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Finals (HV) > GI and Liver > Flashcards

GI and Liver Flashcards

1
Q

What is Barrett’s oesophagus?

A

Metaplasia of the lower oesophageal mucosa

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2
Q

What changes occur in Barrett’s?

A

Squamous epithelium –> Columnar epithelium

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3
Q

What is the mx of Barrett’s?

A

High dose PPI
Endoscopic survilliance
If dysplasia present- radiofrequency ablation or resection

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4
Q

List 3 RF of Barrett’s?

A

Male
GORD
Obesity (Central)
Smoking

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5
Q

What is Haemochromotosis?

A

An autosomal recessive disorder of iron absorption and metabolism thus iron accumulation

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6
Q

List the sx of haemochromotosis?

A

Liver cirrhosis
Jaundice
Hyperpigmemtation (Bronze/slate grey)
Hair loss
ED
Amenorrhoes
Diabetes
Malabsorbtion issues

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7
Q

What first and GS ix is indicated in haemochromotosis and what are the results?

A

1st- iron studies
Ferritin- High
TIBC- Low
Transferrin- High

GS- Genetic testing (if heriditary component)

other- Liver biopsy, CT abdo

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8
Q

What is the mx of haemochromotosis?

A

1st line- Weekly venesection
2nd line- Deferoxamine

additionally inform patients to avoid alcohol

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9
Q

List 4 red flags for gastric cancer?

A

Unexplained weight loss
New onset dyspepsis >55
Unexplained persistent vomitting
Epigastric pain
Odonophagia
Worsening dysphagia

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10
Q

What is the Ix of choice in gastric cancer?

A

OGD with biopsy

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11
Q

List 3 RF for gastric cancer?

A

H pylori
Smoking
Pernicious anaemia
Blood group A

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12
Q

What are the 2 areas of lymphatic spread in gastric cancer?

A

Left supraclavicualr node (Virchow’s node)
Periumbilical node (Sister mary joseph node)

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13
Q

What antibodies are present in Autoimmune hepatitis?

A

ANA
Anti smooth muscle
Anti soluble liver antigen

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14
Q

What antibodies are present in PBC?

A

Anti mitochondrial antibodies

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15
Q

What is Primary sclerosisng cholangitis?

A

chronic condition of unknown cause characterised by inflammation and fibrosis of intra and extraheaptic ducts

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16
Q

What 2 conditions are closely linked with PSC?

A

Ulcerative colitis (most common) , HIV, and Chrons

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17
Q

What blood marker can differentiate between an upper and lower GI bleed?

A

High urea levels- present in upper GI bleed

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18
Q

What sx are present in PSC?

A

Jaundice
Pruritus
RUQ pain
Fatigue

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19
Q

What LFT markers suggest a diagnosis of PSC?

A

High billirubin and ALP

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20
Q

What blood markers are used to monitor management in haemochromatosis?

A

Ferritin (below 50ug/L)
Transferrin Saturations (below 50%)

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21
Q

List the common abx causes of C.diff?

A

Clindamycin
2nd and 3rd gen cephalosporins
Co-amoxiclav
Ciprofloxacin

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22
Q

What conservative measures should be taken if a patient on the ward has c-diff?

A

Side room, wash hands, dispose of gloves and aprons

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23
Q

What is the 1st line Abx for c-diff?

A

Oral vancomycin 10 days

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24
Q

What is the 2nd line Abx for c-diff?

A

Oral Fidaxomicin

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25
Q

What is the 3rd line Abx for c-diff?

A

IV metronidazole + Oral vancomycin

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26
Q

What other alternative therapies other than Abx can be used to treat c-diff?

A

Bezlotuxmab- monoclonal antibody which targets c-diff toxin B

Faecal microbiota transplant- may be considered for patients who have had 2 or more prev episodes

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27
Q

What is Plummer visson syndrome?

A

Characterised by dysphagia, IDA, Glossitis, cheliosis, and oesophageal webs

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28
Q

What is Crohn’s disease?

