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FINALS: PASSMED/QUESMED > Gastro > Flashcards

Gastro Flashcards

1
Q

What should patients with coeliac receive every 5 years?

A

PCV vaccine due to hyposplenism

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2
Q

What should patients with spontaneous bacterial peritonitis receive?

A

Abx prophylaxis

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3
Q

Patients with raised platelets and nausea need what?

A

Non urgent referral for endoscopy

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4
Q

Management of patient with suspected upper GI bleed?

A

endoscopy within 24 hours of admission

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5
Q

What is the treatment of wilsons?

A

Penicillamine

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6
Q

Sudden onset severe abdo pain with vomiting and rapid bloody diarrhoea?

A

Acute mesenteric ischaemia

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7
Q

Raised transferrin and ferritin with low TIBC suggests what?

A

Haemochromatosis

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8
Q

Sudden onset abdo pain in someone with peptic ulcer disease?

A

Perforated peptic ulcer

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9
Q

How are perforated peptic ulcers managed?

A
  • Erect CXR which shows free air under diaphragm
  • Refer to general surgery
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10
Q

Tx of C diff?

A
  • Oral vancomycin for 10 days
  • If reoccurs: oral fidaxomicin
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11
Q

Anti-mitochondrial antibodies suggest what?

A

Primary Biliary Cholangitis

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12
Q

First line medication for PBC?

A

Ursodeoxycholic acid

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13
Q

What is associated with UC?

A

Primary sclerosing cholangitis

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14
Q

Investigation of choice for suspected pancreatic cancer?

A

High resolution CT

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15
Q

Management of liver abscess?

A

Percutaneous drainage with IV Abx - usually amoxicillin, ciprofloxacin and metronidazole

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16
Q

Vomiting followed by severe chest pain and signs of shock?

A

Oesophageal rupture (Boerhaave syndrome)

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17
Q

What cancer is associated with PSC patients?

A

Cholangiocarcinoma

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18
Q

What does pernicious anaemia predispose to?

A

Gastric carcinoma

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19
Q

Management of C diff if symptoms still ongoing after 10 days?

A

Oral vancomycin and IV Metronidazole

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20
Q

What should be measured to monitor treatment of haemachromatosis?

A

Transferrin saturation and serum ferritin

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21
Q

Management of haemachromatosis?

A
  • Venesection
  • Desferrioxamine
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22
Q

What should be given to patients with suspected variceal bleeding before endoscopy?

A

Terlipressin

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23
Q

Coeliac disease increased risk of which cancer?

A

enteropathy associated T cell lymphoma of small intestine

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24
Q

Diarrhoea with greasy stools in swimming pool user?

A

Giardia lamblia

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25
Q

What is SAAG (serum ascites-albumin gradient) used to measure?

A
  • Portal HTN
  • If >11, then portal HTN
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26
Q

How is dyspepsia managed?

A
  • Trial of PPI for 1 month OR test and treatH pylori
  • If either is unsuccessful, try the other approach
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27
Q

What are patients with haemochromatosis at risk of?

A

Hepatocellular carcinoma -> screening with US needed

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28
Q

sweet and fecal breath is indicative of what?

A

Liver failure

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29
Q

When should PPIs be stopped before upper GI endoscopy?

A

2 weeks before

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30
Q

Which artery is most likely to be the source of bleeding for someone with peptic ulcer disease?

A

Gastroduoedenal artery

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31
Q

Tenesmus is generally associated with which IBD?

A

Ulcerative Colitis

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32
Q

Crohn’s Disease

A

N – No blood or mucus (PR bleeding is less common)
E – Entire gastrointestinal tract affected (from mouth to anus)
S – “Skip lesions” on endoscopy
T – Terminal ileum most affected and Transmural (full thickness) inflammation
S – Smoking is a risk factor

Other
- Terminal ileum
- Ulcer, cobblestone appearance
- Non-caseating granulomas

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33
Q

Ulcerative Colitis

A

C – Continuous inflammation
L – Limited to the colon and rectum
O – Only superficial mucosa affected
S – Smoking may be protective (ulcerative colitis is less common in smokers)
E – Excrete blood and mucus
U – Use aminosalicylates
P – Primary sclerosing cholangitis

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34
Q

What is the histology of UC?

