GI Flashcards
Risk of which cancer increases following renal transplantation?
squamous cell carcinoma of the skin
What organism causes peritonitis secondary to peritoneal dialysis?
Staphylococcus epidermis
What is Henoch-Schonlein purpura?
IgA mediated small vessel vasculitis
Seen in children following an infection
What are the H causes of acute pancreatitis in GET SMASHED?
hypertriglyceridemia
Hyperchylomicronaemia
Hypercalcaemia
Hypothermia
What are features of Granulomatosis with polyangiitis/Wegener’s granulomatosis?
Upper respiratory tract: epistaxis, sinusitis, nasal crusting
Lower respiratory tract: dyspnoea, haemoptysis
Rapidly progressing glomerulonephritis
Saddle-shape nose deformity
Others: vasculitis, rash, eye involvement, cranial nerve lesions
What are the features of hyperacute rejection of a transplant?
Due to pre-existing antibodies against ABO or HLA antigens
An example of a type II hypersensitivity reaction
Leads to widespread thrombosis of graft vessels -> ischaemia and necrosis of the transplanted organ
No treatment is possible and the graft is removed
What are the features of acute graft failure?
occurs before 6 months
usually due to mismatched HLA - cell-mediated (cytotoxic T cells)
usually asymptomatic and is picked up by a rising creatinine, pyuria (pus in urine) and proteinuria
Other causes include CMV infection
May be reversible with steroids and immunosuppressants
What is given as prophylaxis for hepatic encephalopathy?
lactulose first-line with the addition of rifaximin
What is the most common renal malignancy?
renal cell carcinoma - an adenocarcinoma of the renal cortex
What is Budd-Chiari syndrome?
hepatic vein thrombosis - seen in the context of underlying haematological disease
What are the causes of Budd-Chiari syndrome?
polycythaemia rubra vera
thrombophilia
pregnancy
COCP
What are the features of Budd-Chiari syndrome?
abo pain - sudden onset, severe
ascites
tender hepatomegaly
What is the initial investigation if you suspect Budd Chiari syndrome?
ultrasound with Doppler flow studies
What is used to treat acute episodes of alcoholic hepatitis?
steroids e.g. prednisolone
What is the management for RCC?
for confined disease - partial or total nephrectomy - patients with a T1 tumour < 7cm in size are typically offered a partial nephrectomy
What are the features of primary sclerosing cholangitis?
cholestasis: jaundice, pruritus, raised bilirubin + ALP
right upper quadrant pain
fatigue
what is primary sclerosing cholangitis?
biliary disease of unknown aetiology characterised by inflammation and fibrosis of intra and extra-hepatic bile ducts
what is typically seen on x-ray in sigmoid volvulus?
large bowel obstruction: large, dilated loops of colon, often with air-fluid levels
coffee bean sign
What are the complications of laparoscopy?
general risks of anaesthetic
vasovagal reaction e.g. bradycardia in response to abdo distention
- extra-peritoneal gas insufflation - surgical emphysema
- injury to GI tract
- injury to blood vessels e.g. common iliacs, deep inferior epigastric artery
What feature is most suggestive of Wilson’s disease?
serum caeruloplasmin is decreased
What are the investigation findings in alcoholic hepatitis?
gamma-GT is characteristically elevated
Ratio of AST:ALT is normally >2, a ratio >3 is strongly suggestive of acute alcoholic hepatitis
What is acute intermittent porphyria?
- deficiency of one of the enzymes needed to synthesize haem
- build up can cause acute attacks of severe abdominal pain, with vomiting, hypertension, tachycardia
How does acute intermittent porphyria present?
abdo: abdo pain, vomiting
neurological: motor neuropathy
psychiatric: depression
hypertension and tachycardia common
What is small bowel bacterial overgrowth syndrome?
disorder characterized by excessive amounts of bacteria in the small bowel resulting in GI symptoms
what are risk factors for small bowel bacterial overgrowth syndrome and how does it present?
risk factors:
- neonates with congenital GI abnormalities
- scleroderma
- diabetes mellitus
features:
- chronic diarrhoea
- bloating, flatulence,
- abdo pain
hhow is small bowel bacterial overgrowth syndrome diagnosed?
- hydrogen breath test
- small bowel aspiration and culture
- clinicians may sometimes give a course of abx as a diagnostic trial
how do you calculate an anion gap?
(sodium + potassium) - (bicarb + chloride)
what is a normal anion gap?
8-14 mmol/l
what are causes of a normal anion gap metabolic acidosis?
- GI bicarb loss: diarrhoea, fistula
- renal tubular acidosis
- drugs: acetazolamide
- addison’s
What are causes of a raised anion gap metabolic acidosis?
- lactate: shock, hypoxia
- ketones: dka, alcohol
- urate: renal failure
- acid poisoning: salicylates, methanol
what complications are associated with coeliac disease?
- anaemia: iron/folate/b12
- hyposplenism
- osteoporosis/osteomalacia
- lactose intolerance
- enteropathy associated t-cell lymphoma
- subfertility
What is a Hartmann’s procedure and what does it involve/when is it indicated?
resection of the rectosigmoid colon
when there is perforation of the rectosigmoid bowel, and subsequent peritonitis - can be due to colon cancer, diverticulitis, trauma etc…
An end colostomy is formed which is brought out onto the left side of the abdomen and sewn flush with the skin, and a rectal stump is sewn
What is membranous glomerulonephritis?
commonest type of glomerulonephritis in adults and is the third most common cause of end-stage renal failure - presents with nephrotic syndrome or proteinuria
What is seen on renal biopsy in membranous glomerulonephritis?
basement membrane is thickened with subepithelial electron dense deposits - “spike and dome” appearance
what is the management of membranous glomerulonephritis?
all patients should receive and ACE inhibitor or ARB
What is the prognosis for membranous glomerulonephritis?
rule of thirds:
- 1/3 = spontaneous remission
- 1/3 = remain proteinuric
- 1/3 = develop ESRF
what are the causes of membranous glomerulonephritis?
idiopathic: due to anti-phospholipase A2
infections: hep B, malaria, syphilis
malignancy: prostate, lung, lymphoma, leukaemia
drugs: gold, penillamine, NSAIDS
autoimmune disease: SLE, thyroiditis, rheumatoid
What is the management of ascites?
reducing dietary sodium
fluid restriction is sometimes recommended if sodium is < 125 mmol/L
aldosterone antagonists e.g. spironolactone
drainage if tense ascites
In what surgeries is there definite chance of transfusion and how much should be given?
cross match 4-6 units in:
- total gastrectomy
- oophorectomy
- oesophagectomy
- elective AAA repair
- cystectomy
- hepatectomy
In what surgeries is there likely chance of transfusion and how much should be given?
cross-match 2 units in:
- salpingectomy for ruptured ectopic
- total hip replacement