A

An inflammatory bowel disease characterised by transmural inflammation of the GI tract

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29
Q

List the 4 layers o the gastric mucosa?

A

Mucosa
Submucosa (mesissners plexus)
Muscularis propria (Aurchbachs plexus)
Serosa

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30
Q

List the features of crohns?

A

Non-specific sx (WL and lethargy)
Diarrhoea
Abdo pain (RIF)
Perianal disease

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31
Q

What will be seen on the histology findings in Crohn’s?

A

Inflammation in all layers
Increased Goblet cells
Granulomas

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32
Q

What will be seen in endoscopy of Crohn’s?

A

Deep ulcers
Skip lesions- Cobblestone appearance

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33
Q

What will be the findings in radiology of Crohn’s?

A

Strictures- Kantor’s string sign
Proximal bowel dilation
Rose thorn ulcers
Fistulae

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34
Q

What is the 1st line mx of inducing remission in crohn’s?

A

Oral/Topical/IV glucocorticoids

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35
Q

What is the 1st line tx to maintain remission in crohns patients?

A

Stop smoking
1st line- Azathioprine or Mercaptopurine

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36
Q

What is the 2nd line tx to maintain remission in crohns patients?

A

Methotrexate

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37
Q

What should be tested in patients prior to starting azathioprine or mercaptopurine?

A

assess thiopurine methyltransferase (TPMT) activity

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38
Q

What is UC?

A

a type of IBD that characteristically involves rectum and extends proximally

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39
Q

What are the features of UC?

A

Bloody diarrhoea
Abdominal pain in LLQ
Tenesmus

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40
Q

What are the features seen on histology in UC?

A

No Inflammation beyond submucosa
Crypt abscesses
Depletion of goblet cells

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41
Q

What are the features seen on endoscopy in UC?

A

Pseudopolyps

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42
Q

What are the features seen on radiology in UC?

A

Loss of haustrations
pseudopolyps
‘Drainpipe colon’ (colon is narrow)

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43
Q

How is the severity of UC classified?

A

mild: < 4 stools/day, only a small amount of blood

moderate: 4-6 stools/day, varying amounts of blood, no systemic upset

severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

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44
Q

What is the 1st line mx to induce remission in UC?

A

Topical aminosalicylate

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45
Q

If remission is not achieved using the 1st line mx in UC what further mx should be added?

A

Add oral aminosalicylate

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46
Q

What is the mx of severe colitis?

A

should be treated in hospital
IV steroids are usually given first-line
-IV ciclosporin may be used if steroids are contraindicated

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47
Q

What is 1st line tx for maintaining remission in UC?

A

Topical (rectal) aminosalicylate

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48
Q

What is the tx for maintaining remission following a severe relapse or >=2 exacerbation in the past year?

A

Oral azathioprine or oral mercaptopurine

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49
Q

What blood test distinguishes between IBS and IBD?

A

Faecal calprotectin

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50
Q

What is Coeliac’s disease?

A

A systemic autoimmune disease triggered by dietary gluten peptides that cause inflammation in the small bowel

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51
Q

What are the signs and sx of Coeliacs?

A
  • Diarrhoea
  • Steatorrhoea
  • Abdominal pain
  • Bloating
  • Irritable bowel syndrome
  • Faltering growth
  • Prolonged fatigue
  • Mouth ulcers
  • Deficiencies
  • Dermatitis herpetiformis
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52
Q

List the complications of coeliac’s?

A

anaemia- Iron, Folate, Vitb12
Hyposplenism
Osteoporosis
Enteropathy assocated T cell lymphoma

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53
Q

What is the 1st line Ix for coeliacs?

A

Tissue transglutaminase (TTG) antibodies (IgA)

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54
Q

What is the GS Ix for coeliacs?

A

Endoscopic intestinal biopsies

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55
Q

What findings on endoscopy are supportive of coeliacs disease?

A

villous atrophy
crypt hyperplasia
increase in intra epithelial lymphocytes
lamina propria infiltration with lymphocytes

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56
Q

What is the mx of coeliac’s disease?

