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General Medicine > GI > Flashcards

GI Flashcards

1
Q

What is boerhaave’s syndrome

A

Oesophageal wall rupture due to vomiting.

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2
Q

What area of the GIT does crohn’s affect

A

Anywhere from mouth to anus.

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3
Q

Syx of Crohn’s disease

A 
Abdo pain
Loss of appetite 
Weight loss
Diarrhoea 
Passage of blood / mucus rectally
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4
Q

Most common cause of painless rectal bleeding

A

Haemorrhoids

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5
Q

Syx of an anal fissure

A

Streaks of blood on toilet paper

Pain on defecation

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6
Q

What is cholestyramine and what is it used for?

A

Bile acid sequestrant

Used in primary biliary cirrhosis

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7
Q

What is goodpastures syndrome

A

Anti-glomerular basement antibody disease

Leading to glomerulonephritis and lung haemorrhage

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8
Q

What is primary sclerosing cholangitis

A

Disease of bile ducts.

Progressive inflammation and fibrosis of intra and extra-hepatic bike ducts.

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9
Q

Symptoms of primary sclerosing cholangitis

A 
Fatigue
Jaundice 
Pruritus 
Malabsorption + steatorrhoea 
Dark urine 
RUQ pain (hepatomegally)
Weightloss
Fever / rigors
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10
Q

Diagnosis of primary sclerosing cholangitis

A

Raised bilirubin
Raised alkaline phosphatase / GGT
Endoscopic retrograde cholangiopancreatography
80% have p-ANCA

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11
Q

What is Primary biliary cirrhosis

A

Chronic inflammatory liver disease
Progressive destruction of intrahepatic bile ducts
Probably autoimmune

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12
Q

Symptoms of Primary biliary cirrhosis

A 
Pruritus 
Fatigue 
Weightloss
Arthralgia 
Jaundice 
RUQ pain (hepatomegally) 
Xanthelasma 
Hyperpigmentation
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13
Q

What is biliary colic

A 
Severe RUQ/epigastic pain - radiate to scapula 
Related to cholecystitis and gallstones 
Lasts several hours 
May be precipitated by fatty meal 
\+/- n+v
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14
Q

What is cholangitis

A

Infection of the common bile duct

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15
Q

What is Wilson’s disease

A

Autosomal recessive condition leading to reduced biliary excretion of copper
Accumulates in liver and brain

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16
Q

Management of Wilson’s disease

A

Penicillamine = chelating agent

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17
Q

Symptoms of Wilson’s disease

A

Liver infiltration –> jaundice, easy bruising, variceal bleeding, encephalopathy
Neuro –> dyskinesia, rigidity, tremor, dysarthria, dementia, ataxia
Psych syx

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18
Q

Signs of hepatocellular carcinoma

A 
Weightloss
Lymphadenopathy 
Nodular hepatomegally 
Jaundice 
Ascites 
(Liver bruit)
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19
Q

Signs of alcohol excess

A 
Malnourished
Palmar erythema
Dupuytrens contracture
Facial telangiectasia
Parotid enlargement 
Spider naevi
Gynaecomastia 
Testicular atrophy 
Hepatomegally
Easy bruising
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20
Q

Symptoms of alcoholic hepatitis?

A 
Mild illness
Nausea
Malaise
Epigastric or R hypochondrium pain
Low-grade fever
Jaundice
Ascites
Peripheral oedema
GI bleed
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21
Q

When do Kayser fleischer rings occur?

A

Wilsons disease

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22
Q

Clinical features of pancreatitis?

A 
Epigastric pain radiating to the back
Nausea and vomiting
Previous episodes
Known gallstones
(Tachycardia, Hypotension)
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23
Q

Standard diagnostic test for pancreatitis?

A

Serum amylase

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24
Q

What is courvoisiers law?

A

In painless jaundice palpable gallbladder is unlikely to be gallstones

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25
Q

What is a choledocholithiasis

A

Gallstone in the common bile duct

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26
Q

Risk factors for hepatocellular carcinoma?

