Gastro Flashcards
(191 cards)
1
Q
Ranking severity of UC/Crohns
A
Mild- <4 stools, minimal blood
Mod- 4-6- vary blood, no systemic
Severe- >6 bloody stools, systemic
2
Q
Scores for Upper GI bleed
A
Blatchford- determine if managed at OP- 0
Endoscopy within 24hrs
Rockall- after endoscopy- determines mortality and risk of rebreeding
3
Q
Mx of achalasia
A
Heller cardiomyotomy
CCB or nitrates, botox- since is a failure to relax
4
Q
Mx of crohns fistula and abscess
A
If symptomatic Oral metronidazole
If complex- draining seton
Abscess- incision and drainage
5
Q
Mx of crohns
A
Induce with steroids
Mild- Oral pred, severe- IV HC
Maintains with azathioprine or mecapto
6
Q
Ix of coeliac
A
Anti TTG
Jejunal biopsy or duodenal
7
Q
Mx of alcoholic hepatitis
A
Maddrey discriminant- benefit from Prednisilone
8
Q
Plummer Vinson Sx
A
Triad- dysphagia, glossitis, IDA
9
Q
Mx of UC
A
Inducing remission
Topical aminosalicylates
If not induced in 4 weeks add oral
Add CS if still not working
Extensive disease- topical and rectal 4w
CS after
Severe fulminant - IV steroids
Maintaining remission
Topical aminosalicylates- add oral
Extensive- oral
Severe or 2 or more relapses per year- azathioprine /mercaptopurine
10
Q
Areas where you get Haemorrhoids
A
3, 7, 11
11
Q
Signs in appendicitis
A
Rovsing- pain greater in RIF when pressure on left
Psoas- pain when extending hip
12
Q
Colic vs cholecystitis vs cholangitis
A
Pain- colic
Pain + fever- cholecystitis
Pain + fever + jaundice- cholangitis
13
Q
Mx of cholecystitis and cholangitis
A
IV Abx
Laparoscopic cholecystectomy within 1 week- cholecystitis
ERCP within 24-48hrs for cholangitis
14
Q
PBC vs PSC
A
PBS- anti-mitochondrial - diagnostic
Sjogrens
Middle aged women
Jaundice
PSC- pANCA
Intra and extra
Male
UC
Dx- with MRCP
15
Q
Chronic stable liver disease Sx
A
Palmar erythema
Dupuytrens
Clubbing
Gynaecomastia
Spider nave
16
Q
Sx of acute decompensation liver
A
Portal hypertension SAVE
Splenomegaly
Ascites
Varices
Encephalopathy
Failes synthetic funciton
GI can precipitate this
17
Q
Dx of SBP
A
USS to confirm ascites
Ascites tap- PMN >250
18
Q
Mx of SBP
A
Tazocin
Cipro and propanolol prophylaxisif ascites and SAAG <15
19
Q
Ix of Haemachromatosis
A
Raised ferritin
TIBC reduced- reduced transferrin production
TF saturation- >55% male, 50 female
Pearl stain of liver biopsy
20
Q
Acute Pancreatitis Sx
A
Epigastric pain
Cullen, grey turner
Vomitting
21
Q
Prognosis scoring of pancreatitis
A
PANCREAS
PaO2- <8
Age 55
Neuts- >15
Ca <2
Renal urea- >16
Enzymes- AST/ALT >200
Albumin <32
Sugar- >10
22
Q
Sx of chronic pancreatitis
A
Pain 15-30- mins after meal
Steatorrhoea
DM- 20 yrs after
23
Q
Ix for acute pancreatitis
A
Serum amylas, lipase
USS for stones
Contrast CT
24
Q
Ix for chronic pancreatitis
A
USS and contrast CT
Faecal elastase- reduced
25
Ix of diverticulitis
CT abdomen - acute
Barium enema- chronic
26
Mx of diverticulitis
Acute mild- PO ABx
Severe- IV ABx, drip and suck hartmanns
Chronic- high fibre diet
27
Urgent 2ww OGD
Dysphagia
Upper abdo mass
AGe >55 + weight loss and dyspepsia, gord, upper abdo pain
