GI Flashcards

(91 cards)

1
Q

what is AST a marker of?

A

hepatocellular damage

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2
Q

what can AST:ALT ratio tell you?

A

if AST >ALT = think more cirrhosis or acute alcoholic hepatitis

If ALT>AST = think more chronic liver disease

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3
Q

what is ALT a marker of?

A

hepatocellular damage

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4
Q

ALT increase of 3 fold suggestive of….

A

..cholestasis

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5
Q

ALT increase of 10 fold suggestive of…

A

…Hepatocellular injury

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6
Q

which LFT marker is most sensitive and which is most specific fro liver injury?

A

AST more sensitive

ALT more specific

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7
Q

What is ALP a marker of?

A

Cholestasis - comparison with ALT usually helpful in distinguishing

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8
Q

What does an isolated rise in ALP suggest?

A

bony mets/primary bone tumors
vit D def

*ALP rise not associated with GGT rise - hepatobiliary pathology

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9
Q

What is GGT a marker of?

A

marker of liver damage/disease

- more specific to liver than ALP

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10
Q

GGT indications?

A

screen for liver disease (bile duct problems)

  • if associated with ALP rise - bile duct/liver disease

screen for alcohol abuse

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11
Q

What is albumin a marker of?

A

marker of synthetic function of the liver

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12
Q

What can cause a drop in albumin?

A

liver disease, inflammation in the liver and excessive loss (enteropathy or nephrotic syndrome)

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13
Q

What are other markers of synthetic function

A

INR/PT

Bilirubin - both reflection of liver function and damage - if levels are high - suggestive of obstruction

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14
Q

Bilirubin Indication?

A

measures jaundice - can also indicate cholestasis or liver (failure to conjugate bili)

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15
Q

what is serum lipase/amylase used for?

A

to test for acute pancreatitis

- often 3x ULN

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16
Q

what is calprotectin?

A

marker for IBD - higher in UC not very specific in cases of Crohn’s

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17
Q

Coeliac disease Ix?

A

Gold standard = OGD with duodenal biopsies

coeliac serology - TTG
total IgA & IgA TTG

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18
Q

what is faecal elastase?

A

measure of pancreatic insufficiency
low faecal elastase - suggestive of pancreatic insufficiency

patient usually presents with steatorrhoea - needs pancreatic enzyme supplementation

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19
Q

What are the main ways to test for H.Pylori?

A
  1. C13 urea breath test
    - 6hrs fasting and 2wks ceasation of PPI use
  2. Stool antigen - most common test
    - off PPI for 2/52
  3. H,pylori serology - IgG Ab - only slowly falls after eradication
  4. Invasive testing for H.Pylori
    - OGD and biopsy
    - OCG & CLOtest - colour change from yellow to red
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20
Q

What is the QFIT test used for?

A

Quantitative Faecal Immunochemical test (qFIT)
- used to detect occult blood in faeces as part of colorectal screening programme
= every 2yrs ages 60-74

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21
Q

What should be done if FIT test results are abnormal?

A

Colonoscopy

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22
Q

Stool sample test indicated when?

What is tested for?

A

changes in bowel habit - typically diarrhoea

Campylobacter, Salmonella, Shigella and E.coli
Rotavirus
C.Diff
Ova/Parasites (3 samples <10day period)

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23
Q

what Ix is preferred when investigating threadworms?

A

perianal swab

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24
Q

Barium studies types and indications?

