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GI Flashcards

1
Q

What is psuedomembranous colitis
What abx are associated with it
Blood results

A

Severe inflammation of the colon usually due to overgrowth of C Diff

Clindamycin
Penicillins
Cephalosporins

Leukocytosis

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2
Q

Complications of pseudomembranous colitis

A

Paralytic ileus
Perf
Multi organ failure

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3
Q

Sx of pseudomembranous colitis

A

Diarrhoea - may be mucusy or bloody, can be up to 15 times a day
Fever
Abdo pain
Dehydration
Hx of abx

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4
Q

Medical/organic causes of diarrhoea (non GI system)

A

Hyperthyroidism
Pancreatic insufficiency

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5
Q

Causes of acute diarrhoea

A

Abx
Gastroenteritis - adeno,rhino,enterovirus

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6
Q

Definition of chronic diarrhoea

A

4 weeks
> or = 3 stools per day

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7
Q

Ix for pseudomembranous colitis

A

FBC - raised WCC
CRP
Stool culture
Abdo xray
Consider sigmoidoscopy

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8
Q

Rx of pseudomembranous colitis - general, non-severe, severe, toxic megacolon

A

Stop causative abx
Avoid antidiarrhoeals and opiates
Side room

1st line non severe - metronidazole
1st line severe - oral vancomycin if fails to improve add IV metronidazole

Toxic megacolon - urgent colectomy

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9
Q

Define constipation

A

Less than 3x week
Or
Less often than normal with difficulty straining

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10
Q

Causes of constipation
OPENED IT

A

Obstruction - mechanical (hernia, adhesions, ca)
Pain - anal fissures
Endocrine - hypothyroid, hypocalcium, hypopitassium
Neuro - MS, CES
Elderly
Diet/dehydration
IBS
Toxins - opioids

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11
Q

Causes of chronic diarrhoea

A

IBD
Coeliacs

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12
Q

Rx of constipation

A

Treat underlying cause
Diet and lifestyle advice - fibre (lentils, beans, veg) and hydration

Can give laxatives, PR if impacted

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13
Q

Types of laxatives, examples and MOA

A

Osmotic - lactulose, draw fluid into gut
Stimulant - senna. Bisacodyl, sodium picosulfate : induce peristalisis
Bulk forming - ispaghula : indigestible so stay in bowel to bulk stool and induce peristalsis

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14
Q

Example of a stool softener

A

Docusate sodium

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15
Q

Example of a suppository

A

Glycerol (stimulant laxative)

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16
Q

What is used for an enema

A

Phosphate enema

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17
Q

Medical rx of IBS

A

Antispasmodics - buscopan, mebeverine
Loperamide for diarrhoea

Lifestyle - reduce caffeine, stay hydrated

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18
Q

Dx of the dysphagia if:
Liquids and solids
Solids>liquids
Difficulty making swallowing
Odynophagia
Neck bulges or gurgles

A

Motility disorder
Stricture
Bulbar palsy
Ca, oesophageal ulcer, spasm
Pharyngeal pouch

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19
Q

How long before an OGD do you need to stop PPIs

A

2 weeks

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20
Q

Pathophys of achalasia

A

Degeneration if myenteric plexus causes LOS to not relax

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21
Q

Achalasia presentation

A

Dysphagia - both liquid and solid
Regurge
Weight loss
Arching if neck/standing sitting up straight

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22
Q

Complication of achalasia

A

Oesophageal Ca

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23
Q

Sign on barium swallow for achalasia

A

Bird beak sign

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24
Q

Rx of achalasia

A

Surgical cardiomyotomy
Can also do botox or medical rx with CCBs or nitrates

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25
Q

How does diffuse oesophageal spasm present

A

Intermittent dysphagia with chest pain

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26
Q

Red flags with dyspepsia
ALARMS

A

Anaemia/bleeding
Loss of weight
Anorexia
Recent onset and progressive
Maleana or haematemesis
Swallowing difficulty

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27
Q

Rx of dyspepsia if >60 or ALARMS

A

OGD 2ww

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28
Q

Rx of dyspepsia is no alarming criteria and <60

Conservative and then ix if continues

A

Stop NSAiDs/CCBs,
Stop smoking
Stop alcohol
Modify diet
Weight loss

Try anatacids.

