotrexate

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6
Q

Crohn’s management (strictural terminal ileal disease, perianal fistulae (including investigation))

A

STID: ileocecal resection
Perianal fistula: MRI -> oral metronidazole

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7
Q

UC management (induce remission, maintain remission)

A

Induce remission
1) Topical rectal 5-ASA
2) Oral 5-ASA
3) Oral corticosteroid

Maintain remission
1) Topital/oral 5-ASA
2) Azathioprine or mercaptopurine

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8
Q

UC management (severe colitis)

A

IV steroids or ciclosporin

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9
Q

Internal haemorrhoids grading

A

1) No prolapse
2) Prolapse on defecation (reduces spontaneously)
3) Prolapse on defecation (reduces manually)
4) Can’t reduce prolapse

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10
Q

Haemorrhoids management

A

1) Conservative
2) Sclerotherapy
3) Rubber band ligation
4) Surgical haemorrhoidectomy

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11
Q

Management of anal fissure present for < 1 week

A

Conservative
Laxatives (bulk-forming)
Analgesia (including topical anaesthetics)

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12
Q

Management of anal fissure present for >6 weeks (chronic)

A

Topical GTN
Sphincterotomy/botox

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13
Q

Cause of perianal abscess

A

E. coli (most common)
Staph. aureus (from skin)

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14
Q

Perianal abscess investigations

A

Clinical
MRI gold standard but used for complications

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15
Q

Perianal abscess management

A

Incision and drainage
Abx if systemic

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16
Q

Skin sign and deficiencies in coeliac disease in order of prevalence

A

Dermatitis herpetiformis

Irond deficiency anaemia > folate > B12

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17
Q

Coeliac management

A

Replace B12 then folate
Gluten-free diet
Refer to dietician or gastro - annual review

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18
Q

Autoimmune hepatitis antibodies

A

ANA
SMA
LKM1

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19
Q

Autoimmune hepatitis biopsy findings

A

Piecemeal necrosis
Bridging necrosis

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20
Q

Autoimmune hepatitis management

A

Steroids, immunosuppressants
Liver transplant

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21
Q

Primary biliary cholangitis presentation

A

Pruritus before jaundice
Fatigue
May have RUQ pain

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22
Q

What is PBC?

A

Intrahepatic inflammation of bile ducts causing cholestasis

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23
Q

PBC antibodies

A

AMA

24
Q

PBC treatment

A

1) Ursodeoxycholic acid
2) Liver transplant

25
Q

What is primary sclerosing cholangitis?

A

Inflammation and fibrosis of intra and extrahepatic bile ducts

26
Q

PSC antibodies

A

pANCA

27
Q

PSC MRCP finding

A

Beaded

28
Q

PSC management

A

1) Cholestyramine / immunsuppresants
2) Liver transplant

29
Q

Acute decompensation of liver disease signs

A

Splenomegaly
Ascites
Encephalopathy
Varices
Failed liver function e.g. poor clotting

30
Q

Ascites management

A

Restrict fluids
Spironolacton
SBP prophylaxis (ciprofloxacin + propranolol)
TIPSS shunt between hepatic portal vein and hepatic vein
Paracentesis if tense

31
Q

SBP investigation

A

USS
Ascitic tap PMNL >250

32
Q

SBP management

A

Piptazobactam

33
Q

Haemochromatosis transferrin, ferritin, iron, and TIBC

A

Transferrin: high
Ferritin: high (late)
Iron: high
TIBC: low

34
Q

Stain for liver biopsy and finding in joint xray in haemochromatosis

A

Perl’s stain
Chondrocalcinosis

35
Q

Haemochromatosis management

A

1) Venesection
2) Desferrioxamine

36
Q

Alcoholic hepatitis LFT findings

A

Very high GGT
AST 2 or 3x ALT

37
Q

Alcoholic hepatitis management

A

Prednisolone (Maddrey’s discriminant function)
Pentoxyphilline

38
Q

T1 and T2 in Budd-Chiari syndrome (blockage of hepatic vein: liver to vena cava)

A

T1: thrombosis
T2: tumour

39
Q

Budd-Chiari investigation

A

USS with doppler flow

40
Q

Cause of achalasia

A

Loss of ganglia from Auerbach’s plexus - lower oesophageal sphincter contracted

41
Q

Achalasia gold standard investigation

A

Manometry

42
Q

How to exclude malignancy if achalasia symptoms

A

Endoscopy

43
Q

Achalasia medication whilst waiting for surgery

A

CCB

44
Q

Surgical achalasia management

A

Pneumatic dilatation
Laparoscopic cardiomyotomy / peroral endoscopic myotomy

45
Q

Carcinoid syndrome investigation

A

Urinary 5-HIAA

46
Q

Carcinoid syndrome management

A

Somatostatin analogue e.g. octreotide

47
Q

C. difficile complication

A

Severe megacolon

48
Q

C. difficile diagnosis

A

Toxin in stool
Antigen shows exposure, not current infection

49
Q

C. difficile management

A

1) Oral vancomycin
2) Oral fidaxomicin (or first if recurrence)
3) Oral vancomycin + IV metronidazole

50
Q

Small bowel overgrowth investigations

A

Hydrogen breath test
High folate
Culture
Abx trial

51
Q

Small bowel overgrowth management

A

Rifaximin

52
Q

Boerhaave’s syndrome presentation (rupture of oesophagus from vomiting)

A

Chest pain
Subcutaneous emphysema

53
Q

Boerhaave’s syndrome investigation

A

CT contrast swallow

54
Q

Boerhaave’s syndrome management

A

< 12 hours: thoracotomy and lavage
> 12 hours: T tube (fistula between oesophagus and skin)

55
Q

Basal ganglia degeneration, renal tubular acidosis, blue nails - which eye signs would you expect?

A

Kayser-Fleischer rings

(Wilson’s disease)

56
Q

Wilson’s disease investigations

A

Slit lamp

Low serum caeruloplasmin

Low total serum copper
High free serum copper

57
Q

Wilson’s disease management

A

1) Penicillamine
2) Trientine hydrochloride

Year 6 (19 decks)

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