A

Oesophageal/oropharyngeal dyphagia = barium swallow

Barium enema - not common
- done before CT colon/colonoscopy

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25
indications for Upper GI endoscopy/OGD?
Pts with refractory symptoms of reflux disease
26
indications of sigmoidoscopy?
- rectal bleeding - diarrhoea in a young patient - IBS - left sided coilits - bowelscope (aged 55)
27
Colonoscopy indication? | What's involved?
Indications include - altered bowel habit, IBD, Bowel cancer screen, poly surveillance, pathology further investigated from sigmoidoscope full bowel prep - laxatives the day prior to procedure
28
What is ERCP
type of endoscopy which observes the bile and pancreatice duct - can be used for both diagnostic and therapeutic purposes - mainly used to check for blockages/stones more therapeutic procedure - removal of obstructing stones
29
What is laparoscopy and its indications?
Laparoscopy is an operation performed in the abdomen or pelvis using small incisions with the aid of a camera. It aid diagnosis and mx of certain problems Investigative purposes = endometriosis Therapeutic purposes = appendecitis, splenectomy, renal tumours
30
What is Laparotomy and its uses?
more invasive compared to laparoscopy , involved a larger incision into the abdomen.
31
What is seHCAT and it's uses?
A SeHCAT Scan is a diagnostic procedure to determine how well your gut is able to absorb bile acids. Poor absorption of the bile acid can result in chronic diarrhoea - chronic diarrhoea is the main indication usually a 3hr and 7 days oral administration of Gamma-emitting synthesis bile acid - tauroselcholic [75 selenium] acid 10-15% retention value - mild malabsorption 5-10% - moderate malabsorption 0-5% - severe malabsorption
32
What is manometry and its uses?
catheter inserted into the oesophagus detector picks up the lower oesophageal sphincter pressure as you swallow water uses = diagnosis of achalasia and oesophageal motility disorders
33
Indication of a liver biopsy?
useful when liver screen NAD and imaging uncertain Indicated in autoimmune hepatitis and haemachromatosis (Perl's stain) used to - diagnostic clues - identify dominant pathology - severity of disease processes = inflammation/fibrosis
34
Ambulatory pH-impedence monitoring
NG tube inserted via nasal passageway into oesophagus - measure acidic levels for 24hrs Pts with refractory symptoms non-responsive to PPI use cannot tolerate PPI
35
Investigations for bowel obstruction?
Gold standard - CT MRI can also be used in IBD to look for obstruction
36
Abdo US indications? | Pros and cons?
first line for abnormal LFTS pros - quick, cheap, no radiation/safe, doppler allows assessment of blood flow
37
CT abdomen Pros and cons?
pros - cross-sectionla imaging, good anatomical detail, quick, visualises pancrease Cons - radiation exposure
38
MRI Pros and cons?
pros - great resolution, no radiation, good for biliary pathology and liver lesions Cons - costly, claustrophobia and lengthy, avoided with metallic implants
39
what is used to stratify upper GI bleeds
Blatchford Score - Hb, HR, sysBP, gender, melena, recent syncope, heaptic disease hx and nlood urea nitrogen >1 = need endoscopy in hopsital
40
Investigations in diarrhoea
- FBC, iron studies - blood loss or infection - B12/folater - anaemia - U+Es, ESR/CRP, TFTd and coeliac screen - stool test - MCS & OVP - faecal elastase and calprotectin - sigmoid/colonoscopy - uread breath test
41
2WWR Clinic Ix Include...
OGD/colonoscopy Blood tests CT /MRI
42
Investigations in suspected Biliary Colic?
Abdo US
43
Investigations in suspected Acute Cholecystitis?
Abdo US - if unclear HIDA scan Bloods - LFTs usually normal (ALP rise compared to ALT), CRP, WCC & amylase
44
Investigations in suspected Ascending Cholangitis?
Abdo US - presence of stone & bile duct dilatation | Bloods - raised ALT/ALP/Bilirubin
45
Investigations in suspected Primary Sclerosing Cholangitis?
Diagnostic - ERCP/MRCP = beaded strictures of biliary ducts LFTs = ALP and bili, pANCA +ve Biopsy = fibrosis, onion skin appearance