28
Non urgent OGD
Haematemesis
Age >55- pain with low Hb and pain, N+V with reflux, raised Plt and wt loss nausea
29
Ix for dyspepsia
If alarm features- OGD
No alarm- breath/stool test for H pylori
30
Mx of dyspepsia
Review medication
Then PPI 4w
Then test H pylori
31
Anal fissure mx acute and chronic
Acute- laxatives
Chronic- GTN then spincterectomy if not resolved after 8 weeks
32
Prognosis scoring of alcoholic hepatitis
Child Pugh
ABCDE
Albumin, Bilirubin, Clotting, distention (ascites), encephalopathy
33
Budd chiari syndrome Sx and IX
Block of hepatic vein
Pain, ascites, tender hepatomegaly
Abdo USS
34
Sx of carcinoid syndrome
Flushing, diarrhoea, bronchospasm
35
Perianal abcess Sx and Mx
Pain worse when sitting, discharge
Drain under local
36
Boerhaaves Sx
Chest pain
SC emphysema- air under skin
Vommiting
Shock
37
Ischaemic colitis Sx and Ix
Occlusion of IMA
Pain, bloody, large intestine- splenic flexure
Sigmoidoscopy
38
Acute vs chronic ischaemia
Acute- sudden, pain, normal exma
Chronic- colic pain
39
Small intestinal bowel overgrowth- RF, sx and mx
DM- risk factor
Chronic diarrhoea, flatulence and pain
Rifampicin
40
Pellagra sx
Diarrhoea, dermatitis, dementia
B3
41
Index for measuring malnutrition
MUST
42
Wilson disease sx
Liver
Neuro- psychiatric
43
Haemachromatosis
Fatigue, ED, arthralgia
Bronze skin
DM
Liver
CF
44
Mx of ascites secondary to liver disease
Spironolactone
45
Pharyngeal pouch sx
Halitosis
Problems swallowing
46
Dysphagia causes
Mechanical- stricture- Plummer vinson, malignancy, pharyngeal pouch
Neuro/motility- bulbar/pseudobulbar palsy, achalasia, CREST, MG
Inflammation- oesophagitis, candida, pharyngitis, tonsilitis
47
Achalasia Ix
Mamometry
Barium swallow
OGD- exclude malignancy
48
Oesophageal cancer Ix
Endoscopy and biopsy
If barium swallow- apple core
49
GORD sx
Acid taste
Worse laying down
Worse after eating
50
Mx of GORD
Lose wt, less alcohol
Antacids then PPI
51
Sx of duodenal ulcers
Epigastric pain before meals and at night
Relieved by eating
52
Ix of Peptic ulcers
Bloods, breath test, OGD- biopsy ulcers
53
Mx of perforated ulcer
DU: abdominal washout + omental patch repair
GU: excise ulcer and repair defect
No medical mx needed apart from stop meds that might be causing
54
Gallstone ileus Sx
Rigler triad- pneumobillia, SBO, gallstone in RLQ
55
CT signs of pancreatitis
Panc has lost its defined architecture
Fat stranding- CT
56
When is MRCP used
If dilated duct on USS - for CBD occlusions
PSC
57
Raised amylase weeks after acute panc
Pseudocyst
58
Tx of pancreatic pseudocyst
<6- spontaneous
>6cm- drainage
59
Complications of pancreatitis
Early
Resp- ARDS, effusion
Shock
Renal failure
DIC
Metabolic
Late- pancreatic necrosis, infection, access, thrombosis, pseudocyst
60
Chronic cholecystitis sx
Abdo discomfort
Sx exacerbated by fatty foods
Nausea
Flatulence
61
RF for cholangiocarcinoma
PSC
UC
62
Tx of cholagiocarcinoma
Poor prognosis: no curative Rx
Palliative stenting by ERCP
63
Differentials for appendicitis
Diverticulitis
Meckel diverticulitis
Ectopic- preg test !!!