A

Gluten free diet

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57
Q

What foods should be avoided in coeliacs?

A

Wheat; bread, pasta, pastry
Barley; beer
Rye
Oats

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58
Q

List foods which are gluten free?

A

Rice
potatoes
Corn (Maize)

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59
Q

What advice should be given to patients with suspected coeliacs before they undergo any testing?

A

Should eat gluten for 6 weeks prior

60
Q

List the RF of GORD?

A

Obesity
Smoking
Alcohol
Coffee
Drugs (TCAs, CCBs, Nitrates)
Over-eating , eapsecially fatty meals
Hiatus hernia
Pregnancy

61
Q

What is the 2 main contributing factors of GORD?

A

Lower oesophageal sphincter abnormalities
Transient LOS relaxation

62
Q

List the sx of GORD?

A

Heartburn- retrosternal sensation worse by stooping, straining and lying
Belching
Acid Brash
Odynophagia
Nocturnal asthma

63
Q

What is the GS Ix for GORD?

A

Oesophageal manometry

64
Q

What is the mx of GORD?

A

Lifetsyle inetrventions
PPIs

65
Q

What is the mx of a perianal fistula in a patient with Crohn’s?

A

Oral metronidazole

66
Q

What are the two types of oesophageal cancer?

A
  1. Adenocarcinoma
  2. Squamous cell carcinoma
67
Q

What are the RF for oesophageal adenocarcinoma?

A

GORD
Barretts
Smoking
Obesity

68
Q

What part of the oesophageal adenocarcinoma?

A

Lower 1/3rd of oesophagus (More prevalent in developed world)

69
Q

What part of the oesophageal squamous cell carcinoma?

A

Upper 2/3rds of oesophagus

70
Q

List the RF for oesophageal squamous cell carcinoma?

A

Smoking
Alcohol
Achalsia
Plummer visson
Diets rich nitrosamine

71
Q

List the causes of acute pancreatitis?

A

I GET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion sting
Hypercalcaemia
ERCP
Drugs (NSAIDs, Azathioprine, Furosemide)

72
Q

List the 2 most common causes of acute pancreatitis?

A

Gallstones and Alcohol

73
Q

List the clincial features/sx of acute pancreatitis?

A

Epigastric pain radiating to the back
Nausea and Vomiting
Epigastric tenderness

74
Q

List the signs that may be found on examination in acute pancreatitis?

A

Cullen’s sign - periumbilical bruising
Grey-turner’s sign - bruising in the flanks

75
Q

What Ix are done for acute pancreatitis?

A

Serum amylase or serum lipase (3 x the upper limit of normal - diagnostic)

USS- Gallstones
Contrast CT- pancreatic oedema

76
Q

How is the severity of pancreatitis classified?

A

Glasgow score (score of >=3 predicts severe pancreatitis)

Mnemonic - PANCREAS:
PaO2 < 8 / Age > 55 / Neutrophils > 15 / Ca < 2 / Renal – Urea > 16 / Enzymes – AST>200/LDH>600 / Albumin < 32 / Sugar >10

77
Q

What are the causes of chronic pancreatitis?

A

The primary cause of chronic pancreatitis is chronic alcohol excess.
Cystic fibrosis
Pancreatic cancer

78
Q

List the sx of chronic pancreatitis?

A

Epigastric pain, typically exacerbated after eating fatty food and relived by sitting forward
Bloating
WL
Steatorrhoea
Diabetes mellitus

79
Q

What Ix are done in chronic pancreatitis?

A

Amylase/lipase are often normal in chronic disease
Low faecal elastase - demonstrates exocrine dysfunction

Imaging
AXR - pancreatic calcification
CT - pancreatic atrophy, calcification, pseudocysts

80
Q

What is the mx of chronic of pancreatitis?

A

Management of underlying causes
Exocrine supplementation
CREON / pancreatin – 50,000 units with each meal + 25,000 with snacks
Analgesia

81
Q

What is acute cholangitis?