Do breath test and stool sample for H Pylori

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29
Q

H Pylori triple therapy

A

7 days of PPI, Amoxicillin and clarithro
Or metronidazole if pen allergy

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30
Q

ADRs of PPIs

A

Hyponatramia
Osteoporosis
Increased risk of C Diff
Microscopic colitis

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31
Q

Risk factors for PUD

A

Alcohol
Smoking
H Pylori
NSaids
Steroids
Bisophosphonates

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32
Q

Ix for PUD

A

H pylori breath testing C12
OGD
Bloods
Gastrin if ZE suspected

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33
Q

What is the Glasgow blatchford score used for

A

Predict the need to treat pts with upper gi bleeds

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34
Q

Presentation of GORD

A

Halitosis
Chrinic cough
Burning related to meals, lying down
Burping

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35
Q

Surgery used for severe GORD

A

Nissen fundoplication

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36
Q

Types of hiatus hernia, which one is worse

A

Sliding
Rolling - can become strangulated

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37
Q

What is diagnostic ix for hiatus hernia

A

Ba Swallow
CXR - will show has bubble and fluid level in chest cavity

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38
Q

Ddx for haematemesis VINTAGE

A

Varices
Inflammation
Neoplasia
Trauma eg MW, boerhaaves
Angiodysplasia
General eg warfarin
Epistaxis

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39
Q

If urea is raised but creatinine is normal what blood test should you check and why

A

Hb for upper gi bleed

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40
Q

What is the rockall score

A

Predicts risk of re bleeding in upper GI bleed

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41
Q

What dx does coffee ground vomit suggest

A

PUD

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42
Q

Immediate rx of upper GI bleed

A

Resuscitation
Consider terlipressin (variceal)
Urgent endoscopy

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43
Q

What meds must you give in/after urgent OGD for upper GI bleed

What else should you do (ie what info is important for nurses)

A

Adrenaline
Antibiotics
Offer vit k

Keep NBM for 24hrs

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44
Q

Causes of prehepatic jaundice

A

Excess biliruben production - haemolytic anaemia
Or ineffecive erythropoeisis eg SCD, G6PD, thalassaemia

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45
Q

Causes of hepatic jaundice

A

Drugs - rifampicin, isoniazid, ethmbutol
Hepatitis
Cirrhosis
Congenital causes - haemochromatosis, wilsons, a1ATD
Autoimmune
Alcohol
Infectious - cmv, ebv, hep abc

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46
Q

Post hepatic causes

A

Cholestasis
Pancreatic cancer
Biliary atresia

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47
Q

Signs of liver failure

A

Jaundice
Oedema and ascitis
Encephalopathy
Signs of portal hypertension in cirrhosis

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48
Q

Pathophys of hepatorenal syndrome

A

Cirrhosis - release of mediators causing splanchnic artery vasodilation, reduces vascular resistance - RAAS activation - renal artery vasoconstriction

Persistent hypoperfusion - failure

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49
Q

Rx of hepatorenal syndrome

A

IV albumin
Spanchnic vasoconstrictor - terlipressin
Haemodialysis
Liver transplant

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50
Q

Rx if liver failure

A

Rx of underlying cause
Good nutrition - NGT
Thiamine supplements

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51
Q

Complications of liver failure

A

Bleeding
Sepsis
Ascites
Hypoglycaemia
Encephalopathy - seizures, cerebral oedema

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52
Q

Drug for cerebral oedema

A

Mannitol

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53
Q

Drug for ascites

A

Spiro

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54
Q

Drugs to avoid in liver failure

A

Opiates
Hypoglycaemics
Na containing IVI
Caution - warfarin
Hepatotoxic drugs - paracetamol, methotrexate, isoniazid, tetracyclines

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55
Q

Signs of cirrhosis in hands

A

Hepatic flap
Duputyrons
Spider naevi
Leuconychia
Clubbing
Palmar erythema

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56
Q

Causes of cirrhosis

A

Alcohol excess
Chronic HepC
NASH/NAFLD
hepB
a1AT
wilsons
haemochromatosis

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57
Q

What ix suggest that cirrhosis is caused by:
- alcohol
- NAFLD
- infection
- genetics

A
  • increased MCV, increased GGT
  • hyperlipidaemia, increased glucose
  • serology positive
  • genetic stuff
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58
Q

