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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

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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

27
Q

What is Plummer visson syndrome?

A

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

28
Q

What is Crohn’s disease?

A

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

29
Q

List the 4 layers o the gastric mucosa?

A

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

30
Q

List the features of crohns?

A

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

31
Q

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

A

Inflammation in all layers
Increased Goblet cells
Granulomas

32
Q

What will be seen in endoscopy of Crohn’s?

A

Deep ulcers
Skip lesions- Cobblestone appearance

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

34
Q

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

A

Oral/Topical/IV glucocorticoids

35
Q

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

A

Stop smoking
1st line- Azathioprine or Mercaptopurine

36
Q

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

A

Methotrexate

37
Q

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

A

assess thiopurine methyltransferase (TPMT) activity

38
Q

What is UC?

A

a type of IBD that characteristically involves rectum and extends proximally

39
Q

What are the features of UC?

A

Bloody diarrhoea
Abdominal pain in LLQ
Tenesmus

40
Q

What are the features seen on histology in UC?

A

No Inflammation beyond submucosa
Crypt abscesses
Depletion of goblet cells

41
Q

What are the features seen on endoscopy in UC?

A

Pseudopolyps

42
Q

What are the features seen on radiology in UC?

A

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

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)

44
Q

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

A

Topical aminosalicylate

45
Q

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

A

Add oral aminosalicylate

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

47
Q

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

A

Topical (rectal) aminosalicylate

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

49
Q

What blood test distinguishes between IBS and IBD?

A

Faecal calprotectin

50
Q

What is Coeliac’s disease?

A

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

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
52
Q

List the complications of coeliac’s?

A

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

53
Q

What is the 1st line Ix for coeliacs?

A

Tissue transglutaminase (TTG) antibodies (IgA)

54
Q

What is the GS Ix for coeliacs?

A

Endoscopic intestinal biopsies

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

56
Q

What is the mx of coeliac’s disease?

A

Gluten free diet

57
Q

What foods should be avoided in coeliacs?

A

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

58
Q

List foods which are gluten free?

A

Rice
potatoes
Corn (Maize)

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

Finals (HV) (15 decks)

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