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Finals revision > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Give consequences of a low vitamin A

A

blindness

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2
Q

Give consequences of a low vitamin B1

A

Beri beri
wet - heart failure
dry - neuropathy

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3
Q

Give consequences of a low vitamin B3

A

niacin

Pellagra - diarrhoea / dementia / dermatitis

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4
Q

Give consequences of a low vitamin C

A

Scurvy
bleeding
Poor healing

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5
Q

function of G cells

A

Secrete gastrin - stimulates parietel cells to produce HCL

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6
Q

Function of D cells

A

Secrete somatostatin - inhibits G cells

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7
Q

Function of chief cells

A

secrete pepsinogen

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8
Q

2 factors delaying gastric emptying

A

CCK - also stimulates gallbladder
Secretin - also stimulates pancreas

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9
Q

Where else is somatostatin released other that the stomach

A

Pancreas - Delta cells

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10
Q

Function of CCK

A

Delays gastric emptying
stimaultes gallbladder contraction
stimulates sphincter of Oddi

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11
Q

RF for chrons disease

A

FHx
Jewish
T1DM

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12
Q

RF for chrons disease

A

FHx
Jewish
Chronic stress

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13
Q

Sx and signs of chrons disease

A

sx
- weight loss
- RIF abdominal pain
- Diarrhoea

signs
- clubbing
- pallor
- Apthous ulcers
- RIF Tenderness / mass
- PR fistulae / mass / skin tag

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14
Q

extraintestinal features of crohns

A

Erythema nodosum
Pyoderma gangrenosum
Gallstones
Arthiritis
Anterior uveitis

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15
Q

Features of anterior uveitis and mangement

A

Acute red eye
Ciliary flush
Reduced visual acuity
Small fixed oval pupil
Photophobia

Iris
Ciliary body
Choroid

Mx - urgent opthamology r/v

Cyclopentolate
Atropine
Dilate pupil to prevent pain

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16
Q

Management of crohns

A

C - Smoking cessation

M-
Induce
PO/IV steroids
Mesalazine
Infliximab

Maintain
Azathiporine
MXT

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17
Q

Complications of crohns

A

osteoporosis
Abscess
strictures
small bowel cancer
colorectal carcinoma

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18
Q

Complications of crohns

A

osteoporosis
Abscess
Fistula
strictures
small bowel cancer
colorectal carcinoma

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19
Q

sx and signs of UC

A

sx
- LLQ pain
- tenesmus and urgency
- Diarrhoea
- blood and mucus
- weight loss

Clubbing
Pallor
RLQ mass and tenderness
PSC
- Jaundice + pruritus

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20
Q

Features of PSC

A

Jaundice
Pruritus
Increased bilirubin
Increased ALP
RUQ pain

P-ANCA

Ix - MRCP

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21
Q

Microscopic features of UC

A

Pseudopolyps - ulceration with preserved adjacent mucosa
colon only
circumfrential and continuous

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22
Q

Macroscopic features of UC

A

Pseudopolyps - ulceration with preserved adjacent mucosa
colon only
circumfrential and continuous

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23
Q

Microscopic features of UC

A

Decreased goblet cells
No granuloma
crypt abscess
mucosal inflammation only

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24
Q

barium enema findings of UC

A

Lead pipe colon
Loss of haustral markings

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25
Q

Management of UC - induce

A

Induce
Mild/mod
- distal - topical mesalazine
extensive
- topical
- PO

Severe - IV steroids

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26
Q

Manageemnt of UC - Maintenance

A

Mild/mod -
distal - meslazine
extensive PO

severe - PO Azathiprine

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27
Q

What is toxic megacolon

A

toxic non obstructive dilatation of colon

tenderness and distension

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28
Q

Complications of PSC

A

Biliary stricure
cholangiocarcinoma
hepatitis
LF
Fat soluble vitamin def

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29
Q

Management of PSC

A

Liver transplant can be curative but is associated with its own problems

ERCP can be used to dilate and stent any strictures

Colestyramine is a bile acid sequestrate in that it binds to bile acids to prevent absorption in the gut and can help with pruritus due to raised bile acids