A

Increasing age
Male
Hepatitis B
Cirrhosis

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27
Q

Risk factors for developing acute cholangitis

A

Choledocholithiasis
Biliary stricture
Tumours
ERCP

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28
Q

Treatment of acute cholangitis

A

Antibiotic

Remove cause

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29
Q

What is Charcots triad

A

Fever, jaundice and abdominal pain

Associated with acute cholangitis

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30
Q

What is the acute cholangitis

A

Bacterial infection in conjugation with obstruction of the biliary tree
Commonly due to gallstones

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31
Q

Symptoms of acute cholangitis?

A 
Epigastric pain
Right upper quadrant pain
Vomiting
Fever
Peritonism
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32
Q

What is Gilbert’s syndrome?

A

Raised unconjugated bilirubin
More marked in fasting or illness
Autosomal recessive

No long-term sequelae

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33
Q

Features of an amoebic liver abscess

A

Entamoeba histoltica
90% Are solitary
Commonly involves right liver lobe
Treated by aspiration

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34
Q

Types of pancreatic Cancer

A 
80% = adenocarcinoma
Rest = adenosqamous And mucinous cystadenocarcinoma

75% in head/neck of pancreas
15% in body
10% in tail

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35
Q

Symptoms of pancreatic cancer

A

Anorexia
Weight loss
Malaise

Later jaundice and epigastric pain

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36
Q

Symptoms of acute pancreatitis

A 
Severe epigastric pain radiating to the back
Relieved by sitting forward
Worse on movement
Anorexia
Nausea and vomiting
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37
Q

What is Cullens sign?

A

Discolouration around the umbilicus inpatients with acute pancreatitis

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38
Q

What is grey-turners sign?

A

Bruising of the flanks

Can occur in a severe attack of acute pancreatitis

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39
Q

Features of amoebiasis

A

Pain
Bloody diarrhoea.
Flask-shaped ulcers on colon
PAS +ve trophozites + ingested RBC

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40
Q

Features of congenital toxoplasmosis

A 
Jaundice
Hepatomegally 
Hydrocephalus 
Choroidoretinitis
necrosis of brain, liver, heart, lung, retina
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41
Q

Features of toxoplasmosis in adults

A

Sub clinical infection

Mild lymphadenopathy

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42
Q

Weightloss plus anaemia in a patient with a change in bowel habit and PR bleeding suggests what?

A

Colorectal carcinoma

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43
Q

Paroxysmal Flushing, wheezing, abdominal pain, diarrhoea and bronchospasm suggests what?

A

Carcinoid syndrome

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44
Q

What is a Hartman’s procedure?

A

Primary resection of a lesion leaving a temporary colostomy and oversewing the rectum.
For later re-anastomosis.
Emergency procedure.

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45
Q

Complications of stomas

A 
Fluid loss
Odour
Skin ulceration
Leaking
Stenosis
Herniation
Prolapse
Ischaemia
Psychosocial / sexual
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46
Q

Where do haustrae occur

A

Large bowel

Not full width

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47
Q

Where do valvulae coniventes occur?

A

Small bowel

Complete width

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48
Q

Symptoms of intestinal obstruction

A

Pain
Vomiting
Distension
Absolute constipation - no flatus or faeces

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49
Q

Causes of bowel obstruction

A 
Adhesions
Hernias
Tumours
Gall stone ileus
Sigmoid or caecal volvulus
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50
Q

Features of spontaneous bacterial peritonitis in a patient with ascites

A 
Generalised abdominal pain
Worsening ascites
Vomiting
Fever
Rigor
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51
Q

Most common causative organisms in spontaneous bacterial peritonitis

A

E. coli

Klebsiella

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52
Q

Portal hypertension causes varices where

A

Oesophagus
Rectum
Umbilical veins

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53
Q

Management of Oesophageal variceal bleeding

A

Therapeutic endoscopy
Banding or sclerosis of varices

If unresponsive haemostasis is achieved with balloon tamponade
= sengstaken-blakemore tube

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54
Q

Secondary prophylactic measures to reduce the risk of variceal rebleeding

A

Elective endoscopic variceal banding/sclerotherapy

Propranolol to reduce portal Venous pressure

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55
Q

Clinical features of hepatic encephalopathy

A 
Reversed sleep pattern
Asterixis
Constructional apraxia
Agitation
Reduced consciousness
Coma
 Death
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56
Q

