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Finals > Gastroenterology Mx/Invx 🚽✅ > Flashcards

Gastroenterology Mx/Invx 🚽✅ Flashcards

1
Q

Oesophageal varices investigation

A

Gastroscopy

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2
Q

Medication for prophylaxis for oesophageal varices

A

Beta blocker (propanolol)

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3
Q

Medications when oesophageal varices ruptured

A

Ocreotide first, Terlipressin second. Abx

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4
Q

Endoscopic management for esophageal varices. Consider portal HTN too

A

Band ligation. Balloon Tamponade if bleeding. TIPS to decrease portal hypertension

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5
Q

Mallory-Weiss management

A

Treat like every upper GI bleed. Can-do epinephrine, thermal therapy, sclerosant therapy in endoscopy. Gastric artery ligation 2nd. Antibiotics. If bleeding stops can just give PPI.

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6
Q

Boerhaave Invx

A

If suspect, do contrast oesophagram with gastrographin

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7
Q

Treatment for boerhave

A

Broad-spectrum antibiotics, repair the tear, mediastinal wash, fluids, NPO

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8
Q

Some main investigations for lower GI bleed

A

Colonoscopy/push enteroscopy/Cam. Vascular studies is a second line. Open laparoscopy last line

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9
Q

Diverticulosis management

A

High fibre meals high water intake

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10
Q

Diverticulitis management

A

Antibiotics and if perforation do surgery and peritoneal lavage

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11
Q

Investigations for diverticulitis/diverticulosis

A

Colonoscopy or CT. Chest x-ray if perforation

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12
Q

Stages 1–4 for haemorrhoids

A

One – not visible, two – returns itself, three – returns with finger, four – doesn’t return

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13
Q

First line management ideas for haemorrhoids

A

High fibre, exercise, stool softener, topical steroids

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14
Q

Aside from Conservative management, haemorrhoids grade one – two can both be managed with which intervention

A

Sclerotherapy

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15
Q

Aside from Conservative management, haemorrhoids grade 2 and 3 can both be managed with which intervention

A

Rubber band ligation or haemorrhoidopexy

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16
Q

Grade 4 haemorrhoids usually need what Treatment

A

Haemorrhoidectomy

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17
Q

General GI bleed management

A

ABC, two bore needles, crossmatch, take bloods, IV saline, catheter and urine output, ECG, chest x-ray, terlipressin if suspect varices, antibiotics. If upper bleed do endoscopy within 24 hours

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18
Q

GERD investigations in a patient less than 40

A

PPI trial for one month

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19
Q

GERD investigations for a patient more than 40 years old or has dysphasia or has a ALARMS symptoms

A

Endoscopy and 24 hour pH monitoring

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20
Q

First line therapy for GERD

A

Lifestyle modifications, antacids if mild, PPI if more severe

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21
Q

Indications for Nissen fundoplication

A

GERD refractory to medical therapy or has complications

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22
Q

Los Angeles classification grade A

A

GERD. One or more mucosal erosions confined to mucosal folds. Do not exceed 5 mm

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23
Q

Los Angeles classification grade B

A

Mucosal breaks confined to mucosal folds. Do exceed 5 mm

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24
Q

Los Angeles classification grade C

A

Mucosal breaks beyond mucosal folds

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25
Q

Los Angeles classification D

A

75% or more of the circumference of the oesophagus is eroded

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26
Q

Two potential investigations for hiatal hernia

A

Endoscopy (to rule out other pathology). CT plus IV contrast diagnose is it

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27
Q

Treatment for most cases of hiatal hernia

A

Conservative. Decrease weight. PPI

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28
Q

Indications for surgery in hiatal hernia

A

Medications did not work, or complicated case

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29
Q

Barretts oesophagus endoscopic surveillance, if no dysplasia

A

Every 3 to 5 years

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30
Q

Barretts oesophagus surveillance, if dysplasia present

A

Endoscopy every 6 to 12 months

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31
Q

How to manage Barretts in young patients or patients with high-grade dysplasia

A

Perform in oesophagectomy

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32
Q

Eosinophilic oesophagitis management

A

Corticosteroids and avoid trigger in diet

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33
Q

Investigation of choice for oesophageal cancer

A

Endoscopy. Then for metastasis do CT, Laparoscopy to check for partner your maths, and consider endoscopic ultrasound

