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GI guidelines Flashcards

1
Q

Testing for H pylori 2 options

A

Urea breath test and stool antigen test

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2
Q

Test of cure H pylori test

A

Only urea breath test

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3
Q

Most sensitive test for H pylori

A

Biopsy urease test during biopsy

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4
Q

Mx for H.pylori negative peptic ulcers

A

PPI only

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5
Q

Mx for H.pylori positive peptic ulcers

A

PPI + amoxicillin + clari
PPI + met + clari if pen allergic
2nd line = PPI + bismuth chelate + met + tetracycline

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6
Q

how long do you treat someone with ferrous sulphate for in iron def anaemia

A

3 months after blood go to normal

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7
Q

Mx of mild diverticulitis in primary care

A

conservative with antibiotics. If no improvement in 72 hours need hospital admission

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8
Q

Hinchey and Mx

A 
0 = no complication
1 = paracolic abscess --> drain
2 = pelvic abscess --> drain
3 = purulent peritonitis --> Hartmasns or washout
4 = feculant peritonitis --> Hartmans
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9
Q

CRC screening (2 parts)

A

one off flexi-sig at 55

60-74 = FIT testing every two years (colonoscopy if +ve)

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10
Q

2WW colonoscopy guidelines

A

40 + weight loss + abdo pain
50 + blood in stool
60 + iron def anaemia

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11
Q

Amsterdam criteria

A

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

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12
Q

cholecystitis vs cholangitis Mx

A 
cholecystitis = lap chole witihn 48hrs
cholangitis = IV ABx + ERCP within 48hrs
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13
Q

Mx of asymptomatic inguinal hernia

  • first time
  • recurrent or bilateral
A

Surgery on asymptomatic hernias.
1st = open mesh repair
recurrent/bilateral = laparoscopic

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14
Q

Inguinal hernia op in children

A

6/2 rule
<6w = 2d
<6m = 2w
<6yr = 2m (elective)

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15
Q

umbilical hernia in children - when do you operate

A

only if persisting to 3

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16
Q

femoral hernia management

A

Always operate due to high risk of strangulation

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17
Q

C.diff abx

A 
1st = metronidazole
2nd+ = vancomycin
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18
Q

campylobacter abx

A

clarithomycin

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19
Q

shigella and salmonella abx

A

ciprofloxacin

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20
Q

GORD gold standard Ix

A

24 hour oesophageal pH monitoring

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21
Q

GORD urgent and non-urgent endoscopy indications

A 
Urgent = >55 + weight loss + GORD, mass, dysphagia
Non-urgent = >55 + 4w PPI resistant reflux, haematemesis
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22
Q

GORD Mx (to do with endoscopy)

A

Un-investgated
- 4w PPI

Endoscopically proven oesophagitis

  • 4w PPI
  • 4w double dose PPI

Endoscope showed no oesopaphgitis

  • 4w PPI
  • 4w H2RA
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23
Q

Acute variceal haemorrhage Mx
first thing once controlled
first thing once back from endoscopy

