Passmed GI / liver Flashcards by Hamish Reed-Embleton

An 18-year-old female presents with tremor and dysarthria. There is a family history of early onset liver disease…

Dx?

Wilsons

Onet 10-25
Liver + Neurological problems may manifest as dementia, tremor or dyskinesias.

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Triad in Plummer-Vinson syndrome?

Mx?

dysphagia (secondary to oesophageal webs)
glossitis
iron-deficiency anaemia

iron supplementation and dilation of the webs

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If severe vomiting -> oesophageal rupture…called what?

Boerhaave syndrome

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What is melanosis coli? seen in?

Melanosis coli is a disorder of pigmentation of the bowel wall. Histology demonstrates pigment-laden macrophages

It is associated with laxative abuse

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Amsterdam criteria for HNPCC

at least 3 family members with colon cancer

the cases span at least two generations

at least one case diagnosed before the age of 50 years

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Small bowel bacterial overgrowth syndrome Rfs

neonates with congenital gastrointestinal abnormalities
scleroderma
diabetes mellitus

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Small bowel bacterial overgrowth syndrome features

chronic diarrhoea
bloating, flatulence
abdominal pain

[Similar to IBS]

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Small bowel bacterial overgrowth syndrome Dx / Mx

Hydrogen breath test

Mx underlying disorder
Co-amoxiclav or metronidazole or rifaximin

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Peutz-Jeghers syndrome features

hamartomatous polyps in GI tract (mainly small bowel)

pigmented lesions on lips, oral mucosa, face, palms and soles

intestinal obstruction e.g. intussusception

gastrointestinal bleeding

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Where is most likely to be affected by ischemic colitis

splenic flexure

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Usual cause of acute mesenteric ischemia?
Common precipitating factor?
Mx?

Embolism
AF

Urgent surgery

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Why does ischemic colitis usually occur at splenic flexure?

‘watershed’ area supplied by both areas

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Seen on Xray of ischaemic colitis ?

thumbprinting’ may be seen on abdominal x-ray due to mucosal oedema/haemorrhage

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Mx ischemic colitis

usually supportive

- surgery may be required

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Why do you get pneumococcal vaccine in coeliac?

hyposplenism

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Why do you avoid metoclopramide in obstruction

is a pro-kinetic anti-emetic so could cause a perforation

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Carcinoid syndrom effect on heart

Right side compression -> tricuspid insufficiency and pulmonary stenosis

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Coeliac
-> Weight loss, abdo distension, fevers, night sweats, diarrhoea
+lymphadenopathy

enteropathy-associated T cell lymphoma

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Bar NSAIDS what other class of drug cause PUD

SSRIs

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Zollinger-ellison often occur due to what syndrome? Other parts of it?

multiple endocrine neoplasia type I (MEN-I)

parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia
pituitary (70%)
pancreas (50%

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What happens in Zollinger-Ellison syndrome? Name 2 features?

excessive levels of gastrin, usually from a gastrin secreting tumour

multiple gastroduodenal ulcers
diarrhoea
malabsorption

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2 scoring systems for acute upper GI bleed

Blatchford score at first assessment,

Rockall score after endoscopy

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Seen on histology of gastric ca

signet ring cells

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A 29-year-old man who is known to have ulcerative colitis is admitted to hospital with a flare of his disease. For the past three days he has been passing up to five bloody stools per day. Over the past 24 hours he has also developed abdominal pain and a low grade pyrexia
What might this be and whats the Ix

toxic megacolon

AXR

Dermatitis, diarrhoea, dementia/delusions, leading to death...?

Pellagra - vit B3 deficiency

HBsAg anti-HBc anti-HBs

HBsAg = ongoing infection, either acute or chronic if present > 6 months anti-HBc = caught, i.e. negative if immunized Anti-HBs implies immunity (either exposure or immunisation). It is negative in chronic disease

Main risk of clindamycin mx

Clostridium difficile

Mx c diff

metronidazole +isolate for 48hrs [vanc after]

What do you give when draining large volume ascites? why?

