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Fire Through Finals > General Medicine: Gastroenterology > Flashcards

General Medicine: Gastroenterology Flashcards

1
Q

Who gets an urgent endoscopy?

A

All with dysphagia or upper abdo mass
>-55 yrs with weight loss + reflux symptoms

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2
Q

How do you test for H. pylori? How do PPIs play a role

A

Urea breath test or stool antigen test
Must be 2 weeks off PPI for test

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3
Q

What do you do if there is Peptic ulcer disease with
+ve H. Pylori
-ve H. Pylori

A

+ve: PPI + Amoxicillin + metronidazole/ clarithromycin for 7 days
-ve: PPIs/H2RA for 1 month

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4
Q

How do you treat a patient with GORD that does not respond to initial PPI treatment

A

If endoscopy +ve: 2x dose 1 month
If endoscopy -ve: H2RA/ prokinetic

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5
Q

How do you treat barrett’s oesophagus?

A

High dose PPI
Endoscopic surveillance every 3-5 years
Resect/ablate if dysplasia identified

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6
Q

How can pain help differentiate peptic ulcers?

A

Worse when hungry, relieved on eating: Duodenal
Pain worse on eating: Gastric

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7
Q

Patient with duodenal ulcer has a 30 minute history of vomiting, low BP and high HR, what has likely happened and how is it treated?

A

Duodenal artery bleed
IV PPIs
Endoscopic treatment

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8
Q

What would indicate ulcer perforation
Clinically
On imaging

A

Acute abdomen/peritonism
CXR/CT showing free air

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9
Q

How does coeliac differ clinically from IBS or IBD

A

No PR bleeding like IBD
Pain following gluten consumption, not on eating and relieved on defecation like IBS

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10
Q

How do you investigate for coeliac

A

IgA (Anti-Ttg/EMA) AFTER 6 weeks gluten
Jejunum biopsy if confirmation needed

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11
Q

How do you manage coeliac disease?

A

Gluten free diet

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12
Q

When would you clinically suspect IBS?

A

6 months abdo pain, altered stool form and 2 of:

  • Altered stool passage
  • Bloating
  • Worse on eating
  • Mucus
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13
Q

What tests confirm IBS

A

-ve inflammatory, coeliac and faecal calprotectin

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14
Q

How do you treat IBS

A
  1. Loperamide if diarrhoea, non-lactulose laxative for constipation
  2. Tricyclics
  3. SSRIs
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15
Q

How can Crohn’s and UC be distinguished clinically

A

Crohn’s: Skin tags and mouth ulcers
Ulcerative Colitis: Bloody diarrhoea + mucus

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16
Q

Which IBD is associated with
Gallstones
PSC
Renal stones

A

Crohn’s: Stones
UC: PSC

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17
Q

Goes beyond mucosal
Goblet cells
Granulomas
Which IBD involves the above 3 features

A

Crohn’s

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18
Q

Crypt abcesses and pseudopolyps are features of which IBD?

A

UC

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19
Q

Which IBD has cobblestoning?

A

Crohn’s

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20
Q

What is the gold standard investigation for IBD? What is the exception to this?

A

Endoscopy + biopsy
Don’t perform if severe colitis, use flexible sigmoidoscopy

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21
Q

For Crohn’s remission, how do you
Induce
Maintain

A

Induce
1. Glucocorticoids
2. Mesalazine
3. Azathioprine/mercaptopurine
Maintain
- Stop smoking
1. Azathioprine/mercaptopurine
2. Methotrexate if TPMT activity has been checked

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22
Q

For UC remission, how do you
Induce
Maintain

A

Induce
Mild moderate:
1. Topical AS
Proct: oral AS/steroid
Severe: IV steroids + ciclosporin if no improvement

Maintain
Mild-moderate:
Top/oral/both AS
Severe or >=2 relapses per year: oral immunosuppressants

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23
Q

How do you manage a perianal abscess in Crohn’s?

A

Incision and drainage
Draining seton if tract identified

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24
Q

How do you manage perianal fistulae in Crohn’s?

