Gastroenterology

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mewinstanley@googlemail.com
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260850
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Gastroenterology
Updated:
2014-02-09 07:54:00
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finals gastro
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Gastro for finals
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  1. Define dysphagia?
  2. Give an outline of the causes of N+V?
  3. What are the red flags for Nausea + Vomiting?
    • Weight loss
    • anaemia
    • Blood [haematemesis/Malaena]
    • Dysphagia
    • Palpable abdo mass
  4. How is N+V Investigated?
    • <55yo = H.Pylori serology/Stool antigen
    • >55yo = Endoscopy
    • Red flags = endoscopy
  5. Define diarrhoea? And give 3 types:
    Diarrhoea = >200g stool daily [by volume] stool takes shape of container, assoc w urgency + incontinence

    Osmotic [stops when fasted, too much water drawn into bowel] -> drugs [lactulose, Mg salts] sweeteners

    Secretory [high volume, increase in secretion of anions -> movement of water] -> toxins [cholera, C diff, E.coli], tumours, drugs [erythromycin]

    Motility -> IBS, stimulating laxatives [senna]
  6. Give 3 causes of Travellers diarrhoea?
    • Campylobacter Jejuni
    • E coli
    • Giardia
    • Cryptosporidium

    • Bloody? -> dysentery
    • Salmonella typhi
    • Shigella
    • Campylobacter
  7. Give 4 CF of GORD
    • heart burn
    • regurgitation
    • brackish taste at back of mouth
    • chronic cough
    • sore throat
    • horaseness
    • dental erosions
    • chest pain
  8. Give 3 Mx for GORD
    • PPI -> omeprazole
    • PRN Antacid
    • Lifestyle modification -> weight loss, elevate head in bed
    • Surgical -> Nissen fundoplication
  9. What is the main complication of GORD? Give 2 others
    • Oesophageal strcture
    • bleeding
    • ulcer

    Barretts Oesophagus -> gastric epithelial metaplasia with risk of trasnformation to carcinoma -> surveillence
  10. Give 3 causes for peptic ulcer disease?
    H. Pylori infection -> serology/stool antigens -> triple therapy [PPI, amoxil, clarith/metronidazole]

    Drugs -> NSAIDs -> Disrupt mucosal permeability, ^^susceptible to damage

    Lifestyle -> smoking, alcohol, caffeine

    Physiological stress -> burns patients, CNS, Trauma [ICU patients]

    Hyper secretory state [rare] Zolinger Ellison Gatrinoma
  11. Give 3 CF suggestive of Peptic Ulcer
    • Episodic epigastric pain
    • Before food, relieved by eating
    • vomiting
    • anaemia
    • Haematemesis/Perforation
  12. Give 3 causes of upper GI bleeding?
    Common;

    • Ulcers [H.Pylori, NSAID]
    • Oesephageal varices
    • Mallory-Weiss tear
    • Erosive Oesophagitis
    • Erosive Gastritis

    Uncommon;

    • Tumours
    • AV Malformation
    • Portal Hypertensive Gastopahty
  13. What is the acute Mx of Upper GI Bleeding?
    • Major Haemorrhage Protocol
    • ABC
    • Fluid resuscitation
    • Urgent Endoscopy
  14. Outline the acute Mx of Oesopheageal varices?
  15. Mx of varices? Acute + chronic
    Acute

    • Terlipressin IV -> vasopressin analogue, achieve haemostasis
    • TIPSS -> Transjugular Intrahepatic Porto-Systemic Shunt -> relieve portal hypertension

    Chronic

    • Prophylaxis -> Prpanolol/Carvedolol
    • TIPSS
    • Banding
  16. Look at this pretty picture
  17. Give 3 causes of Jaundice?
  18. What is Gilberts Syndrome?
    • Congenital Hyperbilirubinaemia
    • jaundiced during times of stress [isolated rise in bilirubin]
  19. What is Portal vein thrombosis?
    Thrombosis of hepatic portal vein [cirrhosis, pancretitis, post-splenectomy]

    CF -> sudden onset RUQ pain, signs of Portal HTN [Ascites, caput medusae]
  20. What is PSC? [Primary Sclerosing Cholangitis]
    • Inflammation + obstruction of bile ducts [intra+extrahepatic]
    • Autoimmune, Linked to UC, M>F 2:1

    CF -> Chronic fatigue, malabsorption, cirrhosis, Cholangiocarcinoma
  21. Give 3 causes of acute liver failure?
    Uncommon but serious problem

    • Drugs -> Paracetamol, halothane, Anti-TB
    • Cryptogenic -> unknown
    • Viral infection -> Hep, A, B, E
    • Poisons -> Magic Mushrooms
    • Misc -> Budd-chiari, wilsons, liver mets, lymphoma
  22. Outline the 4 stages of hepatic encephalopathy?
    1 - slurred speech, poor concentration, retardation

