GI Flashcards
Acute pancreatitis- 2 main causes
gallstones
alcohol
Acute pancreatitis- diagnosis
raised serum amylase
raised Lipase (more sensitive and specific than lipase)
Acute pancreatitis- scoring system used
Glasgow score
what is primary sclerosing cholangitis?
intrahepatic and extrahepatic duct become strictured/ fibrotic, resulting in obstruction to bile flow out of the liver
causes backflow, inflammation and fibrosis/ cirrhosis
what is primary sclerosing cholangitis associated with?
ulcerative colitis
presentation of primary sclerosing cholangitis
jaundice
fatigue
pruritus
RUQ pain
hepatomegaly
some cirrhosis signs
primary sclerosing cholangitis- blood results
‘cholestatic picture’
significantly raised Alk Phos (ALP)
raised bilirubin
transaminases (ALT, AST) raised
diagnosis of primary sclerosing cholangitis
MRCP
management of primary sclerosing cholangitis
ERCP- to stent strictures
ursodeoxycholic acid
colestyramine
liver transplant
what does alpha-1-antitrypsin deficiency effect and cause?
liver- cirrhosis
lungs- bronchiectasis and emphysema
causes of hepatitis
- alcoholic hepatitis
- NAFLD
- viral hepatitis
- autoimmune
- drug induced (paracetamol)
presentation of hepatitis
abdo pain, fatigue, pruritis, muscle/ joint aches, N&V, jaundice, fever
blood results in hepatitis
hepatic picture
raised AST/ ALT (transaminases)
ALP raised but to a less extent
raised bilirubin
transmission of each type of viral hepatitis
A- faeco-oral
B- blood/ bodily fluid
C- blood/bodily fluid
D- blood/ bodily fluid-but must have primary infection with hepatitis B
E- faeco-oral
Barrett’s oesophagus changes
replacement of stratified squamous epithelium with columnar epithelium
management of small bowel obstruction
drip and suck
iv fluids and an ng tube to decompress stomach
HNPCC- associated cancers
colorectal
endometrial
pancreatic
what is the psoas sign and what condition is it seen in
The test is performed by passively extending the thigh of a patient with knees extended. In other words, the patient is positioned on his/her left side, and the right leg is extended behind the patient. If abdominal pain results, it is a positive psoas sign.
appendicitis
liver failure triad
triad of encephalopathy, jaundice and coagulopathy
iron study profile in haemochromatosis
Raised transferrin saturation and ferritin, with low TIBC is the characteristic iron study profile in haemochromatosis
pancreatic cancer- blood marker
CA 19-9
initial management of haemochromatosis
Venesection
RF’s for IBD
Smoking (a risk factor in Crohn’s, but protective in ulcerative colitis)
Family history - NOD2 mutations, HLA-B27 positive have both been linked
White ethnicity - a risk factor for ulcerative colitis
if a patient is ascitic, what Abx should be used as prophylaxis against spontaneous bacterial peritonitis?
ciprofloxacin/ norfloxacin
what antibody can be present in PSC?
p-ANCA
Where does UC most commonly affect?
rectum
management of c.diff infection
ORAL vancomycin- even in severe disease, as better uptake into GI system compared to IV
If life threatening, add IV metronidazole
why does c diff infection occur?
Clostridium difficile is a Gram positive rod often encountered in hospital practice. It produces an exotoxin which causes intestinal damage leading to a syndrome called pseudomembranous colitis. Clostridium difficile develops when the normal gut flora are suppressed by broad-spectrum antibiotics.
risk factors for c diff
Clindamycin is historically associated with causing Clostridium difficile but the aetiology has evolved significantly over the past 10 years. Second and third generation cephalosporins are now the leading cause of Clostridium difficile. (cefuroxime, ceftriaxone etc)
PPI’s
what is carcinoid syndrome?
Carcinoid syndrome is a neuroendocrine tumour. There are many locations that they can occur in such as in the GI tract, in the respiratory tract and many other places. They can secrete serotonin which leads to many of the symptoms this patient suffers
features of carcinoid syndrome
flushing (often earliest symptom)
diarrhoea
bronchospasm
hypotension
right heart valvular stenosis (left heart can be affected in bronchial carcinoid)
other molecules such as ACTH and GHRH may also be secreted resulting in, for example, Cushing’s syndrome
pellagra can rarely develop as dietary tryptophan is diverted to serotonin by the tumour
what is elevated in carcinoid syndrome?
urinary 5-HIAA
management of carcinoid syndrome
octreotide (somatostatin analogue)
surgery
features of a pharyngeal pouch
dysphagia
regurgitation
aspiration
neck swelling which gurgles on palpation
halitosis (bad breath)
how would a suspected pharnygeal pounch be investigated?
barium swallow
PBC- antibody?
AMA (anti-mitochondrial antibody)
what is Peutz-Jegher’s syndrome?
Peutz-Jegher’s syndrome is an autosomal dominant condition causing GI tract polyp formation and hyperpigmented lesions of the face, palms, lips and soles
spontaneous bacterial peritonitis- most common causative organism?
e.coli
what is pernicious anaemia?