Cyst torsion
UTI
64
Extra abdominal sx of IBD
Erythema nodosum
Clubbing
Arthritis
Iritis
65
Type of ulceration in each IBD
UC- shallow broad
Crohsn- deep, wavy- cobblestone mucosa
66
Microscopic features of UC and crohns
Crohns- fibrosis, granuloma, fistulae, goblet cells
Strictures- macro
UC- crypt abcsess, pseudopolyps
67
Ix of diverticula disease
Contrast CT
Colonoscopy- not in acute attack
Enema
68
Complications of diverticulitis and their Tx
Perf- sudden pain, shock- Hartmanns
Haemorrhage- painless red PR- mesenteric angio- may stop spon
Abcess- swinging fever- abs and drainage
Fistulae- enterocoelic SB and LB, colovaingal, colovesicular- resection
Strcitutres- resection or standing
69
Types of bowel obstruction
Simple- 1 obstruction
Closed- 2 points- volvulus
Strangulated- localised, constant pain, peritoneum, fever, High WCC
70
Tx of Bowel obstruction
Medical- Drip and suck
NBM
Fluids
Catheterise- monitor UO
Analagesia
ABx
Gastrogaffin study
Surgical- if closed, strangulated
71
Colorectal cancer Ix
Bloods
FBC: Hb
LFTs: mets
Tumour Marker: CEA
Imagining- CXR, CT and MRI- better for rectal and liver
Endoscopy + biopsy
72
TNM staging of colorectal cancer
TIS: carcinoma in situ
T1: submucosa
T2: muscularis propria
T3: subserosa
T4: through the serosa to adjacent organs
N1: 1-3 nodes
N2: >4 nodes
73
Dukes staging
A- bowel wall- 90% 5 yr
B- through wall no LN- 60%
C- regional LN- 30%
D- distant- <10%
74
Differentials for anal pain
Proctalgia fugax- crampy anal pain in young men at night
Anal fissure - pain when defacating, fresh bleed, constipated
Thrombosed haemorrhoid
Fistula- discharge persistent
Peri anal abscess- worse on sitting, fever
75
Surgery for Femoral hernia
Need surgery ASAP
Elective- Lockwood- herniotomy and herniorrharpy
Emergency- McEvedy- allows resection of non viable bowel
76
How anal fistulas are treated
Low- fistulotomy- heals as flat scar
High- suture- tighten it over months
77
Inducing remission UC
Topical mesalazine
Mod- add oral
Sev- Add CS
>/= 2 relapses or severe- azathioprine or mercaptopurine
78
Maintaining remission UC
Mild-mod- topical /+ oral
Extensive- oral
Severe/ >2 in a year- oral azathioprine or mercapto
79
What type of oesophageal cancers are found where
Adeno- bottom 1/3
Squamous- middle 1/3
80
Prophylaxis of variceal bleed
Beta blockers- propanolol
Endoscopic variceal band ligation
81
Acute tx of variceal bleed
ABC
FFP, Vit K
Terlipressin
IV ABx
During endoscopy- band ligation
If uncontrollable bleed and too long for endoscopy- sengstaken Blakemore tube
After- propanolol
82
Wilsons disease Sx
Neuro- incoordination basal, psychiatric
Liver - cirrhosis
Kayser Fleischer
Blue nails
83
Ix for Wilsons
Reduced caeruloplasmin
Reduced copper
84
Tx of Wilsons
Penicillamine
85
Flare up with chronic Hep B infection
Hep D superinfection
Jaundice, fever, pruritus
86
Mx of C diff
Oral vancomycin
2nd- fidaxomicin
3rd- Oral Vancomycin +/- iv met
87
Which artery can be damaged and caused massive GI bleed with ulcers
Gastroduodenal ulcer
88
Most common cause of chronic pancreatitis
Alcohol abuse
89
Haemachromatosis iron studies
TS- high
Ferritin- high- correlate to iron storage
TIBC- low
90
Travellers diarrhoea organism
ETEC
91
Dull ache of RUQ with mildly raised ALT with HF
Congestive hepatomegaly
92
Which anti-emetic to avoid in bowel obstruction
Metoclopramide
93
Deficiency in what causes wernickes encephalitis
Thiamine
B1
94
SE of PPI
OP and fractures
95
Puetz jeghers sx
Obstruction
Freckles on lips
96
