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CBL > GI CBL > Flashcards

GI CBL Flashcards

1
Q

Differential dx of diarrhoea

A

Coeliac
Small bowel chrons
Ulcerative colitis
Infective gastroenteritis

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2
Q

What does steatorrhoea point to?

A

Fat malabsorption due to pancreatic insufficiency

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3
Q

What is the relevance of family hx in a GI history?

A

Relevance of autoimmune diseases - possibility of another disease causing symptoms e.g. thyrotoxicosis, addisons disease, coeliac disease

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4
Q

Relevance of itchy rash in GI hx

A

May point towards dermatitis herpetiformis - coeliac disease

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5
Q

What does faecal calprotectin show?

A

Protein produced in the gut as a result of inflammation. Can be used to differentiate between functional and organic GI disorders. It is non specific and may be raised due to any cause of underlying inflammation

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6
Q

What does faecal elastase show?

A

It is a pancreatic enzyme which doesn’t undergo degradation. Useful marker of pancreatic activity. Low faecal elastase (<500) may point to pancreatic exocrine insufficiency.

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7
Q

Genetic basis of coeliac disease

A

HLADQ2/8 (95% patients)

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8
Q

Investigations in GI

A 
Haematology - Hb, MCV, B12, Folate, Ferritin
Biochemistry
Faecal calprotectin
Faecal elastase
Immunology - TTG, anti-endomysial 
CXR - excludes malignancy/TB
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9
Q

What classification system is used in coeliac disease?

A

Marsh classification

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10
Q

Potential complications of coeliac disease

A

Osteoporosis
Iron deficiency anaemia
Small bowel malignancy

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11
Q

How would a patient be seen as non compliant with gluten free diet?

A

TTG stays positive with ongoing exposure to gluten. Patients may be compliant with GFD but have ongoing villous atrophy - refractory coeliac disease

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12
Q

Investigations in coeliac for pathology

A

OGD (gastroscopy) with duodenal biopsy

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13
Q

Why may people with coeliac be more prone to infections?

A

Functional hyposplenism - indicated by howell-jolly bodies on blood film

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14
Q

A patient has been compliant with GFD, however is not getting any better. What are alternative diagnoses?

A

IBS
lymphocytic colitis
autonomic neuropathy
refractory coeliac disease

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15
Q

Risk factors for viral hepatitis to ask for in hx

A

IVDU

Historical transfusion

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16
Q

Which over the counter drug can derange LFTs?

A

Paracetamol

17
Q

Important questions in hx for hepatitis?

A

Sexual history
IVDU
Historical transfusion
Flu like symptoms - viral hepatitis

18
Q

Differential diagnosis for deranged LFTs

A

Hepatitis: drug induced, viral hepatitis, autoimmune
NAFLD
Haemochromatosis
Obstructive jaundice secondar to cholelithiasis
Pancreatic malignancy

19
Q

Liver investigations

A

Biochemistry - LFTs, U/E
Haematology - FBC, Coag profile
Liver screen - Liver autoantibodies, Ferritin, Immunoglobulins, viral hepatitis serology
USS abdomen

20
Q

Define autoimmune hepatitis (AIH)

A

Chronic inflammatory liver disease which if untreated leads to cirrhosis, liver failure and death. Women are affected 3-4x more than men.

21
Q

Key findings in investigations that point towards AIH

A

Elevated ALT and AST
Raised serum immunoglobulins
Negative hepatitis serum
High titres of circulating autoantibodies (IgG)

22
Q

Once AIH is suspected, what would be the next step?

A

Liver biopsy - grade of inflammation and fibrosis can be described using validated pathological index

23
Q

Treatment for AIH

A

Immunosuppresive glucocorticoids

with or without azathioprine

24
Q

Important investigations in strong clinical suspicion of colorectal cancer?

A

CT to detect liver or lung metastases
MRI for staging within the pelvis
PET Scan

25
Q

Treatment of colorectal cancer

A

Surgery - site dependent, right hemi-colectomy, excision of ascending/transverse/descending/sigmoid dependent on tumour location
Colostomy may be needed
Chemotherapy
Radiotherapy

26
Q

A resection specimen of a colorectal tumour is sent to pathology. What info can the pathologist provide?

A

Confirmation of dx
Evaluation of whether complete resection had been achieved
Quality of surgery
Evaluation of response by carcinoma to chemo

27
Q

What staging is used in colorectal adenocarcinomas?

A

Dukes staging - ABCD

28
Q

Risk factors for colorectal adenocarcinoma?

A

Size and number of adenomas
Ulcerative colitis
Crohn’s
Cancer syndromes (especially APC and Lynch syndrome)

CBL (9 decks)

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