GI guidelines Flashcards
Testing for H pylori 2 options
Urea breath test and stool antigen test
Test of cure H pylori test
Only urea breath test
Most sensitive test for H pylori
Biopsy urease test during biopsy
Mx for H.pylori negative peptic ulcers
PPI only
Mx for H.pylori positive peptic ulcers
PPI + amoxicillin + clari
PPI + met + clari if pen allergic
2nd line = PPI + bismuth chelate + met + tetracycline
how long do you treat someone with ferrous sulphate for in iron def anaemia
3 months after blood go to normal
Mx of mild diverticulitis in primary care
conservative with antibiotics. If no improvement in 72 hours need hospital admission
Hinchey and Mx
0 = no complication 1 = paracolic abscess --> drain 2 = pelvic abscess --> drain 3 = purulent peritonitis --> Hartmasns or washout 4 = feculant peritonitis --> Hartmans
CRC screening (2 parts)
one off flexi-sig at 55
60-74 = FIT testing every two years (colonoscopy if +ve)
2WW colonoscopy guidelines
40 + weight loss + abdo pain
50 + blood in stool
60 + iron def anaemia
Amsterdam criteria
for HNPCC. you get genetic testing for mismatch repair gene if:
3 1st degree relative with CRC, spanning 2 generations and with one person <50
cholecystitis vs cholangitis Mx
cholecystitis = lap chole witihn 48hrs cholangitis = IV ABx + ERCP within 48hrs
Mx of asymptomatic inguinal hernia
- first time
- recurrent or bilateral
Surgery on asymptomatic hernias.
1st = open mesh repair
recurrent/bilateral = laparoscopic
Inguinal hernia op in children
6/2 rule
<6w = 2d
<6m = 2w
<6yr = 2m (elective)
umbilical hernia in children - when do you operate
only if persisting to 3
femoral hernia management
Always operate due to high risk of strangulation
C.diff abx
1st = metronidazole 2nd+ = vancomycin
campylobacter abx
clarithomycin
shigella and salmonella abx
ciprofloxacin
GORD gold standard Ix
24 hour oesophageal pH monitoring
GORD urgent and non-urgent endoscopy indications
Urgent = >55 + weight loss + GORD, mass, dysphagia Non-urgent = >55 + 4w PPI resistant reflux, haematemesis
GORD Mx (to do with endoscopy)
Un-investgated
- 4w PPI
Endoscopically proven oesophagitis
- 4w PPI
- 4w double dose PPI
Endoscope showed no oesopaphgitis
- 4w PPI
- 4w H2RA
Acute variceal haemorrhage Mx
first thing once controlled
first thing once back from endoscopy
ABCDE
Vit K + tazocin + terlipressin + FFP
uncontrolled = sengstaken-blakemore tube (must deflate in 12 hours)
Once controlled = endoscopy for band ligation
Once back from endoscopy –> Rockall score + 72 hours IV PPI
vatical bleeding prophylaxis medical and surgical
propranolol
banding at 2 week intervals until they’re all gone
Crohns
- inducing remission
1st = steroids 2nd = 5ASA drugs
crohns
- maintaining remission
1st = azathioprine and mercaptopurine (check TMPT) 2nd = methotrexate 3rd = infliximab
UC
- severity classification
Truelove and Witt
- mild = 1-3 stools
- mod = 4-6 stools +/- blood mild systemic upset
- severe = 7+ with systemic upset and blood
UC
- inducing remission
severe –> hospital for IV steroids
Mild/mod depends on area
- left only = mesalazine. 4w later add sulphasalazine. 4w later change mesalazine for steroid
- left and right = mesalazine and sulphasalazine. 4 w later change mesalazine for steroid
UC
- maintaining remission
1st line = 5ASA
2nd line/1st line If severe flare = azathioprine
MTX NOT used
Alcoholic liver disease drug
prednisolone
cirrhosis staging
Child Pugh using PT, albumin, bilirubin, encephalopathy, ascites
A = 1-6
B = 7-9
C = 10+
Investigation for cirrhosis
- first and definitive
1st = fibroscan Definitive = biopsy
Ix for NAFLD
enhanced liver fibrosis blood test
Screening for people who have cirrhosis
6 monthly USS and AFP test
Diagnosis of acute liver failure
encephalopathy + INR >1.5 +/- jaundice
1st line treatment for acute liver failure
lactulose
prevention of liver failure antibiotic
rifaximin
hepatorenal syndrome 1st and 2nd line Mx
1st = terlipressin + 20% albumin 2nd = TIPS
Liver transplant post paracetamol OD
24 hours later if pH <7.3
OR
increased PT, increased creatinine, encephalopathy 3 or 4
Ix for ascites
SAAG
>11 = portal hypertension
- so serum albumin»_space; ascites. ascites is lacking protein as fluid is being forced out.