Pernicious anaemia is an autoimmune disorder affecting the gastric mucosa that results in vitamin B12 deficiency
leads to macrocytic anaemia
antibody test in pernicious anaemia
anti-intrinsic factor antibodies
causes of bile acid malabsorption
primary- excess bile acid
Secondary causes are often seen in patients with ileal disease, such as with Crohn’s. Other secondary causes include:
cholecystectomy
coeliac disease
small intestinal bacterial overgrowth
management of bile acid malabsorption
bile acid sequestrants e.g. cholestyramine
potential complication of pernicious anaemia
Pernicious anaemia predisposes to gastric carcinoma
mesenteric ischaemia triad
Mesenteric ischaemia: triad of CVD, high lactate and soft but tender abdomen
what is Cheilitis?
inflammation of the lips
In Gilberts syndrome, when is jaundice usually seen?
jaundice may only be seen during an intercurrent illness, exercise or fasting
what should be prescribed to maintain remission in patients with UC?
A topical (rectal) aminosalicylate +/- an oral aminosalicylate is used first-line in maintain remission in ulcerative colitis patients with proctitis and proctosigmoiditis
what deficiencies does coeliac disease present with?
Coeliac disease is associated with iron, folate and vitamin B12 deficiency
barrett’s oesophagus management
endoscopic surveillance with biopsies
high-dose proton pump inhibitor
if dysplasia noted- endoscopic resection/ ablation
inhertiance of haemochromatosis
autosomal recessive disorder of iron absorption and metabolism resulting in iron accumulation. It is caused by inheritance of mutations in the HFE gene on both copies of chromosome 6*
symptoms of haemochromatosis
early symptoms include fatigue, erectile dysfunction and arthralgia (often of the hands)
‘bronze’ skin pigmentation
diabetes mellitus
liver: stigmata of chronic liver disease, hepatomegaly, cirrhosis, hepatocellular deposition)
cardiac failure (2nd to dilated cardiomyopathy)
hypogonadism (2nd to cirrhosis and pituitary dysfunction - hypogonadotrophic hypogonadism)
arthritis (especially of the hands)
most common organisms found in pyogenic liver abscesses in adults and children
Staphylococcus aureus in children and Escherichia coli in adults.
in acute liver failure, which blood markers are most accurate to assess for liver function?
coagulation (PT, APTT) and albumin
liver enzymes are a poor way to look at liver function as they remain normal for a long time, whilst coagulation and albumin are better measures.
crohns- histology
inflammation in all layers from mucosa to serosa
goblet cells
granulomas
complication of ERCP
pancreatitis
prior to being investigated for coeliac, what must the patient do and why?
must eat a gluten containing diet for 6 weeks
If gluten is not consistently consumed the biopsy findings may be normal or less convincing and the patient may have to undergo the endoscopy again unnecessarily to confirm the diagnosis. Therefore all patients will be given the advice to consume gluten 6 weeks prior to endoscopy. Note that this is also the case for assessing coeliac antibodies (usually anti-tissue transglutaminase antibodies). To avoid a false negative result, patients must also consume gluten prior to testing. Thereafter, the antibody test may be used for monitoring adherence to the diet.
coeliac- histology
villous atrophy, raised intra-epithelial lymphocytes, and crypt hyperplasia
side effect of aminosalicylate’s
Aminosalicylates are associated with a variety of haematological adverse effects, including agranulocytosis - FBC is a key investigation
what does the double duct sign on MRCP indicate?
pancreatic cancer
surgical management of an upper rectal tumour
anterior resection
management of an overactive bladder
antimuscarinics (oxybutynin, tolteridone)
h.pylori urea breath test- what medication criteria should be met before starting?
Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks
h.pylori urea breath test- what medication criteria should be met before starting?
Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks
GI bleed- what do high urea levels indicate?
High urea levels can indicate an upper GI bleed versus lower GI bleed
ascites- what does a high serum ascitic albumin gradient indicate?
Ascites: a high SAAG gradient (> 11g/L) indicates portal hypertension:
Liver disorders are the most common cause
cirrhosis/alcoholic liver disease
acute liver failure
liver metastases
Cardiac
right heart failure
constrictive pericarditis
Other causes
Budd-Chiari syndrome
portal vein thrombosis
veno-occlusive disease
myxoedema
what monoclonal antibody is specific to C.diff toxin b?
Bezlotoxumab
crohns- management of a perianal fistula
Oral metronidazole is useful in the management of Crohn’s patients who develop a perianal fistula
where does ischaemic colitis most likely affect?
The splenic flexure is the most likely area to be affected by ischaemic colitis
what blood result can indicate severe pancreatitis?
hypocalcaemia
c.diff management
1st- oral vancomycin
2nd- oral findaxomicin
3rd (or if severe)= oral vancomycin and IV metronidazole
other than antibiotics, what other medication class is a risk factor for c.diff?
PPI’s
management of alcoholic ketoacidosis
Alcoholic ketoacidosis is managed with an infusion of saline and thiamine
what is the double duct sign and what is it seen in?
‘double duct’ sign - the presence of simultaneous dilatation of the common bile and pancreatic ducts
what can coeliac disease increase the risk of development of?
Coeliac disease increases the risk of developing enteropathy-associated T cell lymphoma. This is due to the neoplastic transformation of intraepithelial T lymphocytes in coeliac patients. Risk factors include poor adherence to a gluten-free diet and late diagnosis of coeliac disease.