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30
Q

Features of IBS

A

Abdominal pain relieved by defication or associated with change in bowel habit

+

Abnormal passage of stool
mucus PR
Bloating
sx worse after eating

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31
Q

Ix for IBS

A

FBC - CRP / WCC
Feacal calpotectin
coeliac serology

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32
Q

IBS management

A

Fluids / smaller meals / decrease alcohol / FODMAP / CBT

Cramps - Hycosine butylbromide
TCA
SSRI

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33
Q

define coeliac disease

A

AI mediated disorder due to insensitivity to proteins in gluten causing chronic inflammation - Type 4 hypersensitivity

34
Q

Sx of coeliac disease

A

abdominal pain
bloating
N+V
Diarrhoea
greasy smelly stooly
weight loss
fatigue

35
Q

signs of coeliac disease

A

FTT
Short stature
wasted buttocks
Pallor - Anaemia
dermatitis hepatiformis - elbows / knees / buttocks
abdominal distension
angular stomatitis
bloating

36
Q

Complications of coeliac disease

A

IDA
B12 / Folate
Hyposplenism
osteoperosis
T cell lymphoma

37
Q

Investigations of coeliac disease

A

Stool culture
IgA level
Bloods - faceal calprotection / FBC / Anti TTG
OGD and biopsy

38
Q

Findings on biopsy of coeliac

A

villous atrophy
crypt hyperplasia
lyphocyte infiltration

39
Q

features of peritonism

A

rebound tenderness
percussion tenderness
guarding
rigidity

40
Q

sx of appendicitis

A

periumbilical –> RIF pain
Fever
N+V
Dysuria
Diarrhoea

41
Q

signs of appendicitis

A

Mc burneys point sign
Rovsign sign
Obturator sign - pain in RIF on internal hip rotation
Psoas sign - pain in RIF on hip extension

42
Q

Investigations in appendicitis

A

Urine dip and urinalysis
FBC / CRP / U+E / Clotting / G&S
VBG - Lactate
Urine HCG

CXR
USS - Female
CT

43
Q

Define:
Diverticulum
Diverticulosis
Diverticular disease
Diverticulitis

A

Outpouching of colonic mucosa and submucosa

Presence of multiple diverticula

Presence of multiple symptomatic diverticula

Inflammation of diverticula

44
Q

RF for diverticulosis

A

Increasing age
Low fibre diet
chronic constipation
obesity
NSAIDs

45
Q

Presentation of diverticular disease

A

LIF pain
chronic constipation - altered bowel habit
PR bleeding

46
Q

management of diverticular disease

A

hydration
high fibre diet

bulk forming laxative

47
Q

presentation of acute diverticulitis

A

pain and tenderness in LLQ
Fever
diarrhoea
N+V
PR bleeding

48
Q

Investigations for diverticulitis

A

Bloods - WCC / CRP

AXR

CT

49
Q

Management of diverticulitis

A

PO Co-amoxiclav

50
Q

what is a haemorrhoid

A

swollen vascular cushion in anal canal

51
Q

classification of haemorrhoids

A

upper 2/3rds - painless
rectal columnar epithelium

lower 1/3rd - Painful and itchy
stratified squamous

52
Q

RF for haemorrhoids

A

prolonged sitting
obesity
constipation
increased age

53
Q

sx of haemorrhoids

A

painless PR bleed
perianal irritation
mucosal discharge

54
Q

management of haemorrhoids

A

conservative
- prevent constipation
- increase fibre / fluid

medical
- laxatives

surgical
- topical anaesthetics and steroids
- rubber band ligation

55
Q

Risk factors for GORD

A

Obesity
Pregnancy
Hiatus hernia
Smoking
Alcohol
NSAIDs
Caffeine

56
Q

Definition of GORD

A

Regurgitation of contents into oesophagus due to relaxation of LOS

57
Q

Sx and signs of GORD

A

Sx
Heartburn
Dyspepsia
Regurgitation - worse when lying down
Epigastric pain
cough

