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GI: Key Information > 4th Year Extra bits > Flashcards

4th Year Extra bits Flashcards

1
Q

what causes oral hairy leukoplakia?

A

EBV

increased risk if you have HIV

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2
Q

does leukoplakia brush off?

A

no, candidiasis does

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3
Q

when should you biopsy an ulcer?

A

> 3 weeks and not healing

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4
Q

management of aphthous ulcers

A

tetracyclines
topical steroids
analgesia

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5
Q

management of severe aphthous ulcers

A

systemic corticosteroids

thalidomide

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6
Q

management of candidiasis

A

nystatin suspension

oral fluconazole

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7
Q

what is microstomia?

A

small mouth from thickening/ tightening of perioral skin (burns, systemic sclerosis)

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8
Q

when should you stop PPIs before endoscopy?

A

2 weeks beforehand to avoid pathology masking

nil by mouth for 6 hours prior

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9
Q

what kind of cancer is barretts?

A

adenocarcinoma

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10
Q

what to suspect when urea high and creatinine is not also elevated?

A

upper GI bleed

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11
Q

acute management of varices

A

terlipressin, improve bleeding with vitamin K, FFP and IV antibiotics before endoscopy

if bleeding not managed > balloon tamponade (Sengstkain-Blakemore)

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12
Q

long-term management of oesophageal varices

A 
beta blockers (propranolol)
EVL (medium- large, 2 week intervals)
sclerotherapy via OGD
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13
Q

what is group and save?

A

check patient’s blood group and sample is kept in case

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14
Q

what is crossmatch?

A

lab find out if patients blood is compatible and keep blood in fridge ready to use

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15
Q

what is Osler-Weber-Rendu syndrome?

A

HHT > telangiectasia and AVM

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16
Q

what is Boerhaave’s syndrome?

A

complete rupture of the lower thoracic oesophagus

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17
Q

signs in Boerhaave’s syndrome

A

hartmann’s sign (crunching upon heart auscultation)
chest pain
shock
subcutaneous emphysema

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18
Q

presentation of Plummer-Vinson syndrome

A

dysphagia
iron deficiency anaemia
oesophageal webs

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19
Q

drugs that can cause peptic ulcer

A

SSRIs
NSAIDs
steroids

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20
Q

why are posterior duodenal ulcers at the most risk of bleeding excessively?

A

near the gastroduodenal artery

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21
Q

pain in gastric ulcers on eating?

A

worsens pain

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22
Q

pain in duodenal ulcers on eating?

A

improves pain

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23
Q

diagnosis of peptic ulcer

A

<55 with no alarm symptoms do CLO (urea breath test)

>55 or alarm symptoms do OGD

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24
Q

repeat endoscopy in peptic ulcer H. pylori

A

6-8 weeks to exclude malignancy

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25
Q

test for confirmation of H.pylori eradication

A

13C urea breath test

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26
Q

what is Bechet’s syndrome?

A

vasculitis

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27
Q

presentation of Bechet’s

A 
multiple ulcers (genital)
uveitis
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28
Q

management of bechet’s

A

steroids

immunosuppressants

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29
Q

score for upper GI bleed severity

A

Glasgow-Blatchford score

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30
Q

what is Zollinger-Ellison syndrome?

A

formation of tumours in pancreas and duodenum (gastrinomas) which secrete gastrin causing excessive acid production

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31
Q

what do GIST gastric cancers look like?

A

spindle cells

stain with DOG1

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32
Q

acute management of Crohn’s

A

steroids

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33
Q

maintenance of Crohn’s

A

azathioprine
mercaptopurine
methotrexate

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34
Q

when is infliximab used in Crohn’s?

A

fistulating Corhn’s

not responding

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35
Q

what needs to be done before starting infliximab?

A

screen for TB

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36
Q

management of toxic megacolon

A

IV hydrocortisone
LMWH
IV fluids
assess response in 72 hours > no improvement surgery

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37
Q

severity of UC score?

A

Truelove and Witt criteria

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38
Q

mild UC

A

<4 stools/day

small amount of blood

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39
Q

moderate UC

A

4-6 stools/day
varying blood
no systemic upset

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40
Q

severe UC

A 
6+ stools a day
systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
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41
Q

inducing remission in mild/mod UC

A

rectal aminosalicylates > can add oral > oral prednisolone

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42
Q

inducing remission in severe UC

A

IV corticosteroids > IV ciclosporin

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43
Q

maintaining remission in UC

A

rectal aminosalicylate, can be combined with oral
azathioprine
mercaptopurine

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44
Q

positive PAS stain?