A
  • Large bowel
  • Mucosal involvement only
  • Crypt abscess, reduced goblet cells and no granulomas
  • Continuous inflammation
  • Pseudo polyps and ulcers may form
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35
Q

What is the histology of Crohns?

A
  • Entire GI tract affected
  • Transmural inflammation
  • Non-caseating granulomas
  • Discontinuous inflammation (skip lesions)
  • Cobblestone appearance: fissures and deep ulcers
  • Fistula formation
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36
Q

Diarrhoea, fatigue, osteomalacia?

A

Coeliac disease

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37
Q

What is carcinoid syndrome?

A

A condition usually when metastases are in the liver and then release serotonin into circulation

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38
Q

How does carcinoid syndrome present?

A
  • Flushing
  • Diarrhoea
  • Bronchospasm
  • Hypotension
  • urinary 5-HIAA should be measured with ocreotide to treat
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39
Q

What is a key intervention in patients with asictes?

A

Restrict dietary sodium

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40
Q

Management of Barret’s?

A

High dose PPI + endoscopic surveillance

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41
Q

What should be avoided in patients with severe colitis?

A

Endoscopy -> risk of perforation -> use flexible sigmoidoscopy instead

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42
Q

What are the red flags for GI cancer?

A

new-onset dyspepsia in a patient aged >55 years
unexplained persistent vomiting
unexplained weight-loss
progressively worsening dysphagia/
odynophagia
epigastric pain

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43
Q

fatigue, erectile dysfunction and arthralgia?

A

Haemochromatosis

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44
Q

How can haemochromatosis present?

A
  • Bronze skin
  • Diabetes
  • Liver disease
  • Cardiac failure secondary to dilated cardiomyopathy
  • Arthritis
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45
Q

signet ring cells are indicative of?

A

Gastric adenocarcinoma

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46
Q

How does achalasia present?

A
  • Dysphagia of liquids and solids
  • Heartburn
  • Regurgitation of food
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47
Q

How is achalasia investigated?

A
  • Gold standard: Oesophageal manometry which shows excessive lower oesophageal sphincter tone
  • Barium swallow shows bird’s beak appearance
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48
Q

How is achalasia managed?

A
  • Pneumatic balloon dilation
  • Surgical intervention: Heller cardiomyotomy
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49
Q

What sign may be seen in pancreatic cancer?

A

Double duct sign -> dilated common bile duct and dilated pancreatic duct

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50
Q

What does Riglers sign indicate?

A
  • Gas in the peritoneal cavity: sign of perforation
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51
Q

How should gallstones be managed?

A

If asymptomatic and in the gallbladder, no treatment needed
If in the common bile duct, surgery should be considered
If symptomatic, surgery

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52
Q

What is acute mesenteric ischaemia?

A

Occlusion of an artery supplying the small bowel, usually superior mesenteric artery
History of AF is common
Sudden-onset, severe pain with normal examination

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53
Q

How does acute mesenteric ischaemic be managed?

A
  • Test serum lactate which will be raised
  • Urgent surgery needed
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54
Q

What is ischaemic colitis?

A

Occlusion of blood flow to the large bowel resulting in inflammation, ulceration and haemorrhage

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55
Q

Where is ischaemic colitis most likely to occur?

A

Splenic flexure

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56
Q

How will ischaemic colitis be managed?

A

Abdo X ray - thumbprinting seen
Supportive treatment, surgery if severe

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57
Q

How should a severe flare of UC be treated?

A

IV corticosteroids

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58
Q

Iron defiency anaemia vs. anaemia of chronic disease

A

TIBC is high in iron deficiency but low/normal in chronic disease

Think of TIBC as the amount of space in the body to store iron: this will be high in iron deficiency as no iron

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59
Q

What should be given alongside isoniazid to prevent peripheral neuropathy?

A

Pyridoxine (vitamin B6)

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60
Q

T2DM with abnormal LFTs

A

NAFLD

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61
Q

What blood test can be done alongside incidental findings of NAFLD?

A

Enhanced liver fibrosis test

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62
Q

Which drugs are used to maintain remission in Crohns?

A

Azathioprine or mercaptopurine

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63
Q

Mild vs Moderate vs Severe flares of UC

A

Mild - <4 stools daily with no systemic disturbance
Moderate - 4-6 stools per day with minimal systemic disturbance
Severe - >6 stools per day with systemic disturbance

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64
Q

What is a severe complication of IBD flare up?