What imaging is used for cirrhosis

A

US liver

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59
Q

Complications of cirrhosis

A

SBP
Portal htn and varices
Wernickes encephalopathy and korsakoff psychosis

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60
Q

Rx of wilsons drug

A

Penicillamine

61
Q

Rx of ascites

A

Fluid and salt restriction
Spiro

2nd line furosemide, tap, daily weights

62
Q

Pathophys of ascites

A

portal hypertension
Splanchnic vasodilation
RAAS activation
Sodium and water retention
PLUS Hypoalbuminaemia

Leads to ascites

63
Q

Blood results of alcoholism

A

Increased Mcv anaemia
Folate deficiency

64
Q

Rx of alcohol withdrawal in hospital

A

Chlordiazepozide
Thiamine (pabrinex)

65
Q

Sx of alcoholic hepatitis

A

Tender hepatomegalt
Anorexia
Diarrhoea
Vomiting
Ascites
Jaundice, varices, encephalopathy if severe

66
Q

What is NAFLD

A

Non alcoholic fatty liver disease caused by insulin resistance and metabolic syndrome
NASH is most common form

67
Q

Examination findings in NAFLD

A

Truncal obesity
Hepatosplenomegaly
Hx of obesity, diabetes, htn etc

68
Q

What makes up metabolic syndrome

A

Obesity
HTN
High fasting glucose/insulin resistance
High triglycerides
Low HDL cholesterol

69
Q

Rx of NAFLD

A

Diet and lifestyle changes
Control htn, dm

70
Q

What is budd chiari syndrome

A

Hepatic vein obstruction - ischaemia and hepatocyte damage - insidious cirrhosis and liver failure

71
Q

Causes of budd chiari

A

Hypercoaguable state
Myeloproliferative disorders eg PV
HCC local tumour

72
Q

Triad for Budd Chiari presentation

A

RUQ
Hepatosplenomegaly
Ascites

73
Q

What is hereditary haemochromotosis

A

Increased intestinal iron absorption leading to deposition in multiple organs
Called bronze diabetes

74
Q

Rx of hereditary haemochromotosis

A

Venesection

75
Q

Presentation of a1AT deficiency

A

Neonatal and childhood Hepatitis
Cirrhosis
Emphysema

76
Q

Clinical features of wilsons disease

A

Kayser fleischer rings
Liver disease - childhood presentation
Arthritis
Parkinsonism
RTA
Haemolytic anaemia

77
Q

Rx of wilsons

A

Penicillamine lifelong
Avoid high cooper foods: liver, chocolate, nuts

78
Q

What is primary biliary cholangitis

A

Intrahepatic bile duct destruction by chronic inflammation leading to cirrhosis

79
Q

Who is primary biliary cholangitis common in
What immunology blood test is raised

A

Liver failure in a Middle age woman with signs of rheum/autoimmune conditions

IgM

80
Q

Rx if primary biliary cholangitis

A

Pruritus: cholestyramine
Diarrhoea: codeine
Osteoporosis: bisphosphonates
ADEK vitamins
Ursodeoxycholic acid
Immune supression - pred, azathioprine
Liver transplant

81
Q

How do PBC and PSC duffer

A

PBC effects only the intrahepatic billiary ducts

82
Q

Complications of primary sclerosing cholestasis

A

Cirrhosis
Increased risk of cholangiocarcinoma and colorectal cancer

83
Q

Disease commonly associated with primary sclerosing cholangitis

A

80% of those with PSC have IBD

84
Q

Management of PSC

A

Same as PBC
Plus US gallbladder and Ca19-9
Plus colonoscopy for CRC

85
Q

Presentation of cholangiocarcinoma

A

Fever
Malaise
Abdo pain
Ascites
Jaundice

86
Q

Indications for liver transplant

A

Advanced cirrhosis
HCC
Cholangiocarcinoma
A1AT deficiency

87
Q

Is smoking good or bad in IBD

A

Good for UC
Bad for chrons

88
Q

Features of Crohns vs UC

A

Crohns
- transmural (full thickness) inflammation
- no PR blood or mucus
- entire gi tract affected
- skip lesions
- terminal ileum most common place affected (may be B12 deficient)
- perianal disease

