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Finals > Gastro > Flashcards

Gastro Flashcards

1
Q

2 scores for assessing pancreatitis severity and prognosis?

A

APACHE and modified glasgow score

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2
Q

what does the modified glasgow score look at?

A

PANCREAS - PaO2, Age, Neutrophilic, Calcium, Renal function, Enzymes, Albumin, Sugar

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3
Q

Common causes of pancreatitis?

A

gall stones, trauma, alcohol, ERCP

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4
Q

Amylase in chronic pancreatitis?

A

usually normal

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5
Q

what score is used to assess upper GI bleed prior to OGD?

A

Blatchford

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6
Q

risk factors for both kinds of oesophageal cancer?

A

smoking, red / processed meat, breast RT, obesity

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7
Q

cancer in the upper 2/3rds of oesophagus?

A

squamous cell carcinoma

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8
Q

specific risks for oesophageal adenocarcinoma?

A

GORD, barret’s

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9
Q

specific risks for oesophageal SCC?

A

coeliac, Plummer-Vinson, alcohol, achalasia

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10
Q

achalasia Tx?

A

medical only works for 10% (CCB and nitrates); either endoscopic dilatation or Heller’s cardiomyotomy (+ partial fundiplication)

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11
Q

CXR findings of achalasia?

A

dilation of oesophagus

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12
Q

target audience of bowel cancer screening program?

A

men and women 60-74, every 2 years

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13
Q

in bowel cancer, what do Dukes A-D criteria equate to in regards invasion?

A 
A = mucosa
B = muscular propria
C = serosa and LN
D = mets
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14
Q

operation for sigmoid CRC?

A

sigmoid colectomy

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15
Q

operation for caecum / right sided CRC?

A

Right hemicolectomy

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16
Q

operation for low rectal tumours?

A

abdominoperineal resection (AP resection)

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17
Q

operation for high rectal / low sigmoid tumours?

A

anterior resection

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18
Q

Genes in Crohns disease?

A

HLA-B27, HLA-DQ1,NOD-2

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19
Q

classification of IBD?

A

Montreal classification. L1-4 and P for crohns; E1-3 for UC; True-love and Witt’s criteria for acute attack of UC; Crohns disease activity index.

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20
Q

extra-intestinal manifestations in IBD?

A

eyes (iritis, uveitis, episcleritis), mouth (apthous ulcers), lungs (bronchiectasis), lymphadenopathy, skin (pyoderma gangernosum, erythema nodosum), MSK (ank spend, enteropathic arthritis). PSC in UC

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21
Q

treatment of chronic pancreatitis?

A

conservative (alcohol reduction, low fat diet)and medical (enzyme replacement, fat soluble vitamins, insulin, pain control up the WHO ladder), surgical (pancreatectomy - partial or total; in disease with unremitting pain, weight loss or narcotic abuse)

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22
Q

the majority of pancreatic cancers are?

A

adenocarcinomas (90% - ductal instead of acinar); exocrine (95%) and head of pancreas (60-70%)

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23
Q

symptoms of cancer at the head of the pancreas?

A

painless, progressive obstructive jaundice

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24
Q

symptoms of cancer at the tail of pancreas?

A

epigastric pain radiating through to the back, “boring” constant pain

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25
Q

what is Trousseau’s sign of malignancy?

A

thrombophlebitis migrans - recurrent superficial thrombophlebitis. It is caused by small clots occurring in the hypercoaguable state. it is classically an early sign of pancreatic cancer but is also seen in lung adenocarcinomas and some gliomas. Can also get nonbacterial thrombotic endocarditis.

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26
Q

what is courvoisier’s law?

A

painless jaundice with palpable gall bladder = unlikely to be gall stones.

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27
Q

tumour marker for pancreatic cancer?

A

CA19-9 (also raised in chronic pancreatitis)

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28
Q

what percentage of ampullary cancers are resectable at diagnosis?

A

90% - good prognosis.

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29
Q

what is whipple’s procedure?

A

pancreaticodeuodenectomy - removal of diseased part of pancreas, common bile duct and duodenum

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30
Q

Which kind of gall stones are the mot prevalent in the west?

A

cholesterol

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31
Q

what would you see in a fasting gallbladder USS in chronic bile stones?

A

dilatation of the common bile duct, thickened gallbladder wall, small fibrotic gallbladder

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32
Q

most common cause of acute cholecystitis?

A

gall stones (95%)

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33
Q

what is murphy’s sign?

A

lay 2 fingers of RUQ and ask patient to inhale. as the lungs expand, the gall bladder will be pushed down and hit the fingers, causing pain. only truly positive if negative on left side.

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34
Q

what investigation is second line in gall stones / cholecystitis if USS is inconclusive?

A

MRCP

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35
Q

Tx for acute cholecystitis?

