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ICSM Year 6 > Medicine - Gastroenterology > Flashcards

Medicine - Gastroenterology Flashcards

1
Q

Describe and differentiate the symptoms of mild, moderate and severe flares of ulcerative colitis

A

Mild: <4 stools per day, little blood
Moderate: 4-6 stools per day, varying blood
Severe: >6 stools per day, bloody diarrhoea, systemic upset

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2
Q

What is the name of the criteria used to stage IBD, and what are the 6 criteria?

A 
Truelove and Witts: 
Heart rate
Temperature
Bowel movements 
PR bleeding 
Haemoglobin
ESR
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3
Q

Recall 2 typical histological findings of the gut layer for Crohn’s and then UC

A

Crohn’s: Increased goblet cells, granulomas

UC: Decreased goblet cells, crypt abscesses

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4
Q

What is the most common affected portion of the bowel in Crohn’s vs UC?

A

Crohn’s: terminal ileum (so RIF mass)

UC: rectum

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5
Q

Describe the typical features of inflammation in Crohn’s vs UC

A

Crohn’s: Skip lesions, rose-thorn ulcers, cobblestoning, string sign of kantor (narrow ileum stricture)
UC: ‘lead-pipe’, pseudo-polyps, thumbprinting

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6
Q

Which type of IBD carries the highest risk of colorectal cancer?

A

UC

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7
Q

In which form of IBD are fissures more common and why?

A

Crohn’s - because it affects the full thickness of the bowel wall

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8
Q

Differentiate the appearance of stool in active Crohn’s vs UC

A

Crohn’s: non-bloody diarrhoea

UC: bloody diarrhoea which may contain mucous

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9
Q

Which type of IBD is associated with gallstones and why?

A

Crohn’s

Bile acids are not properly absorbed as terminal ileum is affected

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10
Q

In which form of IBD can surgery be curative?

A

UC

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11
Q

Recall the possible extra-intestinal manifestations of IBD

A 
A PIE SAC
Aphthous ulcers
Pyoderma gangrenosum (skin ulcers)
I (eye) = uveitis, iritis, episcleritis
Erythema nodosum
Sclerosing cholangitis (UC Only) 
Arthritis
Clubbing (Crohn's moreso)
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12
Q

Describe the process of inducing remission in Crohn’s

A

Steroids:
If mild: oral prednisolone
If severe: IV hydrocortisone
If no improvement after 5 days –> infliximab
Oral budesonide can be used in disease between the distal ileum and the ascending colon

Nutritional:
Replace diet with whole protein modular diet - excessively liquid, for 6-8 weeks - this helps to replace lost weight

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13
Q

Describe the process of maintaining remission in Crohn’s

A

First line: DMARDs (eg azothioprine)

Alternatives: infliximab/ aminosalicylates

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14
Q

Describe the management of UC

A

Severe disease:
Fulminant: IV steroids and anti-TNF (ciclosporin/infliximab)
Non-fulminant: oral aminosalicylates and corticosteroids with topical aminosalicylates

Non-severe disease:
1st line:
If distal colitis –> oral + topical aminosalicylates
If extensive colitis (past splenic flexure) –> topical and oral salicylates

2nd line:
Topical –> oral corticosteroids

3rd line:
Oral tacrolimus

4th line: biologics

5th line: surgery

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15
Q

What is the main side effect of aminosalicylates to remember?

A

Acute pancreatitis

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16
Q

In which form of IBD is surgical management most useful?

A

UC

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17
Q

What are the options for surgery in UC?

A

Emergency:
Hartmann’s protosigmoidectomy + end ileostomy –> later IPAA (ileal-pouch ana anastomosis)

Non-emergency:
Protocolectomy + IPAA or
Panprotocolectomy + end ileostomy

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18
Q

What are the criteria used to diagnose IBS?

A

It’s a diagnosis of excusion based on the ROME III criteria:

  • Improvement with defaecation
  • Change in stool frequency
  • Change in stool form/ appearance/ consistency
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19
Q

Recall the grading of haemarrhoids

A

1st: in rectum after defaecation
2nd: prolapse at defaecation, spontaneous reduction
3rd: prolapse at defaecation, manual reduction
4th: persistently prolapsed

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20
Q

What is the first line management of haemorrhoids?

