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AY Gastrointestinal > Peer Tutoring > Flashcards

Peer Tutoring Flashcards

1
Q

What is air under the diaphragm called?

A

Pneumoperitoneum

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2
Q

65 year old male with a history of alcoholism and gallstones presents with severe epigastric pain, which radiates to his back. He has vomited 5 times in the last 5 hours.

A

Acute pancreatitis

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3
Q

Causes of pancreatitis

A 
G - gallstones 
E - ethanol
T - trauma
S - scorpion bites
M - mumps
A - autoimmune
S - steroids 
H - hyperlipidaemia 
E - ERCP
D - drugs
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4
Q

A 16 year old female presents with fever, nausea and pain in the RIF. The pain had originated around the umbilicus. A pregnancy test performed on the ward was negative.

A

Acute appendicitis

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5
Q

49 year old obese female presents with a one day history of continuous right upper quadrant pain, fever and vomiting. On examination Murphy’s sign is positive.

A

Acute cholecystitis (fat forty something female)

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6
Q

A 22 year old male presents with a one week history of diarrhoea and abdominal pain. Has lost 10kg in the last 2 months. On examination he has generalised abdominal tenderness, particularly in the RIF. A blood sample taken on admission reveals a deficiency of vitamin B12

A

Crohn’s disease

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7
Q

A 73 year old lady has a longstanding history of intermittent LIF pain and constipation. In the last few days this has become more severe and she has felt nauseous and unable to eat. Examination reveals tenderness and guarding in the LIF.

A

Diverticulitis

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8
Q

An 18 year old female medical student attends A+E after gaudie night. Having vomited several times, she notices bright red blood in her vomit.

A

Mallory-Weiss tear

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9
Q

A 70 year old male with a history of several years o the heartburn reports intermittent haematemesis. Biopsies taken from the spdistal oesophagus at the subsequent endoscopy and reported showing intestinal-type-metaplasia.

A

Barrett’s oesophagus

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10
Q

What can Barrett’s Oesophagus lead to?

A

Adenocarcinoma

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11
Q

A 55 year old male alcoholic presents with a large volume of bright red haematemesis. On examination he has palmar erythema and spider naevi.

A

Oesophageal varices

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12
Q

A 65 year old female smoker presents with a 2 month history of weight loss, epigastric pain and haematemesis. On examination she has signs of anaemia and you note Virchow’s node in her left supraclavicular fossa.

A

Gastric carcinoma

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13
Q

A 40 year old woman presents to the liver clinic with raised ALP, GGT and AST following a routine blood test. Later she develops progressively worsening lethargy, pruritus and jaundice. A liver biopsy reveals chronic inflammation of the bile ducts.

A

Primary Billiary cirrhosis

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14
Q

A 43 year old Scottish male presents with tiredness, jaundice, spider naevi and palmar erythema. He drinks around 8 units of alcohol a week, on examination his skin appears “slate grey” . Iron studies reveal raised ferritin, serum iron and massively elevated transferrin saturation.

A

Hereditary haemochromatosis

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15
Q

A 34 year old IV drug abuser is seen by the prison doctor with acute onset of jaundice. Investigations reveal abnormal LFT’s and positive serology for HBsAg and anti HHc IgM.

A

Hep B

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16
Q

A 52 year old female presents with symptoms and signs of chronic liver disease. She suffers from emphysema despite never being a smoker. There is a family history of similar problems.

A

Alpha 1 antitripsin deficiency

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17
Q

A 36 year old male smoker gives a several month history of retro sternal pain. He says it’s worse at night in bed and when tying his shoe laces. Food and acid occasionally regurgitate into his mouth.

A

GORD

18
Q

Risk factors for GORD

A 
Smoking 
Alcohol
Obesity
Pregnancy 
Hiatus hernia 
Antidepressants
19
Q

Non pharmaceutical advice would you offer him to prevent recurrence of GORD

A

Smoking cessation
Weight loss
Reduced alcohol intake
Smaller portions - avoid food before bed

20
Q

Medications for GORD

A

Antacid first

PPI

21
Q

Alarm symptoms in GI disease

A 
Weight loss
Hoarseness 
Anaemia 
Haematemesis 
Loss of appetite
22
Q

What is Barrett’s oesophagus?

A

Squamous cell to columnar cell metaplasia

23
Q

What treatment is recommended for Barrett’s oesophagus?

A

High grade - resection

Low grade - PPI, monitor regularly

24
Q

60 year old female presents with a 2 day history of constant pain in the RH. The onset was shortly after the ingestion of a large meal. The pain has also rediated to the right shoulder and sub scapular region. She reports nausea, 2 episodes of vomiting and has been phrexiak for the last 24 hours, she is not jaundiced.

