Gastrointestinal Flashcards

Question

Treatment of Ulcerative Colitis

Answer 1

Mild (<4 motions a day)- - 5 ASA (mesalazine) - +topical steroid foam (hydrocortisone)/ prednisolone Moderate (4-6 motions a day)- - Prednisolone - Then 5-ASA Severe (>6 motions a day) - EXCLUDE INFECTIONS - IV hydration/ electrolyte replacement - IV hydrocortisone/ methylprednisolone - If CRP/ motions are still high- CICLOSPORIN/ INFLIXIMAB

Answer 2

Any part of the GI tract but often targets TERMINAL ILEUM

Answer 3

``` Weight loss Abdominal pain with mass Diarrhoea FEVER Skin lesions Cobblestone mucosa FISTULA FORMATION FISSURE FORMATION Clubbing LINEAR ULCERATION ```

Answer 4

ALBUMIN (low albumin) ESR and CRP Colonoscopy with biopsy Radiology- small bowel follow through/ Abdominal X ray for toxic megacolon AXR - No faecal shadowing - Mucosal thickening/ islands - Colonic dilatation

Answer 5

Mild-moderate- - Prednisolone - Then MAINTENANCE THERAPY Severe- - IV hydration/ electrolyte replacement - IV steroids (hydrocortisone) - If Hb<80, consider BLOOD TRANSFUSION - Switch to prednisolone if improving

Answer 6

``` Stricture and Fistula formation Obstruction Pyoderma gangrenosum ANAEMIA Osteoporosis (from steroid use) ```

Answer 7

Primary sclerosing cholangitis Osteoporosis Increasing incidence of colon cancer Toxic megacolon

Answer 8

Hepatitis Pancreatitis Haemolysis rash Paradoxical worsening of Colitis

Answer 9

PERIANAL DISEASE- - MRI to check for this - Oral antibiotics- INFLIXIMAB - Immunosuppressants - Local surgery

Answer 10

AZATHIOPRINE- - If steroids are contraindicated (DIABETES, OSTEOPOROSIS, TB, CHICKENPOX, HYPERTENSION) - If not, use other immunomodulators (METHOTREXATE/ 6-MERCAPTOPURINE)- which are contraindicated in females of reproducing age BIOLOGICS- - Anti TNF-alpha- contraindicated in SEPSIS, TB, high LFTs, MALIGNANCY NUTRITION- - ENTERAL (polymeric) diet is preferred - Elemental- amino acids can give remission - Low residue- helps in those with active disease or strictures SURGERY if- - Drug failure - FISTULA - PERFORATION - GI OBSTRUCTION from STRICTURE - ABSCESS

Answer 11

Autoantibodies to GLIADIN | Issue with GLUTEN

Answer 12

Proximal part of small intestine

Answer 13

Low B12, Low FERRITIN, Low Hb Steatorrhoea Weight loss

Answer 14

LAND WH Laryngitis Acidic taste in mouth Nocturnal asthma/ chronic cough Dysphagia (swallowing difficulties) ``` Water brash (excessive salivation) Heart burn- worse AFTER LYING DOWN/ STOOPING/ HEAVY MEALS ```

Answer 15

Oesophagitis Genetic inheritance of angle of LOWER OESOPHAGEAL SPHINCTER Rolling hiatus hernia Sliding hiatus hernia

Answer 16

SPEEDO ``` Smoking Pregnancy Excessive alcohol Excessive coffee Drugs (CCB, Antimuscarinics, Tricyclic antidepressants) Obesity ```

Answer 17

If <55yo- - Proceed to treatment unless: 1) Unintentional weight loss 2) DYSPHAGIA 3) Haematemesis 4) Melaena 5) ANOREXIA - Then do ENDOSCOPY if they have these symptoms If >55yo- - Endoscopy and biopsy

Answer 18

Weight loss Raising of head of bed at night 1) ANTACIDS (like Al2O3) 2) PPI (like OMEPRAZOLE) 3) H2 antagonists (RANITIDINE) SURGERY- Nissen's Fundoplication

Answer 19

- Metaplasia of normal SQUAMOUS epithelium of lower oesophagus into COLUMNAR epithelium - Investigate with endoscopy - Treat with radiofrequency ablation or mucosal resection - Complication- ADENOCARCINOMA of oesophagus

Answer 20

``` Drugs (Rifampicin) MALARIA Haemolysis (THALASSAEMIA/ SICKLE CELL ANAEMIA) Haemolytic uraemic syndrome CRIGLER-NAJJAR SYNDROME GILBERT's SYNDROME ```

Answer 21

``` Viral/ drug induced hepatitis ALCOHOLIC liver disease Primary biliary CIRRHOSIS Hepatic CIRRHOSIS LEPTOSPIROSIS Physiological neonatal jaundice ```

Answer 22

``` Pancreatic cancer Cholangiocarcinoma GALLSTONES in COMMON BILE DUCT BILIARY ATRESIA SCHISTOSOMIASIS Mirizzi's syndrome ```

Answer 23

``` URINE- NORMAL STOOL- NORMAL Conjugated bilirubin- NORMAL Unconjugated bilirubin- NORMAL or HIGH Total bilirubin- NORMAL or HIGH Alkaline phosphatase- NORMAL ```

Answer 24

``` URINE- DARK STOOL- PALE Conjugated bilirubin- HIGH Unconjugated bilirubin- HIGH Total bilirubin- HIGH Alkaline phosphatase- HIGH ```

Answer 25