Precipitants of hepatic encephalopathy

A 
High protein diet
Upper GI bleeding
Hypokalaemia
Alcohol
Benzodiazepines
Diuretics
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57
Q

Treatment of hepatic encephalopathy

A

Correct underlying cause
Low protein diet
nurse patient in light room
Lactulose (osmotic laxative)

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58
Q

What is hepatorenal syndrome

A

Acute renal failure despite normal kidneys in a patient with cirrhosis and portal hypertension

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59
Q

What is the odynophagia

A

Pain on Swallowing

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60
Q

Symptoms of GORD

A

Heartburn
regurgitation
dysphagia
(Atypical symptoms= Retrosternal chest pain, hoarseness, hiccups, ear pain, loss of dental enamel, night sweats, chronic wheeze, globus sensation, hypersalivation, halitosis)

61
Q

Complications GORD

A 
Oesophageal inflammation
Erosions
Ulceration
Stricture
Metaplasia of lower oesophagus (Barrett's oesophagus)
62
Q

Management GORD

A

Lifestyle - Weight loss, smoking cessation, avoid late night meals, avoid spicy food, elevate head of bed
Medical - Ranitidine (H2 antagonist), omeprazole (PPI), metoclopramide (Prokinetic)
Surgical - fundoplication

63
Q

Most common causes of small-bowel obstruction

A

Post-op adhesions
Incarcerated hernia
Malignancy
Less common (diverticulitis, gallstone ileus, IBD)

64
Q

What is familial adenomatous polyposis

A

Autosomal dominant
Hundreds of adenomatous polyps in early adulthood
Malignant transformation by age 50

65
Q

What causes pseudomembranous colitis

A

Overgrowth of clostridium difficile
Most occurs following antibiotic use
Treatment is oral Metronidazole

66
Q

Complications of diverticular disease

A 
Diverticulitis
Abscess formation
Fistula
Bleeding
Perforation
67
Q

Features of anorectal abscesses

A

Constant throbbing pain
Discharge of pus per rectum
Rectal lump/nodule

68
Q

What type of stoma has a spout

A

Ileostomy

69
Q

What is an end colostomy and when is it used

A

End colostomy is required after abdomino-perineal resection of a low rectal or anal canal tumour.
It has a single opening.
Usually found in the left iliac fossa - contents will be solid.

70
Q

What is a Hartman’s procedure and when is it used

A

Hartman’s procedure is done after emergency resection of rectosigmoid lesions
When primary anastomosis is unfavourable.
The diseased segment is resected, the proximal end of bowel is made into an end colostomy.
The distal segment of bowel / rectal stump, is oversewn to remain closed.
Secretions from the rectal stump still pass through the anus.
Later once inflammation settled the two ends are rejoined.

71
Q

How can you tell the difference between Hartman’s procedure and an AP resection

A

Digital rectal examination - AP. procedure leave no rectum

72
Q

What is an end Ileostomy and when is it used

A

End ileostomy is an end stoma using distal ileum.
Often created after resection of the colon and rectum, e.g for IBD.

Ileostomies usually found in RIF
Contents will be liquid.

Once outside abdominal wall - small bowel is everted to create a spout to protect the abdominal wall skin from the irritation.

73
Q

What is a defunctioning ileostomy and why is it used

A

Defunctioning ileostomy is a temporary stomas created to protect distal anastomosis at risk of leakage or breakdown.
Allows bowel time to rest.

Commonly used in difficult low rectal anastomoses and in emergency resections.

Reversal of the temporary stoma at about 3-4 months.

74
Q

What is a loop stoma and when is it used

A

Temporary stomas are usually loop stomas.
E.g. Defunctioning stomas

A loop of bowel is brought to the surface.
The loop is supported by a ‘bridge’ beneath it (between bowel and skin) to prevent the loop slipping back in.
The bridge is removed after a few days once wound healed.

Bowel wall is partially cut to create two openings: an afferent limb and an efferent limb.
The afferent limb leads to the functioning part of the bowel and allows stool and gas to pass out.
The efferent limb leads into the non-functioning part of bowel and secretes mucus. This is the mucous stoma.

75
Q

What is a urostomy and when is it used?

A

Urostomies are used for diversion of the urinary system.