A

Toxic megacolon -> abdo X-ray needed

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65
Q

Which scores are used in acute GI bleeds?

A
  1. Glasgow Blatchford score to identify who can be managed as outpatient
  2. Rockall score done after endoscopy to identify risk of rebleeding
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66
Q

Alcohol units formula?

A

volume (ml) * ABV / 1,000

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67
Q

What can be given as prophylaxis for episodes of hepatic encephalopathy?

A

Lactulose

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68
Q

Metabolic alkalosis + hypokalaemia

A

Vomiting

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69
Q

Which tool is used to assess for malnutrition in patients?

A

MUST - malnutrition universal screening tool

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70
Q

What is small bowel bacterial overgrowth syndrome?

A
  • Excessive bacteria in the small bowel
  • Diabetes and Scleroderma are associated with this
  • Presents like IBS: abdo pain, diarrhoea, bloating
  • Hydrogen breath test to diagnose
  • Abx usually rifaximin used to treat alongside correcting cause
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71
Q

severe, colicky post-prandial abdominal pain, weight loss, and an abdominal bruit

A

Intestinal angina/chronic mesenteric ischaemia

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72
Q

What is alcoholic ketoacidosis?

A
  • Euglycaemic ketoacidosis seen in those who drink alcohol excess
  • Presents with metabolic acidosis, elevated ketones but NORMAL/LOW glucose levels
  • Tx with IV fluids and thiamine
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73
Q

Which test should be used to test for eradication of H pylori?

A

Urea breath test

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74
Q

What is the most common cause of inherited colorectal cancer?

A

HNPCC - hereditary nonpolyposis colorectal cancer

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75
Q

What are aminosalicylates associated with?

A

Agranulocytosis - check FBC

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76
Q

Pain on swallowing (odynophagia) can be a sign of what?

A

Oesophageal candida

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77
Q

What is used to determine the severity of the C diff infection?

A

WCC

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78
Q

Bleeding gums and receding

A

Scurvy

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79
Q

liver and neurological disease

A

Wilsons disease

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80
Q

Electrolyte imbalances of refeeding syndrome ?

A

Hypophosphataemia, hypokalaemia and hypomagnesaemia

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81
Q

Abdominal pain, Bloating and Change in bowel habit

A

IBS

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82
Q

Cholestasis vs liver damage on bloods?

A

Liver injury - >10 times increase in ALT and <3 times increase in ALP
Cholestasis - <10 times increase in ALT and >3 times increase in ALP

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83
Q

Which drugs can cause cholestasis?

A
  • COCP
  • Abx including flucloxacillin, co-amoxiclav
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84
Q

Coeliac disease is associated with deficiency of what?

A

iron, folate and vitamin B12 deficiency

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85
Q

Which IBD is associated with gallstones?

A

Crohns

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86
Q

What is used to assess whether glucocorticoid therapy may be beneficial in alcoholic hepatitis?

A

Maddreys function - serum bilirubin and prothrombin time

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87
Q

Antinuclear antibodies, anti-smooth muscle antibodies and raised IgG levels

A

Autoimmune hepatitis

88
Q

dysphagia, glossitis and iron-deficiency anaemia

A

Plummer-Vinson syndrome

89
Q

watery green diarrhoea post cholecystectomy

A

Bile acid malabsorption -> treat with cholestyramine

90
Q

What is decreased in Wilsons disease?

A

serum caeruloplasmin

91
Q

Haemochromatosis is a cause of what?

A

Hypogonadotropic hypogonadism

92
Q

Patients with a suspected GI bleed require what?

A

OGD within 24 hours

93
Q

What LFTs can indicate pancreatic cancer?

A

Cholestatic picture

94
Q

What is an unreliable indicator of iron stored in the body during illness?

A

Ferritin -> use transferrin saturation instead

95
Q

What can be used to differentiate between and upper and lower GI bleed?

A

Urea levels - high in upper GI bleed

96
Q

Investigations for PSC?

A
  1. US scan
  2. MRCP
97
Q

What is used for prophylaxis of oesophageal bleeding?

A

Propranolol

98
Q

Management of severe alcoholic hepatitis?

A

Steroids

99
Q

Which cancers are associated with HNPCC?

A
  • Colorectal
  • Endometrial
  • Ovarian
  • Pancreatic
100
Q

What is the treatment of hypophosphatemia?

