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GI Flashcards

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1
Q

What is psuedomembranous colitis
What abx are associated with it
Blood results

A

Severe inflammation of the colon usually due to overgrowth of C Diff

Clindamycin
Penicillins
Cephalosporins

Leukocytosis

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2
Q

Complications of pseudomembranous colitis

A

Paralytic ileus
Perf
Multi organ failure

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3
Q

Sx of pseudomembranous colitis

A

Diarrhoea - may be mucusy or bloody, can be up to 15 times a day
Fever
Abdo pain
Dehydration
Hx of abx

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4
Q

Medical/organic causes of diarrhoea (non GI system)

A

Hyperthyroidism
Pancreatic insufficiency

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5
Q

Causes of acute diarrhoea

A

Abx
Gastroenteritis - adeno,rhino,enterovirus

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6
Q

Definition of chronic diarrhoea

A

4 weeks
> or = 3 stools per day

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7
Q

Ix for pseudomembranous colitis

A

FBC - raised WCC
CRP
Stool culture
Abdo xray
Consider sigmoidoscopy

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8
Q

Rx of pseudomembranous colitis - general, non-severe, severe, toxic megacolon

A

Stop causative abx
Avoid antidiarrhoeals and opiates
Side room

1st line non severe - metronidazole
1st line severe - oral vancomycin if fails to improve add IV metronidazole

Toxic megacolon - urgent colectomy

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9
Q

Define constipation

A

Less than 3x week
Or
Less often than normal with difficulty straining

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10
Q

Causes of constipation
OPENED IT

A

Obstruction - mechanical (hernia, adhesions, ca)
Pain - anal fissures
Endocrine - hypothyroid, hypocalcium, hypopitassium
Neuro - MS, CES
Elderly
Diet/dehydration
IBS
Toxins - opioids

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11
Q

Causes of chronic diarrhoea

A

IBD
Coeliacs

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12
Q

Rx of constipation

A

Treat underlying cause
Diet and lifestyle advice - fibre (lentils, beans, veg) and hydration

Can give laxatives, PR if impacted

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13
Q

Types of laxatives, examples and MOA

A

Osmotic - lactulose, draw fluid into gut
Stimulant - senna. Bisacodyl, sodium picosulfate : induce peristalisis
Bulk forming - ispaghula : indigestible so stay in bowel to bulk stool and induce peristalsis

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14
Q

Example of a stool softener

A

Docusate sodium

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15
Q

Example of a suppository

A

Glycerol (stimulant laxative)

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16
Q

What is used for an enema

A

Phosphate enema

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17
Q

Medical rx of IBS

A

Antispasmodics - buscopan, mebeverine
Loperamide for diarrhoea

Lifestyle - reduce caffeine, stay hydrated

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18
Q

Dx of the dysphagia if:
Liquids and solids
Solids>liquids
Difficulty making swallowing
Odynophagia
Neck bulges or gurgles

A

Motility disorder
Stricture
Bulbar palsy
Ca, oesophageal ulcer, spasm
Pharyngeal pouch

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19
Q

How long before an OGD do you need to stop PPIs

A

2 weeks

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20
Q

Pathophys of achalasia

A

Degeneration if myenteric plexus causes LOS to not relax

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21
Q

Achalasia presentation

A

Dysphagia - both liquid and solid
Regurge
Weight loss
Arching if neck/standing sitting up straight