A

medical: fluids, naproxen (IM pethidine 2nd line)
surgical: early laparoscopic cholecystectomy (<1w)

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36
Q

what is chariot’s triad?

A

triad for ascending cholangitis: obstructive jaundice, RUQ pain, swinging pyrexia

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37
Q

risk factors for ascending cholangitis?

A

biliary obstruction (calculi, stenosis, malignancy) or iatrogenic (post-stenting; ERCP)

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38
Q

Risk factors for cholangiocarcinoma?

A

PSC, HB/CV, chronic liver disease, parasitic liver disease

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39
Q

initial cause of appendicitis?

A

obstruction of lumen (faecolith or lymphoid hyperplasia)

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40
Q

what pattern of pain would make you worried an appendix has ruptured?

A

umbilical to RIF (standard appendicitis) then sudden generalised abdo pain (perforation)

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41
Q

what is Rovsing’s sign?

A

in appendicitis, pressing on left side of abdomen elicits pain in the RLQ

42
Q

what is psoas stretch sign?

A

sign of inflamed retrocaecal appendix - passive extension of thigh elicits pain

43
Q

what does the alvarado score assess?

A

likelihood of appendicitis - MANTRELS - Migration of pain, anorexia, nausea, tenderness, rebound pain, elevated temperature, Leukocytosis, shift left of leukocytes (neutrophilia)

44
Q

How do you classify complications in diverticulitis?

A 
Hinchey classification 
1 - small abscess 
2 - large abscess 
3 - prurient peritonitis 
4 - faecal peritonitis
45
Q

What are the symptoms of diverticula disease?

A

Intermittent low abdominal pain, passing mucus, bloating

46
Q

Is clostridium gram positive or negative?

A

Positive

47
Q

Treatment of pilonidal cyst ?

A

Pre-op antibiotics and then Excision of tract and primary closure.

48
Q

Treatment for a mucosal rectal prolapse?

A

Banding, stapled anopexy or mucosal excision

49
Q

Treatment for grade I-II haemorrhoids?

A

Rubber band ligation or injection sclerotheraopy

50
Q

Time frame for hyper acute liver failure?

A

encephalopathy 7 days from onset of jaundice

51
Q

time frame for acute liver failure?

A

encephalopathy 8-28 days from onset of jaundice

52
Q

time frame for subacute liver failure?

A

encephalopathy 5- 26 weeks from onset of jaundice

53
Q

what is fulminant liver failure?

A

a clinical syndrome resulting from massive necrosis of liver cells

54
Q

over which dose is paracetamol overdose dangerous?

A

75-150mg/kg can be fatal in malnourished, >150mg/kg otherwise

55
Q

how is hepatic encephalopathy graded?

A

grade 1: altered mood / sleepiness / constructional apraxia
grade 2: drowsiness, confusion, slurred speech
grade 3: incoherent, restless, stupor but responsive
grade 4: unresponsive, coma

56
Q

when would you want to measure blood paracetamol levels in an overdose?

A

4h post-ingestion

57
Q

in what circumstances do you definitely give NAC in a paracetamol overdose?

A

in staggered overdoses; or if on or above treatment line,

58
Q

what is a common side effect of NAC?

A

rash - treat with chlorphenamine

59
Q

how do you decide who has a liver transplant in acute liver failure?

A

King’s College Criteria
Paracetamol induced - arterial pH >7.3 OR all three of INR >6.5, creatinine >300 and HE grade 3-4
Non-paracetamol induce - INR >6.5 OR 3 of the following 5 criteria: bilirubin >300, undermined or drug induced aetiology, age <10 or >40, time interval between citrus and jaundice >7d or INR >3.5.

60
Q

drug regime for immunosuppression post-liver transplant?

A

cyclosporin / tacrolimus + azathioprine + 6m of prednisolone

61
Q

complications of liver transplant?

A

immediate (acute rejection, bleeding, damage to local structures), early (hepatic artery thrombosis, infection, immobility leading to DVT), late (graft failure, GVHD, disease recurrence, infection / malignancy from immunosuppression)

62
Q

in liver failure, what is the most accurate measure of kidney function?

A

creatinine - urea is synthesised by the liver is usually low regardless

63
Q

what special USS test is important in chronic liver disease?

A

fibroscan: measure elastography - measure of fibrosis

64
Q

risk factors for NASH?

A

obesity, t2dm, dyslipidaemia

65
Q

what can cause smokers to lose their taste for tobacco?

A

Hep A

66
Q

which viral hepatitides are transmitted faeco-orally?

A

A C E

67
Q

Indications for treatment in hep B?

A

immunosuppressed, acute liver failure, chronic hepatitis, e antigen positive

68
Q

first line treatment for hep B?

A

tenofovir

69
Q

which viral hepatitides can be chronic?