A

bacterial infection due to bile duct obstruction. Most commonly due to E.coli

82
Q

What are the clinical features of Acute cholnagitis?

A

Charcot’s triad (fever, right upper quadrant pain, jaundice)

Reynolds’ pentad (Charcot’s plus hypotension, altered mental status) in severe case

Nausea/vomiting, lethargy, pale stools and dark urine

83
Q

What is the 1st line imaging in acute cholangitis?

A

USS

84
Q

What would blood tests show in acute cholangitis?

A

Elevated liver function tests (raised ALP and/or bilirubin)
Elevated inflammatory markers

85
Q

What is the 1st line and GS mx for acute cholangitis?

A

Immediate:
IV fluids
Antibiotics- for example ceftriaxone and metronidazole

Definitive:
(ERCP) or (PTC)

86
Q

What are the stages of alcoholic liver disease?

A

ALD has 3 stages of liver damage:
1. Fatty liver (Steatosis)
2. Alcoholic hepatitis (Inflammation and necrosis)
3. Alcoholic liver cirrhosis

87
Q

What are the LFTs in alcoholic liver disease?

A

Liver Function Tests (LFTs):
AST > ALT: Typically in a ratio greater than 2:1,
Elevated bilirubin: Reflecting impaired liver function.
Alkaline phosphatase (ALP): May be moderately elevated.

88
Q

What is the mx of alcoholic liver disease?

A

Alcohol cessation
Nutritional support
1st line- Glucocorticoids (If severe)
2nd line- Pentoxifylline

89
Q

List the sx of appendicitis?

A

Abdominal pain
Classically vague, central abdominal pain which subsequently migrates to the right iliac fossa
Nausea and vomiting, anorexia

90
Q

What are the examination signs/findings

A

Abdominal pain, worst over McBurney’s point, with rebound and percussion tenderness

Rovsing’s sign - RIF pain on palpation of LIF

Psoas sign - RIF pain with extension of right hip

91
Q

What is the 1st line imaging in appendicitis?

A

USS

92
Q

What is the classification of ascites?

A

The SAAG
SAAG > 11 = Portal hypertensive ascites
SAAG < 11 = Non portal hypertensive ascites

93
Q

List the causes of asictes wih SAAG >11

A

Liver cirrhosis
Alcoholic hepatitis
Acute liver failure
Budd chiari / portal vein obstruction
Spontaneous bacterial peritonitis (SBP)
Heart failure

94
Q

List the causes of ascites with SAAG <11

A

Nephrotic syndrome
Hepato-renal syndrome
Protein losing enteropathies
Peritoneal carcinoma or TB

95
Q

What is the mx of ascites?

A

Undress underlying cause
Salt and fluid restriction
Spironalactone

96
Q

What is the abx of choice for tx of SBP?

A

Intravenous Tazocin (piperacillin-tazobactam)

97
Q

What is cholecystitis?

A

Inflammation of gallbladder, most commonly due to gallstones

98
Q

What sign are you looking for in acute cholecystitis?

A

Murphy’s sign- inspiration inhibited by pain on palpation when examiner’s hand positioned along costal margin)

99
Q

What is the mx of acute cholecystitis?

A

Admit to hospital
Supportive
Intravenous fluids
Antibiotics
Analgesia
ERCP if stones in common bile duct
25-30% require surgery (cholecystectomy) or develop complications

100
Q

What is Mirizzi Syndrome?

A

Stone in Hartmanns pouch or cystic duct causes compression of adjacent common hepatic duct (and therefore causes obstructive jaundice)

101
Q

List the sx and signs of autoimmune hepatitis?

A

Fever
Jaundice
Amenorrhoea
Glomerulonephritis
acute hepatitis (deranged ALT/AST)
Fatigue
Anorexia
Hepatosplenomegaly

102
Q

What would the bloods be in autoimmune heaptitis be?

A

Elevated AST/ALT
INR elevated
Antibodies
* Anti smooth muscle
* Anti liver Kidney microsomal
* Anti soluble liver antigen
**Hypergammaglobulinaemia **

103
Q

What is the mx of autoimmune hepatitis?