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34
Q

Treatment for oesophageal cancer in the initial stages (mucosa in submucosal invasion)

A

Ablation, endoscopic resection, or oesophagectomy

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35
Q

Advanced oesophageal cancer treatment

A

Iver Lewis and chemotherapy

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36
Q

For late stages of oesophageal cancer patients may get dysphasia, how can we manage this

A

Stent placement

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37
Q

Investigations for acute/general gastritis

A

H. pylori test (either urea breath or stool antigen), B12, endoscopy and biopsy

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38
Q

General treatment for acute gastritis/ulcers

A

PPIs and treat cause

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39
Q

Treatment for H. pylori

A

Triple therapy (PPI, clarithromycin, amoxicillin or metronidazole) can also add bismuth

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40
Q

Bleeding peptic ulcer management

A

PPI, tranexamic acid, somatostatin analog, do endoscopy if active bleeding

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41
Q

Investigations for peptic ulcer disease

A

Endoscopy is the gold standard, and should biopsy to rule out malignancy. Chest x-ray if suspect perforation. Order urea breath test, full blood count, Gastro

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42
Q

Management of gastric cancer (local versus extensive)

A

If local can do endoscopic resection. If extensive should do gastrectomy and lymph node ectomy

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43
Q

Peritonitis investigations

A

Supine and upright abdomen x-ray (in case of perforation), CT, paracentesis undo SAAG

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44
Q

Treatment for peritonitis

A

Third generation cephalosporin, consider albumin infusion if suspected liver cause, laparoscopic surgery if perforation case

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45
Q

Infectious diarrhoea treatment Generally

A

Oral fluids is best, but IV fluids if vomiting or situation severe. Empiric antibiotics only if suspect infectious bacterial diarrhoea

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46
Q

C diff antibiotics

A

Fidoximicin or oral vancomycin for mild

Fidoximicin or oral vancomycin for more severe

Fulminant cases, oral vancomycin and IV metronidazole are best

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47
Q

Pneumoperitoneum investigation and management

A

Chest x-ray, supine abdominal x-ray, CT. And laparoscopy to fix

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48
Q

Investigation for C. difficile

A

Toxin A and B to check in stool, PCR is also okay.: colonoscopy can be done

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49
Q

Investigations/diagnosis of Crohn’s

A

Endoscopy and biopsy. Blood tests are important to

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50
Q

Treatment overview for Crohn’s

A

Steroids for flares. Mesalazine is the best initial maintenance therapy, reserved for mild diseases. Azathioprine and MTX reserved for moderate disease. TNF alphas for late

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51
Q

Colon cancer surveillance for Crohn’s patients

A

Start eight years after diagnosis. Do every 1 to 3 years

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52
Q

Investigations for ulcerative colitis

A

Stool culture to rule out infection. Bloods are important. Radiograph to rule out megacolon, colonoscopy and biopsy is diagnostic

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53
Q

Management overview for ulcerative Colitis
🥲

A

Acute: mesalamine for mild, CSs for moderate, IV steroids for severe

Maintenance: mesalamine for mild, other biologicals for step up

Last line colectomy

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54
Q

Diagnosis/investigations for appendicitis

A

Dx by Clinical diagnosis and imaging. Ultrasound can be done first and is the main stay in kids and pregnancy. CT with contrast is the best however. MRI for preg and children is an alternative.