58
Q

What is toxic megacolon

A

toxic non obstructive dilatation >6cm

Abdo tenderness
Distension

59
Q

Causes of clubbing

A

CHD - Cyanotic
CF
Lung cancer
UC
Bronchiectasis
IE
IPF
Crohns

60
Q

what is acute mesenteric ischemia

A

thrombus / embolus blocking mesenteric ischaemia

RF - AF

Sx out of keeping with clinical presentation

Ix
- metabolic acidosis
- 1st line CT angiogram
- GOLD - Colonoscopy

Mx
- IV Abx + Heparin + surgery

61
Q

what is pseudomembranous colitis

A

inflammation of colon due to overgrowth of C.Diff

62
Q

RF for pseudomembranous colitis

A

Clindamycin
PPI
Hospital admission

63
Q

sx of pseudomembranous colitis

A

diarrhoea
abdominal pain
Raised WCC
Toxic megacolon

64
Q

management of psudomembranous colitis

A

Vancomycin
Fidaxomicin

recurrent
12 weeks - fidoxamicin

life threatening
vancomycin + metronidazole

65
Q

SBO features
- causes
- sx
- signs
- Ix

A

Adhesions / Henria / Crohns stricture

Colicky abdominal pain
N+ Bilious vomiting
Abdominal distension
constipation
no flatulence

abdo tenderness
tinkling bowel sounds

AXR - >3cm / valvulae all across
CT with contrast

66
Q

AXR in bowel obstrcution

A

Both
- fluid level in bowel
- no air in distant bowel
- distended bowel loops

Small
- valvuale seen all across

large
- loss of haustra

67
Q

causes of LBO

A

Malignancy
Volvulus
Hernia
Diverticular disease
Intusussception

68
Q

What is pseudo-obstruction

A

non mechanical dilatation of bowels due to paralytic ileus

69
Q

causes of pseudo-obstruction

A

Post op - paralytic ileus
Parkinsons disease
Opiates
electrolyte imbalances
recent trauma or surgery
Hirschprung

70
Q

causes of appendictis

A

faecolith
foreign bodies
lymphoid hyperplasia

71
Q

signs of appendicitis

A

Rovsings
rebound tenderness
guarding
Psoas sign
Obturator - hip flexion and internal rotation

72
Q

Investigations in appendicitis

A

Bloods
- WCC / CRP

Urinalysis

Pregnancy test

Abdominal USS - Children and pregnant women

Abdominal CT with contrast

73
Q

Investigations in appendicitis

A

Bloods
- WCC / CRP / lactate

Urinalysis

Pregnancy test

Abdominal USS - Children and pregnant women

Abdominal CT with contrast

74
Q

Post gastroenteritis complications

A

lactose intolerance
IBS
Reative arthiritis
GBS

75
Q

Features of anal fissure

A

throbbing pain worse on sitting
pruritus ani
blood / mucus in stool

76
Q

features of oesophageal cancer

A

progressive dysphasia
weight loss
hoarse voice
odynophagia
ALARMS

77
Q

features of gastric cancer

A

Antrum and lesser curvature

RF: Male / older / smoking / Pernicious aneamia / H pylori

Epigastric pain
wt loss
N+V
Dysphasia
Lymphatic spread - virchows node

78
Q

RF for colon cancer

A

FAP - Multiple polyps
Lynch syndrome - HNPCC
Smoking
Obesity
Alcohol
IBD

79
Q

Sx and signs of bowel cancer

A

Change in bowel habit
weight loss
PR bleeding
Tenesmus
Abdominal pain
ALARM

PR - Rectal mass
Abdominal mass

80
Q

Screening for colon cancer

A

FIIT Test
Aged 60 -74 every 2 years

81
Q

what cell type is affected in small bowel cancer

A

Enterochromaffin

Finals revision (17 decks)

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