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22
Q

Complication of achalasia

A

Oesophageal Ca

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23
Q

Sign on barium swallow for achalasia

A

Bird beak sign

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24
Q

Rx of achalasia

A

Surgical cardiomyotomy
Can also do botox or medical rx with CCBs or nitrates

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25
How does diffuse oesophageal spasm present
Intermittent dysphagia with chest pain
26
Red flags with dyspepsia ALARMS
Anaemia/bleeding Loss of weight Anorexia Recent onset and progressive Maleana or haematemesis Swallowing difficulty
27
Rx of dyspepsia if >60 or ALARMS
OGD 2ww
28
Rx of dyspepsia is no alarming criteria and <60 Conservative and then ix if continues
Stop NSAiDs/CCBs, Stop smoking Stop alcohol Modify diet Weight loss Try anatacids. Do breath test and stool sample for H Pylori
29
H Pylori triple therapy
7 days of PPI, Amoxicillin and clarithro Or metronidazole if pen allergy
30
ADRs of PPIs
Hyponatramia Osteoporosis Increased risk of C Diff Microscopic colitis
31
Risk factors for PUD
Alcohol Smoking H Pylori NSaids Steroids Bisophosphonates
32
Ix for PUD
H pylori breath testing C12 OGD Bloods Gastrin if ZE suspected
33
What is the Glasgow blatchford score used for
Predict the need to treat pts with upper gi bleeds
34
Presentation of GORD
Halitosis Chrinic cough Burning related to meals, lying down Burping
35
Surgery used for severe GORD
Nissen fundoplication
36
Types of hiatus hernia, which one is worse
Sliding Rolling - can become strangulated
37
What is diagnostic ix for hiatus hernia
Ba Swallow CXR - will show has bubble and fluid level in chest cavity
38
Ddx for haematemesis VINTAGE
Varices Inflammation Neoplasia Trauma eg MW, boerhaaves Angiodysplasia General eg warfarin Epistaxis
39
If urea is raised but creatinine is normal what blood test should you check and why
Hb for upper gi bleed
40
What is the rockall score
Predicts risk of re bleeding in upper GI bleed
41
What dx does coffee ground vomit suggest
PUD
42
Immediate rx of upper GI bleed
Resuscitation Consider terlipressin (variceal) Urgent endoscopy
43
What meds must you give in/after urgent OGD for upper GI bleed What else should you do (ie what info is important for nurses)
Adrenaline Antibiotics Offer vit k Keep NBM for 24hrs
44
Causes of prehepatic jaundice
Excess biliruben production - haemolytic anaemia Or ineffecive erythropoeisis eg SCD, G6PD, thalassaemia
45
Causes of hepatic jaundice
Drugs - rifampicin, isoniazid, ethmbutol Hepatitis Cirrhosis Congenital causes - haemochromatosis, wilsons, a1ATD Autoimmune Alcohol Infectious - cmv, ebv, hep abc
46
Post hepatic causes
Cholestasis Pancreatic cancer Biliary atresia
47
Signs of liver failure
Jaundice Oedema and ascitis Encephalopathy Signs of portal hypertension in cirrhosis
48
Pathophys of hepatorenal syndrome
Cirrhosis - release of mediators causing splanchnic artery vasodilation, reduces vascular resistance - RAAS activation - renal artery vasoconstriction Persistent hypoperfusion - failure
49
Rx of hepatorenal syndrome
IV albumin Spanchnic vasoconstrictor - terlipressin Haemodialysis Liver transplant
50
Rx if liver failure
Rx of underlying cause Good nutrition - NGT Thiamine supplements
51
Complications of liver failure
Bleeding Sepsis Ascites Hypoglycaemia Encephalopathy - seizures, cerebral oedema
52
Drug for cerebral oedema
Mannitol
53
Drug for ascites
Spiro
54
Drugs to avoid in liver failure
Opiates Hypoglycaemics Na containing IVI Caution - warfarin Hepatotoxic drugs - paracetamol, methotrexate, isoniazid, tetracyclines
55
Signs of cirrhosis in hands
Hepatic flap Duputyrons Spider naevi Leuconychia Clubbing Palmar erythema
56
Causes of cirrhosis
Alcohol excess Chronic HepC NASH/NAFLD hepB a1AT wilsons haemochromatosis
57
What ix suggest that cirrhosis is caused by: - alcohol - NAFLD - infection - genetics
- increased MCV, increased GGT - hyperlipidaemia, increased glucose - serology positive - genetic stuff
58
What imaging is used for cirrhosis
US liver
59
Complications of cirrhosis
SBP Portal htn and varices Wernickes encephalopathy and korsakoff psychosis
60
Rx of wilsons drug
Penicillamine
61
Rx of ascites
Fluid and salt restriction Spiro 2nd line furosemide, tap, daily weights
62
Pathophys of ascites
portal hypertension Splanchnic vasodilation RAAS activation Sodium and water retention PLUS Hypoalbuminaemia Leads to ascites
63
Blood results of alcoholism
Increased Mcv anaemia Folate deficiency
64
Rx of alcohol withdrawal in hospital
Chlordiazepozide Thiamine (pabrinex)
65
Sx of alcoholic hepatitis
Tender hepatomegalt Anorexia Diarrhoea Vomiting Ascites Jaundice, varices, encephalopathy if severe
66
What is NAFLD