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55
Q

Management for appendicitis. Consider non-ruptured, ruptured, ruptured but stable

A

Antibiotics and appendectomy. Appendectomy should be done within 12 hours of diagnosis. If that is perforation appendectomy should be done immediately. If perforated but patient is still stable can do IV antibiotics, drainage of any abscess, and a rescue appendectomy

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56
Q

Diagnosis and investigations for small bowel obstruction

A

Best initial test is abdominal x-ray. CT is best to find the cause (diagnostic). Do ABG, full blood count, lactate et cetera also

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57
Q

What investigation can be done for patients who do not respond to Conservative treatment for SBO, and can potentially rule out the need for surgery

A

Small bowel follow through with Gastrografin

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58
Q

Nonsurgical/Conservative treatment for SBO

A

Fluids, NPO, NG decompression, attempt to treat underlying cause

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59
Q

Indications for surgery for SBO

A

Peritonitis, acidosis, continuous pain, systemic symptoms, or need to lyse adhesions. Or Conservative therapy does not work for 24 hours

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60
Q

Patient has fever and paralytic ileus 5–7 days after bowel surgery. What is happening

A

Anastomotic leak

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61
Q

Patient has closed loop large bowel obstruction. How to manage according to GI surgeon guy

A

Do Hartmanns procedure and anastomosis later

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62
Q

Management of large bowel obstruction (general)

A

Hospitalised, Xray and CT, Gastrografin enema, Colonoscopy. Surgery usually required

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63
Q

When do you not do surgery in SBO

A

If abdomen soft non-tender. Or if partial SBO

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64
Q

Stage 1234 colorectal cancer

A

Stage one is mucosal. Stage two is muscularis. Stage three is lymph nodes. Stage four is distant metastasis.

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65
Q

How to manage a stage one colo rectal cancer

A

Resect locally

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66
Q

How to manage a stage 2 colorectal cancer

A

Partial colectomy and lymph node ectomy

67
Q

How to manage a stage three colorectal cancer

A

Partial colectomy and lymph node ectomy And chemotherapy

68
Q

How to manage a stage 4 colorectal cancer

A

Partial colectomy and lymph node ectomy And chemotherapy. Consider full colectomy

69
Q

Patient with lynch syndrome. Went to screen for colorectal cancer

A

Start a 20 and do every one year

70
Q

When to start screening for colorectal cancer in FAP

A

Start at 10 years old

71
Q

Management of toxic megacolon

A

Broad-spectrum antibiotics and corticosteroids. NG decompression, fluids. It doesn’t improve after 48 hours colectomy

72
Q

Ischaemic colitis best initial test. And then best test overall

A

CTA without contrast, endoscopy and biopsy respectively (needed for Dx)

73
Q

Management of mild colonic ischaemia

A

Bed rest and observe. NGT if Ileus

74
Q

Management of moderate colonic ischaemia

A

Antibiotics

75
Q

Management of severe colonic ischaemia

A

Exploratory laparotomy. May need to resect the necrotic bowel. Indicated if you see peritonitis, gangrene , pneumatosis

76
Q

Best initial investigation and best overall investigation for acute mesenteric ischaemia

A

CTA (non invasive), mesenteric angiography (invasive) respectively. Angio needed to confirm Dx

77
Q

Overview of management for acute mesenteric ischaemia

A

NGT decomp, fluids and NPO. Angioplasty or thrombolysis, and emergency laparotomy if signs of necrosis or peritonitis

77
Q

When to invx penetrative retroperitoneal trauma? and blunt trauma?

A

Always invx penetrative. blunt only if zone 1

78
Q

Treatment of gallstone ileus

A

Laparotomy to extract stone, close to fistula, cholecystectomy

79
Q

Diagnosis of gallstone ileus

A

X-ray of the abdomen first, to see small bowel obstruction and pneumobilia. This usually confirms the diagnosis. Can do upper GI barium contrast

80
Q

Suspect cholelithiasis , How to investigate

A

Ultrasound, and MRCP/ERCP if US equivocal

81
Q

Management of incidental asymptomatic gallstones in GB

A

No treatment needed.

82
Q

Investigations for choledocolithiasis

A

Right upper quadrant ultrasound first, then either MRCP (middle risk of choledoc), or ERCP (if high-risk of choledoc)

83
Q

Management of biliary colic (consider when to do Sx)

A

Analgesia, rehydration. And an elective cholecystectomy If severe symptoms, porcelain, Empyema , pancreatitis. This is not choledocolithiasis remember

84
Q

Management for choledocho lithiasis

A

 ERCP, it’s both diagnostic and therapeutic. After 72 hours after ERCP should do cholecystectomy

85
Q

Investigations for ascending cholangitis

A

Right upper quadrant ultrasound first. Then either an ERCP or MRCP.