A

Intravenous infusion of phosphate polyfusor

101
Q

Most common organism causing SBP?

A

Gram negs - E coli, Klebsiella

102
Q

Management of Dysplasia on biopsy in Barrett’s oesophagus

A

Endoscopic intervention

103
Q

What should you test to screen for haemochromatosis?

A

Transferrin saturation

104
Q

Psychosis is a complication of what?

A

Wilsons disease

105
Q

What is the investigation of choice for perianal fistulae in Crohns?

A

MRI

106
Q

Bleeding vs perforated peptic ulcer?

A

Perforated ulcer should present with signs of peritonitis e.g. abdo pain, distension, guarding

107
Q

Deranged LFTs and AKI in someone with septic shock?

A

Think ischaemic hepatitis

108
Q

Patients allergic to aspirin may also react with what?

A

Sulfasalazine

109
Q

What is Richter’s hernia?

A

A rare hernia which causes a firm, erythematous mass -> often presents with symptoms of strangulation (ischaemia/necrosis over the skin)

110
Q

What should be given for prophylaxis of variceal bleeds?

A

Propranolol

111
Q

Management of SBP

A

Acute: IV Cefotaxime
Abx prophylaxis if they have ascites: Ciprofloxacin until ascites resolves

112
Q

Back pain worse on lying down, appetite loss and weight loss

A

Pancreatic cancer

113
Q

What is the most common type of oesophageal malignancy in patients with GORD?

A

Adenocarcinoma

114
Q

What can cause a wheeze in people with GORD?

A

Inhalation of small amounts of gastric contents

115
Q

What is the gold standard investigation for GORD?

A

Oesophageal pH manometry

116
Q

What surgery can be done for GORD and what does this do?

A

Nissen fundoplication - fundus wrapped around the abdo oesophagus to improve strength of the gastro-oesophageal junction

117
Q

What is a complication of Nissen fundoplication?

A

Dysphagia from compression of the junction

118
Q

Examination signs of chronic liver disease

A
  • Clubbing
  • Palmar erythema
  • Dupuytren’s contracture
  • Hepatosplenomegaly
  • Ascites
119
Q

What are complications of liver cirrhosis?

A
  • Encephalopathy
  • Sepsis
  • SBP
  • Ascites
  • Varices
120
Q

What dietary advice would you give someone with ascites?

A
  • Fluid restriction
  • Low sodium
121
Q

Why is lactulose given in encephalopathy?

A

Reduce number of nitrogen producing bacteria in the gut which contribute to hepatic encephalopathy

122
Q

Why can anti-EMA antibodies be negative in severe malabsorption in coeliac?

A

Deficiency in proteins such as IgA

123
Q

Haematemesis + distended abdomen

A

Variceal bleeding

124
Q

What is an indicator of pancreatitis severity?

A

Hypocalcaemia

125
Q

What is the most common cause of large bowel obstruction?

A

Tumour then volvulus/diverticular disease

126
Q

What do Hepatitis B serology markers mean?

A

HBSAg - acute infection (if > 6 months then chronic infection)
Anti-HBs - immunity
Anti-HBc - previous/current infeection

127
Q

Causes of different types of jaundice

A

Pre - Sickle cell, G6PD, Hereditary spherocytosis
Hepatic - Hepatitis, PBC, PSC, EPV, HCC
Post hepatic - biliary atresia, gallstones, pancreatitis

128
Q

Stages of liver disease

A

Steatosis -> Fibrosis/Steatohepatitis -> Cirrhosis

129
Q

When is liver transplant indicated in liver disease?

A

In chronic liver disease, patients must have stopped alcohol for atleast 6 months

130
Q

What are complications of GORD?

A
  • Barret’s
  • Adenocarcinoma
  • Oesophageal stricture
  • Chronic cough
131
Q

What are complications of UC?

A
  • Colon cancer
  • Toxic megacolon
  • Bowel perforation
132
Q

Where does volvulus cause large bowel obstruction?

A

Sigmoid

133
Q

What is coffee bean sign indication of?

A

Sigmoid volvulus

134
Q

What is the management of sigmoid volvulus?

A

Stable - rigid sigmoidoscopy with flatus tube insertion
Unstable - Urgent laparotomy

135
Q

Palpable fullness in the gallbladder with painless jaundice?

