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2A - Stuff i just cannot remember > GI > Flashcards

GI Flashcards

1
Q

Acute Cholangitis presentations

A

CHARCOT’s triad:
Biliary pain (RUQ)
Fever
Jaundice

Pale stool, pruritus

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2
Q

Gold standard investigation for Acute Cholangitis

A

ERCP - endoscopic retrograde cholangiopancreatography + biopsy

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3
Q

Gold standard investigation for Primary Biliary Cholangitis

A

PBC-antibodies + elevated alkaline phosphatase.

Common Ab = AMAs (anti-mitochondrial)

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4
Q

Management of Primary Biliary Cholangitis

A

ursodeoxycholic acid

(bile acid analogue) + prednisolone

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5
Q

Management of Acute Cholecystitis

A

Early Laparoscopic Cholecystectomy (w/in 1 week)

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6
Q

Management of Acute Cholangitis

A

Abx + ERCRP drainage + decompression

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7
Q

Presentation of Acute Cholecystitis

A

Inflamed gallbladder, biliary pain >8hr. Murphy’s sign.

RUQ/epigastric pain (radiating to right shoulder tip if the diaphragm is irritated)
Fever, N/V
Tender RUQ
Murphy’s sign positive

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8
Q

Presentation of Choledocholithiasis

A

Colicky RUQ pain
Worse after eating
No fever
Murphy’s sign negative

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9
Q

Chronic cholecystitis presentations

A 
Flatulent dyspepsia
Minimal abd pain
Nausea
Bloating
Sometimes colicky pain

Worse after fatty meal

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10
Q

An X-ray demonstrating pneumobilia + dilated small bowel indicates…

A

Gallstone ileus

Complication: small bowel obstruction

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11
Q

Pt presents with dull, aching LUQ pain. They have a low-grade fever, feel nauseous and are vomiting. They’ve noticed abnormal bowel movements.

Likely cause?
Treatment?

A

Diverticulitis

  • E coli
  • B fragilis

Uncomplicated: Co-amoxiclav, ciprofloxacin + metronidazole

Complicated: piperacillin-tazobactam

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12
Q

Pt presents with faecal-like vomiting, constipation and abdominal pain + distension. They have a PHx of Crohn’s.

Likely cause? Management?

A

Small Bowel Obstruction

Nasogastric decompression

IV Fluid

Laparotomy

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13
Q

Pt presents with rapid abdominal distention, and intermittent pain.

They have been unable to pass wind OR faeces.

Likely cause? Treatment

A

Large bowel obstruction

Nasogastric Compression

IV Fluid

Laparotomy

IV Neostigmine if CT finds pseudo-obstruction

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14
Q

Squamous Cell Carcinomas occur where in the oesophagus? What are the RFs for SSCs?

A

Upper 2/3

Alcohol, smoking

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15
Q

Adenocarcinomas occur where in the oesophagus? What are the RFs for Adenocarcinomas?

A

Lower 1/3

Barret’s/ GORD, gland.

= most common!

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16
Q

Pt presents with lymphadenopathy and abdominal pain. They are being treated for Pernicious anaemia.

Likely cause? Other RFs?

A

Adenocarcinoma (epithelial) of the stomach.

RF: H pylori, N-nitroso, Pernicious anaemia

17
Q

Who should undergo a prophylactic proctocolectomy?

A

Someone with an APC mutation - Familial Adenomatous Polyposis

Huge risk of developing colon cancer

18
Q

What percentage of colorectal cancers occur in the colon vs rectum?

A

Colon - 71%

Rectum - 29%

19
Q

What would a biopsy show in a pt with Barrett’s oesophagous?

A

Lower 1/3 stratified squamous > stratified columnar.

Oesophagoscopy - salmon mucosa

20
Q

Pt presents with upper web, post-cricoid dysphagia and is found to have iron-deficiency anaemia.

What is the diagnosis?

A

Plummer-vinson Syndrome (Squamous Cell Carcinoma)

21
Q

GORD Management

A

PPI - Omeprazole

+/- Adjunct Famotidine (H2A)

22
Q

Pt presents with upper abdominal pain which is worse when hungry, and eased with eating. They’re also bloated and nauseous/ vomiting

They are taking aspirin, steroids, are on SSRIs and are Blood-type O.

Likely diagnosis?

A

DUODENAL Ulcer

23
Q

Pt presents with upper abdominal pain which is worse when hungry, and eased with eating. They’re also bloated and nauseous/ vomiting.

They were recently diagnosed with H pylori, and live a stressful lifestyle.

Likely diagnosis?

A

GASTRIC Ulcer

*Other RF include anything that delays gastric emptying + NSAIDs

24
Q

Management of Peptic Ulcer Disease

A

ie duodenal/ gastric ulcers

4-8 wk PPI - Omeprazole

If H Pylori:
PPI + 2 ABx
- Amoxicillin + Clarithromycin 1wk

If penicillin allergy: Metronidazole + Clarithromycin

25
Q

Ulcerative colitis endoscopy shows

A

Crypt abscesses

26
Q

Crohn’s endoscopy shows

A

NON-caseating TRANSMURAL inflammation in SKIP lesions

Broad linear, transverse, longitudinal ulcerations + inflamed mucosa

27
Q

Coeliac disease endoscopy shows

A

Villous atrophy
Crypt hyperplasia
Lymphocytic infiltration

28
Q

Extra intestinal symptoms of ulcerative colitis

A

Arthritis
Conjunctivitis
Clubbing
Pyoderma Gangrenosum

29
Q

Pt presents with severe abdominal pain. The pain is episodic and exacerbated by eating. You suspect an ulcer.

Investigations?

A

1L

  • 13c Urea Breath Test (H pylori?)
  • Stool Antigen test

GOLD: Upper GI endoscopy

30
Q

GORD Mx

A

1L: PPI - Lansoprazole

2L: H2 receptor blocker - Ranitidine

31
Q

65-M presents with intermittent rectal bleesing. He has experienced diarrhoea + feeling of incomplete bowel emptying for 8 months. He has lost 8kg recently.

Likely diagnosis? Investigations?

A

Colorectal cancer

  • tenesmus
  • rectal bleeding
  • wt loss

GOLD: Colonoscopy

32
Q

Severe UC criteria

A

Truelove and Witt’s:

  • > 6 stools in 1 day
  • 1 day of:
    • HR>90
    • Temp >37.5
    • Hb<10.5
    • ESR >30mmol/L

Admit to hospital!

33
Q

Smoking in Crohn’s and UC

A

Crohn’s: Smoking = RF

UC: Smoking = protective

34
Q

Lynch syndrome is a RF for which cancer?

A

Genetic predisposition to non-polyposis colorectal cancer

35
Q

P tis recovering from resection of the ileo-cecal bowel.

Supplement?

A

B12

  • absorbed in terminal ileum
  • no ileo-cecal section = no IF-B12 absorption
36
Q

Histological change in Barrett’s

How many progress to cancer? What kind of cancer?

A

Metaplasia

Stratified squamous > SIMPLE columnar epithelium

(stomach lining moves UP into oesophagus)

10% > adenocarcinoma

37
Q

Causes of gastritis

A

1) H PYLORI - urea breath test

  • HSV
  • Cytomegalovirus
  • Duodenogastroreflux
  • Crohn’s
38
Q

Describe C diff in Microbiology terms

What increases the risk of getting C diff?

A

GRAM POSITIVE BACILLIS

ANAEROBIC

Hospitalisation + tx with Cephalosporins (Ceftriaxone - meningitis, pneumoniae)

2A - Stuff i just cannot remember (19 decks)

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