Gastrointestinal Flashcards
Features of Whipple’s Disease (7)
Gene association
Steatorrhoea
Malabsorption
Abdominal Pain
Polyarthralgia
Hyperpigmentation
Petechiae
Photosensitivity
Gene = HLAB27
Factors for liver transplant - paracetamol overdose (4)
pH <7.3 after 24 hours
Cr >300
PT >100
Grade III or IV encephalopathy
Determining cause of ascites
- albumin
Serum: ascites albumin gradient
serum - ascites albumin value = gradient
SAAG >11 = portal hypertension
- Infectious or malignant ascites results in low gradient (albumin values are approx same because different pathology)
Marker of severity in pancreatitis
CRP
- associated rise with pancreatic necrosis
Check for h.pylori following eradication therapy
Urea breath test
- ideally wait 4 weeks after finishing treatment
Treatment of pyoderma gangrenosum in IBD
Oral prednisolone
Difference between Type 1 and Type 2 Hepatorenal Syndrome
Type 1 = rapid, Cr >250
Type 2 = more insidious
Acute alcohol intake in paracetamol overdose - good or bad?
May be protective - chronic alcohol excess worse
Best anti-emetic for travel sickness
Hyoscine
Blood results in haemochromatosis
Raised iron
Raised ferritin
Low or normal transferrin
Management of UC
- >= 2 exacerbations in 12 months
PO azathioprine or mercaptupurine as maintenance
Management of UC
- disease beyond L side of colon
PO 5ASA + rectal 5ASA
Enemas only go so far
Management of UC
- flare
IV steroids
If not improving 72 hours then consider ciclosporin
What is normal oesophageal mucosa made up of?
What happens in Barrett’s?
Normal = squamous
Barrett’s = metaplasia from squamous to columnar
HELPP vs Acute Fatty Liver of pregnancy
Hypertension VS normotension
Haemolysis VS no haemolysis
Investigation of hepatic vein thrombosis
- initial
- definitive
Initial = US with doppler flow
Definitive = hepatic venography
Pathogenesis of achalasia
Loss of ganglia of Auerbach’s plexus
= loss of peristalsis and increased tone at lower oesophageal sphincter
Investigation of choice in achalasia
Manometry +- barium swallow
Pathogenesis of pharyngeal pouch
Posteromedial herniation of pharynx
Management of eosinophilic oesophagitis
Dietary modification
(topical steroids are 2nd line)
Plummer Vinson
= glossitis, IDA, oesophageal webs
Boerhave’s Syndrome =
= complete transmural oesophageal rupture
Monitoring for Barrett’s oesophagus
Endoscopy
- at least every 3-5 years
Staging investigation for oesophageal cancer
Endoscopic US
Risk factors for Gastric Cancer (2)
Investigation sign
Blood Group A, Smoking
= signet ring sign
Why is angiodysplasia associated with aortic stenosis?
= theory is turbulence of flow at the aortic valve results in loss of vWF
Gene loci associated with Coeliac disease
Disease association
HLA DQ2/HLA DQ8
T cell lymphoma
Bilirubin metabolism
Haem > iron + bilverdin
(haem oxygenase)
iron + bilverdin > unconjugated bilirubin
(bilverdin reductase)
> conjugated bilirubin
(UDP-GT)
Causes of unconjugated hyperbilirubinaemia (2)
Genetic inheritance
Gilbert’s Syndrome
Crigler-Najjar Syndrome
Autosomal recessive
Prophylaxis of c.difficile
Bezotoxumab
Investigation for small bowel overgrowth
Management for small bowel overgrowth
H breath test
Rifaximin
Organism implicated in Whipple’s Disease
Management
Tropheryma whipplei
Need long duration of antibiotics - IV penicillin then PO co-trimoxazole for at least 1 year
Biopsy finding in tropical sprue
Mononuclear cell infiltrates
6 months of tetracyclines
Gastroenteritis - severe vomiting immediately after eating food
Staph aureus
Colorectal cancer screening
Between 60-74 years
Every 2 years, send FIT, if FIT positive then invited for colonscopy
What criteria is used for staging colorectal cancer?
