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ICM Revision > GI > Flashcards

GI Flashcards

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
Q

indications for Upper GI endoscopy/OGD?

A

Pts with refractory symptoms of reflux disease

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26
Q

indications of sigmoidoscopy?

A
  • rectal bleeding
  • diarrhoea in a young patient
  • IBS
  • left sided coilits
  • bowelscope (aged 55)
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27
Q

Colonoscopy indication?

What’s involved?

A

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

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28
Q

What is ERCP

A

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

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29
Q

What is laparoscopy and its indications?

A

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

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30
Q

What is Laparotomy and its uses?

A

more invasive compared to laparoscopy , involved a larger incision into the abdomen.

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31
Q

What is seHCAT and it’s uses?

A

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

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32
Q

What is manometry and its uses?

A

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

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33
Q

Indication of a liver biopsy?

A

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

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34
Q

Ambulatory pH-impedence monitoring

A

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

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35
Q

Investigations for bowel obstruction?

A

Gold standard - CT

MRI can also be used in IBD to look for obstruction

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36
Q

Abdo US indications?

Pros and cons?

A

first line for abnormal LFTS

pros - quick, cheap, no radiation/safe, doppler allows assessment of blood flow

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37
Q

CT abdomen Pros and cons?

A

pros - cross-sectionla imaging, good anatomical detail, quick, visualises pancrease

Cons - radiation exposure

38
Q

MRI Pros and cons?

A

pros - great resolution, no radiation, good for biliary pathology and liver lesions

Cons - costly, claustrophobia and lengthy, avoided with metallic implants

39
Q

what is used to stratify upper GI bleeds

A

Blatchford Score
- Hb, HR, sysBP, gender, melena, recent syncope, heaptic disease hx and nlood urea nitrogen

> 1 = need endoscopy in hopsital

40
Q

Investigations in diarrhoea

A
  • 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
Q

2WWR Clinic Ix Include…

A

OGD/colonoscopy
Blood tests
CT /MRI

42
Q

Investigations in suspected Biliary Colic?

A

Abdo US

43
Q

Investigations in suspected Acute Cholecystitis?

A

Abdo US
- if unclear HIDA scan

Bloods - LFTs usually normal (ALP rise compared to ALT), CRP, WCC & amylase

44
Q

Investigations in suspected Ascending Cholangitis?

A

Abdo US - presence of stone & bile duct dilatation

Bloods - raised ALT/ALP/Bilirubin

45
Q

Investigations in suspected Primary Sclerosing Cholangitis?

A

Diagnostic - ERCP/MRCP = beaded strictures of biliary ducts
LFTs = ALP and bili, pANCA +ve
Biopsy = fibrosis, onion skin appearance

46
Q

Investigations in suspected acute pancreatitis?

A

Serum amylase/lipase
potential raised ALP

Imaging - early US or contrast-enhanced CT

MRCP done if underlying cause unclear

47
Q

Investigations in suspected chronic pancreatitis?

A

Abdo XR - pancreatic calcifications
CT abdo - more sensitive
Faecal elastase - asses exocrine function

48
Q

Investigations in suspected Pancreatic cancer?

A

CT abdo preferred - US can be done but less sensitive
bloods - ALP raised, CA19-9, lipase and amylase raised
LFTS = cholestatic LFTs picture

49
Q

Interpretation of hepatitis B serology?

A

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
Q

Investigations in suspected Hepatitis?

A

LFTs - derranged ⇒ high levels of AST/ALT and proportional rise in ALP = ‘hepatic picture’

Hep B serology or Hep C testing

51
Q

Investigations in suspected Autoimmune Hepatitis?

A

Diagnosis is given from liver biopsy results

52
Q

Investigations in suspected Cirrhosis?

A

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
Q

Investigations in suspected hepatocellular carcinoma?

A

aFP and abdo US

54
Q

Investigations in suspected Non-alcoholic Fatty liver disease?

A

usually asymptomatic - incidental finding on US

enhanced liver cirrhosis ELF test - allows detection of any advanced cirrhosis

55
Q

Investigations in suspected Peritonitis?

A

paracentesis - MSC, >250 neutrophils

MSC usually cultures E.Coli

56
Q

Investigations in suspected GI (peptic ucler) perforation?

A

Erect CXR = pseudo diaphragm

57
Q

Investigations for suspected Peptic Ulcer Disease?

A

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
Q

Investigations for suspected C.difficile Infection?

A
  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
Q

Investigations for suspected Gastroenteritis?

