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Gastrointestinal > PassMedicine > Flashcards

PassMedicine Flashcards

1
Q

what are the features of a surgical sieve

A 
infective
inflammatory
vascular
traumatic
metabolic
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2
Q

what sort of pain does biliary colic present as

A

RUQ pain

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3
Q

features of biliary colic

A

gallstone lodged in bile duct

provoked after a fatty meal

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4
Q

how is acute cholecystitis as biliary colic differentiated

A

biliary colic - no fever and inflammatory markers are normal

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5
Q

what sort of pain does acute cholecystitis present as

A

RUQ pain

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6
Q

features of acute cholecystitis

A

inflammation/infection of gallbladder secondary to impacted gallstones
murphys sign positive

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7
Q

what is murphys sign

A

tests for gallbladder inflammation

arrest of inspiration on palpation of RUQ

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8
Q

what sort of pain does ascending cholangitis present as

A

RUQ pain

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9
Q

features of ascending cholangitis

A

bacterial infection of biliary tree

charcots triad

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10
Q

what is the most common predisposing factor in ascending cholangitis

A

gallstones

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11
Q

what is charcots triad

A

associated with ascending cholangitis
1 RUQ pain
2 fever
3 jaundice

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12
Q

acute pancreatitis presenting pain

A

epigastric pain

can radiate to the back

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13
Q

what is commonly associated with acute pancreatitis

A

1 alcohol

2 gallstones

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14
Q

peptic ulcer disease presenting pain

A

epigastric pain

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15
Q

history of peptic ulcer disease

A

history of NSAID use or alcohol excess

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16
Q

features of duodenal and gastric ulcers

A

duodenal>gastric
duodenal ulcers - pain relieved with eating
gastric ulcers - pain worsened with eating

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17
Q

what are common lower Gi problems of acute abdominal pain

A

1 appendicits
2 acute diverticulitis
3 intestinal obstruction

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18
Q

appendicitis presenting pain

A

RIF pain

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19
Q

features of RIF pain - appendicitis

A

pain initially in central abdomen before localising to RIF
anorexia common
rovsings sign

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20
Q

what is rosvings sign

A

sign of appendicitis

pain in RIF when LIF pressed

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21
Q

acute diverticulitis presenting pain

A

LLQ pain (colicky)

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22
Q

features of acute diverticulitis

A

diarrhoea (sometimes bloody)

fever, raised inflammatory markers, raised WCC

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23
Q

intestinal obstruction presenting pain

A

central pain

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24
Q

features of intestinal obstruction

A

history of malignancy (intraluminal obstruction) or operations (adhesions)
‘tinkling’ bowel sounds

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25
Q

common urological causes od acute abdominal pain

A

1 renal colic
2 acute pyelonephritis
3 urinary retention

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26
Q

renal colic presenting pain

A

loin pain radiating to groin

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27
Q

features of renal colic

A

visible or non-visible haematuria

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28
Q

acute pylonephritis presenting pain

A

loin pain

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29
Q

urinary retention presenting pain

A

suprapubic pain

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30
Q

features of urinary retention

A

obstruction of bladder outflow
men>women
history of benign prostatic hyperplasia in men

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31
Q

ectopic pregnancy pain

A

right or left iliac fossa pain

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32
Q

features of ectopic pregnancy

A

history of amenorrhoea

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33
Q

common vascular causes of abdominal pain

A

1 ruptured AAA

2 mesenteric ischaemia

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34
Q

rupture AAA pain

A

central abdominal pain radiating to back

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35
Q

features of ruptured AAA

A

if severe, sudden collapse

patients may go into shock (hypotension, tachycardia)

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36
Q

mesenteric ischaemia pain

A

central abdominal pain

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37
Q

features of mesenteric ischaemia

A

history of AF
diarrhoea/rectal bleeding
metabolic acidosis is often seen due to ‘dying’ tissue