Met Bowel cancer causing obstruction, what drugs in syringe driver
Hyoscrine and morphine
97
Drugs to prevent hepatic encephalopathy
Lactulose and riftximin
98
Mx of massive variceal bleed
Terlipressin
Sengstaken Blakemore tube
Endoscopic ligation
99
Niacin deficiency sx
Dermatitis
Dementia
Diarrhoea
Pellagre
100
Small bowel overgrowth syndrome sx
Chronic diarrhoea
Bloating, flatulence
Abdo pain
101
SBOS dx
Hydrogen breath test
102
Tx of haemachromatosis
Venesection 1st
Desferrioxamine 2nd
103
What can exacerbate NAFLD
Sudden weight loss
104
SE clindamycin that patients should be made aware of
C diff
105
Triad of Budd chiari
Sudden severe abdo pain
Ascites
Tender hepatomegaly
106
Ix of Budd chiari
US with doppler flow
107
What is prescribed with large paracentesis
IV Human albumin solution
108
Sx of achalasia
Dysphagia of food and liquids from the start
Heartburn
109
What is the most specific and sensitive lab marker for CLD turning into cirrhosis
Plt <150
110
Screening for PCKD
US
111
What is used to monitor tx in haemachromatosis
Ferritin
Transferrin saturation
112
Vaccine for coeliac
Pneumococcal
Due to hyposplenism
113
Haemachromatosis inheritance
AR
114
Mx of chronic anal fissure
Topical GTN if not effective after 8 weeks
Consider surgery or botulism
115
When should you refer urgent 2ww colorectal
>40 with unexplained wt loss and abdo pain
>50 unexplained rectal bleeding
>60 with IDA or bowel habit change
116
Refeeding syndrome sx
Low phosphate, potassium, Mg, abnormal fluid balance, arrhythmia
117
Tx of ascites medically
Spironolactone
118
Grading hepatic encephalopathy
1- irritable
2- confusion
3- incoherent
4- coma
119
Tx of H pylori with pen allergy
Clarithro, metronidazole, omeprazole
120
Skin signs in abdo exam
Erythema nodosum- on shins- IBD
Pyodeerma gangrenosum- ulcer- IBD
Jaundice- liver
Slate grey- Haema
121
Scars in abdo exam and uses
Kocher- biliary
Rutherford morrison- kidney transplant
Nephrectomy- lower midline
Laparotomy- AAA, Hartmans
Xanthelasma- PBC
122
Signs in chronic liver diases
Hands- dupuytrens, clubbing, leuconychia, erythema
Asterixis, ascites - decomp
Spider naevi, gynaecomastia
Jaundice
Splenomegaly
123
Causes of cirrhosis
Alcohol
Hep B and C
AI Hep
PBC, PSC
Wilsons
Haemachromatosis
NAFLD
Budd chiari
A1AT
124
Cause of ascites
Chronic liver disease
Malignancy
Nephrotic syndrome
125
Areas where hepatitis is prevalent
Africa
Asia
126
Anal fissure tx
Laxatives and high fibre
Chronic- topical GTN
Resistant- sphincterotomy
127
If dysplasia on endoscopy in barrels what is mx
EMR- resection
128
Electrolyte imbalance caused by diarrhoea
Metabolic acidosis with low K
129
Organism in ascites
E coli
130
Blood results of upper GI bleed
High urea
Anaemic
131
Description of NAFLD on USS
Increased echogenicity
132
What is dx of malnutrition
>wt loss than 10% in 3-6 months
133
Tx of IBS diarrhoea
Loperamide
134
Maintaining remission with crohns
Mercaptopurine or azathioprine
135
If TMPT + in crowns what should be used in remission
Methotrexate
136
Tx of C diff if repeat episode within 12 weeks
Fidoxomicin
137
Intestinal angina/ chronic mesenteric ischaemia sx
Triad- colicky pain, weight loss, abdominal bruit
138
When to stop statins
When 3x ULN LFTs
139
Peritonitis secondary to peritoneal dialysis organism
Staph epidermis
140
Tx of fistula in crohns
Seton
141
Which drug is a RF for C diff that's not an AB
PPI
142
Women with deranged LFTs and secondary amenorrhea ant tx
AI Hepatitis
Steroids- liver transplant
143
If pernicious anaemia which cancer predisposed to