A

Increased fruit/ fibre
Stool softener
Topical analgesics
Topical steroids (suppository)

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21
Q

Recall some non-operative ways of managing haemorrhoids?

A

Rubber-band ligation
Sclerotherapy
Electrotherapy
Infrared coagulation

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22
Q

Recall 3 surgical options for managing haemorrhoids

A

Haemarrhoidectomy
Haemorrhoidopexy
HALO (haemorrhoidal artery ligation operation)

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23
Q

What is the standard treatment for C diff enterocolitis?

A

PO vancomycin
2nd line fidaxomicin
If severe/unresponsive –> IV vanc + met

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24
Q

Which bacteria demonstrates “tumble weed motility”?

A

Listeria monocytogenes

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25
Q

How can listeria gastroenteritis be treated?

A

Amoxicillin/ ampicillin

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26
Q

Which 3 antibiotics are most associated with causing C diff enterocolitis?

A

Cephalosporin
Clindamycin
Ciprofloxacin

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27
Q

Which gastroenteritis-causing pathogen is associated with undercooked seafood?

A

Vibrio parahaemolyticus

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28
Q

Which gastroenteritis-causing pathogen is associated with shellfish handlers?

A

Vibrio vulnificus (in immunocompetent usually causes cellulitis/ nec. fasciitis)

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29
Q

Recal the site of absorption of iron, folate and B12

A

Iron: Duodenum
Folate: Jejunum
B12: Ileum

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30
Q

Which skin condition is pathognomonic for coeliac disease?

A

Dermatitis herpetiformis

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31
Q

Describe the appearance of stool in coeliac disease

A

Waterey, grey, frothy

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32
Q

What system is used to grade coeliac disease?

A

Marsh system

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33
Q

Recall some typical histological findings in coeliac disease

A

Villous atrophy and crypt hyperplasia

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34
Q

Recall the name of the scoring system used to diagnose appendicitis and its components

A

Alvarado score:

Signs:
RLQ tenderness (+2)
Fever
Rebound tenderness

Symptoms:
Anorexia
Nausea/vomiting
Pain migration to RLQ

Lab:
Leucocytosis (WBC > 10,000) (+2)
Left shift (>75% neutrophils)

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35
Q

Recall some eponymous signs on examination that are indicative of appendicitis

A

Rovsing’s sign: Pain greater in RIF than LIF when LIF pressed
Cope’s sign: Pain on passive flexion and internal rotation of the hip

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36
Q

What does rebound tenderness indicate about appendicitis?

A

That it involves peritoneum

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37
Q

What sign can be used to demonstrate a retrocaecal appendix?

A

Pain on extending hip (Psoas sign)

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38
Q

How should an un-perforated appendix be managed?

A

Prophylactic antibiotics followed by laparoscopic appendectomy

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39
Q

How should a perforated appendix be managed?

A

Abdominal lavage

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40
Q

What is “Amirand’s triangle”?

A

Triad of conditions that predisposes to gallstone disease:
Low lecithin
Low bile salts
High cholesterol

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41
Q

How can the symptoms of cholecystitis and cholangitis be differentiated?

A 
Cholecystitis = no jaundice
Cholangitis = obstructive jaundice
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42
Q

How can the symptoms of cholecystitis and biliary colic be differentiated?

A

Biliary colic = RUQ pain

Cholecystitis = RUQ pain + fever

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43
Q

What is Charcot’s triad?

A

Triad of classical symptoms of ascending cholangitis
Jaundice
RUQ pain
fever

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44
Q

What is Reynauld’s pentad?

A 
Pentad of classical symptoms of severe ascending cholangitis 
Jaundice
RUQ pain
Fever
Hypotension
Confusion
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45
Q

Within what time frame should a laparoscopic cholecystectomy be performed for cholecystitis?

A

1 week (use antibiotics whilst waiting)

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46
Q

What is “Mirizzi syndrome”?

A

Impaction of common hepatic duct by a GB stone

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47
Q

What is the pathophysiology of “porcelain gallbladder”?

A

Chronic cholecystitis can –> calcification of GB walls

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48
Q

Recall some complications of acute cholecystitis

A 
Chronic diarrhoea (GB removal --> more bile reaches large intestine --> more water and salt draw into bowel)
Vitamin ADEK malabsorption (can --> bleeding due to less 2,7,9,10 production)
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49
Q

What is a SeHCAT study?