    2 - drowsy, occaisionally aggressive, lethargic

    3 - Confusion, dec GCS, Gross disorientation

    4 - Unconscious
  23. Give 4 CF of Acute liver failure
    • Heptatic encephalopathy
    • Derebral oedema
    • Jaundice
    • Fetor Hepaticus [smelly breath]
    • Ascites + oedema -> late
  24. Ix of acute liver failure?
    • Prothrombin [PT] time -> prognostic indicator
    • Bilirubin
    • Transaminases
    • HBsAg
    • Serology -> HEV, HCV, CMV, HSV, EBV
    • USS liver + doppler hepatic veins
  25. Mx of acute liver failure?
    • Co-ordinate w ICU/HDU
    • NANC in paracetamol
    • Cerbral oedema/Encephalopthy -> Reduce ammonia burden -> Lactulose, 30degree head tilt
    • Coagulopathy -> FFP
    • NBM -> IV glucose to avoid hypo, NGT, TPN
    • Transplantation
  26. Define Cirrhosis?
    • Diffuse hepatic fibrosis + nodule formation leading to a loss of the normal liver architecture
    • Stage 1 -> compensated & asymptomatic -> 10-20yrs
    • Stage 2 -> decompensated -> lver failure, varices, ascites
  27. Give 4 causes for liver cirrhosis?
    • Alcohol
    • Chronic viral hepatitis [B+C]
    • Non-alcoholic fatty liver
    • Immune -> PSC/Autoimmune liver disease
    • Biliary -> PBC, CF
    • Genetic -> haemochromatosis, Wilsons
  28. Give 6 CF of Cirrhosis?
    • Hepatomegaly [or small + hard]
    • Ascites
    • Circulatory changes -> spider naevi, palmar erythema, cyanosis
    • Portal Hypertension -> Spleenomegaly, caput, variceal bleeds
    • Gynaecomastia
    • haemorrhagic tendency -> Bruises, purpura, epistaxis
    • Hepatic encephalopathy
  29. Draw the mechanism of ascites?
  30. Give 3 investigations for cirrhosis?
    • Liver biopsy = gold standard
    • Bloods -> PLTS, ^INR, ^[bilirubin], hypoalbuminaemia
    • USS -> advanced disease
    • CT-abdo
  31. Mx
    • Treat cause
    • treat complications
    • adequate nutrition
  32. Give 2 complications of liver cirrhosis?
    • Ascites -> fluid in peritoneal cavity -> Spontaeneous bacterial peritonitis
    • Hepato-renal syndrome -> renal vascoconstriction + underfilling
    • Varices -> oesophageal
    • Hepatocellular carcinoma -> resect + transplant or percutaneous ethanol ablation
  33. How do you Mx Ascites?
    • Only symptomatic relief
    • Fluid restriction
    • Diuretics -> Spironalactone/Epleranone + Furosemide
    • Paracentesis [for refractory]
    • Peritoneo-venous shunt
    • Transjugular Intrahepatic porto-systemic shunt
  34. What is Primary Biliary Cirrhosis [PBC]?
    • Progressive cholestatic liver diseas of unknown aetiology [assoc with anti-mitochondrial antibody]
    • middle aged women with xanthelasma

    LFT -> cholestatic picture
  35. Outline the CF, genetics Ix + Mx of Haemachromatosi?
    • Hereditary condition -> Fe deposition in liver, pancrease and endocrine glands
    • Genetics -> C282Y + H63D

    CF -> M>F, >40yo, fatigue, arthropathy, bronze diabetes, cardiac failure

    Ix -> ^^serum ferritin, ^Plasma[Fe], Transferrin saturation >45%

    Mx -> weekly venesection, treat cirrhosis + DM, Ix FH
  36. Alcoholic liver disease
    >28units/week, 21 in fems

    continuous >>binge

    ^^oxidative stress of ETOH metabolism

    Ix -> ^^GGT + Macrocytosis

    Mx -> stop drinking, treat addiction, Thiamine
  37. Hep A?
    • ssRNA unenveloped hepatovirus
    • causes acute hepatitis
    • Faecal-oral spread
  38. Hep B?
    • dsDNA hepatovirus
    • acute + chronic infection

    chronic = infected whilst young

    Patho -> CD8+ T cell mediated hepatocyte necrosis

    Serology -> eAg = ^^infective, sAg = chronic carrier
  39. Hep C?
    • ssRNA enveloped Flavivirus
    • 6 major genotypes

    Chronic infection since immune response is not pretective [sero = RNA positive -> PCR]

    TMx -> IVDU, Blood + products
  40. Define UC + give its pathological features?
    • Gradual onset bloody diarrhoea [>4/day]
    • 15-25yo

    • begins @ ano-rectal margin w proximal extension
    • confined to mucosa + submucosa [no granulomas]
    • crypt distortion + crypt abscess
    • loss of goblet cells
  41. How is UC Mx? Give 2 drugs + their MoA
    5-ASA -> Mesalazine -> bowel specific aminosalycate -> decreases Pg + Leukotrienes

    Corticosteroids -> Systemic anti-inflammatory

    Azathioprine -> Purine anti-metabolite, inhibit mitosis -> decrease inflammatory cells

    Colectomy = curative
  42. Define Crohns and give 4 CF?
    Inflammatory disease of alimetary canal, can occur anywhere from mouth to anus.

    CF

    • Cramping abdo pain
    • mouth ulcers
    • fever
    • weight loss
    • fatigue
    • diarrhoea
    • rectal bleeding
  43. Outline the pathology of Crohns?
    • Mouth to anus
    • Patchy disease [skip lesions]
    • Transmural inflammation -> fissures + fistulae
    • Granulomas
    • non-caseous necrosis
  44. Give 3 drugs for Crohns + their MoA?
    Azathioprine -> Purine antimetabolite

    Corticosteroids -> systemic antiinflammatory

    MTX -> folic acid antagonist -> 1/week

    Infliximab -> Anti-TNF
  45. What is IBS + how is it managed?
    recurrent cramping abdo pain with psuchological interactions

    • Diarrhoeal symptoms -> loperamide
    • Constipation -> Lactulose
    • Pain + bloating -> Mebeverine/Peppermint oil

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