UC
- only superficial mucosa effected
- blood and mucus PR
- only colon and rectum affected
- continuous inflammation
- associated with PSC

89
Q

Extra gi presentations of IBD

A

Erythema nodosum
Pyoderma gangrenosum
PSC
Episcleritis, scleritis, anterior uveitis
Enteropathic arthritis

90
Q

Diagnosing IBD ix

A

Fecal calprotectin
Colonoscopy

91
Q

Acute UC rx

A

Mild/mod - aminosalicylate or oral pred
Severe - iv steroids

92
Q

Maintenance UC rx

A

Aminosalicylate eg mesalazine first
Azathioprine

93
Q

Surgical UC rx

A

Panproctocolectomy - will have perm ilieostomy or j pouch

94
Q

Acute Crohns rx

A

Oral pred or IV hydro are first line
Enteral nutrition - special liquid diet

Azathioprine, methotrexate, infliximab if not working

95
Q

Maintenance and surg rx of crohns

A

Azathioprine or mercaptopurine.
Methotrexate as 2nd line

Surgery - resect distal ileum, treat strictures and fistulas

96
Q

Complications of IBD

A

Toxic megacolon (Uc)
CRC and cholangiocarcinoma
Strictures
Fistula (crohns)

97
Q

AXR findings in UC

A

Lead pipe - no haustra
Thumbprinting - mucosal inflammation
Possible toxic megacolon

98
Q

What do we also test for in pts with newly diagnosed T1DNM or autoimmune thyroid disease

A

Coeliacs

99
Q

Microscopy findings in coeliacs

A

Villous atrophy and crypt hypertrophy

100
Q

Main antibody associated with coeliacs .
What must you also test alongside this

A

Anti TTG (tissue transglutaminase)

IgA bc an IgA deficiency will mean the antibody test is negative even in crohns

101
Q

Extra gi presentations of coeliacs

A

Dermatitis herpetiformis
Anaemia - bc low iron, b12, folate
Hyposplenism
Osteoporosis
Can lead to Lymphoma (enteropathy associate T cell lymphoma)

102
Q

Risk factors of pancreatic ca

A

Smoking
Chronic pancreatitis
Alcohol
DM
HNPCC
MEN
BRCA2

103
Q

Presentation of pancreatic ca

A

Male >60
Painless obstructive jaundice
Dark urine, pale stools
Epigastric pain radiating to back relieved sitting forwards
Anorexia and weight loss
Sudden onset dm in the elderly

104
Q

Rx of pancreatic ca

A

Whipples procedure
Or palliation

105
Q

A patient has no abdo pain, jaundice but has palpable gallbladder. Dx?

A

Courvosiers law says that painless enlarged gallbladder is unlikely to be gallstones

Consider pancreatic ca

106
Q

Chronic pancreatitis presentation

A

Epigastric pain radiates to back, relieved by sitting up
Exacerbated by fatty food
Steatorrhoea
Weight loss
DM

107
Q

Rx of chronic pancreatitis

A

Analgesia
Creon (pancreatic enzymes)
ADEK
Rx DM
Reduce fat intake
No alcohol

108
Q

Presentation of B12 deficiency

A

Glossitis
Peripheral neuropathy
Subacute combined degeneration of the cord

109
Q

Scurvy (vit c deficiency) presentation

A

Gingivitis
Bleeding gums
Muscle pain and weakness
Oedema
Corkscrew hairs

110
Q

What factors are vit k dependent

A

2,7,9,10

111
Q

Presentation of acute mesenteric ischaemia
Who is it likely in

A

Clot in superior mesenteric artery
Acute non specific abdo pain disproportionate to findings.

Elderly pt with AF

112
Q

Diagnostic scan of choice for AMI

A

Contrast CT abdo

113
Q

Triad of chronic mesenteric ischaemia

A

Colicky abdo pain
Weight loss
Abdominal bruit

114
Q

MUST score

A

Find pic

115
Q

Calculate alcohol units

A

Volume (ml) x % divided by 1000

116
Q

Metabolic disturbances in refeeding syndrome

A

Hypo
- phosphate
- potassium
- magnesium

117
Q

Who is at high risk of refeeding

A

Bmi less than 16
Little nutritional intake >10 days
Unintentional wl >15% over 3 months

118
Q

Rx of severe alcoholic hepatitis (think inflammation)