A

Selenium in Homocholic Acid Taurine - assesses bile acid retention to see if this is cause of diarrhoea

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50
Q

How can diarrhoea post-cholecystectomy be managed?

A

Cholestyramine (binds to bile acids and makes the biologically inactive)

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51
Q

How can ascending cholangitis be managed?

A

IV antibiotics followed by therapeutic ERCP within 48 hours

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52
Q

What are the key symptoms of cholangiocarcinoma?

A

Palpable gallbladder, obstructive jaundice

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53
Q

What is the gold-standard investigation for staging cholangiocarcinoma?

A

ERCP

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54
Q

Recall and compare the symptoms of PBC vs PSC

A

PBC:
Pruritis, obstructive jaundice, RUQ pain in 10%, hyperholesterolaemia

PSC:
Pruritis, obstructive jaundice, steatorrhoea, splenomegaly

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55
Q

Recall and compare the antibodies involved in PBC vs PSC

A

PBC: AMA
PSC: p-ANCA

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56
Q

Recall and compare the best way to investigate PBC vs PSC

A

PBC: cholestatic liver biochemistry and AMA blood test (biopsy is diagnostic but often not carried out)

PSC: MRCP is preferred to start (rosary sign), then p-ANCA + BIOPSY (‘onion skin’ appearance of obliterated cholangitis)

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57
Q

Recall and compare the management approaches for PBS vs PSC

A

PBS: ursodeoxycholic acid + cholestyramine + prednisolone for associated autoimmune disease

PSC: observation –> liver transplant

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58
Q

What % of patients with PSC get cholangiocarcinoma?

A

10%

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59
Q

Which autoimune gallbladder disease is associated with IBD?

A

PSC (ulcerative colitis)

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60
Q

How are the 3 types of autoimmune hepatitis characterised?

A

T1: high titres of ANA or ASMA - adults and children
T2: Anti-LKM-1,2,3 - affects children
T3: Anti-SLA (soluble liver antigen) - middle age

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61
Q

What are the key symptoms of autoimmune hepatitis?

A

Amenorrhoea

Chronic liver disease OR acute hepatitis

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62
Q

Which type of autoimmune gallbladder disease can affect extrahepatic ducts?

A

PSC

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63
Q

How is autoimmune hepatitis managed?

A

Steroids + azothioprine

Eventual liver transplantation

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64
Q

What are the 4 signs of portal hypertension?

A 
SAVE
Splenomegaly
Ascites
Varices
Encephalopathy
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65
Q

What is the triad of symptoms of Wernicke’s encephalopathy?

A

Ataxia
Confusion
Ophthalmoplegia

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66
Q

Recall the mainstay of management for hepatic vs wernicke’s encephalopathy

A

Hepatic encephalopathy: lactulose + rifaximin

Wernicke’s encephalopathy: thiamine, magnesium, folic acid

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67
Q

What are the principles of managing ascites?

A

Diet: restrict EtOH and fluids, daily weights

Diuretics: spironolactone (+/- furosemide)

Prophylaxis (for SBP): ciprofloxacin + propranolol

For refractory disease: TIPPS/ transplant

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68
Q

What is an abdominal paracentesis procedure used to treat?

A

Tense ascites

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69
Q

What is the most common pathogen in SBP?

A

E coli

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70
Q

What investigation is used to confirm ascites?

A

USS abdomen

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71
Q

How can SBP be confirmed?

A

Ascitic tap with PMN>250 and MC+S

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72
Q

What drugs are used to treat vs as prophylaxis for SBP

A

Treatment: piptazobactam/cefotaxime

Prophylaxis: ciprofloxacin + propranolol

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73
Q

When should SBP prophylaxis be started?

A

Ascites protein <15g/L

74
Q

What is the screening test for haemachromatosis?

A

Transferrin saturation - >55% in males and >50% in females may indicate further investigation

75
Q

What stain can be used on liver biopsy to identify haemachromatosis?

A

Perl’s stain

76
Q

What is the 1st and 2nd line management for haemachromotosis?