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38
Q

what is the difference in pain between renal colic and acute pylonephritis

A

renal colic is colicky

acute pylonephritis is constant pain

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39
Q

coeliac disease is associated with what

A

anaemia

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40
Q

type 1 renal tubular acidosis is associated with what

A

renal stones

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41
Q

what causes coeliacs disease

A

sensitivity to gluten

repeated exposure leads to villous atrophy and results in malabsorption

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42
Q

what conditions are coeliacs disease associated with

A 
dermatitis herpetiformis
autoimmune disorders (T1DM, autoimmune hepatitis)
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43
Q

what HLA are associated with coeliacs

A

HLA-DQ2

HLA-B8

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44
Q

signs and symptoms in coeliacs

A

chronic/intermittant diarrhoea
persistant/unexplained GI symptoms (N+V)
fatigue
weight loss

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45
Q

a 70y/o man presents with anorexia, weight loss, painless jaundice

A

pancreatic cancer

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46
Q

a 65-year-old woman presents with jaundice, weight loss and passing clay-coloured stools. She also describes recurrent bouts of colicky RUQ abdominal pain. On examination a mass is palpable in the RUQ

A

Cholangiocarcinoma

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47
Q

a 20-year-old woman presents with recurrent episodes of abdominal pain associated with bloating. The pain is relieved on defecation. She normal passes 3 loose stools with mucous in the mornings

A

Irritable bowel syndrome

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48
Q

a 20-year-old man presents with a 3 week history of bloody diarrhoea associated with tenesmus

A

Ulcerative colitis

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49
Q

what antibodies are looked for in coeliac screen

A

tissue transglutaminase antibodies

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50
Q

a 40y/o man presents with severe pain on the right side of his back. this comes in waves. on examination he is restless with blood on the urine dipstick

A

renal colic

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51
Q

renal colic - presenting pain

A

loin pain radiating to groin

-colicky

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52
Q

what would be found in the urine with renal colic

A

visible or non-visible haematuria may be present

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53
Q

what are the two types of IBD

A

UC

CD

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54
Q

what are commonly found in both UC and CD

A

diarrhoea
arthritis
erythema nodosum
pyoderma gangrenosum (ulcers)

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55
Q

is blood diarrhoea associated with UC or CD

A

UC

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56
Q

PSC associated with UC or CD

A

UC

57
Q

where does UC affect in the bowel

A

continuous disease
affects from rectum to ileocaecal valve
no inflammation beyond submucosa

58
Q

where does CD affect in the bowel

A

skip lesions
anywhere from mouth to anus
inflammation in all layers

59
Q

crypt abscesses - UC/CD
goblet cells - UC/CD
bowel obstruction - UC/CD

A

UC
CD
CD

60
Q

which IBD is associated with loss of haustrations

A

UC

61
Q

a 70/yo male presents with anorexia, weight loss, painless jaundice

A

pancreatic cancer

62
Q

give two examples of PPIs

A

omeprazole

lansoprazole

63
Q

what is the MOA for PPIs

A

reduce acid secretion in the stomach

irreversibly block H+/K+ ATPase of the gastric parietal cell

64
Q

a 65y/o woman presents with jaundice, weight loss, passing of clay-coloured stools, she describes bouts of colicky RUQ pain, OE a mass is palpable in the RUQ

A

cholangiocarcinoma

65
Q

what are the common features of a history of viral hepatitis

A

question may indicate foreign travel or IV drug use

nausea+vomiting
myalgia
RUQ pain

66
Q

what are the common features of a history of biliary colic

A

RUQ pain

  • colicky
  • usually begins suddenly and subsides gradually
  • often occurs after eating
67
Q

who does biliary colic commonly affect

A

“female, forties, fat”

68
Q

what are common features of a history of acute cholecystitis

A

RUQ pain

  • constant
  • more severe than biliary colic
69
Q

what condition is murphys sign associated with

A

acute cholecystitis

70
Q

what is charcots triad and what condition is it associated with

A

ascending cholangitis

1 fevers
2 RUQ pain
3 jaundice

71
Q

what is reynolds pentad

A

associated with ascending cholangitits

1 fevers
2 RUQ pain
3 jaundice
4 hypotension
5 confusion
72
Q

what are common features of a history of cholangiocarcinoma

A 
persistant biliary colic symptoms
weight loss
courvoisiers sign
sister mary joseph nodes
virchows node
73
Q