86
Q

Management of ascending cholangitis

A

Acutely managed. Empiric antibiotics (ceftriaxone ) and ERCP. Cholecystectomy after. Percutaneous drainage performed if ERCP did not work or cannot be done

87
Q

Investigations for cholecystitis

A

Right upper quadrant sound first. If findings are equivocal and suspicion is strong can do HIDA scan

88
Q

How to manage cholecystitis

A

Supportive care (analgesia and fluids), nonemergent cases do cholecystectomy in less than 72 hours. Emergent cases (perforation, gangrene) do cholecystectomy right away

89
Q

Investigations for primary biliary cirrhosis

A

Antimitochondrial antibodies, LFTs, ultrasound of the liver. Biopsy only if suspicion high and AMA is negative

90
Q

Treatment for primary biliary cirrhosis

A

Ursodeoxycholic acid. Consider cholestyramine. Transplant in cirrhosis

91
Q

Investigations for primary sclerosing cholangitis

A

MRCP is first line. ERCP similar to MRCP but is considered a gold standard. LFTs needed. Biopsy if inconclusive. P-ANCA not needed

92
Q

Treatment of primary sclerosing cholangitis

A

Ursodeoxycholic acid. Can do stenting and balloon dilation. Liver transplant may be needed

93
Q

investigation ideas for ischaemic hepatitis

A

rule out hepatitis from viruses and medication/paracetamol. Do LFTs of course

94
Q

Treatment for ischaemic hepatitis

A

Resus and treat underlying cause

95
Q

Investigation for autoimmune hepatitis

A

Rule out viruses and paracetamol. LFTs. Anti-smooth-muscle antibody. Biopsy usually needed And is most accurate

96
Q

Treatment for a autoimmune hepatitis

A

Corticosteroids. Plus or minus Azathioprine. If fails do liver transplant

97
Q

Grade one, two, three, four hepatic encephalopathy

A

Grade 1 is irritable. Grade 2 is confused and inappropriate. Grade 3 is incoherent and restless. Great 4 is coma (IIIC)

98
Q

Investigations for hepatic encephalopathy

A

Clinical diagnosis. Ammonia and urea measurements. Consider CT or MRI

99
Q

Type A versus B versus C hepatic encephalopathy 

A

Type A is Acute liver failure. Type B is Bypass shunt. Type C is Cirrhosis

100
Q

Management of hepatic encephalopathy

A

Lactulose and rifaximin

101
Q

Investigations for Budd-Chiari

A

Ultrasound with Doppler is first line. Arteriography is gold standard

102
Q

Management of Budd-Chiari

A

Anticoagulant and diuretics (for ascites). Consider TIPS. Consider thrombolysis

103
Q

Management for the fatty liver disease

A

Lifestyle

104
Q

Wilson’s disease investigations

A

Non invasive first: 24 urinary copper excretion, ceruloplasmin and serum copper, slitlamp exam. Liver biopsy not always needed, can do genetic testing

105
Q

Treatment for Wilson’s

A

Penicilamine and oral zinc is first line. Transplant if medication fails

106
Q

 Main investigations for acute pancreatitis

A

Bloods as usual (especially amylase). Ultrasound first (check stones), CT best

107
Q

Management of acute pancreatitis

A

Remove offending agent, opioids, fluids, electrolyte, bowel rest, NG decompression, IV antibiotics. ERCP if gallstone pancreatitis, surgical debride meant if necrosis

108
Q

Investigations for chronic pancreatitis

A

Bloods as usual. CT first and best (MRCP good also), and/or proof of insufficiency such as faecal fat, elastase tests

109
Q

Modified Glasgow criteria for acute pancreatitis

A

PANCREAS. PA02 below 8, age above 55, neutrophils above 15, calcium below 2, renal function with a urea above 16, enzymes with LGH above 600 and AST above 2000, albumin below 32 and sugar above 10

110
Q

Management for a chronic pancreatitis patient

A

CREON, low-fat, vitamin ADEK, PPI, insulin if needed, opiate or NSAIDs, stop alcohol and smoking

