GI Flashcards
(91 cards)
1
Q
what is AST a marker of?
A
hepatocellular damage
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
3
Q
what is ALT a marker of?
A
hepatocellular damage
4
Q
ALT increase of 3 fold suggestive of….
A
..cholestasis
5
Q
ALT increase of 10 fold suggestive of…
A
…Hepatocellular injury
6
Q
which LFT marker is most sensitive and which is most specific fro liver injury?
A
AST more sensitive
ALT more specific
7
Q
What is ALP a marker of?
A
Cholestasis - comparison with ALT usually helpful in distinguishing
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
9
Q
What is GGT a marker of?
A
marker of liver damage/disease
- more specific to liver than ALP
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
11
Q
What is albumin a marker of?
A
marker of synthetic function of the liver
12
Q
What can cause a drop in albumin?
A
liver disease, inflammation in the liver and excessive loss (enteropathy or nephrotic syndrome)
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
14
Q
Bilirubin Indication?
A
measures jaundice - can also indicate cholestasis or liver (failure to conjugate bili)
15
Q
what is serum lipase/amylase used for?
A
to test for acute pancreatitis
- often 3x ULN
16
Q
what is calprotectin?
A
marker for IBD - higher in UC not very specific in cases of Crohn’s
17
Q
Coeliac disease Ix?
A
Gold standard = OGD with duodenal biopsies
coeliac serology - TTG
total IgA & IgA TTG
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
19
Q
What are the main ways to test for H.Pylori?
A
- C13 urea breath test
- 6hrs fasting and 2wks ceasation of PPI use - Stool antigen - most common test
- off PPI for 2/52 - H,pylori serology - IgG Ab - only slowly falls after eradication
- Invasive testing for H.Pylori
- OGD and biopsy
- OCG & CLOtest - colour change from yellow to red
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
21
Q
What should be done if FIT test results are abnormal?
A
Colonoscopy
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)
23
Q
what Ix is preferred when investigating threadworms?
A
perianal swab
24
Q
Barium studies types and indications?
A
Oesophageal/oropharyngeal dyphagia = barium swallow
Barium enema - not common
- done before CT colon/colonoscopy
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