what is courvoisers sign

A

palpable mass in RUQ

74
Q

what is sister mary joseph nodes

A

periumbilical lyphadenopathy

75
Q

what are common features of a history of acute pancreatitis

A

severe epigastric pain
vomiting
tenderness

76
Q

what is cullens sign

A

sign of acute pancreatitis

periumbilical discolouration

77
Q

what is grey-turners sign

A

sign of acute pancreatitis

flank discolouration

78
Q

what are common features of a history of pancreatic cancer

A

painless jaundice

weight loss

79
Q

an overweight 45y/o woman presents with recurrent episodes of RUQ pain that is made worse by eating a fatty meal

A

biliary colic

80
Q

a 50y/o man presents with epigastric pain relieved by eating

A

duodenal ulcer

81
Q

painless jaundice

steatorrhoea

A

pancreatic cancer

82
Q

common pancreatic tumours

A

adenoncarcinoma (head of pancreas) - 80%

83
Q

risk factors for pancreatic cancer

A

age
smoking
diabetes
chronic pancreatitis

84
Q

features of pancreatic caner

A

painless jaundice
patients usually present in a non-specific way (weight loss, epigastric pain)
loss of exocrine function (steatorrhoea)

85
Q

A 20-year-old woman presents with recurrent episodes of abdominal pain associated with bloating. The pain is relieved on defecation. She normal passes 3 loose stools with mucous in the mornings

A

IBS

86
Q

a 45y/o woman presents with fatigue and pruritus, blood tests show raised bilirubin, ALP, IgM

A

primary biliary cirrhosis/cholangitis

87
Q

who is PBC commonly seen in

A

females

middle-aged

88
Q

classic presentation of PBC

A

pruritus/itching

in a middle aged woman

89
Q

clinical features of PBC

A 
early:
-asymptomatic
-raised ALP
later:
-jaundice
-hyperpigmentation (over pressure points)
-xanthalasma/xanthamata
90
Q

An obese 50-year-old woman presents with pain in the RUQ which radiates to the interscapular region. She is apyrexial and not jaundiced

A

biliary colic

91
Q

what is metoclopramide

A

antiemetic

D2 receptor antagonist

92
Q

side effects of metoclopramide

A

hyperprolactinaemia

parkinsonism

93
Q

gallstones is common in which IBD

A

CD

94
Q

A patient with a history of heartburn presents with odynophagia. There no weight loss, vomiting or anorexia

A

oesophagitis

95
Q

what are 4 common causes of dysphagia

A

oesophageal cancer
oesophagitis
achalasia
myasthenia gravis

96
Q

features of oesophageal cancer

A

dysphagia

  • associated with weight loss, vomiting during eating
  • PMH of barrett’s oesophagus, GORD, alcohol, smoking
97
Q

features of oesophagitis

A

dysphagia
odynophagia
history of heart burn

98
Q

features of achalasia

A

dysphagia of both liquids and solids from the start
heartburn
regurgitation

99
Q

features of myasthenia gravis

A

dysphagia

extraocular muscles weakness/ptosis

100
Q

A 70-year-old man with a history of benign prostatic hyperplasia presents with constant, severe suprapubic pai

A

urinary retention

101
Q

a 40-year-old man presents with severe pain on the right side of his back. This comes in waves. On examination he is restless with blood+ on the urine dipstick

A

renal colic

102
Q

a 35-year-old woman presents with pain on the right side of her back. This is constant and associated with fever and rigors

A

Acute pyelonephritis

103
Q

what is common in acute pylonephritis

A

loin pain
fevers + rigors
vomiting

104
Q

what is leukoplakia

A

oral mucosa white patches which do not run off

a premalignant lesions

105
Q

what are aphthous ulcers

A

small shallow ulcers in the mouth

associated with CD, coeliacs

106
Q

what is cheilitis (angular stomatitis)

