Passmed GI / liver Flashcards
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.
Triad in Plummer-Vinson syndrome?
Mx?
dysphagia (secondary to oesophageal webs)
glossitis
iron-deficiency anaemia
iron supplementation and dilation of the webs
If severe vomiting -> oesophageal rupture…called what?
Boerhaave syndrome
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
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
Small bowel bacterial overgrowth syndrome Rfs
neonates with congenital gastrointestinal abnormalities
scleroderma
diabetes mellitus
Small bowel bacterial overgrowth syndrome features
chronic diarrhoea
bloating, flatulence
abdominal pain
[Similar to IBS]
Small bowel bacterial overgrowth syndrome Dx / Mx
Hydrogen breath test
Mx underlying disorder
Co-amoxiclav or metronidazole or rifaximin
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
Where is most likely to be affected by ischemic colitis
splenic flexure
Usual cause of acute mesenteric ischemia?
Common precipitating factor?
Mx?
Embolism
AF
Urgent surgery
Why does ischemic colitis usually occur at splenic flexure?
‘watershed’ area supplied by both areas
Seen on Xray of ischaemic colitis ?
thumbprinting’ may be seen on abdominal x-ray due to mucosal oedema/haemorrhage
Mx ischemic colitis
usually supportive
- surgery may be required
Why do you get pneumococcal vaccine in coeliac?
hyposplenism
Why do you avoid metoclopramide in obstruction
is a pro-kinetic anti-emetic so could cause a perforation
Carcinoid syndrom effect on heart
Right side compression -> tricuspid insufficiency and pulmonary stenosis
Coeliac
-> Weight loss, abdo distension, fevers, night sweats, diarrhoea
+lymphadenopathy
enteropathy-associated T cell lymphoma
Bar NSAIDS what other class of drug cause PUD
SSRIs
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%
What happens in Zollinger-Ellison syndrome? Name 2 features?
excessive levels of gastrin, usually from a gastrin secreting tumour
multiple gastroduodenal ulcers
diarrhoea
malabsorption
2 scoring systems for acute upper GI bleed
Blatchford score at first assessment,
Rockall score after endoscopy
Seen on histology of gastric ca
signet ring cells
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