A

Prednisolone

119
Q

Complications of cirrhosis

A

SBP
Hepatorenal syndrome
PHTN, Varices
Malnutrition
Ascites
Hepatic encephalopathy

120
Q

Scores used to assess prognosis in cirrhosis

A

MELD (model for end- stage liver disease)
Child Pugh score - Albumin, biliruben, clotting, dilation (ascites), encephalopathy

121
Q

How does cirrhosis cause malnutrition

A

Reduced protein metabolism in the liver
Reduced ability to store glucose as glycogen

122
Q

How does liver disease cause ascites

A

PHTN causes capillaries in abdominal cavity to leak
Reduced BP
RAAS activation causes increased sodium resorption
Leading to a transudative ascites

123
Q

Most common organisms of sbp
Which complication of cirrhosis is it as a result of

A

E coli
Klebsiella pneumoniae

10-20% of pts with ascites as infection develops within the ascitic fluid

124
Q

Rx of hepatic encephalopathy
(What is accummulating)

A

Lactulose - helps to reduce ammonia levels
Abx - to reduce number of intestinal bacteria producing ammonia
Nutritional support

125
Q

Presentation of an iron overdose and why do some of these present

A

N+v
Diarrhoea
Black stool
Gi ulceration
Gi haemorrhage
Rectal bleeding
Haemodynamic collapse - free plasma iron is a potent vasodilator

126
Q

Side effect of desferroxamine

A

Orange red urine

127
Q

med of choice for campylobacter

A

clarithromycin

128
Q

presentation of gilberts syndrome

A

episode of jaundice triggered by/associasted with dehydration, poor sleep, stress, physical exertion, illness.
lots normal bar bilirubin,
no other sx of liver disease

129
Q

what is Small intestine bacterial overgrowth syndrome
ix
rf
rx

A

too much bacteria causing chronic diarrhoea, bloating, flatulance and abdominal pain
ix - hydrogen breath test
rf - diabetes, congenital gut issues, scleroderma
rx - abx - rifaxamin, metrodizole or co amox

130
Q

rx for achalasia

A

cardiomyotomy

131
Q

side effects of metoclopramide to be aware of

A

EPS eg acute dystonia, parkinsonism etc

132
Q
A
133
Q

Presentation of mesentaeric ischaemia

A

Acute onset generalised colicky abdo pain
Clinically shocked
Pain and shock disproportionate to clinical findings
Often in afib which throws off a clot into the mesenteric arteries

134
Q

drug causes of pancreatitis

A

mesalazine,
azathioprine
steroids
sodium valproate

135
Q

how is liver cirrhosis diagnosed - imaging of choice

A

fibro scan (transient elastography) (basically an ultrasound)

136
Q

what are the best blood results to acutely measure the synthetic function of the liver

A

INR
Albumin - least of the 3
PT

137
Q

drugs associated with cholestasis

A

COCP
co-amox
sulphonylureas
anabolic steroids

138
Q

features of acute liver failure

A

jaundice
ascites
hypoalbuminaemia
coagulopathy
renal failure - hepatorenal syndrome
hepatic encephalopathy

139
Q

rx of acute alcoholic hepatitis

A

prednisolone

140
Q

Rx of ascites

A

Spironolactone
low salt intake
prophylactic abx to prevent against SBP
Paracentesis (drain) if tense ascites

141
Q

first line drug used in hepatic encephalopathy and why

A

lactulose - thought to decrease ammonia

142
Q

risk factors for hepatocellular carcinoma

A

biggest is liver cirrhosis! 2’ to alcohol, hep b, hep c, haemochromatosis,
a1AT
DM

143
Q

tumour marker for HCC

A

AFP

144
Q

what can trigger decompensation in liver cirrhosis

A

constipation
infection, electrolyte imbalances, dehydration, upper GI bleeds or increased alcohol intake.

145
Q

wernickes triad

A

ataxia
ophthalmoplegia
confusion

146
Q

microscopic findings in UC, crowns and coeliacs

A

All - lymphocytic infiltration
UC - crypt accesses and goblet cell loss
Cr - granulomas, lymphoid hyperplasia
Coe - villous atrophy and crypt hyperplasia

147
Q

examination finding in liver in RHF

A

pulsatile smooth enlarged liver

148
Q
A

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