111
Q

Stage one, two, three, four for pancreatic cancer

A

Stage one is less than 2 cm. Stage two is 2 cm or more. Stage three is spread to neighboring tissue. Stage four is distant metastasis

112
Q

First imaging modality for pancreatic cancer suspicion. Consider if jaundice present or not present

A

If you want this present do ultrasound first, if jaundice not present do CT first

113
Q

When is an ERCP used in the investigations of pancreatic cancer

A

If both CT an ultrasound or unequivocal

114
Q

Aside from imaging which investigations should be done for pancreatic cancer

A

CA 19–9, lipase, LFTs

115
Q

Surgical procedure for pancreatic head cancer

A

Whipples (pancreatoduodenectomy)

116
Q

Patient has dysphasia. Only to solid food and is intermittent. What is the differential

A

Can be webs, rings, stricture. Eosinophilic oesophagitis

117
Q

Patient has dysphasia to solid foods. And has been progressive… may start to impede liquids too

A

Can be peptic stricture (young good patient). Or oesophageal cancer

118
Q

Patient has dysphasia to both solids and liquids and is intermittent. Patient has chest pain in these periods

A

Diffuse oesophageal spasm

119
Q

Patient has dysphasia. Has been progressive. And is to solids and liquids (was to both initially and equally). What are two differentials

A

Scleroderma or achalasia

120
Q

Patient has dysphasia, specifically an issue initiating swallowing. Is this oesophageal or oropharyngeal

A

Oropharyngeal

121
Q

Hepatic angioma, investigation/diagnosis. Any CI’s?

A

Contrast enhanced imaging. Likely done by ultrasound or CT. Do not biopsy

122
Q

Hydatid cyst diagnosis/investigation

A

Imaging (usually ultrasound), with a follow-up with CT. Alongside an ELISA.

123
Q

Diagnosis/investigations for hepatocellular cancer

A

LFTs, CT or ultrasound, AFP, biopsy only if diagnosis uncertain.

124
Q

definition of chronic diarrhea

A

Abnormal passage of 3 or more loose stools/day for more than 1 month

125
Q

what is ROME criteria used for?

A

IBS

126
Q

assymptomatic gall stones in biliary tree vs gall bladder (mx of both?)

A

in GB? Do reassurance. In tree? Do cholecystectomy and bile duct clearance

127
Q

GB empyema Tx?

A

percutaneous cholecystotomy

128
Q

H pylori Mx

A

PPI+amoxicillin+clarithromycin for 7 days

129
Q

Mx of mild to moderate UC… whether in acute flare or not (doesnt matter)

A

oral 5-aminosalicylic acid (5-ASA) medications and 5-ASA enemas. Not CSs

130
Q

Prior to Nissen fundoplication, what needs to be done

A

24 hr pH monitoring with a pH of 4 or less

131
Q

Dyspepsia Mx…. algorithm ideas

A

Clinically Dx (incl urea breath test), then preemptively Tx (PPI/triple therapy etc.) and see if gets better. EGD only if doesn’t improve (confirmatory)

132
Q

Tx of NSAID-induced PUD

A

stop NSAID use and introduce proton pump inhibitor (PPI) use

133
Q

which peritonitis types are pauci-bacillary and which are polymicrobial

A

pauci = Primary spont. bac (only cocci can cross barrier
poly = secondary causes (perforation)

134
Q

main cause of dialysis associated peritonitis

A

staph epidermidis

135
Q

definition of acute and persistent diarrhea

A

acute = less than 2 weeks
persistent = 2-4 weeks

136
Q

ABx coverage in gastroenteritis?

A

o Most bacteria are gram –ive bacteria
Cephalosporin (3rd gen)
Quinolones (ciprofloxacin)
o Anaerobic coverage
Metronidazole
o Clostridium infection
Metronidazole IV or vancomycin PO (IV maybe)

137
Q

Option for testing in IgA def patients for celiacs

A

for patients with IgA deficiency, deamidated gliadin peptide (DGP) IgG testing is available

137
Q

Is peritonitis a CI for anastomosis?

