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Finals > GI > Flashcards

GI Flashcards

1
Q

What genes is coeliac disease associated with?

A

HLA-DQ2 + HLA-DQ8

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2
Q

Investigations for coeliac disease?

A

serum IgA transglutaminase antibody (tTGA) + total IgA

GOLD STANDARD diagnostic test - OGD and duodenal/jejunal biopsy

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3
Q

Skin condition associated with coeliac?

A

dermatitis herpetiformis

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4
Q

complications of coeliac?

A
  • anaemia
  • hyposplenism
  • osteoporosis
  • lactose intolerance
  • enteropathy-associated T-cell lymphoma of the small intestine
  • sub-fertility
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5
Q

scoring system for NAFLD?

A

FIB-4 (fibrosis - 4) or NFS (NAFLD fibrosis score)

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6
Q

LFT pattern for NAFLD with advanced fibrosis?

A
  • bilirubin may be raised
  • AST > ALT ratio
  • low albumin
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7
Q

Most common causes of hepatocellular carcinoma?

A

Chronic hepatitis B or C

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8
Q

What do you use to screen for hepatocellular carcinoma?

A

USS +/- alpha-fetoprotein

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9
Q

Who should be considered for screening of hepatocellular carcinoma?

A

high risk groups such as patients with liver cirrhosis secondary to hepatitis C/B or haemochromatosis or men with alcoholic liver cirrhosis

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10
Q

Management of hepatocellular carcinoma?

A
  • if early - surgical resection
  • liver transplant
  • radiofrequency ablation
  • transarterial chemoembolisation
  • sorafenib - a multikinase inhibitor
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11
Q

Typical symptoms of UC?

A
  • bloody diarrhoea
  • abdo pain in lower left quadrant
  • tenesmus
  • urgency
    -extra-intestinal symptoms
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12
Q

Examples of extra-intestinal symptoms of IBD?

A
  • arthritis
  • erythema nodosum
  • episcleritis
  • osteoporosis
  • PSC
  • uveitis
  • pyoderma gangrenosum
  • clubbing
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13
Q

Investigation for diagnosis of UC?

A
  • colonoscopy + biopsy
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14
Q

severity of UC classification?

A

mild - <4 stools/day + small amount of blood
moderate - 4-6 stools/day, varying amounts of blood
severe - >6stools/day bloody, systemic upset

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15
Q

Treatment for mild-moderate UC?

A
  1. topical (rectal) aminosalicylate (mesalazine)
    if not change within 4 weeks then:
  2. oral aminosalicylate
  3. oral corticosteroid
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16
Q

treatment for severe UC?

A
  • should be treated in hospital
  • iV steroids - first line
  • IV ciclosporin if steroids contraindicated
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17
Q

treatment for severe relapse or >/= 2 exacerbations of UC in a year?

A

oral azathioprine or oral mercaptopurine

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18
Q

treatment for mild-moderate UC flare?

A

aminosalicylate (either topical or oral - depending on flare)

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19
Q

Adverse effects of PPI’s?

A
  • hyponatraemia
  • hypomagnasaemia
  • osteoporosis
  • microscopic colitis
  • increased risk of c.diff infections
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20
Q

Gold standard investigation for coeliac following serology?

A

endoscopic intestinal biopsy (jejunal)

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21
Q

Two main causes of duodenal ulcers?

A

H.pylori
NSAID’s

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22
Q

hiatus hernia investigation?

A
  1. barium swallow
  2. endoscopy
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23
Q

hiatus hernia management?

A
  1. conservative e.g. weight loss
  2. medical e.g PPI
  3. surgical
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24
Q

management of diverticulitis?

A

oral antibiotics (co-amoxiclav OR cefalexin + metronidazole OR trimethoprim + metronidazole) + liquid diet + analgesia

if symptoms don’t settle within 72 hours then admit and IV antibiotics

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25
Q

most common cause of large bowel obstuction?

A

colon cancer

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26
Q

investigations for large bowel obstruction?

A

Abdominal Xray
CT

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27
Q

management of large bowel obstruction?

A
  1. nil by mouth + IV fluids + NG tube with free drainage
  2. conservative management can be trailed if low risk
  3. IV antibiotics if risk of perforation or surgery
  4. surgery
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28
Q

investigation for upper GI bleed?

A
  1. the Glasgow-Blatchford score at first assessment
  2. resus
  3. endoscopy (OGD) within 24 hours
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29
Q

management of non-variceal upper GI bleed?

A
  1. PPI
  2. If further bleeding then options include repeat endoscopy, interventional radiology and surgery
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30
Q

management of variceal upper GI bleed?

A
  1. terlipressin and prophylactic antibiotics should be given to patients at presentation (i.e. before endoscopy)
  2. band ligation for oesophageal varices and injections of N-butyl-2-cyanoacrylate for gastric varices
  3. transjugular intrahepatic portosystemic shunts (TIPS) should be offered if bleeding from varices is not controlled with the above measures
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31
Q

Investigation of acute cholecystitis?

A

USS - 1st line
- if unclear then cholescintigraphy (HIDA scan)

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32
Q

treatment of acute cholecystitis?