A

Acute Cholecystitis

25
Q

Physical examination of acute cholecystitis

A 
Murphy's sign positive 
Localised peritoneum 
Guarding, rebound 
Obese 
Hyperlipidaemia
26
Q

Investigations to confirm a diagnosis of acute cholecystitis

A

US - (always for gallbladder) - thickened wall - cholecystitis
FBC - WCC, LFT’s, CRP

27
Q

Treatment for acute cholecystitis

A

Analgesia
IV fluids
Antibiotic

28
Q

What LFT’s suggest cholestatis?

A

Raised ALP
Raised GGT
Raised Bilirubin
(Post hepatic)

29
Q

26 year old male, 2 day history of bloody diarrhoea and a stool frequency of 10 times daily with urgency including nocturnal episodes. He has generalised abdominal pain that is partially relieved by defaecation. 2 week history of loose stools and 5kg weight loss in the past month. No previous episodes of similar symptoms. On examination he appears pyrexial, lethargic with general abdominal tenderness. PR exam shows presence of blood.

A

IBD (UC)

30
Q

Investigations for IBD

A

FBC - increase CRP increase WCC low Hb U+E’s albumin

Colonoscopy

31
Q

Treatment for UC

A

Mild: oral prednisolone or topical steroid foam

Moderate: higher doses of oral steroids and additional 5ASA foam enemas

Severe: IV hydrocortisone and IV fluids

32
Q

2 main causes of small bowel obstruction

A

Hernia

Adhesions

33
Q

2 main causes of large bowel obstruction

A

Diverticular

Malignancy

34
Q

Difference between UC and Crohn’s

A

UC

  • continuous diffuse disease
  • superficial ulceration and inflammation
  • crypt abscesses
  • pseudopolyps
  • no granulomas

Crohn’s disease

  • segmental patchy disease with ‘skip lesions’
  • transmutation ulceration
  • crypt abscesses
  • deep knife like fissuring ulceration
  • granulomas present in 50%
35
Q

Intestinal complications of IBD

A 
Toxic megacolon 
Bowel obstruction 
Perforation 
Malabsorption
Fistulae - more likely in Crohn's 
Perinatal abscess - Crohn's 
Fissures - Crohn's 
Strictures 
Malignancy - UC
36
Q

Extra intestinal complications of IBD

A

Relates to manifestations e.g. erythema nodosum; pyoderma gangrenosum conjunctivitis; episcleritis; iritis; sarcroilitis; ankylosing spondylitis*; fatty liver; primary sclerosing Cholangitis (UC); cholangiocarcinoma (UC)
Other: hypercoaguable state; osteoporosis; urinary complications (more common in Crohn’s e.g. calculi; obstruction of ureters due to small bowel inflammation leading to hydronephrosis.

37
Q

Features of acute alcoholic liver disease

A 
Drowsiness 
Confusion 
Slurred speech 
Jaundice 
Abdominal tenderness 
Ascites 
Confusion
Foetor hepaticus
38
Q

Features of chronic alcoholic liver disease

A 
Cachexia
Palmar erythema 
Clubbing 
Spider naevi 
Capitol medussa
Gynaecomastia 
Testicular atrophy 
Muscle wasting 
Darkened skin
39
Q

Pathological features of ALD

A

2-3 days: fatty liver which is reversible (fat vacuoles in hepatocytes)

4-6 weeks hepatitis: reversible (hepatocytes necrosis, neutrophils, Mallory bodies, pericellular fibrosis)

Months-years: cirrhosis - bands of fibrosis separating regenerative nodules of hepatocyte

40
Q

Causes of cirrhosis

A

Iron overload
Autoimmune liver disease
Hepatitis and other viruses
Gallstones

41
Q

Complications of ALD

A

Oedema: reduced albumin synthesis resulting in hypoalbuminaemia
Ascites: hypoalbuminaemia; secondary aldosteronism; portal hypertension. With this there is also a risk of spontaneous bacterial peritonitis.
Haematemesis: ruptured oesophageal varices due to portal hypertension
Spider naevi and gynocomastia: hypogonadism
Purpura and bleeding: reduced clotting factor synthesis
Infection: reduced Kupffer cell number and function
Hepatic encephalopathy
Liver cancer

42
Q

37 year old male, presents with rapid-onset, severe, constant epigastric pain. On examination the abdomen is rigid with absent bowed sounds. An erect chest x-ray shows air under the diaphragm.

A

Perforated duodenal ulcer

AY Gastrointestinal (21 decks)

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