Used for bladder cancers, urinary incontinence not anemable to other treatments, and neuropathic bladders.

Requires an ileal conduit = a segment of ileum open at 1 end + closed at the other.
Ureters are implanted into this.
The open end is used to create a spout similar to an ileostomy

It allows urine collection in a stoma bag.

76
Q

Classic presentation of acute pancreatitis

A

Epigastric pain
Radiating to the back
Hx of gallstones, alcohol

77
Q

Causes of raised serum amylase in an acute abdomen

A

Acute pancreatitis
Perforation
Cholecystitis

78
Q

What is murphy’s sign

A

Place hand on RUQ and ask patient to breathe in. Causes pain as gallbladder contacts hand. –> arrest of inspiration.
Repeat on LUQ.
+ve = pain on RUQ palpation and not on L.
Indicates acute cholecystitis

79
Q

Presentation of small bowel obstruction

A

Early onset vomiting - bilious not faceculant
Late onset distension
Abdominal pain - colicky

80
Q

Presentation of large bowel obstruction

A

Early onset distension
Late onset vomiting - faeculant
Abdominal pain - colicky

81
Q

Presentation of a duodenal ulcer

A

Epigastic pain relieved by eating or milk

Worse at night

82
Q

Presentation of a gastric ulcer

A

Epigastric pain worse on eating

83
Q

RF for duodenal ulceration

A

H. Pylori

Chronic NSAID use

84
Q

Classic presentation of appendicitis

A

Central colicky abdominal pain
Shifts to RIF once peritoneum inflamed
Rebound tenderness

85
Q

Is it crohn’s or UC that is transmural

A

Crohn’s

86
Q

Crohn’s can occur anywhere from mouth to anus but which area does it favour

A

Terminal ileum

87
Q

Surgical repair of a AAA is indicated at what diameter?

A

> 5.5cm

88
Q

Presentation of gastric carcinoma

A 
Persistent dyspepsia 
Mass above L clavicle 
Weight loss
Fatigue (anaemia) 
Ascites if advanced
89
Q

Right sided colon cancers (caecum / ascending colon) commonly present with…

A

Weight loss
Anaemia
RIF mass

90
Q

Left sided colon cancers (sigmoid / rectum) commonly present with…

A

Change in bowel habit

PR bleeding

91
Q

In a patient >40yo presenting with features of acute appendicitis it is important to consider the diagnosis of….

A

Caecal carcinoma

92
Q

Features of a pancreatic pseudocyst

A

Abdominal discomfort
Nausea
Early satiety

Usually due to acute or chronic pancreatitis

110
Q

Causes of a hard liver edge

A

Liver metastasis
Hepatocellular carcinoma
Conditions causing macronodular cirrhosis (Viral hepatitis B or C. Wilson’s disease. Alpha-1-antitrypsin deficiency)

111
Q

Presentation of haemochromatosis

A 
Lethargy 
Arthralgia
Features of chronic liver disease
Bronze diabetes 
(Dilated cardiomyopathy)
112
Q

Classical patient with haemochromatosis

A

Male

Middle aged

113
Q

Inheritance of haemochromatosis

A

Type 1 = autosomal recessive
Mutation of HFE gene
Disorder of iron metabolism

114
Q

Signs of chronic liver disease

A 
Spider naevi
Gynaecomastia 
Testicular atrophy
Clubbing
Leuconychia
Dupuytrens contracture
Palmar erythema 
Parotid enlargement
115
Q

What is a green-ish brown ring at the corneo-scleral junction best seen with a slit lamp called. And when does it occur

A

Kaiser-fleischer ring

Pathognomonic of Wilson’s disease

116
Q

Management of Wilson’s disease

A

Long term penicillamine

Copper-chelating agent

117
Q

When is alkaline phosphatase raised

A

Biliary tract diseases

118
Q

When is serum bilirubin raised

A

Hepatic and post hepatic disease

119
Q

When are alanine transaminase and aspartate transaminase raised

A

Hepatocellular disease

120
Q

When is alkaline phosphatase raised

A

Biliary tract diseases

121
Q

When is serum bilirubin raised

A

Hepatic and post hepatic disease

122
Q

When are alanine transaminase and aspartate transaminase raised

A

Hepatocellular disease

123
Q

Features of crigler-Najjar syndrome

A

Congenital hyperbillirubinaemia
Unconjugated jaundice
Causes severe brain damage in early years

124
Q

Intermittent RUQ pain exacerbated by fatty foods is likely to be due to…

A

Biliary tract obstruction

Commonly due to gallstones

125
Q

Diagnostic test for Wilson’s disease

A

Ceruloplasmin level (low)

126
Q

Diagnostic test for hereditary haemochromatosis

A

Raised ferritin

Reduced total iron binding capacity

127
Q

What antibody is commonly found in primary biliary cirrhosis?