A

Think pancreatic cancer

136
Q

Fever, abdo pain, cirrhosis and portal HTN?

A

Think SBP

137
Q

Hypertrophic pulmonary osteoarthropathy is associated with what?

A

Squamous cell carcinoma of lung

138
Q

Achalasia increases the risk of what?

A

Squamous cell carcinoma of the oesophagus

139
Q

What is the best way to assess someone response to Hep C treatment?

A

Viral load

140
Q

Ongoing jaundice + pain post cholecystectomy?

A

Gallstone in common bile duct

141
Q

Management of malignant distal obstructive jaundice due to unresectable pancreatic carcinoma

A

Biliary stenting

142
Q

Flu like illness with RUQ pain, tender hepatomegaly and deranged LFTs?

A

Think Hep A

143
Q

What would biliary colic blood show?

A

Everything normal

144
Q

What should you not do in someone with suspected pancreatitis?

A

Make them nil by mouth - enteral feeding should be offered

145
Q

What is the treatment for symptomatic perinala fistulae in Crohn’s?

A

Oral metronidazole

146
Q

History of vascular disease and lactic
acidosis

A

Think mesenteric ischaemia

147
Q

What is the most sensitive/specific test for pancreatitis?

A

Lipase

148
Q

What is the marker of choice to assess liver synthetic function?

A

INR (prothrombin time)

149
Q

What are some components of Child-Pugh score?

A
  • Bilirubin
  • Albumin
  • PT
  • Encephalopathy
  • Ascites
150
Q

What should be the first investigation in A+E if someone comes in with pain/vomiting?

A

Erect CXR to look for pneumoperitoneum suggestive of perforation

151
Q

What are the components of Glasgow score for pancreatitis?

A

Pa02
Age > 55
Neutrophils
Calcium < 2
Renal function
Enzymes
Albumin
Sugar

152
Q

Why is US scan helpful in pancreatitis?

A

Assess for presence of gallstones

153
Q

What are the 2 signs of pancreatitis?

A

Grey Turners - Bruising along flanks suggestive of haemorrhagic pancreatitis (sign of retroperitoneal bleeding)
Cullen - Bruising around umbilicus

154
Q

Pigmented gallstones are associated with what?

A

Sickle cell anaemia

155
Q

pseudomembranous colitis is what?

A

C diff colitis

156
Q

What is the treatment for cholecystitis?

A

IV Abx with laparoscopic cholecystectomy within 1 week of diagnosis

157
Q

What can be used to manage complex anal fistulae?

A

Draining seton

158
Q

What is the most common disease pattern in UC and Crohns?

A

UC - Proctitis
Crohns - Ileitis

159
Q

What drugs should be stopped in C diff infection?

A

Opioids

160
Q

anorectal pain and a tender lump on the anal margin

A

Thrombosed haemorrhoids

161
Q

short incubation period and severe vomiting

A

Staph aureus gastroenteritis

162
Q

Which Abx can be used for Campylobacter infection if severe/immunocompromised?

A

Clarithromycin

163
Q

Charcot’s triad plus hypotension and confusion

A

Reynolds pentad

164
Q

What is necessary before a diagnosis of PBC?

A

Imaging to exclude a extrahepatic biliary obstruction

165
Q

Management of acute anal fissues?

A

Bulk forming laxatives

166
Q

What is Troisier’s sign?

A

Enlarged hard left supraclavicular lymph node which indicates metastatic abdo malignancy

167
Q

What are risk factors for gastric cancer?

A
  • H pylori
  • Gastric polyps
  • Pernicious anaemia
  • Gastric ulceration
168
Q

What does TNM staging assess?

A

Size of tumour
Presence of lymph nodes
Evidence of metastases

169
Q

What is the marker for HCC?

A

AFP

170
Q

Surgical procedures for pancreatic cancer?

A
  • Pancreaticoduodenectomy
  • Whipples
171
Q

flu-like symptoms, RUQ pain, tender hepatomegaly and deranged LFTs

A

Hepatitis A

172
Q

Hepatitis serology

A

IgM - acute infection
IgG - chronic infection

173
Q

Severe hepatitis in a pregnant woman

A

Hep E

174
Q

Man returns from trip abroad with maculopapular rash and flu-like illness

A

Think HIV seroconversion

175
Q

Undercooked pork?