A

yes

138
Q

Overview of management for chronic mesenteric ischaemia

A

NGT decomp, fluids and NPO. Vasodilator, anticoag Tx

139
Q

Lynch syndrome Amsterdam criteria

A

3 fam members, 2 generations, 1 less than 50 yo

140
Q

Sepsis Mx

A

ABCDEFG
AIRWAY = maintain airway (and check for patency)
BREATHING = give O2 and aim for SpO2 >95%
CIRCULATION – 2 large bore IV lines Get IV access, collect blood and check blood
Bloods for culture (x2 at 2 different sites)
FBC, EUC, CRP, LFT, Glucose, Calcitonin
IV fluid for resuscitation (250-500ml NaCl 0.9% bolus)
Administration of IV broad spectrum Abx.
Early antibiotic use with empiric broad spectrum, depending on where you think the infection is coming from
Add vasopressors if fluid not enough and allow for Mean arterial presser >65mmHg (use adrenalin)
DISABILITY = GCS
EXAMINE
Swab, Culture, Chest X-ray, Check skin for infection or cutaneous manifestations such as rash
FLUID BALANCE
GLUCOSE LEVEL

Monitor for signs of deterioration (maintain charts, and look at the trends)
 Decreased consciousness
 Increased tachypnea or tachycardia
 Decrease urine output (fluid balance)
 Increased serum lactate

141
Q

What is post cholecystectomy Sy

A

Post cholecystectomy syndrome
occurs after a cholecystectomy:
presents with right upper quadrant pain, bowel habit changes, reflux, increased AST/ALT and alkaline phosphatase

142
Q

Lynch syndrome Amsterdam criteria

A

3 fam members, 2 generations, 1 less than 50 yo

143
Q

Gold standard to Dx Hep C acute infx

A

HCV RNA test (gold standard) – identified current acute or chronic infection

144
Q

on US and CT, you see cirrhosis…. one nodule is above 10 mm… are you concerned?

A

Yes, above 10mm nodule is concerning for HCC

145
Q

Main difference between Invx in acute and chronic pancreatitis

A

acute = lipase/amylase is needed (CT not always)
chronic = CT is gold

146
Q

Hepatic angioma…. when to be conservative, and what to do

A

If assymp and less than 5cm…. then lifestyle mod, remove OCP, do MRI in 6mo. If in 6 mo, size increased…. resect

147
Q

Hepatic angioma, when to do conservative therapy. What do we do

A

Assymp, and less than 5cm. remove OCP, and weight loss, then repeat MRI in 6 mo. If still grown, resect.

148
Q

Hydatid cyst Tx

A

Albendazole, then aspirate or resect

149
Q

When to leave a hepatic angioma and when to do follow up? (clue: size wise)

A

Less than 5mm, leave it

150
Q

Anal pain = sign of what?

A

anal cancer

151
Q

how to mx thrombosed hemorrhoid

A

general anesthesia prior to examination…

152
Q

blood hits water basin…. sign of what?

A

hemorrhoid

153
Q

blood mixed in with stool, potentially what? thus invx how?

A

sign of sigmoidal cancer, do sigmoidoscopy.

154
Q

Mx of perianal abscess

A

general anesthesia (lidocaine wont work) and emergency drainage. Check for Crohns after

155
Q

Perianal fistula Mx

A

examine under GA. Insert probe through to assess anatomy. If doesnt involve anal muscles = do fistulotomy. If does, insert sling, and do MRI 3 weeks later.

156
Q

Pilonidal abcess/cyst Mx

A

GA, incision and drainage… allow to heal by secondary intention (leave it open)

157
Q

Bascom and Karydakis are used to Mx what

A

pilonidal cyst/abcess

158
Q

First line Mx for anal fissure

A

fiber, stool softener, lidocaine, CCB ointment

Botox in sphincter and sphincterotomy last line

159
Q

peritonitis and bacteria only cocci (no bacilli), means what cause

A

primary spont. bac peritonitis

160
Q

peritonitis and bacteria mainly gram +

A

proximal visceral rupture

161
Q

peritonitis and bacteria mainly gram -

A

distil vicseral rupture

Finals (11 decks)

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