A

MRI to visualise extent
Oral metronidazole +/- anti-TNF agents if symptomatic

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25
Compare the complications of Crohn’s and UC
Crohn’s: Bowel cancer (small\>large), osteoporosis UC: Colorectal cancer
26
43 year old woman presents with a 3 month Hx fatigue, joint pain and now a 1 month history of hair loss and bronzed skin, what is the likely diagnosis?
Haemochromatosis (CH6-HFE mutation) More likely in \>40s and post-menopausal women (period removes iron)
27
Why is transferrin saturation better than serum ferritin?
90% of raised serum ferritin due to other causes (CKD, ALD, cancer) not iron overload
28
How do you calculate transferrin saturation? How does this explain a raised result in haemochromatosis?
``` Serum iron / TIBC Iron overload (high iron) / reduced binding (due to genetic defect) ```
29
How do you manage haemochromatosis? What is the metrics for success?
1st line:Venesection 2nd: Desferrioxamine \<50% transferrin / \<50ug/l ferritin
30
What is the venesection regime for haemochromatosis?
Initial: 500ml every 1-4 weeks Maintenance: 3-4 year
31
How should the following be screened for haemochromatosis? General population Family members
General: Transferrin Family: HFE mutation
32
What pattern of inheritance is haemochromatosis?
Autosomal recessive
33
23 year old patient presents with tremor, poor memory and a history of deteriorating mental health. They also have blue nails and appear slightly yellow. What is the suspected diagnosis?
Wilson’s disease Presents in 10-25yrs olde, younger show liver signs first, older show neurological signs Neuropsychiatric changes with jaundice/blue nails + Kayser-Fleischer rings
34
What is the underlying pathology of Wilson’s disease
AR inheritance of ATP7B gene Reduced hepatic excretion and increased intestinal absorption of copper
35
What are the 1st line and GS tests for Wilson’s disease?
1st line Reduced serum caeruloplasmin (.’. total serum as 95% of this is in caeruloplasmin) Raised 24hr copper excretion GS: Genetics for ATP7B gene
36
What is the management of Wilson’s disease?
Penicillamine
37
Which hepatitis are spread via Faeco-oral Bodily
fAEco-oral Rest are bodily fluids
38
Which hepatitis have vaccines?
A+B
39
Which hepatitis are RNA-based?
A, C, E
40
Which hepatitis are only acute in nature?
A+E (get it, cos its acute?) A: 2-4 week incubation E: 3-8 weeks
41
Since hep A+E are both acute and faeco-oral, how can you tell them apart?
A: younger (inc children), Hx recent foreign travel E: Older men, between tropic of cancer and equator (Latin, top half of Africa, SE asia), Hep B infection Ultimately serology tells them apart
42
How can you clinically distinguish Hep A+ B
Itch and joint pain more common in B B spread through bodily fluids
43
Which hepatitis is most associated with transient jaundice, fatigue, joint pain but typically asymptomatic
Hep C
44
How do you screen and diagnose Hep C
Screen with Antibodies Confirm with PCR
45
How do you treat for Hepatitis A-E
A: Supportive, avoid alcohol, 2 immunisations B: 1. peg-IF 2. Antivirals; immunise sex partners C: Combo of protease inhibitors +/- ribavirin D: Interferon, may need transplant E: Supportive
46
Amenorrhea + jaundice +/- fever in a young female is most likely what condition?
Autoimmune hepatitis Amenorrhea most common feature, acute fever and jaundice only in 25% patients
47
In suspected AIH, what do the following liver screen results mean Raised IgG ANA SMA LKM1 Soluble liver/kidney antigen
IgG: Common to all forms ANA + SMA: Type 1 (adults + children) LKM1: Children only Soluble: Type 3, middle aged adults
48
Following serology for AIH, what would help confirm diagnosis
‘Piecemeal’ necrosis on liver biopsy
49
How do you manage AIH
Steroids/Immunosuppressants Liver transplant if this fails
50
Differentiate NAFLD And ALD in terms of Clinical features Bloods Imaging Treatment
NAFLD // ALD Asymptomatic // liver disease picture ALT \> AST // AST \> ALT, raised gGT USS echogenicity, Fibrosis on ELF // none specific Weight loss, monitoring // Prednisilone
51
What are the causes of acute liver failure
Paracetamol overdose Alcohol Hep A+B Acute fatty liver of pregnancy
52
Acute history of jaundice + confusion + flapping tremor indicates what
Acute liver failure
53
What is the best lab test to determine acute liver failure
Check PT and albumin for synthetic function LFTs still useful
54
What imaging can help identify cirrhosis
1st: USS Fibroscan or ELF better but not widely used
55
What is the treatment for acute liver failure?