A

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

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24
Q

vatical bleeding prophylaxis medical and surgical

A

propranolol

banding at 2 week intervals until they’re all gone

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25
Crohns | - inducing remission
``` 1st = steroids 2nd = 5ASA drugs ```
26
crohns | - maintaining remission
``` 1st = azathioprine and mercaptopurine (check TMPT) 2nd = methotrexate 3rd = infliximab ```
27
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
28
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
29
UC | - maintaining remission
1st line = 5ASA 2nd line/1st line If severe flare = azathioprine MTX NOT used
30
Alcoholic liver disease drug
prednisolone
31
cirrhosis staging
Child Pugh using PT, albumin, bilirubin, encephalopathy, ascites A = 1-6 B = 7-9 C = 10+
32
Investigation for cirrhosis | - first and definitive
``` 1st = fibroscan Definitive = biopsy ```
33
Ix for NAFLD
enhanced liver fibrosis blood test
34
Screening for people who have cirrhosis
6 monthly USS and AFP test
35
Diagnosis of acute liver failure
encephalopathy + INR >1.5 +/- jaundice
36
1st line treatment for acute liver failure
lactulose
37
prevention of liver failure antibiotic
rifaximin
38
hepatorenal syndrome 1st and 2nd line Mx
``` 1st = terlipressin + 20% albumin 2nd = TIPS ```
39
Liver transplant post paracetamol OD
24 hours later if pH <7.3 OR increased PT, increased creatinine, encephalopathy 3 or 4
40
Ix for ascites
SAAG >11 = portal hypertension - so serum albumin >> ascites. ascites is lacking protein as fluid is being forced out. <11 = peritoneal
41
Ascites management - medical - if large volume - SBP prophylaxis - surgical
spironolactone paracentesis + IV albumin cover beforehand ciprofloxacin is SBP cover TIPS is the surgery
42
which is the DNA hepatitis
B, rest are RNA
43
Which hepatitis is most common in UK and world
``` C = UK B = world ```
44
hep A common in
travellers
45
hep E common in
pork eaters
46
hep C common in
IVDU
47
hep B common in
sex workers
48
which have vaccines
A and B
49
only treatment for hep b
pegylated interferon alpha
50
investigation for B, C, D
``` B = serology testing C/D = HCV-RNA-PCR or HDV-RNA-PCR ```
51
hep C Tx
protease inhibitor +/- ribavarin
52
hep D Tx
interferon
53
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
54
1st line for oesophageal cancer
endoscopy | - BARIUM swallow has NO PLACE - it is only for motility disorders
55
Drug for HCC?
Sorafenib (multikinase inhibitor) | Obvs surgery is still better
56
Best Ix for staging gastric cancer
endoscopic USS (better than CT!)
57
first line to Ix gastric cancer
endoscopy and biopsy (signet ring cells)
58
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
59
1st line for MALT lymphoma
H.pylori eradication is 80% effective!!!
60
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
61
haemorhoids 1st vs definitive
``` 1st = fibre and fluid + topical anaesthetic/steroid definitive = band ligation ```
62
acutely thrombosed haemorrhoids Mx
<72hrs --> excise | >72hrs --> ice pack, docusate softener, analgesia
63
rectal cancer surgery and anastomosis?
abdominoperineal excision of the rectum. | defuncitoning loop ileostomy (Cant anastomose as its too low)
64
Lipase or amylase
lipase is more sensitive and specific
65
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 ```
66
antibiotics in pancreatitis
not normally
67
complication of pancreatitis Mx | - necrosis
with infection = necrosectomy + imipenem | without infection = imipenem to prevent infection
68
complication of pancreatitis Mx | - pseudocyst
with infection = drain (as it's an abscess) | without infection = observe for 12 weeks (50% clear) then drain
69
best test for chronic pancreatitis
CT pancreas with contrast
70
test for exocrine function of pancreas in chronic pancreatitis
fecal elastase
71
Mx for chronic pancreatitis
not much | creon enzyme supplements
72
best test for bowel obstruction
CT
73
imaging in appendicitis
none usually. do USS to exclude other diagnosis. otherwise can diagnose based on history, exam, CRP and WCC.
74
conservative management in appendicitis?
No
75
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) ```
76
what foods are gluten free
corn (maize), rice, potatoes
77
Ix for pancreatic cancer
high res CT scanning
78
surgery name for pancreatic cancer
whipples
79
Best Ix for acute mesenteric ischaemia | Also, what do blood tests show
CT | WCC raised and lactic acidosis
80
Mx for acute mesenteric ischaemia
interventional radiology can help but if bowel is dead need surgery urgently
81
Ix and Mx for ischaemic colitis
``` Ix = CT (also AXR shows thumbprinting) Mx = conservative ```
82
antibodies for autoimmune hepatitis what random thing is raised biopsy?
antibodies for ANA, LMK1, Smooth-muscle (SMA) also IgG is raised show piecemeal necrosis
83
Mx of autoimmune hepatitis
Steroids and immunosuppression | transplant
84
PBC versus PSC | - antibody
PBC = IgM AMA M2; PSC = pANCA
85
Whats in Blatchford score
urea Hb SBP pulse malaria, syncope, hepatic disease, heart failure
86
Whats in Rockall score
age SBP USS diagnosis, major comorbidity (any), signs of recent bleeding on USS
87
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

3rd year medicine (31 decks)

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