GI Flashcards
if active UGI bleed how many units should you Xmatch?
6
what are transfusion criteria following UGI bleed?
Hb <70
platelets <50 and active bleeding
PTT>1.5 transfuse FFP
which score can be done pre-endoscopy to calculate the risk of a re-bleed?
Blatchford score
Which score can be done post endoscopy to predict mortality?
Rockall
What is the management for a non-variceal bleed?
endoscopy:
either heat treatment of dual therapy (adrenaline + other)
PPI if stigmata of bleed on endoscopy
test H pylori
What is the management of a variceal bleed
terlepressin and broad spectrum Abx on presentation
band ligation/ glueing in endoscopy
If unable to contro variceal UGI bleed what tube can be used?
Sengstaken-Blakemore tube
define chronic constipation
stools <3/52
more than 6 months
symptoms- straining/ pain on defecation
what investigations would you send a stool sample for in acute diarrhoea?
MC+S
ova and parasites
cysts
c diff toxin
Using a surgical seive list causes of chronic constipation
(Vascular) Inflammatory/ infective- IBS/ diverticular disease Trauma- obstruction (AI) Metabolic- pregnancy, hypercalcaemia Idiopathic/ iatrogenic- lack of fibre/ activity, opiates neoplastic- colon cancer Congenital- hirschprung degenerative- MS, Parkinsons endocrine- hypothyroid
Using a surgical sieve list causes of diarrhoea
(Vascular)
Inflammatory/ infective- IBS/ diverticular disease/ infection e.g. C diff- viral, bacterial or parasitic, appendicitis
Trauma- short bowel syndrome
AI- crohns
Metabolic- anxiety, pancreatic insufficiency
Idiopathic/ iatrogenic- antibiotic colitis/ laxatives, constipation with overflow
neoplastic- colon cancer
Congenital-
degenerative-
endocrine- hyperthyroid
what food item might you advise patients to avoid during acute diarrhoea?
dairy- risk of future intolerance
when are anti-motility drugs contraindicated in acute diarrhoea?
blood in stool
which pathogens causing acute diarrhoea are more likely to cause reactive complications?
shigella
campylobacter
salmonella
which drug is used to treat C diff
metronidazole
which pathogens cause non-bloody diarrhoea with mid-abdominal pain?
giardia lamblia- explosive, flatulance, dirty water
noravirus/ rotavirus
which pathogens are more likely to cause lower abdo pain/ tenesmus/ bloody diarrhoea?
Campylobacter- petting zoo
shigella
salmonella- can cause TMC
E coli 0157- can cause HUS
What should be avoided in E coli 0157?
antibiotics increase risk of HUS
what is HUS?
haemolytic uraemic sundrome- AKI + haemolytic anaemia
which blood test can be used to test for coelic’s?
anti a-gliadin, total immunoglobulin A, IgA tissue transglutaminase (ttg)
How is hepatitis A spread?
faecal-oral- long incubation period so often difficult to identify cause
investigations for Hep A
IgM
who can get infected with hepatitis D?
anyone already infected with hep D, increases risk of HCC and cirrhosis
what is the first line treatment for chronic hep B?
interferon,
if not tolerated then lifelong NRTI
Patient with Hep B bloods as follows:
sAg +
anti HBs -
anti HBc +
current Hep B infection (sAg marker of current infection, anti HBc not found in vaccine)
Patient with Hep B bloods as follows:
sAg -
anti HBs +
anti HBc +
previous Hep B infection (anti HBs marker of current immunity, anti HBc not found in vaccine)
Patient with Hep B bloods as follows:
sAg -
anti HBs +
anti HBc -
previously immunised against Hep B
what is the prognosis for hep C infection?
poor- some may clear spontaneously
20 years 15% cirrhosis
up to 20% HCC
Pain in RUQ, worse after eating, radiates to back, reduces spontaneously
biliary colic
what is murphy’s sign?
2 fingers pressed on RUQ on inspiration causes pain and arrest of inspiration
not reproducable on L
sign of cholecystitis
RUQ and fever, murphys sign positive
cholecystitis
RUQ pain, fever and jaundice, dark stools and pale urine
cholangitis`- charcots triad
what is the difference between MRCP and ERCP?
MRCP diagnostic, ERCP can be used for treatment too
when should you perform a lap cholecystectomy?
if acute pancreatitis/ recurrent within a week, otherwise 6-8 weeks after symptoms stop
what score can be used in cirrhosis to estimate life expectency?
child-pugh score
what score can be used in decompensated cirrhosis for transplant planning?
MELD score
how often should USS be performed in cirrhosis?
every 6 months + AFP to screen for HCC
What can be used for pruritus in cirrhosis?
antihistamine
list 3 causes of portal hypertension
pre-hepatic: portal vein thrombosis/ extrinsic tumours
hepatic causes: cirrhosis, chronic hepatitis, schistosomiasis
post-hepatic causes: RHF, budd chiari syndrome
what screening should be performed in pulmonary hypertension?
endoscopy for varices, if none 2-3 yearly
if small yearly
if larger prophylactic BB/ banding
screen for HCC and cirrhosis
how much fluid in ascites can be detected by shifting dullness?
1.5L
how much fluid in ascites can be setected on USS?
500ml
Name 3 causes of ascites
cirrhosis
malignancy
HF
how soon after admission should an ascitic tap be performed?
within 24 hours
what does a low serum ascites-albumin gradient (<11g/L) indicate?
peritoneal cause of ascites- malignancy, TB, peritonitis
what does a high serum ascites-albumin gradient (>11g/L) indicate?
portal hypertension cause of ascites:
cirrhosis, HF, nephrotic syndrome
what is the best initial treatment for ascites?
reduced sodium diet
spironolactone
aim for 0.5-1kg wight loss/ day
what should be given following therapeutic paracentesis?
small (<5L) synthetic plasma expander
large (>5L) HAS
which condition is associated with crypt abscesses?
UC
Crohn’s may have what appearance?
cobblestone appearance
Where are Crohns lesions most commonly found?
terminal ileum
which form of IBD has transmural lesions?
Crohn’s
what is faecal calprotectin a marker of?
inflammation in colon
what staging system can be used for Crohn’s?
Crohn’s disease severity index
which medication should be avoided in UC?
loperamide, increases risk of TMC
treatment for mild UC?
5-ASA
no improvement add steroids
treatment for mod UC?
prednisolone + 5-ASA, +/- steroid enemas
treatment for severe UC (systemically unwell + 6+ bowel motions a day)?
IV + rectal steroids +5-ASA
?NBM
examine BD for TMC
if no response consider surgery/ ciclosporin or infliximab to maintain remission
what is used to maintain remission in UC?
5-ASAs (sulphasalazine)
which form of IBD is pANCA +ve?
UC
which form of IBD can present with a RLQ mass?
Crohn’s
list 3 extra-intestinal symptoms of IBD?
large joint arthritis
erythema nodosum
irisitis
pyoderma gangrenosum
what treatments are used in Crohn’s?
only to induce remission not to maintain- no 5-ASA only steroids. No response to steroids infliximab
surgical management for Crohn’s?
resection
Surgical treatment for UC?
resection + restorative protocolectomy 92 operations- 1 to create pouch out of ileus and 1 to attach to anus)
what is the M rule?
for primary biliary cirrhosis
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females
LLQ pain increased on eating, decreased on OB
divertticular disease