Duke’s criteria
e.g. Grade C = lymph node spread (A/B to do with wall thickness spread)
HNPCC
- inheritance
- gene
- presentation
= Lynch syndrome
Autosomal dominant
Mismatch repair gene - MSH2
Proximal colorectal, endometrial
FAP
- inheritance
- gene
- management
= familial adenomatous polyposis
Autosomal dominant
APC gene on chromosome 5
Total colectomy + ileo-anal pouch
Gardener’s Syndrome
FAP
with
facial osteomas, thyroid cancer
Peutz-Jegher’s Syndrome
- inheritance
- gene
- presentation (3)
Autosomal dominant
STK11/LKB1
Harmatous polyps, GI bleeding, intusseption
Cowden’s Syndrome
- gene
- presentation
- associated cancers (3)
PTEN (tumour suppressor gene)
Harmatomous polyps
Breast, uterine, thyroid cancer
Mechanism of action of 5-ASA
Inhibits prostaglandin synthesis
Mechanism of action of azathioprine
Inhibits purine synthesis
Mechanism of action of methotrexate
Inhibits dihydrofolate reductase
Management of refractory Crohn’s disease
Infliximab
Medications used for maintaining remission in Crohn’s disease
Need to check?
Azathioprine/Mercaptopurine
Need to check TPMT status prior to commencing
Biopsy appearance of Crohn’s disease (2)
Transmural
Cobblestoning appearance
Definition of severe flare of ulcerative colitis
> 6 stools/day with blood
+- fever, tachycardia, pain
Investigation findings of ulcerative colitis (4)
Submucosal
Crypt abscesses
Pseudopolyps
Drainpipe colon
Topical 5-ASA, when not to use?
If inflammation extends beyond splenic flexure, need PO as well: enemas can only go so far
EEG findings in encephalopathy
Triphasic slow waves
Monitoring in ulcerative colitis
All need colonoscopy
- either every 1, 3 or 5 years depending on risk
Anti-HbC
- acute vs chronic infection?
IgM - acute
IgG - cleared or chronic infection
(HBsAg will be positive in active infection)
Associations with hepatitis B (4)
Chronic infection
Polyarteritis nodosa
Cryoglobulinaemia
Hepatocellular Carcinoma
Associations with hepatitis C (5)
Chronic hepatitis C
Hepatocellular carcinoma
Type II cryoglobulinaemia
Sjogren’s syndrome
Porphyria
Medical management of HCC
Sorafenib
Contra-indications for liver biopsy (5)
INR >1.4
PLT <60
Ascites
Anaemia
Hydatid cyst disease
Pathophysiology of hepatic encephalopathy
Accumulation of ammonia and glutamine
SAAG
>1.1g/dl
Reflects portal hypertension causing ascites
Investigation for pancreatitis
CT with contrast
US - determine aetiology e.g. gallstones
Most common cause of SBP in alcoholic liver disease
E.coli
Gene implicated in Wilson’s disease
ATP7B gene on chromosome 13
Pathogenesis of hepato-renal syndrome
Vasoactive mediators produced by liver = vasodilation
= hypoperfusion of kidneys
Activation of RAAS to try and compensate
= fluid overload - continuous cycle
Investigation findings in Wilson’s Disease
Reduced caeruloplasmin levels
Decreased total copper levels (reduced transport)
Gene locus associated with autoimmune hepatitis
HLA DR3
Type 1 autoimmune hepatitis
Adults/kids
ANA/smooth muscle antibody
Type 2 autoimmune hepatitis
Children
Anti-liver kidney microsomal antibody8
Type 3 autoimmune hepatitis
Anti-soluble liver antibody
Antibody associated with PBC
anti-mitochondrial antibodies subtype M2
- may also see raised IgM and anti-SMA
Investigation of PSC
- finding
ERCP/MRCP
Beaded appearance of the ducts
Where is the most common site for pancreatic adenocarcinoma?
Head of pancreas
Presentation of pancreatic cancer (3)
Investigation of pancreatic cancer
New diabetes, steatorrhoea, migratory thrombophlebitis
HRCT
C urea breath test
- rules around medications
No antibiotics in the last 4 weeks
PPI stopped for 2 weeks
Barium swallow - oesophageal stricture with apple core effect =
= oesophageal cancer
Hepatic vein thrombosis =
Budd Chiari Syndrome
Hepatic portal vein thrombus has a more indolent course
Gold standard test for bile acid malabsorption
SEHCAT test
- nuclear medicine test using selenium: swallow as a capsule
Gold standard investigation for GORD
Oesophageal 24 hour pH monitor
Ca125 can also be used as marker in…
Peritoneal cancer
Pigment laden macrophages on GI biopsy
Laxative abuse
What feature of IBD is not associated with disease activity?
Primary sclerosing cholangitis
Electrolyte abnormality associated with ileostomy
= hypomagnesaemia
(there is impaired PTH secretion which then results in hypocalcaemia = mechanism by which ileostomy causes hypocalcaemia)
What cells are responsible for liver fibrosis?
Stellate cells
Icthyosis + pancreatic cancer - what associated mutation?
KRAS mutation
What is related to the risk of re-feeding syndrome?
BMI