A

Whipple’s disease

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45
Q

management of Whipple’s?

A

penicillin V or ceftriaxone

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46
Q

management of hep C

A

direct acting antivirals

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47
Q

which liver condition can have secondary amenorrhoea?

A

AI hepatitis

48
Q

triad in hepatorenal syndrome

A

cirrhosis
ascites
renal failure

it is due to a reduction in blood flow to the kidneys causing them to not function correctly.

49
Q

management of hepatorenal syndrome?

A

transplant
terlipressin
TIPPS

50
Q

most common cause of SBP

A

e. coli

51
Q

management of ascites

A 
low sodium diet
spironolactone
prophylactic antibiotics (ciprofloxacin)
paracentesis
TIPPS
52
Q

criteria for pancreatitis

A

Modified Glasgow score
Ranson’s criteria

does not include amylase

53
Q

presentation of insulinoma

A

recurrent hypoglycaemic attacks

54
Q

presentation of glucagonoma

A

diabetes

dermatitis

55
Q

VIPoma

A

vasoactive intestinal peptide

watery diarrhoea

56
Q

presentation of gastrinoma

A

recurrent GI ulceration

57
Q

key RF for mesenteric ischaemia

A

AF

58
Q

first line diagnosis of mesenteric ischaemia

A

CT contrast

59
Q

triad for chronic mesenteric ischaemia

A
  1. central colicky abdo pain (starts around 30 minutes after eating)
  2. weight loss due to food avoidance
  3. abdominal bruit
60
Q

management of chronic mesenteric ischaemia

A

statins, antiplatelets
weight loss
stent insertion
transluminal angioplasty

61
Q

genetic mutation in Lynch syndrome

A

MSH2/MLH1

62
Q

screening in Lynch

A

from 25 with annual colonoscopy
women get TVUS/abdo USS
Ca125

63
Q

genetic mutation in FAP

A

APC gene mutation

64
Q

variant of FAP

A

Gardner’s syndrome – osteomas of skull and mandible, retinal pigmentation, thyroid carcinoma and epidermoid cysts on skin.

65
Q

which nerves are affected in Hirschsprung’s

A

parasympathetic nerve dysfunction

66
Q

management of haemorrhoids

A
  • Only if symptomatic
  • Topical therapies include anusol and germoloid creams.
  • Grade I-III= sclerosation banding or rubber banding ligation
  • Grade IV Haemorrhoidectomy
  • HALO/THD procedure (US locates arteries supplying the haemorrhoids and ties them off)
67
Q

discharge planning score for major lower GI bleeds

A

Oakland score

68
Q

perianal haemtoma

A

rupture of perianal subcutaneous blood vessel

black/ blue buldge at anal margin

69
Q

diagnosis of carcinoid syndrome

A

produce serotonin (5-HT) so check urinary 5-HIAA

70
Q

management of carcinoid syndrome

A

octreotide

71
Q

nerve most likely to be injured during appendicectomy?

A

ilioinguinal

72
Q

what is geographic tongue

A

areas of depapillation

soreness when eating spicy or acidic food

73
Q

what is Mirizzi syndrome?

A

gallstone impacts neck of gallbladder causing compression of CBD

74
Q

half-life of lipiase

A

24 hours

75
Q

three types of acute liver failure

A
  1. Hyperactive/fulminant liver failure= encephalopathy develops within 1 week
  2. Acute liver failure= encephalopathy develops within 2-4 weeks
  3. Subacute liver failure= encephalopathy develops within 4-8 weeks.
76
Q

hepatic encephlopathy

A 
I= irritable 
II= lethargy, moderate confusion
III= confusion,incoherent
IV= coma
77
Q

what is TIPS

A

connection between portal vein and hepatic vein

78
Q

Los Angeles classification of reflux oesophagitis

A
  • A= one or more mucosal breaks <5mm
  • B= mucosal breaks >5mm but with no continuity across mucosal folds
  • C= breaks span across two mucosal folds, but <75% oesophageal circumference
  • D= mucosal breaks involving >75% circumference
79
Q

SIBO B12 and folate

A

low B12

high folate

80
Q

layers of the skin on a midline abdo incision

A

skin, Camper’s fascia, Scarpa’s fascia, linea alba, transversalis fascia, extraperitoneal fat, peritoneum

81
Q

colorectal adenoma surveillance

A
  • Low risk= one or two adenomas <10mm > colonoscopy at 5 years.
  • Intermediate risk= three/four adenomas <10mm or on/two if one is >10mm. colonoscopy at 3 years
  • High risks= 5 or more <10mm or 3 or more if one if >10mm. colonoscopy at 1 year.
82
Q

drainage to lymph nods inferior to pectinate line

A

superficial inguianl nodes

83
Q

pint ml

A

568ml

84
Q

how can ascites be classified?

