Mild ( 6 blood stools, systemic upset)

Gastroenterology (medical) Flashcards by Yash Kapoor

UC classification

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

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IBD investigation

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

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UC features

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

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CD features

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

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Crohn’s management (induce remission, maintain remission)

Induce remission
1) Glucocorticoids

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

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

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

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UC management (induce remission, maintain remission)

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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UC management (severe colitis)

IV steroids or ciclosporin

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Internal haemorrhoids grading

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

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Haemorrhoids management

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

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Management of anal fissure present for < 1 week

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

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

Topical GTN
Sphincterotomy/botox

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Cause of perianal abscess

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

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Perianal abscess investigations

Clinical
MRI gold standard but used for complications

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Perianal abscess management

Incision and drainage
Abx if systemic

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Skin sign and deficiencies in coeliac disease in order of prevalence

Dermatitis herpetiformis

Irond deficiency anaemia > folate > B12

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Coeliac management

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

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Autoimmune hepatitis antibodies

ANA
SMA
LKM1

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Autoimmune hepatitis biopsy findings

Piecemeal necrosis
Bridging necrosis

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Autoimmune hepatitis management

Steroids, immunosuppressants
Liver transplant

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Primary biliary cholangitis presentation

Pruritus before jaundice
Fatigue
May have RUQ pain

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What is PBC?

Intrahepatic inflammation of bile ducts causing cholestasis

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PBC antibodies

AMA

PBC treatment

1) Ursodeoxycholic acid
2) Liver transplant

What is primary sclerosing cholangitis?

Inflammation and fibrosis of intra and extrahepatic bile ducts

PSC antibodies

pANCA

PSC MRCP finding

Beaded

PSC management

1) Cholestyramine / immunsuppresants 2) Liver transplant

Acute decompensation of liver disease signs

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

Ascites management

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

SBP investigation

USS Ascitic tap PMNL >250

SBP management

Piptazobactam

Haemochromatosis transferrin, ferritin, iron, and TIBC

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

Stain for liver biopsy and finding in joint xray in haemochromatosis

Perl's stain Chondrocalcinosis

Haemochromatosis management

1) Venesection 2) Desferrioxamine

Alcoholic hepatitis LFT findings

Very high GGT AST 2 or 3x ALT

Alcoholic hepatitis management

Prednisolone (Maddrey's discriminant function) Pentoxyphilline

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

T1: thrombosis T2: tumour

Budd-Chiari investigation

USS with doppler flow

Cause of achalasia

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

Achalasia gold standard investigation

Manometry

How to exclude malignancy if achalasia symptoms

Endoscopy

Achalasia medication whilst waiting for surgery

CCB

Surgical achalasia management

Pneumatic dilatation Laparoscopic cardiomyotomy / peroral endoscopic myotomy

Carcinoid syndrome investigation

Urinary 5-HIAA

Carcinoid syndrome management

Somatostatin analogue e.g. octreotide

C. difficile complication

Severe megacolon

C. difficile diagnosis

Toxin in stool Antigen shows exposure, not current infection

C. difficile management

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

Small bowel overgrowth investigations

Hydrogen breath test High folate Culture Abx trial

Small bowel overgrowth management

Rifaximin

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

Chest pain Subcutaneous emphysema

Boerhaave's syndrome investigation

CT contrast swallow

Boerhaave's syndrome management

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

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

Kayser-Fleischer rings (Wilson's disease)

Wilson's disease investigations

Slit lamp Low serum caeruloplasmin Low total serum copper High free serum copper

Wilson's disease management

1) Penicillamine 2) Trientine hydrochloride