Non alcoholic fatty liver disease caused by insulin resistance and metabolic syndrome NASH is most common form
67
Examination findings in NAFLD
Truncal obesity Hepatosplenomegaly Hx of obesity, diabetes, htn etc
68
What makes up metabolic syndrome
Obesity HTN High fasting glucose/insulin resistance High triglycerides Low HDL cholesterol
69
Rx of NAFLD
Diet and lifestyle changes Control htn, dm
70
What is budd chiari syndrome
Hepatic vein obstruction - ischaemia and hepatocyte damage - insidious cirrhosis and liver failure
71
Causes of budd chiari
Hypercoaguable state Myeloproliferative disorders eg PV HCC local tumour
72
Triad for Budd Chiari presentation
RUQ Hepatosplenomegaly Ascites
73
What is hereditary haemochromotosis
Increased intestinal iron absorption leading to deposition in multiple organs Called bronze diabetes
74
Rx of hereditary haemochromotosis
Venesection
75
Presentation of a1AT deficiency
Neonatal and childhood Hepatitis Cirrhosis Emphysema
76
Clinical features of wilsons disease
Kayser fleischer rings Liver disease - childhood presentation Arthritis Parkinsonism RTA Haemolytic anaemia
77
Rx of wilsons
Penicillamine lifelong Avoid high cooper foods: liver, chocolate, nuts
78
What is primary biliary cholangitis
Intrahepatic bile duct destruction by chronic inflammation leading to cirrhosis
79
Who is primary biliary cholangitis common in What immunology blood test is raised
Liver failure in a Middle age woman with signs of rheum/autoimmune conditions IgM
80
Rx if primary biliary cholangitis
Pruritus: cholestyramine Diarrhoea: codeine Osteoporosis: bisphosphonates ADEK vitamins Ursodeoxycholic acid Immune supression - pred, azathioprine Liver transplant
81
How do PBC and PSC duffer
PBC effects only the intrahepatic billiary ducts
82
Complications of primary sclerosing cholestasis
Cirrhosis Increased risk of cholangiocarcinoma and colorectal cancer
83
Disease commonly associated with primary sclerosing cholangitis
80% of those with PSC have IBD
84
Management of PSC
Same as PBC Plus US gallbladder and Ca19-9 Plus colonoscopy for CRC
85
Presentation of cholangiocarcinoma
Fever Malaise Abdo pain Ascites Jaundice
86
Indications for liver transplant
Advanced cirrhosis HCC Cholangiocarcinoma A1AT deficiency
87
Is smoking good or bad in IBD
Good for UC Bad for chrons
88
Features of Crohns vs UC
Crohns - transmural (full thickness) inflammation - no PR blood or mucus - entire gi tract affected - skip lesions - terminal ileum most common place affected (may be B12 deficient) - perianal disease UC - only superficial mucosa effected - blood and mucus PR - only colon and rectum affected - continuous inflammation - associated with PSC
89
Extra gi presentations of IBD
Erythema nodosum Pyoderma gangrenosum PSC Episcleritis, scleritis, anterior uveitis Enteropathic arthritis
90
Diagnosing IBD ix
Fecal calprotectin Colonoscopy
91
Acute UC rx
Mild/mod - aminosalicylate or oral pred Severe - iv steroids
92
Maintenance UC rx
Aminosalicylate eg mesalazine first Azathioprine
93
Surgical UC rx
Panproctocolectomy - will have perm ilieostomy or j pouch
94
Acute Crohns rx
Oral pred or IV hydro are first line Enteral nutrition - special liquid diet Azathioprine, methotrexate, infliximab if not working
95
Maintenance and surg rx of crohns
Azathioprine or mercaptopurine. Methotrexate as 2nd line Surgery - resect distal ileum, treat strictures and fistulas
96
Complications of IBD
Toxic megacolon (Uc) CRC and cholangiocarcinoma Strictures Fistula (crohns)
97
AXR findings in UC
Lead pipe - no haustra Thumbprinting - mucosal inflammation Possible toxic megacolon
98
What do we also test for in pts with newly diagnosed T1DNM or autoimmune thyroid disease
Coeliacs
99
Microscopy findings in coeliacs
Villous atrophy and crypt hypertrophy
100
Main antibody associated with coeliacs . What must you also test alongside this
Anti TTG (tissue transglutaminase) IgA bc an IgA deficiency will mean the antibody test is negative even in crohns
101
Extra gi presentations of coeliacs
Dermatitis herpetiformis Anaemia - bc low iron, b12, folate Hyposplenism Osteoporosis Can lead to Lymphoma (enteropathy associate T cell lymphoma)
102
Risk factors of pancreatic ca
Smoking Chronic pancreatitis Alcohol DM HNPCC MEN BRCA2
103
Presentation of pancreatic ca
Male >60 Painless obstructive jaundice Dark urine, pale stools Epigastric pain radiating to back relieved sitting forwards Anorexia and weight loss Sudden onset dm in the elderly
104
Rx of pancreatic ca
Whipples procedure Or palliation
105
A patient has no abdo pain, jaundice but has palpable gallbladder. Dx?
Courvosiers law says that painless enlarged gallbladder is unlikely to be gallstones Consider pancreatic ca
106
Chronic pancreatitis presentation
