Week 13 - GI Flashcards
What is a peptic ulcer?
A break in the mucosal lining, more than 5mm diameter and depth to the submucosa
What skin conditions is associated with coeliac disease?
Dermatitis herpetiformis
What infection might patients with cirrhotic liver disease get?
Spontaneous bacterial peritonitis - associated with spontaneous infection of ascites
What is an acute abdomen?
Sudden onset of severe abdominal pain of less than 24 hours duration.
RUQ- biliary colic, acute cholangitis
RIF - ectopic pregnancy, acute appendicitis, ovarian cyst
What are consequences of peptic ulceration?
Haemorrhage, perforation, fibrosis
What characterises diffuse gastric cancer?
Linitis plastica (leather bottle stomach) (also has signet ring cells- malignancy with mucin vacuoles)
What drug is a risk factor for gallstones?
Ceftriaxone
What tumour marker would indicate pancreatic cancer?
CA19-9
What tumour marker is present in colorectal cancer?
Carcinomembryonic antigen
What tumour marker is present in hepatocellular carcinoma?
Alpha-fetoprotein
What score assesses severity of liver cirrhosis?
Child-turcotte-pugh score
What antibiotic is used in spontaneous bacteria peritonitis?
Ciprofloxacin
What hepatitis is associated with travel?
Hepatitis A
What type of vaccine is the hepatitis A?
Inactivated virus
What can Hepatitis E cause in pregnant women?
Fulminant hepatitis
What does Hep D need to survive?
Hepatitis B
What might augmentin cause?
Acute cholestatic hepatitis
Give an example of a liver cyst.
Von meyenberg complex (simple biliary hamartoma)
What can itching be a sign of? (GI)
Primary biliary cirrhosis
What might coeliac disease cause?
Enteropathy associated T cell lymphoma
What does T3 mean?
Invasion through the muscular propria and into the sub-serosa or non-peritonelaised pericolic tissue
What condition might present with aphthous oral ulcers?
Ulcerative colitis
What drugs would you give in a patient with frequently severe relapses of UC? and what is a risk of it?
Azathioprine/6-mercaptopurine
Risk of lymphoma
What is Crohn’s disease?
Chronic, transmural, inflammatory granulomatous disease from mouth to anus.
What acute changes are seen in IBD?
Ulceration, crypt abscess formation, loss og goblet cells. acute inflammation
What is localised peritonisitis caused by?
Underlying organ inflammation - appendicitis or cholecysitis
What is generalised peritonitis caused by?
Perforation of an abdominal organ - perforated duodenal ulcer, ruptured appendix
What drugs may cause cirrhosis?
Amiodarone, methotrexate, Na valproate
What might cause hepatic encephalopathy?
GI bleeding, infections, constipation, electrolyte imbalance
What might be a complication of Coeliac disease?
T cell lymphoma
Infections, osteoporosis, refractory coeliac disease, malignancy (adenocarcinomas - bowel, oesophagus)
What is a complication of C.Diff infection?
Pseudomembranous colitis
Toxic megacolon
How might you differentiate between inflammatory bowel disease and irritable bowel syndrome?
Faecal calprotectin
Calcium binding protein derived from neutrophils
Not disease specific
How might infective colitis present?
Short history of diarrhoea ± vomiting Abrupt onset ± resolution of Sx Systemic upset and fever Travel, ill contacts, immunocompromised. Stool culture and C.diff toxin assay (need 4)
How might ischaemic colitis present?
Abrupt onset pain, bloody diarrhoea ± SIRS
IV fluids ± antibiotics
CV disease, Heart failure, elderly
What does ‘Back wash ileitis’ mean?
When the terminal ileum is involved in Ulcerative colitis
severe cases
What type of oesophageal cancer is smoking and drinking associated with?
What is the other type?
Squamous carcinoma
Adenocarcinoma - GORD and obesity
When would you use the Seattle protocol?
Diagnosing Barretts oesophagus
4 biopsies every 2cm
What type of cells are seen in Diffuse gastric cancer that can be described as ‘individual malignant cells with mucin vacuoles’.
Signet ring cells
What are the types of gastric cancer?
Diffuse - Women <50 (signet ring cells)
Intestinal - Elderly men (end result of inflammation causing dysplasia)
What is the Glasgow-Blatchford score used for?
Based on clinical presentation. Risk of having an upper GI bleed, in a suspected bleed. > 0 is high risk
What is the Rockall score used for?
Calculates the risk of a re-bleed if patients get endoscopied
How might someone with an upper GI bleed present?
ABATED for upper GI bleed management
Melaena, coffee ground vomit, haematemesis, haemodynamic instability
How would you manage a patient with variceal bleeding?
- Restore circulating volume, transfuse once Hb <7g/dL
- Endoscopy
- Ciprofloxacin + Terlipressin, endoscopic banding (1st Line), TIPS
What would you give for prophylaxis of variceal bleeding?
Beta blockers or band ligation
Same for prevention of re-bleed
How would you manage uncontrolled variceal bleeding?
Sengstaken tube
Define Tenesnus.
A feeling of fullness in the rectum even after opening your bowels
Who would get screened for bowel cancer?
50-74 every 2 years
Faecal immunochemistry test to look for human Hb
Then 2 weeks wait referral to colonoscopy
What are the options for pre-exposure prophylaxis to Hep A?
Hep A can cause Acute liver failure
Inactivated virus - Hep A vaccine
If vaccine allergic. <4 weeks to travel, confers 3-6 months immunity - Hep A immunoglobulin - Pooled Ig
Hepatitis E can cause neurologic features, give an example.
Guillain barre syndrome
How would you treat Hep E?
Ribavirin
What does sAg mean?
Active infection
What does eAg mean?
Highly infections, high risk of CLD, HCC, highly infectious
Indicates viral réplication
What is is used in Hep Vaccines?
sAg
What does cAb mean?
Previous infection
What does HBV DNA?
Viral load
In assessing Ascites via a diagnostic tap, what can you look for?
Cell count - > 500WBC/cm3 >250 neutrophils
Serum ascites albumin gradient - Sr MINUS ascites albumin. (high SAAG) LOW protein ascites >11g/L - portal hypertension
What symptoms might lead you to believe a patient has acute pancreatitis?
Constant epigastric pain that may radiate to the back
Relieved when leaning forward
Guarding of the abdomen
List some types of pancreatic cysts.
Intraductal papillary mutinous neoplasm - in continuity with the main pancreatic duct, dysplastic papillary lining secreting mucin
Mucinous cystic neoplasm - ‘ovarian type stroma’
Serous cyst adenoma - no mucin, almost always benign
What are some causes of acute cholestasis?
Hep A and E
Drug induced
Extrahepatic biliary obstruction
What are some causes of Chronic hepatitis?
Hep B and C (D)
Genetic depositions - Wilsons, haemochromatosis
AI
How could you grade mental state in encephalopathy?
Conns score (west haven classification)