Albumin | -reduce risk of paracentesis-induced circulatory dysfunction

3 drugs causing pancreatitis

steroids valproate mesalazine, azathioprine

Big Upper GI bleed blood Ix

Raised Urea

What drug pre endoscopy for varicies

terlipressin

What is this? A 50-year-old male with a long history of cirrhosis secondary to chronic hepatitis C is brought to the emergency department by his partner with a 2-day history of increasing confusion. He is drowsy but is rousable to voice. He is able to obey commands but is not oriented to where he is. Further examination revealed significant hepatic flap, multiple spider naevi on the torso, and mild abdominal distension with shifting dullness. He is afebrile and his partner denies any history of recent infection. Mx?

hepatic encephalopahty Lactulose -> stop ammonia absorption [+rifaximin]

mx of hepatorenal

terlipressin albumin for volume expansion TIPS

bar colon most common Ca in HNPCC

Endometrial

NAFLD - found incidentally on US.... What Ix should you do

enhanced liver fibrosis (ELF) blood test to check for advanced fibrosis

Key ix screen current infection with HBV

HBsAg

A 57-year-old woman with a history of gallstones presents with progressive right upper quadrant pain, rigors and jaundice. Dx

Ascending cholangitis

A 62-year-old presents with upper abdominal pain. She has recently been discharged from hospital where she underwent an ERCP to investigate cholestatic liver function tests. The pain is severe. On examination she is apyrexial and has a pulse of 96 / min. Dx

Acute pancreatitis

A 76-year-old woman presents with abdominal pain, distension and vomiting. She recently had an episode of acute cholecystitis and is awaiting a cholecystectomy. She feels her symptoms have returned over the past few days. On examination her abdomen is distended. Dx

Gallstone ileus

Dx of wilsons

Reduced serum caeruloplasmin / copper increased 24hr urinary copper excretion

vessles in TIPS

Hepatic vein Portal vein [MAD TING - no jugular)

What electrolyte change indicates risk of refeeding syndrome

hypophosphate

LFTs are not often best way of looking at liver health - what is?

PT | Albumin

Best ix for cirrhosis

fibroscan (Transient elastography)

what is gilberts syndrome

high bilrubin in blood

What else do you screen for with diagnosis of AI thyroid / T1DM?

Coeliac

Why is crohns associated with gallstones

can result in terminal ileitis, this is the section of the bowel where bile salts are reabsorbed. When this area is inflamed and the bile salts are not absorbed and people are prone to development of gallstones.

What is tenesmus

need to keep emptying bowels

deranged LFTs combined with secondary amenorrhoea in a young female

AI hepatitis

Best screen for harmful alcohol drinking and alcohol dependence?

AUDIT questionnaire

On examination, she was found to have a painful palpable umbilical node. This metastatic nodule representing advanced malignancy is eponymously referred to as?

sister mary joseph's node

Key finding that indicates cirrhosis has occurred in chronic liver disease

Low platelets

A 35-year-old lady presents to the emergency department with right upper quadrant pain. She has also noticed that her skin seems slightly yellower over the last week or so and you notice a yellow tinge to her sclera. On further questioning, she complains of itching of her arms. Her only past medical history of note includes ulcerative colitis for which she takes mesalazine. Given her presentation, what is the best investigation to diagnose the most likely underlying condition? Key Ix?

ERCP - investigation of choice in primary sclerosing cholangitis

Key comp of PSC

Cholangiocarcinoma

A 66-year-old gentleman with hypertension, gout, type 2 diabetes, and atrial fibrillation presents to the emergency department with a 12-hour history of bloody diarrhoea and abdominal pain, which he describes as “the worst pain he's ever had” and rates as 10/10. He has no recent travel history, and his contacts are well. On examination, he is apyrexial and has a blood pressure of 126/82 mmHg. His abdomen is soft, non-tender, and there are normal bowel sounds. Digital rectal examination reveals blood mixed with the diarrhoea but is otherwise normal Ix for Dx ?

Serum lactate Acute mesenteric ischaemia causes a raised lactate

Always examin what in right iliac fossa pain

scrotum

PBC LFTs? Antibody?

rise in ALP and γGT Anti Mitochondrial antibodies