Gastric
144
What changes the efficacy of hydrogen breath test
Antibiotics in last 4 weeks
PPIs in last 2
145
Appendicitis symptoms what ix
USS
146
How TIPS works, what it treats and its complications
Shunt from portal vein to hepatic to bypass liver for variceal bleeds
As bypassing liver- can cause build up of nitrogen waste products
147
Puetz Jeghers sx
Hamartomas
Freckled lips
148
Ix for liver cirrhosis
Transient elastography
149
When to ix for liver cirrhosis
Hep C infection
>50 units men, 35 women
Alcohol related LD
150
Ix of ascites
USS then tap
confirm for SBP
151
Lymphoma associated with coeliac
Enteropathy T cell lymphoma
152
Diarrhoea causes what metabolic disturbance
Acidosis normal anion gap
153
Cause of highly pigmented colon
Laxative abuse
Melanosis coli
154
Tx of AI hepatitis
Steroids
155
If going for diagnostic biopsy for coeliac what should the patient continue to do
Eat gluten
156
Dysentry after long incubation
Amoebi
157
Nicorandil SE
GI ulceration
158
Most common complaint of peutz jegher syndrome
Small bowel obstruction
159
How does pseudomembranous colitis look on sigmoidoscopy
Yellow plaques in lumen
160
Cause of IDA returning from India
Hookworm
161
If H pylori + but have ALARMD sx what do you do
Endoscopy- main - if ALARMD sx or >55
Treat H pylori too- usually if <55
ALARMD- anaemia, Loss of weight, anorexia, recent, Selena, dysphagia
162
Prev severe UC remission tx
Azathioprine
163
Ix for mesenteric ischaemia
VBG- lactate
164
Life threatening C diff infection
Hypotension
Toxic megacolon
Then treat with oral vans and IV met
165
Gluten free common foods
Rice, maize/corn, potatoes
166
Tx of campylobacter
Clarithromycin
167
Dx of carcinoid
Urinary 5 HIAA
168
Main causes of pruitis
IDA
Lymphoma
Polycythaemia
Liver failure
CKD
169
Hepatocellular carinoma marker
AFP
170
Floating stools coming back from Egypt/Russia
Giardia- long incubation period
Long lasting
171
Tx of PSC
Observe
?liver transplant
172
Good indication alcoholic hepatitis needs steroids
High PT and Bilirubin
In Maddrey Discriminant
173
What is caecal volvulus associated with
Malignancy
174
Gastrectomy complications
Dumping sydrome- sugar moves too fast into bowel
Casues- distention, flushing, fainting, sweating
175
Hep A tx and cancer lieklehood
No increase in chance of cancer
Supportive tx
176
Tx of Hep B
Peginterferon alfa-2a
177
Foul smelling discharge at old age and constipated
Diverticulitis- fistula
178
What is CI in bowel obstruction
Laparascopic surgery
179
How should total parenteral nutrition be administered
Through central vein
180
Spider nevi vs telangiectasia
SN- fill centrally
181
What causes dupytres contraction
Alcoholic liver disease
182
Bloody supply of each section in gut
Foregut- coeliac- until 2nd duodenum
Mindgut- SMA- 2/3 along transverse
Hindgut- IMA- rectum
183
What can cause decompensation of cirrhosis
Alcohol, Bleeding, Constipation, drugs, infection
184
AB in AI Hepatitis
Anti Smooth muscle
ANA
Raised IgG
ALKM- types 2
185
UC on barium enema
whole colon, without skip lesions, is affected by an irregular mucosa with loss of normal haustral markings
186
Checking NG tube is in correct position
If pH <5.5
If unable to get aspirate or pH isn't acidic- get CXR
187
Smoking in IBD
Increases relapse in Crohns
Decreases in UC
188
UC on x ray
Lead pipe
189
What to do with PPI before endoscopy
Stop 2 weeks before
190
Liver transplant guidance for paracetamol
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
191
Pedunculated polyps colon cancer
Adenoma