A

intravenous antibiotics
cholecystectomy (laparoscopic - within 1 week of diagnosis)

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33
Q

antibodies for primary biliary cholangitis?

A

Anti michondrial antibodies (AMA)

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34
Q

> 60y + iron deficiency anaemia - what should you be suspicious of + do?

A

colorectal cancer - refer to colorectal services to get a colonoscopy + OGD

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35
Q

Tumour marker for colon cancer (not diagnostic)?

A

CEA - used to see disease progression / establish treatment

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36
Q

Bowel cancer screening test?

A

faecal occult blood (qFIT)

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37
Q

prophylaxis for oesophageal bleeding?

A

non-cardioselective B-blocker e.g. propanolol

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38
Q

which antibodies are raised in autoimmune heptaitis?

A

anti-nuclear (ANA) +/- anti smooth muscle

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39
Q

which antibodies are raised in autoimmune hepatitis?

A

anti-nuclear (ANA) +/- anti smooth muscle (Type 1)

anti-liver/kidney microsomal type 1 antibodies (KLM1) - type 2 (affects children only)

40
Q

management of autoimmune hepaitits?

A

steroids
other immunosuppressants such as azathioprine
liver transplant

41
Q

Management of primary biliary cholangitis?

A

Ursodeoxycholic acid - 1st line

Pruritus = cholestyramine

fat-soluble vitamin supplementation

liver transplantation
e.g. if bilirubin > 100 (PBC is a major indication)

42
Q

What is barrett’s oesophagus?

A

metaplasia of the lower oesophageal mucosa, with the usual squamous epithelium being replaced by columnar epithelium.

43
Q

Management of Barrett’s oesophagus?

A
  • High-dose proton pump inhibitor
  • Endoscopic surveillance with biopsies
    for patients with metaplasia (but not dysplasia) endoscopy is recommended every 3-5 years

If dysplasia of any grade is identified endoscopic intervention is offered. Options include:
- radiofrequency ablation - 1st-line
- endoscopic mucosal resection

44
Q

Management of hepatic encephalopathy?

A

Lactulose - 1st line (removes ammonia from system)
rifaximin - if lactulose not working

45
Q

What is thought to cause hepatic encephalopathy?

A

Excess absorption of ammonia and glutamine from bacterial breakdown of proteins in the gut.

46
Q

Encephalopathy + coagulopathy + jaundice = ?

A

acute liver failure

47
Q

severe, colicky post-prandial abdominal pain, weight loss, and an abdominal bruit = ?

A

Intestinal angina (or chronic mesenteric ischaemia)

48
Q

Causes of acute pancreatitis?

A

G - gallstones
E - ethanol
T - trauma
S - steroids
M - mumps
A - autoimmune (Polyarteritis Nodosa/SLE)
S - scorpion bite
H - Hypercalcaemia, hypertriglycerideaemia, hypothermia
E - ERCP
D - drugs

49
Q

Stabbing-like, epigastric pain which radiates to the back that is relieved by sitting forward or lying in the fetal position + vomiting = ?

A

acute pancreatitis

50
Q

Investigations for acute pancreatitis?

A

U&E + FBC
amylase (3x limit is suggestive) and lipase (more sensitive)
LFT - may be deranged if gallstones

imaging (USS, MRCP, ERCP, CT) - to look for underlying cause

51
Q

Management of acute pancreatitis?

A
  1. fluids
  2. analgesia
  3. anti-emetics
  4. treat underlying cause e.g. ERCP for gallstones, antibiotics if infection
52
Q

What is acute cholangitis?

A

infection of the biliary tree - most commonly caused by obstruction (gallstones)

53
Q

Investigations for acute cholangitis?

A

FBC
U&E
Creatinine
ABG’s - metabolic acidosis if severe
LFT’s - ↑bilirubin, ↑ALP, ↑AST ↑ALT
CRP - ↑
blood cultures
USS
ERCP

54
Q

Management of acute cholangitis?

A

IV antibiotics

ERCP or surgical drainage

55
Q

What is Charcot’s triad?

A

right upper quadrant pain, fever and jaundice - classically linked to ascending cholangitis.

56
Q

Investigations for alcoholic liver disease?

A
  • LFTs - ALT/AST raises, Gamma-GT - raised. Low albumin in severe disease. raised bilirubin if cirrhosis
  • elevated prothrombin
  • deranged U&E’s

USS

57
Q

Management of acute alcoholic hepatitis?

A

glucocorticoids e.g. prednisolone

58
Q

Symptoms of alcohol withdrawal based on time?

A

6-12 hours: tremor, sweating, headache, craving and anxiety
12-24 hours: hallucinations
24-48 hours: seizures
24-72 hours: “delirium tremens”

59
Q

Management of alcohol withdrawal?

A

Chlordiazepoxide (“Librium”) or diazepam
+
IV high-dose B vitamins (pabrinex). + regular lower dose oral thiamine.

60
Q

What comes first Wernicke’s encephalopathy or Korsakoffs syndrome?

A

Wernicke’s

61
Q

Features of Wernicke’s encephalopathy?