A

Antimitochondrial antibody

128
Q

Diagnostic tests for primary biliary cirrhosis

A

+ve for anti-mitochondrial antibody
Hepatic USS
ERCP

129
Q

Management of primary biliary cirrhosis

A

Symptomatic relief
Cholestyramine to treat pruritus
ursodeoxycholic acid for ascites and jaundice

Liver transplant (or death within 2 years of jaundice onset)

130
Q

What may precipitate episodes of carcinoid syndrome

A

Stress
Caffeine
Alcohol

131
Q

Management of proctitis in UC

A

Steroid foam enema

Mesalazine suppositories

132
Q

Management of UC

A
  • Aminosalicylates: - Mesalazine (= 1st line for induction + maintenance of remission in mild cases - topical then oral), olsalazine, balsalazide, sulfasalazine (more SE)
  • Corticosteroids: induce remission in relapses. No role in maintenance. Topical - suppository, liquid, foam enema. Oral or iv.
  • Thiopurines: - Azathioprine (if intolerant of steroids).
  • Ciclosporin: salvage therapy - severe refractory colitis.
  • Infliximab: effective in inducing remission in refractory to conventional treatment
  • Stool bulking agents: - distal transit is rapid but proximal transit is slowed –> proximal constipation.
133
Q

Causes of pancreatitis

A

Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune
Scorpion / snake
Hyperlipidaemia / hypercalcaemia / hypothyroidism
ERCP / embolism
Drugs (azathioprine, steroids, Thiazide diuretic, COCP)

Pregnancy

134
Q

What causes pain in pancreatitis

A

Autodigestion of the pancreas by trypsin.

Fat necrosis by lipases

135
Q

Presentation of acute pancreatitis

A 
Acute onset epigastric pain
Radiates to the back
Severe and constant
Relieved by sitting forwards 
Nausea and vomiting
Fever
\+/- Shock 
\+/- Peritionitis
136
Q

Intermittent RUQ pain exacerbated by fatty foods is likely to be due to…

A

Biliary tract obstruction

Commonly due to gallstones

142
Q

What x-ray feature may suggest acute pancreatitis

A

Sentinel loop of small bowel on a-Xr

Due to localised ileus

144
Q

Symptoms of irritable bowel syndrome

A

Abdominal pain - relieved by defection
Bloating
Change in bowel habit
(Diagnosis of exclusion)

145
Q

What are gallstones made of

A

<10%-pure pigment (Bilirubin breakdown products)
75% - Cholesterol
15% - Mixed

146
Q

What percent of gallstones are radiopaque

A

10%

147
Q

Predisposing factors to gallstone formation

A 
Female 
obesity
Haemolytic anaemia
Hyperlipidaemia
Crohn's 
(Lithogenic bike - innate tendency to form stones)
148
Q

Complications of gallstones

A 
Chronic cholecystitis
Biliary colic
Acute cholecystitis (empyema/biliary peritonitis/abscess)
Mucocele
Gallbladder carcinoma
Obstruction of the common bile duct --> jaundice 
Cholangitis
Pancreatitis
Gallstone ileus
149
Q

Features of mesenteric ischaemia

A

Severe central abdominal pain that occurs soon after eating

153
Q

Causes of pre-hepatic jaundice

A

Increased bile production- Haemolysis

  • hereditary spherocytosis
  • haemolytic transfusion reactions
  • thalassaemia
  • pernicious anaemia

Gilbert’s syndrome (underactive conjugating enzyme)
Crigler-Najjar syndrome (rare autosomal recessive disorder of bilirubin metabolism)