46
Investigations in suspected acute pancreatitis?
Serum amylase/lipase potential raised ALP Imaging - early US or contrast-enhanced CT MRCP done if underlying cause unclear
47
Investigations in suspected chronic pancreatitis?
Abdo XR - pancreatic calcifications CT abdo - more sensitive Faecal elastase - asses exocrine function
48
Investigations in suspected Pancreatic cancer?
CT abdo preferred - US can be done but less sensitive bloods - ALP raised, CA19-9, lipase and amylase raised LFTS = cholestatic LFTs picture
49
Interpretation of hepatitis B serology?
HBsAg ⇒ seen in active infection HBsAb ⇒ seen in current or past infections or as a result of vaccination HBcAB ⇒ current or past infection → IgM = active infection → IgG = past infection HBeAg ⇒ virus actively replicating, acute phase of infection → the higher this marker is, the more infectious the person is
50
Investigations in suspected Hepatitis?
LFTs - derranged ⇒ high levels of AST/ALT and proportional rise in ALP = 'hepatic picture' Hep B serology or Hep C testing
51
Investigations in suspected Autoimmune Hepatitis?
Diagnosis is given from liver biopsy results
52
Investigations in suspected Cirrhosis?
LFTs = reduced synthetic function - low albumin and increased PT abdo US = nodular surface, ascites, splenomegaly, enlarged portal vein Transient Elastography/Fibroscan = offer to pts if above 55yrs, hx of alcoholic fatty liver disease, etoh >50U/week and HepC infection aFP checked as cirrhosis increases risk of hepatocellular carcinomas
53
Investigations in suspected hepatocellular carcinoma?
aFP and abdo US
54
Investigations in suspected Non-alcoholic Fatty liver disease?
usually asymptomatic - incidental finding on US | enhanced liver cirrhosis ELF test - allows detection of any advanced cirrhosis
55
Investigations in suspected Peritonitis?
paracentesis - MSC, >250 neutrophils | MSC usually cultures E.Coli
56
Investigations in suspected GI (peptic ucler) perforation?
Erect CXR = pseudo diaphragm
57
Investigations for suspected Peptic Ulcer Disease?
Reintroduce gluten into diet 6wks prior to Ix 1. TTG Ab serology = first choice Ix - others include = IgA, anti-gliadin/caesin Ab 2. GOLD ST = endoscopic intestinal biopsy - vilious atrophy - crypt hyperplasia - intraepithelial lymphocytes
58
Investigations for suspected C.difficile Infection?
1. Stool MCS 2. Bloods - WCC - if normal = mild CD - if raised with loose stools = moderate - if raised with creatinine elevation, fever or evidence of coilitis = severe Check U&E - creatinine
59
Investigations for suspected Gastroenteritis?
stool MCS
60
Investigations for suspected Crohn's Disease?
routine bloods = FBC, U&Es, LFTs, Ferritin, B12&Folate endoscopy - Colonoscopy preferred = deep ulceration, skip lesions Biopsy & Histology - all layers inflamed, goblet cells and granulomas R/O other pathology = Coeliac serology, CRP/ESR, TFTs, U&Es, Ferritin, VitB12&D and folate
61
Investigations for suspected Ulcerative coilitis?
Bloods = FBC, CRP/ESR, TFTs, U&Es, ferritin, VitB12&D and folate Stool MCS & calprotectin (usually very high) Coeliac serology Barium Enema 1. loss of haustrations 2. short narrow colon - 'drainpipe colon' 3. superficial ulcerations and pseudopolyps
62
Investigations for suspected Constipation & faceal impaction?
usually clinical AXR - faceal impaction
63
Investigations for suspected Irritable Bowel Syndrome?
Bloods = FBC, ESR/CRP, coeliac serology - TTG Ab IBS is a diagnosis of exclusion - investigation results are usually non-specific
64
Investigations for suspected Diverticulitis?
usually diagnosis is given in secondary care - under specialist or colorectal surgery CT colonography Colonoscopy - if perforation is suspected Barium Enema blood test - FBC, U&ES, CRP FIT test - if any PR bleeding
65
Investigations for suspected Appendicitis?
Abdo US first line Raised inflammatory markers - CRP/ESR MAKE SURE TO RULE OUT - UTI - Pregnancy (if female)
66