A

1st line: Venesection

2nd line: Desferrioxamine

77
Q

Describe the typical presentation of NAFLD

A

Acute weight loss followed by jaundice

78
Q

Recall the order in which you would order investigations for NAFLD

A

1st: LFTs (ALT will be > AST)
2nd: USS (will show increased echogenicity)
3rd: Enhanced Liver Fibrosis (ELF) panel OR a fibroscan
4th: Liver biopsy

79
Q

What are the components of an ELF panel?

A

Hyaluronic acid
Procollagen III
Tissue inhibitor of metalloproteinase 1

80
Q

What is the mainstay of management for NAFLD?

A

Lifestyle changes and wt loss

81
Q

What are the classical symptoms of acute pancreatitis?

A

Severe epigastric pain radiating through to back with nausea and vomiting

82
Q

What is Cullen’s sign and what diagnosis does it support?

A

Cullen’s sign = “superficial oedema with bruising in the subcutaneous fatty tissue around the peri-umbilical region”
Indicative of acute pancreatitis

83
Q

What is Grey Turner’s sign and what diagnosis does it support?

A

Grey-Turner’s sign = flank bruising

Indicative of acute pancreatitis

84
Q

How raised is serum amylase likely to be in acute pancreatitis?

A

> 3 times the upper limit of normal (in 75% of patients)

85
Q

What is the most specific marker for acute pancreatitis that will be raised in the blood?

A

Serum lipase

86
Q

What criteria are used to grade severity of acute pancreatitis?

A

Glasgow-Imrie

87
Q

What criteria are used to estimate prognosis in acute pancreatitis?

A 
PANCREAS
PaO2 <8 
Age >55
Neutrophils >15
Calcium <2
Renal urea >16
Enzymes (LDH>600, AST/ALT >200) 
Albumin <32
Sugar >10
88
Q

How long does an acute episode of pancreatitis have to last for to be considered ‘severe’?

A

> 48 hours

89
Q

Recall and differentiate between the management of acute pancreatitis vs necrotising pancreatitis?

A

For both:
Fluids, analgesia (stat boluses of IV morphine until comfortable), enteral feeding maintained, correct the cause
Only if necrotising: antibiotics

90
Q

Recall some possible early complications of acute pancreatitis

A

Haemorrhage
SIRS/ARDS
Hyperglycaemia (see pancreas critera)
Hypocalcaemia (see pancreas criteria)

91
Q

Recall some possible late complications of acute pancreatitis

A

25% –> peri-pancreatic fluid collection
Pseudocysts (appear at around 4w)
Pancreatic abscess (infected pseudocyst)
Pancreatic necrosis

92
Q

What % of chronic pancreatitis is due to alcohol excess?

A

80%

93
Q

What are the signs and symptoms of chronic pancreatitis?

A

Symptoms: epigastric pain, typically worse 15-30 mins post-prandially
Signs: Steatorrhoea, diabetes

94
Q

What investigations can be done in suspected chronic pancreatitis?

A

USS for gallstones
Contrast-enhanced CT
Faecal elastase (measures exocrine function)
Screen for diabetes and osteoporosis

95
Q

What is faecal elastase used to measure?

A

Exocrine function

96
Q

What histological type of cancer are 80% of pancreatic cancers?

A

Adenocarcinomas

97
Q

What is the classical presentation of pancreatic cancer?

A

Painless obstructive jaundice, painless palpable gallbladder (courvoisier’s law), FLAWS
Symptoms of lost exocrine/endocrine function

98
Q

What is trousseau’s sign of malignancy, and in which types of cancer is it sometimes observed?

A

Migratory superficial thrombophlebitis (moves from one leg to the other)
Strongly associated with adenocarcinoma of the pancreas and lung

99
Q

What is the pathognemonic sign on High Resolution CT for head of the pancreatic/bile duct cancer?

A

“Double duct” sign

Shows simultaneous dilation of CBD and pancreatic duct

100
Q

What is the definitive management of pancreatic cancer?

A

Whipple’s procedure

Pancreaticoduodenectomy

101
Q

What are the common complications of Whipple’s procedure?

A 
Dumping syndrome (gastric emptying of contents into duodenum too fast) 
PUD (if delayed gastric emptying instead of dumping syndrome) 
Bile/pancreatic link
102
Q

What is the non-surgical management of pancreatic cancer (eg if metastatic/ unsuitable for resection)?

A

ERCP with stenting

103
Q

What classification is used for diverticular disease?

