GI (passmed) Flashcards
What would cause abnormal LFTs in a non-alcoholic patient with T2DM?
Non-alcoholic liver disease
What imaging tool would you use to diagnose NAFLD?
Ultrasound
How does diabetes cause NAFLD?
Insulin resistance
What diagnostic test would you do to confirm H pylori?
Carbon-13 urea breath test
What is the triple management therapy for H pylori?
Amoxicillin, Clarithromycin & Omeprazole
If a patient has an allergy to penicillin, what other medication is used in the treatment of H pylori?
Metronidazole
In crohn patients who develop a perianal fistula, what medication would you prescribe?
Oral Metronidazole
What does NESTS stand for in Crohn’s disease? (Don’t set the nest on fire)
N - No blood or mucus E - entire GI tract (from mouth to anus) S - Skip lesions T - Terminal ileum S - Smoking
What is the specific test to diagnose IBD?
Faecal calprotectin
What is faecal calprotectin and what does it indicate?
Released by the intestines when inflamed as made by WBC
Indicates IBD and IBS
What is faecal elastase and what does it indicate?
Measures digestive enzymes produced by the pancreas that do not degrade through the digestive tract
Helps to detect pancreatitis, cystic fibrosis, diabetes
What first line steroid is used in the treatment of crohns?
Oral Prednisolone / IV Hydrocortisone
What immunosuppresent medication is used in Crohns disease?
Azathioprine
What does CLOSEUP mean in ulcerative colitis? (U - C CLOSEUP)
C - Continuous inflammation L - limited to colon and rectum O - Only superficial mucosa affected S - smoking is protective E - excrete blood and mucus U - use aminosalicylates P - primary sclerosing cholangitis
If a patient with ulcerative colitis presents with liver symptoms and signs, what condition would you think of as the cause?
primary sclerosing cholangitis
What results would you see on the LFTs when investigating primary sclerosing cholangitis to show a cholestatic picture?
Raised ALP
Raised Bilirubin
Raised ALT and AST
What is the gold standard test for diagnosing primary sclerosing cholangitis and what would it show?
MRCP
- Bile duct lesions
- Bile duct strictures
What is the gold standard investigation for the diagnosis of IBD?
Endoscopy with biopsy
What are the two treatments for oesophageal varices?
Terlipressin
Sengstaken-Blakemore tube
What are oesophageal varices?
Enlarged veins in the oesophagus
In a patient with an ongoing acute upper GI bleed, what is the treatment if endoscopic therapy has not worked?
Laparotomy and surgical exploration
What is the treatment of ascites secondary to liver cirrhosis?
Aldosterone antagonist - Spironolactone
How does using an aldosterone antagnonist like spironolactone reduce ascities?
By inhibiting aldosterone, it leads to reduced sodium retention and increased sodium excretion through the urine
What is a side effect of using a loop diuretic such as furosemide?
Hypokalaemia and alkalosis which promotes the formation of ammonia that can cause hepatic encephalopathy
What serious condition do you need to exclude in a patient presenting with painless jaundice?
Pancreatic cancer
Why would pancreatic cancer cause painless jaundice?
The blockage of the biliary tree without pain means it is not because of gallstones and instead a pancreatic mass
What findings on the LFTs would show and obstructive cause for jaundice?
Bigger raise in ALP and GGT than ALT
What is the first line management for UC flare in hospital?
IV hydrocortisone
What medication can be used for remission in a mild/moderate flare up of UC?
Pt over 55 presents with raised platelets and nausea/vomiting, reflux, weight loss and upper GI Pain
- What type of referral would you do and why?
Non Urgent for endoscopy - rule out upper GI cancers
Pt over 55 presents with dysphagia/upper abdo mass/weight loss/reflux - what is your management?
Urgent referral to gastro
What finding associated with the mouth would you see that is caused by vitB12/folate deficiency?
Glossitis (red swollen tongue)
What type of anaemia causes B12 deficiency anaemia?
Pernicious anaemia
What is the first line treatment for management of severe ulcerative colitis in hospital?
IV steroids
What antibody is detected in ulcerative colitis?