Investigations for suspected Intussusception?
US abdo will show 'target like mass' contrast enema
67
Investigations for suspected Acute Mesenteric Ischaemia?
DIAGNOSTIC - Contrast CT | VBG - metabolic acidosis due to increased lactate
68
Investigations for suspected Chronic Mesenteric Ischaemia?
CT angiography is diagnostic imaging
69
Investigations for suspected Bowel Obstruction?
AXR - intraretroperitoneal space suggestive of colonic perforation CT = GOLD ST, highly specific Bloods = U&Es - may have electrolyte imbalance VBG = metabolic acidosis - increased lactate from ischaemia
70
Investigations for suspected Toxic Megacolon?
``` AXR = massively dilated colon CTTAP = normal haustra absent, thickened walls, colonic dilatation ``` Bloods = FBC, U&Es, Albumin, lactate and CRP/ESR Bloods culture stool MCS
71
Investigations for suspected Oesophagitis?
Endoscopy = inflammed oesophagus | pH testing
72
Investigations for suspected Barretts Oesophagus?
endoscopic biopsy = change from columnar to squamous epithelium
73
Investigations for suspected Mallory Weiss Tears?
endoscopy Bloods - FBC, Coag studies, Platelet count, Routine U&Es, group+save, crossmatch
74
Investigations for suspected oesophageal stricture?
preferred - barium swallow = clarifies nature, length of stricture Endoscopy - often a biopsy can be taken CXR = ?impingment from a mass Bloods - FBC, Ferritin and LFTs
75
Investigations for suspected Oesophageal Neoplasm?
first line = upper GI endoscopy If metastatic - CTAP for staging if not metastatic - US endoscopy Barium swallow helpful in ruling out motility disorders
76
Investigations for suspected Oesophageal Varices?
Bloods = Hb, U&Es, urea, coag profile, LFTs & crossmatch | Endoscopy - ROCKALL SCORING DONE PRIOR
77
Investigations for suspected Achalasia?
Diagnostic/Gold ST = oesophageal manometry - pressure in cardiac sphincter - incomplete relaxation on swallowing - absent peristalasis Barium Swallow - 'birds beak appearance' - grossly expanded oesophagus CXR = widened mediastinum
78
Indications to investigate GORD?
Ix indications - 55yrs or older - persistent symptoms - not responsive to tx - dysphagia - assciated weight loss
79
Investigations for suspected GORD
Endoscopy = assess for peptic ulcers, malignancies H,pylori testing CLO test GOLD ST = if endoscopy neg = 24hr oesophageal pH monitoring
80
Investigations for suspected Gastritis?
Clinical diagnosis
81
Investigations for suspected peptic Ulcer disease?
Diagnostic = endoscopy Biopsy done to rule out any malignancy often CLO test done simultaneously
82
Investigations for suspected Pyloric Stenosis
Abdo US | Bloods may show hyperchloremic, hypokalaemic alkalosis
83
Investigations for suspected Oesophageal Neoplasms?
Diagnostic = endoscopy + biopsy staging - endoscopic US - CT
84
Investigations for suspected Hernias?
US - incisional, inguinal, ventral, umbilical Hiatus - endoscopy, barium swallow and CXR
85
Investigations for suspected Haemorrhoids?
Protoscopy - able to confirm diagnsis, assess severity If hx of significant/Chronic PR bleeding - do an FBC
86
Investigations for suspected suspected Anal Fissure?
clinical diagnosis on DRE exam FBC if significan/chronic bleeding
87
Investigations for suspected Anorectal abscess/fistula?
clinical diagnosis on DRE exam - erythmeatous, painful swelling - surrounding cellulitis - usually DRE to painful to perform
88
Investigations for suspected Pilonodal disease?
clinical diagnosis Ix to r/o - crohn's infectious processes such as TB, Syphillis
89
Investigations for suspected Polyps?
colonoscopy | CT colonography
90
Investigations for suspected Rectal Neoplasms?
colonoscopy & biopsy suspicious lesions (GOLD ST) - sigmoidoscopy CT colonography - unsuitable for colonoscopy or staging confirmed colorectal cancer FBC and CEA
91
Screening for colorectal cancer involves?
FIT test 60-74yrs = every 2 yrs >50yrs with unexplained weight loss <60yrs with change in bowel habit RF patient - offered colonoscopy at regular intervals - Familial Polyadenosis - HNPCC - IBD