<11 = peritoneal
Ascites management
- medical
- if large volume
- SBP prophylaxis
- surgical
spironolactone
paracentesis + IV albumin cover beforehand
ciprofloxacin is SBP cover
TIPS is the surgery
which is the DNA hepatitis
B, rest are RNA
Which hepatitis is most common in UK and world
C = UK B = world
hep A common in
travellers
hep E common in
pork eaters
hep C common in
IVDU
hep B common in
sex workers
which have vaccines
A and B
only treatment for hep b
pegylated interferon alpha
investigation for B, C, D
B = serology testing C/D = HCV-RNA-PCR or HDV-RNA-PCR
hep C Tx
protease inhibitor +/- ribavarin
hep D Tx
interferon
how do you know if hep B immunisation was successful
look at ant-HBs 1-4 months later:
>100 = adequate
10-100 = one additional dose
<10 = restart whole 3 dose course. if fails again will need HBIG if ever exposed
1st line for oesophageal cancer
endoscopy
- BARIUM swallow has NO PLACE - it is only for motility disorders
Drug for HCC?
Sorafenib (multikinase inhibitor)
Obvs surgery is still better
Best Ix for staging gastric cancer
endoscopic USS (better than CT!)
first line to Ix gastric cancer
endoscopy and biopsy (signet ring cells)
surgery based on location of gastric cancer
only in mucosa = endoscopic submucosal resection
<5cm from GOJ = total gastrectomy
5-10cm from GOJ = subtotal gastrectomy
into oesophagus = oesophagogastrectomy
1st line for MALT lymphoma
H.pylori eradication is 80% effective!!!
fissure in ano Mx acute versus chronic
Acute = <6w
- bulk forming laxative + lubricant + topical anaesthetic
Chronic = >6w
- 1st line = GTN or diltiazem cream
- 2nd line (after 8w): botulinum
- 3rd line = internal sphincterotomy
haemorhoids 1st vs definitive
1st = fibre and fluid + topical anaesthetic/steroid definitive = band ligation
acutely thrombosed haemorrhoids Mx
<72hrs –> excise
>72hrs –> ice pack, docusate softener, analgesia
rectal cancer surgery and anastomosis?
abdominoperineal excision of the rectum.
defuncitoning loop ileostomy (Cant anastomose as its too low)
Lipase or amylase
lipase is more sensitive and specific
parameters in glasgow score for pancreatitis
PaO2 <8 Age >55 Neutrophils up Calcium down Renal function, urea up Enzymes, AST/LDH Albumin down Sugar up
antibiotics in pancreatitis
not normally
complication of pancreatitis Mx
- necrosis
with infection = necrosectomy + imipenem
without infection = imipenem to prevent infection
complication of pancreatitis Mx
- pseudocyst
with infection = drain (as it’s an abscess)
without infection = observe for 12 weeks (50% clear) then drain
best test for chronic pancreatitis
CT pancreas with contrast
test for exocrine function of pancreas in chronic pancreatitis
fecal elastase
Mx for chronic pancreatitis
not much
creon enzyme supplements
best test for bowel obstruction
CT
imaging in appendicitis
none usually. do USS to exclude other diagnosis. otherwise can diagnose based on history, exam, CRP and WCC.
conservative management in appendicitis?
No
1st line and definitive Ix for coeliac
1st = IgA TTG antibodies definitive = jejunal biopsy (as long as have been eating gluten for at least 6 weeks, otherwise put them back on it)
what foods are gluten free
corn (maize), rice, potatoes
Ix for pancreatic cancer
high res CT scanning
surgery name for pancreatic cancer
whipples
Best Ix for acute mesenteric ischaemia
Also, what do blood tests show
CT
WCC raised and lactic acidosis
Mx for acute mesenteric ischaemia
interventional radiology can help but if bowel is dead need surgery urgently
Ix and Mx for ischaemic colitis
Ix = CT (also AXR shows thumbprinting) Mx = conservative
antibodies for autoimmune hepatitis
what random thing is raised
biopsy?
antibodies for ANA, LMK1, Smooth-muscle (SMA)
also IgG is raised
show piecemeal necrosis
Mx of autoimmune hepatitis
Steroids and immunosuppression
transplant
PBC versus PSC
- antibody
PBC = IgM AMA M2; PSC = pANCA
Whats in Blatchford score
urea Hb SBP pulse malaria, syncope, hepatic disease, heart failure
Whats in Rockall score
age SBP USS diagnosis, major comorbidity (any), signs of recent bleeding on USS
Barretts management once metaplasia diagnosed
3-5 yearly endoscopy surveillance with biopsies. if retinas metaplasia carry on
If trend into dysplasia then do endoscopic intervention like radio frequency ablation