``` URINE- DARK STOOL- PALE Conjugated bilirubin- HIGH Unconjugated bilirubin- NORMAL Total bilirubin- HIGH Alkaline phosphatase- HIGH ```

Answer 26

Treat UNDERLYING CAUSE Adequate hydration Broad spectrum ANTIBIOTICS if OBSTRUCTION

Answer 27

- Liver/ Renal failure - Pancreatitis - Biliary CIRRHOSIS - SEPSIS - CHOLANGITIS - KERNICTERUS (serious complication in NEONATES)

Answer 28

DNA/RNA- RNA picornvirus Transmission- Faecal-oral transmission, associated with contaminated shellfish- passes into bile after replication within liver cells. Leads to necrosis in ZONE 3 of hepatic lobule Incubation period- 2-3 weeks Investigations- Anti-HAV IgM in serum Treatment- Supportive since often self-resolving Complications- Rarely-acute liver disease

Answer 29

DNA/RNA- DNA Transmission- Contaminated needles, Infected blood products, sexual intercourse, VERTICAL TRANSMISSION Incubation period- 1-5 months Investigations- HBV DNA in serum, and antigens etc. present in histology with GROUND GLASS appearance Treatment- Antiviral medications- - Pegylated alpha 2a interferon - Telbivudine - Lamivudine - Adefovir - Tenofovir - Entecavir Complications- - Hepatic cirrhosis - Hepatocellular carcinoma - Fulminant hepatitis B

Answer 30

DNA/RNA- RNA Transmission- Contaminated needles, Infected blood products, VERTICAL TRANSMISSION Incubation period- 6-9 weeks Investigations- Antibody to HCV in serum Treatment- Antiviral medications- - Pegylated alpha 2a interferon - Ribavirin - Taribavirin - Telaprevir Complications- - Hepatic cirrhosis - Hepatocellular carcinoma - Liver Failure

Answer 31

DNA/RNA- Defective RNA (COINFECTS with HBV) Transmission- Contaminated needles, Infected blood products, sexual intercourse Incubation period- 1-5 months Investigations- Serum IgM anti-D Treatment- - Pegylated alpha 2a interferon Complications- - Hepatic cirrhosis - Hepatocellular carcinoma

Answer 32

DNA/RNA- Single stranded RNA Transmission- Faecal-oral transmission, associated with contaminated WATER Incubation period- 2-3 weeks Investigations- IgG and IgM anti-HEV Treatment- - Usually self-liniting Complications- -High mortality of pregnant women (20%)

Answer 33

2F 3A U ``` Fatigue FAECAL OCCULT BLOOD Anaemia Altered bowel habit ABDOMINAL PAIN Unintentional weight loss ```

Answer 34

Smoking Increased age Family history of CRC INFLAMMATORY BOWEL DISEASE Strep bovis bacteraemia CONGENITAL POLYPOSIS SYNDROMES: - Juvenile polyposis syndrome - Peutz-Jeghers Syndrome Genetic predisposition: - Familial Adenomatous Polyposis (FAP)- all lead to CRC - Hereditary nonpolyposis CRC

Answer 35

- Faecal Occult blood test - Bloods- IRON DEFICIENCY ANAEMIA/ CARCINOEMBRYONIC ANTIGEN - Endoscopy= colonoscopy/ sigmoidoscopy - Double contrast BARIUM ENEMA study 'APPLE CORE' sign

Answer 36

Duke's and TMN

Answer 37

Chemotherapy- - Oxaliplatin - Folinic Acid - 5-Fluorouracil Radiotherapy Surgical resection

Answer 38

CG PAN - Cullen's sign- PERIUMBILICAL BRUISIING - Grey Turner's sign- FLANK BRUISING - Pain in EPIGASTRIC region which radiates to the back - ANOREXIA - Nausea/ vomiting

Answer 39

GET SMASHED Gallstones Ethanol Trauma ``` Scorpion sting Mumps Autoimmune disease STEROIDs HYPERLIPIDAEMIA/ HYPERCALCAEMIA ERCP Drugs (AZATHIOPRINE) ```

Answer 40

Bloods- RAISED serum AMYLASE and LIPASE US to scan for gallstones CT to rule out complications

Answer 41

KEEP NIL BY MOUTH Treatment usually symptomatic relief (ANALGESICS like TRAMADOL) Treat underlying cause (ERCP for gallstones)

Answer 42

HDAMN ``` Haemorrhage Disseminated intravascular coagulation Acute respiratory distress syndrome Multi organ failure Necrosis ```

Answer 43

A epigastric pain which radiates to the back and is also- - recurrent - worse when eating/ drinking heavily - relieved by sitting forward

Answer 44

CAMP Cystic Fibrosis Alcohol Malnourishment Pancreatic duct obstruction

Answer 45

Decreased Faecal Elastase CT SCAN- shows calcification Perform MRCP

Answer 46

Alcohol cessation/ low fat diet Analgesia (TRAMADOL) Pancreatic enzyme replacement therapy Start insulin therapy if diabetes has developed

Answer 47

PODS Pseudocysts Obstruction (pancreatic) Diabetes Mellitus Steatorrhoea

Answer 48

``` Vibrio vulnificus Bacillus cereus Staphylococcus aureus Clostrididium botulinium E. coli ```

Answer 49

``` Campylobacter jejuni Salmonella E. coli Shigella Yersinia enterocolitica ```

Answer 50

Taenia solium