A

stool MCS

60
Q

Investigations for suspected Crohn’s Disease?

A

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
Q

Investigations for suspected Ulcerative coilitis?

A

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
Q

Investigations for suspected Constipation & faceal impaction?

A

usually clinical AXR - faceal impaction

63
Q

Investigations for suspected Irritable Bowel Syndrome?

A

Bloods = FBC, ESR/CRP, coeliac serology - TTG Ab

IBS is a diagnosis of exclusion
- investigation results are usually non-specific

64
Q

Investigations for suspected Diverticulitis?

A

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
Q

Investigations for suspected Appendicitis?

A

Abdo US first line
Raised inflammatory markers - CRP/ESR

MAKE SURE TO RULE OUT

  • UTI
  • Pregnancy (if female)
66
Q

Investigations for suspected Intussusception?

A

US abdo will show ‘target like mass’

contrast enema

67
Q

Investigations for suspected Acute Mesenteric Ischaemia?

A

DIAGNOSTIC - Contrast CT

VBG - metabolic acidosis due to increased lactate

68
Q

Investigations for suspected Chronic Mesenteric Ischaemia?

A

CT angiography is diagnostic imaging

69
Q

Investigations for suspected Bowel Obstruction?

A

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
Q

Investigations for suspected Toxic Megacolon?

A 
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
Q

Investigations for suspected Oesophagitis?

A

Endoscopy = inflammed oesophagus

pH testing

72
Q

Investigations for suspected Barretts Oesophagus?

A

endoscopic biopsy = change from columnar to squamous epithelium

73
Q

Investigations for suspected Mallory Weiss Tears?

A

endoscopy

Bloods - FBC, Coag studies, Platelet count, Routine U&Es, group+save, crossmatch

74
Q

Investigations for suspected oesophageal stricture?

A

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
Q

Investigations for suspected Oesophageal Neoplasm?

A

first line = upper GI endoscopy
If metastatic - CTAP for staging
if not metastatic - US endoscopy

Barium swallow helpful in ruling out motility disorders

76
Q

Investigations for suspected Oesophageal Varices?

A

Bloods = Hb, U&Es, urea, coag profile, LFTs & crossmatch

Endoscopy - ROCKALL SCORING DONE PRIOR

77
Q

Investigations for suspected Achalasia?

A

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
Q

Indications to investigate GORD?

A

Ix indications

  • 55yrs or older
  • persistent symptoms - not responsive to tx
  • dysphagia
  • assciated weight loss
79
Q

Investigations for suspected GORD

A

Endoscopy = assess for peptic ulcers, malignancies

H,pylori testing
CLO test

GOLD ST = if endoscopy neg = 24hr oesophageal pH monitoring

80
Q

Investigations for suspected Gastritis?

A

Clinical diagnosis

81
Q

Investigations for suspected peptic Ulcer disease?

A

Diagnostic = endoscopy
Biopsy done to rule out any malignancy

often CLO test done simultaneously

82
Q

Investigations for suspected Pyloric Stenosis

A

Abdo US

Bloods may show hyperchloremic, hypokalaemic alkalosis

83
Q

Investigations for suspected Oesophageal Neoplasms?

A

Diagnostic = endoscopy + biopsy

staging

  • endoscopic US
  • CT
84
Q

Investigations for suspected Hernias?

A

US - incisional, inguinal, ventral, umbilical

Hiatus - endoscopy, barium swallow and CXR

85
Q

Investigations for suspected Haemorrhoids?

A

Protoscopy
- able to confirm diagnsis, assess severity

If hx of significant/Chronic PR bleeding - do an FBC

86
Q

Investigations for suspected suspected Anal Fissure?

A

clinical diagnosis on DRE exam

FBC if significan/chronic bleeding

87
Q

Investigations for suspected Anorectal abscess/fistula?

A

clinical diagnosis on DRE exam

  • erythmeatous, painful swelling - surrounding cellulitis
  • usually DRE to painful to perform
88
Q

Investigations for suspected Pilonodal disease?

A

clinical diagnosis

Ix to r/o - crohn’s infectious processes such as TB, Syphillis

89
Q

Investigations for suspected Polyps?

A

colonoscopy

CT colonography

90
Q

Investigations for suspected Rectal Neoplasms?

A

colonoscopy & biopsy suspicious lesions (GOLD ST)
- sigmoidoscopy

CT colonography - unsuitable for colonoscopy or staging confirmed colorectal cancer

FBC and CEA

91
Q

Screening for colorectal cancer involves?

A

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

ICM Revision (19 decks)

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