Gastrologi puggings

Colonic transit test

1-6 pills X ray on the 7th day

Eradication of H pylori

2 antibiotics + bismuth compound + PPIs Citrate (block motility bacteria)

Diagnostic criteria for acute pancreatitis

2/3 +! Epigastric (belt like) abdominal pain Increase in pancreatic enzymes (amylase and lipase) Imaging (CT)

Removal of polyps based in size

< 3 mm: remove with the biopsy forceps > 3mm: Snaring > 2 cm: mucosectomy

New examination based on te number of polyps

<3: 5 years > 3: 3 years 10: 1-2 years > 10: familiar polyposis (should be checked for Lynch syndrome for example) > 100: Familiar adenomatous polyposis (FAP) Need to start screening at earlier age (teenage years)

Level of neutrophils indicating spontaneous bacterial peritonitis Tx:

> 250 cells/ml (or general cell count > 500 /ml. Don't need blood cultures to establish diagnosis if this these are positive) Ceftriaxon 2g/day

Lynch sydrome

Affected individuals develop a small number of adenomas that can rapidly progress to colorectal cancer (CRC), resulting in a considerably earlier symptom onset compared to sporadic colorectal cancer. Individuals with Lynch syndrome are also at increased risk of developing other forms of cancer, especially endometrial, gastric, and ovarian cancer.

After how many years of smoking cessation is smoking no longer considered a risk factor

After 15 years

Where in the abdomen should you start the palpation when examining and at what line should the liver be examined

Anti Mcburney Mid-clavicular line

Possible guarding when superficial palpation

Appendicitis Diverticulitis Cholecystitis

At what age does CRC screening start

Around 45/50 depending on country Studies in the states have shown that 45 is a good time for Caucasians, 40 is better for afroamericans

Disease severity of acute pancreatitis

Atlanta

To screen colorectal cancer

Colonoscopy MicroRNA Cologuard?

Staging of liver failure

Child pugh! A prognostic grading scale that assesses survival rate and predicts the likelihood of developing complications based on bilirubin and albumin levels, prothrombin time, and the presence of ascites and encephalopathy

List two reasons for why we can see easier bleeding in liver failure

Impaired production of blood clotting factors Low platelets (due to portal hypertension and increased sequestration by the spleen, and due to the fact that alcohol is toxic to the bone marrow)

Causes of hep

Infections (viral Aspergillus Schistosomiasis Alcohol Drug induced Non alcoholic fatty liver

Cancer in what part of the colon causes changes in bowel habits

Left side: alternating diarrhoea and constipation

Treatment of ascites

No sodium, meat and abstencte from alcohol Due to the increase in RAAS seen in ascites patients --> spironolactone Loop diuretics Paracentesis can be used, but only if very large. Not a permanent fix To lower portal HT --> TIPS!

Classification of intestinal atrophy

OLGA (0-4)

Types of dysphagia and diagnostic approach

Oropharyngeal - swallow X-ray iodine Esophageal -solids: endoscopy and swallow imaging - solids and liquids: endoscopy and manometry

List two general tumor markeres for primary screening

PSA AFP (for hepatocellular carcinoma) (other tumor markers is not so sensitive and rather used for follow up then screening purposes)

Schilling test

To distinguish between ileal and gastric causes of vitamin B12 deficiency

Complications of H pylori

Gastritis, ulcers and MALT lymphoma

List 2 causes of MALT lymphoma

H pylori infection GSE (gluten sensitive enteropathy)

Which hepatitis virus is especially dangerous for pregnant women

HEP E! --> can cause fulminant hep in pregnant women

Viral acute hepatitis

Hep A and E

Oesophageal motility disorders

Chicago

Labs in alcoholic hepatitis

AST/ALT ratio kidney parameters Bilirubin

What are the 3 subtypes of achalasia seen in manometry

Achalasia without pressurazation Pan-esophageal pressurazation Achalasia with spasm

PBC

Autoimmune destruction of interlobular bile ducts. Progressive liver disease evt leading to fibrosis and cirrhosis. Increased ALP, GGT, bilirubin and AMAs

Which BISAP score indicates severe pancreatitis

BISAP > 2

What does BISAP stand for and what does it tell us

Bedside index of severity of acute pancreatitis Estimates in hospital mortality due to pancreatitis Some criteria: - BUN > 8.9mmol - Altered mental status - Age > 60 - Pleural effusion on x ray - Presence of SIRS

List some causes for portal HT

Budd Chiari Tumor Portal vein or splenic v trombosis

Causes for diagnostic biopsy in case of dysphagia

Cancer or eosinophilic oesophagitis

How is GERD typically diagnosed and what is the treatment strategy

Diagnosed based on typical symptoms (ex cannot lay down after meal) PPIs for 2 weeks, if + continue 4 weeks --> stop! > 50 years = endoscopy < 50 no need if PPI test works Han nevnte også noe med 8 uker også check med noe annet PPi relatert.

Los ángeles classification

ERD (erosive reflux disease)

Malignancies: early vs late weight loss

Early: pancreatic and oesophageal cancer Late: CRR

How often should focal occult blood test / colonoscopy be repeated

FOBT: every second year Colonoscopy: every 10 years

How should you ask about weight loss in patients? What percentage of weight loss is considerable?

First ask if any change in body weight. Then ask in different timeframes: what was your weight one year ago/half a year/3 months 5% of body weight

Peptic ulcer disease

Forrest

What is the most common functional GI disorder

Functional bloating IBS used to before they changed the criteria. In IBS the last 30 cm of the colon should be painful

List two mechanisms behind portal encephalopathy

Liver loses its detoxifying abilities in liver failure Portosystemic shunts allow blood to bypass liver

Anorectal diseases

London

How do you screen for lung cancer

Low dose CT

GLuten sensitive enteropathy

Marsch

Alcohol limit as adding it to the risk factor list in women/men

Men: 2dl/day Women: 1dl/day (Small amount beneficial cardiovascular, neurotoxic no matter the amount. Net no amount is good tho)

Ulcerative colitis

Montreal

Causes for Haematochezia (fresh blood stool) and what is important to check before doing a colonoscopy

Most common: diverticular bleeding (OBS! Not the same as diverticulitis egt) Polyps Cancer? Check INR!

Which pro kinetic should you use for constipation

Prucalopride (5HT4 agonist) NB! Metoclopramide acts @ stomach = not for constipation

Criteria for functional GI disorders (disorders of gut-brain interaction)

ROME IV criteria Last > 6 months

What do you check for when examining the liver

Size, edge, surface, consistency, painful or not (Nerve endings in capsule)

Physical examination findings in liver failure patients

Spider nevus (teleangectasia) Jaundice Petechia Gynecomastia (OBS! spironolactone) Ascites Erythema plantare

Guidelines for cholecystitis - Antibiotics

TOKYO Cephalosporins (ceftriaxon) Metronidazole

Detection of H pylori

Urea breath test Stool (antigens) Biopsy/PCR/immune-serology

Which vein can open in portal HT

the umbilical vein