Epigastric pain radiates to back, relieved by sitting up Exacerbated by fatty food Steatorrhoea Weight loss DM
107
Rx of chronic pancreatitis
Analgesia Creon (pancreatic enzymes) ADEK Rx DM Reduce fat intake No alcohol
108
Presentation of B12 deficiency
Glossitis Peripheral neuropathy Subacute combined degeneration of the cord
109
Scurvy (vit c deficiency) presentation
Gingivitis Bleeding gums Muscle pain and weakness Oedema Corkscrew hairs
110
What factors are vit k dependent
2,7,9,10
111
Presentation of acute mesenteric ischaemia Who is it likely in
Clot in superior mesenteric artery Acute non specific abdo pain disproportionate to findings. Elderly pt with AF
112
Diagnostic scan of choice for AMI
Contrast CT abdo
113
Triad of chronic mesenteric ischaemia
Colicky abdo pain Weight loss Abdominal bruit
114
MUST score
Find pic
115
Calculate alcohol units
Volume (ml) x % divided by 1000
116
Metabolic disturbances in refeeding syndrome
Hypo - phosphate - potassium - magnesium
117
Who is at high risk of refeeding
Bmi less than 16 Little nutritional intake >10 days Unintentional wl >15% over 3 months
118
Rx of severe alcoholic hepatitis (think inflammation)
Prednisolone
119
Complications of cirrhosis
SBP Hepatorenal syndrome PHTN, Varices Malnutrition Ascites Hepatic encephalopathy
120
Scores used to assess prognosis in cirrhosis
MELD (model for end- stage liver disease) Child Pugh score - Albumin, biliruben, clotting, dilation (ascites), encephalopathy
121
How does cirrhosis cause malnutrition
Reduced protein metabolism in the liver Reduced ability to store glucose as glycogen
122
How does liver disease cause ascites
PHTN causes capillaries in abdominal cavity to leak Reduced BP RAAS activation causes increased sodium resorption Leading to a transudative ascites
123
Most common organisms of sbp Which complication of cirrhosis is it as a result of
E coli Klebsiella pneumoniae 10-20% of pts with ascites as infection develops within the ascitic fluid
124
Rx of hepatic encephalopathy (What is accummulating)
Lactulose - helps to reduce ammonia levels Abx - to reduce number of intestinal bacteria producing ammonia Nutritional support
125
Presentation of an iron overdose and why do some of these present
N+v Diarrhoea Black stool Gi ulceration Gi haemorrhage Rectal bleeding Haemodynamic collapse - free plasma iron is a potent vasodilator
126
Side effect of desferroxamine
Orange red urine
127
med of choice for campylobacter
clarithromycin
128
presentation of gilberts syndrome
episode of jaundice triggered by/associasted with dehydration, poor sleep, stress, physical exertion, illness. lots normal bar bilirubin, no other sx of liver disease
129
what is Small intestine bacterial overgrowth syndrome ix rf rx
too much bacteria causing chronic diarrhoea, bloating, flatulance and abdominal pain ix - hydrogen breath test rf - diabetes, congenital gut issues, scleroderma rx - abx - rifaxamin, metrodizole or co amox
130
rx for achalasia
cardiomyotomy
131
side effects of metoclopramide to be aware of
EPS eg acute dystonia, parkinsonism etc
132
133
Presentation of mesentaeric ischaemia
Acute onset generalised colicky abdo pain Clinically shocked Pain and shock disproportionate to clinical findings Often in afib which throws off a clot into the mesenteric arteries
134
drug causes of pancreatitis
mesalazine, azathioprine steroids sodium valproate
135
how is liver cirrhosis diagnosed - imaging of choice
fibro scan (transient elastography) (basically an ultrasound)
136
what are the best blood results to acutely measure the synthetic function of the liver
INR Albumin - least of the 3 PT
137
drugs associated with cholestasis
COCP co-amox sulphonylureas anabolic steroids
138
features of acute liver failure
jaundice ascites hypoalbuminaemia coagulopathy renal failure - hepatorenal syndrome hepatic encephalopathy
139
rx of acute alcoholic hepatitis
prednisolone
140
Rx of ascites
Spironolactone low salt intake prophylactic abx to prevent against SBP Paracentesis (drain) if tense ascites
141
first line drug used in hepatic encephalopathy and why
lactulose - thought to decrease ammonia
142
risk factors for hepatocellular carcinoma
biggest is liver cirrhosis! 2' to alcohol, hep b, hep c, haemochromatosis, a1AT DM
143
tumour marker for HCC
AFP
144
what can trigger decompensation in liver cirrhosis
constipation infection, electrolyte imbalances, dehydration, upper GI bleeds or increased alcohol intake.
145
wernickes triad
ataxia ophthalmoplegia confusion
146
microscopic findings in UC, crowns and coeliacs
All - lymphocytic infiltration UC - crypt accesses and goblet cell loss Cr - granulomas, lymphoid hyperplasia Coe - villous atrophy and crypt hyperplasia
147
examination finding in liver in RHF
pulsatile smooth enlarged liver
148
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