A

initial mx- Prednisolone/steroids
Maintanence- Azathioprine

2nd line-immunosuppressants

Transplant

104
Q

What is PBC?

A

an autoimmune condition that causes granulomatous inflammation of intrahepatic bile ducts, resulting in scarring and eventually leading to liver cirrhosis.

105
Q

List the sx of PBC?

A

Classically a middle-aged female with pruritus and fatigue

Extreme fatigue
Pruritus (itching)
Xerosis (dry skin)
Sicca syndrome (dry eyes)
RUQ pain
Xanthelasma
Clubbing
Jaundice

106
Q

What other autoimmune disease is strongly associated with PBC?

A

Sjogren’s disease

107
Q

What would the blood results be for PBC?

A

Abnormal LFTs- Raised ALP
Positive Anti-mitochondrial antibodies
Raised IgM

108
Q

What is the 1st line imaging in PBC?

A

Abdominal USS- rule out extrahepatic biliary obstruction

109
Q

What is the GS Ix for a diagnosis PBC?

A

Liver biopsy

110
Q

What is the mx of PBC?

A

1st LINE: URSODEOXYCHOLIC ACID - reduces symptoms, slows disease progression

Symptom relief - cholestyramine can help pruritus
Liver transplant (especially once bilirubin >100)

111
Q

List the complications of PBC?

A

Liver cirrhosis & portal hypertension resulting in varices, ascites etc
Hepatocellular carcinoma

112
Q

What is PSC?

A

Inflammation of the intra AND extra hepatic bile ducts, with subsequent fibrosis

113
Q

What Ix are indicated in PSC?

A

Deranged LFTS- cholestatic picture
Positive anti smooth muscle and P-ANCA
Hypergammaglobulinaemia
Imaging- ERCP/MRCP

114
Q

What would be seen on imaging in PSC?

A

Multiple beaded biliary strictures seen on MRCP/ERCP

115
Q

What is a complication of PSC?

A

Cholangiocarcinoma

116
Q

What is acalculous cholecystitis?

A

No gallstones, often functional cystic duct obstruction

Risk factors- associated sepsis, trauma, major surgery, burns, on TPN

117
Q

What sis the 1st line Ix for acute cholecystitis and list the findings?

A

Abdominal ultrasound-
Thickened gallbladder wall, gallstones or sludge in gallbladder or fluid around gallbladder

118
Q

What is the most common type of colorectal cancer?

A

Adenocarcinoma

119
Q

List the rf for colorectal cancer?

A

Increasing age
Hereditary syndromes
*Familial adenomatous polyposis
*Hereditary nonpolyposis colorectal cancer (Lynch Syndrome)
*Juvenile polyposis
Peutz-Jeghers syndrome
Increased alcohol intake
Smoking tobacco
Processed meat
Obesity
Previous exposure to radiation
Inflammatory bowel disease

120
Q

List the signs and sx of colorectal cancer?

A

Rectal bleeding
Unexplained WL
Change in bowel habit
Abdominal pain
IDA
Bowel obstruction

121
Q

What is the current NHS screening programme for bowel cancer?

A

Faecal immunochemical test (FIT) every 2 years for men and women age 60-74. If positive patients are referred for colonoscopy.

122
Q

What is the 2ww referral criteria for suspected lower GI cancer?

A

Age 40 years or more:
Weight loss AND abdominal pain

Age 50 years or more :
Unexplained rectal bleeding

Age 60 years or more:
A change in bowel habit OR
Unexplained iron-deficiency anaemia

Positive FIT

123
Q

What is the gold standard ix for colorectal cancer?

A

colonoscopy

if colonoscopy CI- CT colonoscopy

124
Q

How is colorectal cancer tx monitored?

A

CEA levels can monitor treatment response or identify recurrence

125
Q

What is the mx of acute constipation?