A

B C D

70
Q

how is hep C transmitted?

A

via blood. IVDU is a massive risk factor, needle sticks too. sexual transmission much rarer then hep B

71
Q

how is hep C treated

A

ribavirin, peg ifn-a +/- telaprevir

72
Q

complications of hep e?

A

bell’s palsy, GBS, other neuro

73
Q

which GI infection causes HUS?

A

EHEC

74
Q

which GI infections can cause reactive arthritis?

A

C. Jejuni, yersinia

75
Q

causes of bloody diarrhoea?

A

C diff, eiec, ehec, C jejuni, shigella, e. histolytica

76
Q

causes of fever and diarrhoea?

A

listeria, salmonella, e. histolytica, shigella

77
Q

causes of painful diarrhoea?

A

listeria, c. diff, eiec, ehec, salmonella, shigella, c jejuni, giardia

78
Q

what can cause acute decompensation in chronic liver disease?

A

alcohol, bleeding, constipation (commonest), drugs, infection, portal vein thrombosis, malignancy.

79
Q

signs of CLD?

A

dupytren’s contracture, palmar erythema, clubbing, caput medusa, hepatomegaly, gynaecomastia, spider naevi

80
Q

signs of decompensation in acute liver disease?

A

ascites, liver flap, jaundice, bleeding varices.

81
Q

what can be analysed from ascitic tap?

A

MC&S, neutrophils (>250/microlitre = SBP), protein,LDH, glucose, albumin (>11g/L = transudate implying portal HTN; <11g/L =exudate implying cancer)

82
Q

what does the child-pugh score measure?

A

assess prognosis of chronic liver disease and risk of vatical bleed. looks at albumin, bilirubin, clotting, distension (ascites) and encephalopathy. ABCDE.

83
Q

treatment of ascites?

A

conservative - fluid restrict, low salt diet
medical - spironolactone + frusemide if resistant
surgery = therapeutic paracentesis,

84
Q

treatment of hepatic encephalopathy?

A

manage in ITU, head tilt at 20 degrees, well-lit calm environment, avoid constipating drugs and sedation, consider lactulose or phosphate enema

85
Q

treatment for HCC?

A

medical - not particularly radiosensitive or chemosensitive; sorafenib (multikinase inhibitor)
interventional - ablation with radio frequency or percutaneously with ethanol and US guidance. can do transarterial chemo-embolisation
surgical - resection or transplant.

86
Q

what do investigations show in a hyatid cyst?

A

FBC - eosinophilia
AXR - calcification of rim
CT - diagnostic

87
Q

inheritance of wilson’s disease?

A

autosomal recessive. multiple mutations so sequencing not helpful.

88
Q

3 important investigations to do in wilson’s disease?

A

caeruloplasmin, mri and liver biopsy

89
Q

definition of a hernia?

A

protrusion of a viscus or part of a viscus through the wall of it’s containing cavity, resulting in an abnormal position

90
Q

what is richter’s hernia?

A

portion of circumference of small intestine is trapped which may become ishcaemic without being obstructed

91
Q

what is a sliding hernia?

A

contains a partially exztraperitoneal structure (caecum, sigmoid) meaning the sac does not completely surround the contents of the hernia

92
Q

when should surgery be considered in a hernia?

A

if causing symptoms or if there is a high risk of strangulation (such as in femoral or epigastric hernias)

93
Q

Borders of hesselbach’s triangle?

A

medial - linea semilunaris
superlateral - inferior epigastric vessels
inferior - inguinal ligament

94
Q

borders of femoral canal?

A

anterior: inguinal ligament
posterior: pectineal ligament
lateral: femoral vein and iliopsoas
medial border: lacunar ligament and pubic bone

95
Q

what is the landmark for the deep inguinal ring?

A

midpoint of inguinal ligament (halfway between asis and pubic tubercle)

96
Q

landmark for superficial inguinal ring?

A

just superior and medial to pubic tubercle

97
Q

borders of inguinal canal?

A

anterior: EO aponeurosis and IO for lateral half
posterior: transverse fascia laterally, conjoint tendon medially
floor: inguinal ligament
roof: transversalis / internal oblique

98
Q

what disease is associated with a jejunal biopsy showing deposition of macrophages containing Periodic acid-Schiff (PAS) granules?

A

Whipple’s disease

99
Q

what is the most useful prognostic marker in paracetamol overdose?

A

prothrombin time

100
Q

which drug is historically associated with C diff?

A

clindamycin

101
Q

what is Budd-Chiari syndrome?

A

a condition characterized by obstruction to hepatic venous outflow. It usually occurs in a patient with a hypercoagulative state (e.g. antiphospholipid syndrome) but can also occur as a result of physical obstruction (e.g. tumour).

Finals (12 decks)

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