A
  • Confusion
  • Oculomotor disturbances (disturbances of eye movements)
  • Ataxia (difficulties with coordinated movements)
62
Q

Features of Korsakoffs syndrome?

A
  • Memory impairment (retrograde and anterograde)
  • Behavioural changes
63
Q

Treatment of Wernicke-Korsakoff Syndrome (WKS)?

A

thiamine supplementation and alcohol abstaining

64
Q

Ascites drug management?

A

spironolactone

65
Q

What is primary sclerosing cholangitis?

A

biliary disease of unknown aetiology characterised by inflammation and fibrosis of intra and extra-hepatic bile ducts.

66
Q

How does primary sclerosing cholangitis present?

A
  • cholestasis - jaundice, pruritus, raised bilirubin + ALP
  • right upper quadrant pain
  • fatigue
67
Q

Investigations for primary sclerosing cholangitis?

A

ERCP or MRCP - diagnostic (shows ‘beaded’ appearance)

p-ANCA +ve

ANA and Anticardiolipin antibodies may also be raised - less common

68
Q

Complications of primary sclerosing cholangitis?

A
  • cholangiocarcinoma (in 10%)
  • increased risk of colorectal cancer
69
Q

Conditions associated with primary sclerosing cholangitis?

A

UC
crohns
HIV

70
Q

Management of primary sclerosing cholangitis?

A

Liver transplant - curative
ERCP - to dilate and stent
Colestyramine - helps with pruritus

71
Q

What is primary biliary cirrhosis (cholangitis)?

A

Primary biliary cirrhosis is a condition where the immune system attacks the small bile ducts within the liver.

72
Q

Clinical features of PBC?

A

normally middle aged woman
fatigue
pruritus
jaundice
abdo pain
pale stool
xanthelasma / xanthoma
may progress to liver failure

73
Q

Components of Glasgow - blatchford score?

A

Urea
hb
Systolic BP
HR
Malaena
Syncope

74
Q

Causes of upper GI bleed?

A
  • oesophageal varices
  • Mallory - Weiss tear
  • gastric ulcers / duodenal ulcers
  • malignancy
75
Q

Why does urea rise in upper GI bleed?

A

The blood in the GI tract gets broken down by acid and digestive enzymes - one of the breakdown products is urea- the urea is then absorbed by the intestines

76
Q

Clinical features of appendicitis?

A
  • Peri-umbilical pain which radiates to the RIF
  • N&V
  • mild temperatures (37.5-38 degrees celsius)
  • anorexia
  • Rovsing sign
  • Psoas sign
77
Q

Management of appendicitis?

A
  • Appendectomy
  • IV prophylactic antibiotics

if perforated then copious abdominal lavage.

78
Q

Inguinal vs femoral hernia locations?

A

inguinal - superior and medial to pubic tubercle
femoral - inferior and lateral to pubic tubercle

79
Q

What is Budd-chiari syndrome?

A

hepatic vein thrombosis

80
Q

Causes of Budd-chairi syndrome?

A
  • polycythaemia rubra vera
  • thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies
  • pregnancy
  • combined oral contraceptive pill (20% of cases)
81
Q

Features of budd-chairi syndrome?

A

abdominal pain
tender hepatomegaly
ascites

82
Q

Investigations for budd-chairi syndrome?

A

USS with doppler flow studies

83
Q

PSC diagnostic investigation?

A

MRCP

84
Q

Barretts oesophagus - what change?

A

stratified squamous -> simple columnar

85
Q

most common site of colorectal cancer?

A

rectal (40%)
sigmoid (30%)

86
Q

What is the initial and what is the definite investigation for bowel obstruction?

A

initial - abdominal XRAY
definite - abdominal CT

87
Q

H.pylori treatment?

A

clarithromycin/metronidazole, amoxicillin and omeprazole

88
Q

Diverticulitis hospital antibiotics management?

A

IV ceftriaxone + metronidazole

89
Q

Haemochromatosis investigations?

A

Raised transferrin saturation and ferritin,
low TIBC

90
Q

SBP - when do you require prophylactic antibiotics + antibiotic of choice?

A

Patients who have previously suffered an episode of spontaneous bacterial peritonitis and who have a fluid protein <15 g/l require antibiotic prophylaxis, this is most commonly ciprofloxacin or norfloxacin.

91
Q

SBP treatment?

A

intravenous cefotaxime

92
Q

Pancreatitis prognostic criteria - what indicates severe?

A

Modified glasgow score
>/= 3

93
Q

What are the different domains in the modified glasgow scale?

A

P - PaO2 <8kPa

A - Age >55-years-old

N - Neutrophilia: WCC >15x10(9)/L

C - Calcium <2 mmol/L

R - Renal function: Urea >16 mmol/L

E - Enzymes: LDH >600iu/L; AST >200iu/L

A - Albumin <32g/L (serum)

S - Sugar: blood glucose >10 mmol/L

94
Q

H.pylori post eradication therapy investigation?

A

Urea breath test

95
Q

Colostomy vs ileostomy?

A

colostomy - flat
ileostomy - sprouted

Finals (18 decks)

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