Name of the nerve that supplies the rectum
S4, inferior rectal nerve
What is the treatment of H. Pylori?
TRIPLE THERAPY
Omeprazole + Amoxicillin + Clarithromycin
(Metronidazole if Pen allergic)
Which ulcer type does food worsen the symptoms of?
Gastric Ulcer
Which ulcer type does food relieve symptoms of?
Duodenal Ulcer
What is the treatment for acute hepatitis?
Supportive
What is the treatment for chronic hepatitis?
interferon alpha or antiviral (tenofovir)
How is Hep C transmitted and tested for?
Blood borne and sexual transmission
PCR
What is present in all infectious individuals with Hep B?
HbsAg
What does the presence of HBsAg mean?
Had previous infection, acute or chronic
What does the presence of AntiHBsAg mean?
Clinical recovery and immunity
What does the presence of HBeAg mean?
Highly infectious individual
What does the presence of IgM antiHBc mean?
Acute infection
What does the presence of IgG antiHBc mean?
Chronic Infection
Where is Hepatitis E found and how is it spread?
Contaminated/undercooked food
Faecal/oral route
Tropics - Pigs
Hep D only occurs with what hepatitis?
Hep B
What is Bird beak appearance indicative of?
Achalasia
What are the treatment options for achalasia?
Hellers cardiomyotomy
Balloon Dilatation
List treatment of oesophageal varices and acute presentation
Correct clotting abnormalities
IV Terlipressin
Banding
Sengstaken blakemore tube
List prophylactic measures taken for oesophageal varices and acute presentation
Beta-blockers
Upper GI endoscopy (EGD) and banding
TIPSS
List features of Crohn’s disease
Cobblestone mucosa
Recurrent oral stomatitis
Deep fissuring ulceration of mucosa
List the treatment of Crohn’s Disease in order
Corticosteroids - Prednisolone
Immunosuppression - Azathioprine
Anti TNF - infliximab
Surgery - Bowel resection
What is the treatment of a severe flare up of Crohn’s Disease
IV corticosteroids - methylprednisolone
What is Barret’s Oesophagus?
Stratified squamous epithelium metaplasia to simple columnar epithelium with goblet cells
What can be related to positive murphy’s sign?
Cholecystitis, ascending cholangitis
Define dukes stage A
Tumour confined to mucosa
Define Dukes stage B
Tumour invaded through bowel wall
Define Dukes stage C
Involvement of local lymph nodes
Define Dukes stage D
Distant metastasis
How is ascites treated ?
Spironolactone
What are the side affects of spironolactone?
Gynaecomastia
Hyperkalaemia (risk of arrhythmias)
What is thumb printing at the splenic fixture indicative of?
Ischaemic colitis
What type of food take longest to digest?
Fatty foods
Sepsis - BUFALO (give 3, take 3)
Take Bloods Measure Urine output Give fluids Give antibiotics Measure lactate Give Oxygen
What is Wilsons disease and what can be seen?
Excess copper
Kayser-Fleischer rings
What is Grey turners sign (lumbar redness) and cullens signs (umbilical redness) indicative of?
Acute Pancreatitis
What does acute pancreatitis cause a high raise in?
Very raised Amylase + Vomiting
List the causes of Pancreatitis (I GET SMASHED)
Idiopathic Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion sting Hypothermia/hyperlipidaemia ERCP Drugs
What is Virchows node?
Left supraclavicular lymph node
What does the presence of Virchows node indicate?
gastric cancer
What is the most common type of gastric cancer?
Adenocarcinoma
What does intestinal gastric cancer form?
polypoid mass
What type of cancer forms signet ring cells on biopsy?
Diffuse gastric cancer
What gastric cancer can develop into a high grade B cell lymphoma?
Maltoma
What does GISTS stand for?
Gastrointestinal Stromal Tumours (type of sarcoma)
Hepatocellular carcinoma can be identified by measuring what?
Alphafeto protein
What is indicated by a corkscrew oesophagus on barium swallow?
Diffuse oesophageal spasm
Abdominal pain and diarrhoea after sour milk or shellfish is caused by?
Campylobacter
What is Charcot’s triad?
Fever
Jaundice
Abdominal pain
What is Charcot’s triad indicative of?
Acute Cholangitis
What is short bowel syndrome?
<2m of functional small intestine mostly due to surgical resection
What is secreted by parietal cells and what stimulates them?
Secrete HCl
Intrinsic factor (absorption of B12)
Gastrin stimulates parietal cell to secrete HCl
What do Chief cells release?