A

Hinchey classification

104
Q

What is the investigation of choice for:

a) acute diverticulitis
b) chronic diverticular disease?

A

a) CT abdomen

b) barium enema (can’t do in acute phase as may cause perforation)

105
Q

How does the management of mild and severe diverticular disease differ?

A

Medical:
Mild: PO antibiotics
Severe: IV antibiotics (cef + met) + drip and suck (due to BO) + soluble, high-fibre diet

Surgical (only if severe)
Hartmann’s –> primary anastomosis

106
Q

Recall some indications for an urgent (2ww) OGD on suspicion of gastric/oesophageal malignancy?

A

Dyspepsia
Upper abdominal mass
Age >55 AND weight loss AND any of dyspepsia/GORD/upper abdo pain
nb if no weight loss –> NON-urgent OGD

107
Q

What is the gold standard test for diagnosis of GORD?

A

24 hour oesophageal pH monitoring

108
Q

What is the mechanism by which H pylori vs GORD produce dyspepsia?

A

H pylori –> ulcers –> dyspepsia

GORD –> dyspepsia

109
Q

What are the 3 ways in which you can test for H pylori?

A
  1. Carbon-13 urea breath test
  2. Stool antigen test
  3. Lab-based serology
110
Q

What is the mainstay of management for H pylori?

A

Clarithromycin, amoxicillin, PPI

111
Q

How does the medical management differ between endoscopically-proven vs endoscopically-negative GORD?

A

Proven: 2 months PPI trial followed by 1 month trial of double dose, 2nd line = add H2-RA

Negative: 1 month trial of PPI, 2nd line = H2-RA

112
Q

What is the surgical management option for refractory GORD?

A

Nissen fundoplication

113
Q

What are the most common complications of nissen fundoplication?

A

Gas-bloat syndrome (can’t belch/vomit)

Dysphagia (if wrap is too tight)

114
Q

What is Maddrey’s discriminant function?

A

For alcoholic hepatitis:

Predicts prognosis and who will benefit from steroids

115
Q

What score is used to stage liver cirrhosis?

A

Childs Pugh

116
Q

What is Budd Chiari syndrome and how is it classified?

A

Syndrome caused by blockage of the hepatic vein
Type 1 = thrombosis
Type 2 = tumour occlusion

117
Q

What are the possible signs and symptoms of Budd-chiari syndrome?

A

Abdominal pain, ascites, tender hepatomegaly

118
Q

What is the gold standard investigation for budd-chiari syndrome?

A

Abdominal USS with doppler

119
Q

What are the 3 best investigations when suspecting achalasia?

A

LOS manometry
Barium swallow
CXR

120
Q

Recall some signs and symptoms of the carcinoid syndrome, and recall which hormone is responsible for these symptoms

A

Flushing, diarrhoea, bronchospasm, hypotension, pulmonary stenosis, pellagra, endocrine over-function
Serotonin

121
Q

What 2 investigations can be used to investigate the carcinoid syndrome?

A

Urinary 5-HIAA

Plasma chromogranin A y

122
Q

What is the first line management for the carcinoid syndrome?

A

Somatostatin analogues eg octreotide

123
Q

Recall some antibiotics that may predispose to C diff infection

A 
Amoxicillin
Ampicillin
Cephalosporin (eg cefuroxime, ceftriaxone) 
Clindamycin
Co-amoxiclav 
Quinolones
124
Q

Recall the management of C diff colitis

A

1st episode: oral metronidazole
2nd episode/ severe 1st: oral vancomycin
Life-threatening/ ileus: oral vancomycin + IV metronidazole
ALL antibiotics over 10-14 day period

125
Q

Recall 3 risk factors for small bowel overgrowth

A

Neonates with congenital abnormalities
Diabetes mellitus
Scleroderma

126
Q

Recall the signs and symptoms of small bowel overgrowth

A

Very similar to IBS
Chronic diarrhoea
Bloating and flatulence
Abdominal pain

127
Q

Recall 3 ways of investigating for a small bowel overgrowth

A

Hydrogen breath test
Folate (will be high as bacteria produce it)
Diagnostic course of antibiotics

128
Q

What is the usual first line antibiotic for small bowel overgrowth?

A

Rifamixin

129
Q

What is Mackler’s triad?