Vit K to improve PT Lactulose 10-20ml/8 hrs Cefotaxmine Stop drugs, monitor CVD and renal function
56
What electrolyte needs to be avoided if an acute liver failure patient has CLD/ascites
Na+ Would increase fluid retention
57
6 month history of fatigue + weight loss. Also have red hands, distended abdo veins and splenomegaly. Suggests what?
Chronic liver failure
58
What indicates decompensation of liver failure
Jaundice + ascites + confusion Variceal bleeds and easy brusing
59
How can you grade hepatic encephalopathy
I: Change in mood, cant draw star II: Confused III: InCoherent IV: Coma
60
What features would prompt thoughts of hepatorenal syndrome in a cirrhosis patient? How can you treat it?
``` Cirrhosis + Ascites + Renal failure Type 1 (2 weeks): terlipressin + dialysis Type 2 (6 months): Hepatic portal stenting ```
61
Patient with fever, abdo pain and metabolic acidosis has you worried about what. How do you treat
Spontaneous bacterial peritonitis Ascitic culture then immediate cephalosporin therapy
62
What are the 3 most common organisms involved with SBP?
E.Coli K. Pneumoniae G+ve coccus (staph, entero)
63
How do you treat the following complications of liver failure? Malnutrition Encephalopathy Ascites SBP Varices
High calorie + protein, low salt meals every 2-3 hours Lactulose Spironolactone + restrict sodium Ascitic culture + cephalosporin Propanolol + band ligate/sclerose/TIPs if stable Terlipressin, IV abx, Vit-k + fresh frozen plasma, band ligate
64
How can you identify if liver failure is due to paracetamol overdose?
Arterial pH \<7.3 after 24hrs OR all 3 of - PT \>100s - Creatinine \>300umol/L - Grade III/IV encephalopathy
65
What measure can help determine if ascites is liver related or not?
Serum Albumin Ascites Gradient \>11g indicates likely liver failure
66
How can hepatocellular and cholangiocarcinoma be differentiated Clinically Disease markers Treatment
Hepatic // cholangio Late liver symptoms, painful // painless RUQ mass, obstructive jaundice AFP // CA 19-9 Resect if early, ablate + chemo + sorafenib if late // Surgery or palliative stening and chemo
67
What causative pathology is more associated with Hepatocellular carcinoma Cholangiocarcinoma
Cholangio: PSC HCC: Hep B (world), Hep C (Europe), PBC, HC, Alcohol
68
How can you distinguish between coeliac and bacterial overgrowth syndrome based on lab findings?
Folate low in coeliac, high in overgrowth syndrome
69
How do PPIs and lithium affect sodium levels?
PPIs cause hypo Lithium causes hyper
70
What does right sided tenderness on PR indicate
Acute appendicitis
71
Why do coeliacs require regular immunisations?
Functional hyposplenism
72
What LFT findings are seen in autoimmune hepatitis?
ALT/AST (intrahepatic) raised more than ALP (bile duct)
73
What causes pigment laden macrophages in intenstinal mucosa?
Laxative abuse
74
How do you manage a C.diff infection where 1st time Recurrent
**1st time** Oral vancomycin 10 days Oral fidaxomicin Oral vanc +/- IV metronidazole **Recurrent** \<=12 weeks: oral fidaxomicin \>12 weeks: Oral vancomycin OR fidaxomicin **Life threatening** Oral vancomycin + IV metronidazole
75
What is the diagnosis and treatment for the following symptoms Confusion, Hx alcohol abuse and malabsorption Diarrhoea, Dermatitis, Dementia, beefy red tongue Night blindness and dry eyes Spontaneous bleeding and gingival swelling
Deficiencies in B1 (thiamine) B3 (nicotinamide) A
76
Lethargy and fatigue with a macrocytic anaemia and megaloblasts means what Diagnosis? Treatment?
Anti-IF and parietal cell biospy Lifelong cobalamin
77
INR vs albumin for acute liver failure detection?
INR Albumin takes longer to drop so is seen in chronic liver failure
78
When is TIPSS considered for use?
Portal hypertension in Budd-Chiari Refractory ascites Secondary prophylaxis of variceal bleeding
79
Why does Crohn's and terminal ileal disease cause gallstones?
Causes loss of bile salts
80
What is the dietary advice for IBS?
Fluids: - 8 cups water/day - Limit caffeine to <3 drinks/day - Avoid alcohol fizzy drinks Food: - Regularity - Reduce high fibre and fruit intake - Oats/linseed if bloated
81
How can you differentiate IBD and anal fissure?
Anal fissure occurs at midline
82
Outline the acute and chronic management of anal fissure
acute - Soften: High fibre, bulk laxatives (or lactulose) - Lubrication - Topical anaesthetics and analgesia Chronic - Add Top GTN - Refer to surgery if 8 weeks no benefit
83
Outline the prevalence of colon cancer genetics
Sporadic 95% HNPCC 5% FAP <1%
84

Fire Through Finals (32 decks)

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