A

serum ascites albumin gradient (SAAG)

85
Q

classification of ascites

A
  1. SAAG >11g/L indicates portal hypertension (transudative)

2. SAAG <11g/L indicates hypoalbuminaemia (exudative)

86
Q

causes of high SAAG

A

portal hypertension:

  • liver
  • cardiac failure
87
Q

causes of low SAAG

A

nephrotic syndrome

severe malnutrition

88
Q

diet in liver problems

A

high protein

low sodium

89
Q

what does the portal vein come from?

A

SMV and splenic vein

90
Q

what is used to treat schistosomiasis?

A

praziquantel

91
Q

what is used to test exocrine function in the pancreas?

A

faecal elastase

92
Q

management of sigmoid volvulus

A

rigid sigmoidoscopy with rectal tube insertion

if bowel obstruction or peritonitis needs urgent midline laparotomy

93
Q

management of caecal volvulus

A

right hemicolectomy

94
Q

what is the most common cause of large bowel obstruction?

A

cancer

95
Q

what needs to be assessed before starting azathioprine or mercaptopurine?

A

TPMT activity

96
Q

what are SE of aminosalicylates?

A

haematological e.g. agranulocytosis

97
Q

CT sign for pancreatic cancer?

A

double duct sign on CT

98
Q

what can OCP cause on LFTs?

A

drug-induced cholestasis

99
Q

what cancer does achalasia increase the risk of?

A

SCC

100
Q

indications for splenectomy after trauma?

A

uncontrollable splenic bleeding
hilar vascular injuries
devascularised spleen

101
Q

what is the Parkland formula used for?

A

burns

102
Q

what is the Parkland formula?

A

4 x % area burned x weight (kg) for 24 hours fluids, half of which is given in the first 8 hours

103
Q

what is on colonoscopy of pseudomembranous colitis?

A

yellow plaques

often due to c. diff

104
Q

what infection do PPIs increase the risk of?

A

c. diff

105
Q

c. diff classification

A 
MILD= normal WCC
MODERATE= increased WCC <15, 3-5 stools
SEVERE= >15 WCC or raised cr or temp >38.5 or evidence of colitis on XR
LIFE-THREATENING= hypotension, partial/ complete ileus, toxic megacolon or CT evidence of severe disease
106
Q

what toxin is in c diff stool

A

CDT

107
Q

management of c. diff

A

oral vanc 10 days > oral fidaxomicin > oral vanc +/- IV met

108
Q

management of recurrent c. diff

A

within 12 weeks = oral fidaxomicin

after 12 weeks= oral vanc or fidaxomicin

109
Q

Child-Pugh classification for cirrhosis

A 
bilirubin= >50
albumin= <35
PT= >6s
encephlopathy
ascites
110
Q

what can Barrett’s be divided into?

A

long >3cm

short <3cm

111
Q

management of Barrett’s

A

endoscopic surveillance every 3-5 years in metaplasia to watch for dysplasia

112
Q

management of bile malabsorption e.g. post-cholecystectomy

A

cholestyramine

113
Q

preparation for urea breath test

A

no antibiotics in past 4 weeks

no PPIs in past 2 weeks

114
Q

Hinchey classification for diverticulitis

A 
1a= confined inflammation
1b= abscess <5cm
2= intra-abdo abscess, retroperitoneal abscess
3= generalised purulent peritonitis
4= faecal peritonitis
115
Q

Glasgow/ Ranson criteria for pancreatitis

A 
PaO2 <7.9kPa
age >55
neutrophils >15
calcium <2
renal function (urea >16)
enzymes (LDH >600)
albumin <32g/L
sugar (glucose >10)

3 points is severe

116
Q

indications for antibiotic prophylaxis in SBP in ascites

A

episode of SPB
fluid protein <15g/l
child-pugh score of 9
hepatorenal syndrome

GI: Key Information (24 decks)

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