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Medicine > GI > Flashcards

GI Flashcards

1
Q

What does coffee ground vomit suggest?

A

Dark blood that has been altered by contact with gastric acid, suggest a small bleed
Song of upper GI bleeding but less acute than haematemesis
Causes e.g. gastritis, oesophagitis

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2
Q

What are the most common causes of upper GI bleeding?

A

Peptic ulcer

Varices

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3
Q

What is important to ask in the history of an upper GI bleed?

A 
Appearance of the blood
If this has happened before
Drug Hx
Alcohol Hx 
Vomiting (eg Mallory Weiss tear)
Known ulcers/ varices/ liver disease
Red flags
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4
Q

What scoring systems are used for upper GI bleeds?

A

Rockall score

Blatchford score

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5
Q

What are some causes of gastritis?

A

Alcohol
NSAIDs
H Pylori
Zollinger Ellison

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6
Q

What is the Rockall score?

A

Scoring for upper GI bleeds pre and post endoscopy to predict risk of rebleeding and mortality

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7
Q

What is the primary diagnostic investigation for an upper GI bleed?

A

Endoscopy within 24 hours of admission

If severe do after resus

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8
Q

Which scoring system for upper GI bleeds is used pre endoscopy?

A

Blatchford score

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9
Q

What are oesophageal varices?

A

Collaterals between portal and systemic systems formed due to portal hypertension due to liver fibrosis

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10
Q

How would you manage variceal bleeding?

A

Stabilise (ABC, fluids/ transfusion)
IV terlipressin
Band ligation

Aspirin to prevent re bleeding

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11
Q

Dysphagia affecting both solids and liquids from the start is indicative of what condition?

A

Achalasia

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12
Q

What are some clinical features of achalasia?

A
  • dysphagia of both solids and liquids
  • heartburn
  • some food regurgitation
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13
Q

What investigations would you do for suspected achalasia and what would they show?

A
  • manometry would show excess tone in LOS
  • barium swallow would show ‘birds beak appearance’
  • CXR could show wide mediastinum
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14
Q

A combination of liver and neurological disease points towards which diagnosis?

A

Wilson’s disease

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15
Q

What is a useful diagnostic marker for hepatocellular carcinoma?

A

AFP

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16
Q

CEA is a diagnostic marker for which cancer?

A

Bowel cancer

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17
Q

What is the main treatment for haemochromatosis?

A

Regular venesection (therapeutic phlebotomy)

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18
Q

What drug can you give as prophylaxis for variceal bleeding?

A

Non selective beta blocker eg propanolol

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19
Q

Which type of jaundice will present with very high levels of alkaline phosphatase?

A

Post hepatic (due to biliary obstruction)

20
Q

Which type of jaundice will present with pale stool?

A

Post hepatic jaundice

Along with dark urine as there is increased conjugated bilirub8n and this is water soluble so enters the urine

21
Q

What colour will the urinebe in pre hepatic jaundice?

A

Normal

As there is increased levels of unconjugated bilirubin, and this is insoluble so will not enter the urine

22
Q

What is Charcot’s triad?

A

RUQ
Jaundice
Fever

(Due to cholangitis)

23
Q

What is the most common first line imaging in jaundice?

A

USS of liver and biliary tree

24
Q

What are som signs of acute liver failure?

A

Hepatic flap
Hepatic encephalopathy
Jaundice

(If stigmata of chronic disease are present, this suggest acute on chronic liver failure?

25
Q

What are some genetic causes of cirrhosis?

A

Haemachromotisis
Alpha 1 antitrypsin deficiency
Wilson’s disease

26
Q

What are some stigmata of chronic liver disease?

A 
Leukonykia
Dupuytrens contracture
Palmar erythema
Clubbing
Spider navai
Angular stomatitis
Gynaecomastia
Testicular atrophy
Hepatomegaly
27
Q

What will bloods show for a patient with liver cirrhosis?

A 
Raised LFTs (ALT, ALP, GGT, AST)
Low albumin (may have raised INR/ PTT)
Low WCC and platelets may indicate hypersplenism
28
Q

Which diuretic is first line in liver failure?

A

Spironolactone +/- furesomide

29
Q

Which organism causes pseudomembranous colitis?

A

Clostridium difficile

30
Q

Which antibiotics are used for C Diff infection?

A

Oral metronidazole
If severe: oral vancomycin

(If NBM, IV meropenem)

31
Q

What investigation would you do in a patient presenting with diarrhoea?

A

FBC: MCV reduced in coeliac, increased in alcohol abuse, B12 reduced in Crohn’s and coeliac, Raised CRP/ ESR may indicate infection or Ca or IBD
Faecal calprotectin: raised in IBD
Blood and stool culture to look for infective organism
TFT to look for thyrotoxicosis (low TSH)
U&Es to check for dehydration
Sigmoidoscopy and biopsy (IBD, Ca)
Coeliac serology (Raised transaminase antibodies)

32
Q

How will the stools be in coeliac Disease?

A

Steatorrhea (foul smelling, hard to flush)

33
Q

What pharmacological agents can be prescribed in irritable bowel syndrome?

A

1st line
For bloating and abdominal pain: antispasmodic
For diarrhoea: loperamide
For constipation: laxative e.g. ispaghula (avoid lactulose)

2nd line
Low dose TCA e.g. amitriptyline

34
Q

What is coeliac Disease?

A

Autoimmune disease of the small bowel due to gluten intolerance
Causes villus atrophy and malabsorption

35
Q

HLA-DQ2 is associated with 95% of patients who suffer from which condition?

A

Coeliac Disease

36
Q

How may coeliac Disease present in a patient?

A 
Steatorrhea
Weight loss
Failure to thrive (children)
Abdominal pain 
Bloating
Nausea
Fatigue
Fe deficiency anaemia
37
Q

Which antibodies are raised in coeliac Disease?

A

Transaminase antibodies

38
Q

Jejenal biopsy for a patient with coeliac Disease will show what?

A

Villus atrophy
Crypt hyperplasia
Increase in intraepithelial lymphocytes

39
Q

Can a patient with coeliac eat wheats, barley, rice and potato?

A

Wheat and barley no

Rice and potato yes

40
Q

What condition in primary slerosing cholangitis linked with?

A

UC

4% of UC px have PSC, but 80% of PSC Px will have UC

41
Q

What are some symptoms of primary sclerosis cholangitis?

A

RUQ pain
Jaundice
Fatigue
Pruritis

42
Q

What investigation can diagnose primary sclerosing cholangitis?

A

ERCP will show beads on a string appearance (due to the biliary strictures from areas of fibrosis)

43
Q

Antimitochondrial antibodies are raised in which condition?

A

Primary biliary cirrhosis

44
Q

What is a typical patient with primary sclerosing cholangitis?

A

Middle aged male with UC

45
Q

What is primary biliary cirrhosis?

A

Autoimmune condition causing chronic inflammation of interlobular bile ducts
Presents with pruritis

46
Q

How can pruritis be treated?

A

Cholestyramine (eg given for primary biliary cirrhosis and primary sclerosing cholangitis)

Medicine (7 decks)

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