A

Hepatitis E

176
Q

Right-sided tenderness on PR exam

A

Acute appendicitis

177
Q

What is the surgery for bilateral/recurrent inguinal hernias?

A

Laparoscopic repair with mesh

178
Q

Mesalazine can cause what?

A

Drug induced pancreatitis

179
Q

lemon tinge to the skin

A

Pernicious anaemia

180
Q

pH < 7.3 at 24 hours post paracetamol overdose?

A

Liver transplant consideration

181
Q

periodic acid-Schiff- (PAS-) positive macrophages

A

Whipples disease

182
Q

dysphagia, iron deficiency anaemia and glossitis

A

Plummer Vinson syndrome

183
Q

What is a TIPS procedure?

A

Artifical channel within the liver used for variceal bleeding refractory ascites
Major complication is hepatic encephalopathy

184
Q

severe abdominal pain, ascites and tender hepatomegaly

A

Budd-Chiari syndrome

185
Q

Which laxative to prescribe when starting patients on opiates?

A

Senna

186
Q

Management of diverticulitis flare?

A

Oral Abx with admission to hospital if symptoms do not improve within 72 hours

187
Q

Why give albumin for large volume ascites?

A

reduce paracentesis-induced circulatory dysfunction and mortality

188
Q

What is usually normal with acute cholecystitis?

A

LFT tests

189
Q

classic epigastric pain which is relieved on sitting forwards

A

Think chronic pancreatitis

190
Q

What will AST:ALT ratio be in alcoholic hepatitis?

A

2:1

191
Q

caput medusae and splenomegaly in a known alcoholic suggest what?

A

Portal HTN

192
Q

Antibodies for PBC

A

Anti-mitochondrial - most common
Anti-smooth muscle

193
Q

What does a score of 3 or more on Glasgow criteria suggest for pancreatitis?

A

May need ITU input

194
Q

slate-grey skin pigmentation

A

Haemochromatosis

195
Q

Diarrhoea after rice?

A

Bacillus cereus

196
Q

What are the anti emetics of choice in gastroparesis?

A
  • Metoclopramide
  • Domperidone
197
Q

fever, malaise, abdo pain and rose spots on trunk?

A

Typhoid fever -> treat with fluids and Ciprofloxacin

198
Q

Raised ALP and bilirubin suggests what?

A

Cholestatic picture

199
Q

What marker is raised in cholangiocarcinoma?

A

CA19-9

200
Q

MSH2/MLH1 mutation?

A

HNPCC

201
Q

What is the AST:ALT ratio in alcoholic liver disease?

A

2:1 - AST 2 times higher than ALT

202
Q

Gastroenteritis incubation periods?

A

1-6 hours: Staph aureus
12-48 hours: Salmonella, E coli
48-72 hours: Shigella, Campylobacter
>7 days: Giardiasis, Amoebiasis

203
Q

mural thickening of the colon and the presence of pericolic fat stranding in the sigmoid colon

A

Diverticular disease

204
Q

What is the weight loss definition for malnutrition?

A

Loss of >10% in the last 3-6 months

205
Q

What should the prothrombin time be in order to qualify for liver transplant?

A

> 100seconds

206
Q

First line test for coeliac in GP?

A

Total IgA and IgA tissue transglutaminase

207
Q

When should a repeat endoscopy be done after the start of PPI therapy for ulcer?

A

6-8 weeks

208
Q

Autoimmune hepatitis antibodies?

A

Type 1 - ANA, anti-smooth muscle
Type 2 - Anti-LKM-1

209
Q

What can help to confirm SBP from Ascitic fluid?

A

Raised neutrophils

210
Q

triad of vomiting, pain and failed attempts to pass an NG tube

A

Gastric volvulus

211
Q

Post prandial vomiting and abdo pain in someone with chronic pancreatitis?

A

Pancreatic pseudocyst

212
Q

Blockage where does not cause jaundice?

A

Cystic duct or gallbladder

213
Q

ALT/AST in the 10,000s?

A

Think paracetamol overdose

214
Q

AST vs ALT

A

AST - alcohol overdose
ALT - drug overdose/viral hepatitis

215
Q

Suspected cholecystitis in GP?

A

Refer to hospital for urgent admission

216
Q

spiral or comma-shaped gram negative

A

Campylobacter

217
Q
A

FINALS: PASSMED/QUESMED (22 decks)

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