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1c Conditions > Passmed - Gastro > Flashcards

Passmed - Gastro Flashcards

1
Q

Metabolic alkalosis + hypokalaemia →

A

? Prolonged vomiting

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2
Q

Metabolic alkalosis causes?

A

vomiting / aspiration
(e.g. peptic ulcer leading to pyloric stenos, nasogastric suction)
vomiting may also lead to hypokalaemia
diuretics
liquorice, carbenoxolone
hypokalaemia
primary hyperaldosteronism
Cushing’s syndrome
Bartter’s syndrome

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3
Q

Metabolic alkalosis?

A

Metabolic alkalosis may be caused by a loss of hydrogen ions or a gain of bicarbonate. It is due mainly to problems of the kidney or gastrointestinal tract

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4
Q

PPI adverse effects?

A

hyponatraemia, hypomagnasaemia
osteoporosis → increased risk of fractures
microscopic colitis
increased risk of C. difficile infections

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5
Q

Loperamide, a mu-receptor agonist anti-diarrhoeal agent, adverse effects?

A

dry mouth, constipation and dizziness

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6
Q

Beta blocker adverse effects?

A

bronchospasm, cold peripheries and fatigue

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7
Q

Primary sclerosis cholangitis investigation?

A

MRCP

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8
Q

Pancreatic cancer features?

A

classically painless jaundice (pale stools, dark urine, and pruritus; cholestatic liver function tests)
Abdominal mass
Often non-specific way with anorexia, weight loss, epigastric pain
loss of exocrine function (e.g. steatorrhoea)
loss of endocrine function (e.g. diabetes mellitus)
atypical back pain is often seen
migratory thrombophlebitis (Trousseau sign) more common than with other cancers

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9
Q

Pancreatic cancer abdo masses that may be found (in decreasing order of frequency):

A

hepatomegaly - due to metastases
gallbladder - Courvoisier’s law states that in the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones
epigastric mass - from the primary tumour

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10
Q

Double duct sign?

A

Pancreatic cancer

the presence of simultaneous dilatation of the common bile and pancreatic ducts

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11
Q

Pancreatic cancer investigations?

A

USS (60-90% sensitivity)
HRCT scanning is investigation of choice if the diagnosis is suspected
imaging may demonstrate the ‘double duct’ sign - the presence of simultaneous dilatation of the common bile and pancreatic ducts

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12
Q

Pancreatic cancer management?

A

less than 20% are suitable for surgery at diagnosis
a Whipple’s resection (pancreaticoduodenectomy) for resectable lesions in the head of pancreas.
adjuvant chemotherapy is usually given following surgery
ERCP with stenting is often used for palliation

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13
Q

Whipple’s resection

A

(pancreaticoduodenectomy) is performed for resectable lesions in the head of pancreas.

Side-effects - dumping syndrome and peptic ulcer disease

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14
Q

Coeliac disease management?

A

Avoid gluten
Immunisation (due to hyposplenism)

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15
Q

Coeliac disease investigations?

A

tTG-IgA Test
+ IgA antibody

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16
Q

Iron defiency anaemia vs. anaemia of chronic disease

A

TIBC is high in IDA, and low/normal in anaemia of chronic disease

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17
Q

Anaemia of chronic disease bloods?

A

normochromic/hypochromic, normocytic anaemia
reduced serum and TIBC
normal or raised ferritin

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18
Q

Iron deficiency anaemia bloods?

A

TIBC raised
Ferritin low

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19
Q

first line antibiotic for use in patients with C. difficile infection

A

Oral vancomycin

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20
Q

life-threatening C. difficile infection treatment

A

ORAL vancomycin and IV metronidazole

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21
Q

life-threatening C. difficile infection treatment

A

ORAL vancomycin and IV metronidazole

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22
Q

IBS considered if following symptoms for 6 months: ABC

A

Abdominal pain, and/or
Bloating, and/or
Change in bowel habit

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23
Q

A positive diagnosis of IBS should be made if the patient has…

A

abdominal pain relieved by defecation or associated with altered bowel frequency stool form, in addition to 2 of the following 4 symptoms:
- altered stool passage (straining, urgency, incomplete evacuation)
- abdominal bloating (more common in women than men), distension, tension or hardness
- symptoms made worse by eating
- passage of mucus

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24
Q

Primary care investigations for IBS?

A

full blood count
ESR/CRP
coeliac disease screen (tissue transglutaminase antibodies)

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25
Q

Primary biliary cholangitis - the M rule

A

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

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26
Q

Most important intervention to stop further Crohn’s episodes?

A

Smoking cessation

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27
Q

A severe flare of ulcerative colitis should be treated…

A

in hospital with IV corticosteroids

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28
Q

Adenocarcinoma is now the most common type of oesophageal cancer and is more likely to develop in patients with a history of…

A

gastro-oesophageal reflux disease (GORD) or Barrett’s.

29
Q

gold standard for diagnosis of coeliac disease

A

Endoscopic intestinal biopsy

30
Q

Coeliac -> koilonychia?