Pepsinogen (inactive precursor to pepsin)
What cells secrete histamine?
Enterochromaffin like cell (stimulate HCl production)
What cells secrete Gastrin?
G cells (stimulate HCl production)
What cells secrete somatostatin?
D cell (inhibit HCl secretion)
What result does vagal stimulation have on acid production?
Increases secretion of substances in favour of acid production
What is Zollinger-Ellison syndrome?
Gastrin secreting tumour resulting in overproduction of gastric acid and recurrent peptic ulcers
How is Zollinger-Ellison syndrome managed?
High dose PPI
Name a common complication of IBD
Toxic Megacolon
List the management for UC in order
1st line 5-ASA (Mesalazine) Corticosteroids (prednisolone, budesonide) Immunosuppression (Azathioprine) Anti TNF (Infliximab) Curative surgery
What is the treatment for haemochromatosis?
Phlebotomy
What is Leukonychia and what causes it?
White marks on nails caused by hypoalbuminaemia
What is Koilonychia and what causes it?
Nail spooning caused by iron deficiency anaemia
What is pre-hepatic jaundice?
Excess haemolysis
What is intra-hepatic jaundice?
Defects in the conjugation of bilirubin within the liver leading to hepatocellular damage and intrahepatic cholestasis
What is Post hepatic jaundice?
Obstruction to the bile outflow
What would be the expected test results for pre-hepatic jaundice? (LFT, Stool & Urine)
LFT - Normal, raised unconjugated bilirubin
Stool - Normal
Urine - Normal
What would be the expected test results for intra-hepatic jaundice? (LFT, Stool & Urine
LFT - Raised AST/ALT, raised conjugated/unconjugated bilirubin
Stool - Normal
Urine - Dark, raised urobilinogen
What would be the expected test results for post-hepatic jaundice? (LFT, Stool & Urine
LFT - Raised ALP/GGT, raised conjugated bilirubin
Stool - Pale
Urine - Dark, reduced urobilinogen
What are Mallory hyaline bodies (histology) indicative of?
Alcoholic liver disease
What is the pelvic floor muscle important in urination and defecation
Levator ani muscle (it must relax)
At what vertebral level does the Coeliac trunk arise?
T12
What does the coeliac trunk split into? (trifurcates)
Splenic artery
Hepatic artery
Left gastric artery
At which vertebral level does the Vena Cava pass through the diaphragm?
T8 Vena Cava (8 letters)
At which vertebral level does the oesophagus pass through the diaphragm?
T10
Oesophagus (10 letters)
At which vertebral level does the aortic hiatus pass through the diaphragm?
T12 Aortic Hiatus (12 letters)
What is the lowest part of the peritoneal cavity when supine?
Hepatorenal recess
What is the area between the rectum and uterus in females?
Rectovesical pouch
The muscle of the check that moves during mastication
Buccinator
What is the antibodies associated with Primary Biliary Cirrhosis?
Anti-mitochondrial antibody (AMA)
What is the antibodies associated with Autoimmune Hepatitis?
Anti-smooth muscle antibody (ASMA)
What is the antibodies associated with Hepatocellular Carcinoma?
Alphafeto protein
What are the antibodies associated with Coeliac Disease?
Anti-transglutaminase antibody, anti-endomysial antibody
What are the antibodies associated with UC and PSC?
perinuclear-ANCA (pANCA)
What is the antibodies associated with Primary Sclerosing Cholangitis?
Antineutrophil Cytoplasmic Antibodies (ANCA) (cANCA)
What antibodies and symptoms can be associated with Pancreatitis?
Raised amylase, lipase, vomiting, pain
What antibody is associated with Ovarian Cancer?
CA-125
Colicky pain radiating to the groin
Ureteric Colic
Jaundice and constant right upper quadrant (RUQ) pain
Biliary Colic
Severe Epigastric pain radiating to the back
Acute Pancreatitis
Abdominal or back pain with a pulsatile mass
Abdominal Aortic Aneurysm
Iliac fossa pain, positive pregnancy test
Ectopic Pregnancy
What are the true LFT’s?
Albumin
Billirubin
Prothrombin Time
Which type of bilirubin is insoluble?
Unconjugated
What LFT’s are liver damage tests?
ALP
ALT
GGT
AST
What LFT is also raised in bone problems?
ALP
What LFT is raised in liver problems?
ALT
What LFT is an acute liver marker?
Prothrombin time (acute hepatocyte function marker)
What LFT is a chronic liver marker?
Albumin (Chronic hepatocyte function)