A
  1. Underlying causes
  2. Lifestyle measure- Increase dietary fibre, Ensure adequate fluid intake

mx-
1st line: Bulk-forming laxatives (e.g. ispaghula)

2nd line:
*If stools remain hard, add/switch to an osmotic laxative (e.g. macrogol).
*If macrogol is ineffective or not tolerated, offer lactulose

If stools are soft but difficult to pass:
Add a stimulant laxative.

126
Q

What is the choice of laxative in opioid induced constipation?

A

Use osmotic laxative and stimulant laxative (or docusate).

127
Q

What laxatives should be avoided in opioid induced constipation?

A

Avoid bulk-forming laxatives.

because they can worsen the problem by increasing stool bulk in the context of slow gut movement, leading to risks of obstruction or impaction.

128
Q

What is the laxatives of choice in faecal impaction:

A

Hard stools: Start with high-dose macrogol, add stimulant if needed.

Soft stools: Consider bisacodyl suppository or mini enema if oral treatment fails.

129
Q

What is diverticulosis?

A

The presence of asymptomatic diverticula

130
Q

What is diverticular disease

A

The presence of diverticula with associated symptoms (abdominal pain, altered bowel habit)

131
Q

What is Diverticulitis?

A

Inflammation of the diverticula, can be infective in aetiology

132
Q

What are the features of acute diverticulitis?

A

Severe lower abdominal pain - classically sharp pain, worst in the LIF
Systemic upset - malaise, pyrexia, tachycardia
PR bleeding
Features of complications - abscess, perforation - referred to as complicated diverticulitis

133
Q

What is the 1st line ix in acute diverticulitis?

A

CT abdomen-pelvis -

134
Q

What is the mx of acute diverticulitis?

A

Admit if systemically very unwell/suspected complicated diverticulitis

PO Antibiotics: 1st Line (NICE): Co-amoxiclav 625mg TDS 5 days if managed in primary care

Penicillin allergy: cefalexin 500mg TDS plus metronidazole 400mg TDS 5 days

135
Q

List the RF of gallstones?

A

Female
Obesity
Middle aged (> 40)
Pregnancy
Diabetes
Smoking
Ileal disease
Family history
TPN use
Prolonged fasting

136
Q

What is biliary colic?

A

Gallbladder spasm against stone impacted in Hartmann’s pouch (neck of gallbladder)

137
Q

What are the sx of biliary colic?

A

Sudden onset RUQ pain
Colicky (intermittent) in nature
May radiate to shoulder blades/back
Worse following eating fatty foods
Pain resolves after a few hours
Associated nausea/vomiting
No fever

138
Q

What are the Ix of biliary colic?

A

Bloods normal including LFTs
US abdomen
Gallstones present

139
Q

What is the most common type of gastric cancer?

A

Adenocarcinomas most common

Histology
Signet ring cell appearance

140
Q

What is zollinger Ellison syndrome?

A

Occurs in the presence of a gastrinoma – a tumour with autonomous secretion of gastrin resulting in high levels of gastric acid

30% of cases occur in the context of MEN1

141
Q

What are the clinical features of zollinger Ellison syndrome?

A

Multiple gastro-duodenal ulcers
Epigastric pain, diarrhoea, malabsorption

142
Q

WHat is the 1st line Ix of zollinger-Ellison syndrome?

A

First line: Fasting gastrin levels

Alt: Secretin stimulation test (secretin normally suppresses gastrin)

143
Q

What is gilbert’s syndrome?

A

Autosomal recessive condition in which there is a mild deficiency in UDP-glucuronyl transferase (UDP-GT)

144
Q

What is the classic sx of Gilbert syndrome?

A

Jaundice during illness.

145
Q

What are ix for gilberts syndrome?

A

Bilirubin - not in urine (unconjugated)
Diagnosis: Increased bilirubin after fasting or IV nicotinic acid

146
Q

What is Budd chiari syndrome?

A

AKA Hepatic vein thrombosis, is usually seen in the context of underlying haematological disease or another procoagulant condition.

147
Q
A

Finals (HV) (19 decks)

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