154
Q

Features of peutz-jeghers syndrome

A

Multiple blue-black Freckles around the lips nose oral mucosa and fingers.
GI hamartomatous polyps (benign)
Polyps predispose to GI bleeding and intussusception

155
Q

Syx of diverticulitis

A 
Central domino pain, localises to LIF
Vomiting
Diarrhoea
Fever
Local guarding
Leucocytosis
Risk of perforation or fistula formation
156
Q

Hepatic causes of jaundice

A
  • Viral hepatitis - A / B / leptospirosis / brucellosis / Coxiella burnetii/ glandular fever
  • Alcoholic hepatitis.
  • Autoimmune hepatitis
  • Drug-induced hepatitis: paracetamol, rifampicin, isoniazid, allopurinol, amitryptilline, amiodarone, phenytoin
  • Hepatotoxic chemicals: phosphorous, carbon tetrachloride, phenol.
  • Decompensated cirrhosis.
157
Q

Is hepatic jaundice Unconjugated or conjugated

A

Mixed

158
Q

What is the mechanism behind hepatic jaundice?

A

Impaired bile conjugation and excretion

164
Q

Isolated hyperbilirubinaemia in an asymptomatic patient indicates what

A

Gilbert’s syndrome

165
Q

What is achalasia

+ features

A

Progressive failure of relaxation of the lower oesophagus. Degeneration of the ganglia.
Dilated, tortuous, hypertrophy of the oesophagus.
Barium swallow shows a dilated tapering oesophagus

166
Q

What is Zollinger-Ellison syndrome

A

Peptic ulceration secondary to gastric secreting adenoma (gastrinoma) in pancreas, stomach or small bowel.

167
Q

What is glossitis + what causes it

A

Smooth, red, swollen, painful tongue

Iron deficiency
Folate deficiency
B12 deficiency

168
Q

What is a meckels diverticulum

A

Embryological remnant
Variable length
Usually ~5cm from the ileo-caecal valve

169
Q

Symptoms of a meckels diverticulum

A 
Asymptomatic 
Haemorrhage
Intestinal obstruction 
Diverticulitis 
Perforation
170
Q

What is diverticulosis

A

Presence of diverticulae

Without symptoms

171
Q

What is Diverticular disease

A

diverticula with symptoms

E.g. Haemorrhage / infection / fistulae

172
Q

What is Diverticulitis

A

Evidence of diverticular inflammation
Lower quadrant pain h
- fever, tachycardia

173
Q

Management of rectal prolapse

A 
If partial - excise redundant prolapsed mucosa
If complete (involves muscle) - surgical lifting of prolapse. E.g. De lormes procedure
174
Q

What is goodsalls rule?

A

Anterior anal fistulae track directly into the anal track - straight line.
Posterior anal fistulae track around and open in the posterior midline = curved line

175
Q

Managment of an anal fistula

A

If not through the puborectalis muscle - lay open the fistula track.
If it goes through the puborectalis muscle you shouldn’t lay it open as this damages the muscle + causes incontinence - insert a seton (non absorbable) and tie - gradually cuts through the muscle and allows it to heal by scarring

176
Q

What is chaga’s disease + it’s symptoms

A

Parasitic disease from S America.
Skin nodule @ site of inoculation
Fever, anorexia, lymphadenopathy
Long time later - dysphagia + cardiomyopathy

177
Q

Where and what age are diverticula most common

A

Descending and sigmoid colon
Elderly.
Rare before 40

178
Q

Long term complications post gastrectomy

A

Gastrectomy syndrome - rapid gastric emptying
B12 deficiency
Iron deficiency
Osteoporosis (reduced calcium absorption)

179
Q

Investigation of blood in stool

A 
digital rectal examination
Proctoscopy / sigmoidoscopy 
FBC
Clotting studies
LFTs if liver disease is suspected
Colonoscopy
180
Q

When to refer suspected bowel cancer

A

2 week wait for:
- Rectal bleeding plus change of bowel habit for six weeks and are aged 40 years or older.
- Palpable rectal or right-sided lower abdominal mass.
- Iron-deficiency anaemia without any obvious cause
Refer patients aged over 60 under 2 week rule if:
- Rectal bleeding without anal symptoms for six weeks.
- Change in bowel habit for six weeks without rectal bleeding.

General Medicine (25 decks)

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