A

Koilonychia = sign of hypochromic anemia (esp iron-def)
Bloating, fatigue, foul-smelling and greasy stools combined with her elevated serum anti-tTG levels = coeliac disease -> malabsorption in the gut due to villous atrophy -> iron-def anaemia because dietary iron is not adequately absorbed. Iron deficiency -> koilonychia.

31
Q

metastatic HCC treatment?

A

Sorafenib

32
Q

Mesenterio ischaemia triad?

A

CVD, high lactate and soft but tender abdomen

33
Q

first-line in maintain remission in ulcerative colitis patients with proctitis and proctosigmoiditis?

A

A topical (rectal) aminosalicylate +/- an oral aminosalicylate is used
E.g. topical mesalazine

34
Q

first-line medication for primary biliary cholangitis?

A

Ursodeoxycholic acid

35
Q

mainstay of treatment in haemochromatosis

A

Regular venesection

desferrioxamine may be used second-line

36
Q

mild-to-moderate exacerbation of left-sided ulcerative colitis management?

A

topical (rectal) mesalazine or sulphasalazine - topical aminosalicylates

37
Q

Severe ulcerative colitis management?

A

IV steroids
(IV ciclosporine if steroids contraindicated)

38
Q

HBsAg positive, anti-HBs negative, IgM anti-HBc positive

A

Acute hepatitis B

39
Q

Courvoisier’s law

A

A palpable, non tender, enlarged gallbladder accompanied with painless jaundice is unlikely to be due to gallstones. Instead consider malignancy

40
Q

HBsAg negative, anti-HBs positive, IgG anti-HBc positive

A

previous infection, not a carrier

(vaccine would only lead to anti-HBs antibodies)

41
Q

C. diff management?

A

first-line therapy is oral vancomycin for 10 days
second-line therapy: oral fidaxomicin
third-line therapy: oral vancomycin +/- IV metronidazole

Life-threatening - oral vancomycin AND IV metronidazole

42
Q

Aminosalicylates?

A

Sulphasalazine, mesalazine, olsalazine

variety of haematological adverse effects, including agranulocytosis

43
Q

The following drugs tend to cause a hepatocellular picture:

A

paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin

44
Q

The following drugs tend to cause cholestasis (+/- hepatitis):

A

combined oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin*
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates
rare reported causes: nifedipine

45
Q

Patients with ascites secondary to liver cirrhosis should be given

A

an aldosterone antagonist e.g. spironolactone

46
Q

Positive anti-HBc IgG, negative anti-HBc IgM and negative anti-HBc in the presence of HBsAg

A

chronic HBV infection

47
Q

Coeliac disease increases the risk of developing

A

anaemia
hyposplenism
osteoporosis, osteomalacia
lactose intolerance
enteropathy-associated T-cell lymphoma of small intestine
subfertility, unfavourable pregnancy outcomes

48
Q

Antinuclear antibodies, anti-smooth muscle antibodies and raised IgG levels

A

autoimmune hepatitis

49
Q

Type I autoimmune hepatitis?

A

Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA)

Affects both adults and children

50
Q

Type II autoimmune hepatitis?

A

Anti-liver/kidney microsomal type 1 antibodies (LKM1)

Affects children only

51
Q

Type III autoimmune hepatitis?

A

Soluble liver-kidney antigen

Affects adults in middle-age

52
Q

Alcoholic hepatitis management?

A

Glucocorticoids (e.g. prednisolone)

53
Q

diagnostic investigation of choice for pancreatic cancer

A

High-resolution CT scanning

54
Q

investigation of choice for suspected perianal fistulae in patients with Crohn’s

A

MRI

55
Q

Liver failure triad?

A

encephalopathy, jaundice and coagulopathy

56
Q

Acute liver failure features?

A

jaundice
coagulopathy: raised prothrombin time
hypoalbuminaemia
hepatic encephalopathy
renal failure is common (‘hepatorenal syndrome’)

57
Q

In life-threatening C. difficile infection treatment is with

A

ORAL vancomycin and IV metronidazole

58
Q

key investigation for a suspected perforated peptic ulcer

A

Erect chest x ray

59
Q

Overflow diarrhoea =

A

type 7 stools with intermittent hard stools. Treat with faecal disimpaction

60
Q

MSH2/MLH1 gene mutations are associated with

A

hereditary non-polyposis colorectal carcinoma

61
Q

Early signs of haemochromatosis are

A

fatigue, erectile dysfunction and arthralgia

62
Q

Vomiting / aspiration ABG

A

metabolic alkalosis

63
Q

Hepatic encephalopathy management?

A

Lactulose

64
Q

Primary biliary cholangitis - the M rule

A

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

65
Q

Crypt abscesses associated with?

A

UC

66
Q

? may be useful for diagnosing and monitoring the severity of liver cirrhosis

A

Transient elastography

67
Q

The AST/ALT ratio in alcoholic hepatitis is

A

2:1

68
Q

Raised transferrin saturation and ferritin, with low TIBC is the characteristic iron study profile

A

in haemochromatosis

1c Conditions (10 decks)

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