A

inflammation and redness of the corners of the mouth

due to iron or riboflavin (B2) deficiency

107
Q

what is gingivitis

A

gum hypertrophy and inflammation

associated with AML

108
Q

what is glossitis

A

smooth, red, sore tongue

iron/b12/folate deficiency

109
Q

what is macroglossia

A

tongue enlargement

associated with myxoedema (hypothyroidism) and acromegaly

110
Q

how are causes of dysphagia classified

A

mechanical or obstructive
motility disorders
others

111
Q

what are mechanical or obstructive causes of dysphagia

A 
malignant strictures (oesophageal, gastric, pharyngeal cancer)
benign strictures (oesophageal web, peptic stricture)
extrinsic pressure (lung cancer, retrosternal goitre, LA enlargement)
pharyngeal pouch
112
Q

what are motility disorders which cause dysphagia

A

achalasia
diffuse oesophageal spasm
systemic sclerosis
bulbar palsy

113
Q

what are other causes of dysphagia

A

oesophagitis

114
Q

what questions must be asked in a dysphagia history and why

A

1 difficulty swallowing solids AND liquids from the start?
YES - motility disorder
NO - mechanical or obstructive (solids THEN liquids)
2 difficulty making swallowing movement?
YES - bulbar palsy
3 painful swallowing?
YES - malignancy or oesophageal ulcer
4 intermittant dysphagia or constant and worsening?
INTERMITTANT - oesophageal spasm
CONSTANT AND WORSENING - malignant strictures
5 neck bulge or gurgling on swallowing water?
YES - pharyngeal pouch

115
Q

what is achalasia

A

failure of relaxation of LOS due to degeneration of myenteric plexus

116
Q

what are features of achalasia

A

dysphagia (solids and liquids from the start)

regurgitation

117
Q

what does “coffee grounds” when vomiting indicate

A

GI bleeding

118
Q

what does food when vomiting indicate

A

gastric stasis or gastroenteritis

119
Q

what does feculant (containing fecal matter) indicate

A

small BO

120
Q

what does morning vomiting suggest

A

pregnancy

raised ICP

121
Q

what does vomiting 1hr post food suggest

A

gastric stasis

122
Q

what does vomiting which relieves pain suggest

A

peptic ulcer

123
Q

what are the “attackers” in PUD

A

gastric acid

H pylori

124
Q

what are the “defenders” in PUD

A

mucin secretion

bicarbonate secretion

125
Q

what are the GI red flag symptoms

A

ALARM Symptoms

Anaemia (iron deficiency which suggests GI bleeding)
Loss of weight
Anorexia
Recent onset or progressive symptoms
Meleana or haematemesis
Swallowing difficulty
126
Q

which ulcers are more common duodenal or gastric ulcers

A

duodenal

127
Q

what are the risk factors for duodenal ulcers

A

h. pylori
NSAIDs
steroids

128
Q

what are the risk factors for gastric ulcers

A

h. pylori
NSAIDs
smoking

129
Q

what are the symptoms in duodenal ulcers

A

epigastric pain

relieved by eating

130
Q

what are the symptoms in gastric ulcers

A

epigastric pain

worsened by eating

131
Q

how is diagnosis of duodenal ulcer made

A

upper GI endoscopy

132
Q

what is triple therapy

A

for eradication of h. pylori

one week of a full does PPI, amoxicillin (1g) and clarithromycin (500mg)

133
Q

complications of PUD

A

bleeding
perforation
malignancy

134
Q

what are the DDx for dyspepsia

A 
infection (h. pylori)
-gastric or duodenal uclers
inflammation
-oesphagitis
-gastritis
-duodenitis
malignancy (gastric)
135
Q

when should someone with dyspepsia be referred for endoscopy

A

> 55yrs

or ALARM Symptoms

136
Q

what is GORD

A

gastro-oesophageal reflux disease

reflux of acid with or without bile

137
Q

what are the types of hiatus hernia

A

1 sliding HH (80%)
-GOJ moves in to the chest and LOS becomes incompetent leading to reflux of acid with or without bile (GORD)
2 rolling HH (20%)
-part of stomach herniates into the chest while the GOJ remains in the same position, as the GOJ remains intact, the LOS is not affected so there is no reflux

138
Q

what is the first line investigation for a suspected hiatus hernia

A

barium swallow

Gastrointestinal (62 decks)

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