A

The triad of symptoms seen in Boerhaave’s syndrome:
Chest pain
Vomiting
Subcutaneous emphysema

130
Q

In PUD, which artery is most likely to be a major source of bleeding?

A

Gastroduodenal artery

131
Q

When should opioid analgesia NOT be used following major abdominal surgery, and what alternative should be used?

A

In respiratory disease eg COPD

Alternative is epidural anaesthesia

132
Q

How should autoimmune hepatitis be treated?

A

30mg prednisolone PO, followed by introduction of azothioprine
MUST have confirmation of diagnosis from biopsy first unless there is a CI to biopsy

133
Q

How long does autoimmune hepatitis need to be treated for?

A

At least 2 years after blood results normalise before discontinuing therapy

134
Q

How should benign peptic strictures be managed?

A

PPI to treat underlying GORD

Balloon dilatation following benign biopsy

135
Q

What is the most common complication of balloon dilatation of a peptic stricture?

A

Oesophageal rupture (which may cause mediastinitis)

136
Q

How can oesophageal rupture be imaged best?

A

CT with oral contrast

137
Q

Recall some extra-articular manifestations of UC - saying which are related to disease activity and which are not

A 
Examples of extra-intestinal conditions related to activity of colitis:
Erythema nodosum
Aphthous ulcers
Episcleritis
Anterior uveitis
Acute arthropathy

Not related to activity of colitis:
Sacroiliiitis /Ankylosing spondylitis
Primary sclerosing cholangitis

(info from capsule case 202)

138
Q

What is the 1st line management for acute severe ulcerative colitis?

A

IV hydrocortisone

139
Q

How can blood glusose be used to assess liver function?

A

Assesses synthetic function

140
Q

How should variceal bleeds be managed when there is haemodynamic instability?

A
  1. Fluid resuscitation with blood transfusion
  2. IV vasopressin analogue eg terlipressin
  3. IV antibiotics
  4. Refer to endoscopy

nb. No IV PPI given prior to endoscopy

141
Q

What is the best surgical management for bleeding varices?

A

Band ligation or sclerotherapy

142
Q

What is the most appropriate long term management of varices?

A

Non-cardioselective beta blocker

143
Q

If variceal bleeding cannot be stopped with ligation, how can it be managed?

A

Insertion of Sengstaken Blakemore tube

144
Q

What are the 5 components of the Childs Pugh score?

A 
Serum bilirubin
Serum albumin
Prothrombin time
Presence of ascites 
Presence of encephalopathy
145
Q

Recall some differentials for the cause of ascites depending on whether the SAAG is low or high

A

High: portal HTN secondary to cirrhosis/ alcoholic hepatitis/ heart failure/ portal vein thrombosis

Low: peritoneal cause eg. malignancy, infections, pancreatitis and nephrotic syndrome

146
Q

If someone has a diagnostic ascitic tap, what 7 tests should the fluid be sent for?

A 
Culture and sensitivity 
Cytology 
LDH 
Glucose 
Total protein content 
Albumin concentration 
Cell count and differential
147
Q

Which 2 investigations are best for imaging chronic pancreatitis?

A

CT

MRCP

148
Q

Recall 2 drugs and 2 drug classes that can cause drug-induced liver damage

A

Roziglitazone
Flucloxacillin
Macrolides
Statins

149
Q

When is mesenteric angiography used?

A

To find the source of a GI bleed when endoscopy cannot do so

150
Q

What is the programme for screening for hepatocellular carcinoma?

A

In patients with cirrhosis, ultrasound every 6 months with additional CT/MRI if focal lesions seen on USS

151
Q

What is BAM?

A

Bile acid malabsorbption
Bile acids enter colon –> too many bile acids in colon –> profuse waterey diarrhoea
Should be halted by fasting

152
Q

Recall some examples of secretory diarrhoea

A

C diff
E coli 157
Cholera
Neuroendocrine tumours eg vasointestinal peptide-oma –> profound hypokalaemia without being fasted

153
Q

Recall 3 examples of inflammatory diarrhoea

A

UC
Crohn’s
Shigella

154
Q

Recall 4 examples of diarrhoea due to abnormal motility

A

Hyperthyroidism
Autonomic neuropathy (in DM)
Stimulant laxatives eg senna
IBS

155
Q

What is the histological finding of “owl’s eyes” pathognemonic for?