Bianca has ulcerative colitis
P-ANCA
Where do patients normally feel pain with UC?
Left lower quadrant
What is the first line treatment for inducing remission and maintaining mild-moderate UC and please give an example?
Topical and/or oral aminosalicylates
Mesalazine
How is anaemia a complication of GORD?
GORD can lead to inflamed ulcerated oesophagus/cancers that can lead to chronic bleeds
List some complications of GORD
- Benign strictures (narrowing of oesophagus)
- Anaemia
- Barretts oesophagus (oesophagus lining becomes red)
- oesophageal carcinoma
Besides lifestyle advice and antacids, what is the management for endoscopically proven GORD?
Full dose PPI for 1/2 months
then put to low dose
What is the first line treatment for hemochromatosis?
Venesection
What risk factors increase the risk of c diff?
- Prolonged hospital exposure
- PPI
- Antibiotics (cephalosporins)
What is the complication of c difficle?
Toxic megacolon
Which of the following confirms the diagnosis of c difficle?
- Stool C.difficile antigen
- Stool C.difficile toxin
C difficile Toxin confirms current infection
C difficile confirms exposure to bacteria
What is Achalasia and what symptoms present with this condition?
Smooth muscle fibres in the lower portion of the oesophagus do not relax
- Difficulty swallowing
- retrosternal pain
- regurgitation of food
What is Hirschsprung’s disease?
Birth defect where nerves are missing from parts of the intestine
- presents with constipation
What is the difference between a colostomy and ileostomy?
Colostomy - connects the colon to the abdominal wall
- LIF
- Non-spouted
- Formed stool in stoma bag
Ileostomy - connects the last part of the small intestine (ileum) to the abdominal wall
- RIF
- Spouted (prevents touching the skin)
What scoring system is used to determine the severity of cirrhosis?
Child-pugh score
What type of ulcer is associated with UC and crohns?
Pyoderma gangrenosum
What two medications can relax the lower oesophageal sphincter and thus help to resolve achlasia?
Hint - One drug is used in treating BP and the other is an antiplatelet
CCB
Aspirin
How does the cause of difficulty swallowing food differ between achalasia and oesophageal carcinoma?
Achalsia - difficult to swallow foods and liquids at the same time
Carcinoma - difficult swallowing foods first and then liquids later as the tumour grows
What is the investigation of choice for diagnosing coeliac disease?
Serum IgA tissue transglutaminase antibody testing
What skin condition can be associated with coeliac disease and where would you most likely find it on the body?
Dermatitis herpetiformis
- very itchy
- affects elbows, knees, back and buttocks
What other hepatitis does the Hep B vaccination provide immunity to?
Hint - The…needs company ;)
Hep D
- Needs Hep B in order to replicate
List three symptoms that can occur if a patient drinks alcohol whilst on metronidazole
- Flushing
- Tacycardia
- Nausea
Name the 3 symptoms associated with ascending cholangitis? Charcots triad
- RUQ pain
- Fever
- Jaundice
Vit B12 is associated with crohns disease
What social factor is iron deficiency associated with?
Alcoholism
List three symptoms of acute pancreatitis
- Sudden severe epigastric pain
- Nausea/vomiting
- loss of appetite
What blood test is associated with acute pancreatitis?
Serum lipase - released by pancreas to digest fats
What 4 symptoms are associated with bowel obstruction?
- Abdominal pain
- Abdominal distention
- Vomiting
- Constipation
What is acute cholecystitis in comparison to ascending cholangitis?
Acute cholecystitis - inflammation of the gallbladder
– Gallstone stuck in cystic duct that comes out from the gallbladder and so causes the inflammation
Ascending cholangitis - inflammation of the bile duct
– Gallstone has started to travel down the common bile duct but has got stuck and therefore causes inflammation
How does acute cholangitis present?
- Sudden sharp pain in RUQ that radiates to right shoulder
- Worse by deep breathing
- Persistent
- Can have fever/vomiting
- Palpable gallbladder
Jaundice less likely
What are the 5 common risk factors of gallstone disease?
Hint - F
Fat Female Forty Fertile Family history
