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3rd year medicine > GI guidelines > Flashcards

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
Q

Crohns

- inducing remission

A 
1st = steroids
2nd = 5ASA drugs
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26
Q

crohns

- maintaining remission

A 
1st = azathioprine and mercaptopurine (check TMPT)
2nd = methotrexate 
3rd = infliximab
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27
Q

UC

- severity classification

A

Truelove and Witt

  • mild = 1-3 stools
  • mod = 4-6 stools +/- blood mild systemic upset
  • severe = 7+ with systemic upset and blood
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28
Q

UC

- inducing remission

A

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

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29
Q

UC

- maintaining remission

A

1st line = 5ASA
2nd line/1st line If severe flare = azathioprine

MTX NOT used

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30
Q

Alcoholic liver disease drug

A

prednisolone

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31
Q

cirrhosis staging

A

Child Pugh using PT, albumin, bilirubin, encephalopathy, ascites
A = 1-6
B = 7-9
C = 10+

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32
Q

Investigation for cirrhosis

- first and definitive

A 
1st = fibroscan
Definitive = biopsy
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33
Q

Ix for NAFLD

A

enhanced liver fibrosis blood test

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34
Q

Screening for people who have cirrhosis

A

6 monthly USS and AFP test

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35
Q

Diagnosis of acute liver failure

A

encephalopathy + INR >1.5 +/- jaundice

36
Q

1st line treatment for acute liver failure

A

lactulose

37
Q

prevention of liver failure antibiotic

A

rifaximin

38
Q

hepatorenal syndrome 1st and 2nd line Mx

A 
1st = terlipressin + 20% albumin
2nd = TIPS
39
Q

Liver transplant post paracetamol OD

A

24 hours later if pH <7.3
OR
increased PT, increased creatinine, encephalopathy 3 or 4

40
Q

Ix for ascites

A

SAAG
>11 = portal hypertension
- so serum albumin&raquo_space; ascites. ascites is lacking protein as fluid is being forced out.
<11 = peritoneal

41
Q

Ascites management

  • medical
  • if large volume
  • SBP prophylaxis
  • surgical
A

spironolactone
paracentesis + IV albumin cover beforehand
ciprofloxacin is SBP cover
TIPS is the surgery

42
Q

which is the DNA hepatitis

A

B, rest are RNA

43
Q

Which hepatitis is most common in UK and world

A 
C = UK
B = world
44
Q

hep A common in

A

travellers

45
Q

hep E common in

A

pork eaters

46
Q

hep C common in

A

IVDU

47
Q

hep B common in

A

sex workers

48
Q

which have vaccines

A

A and B

49
Q

only treatment for hep b

A

pegylated interferon alpha

50
Q

investigation for B, C, D

A 
B = serology testing
C/D = HCV-RNA-PCR or HDV-RNA-PCR
51
Q

hep C Tx

A

protease inhibitor +/- ribavarin

52
Q

hep D Tx

A

interferon

53
Q

how do you know if hep B immunisation was successful

A

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
Q

1st line for oesophageal cancer

A

endoscopy

- BARIUM swallow has NO PLACE - it is only for motility disorders

55
Q

Drug for HCC?

A

Sorafenib (multikinase inhibitor)

Obvs surgery is still better

56
Q

Best Ix for staging gastric cancer

A

endoscopic USS (better than CT!)

57
Q

first line to Ix gastric cancer

A

endoscopy and biopsy (signet ring cells)

58
Q

surgery based on location of gastric cancer

A

only in mucosa = endoscopic submucosal resection
<5cm from GOJ = total gastrectomy
5-10cm from GOJ = subtotal gastrectomy
into oesophagus = oesophagogastrectomy

59
Q

1st line for MALT lymphoma

A

H.pylori eradication is 80% effective!!!

60
Q

fissure in ano Mx acute versus chronic

A

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
Q

haemorhoids 1st vs definitive

A 
1st = fibre and fluid + topical anaesthetic/steroid 
definitive = band ligation
62
Q

acutely thrombosed haemorrhoids Mx

A

<72hrs –> excise

>72hrs –> ice pack, docusate softener, analgesia

63
Q

rectal cancer surgery and anastomosis?

A

abdominoperineal excision of the rectum.

defuncitoning loop ileostomy (Cant anastomose as its too low)

64
Q

Lipase or amylase

A

lipase is more sensitive and specific

65
Q

parameters in glasgow score for pancreatitis

A 
PaO2 <8
Age >55
Neutrophils up
Calcium down
Renal function, urea up
Enzymes, AST/LDH
Albumin down
Sugar up
66
Q

antibiotics in pancreatitis

A

not normally

67
Q

complication of pancreatitis Mx

- necrosis

A

with infection = necrosectomy + imipenem

without infection = imipenem to prevent infection

68
Q

complication of pancreatitis Mx

- pseudocyst

A

with infection = drain (as it’s an abscess)

without infection = observe for 12 weeks (50% clear) then drain

69
Q

best test for chronic pancreatitis

A

CT pancreas with contrast

70
Q

test for exocrine function of pancreas in chronic pancreatitis

A

fecal elastase

71
Q

Mx for chronic pancreatitis

A

not much

creon enzyme supplements

72
Q

best test for bowel obstruction

A

CT

73
Q

imaging in appendicitis

A

none usually. do USS to exclude other diagnosis. otherwise can diagnose based on history, exam, CRP and WCC.

74
Q

conservative management in appendicitis?

A

No

75
Q

1st line and definitive Ix for coeliac

A 
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
Q

what foods are gluten free

A

corn (maize), rice, potatoes

77
Q

Ix for pancreatic cancer

A

high res CT scanning

78
Q

surgery name for pancreatic cancer

A

whipples

79
Q

Best Ix for acute mesenteric ischaemia

Also, what do blood tests show

A

CT

WCC raised and lactic acidosis

80
Q

Mx for acute mesenteric ischaemia

A

interventional radiology can help but if bowel is dead need surgery urgently

81
Q

Ix and Mx for ischaemic colitis

A 
Ix = CT (also AXR shows thumbprinting)
Mx = conservative
82
Q

antibodies for autoimmune hepatitis

what random thing is raised

biopsy?

A

antibodies for ANA, LMK1, Smooth-muscle (SMA)

also IgG is raised

show piecemeal necrosis

83
Q

Mx of autoimmune hepatitis

A

Steroids and immunosuppression

transplant

84
Q

PBC versus PSC

- antibody

A

PBC = IgM AMA M2; PSC = pANCA

85
Q

Whats in Blatchford score

A

urea Hb SBP pulse malaria, syncope, hepatic disease, heart failure

86
Q

Whats in Rockall score

A

age SBP USS diagnosis, major comorbidity (any), signs of recent bleeding on USS

87
Q

Barretts management once metaplasia diagnosed

A

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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