A

CMV

156
Q

What is Zollinger Ellison syndrome?

A

A rare digestive disorder caused by a neuroendocrine tumour that produces gastrin which leads to excess gastric acid. This excess gastric acid can cause peptic ulcers in the stomach and intestine

157
Q

How should autoimmune hepatitis be treated (broadly)?

A

Prednisolone and azothioprine

158
Q

How to choose ERCP vs MRCP?

A

ERCP is only now used as a therapeutic test - do this if worried about cancer (to take samples) or if there is something you can stent

MRCP is purely diagnostic (eg for PSC, see beading)

159
Q

Recall 3 GI causes of clubbing

A

GI malignancy
IBD
Chronic liver disease

160
Q

What is the cause of leukonychia?

A

Hypoalbuminaemia

161
Q

Recall 3 differentials for hepatomegaly

A

Hepatitis
NAFLD
Haematological malignancy

162
Q

How can you tell the spleen and kidney apart on palpation, apart from location?

A 
Spleen: 
Moves down with inspiration 
You cannot get above it 
Has a notch 
Dull to percussion 
Not ballotable
163
Q

Recall 3 differentials for splenomegaly

A

Haematological malignancies
Alcohol misuse
Primary sclerosing cholangitis

164
Q

Recall 3 differentials for enlarged kidneys

A

Renal vein thrombosis (usually UL)
Obstructive uropathy
PCKD

165
Q

Recall 3 causes of ascites

A

Portal hypertension
Constrictive pericarditis
Ovarian malignancy

166
Q

Recall some causes of cholestasis

A

Pancreatic cancer physically obstructing the gut
PBC (nb AMA pos, high IgM)
Chronic active hepatitis (anti-nuclear factor pos, high IgG)

167
Q

What drugs must be stopped to make a carbon13 Urea breath test reliable?

A

Amoxicillin 4w prior

PPI 2w prior

168
Q

What is the difference in the metabolic derangement that can be caused by diarrhoea vs vomiting?

A

Diarrhoea: normal anion gap acidosis
Vomiting: alkalosis

169
Q

What vaccine is given every 5 years in coeliac disease?

A

Pneumococcal

170
Q

How should a mild-moderate flare of UC be managed?

A

In a mild-moderate flare of ulcerative colitis extending past the left-sided colon, oral aminosalicylates should be added to rectal aminosalicylates, as enemas only reach so far (Passmed)

171
Q

What medication change is required for gastroscopy?

A

Stop PPI (eg omeprazole) 2w before procedure

172
Q

How should nutrition be managed in acute pancreatitis?

A

All patients with moderate to severe acute pancreatitis should be offered enteral nutrition (eg normal feeding or ng tube if needed) within 72 hours. They should only be offered parenteral nutrition if they cannot tolerate food (eg profuse vomiting).

173
Q

How can Crohn’s increase the risk of gallstones?

A

Terminal ileitis can reduce bile salt resorption

174
Q

In which patients with sigmoid volvulus would you NOT treat with a therapeutic flexible sigmoidoscopy?

A

In patients with sigmoid volvulus who have bowel obstruction with symptoms of peritonitis

175
Q

If mild/mod C difficile does not respond to oral vancomycin, what should be used 2nd line?

A

Oral fidaxomicin

If more severe infectiom = oral vancomycin + IV metronidazole

176
Q

How should high grade dysplasia in Barret’s oesophagus be managed?

A

Endoscopic ablation

177
Q

What are the grades of hepatic encaphalopathy?

A

Grade I: Irritability
Grade II: Confusion, inappropriate behaviour
Grade III: Incoherent, restless
Grade IV: Coma

178
Q

How might subcutaneous emphysema appear on examination?

A

Mild crepitus in the epigastric region

179
Q

What are the 2 most important blood tests for monitoring haemachromatosis?

A

Ferritin and transferrin saturation

180
Q

How is alcoholic ketoacidosis managed?

A

Infusion of thiamine and saline

181
Q

What is the limit of protein concentration in ascites for giving antibiotic prophylaxis, and what antibiotic is used?

A

Give antibiotics if protein concentration <15g/L

Abx of choice = ciprofloxacin

182
Q

If coeliac needs to be confirmed by biopsy, what is biopsied?

A

Jejunum

ICSM Year 6 (20 decks)

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