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Gastro Flashcards

1
Q

acute pancreatitis causes

A

GET SMASHED
Gallstones (female)
Ethanol (male)
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hypercalcaemia
ERCP
Drugs: azathioprine, thiazides, mesalazine

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2
Q

acute pancreatitis symptoms

A
  • severe epigastric pain radiates to back
  • nausea and vomiting
  • fever
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3
Q

acute pancreatitis signs

A
  • Grey turner’s: flank bruising
  • Cullen’s: periumbilical bruising
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4
Q

acute pancreatitis bloods

A
  • high serum amylase & lipase (more specific)
  • FBC: high WCC
  • high CRP
  • low calcium
  • LFTs: high ALT suggests gallstones
  • blood gas
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5
Q

acute pancreatitis imaging

A

CT abdomen
US for gallstones

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6
Q

acute pancreatitis severity score

A

Glasgow score: PANCREAS
PO2 < 8
Age > 55
Neutrophils (WCC > 15)
Calcium < 2
Renal (urea > 16)
Enzymes (ALT > 200)
Albumin < 32
Sugar > 10

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7
Q

acute pancreatitis management

A

IV fluids (most important)
IV antibiotics
NGT if vomiting (prefer oral nutrition)
analgesia
antiemetics
oxygen if hypoxic

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8
Q

acute pancreatitis complications

A

pancreatic pseudocyst
chronic pancreatitis
abscess
ARDS
AKI
septic shock

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9
Q

chronic pancreatitis presentation

A

diabetes (annual HbA1c)
loose floaty stools (malabsorption)

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10
Q

chronic pancreatitis causes

A

on going alcohol use

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11
Q

chronic pancreatitis investigations

A

faecal elastase
CT abdomen calcification

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12
Q

chronic pancreatitis management

A

enzyme replacement (Creon)

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13
Q

acute cholangitis causes

A

common bile duct obstruction causes E Coli infection
- gallstones
- iatrogenic strictures

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14
Q

acute cholangitis presentation

A

Charcot’s triad
1. fever
2. RUQ pain
3. jaundice (pruritus, pale stools, dark urine)

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15
Q

acute cholangitis bloods

A
  • FBC: high WCC
  • high CRP
  • LFTs: high ALP, high bilirubin
  • blood culture
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16
Q

acute cholangitis imaging

A

first line: US for all RUQ pain
diagnostic: ERCP (MRCP if uncertain)

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17
Q

acute cholangitis management

A

i) ERCP + fluids + antibiotics + analgesia
ii) elective lap cholecystectomy

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18
Q

acute cholangitis complications

A

bile duct perforation -> sepsis
ERCP complications (pancreatitis)

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19
Q

ulcerative colitis with jaundice, raised ALP?

A

primary sclerosing cholangitis

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20
Q

PSC antibodies

A

p-ANCA

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21
Q

first line management of PSC

A

ursodeoxycholic acid

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22
Q

complication of PSC

A

cholangiocarcinoma

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23
Q

PSC investigations

A

MRCP/ERCP

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24
Q

pancreatic cancer histology

A

adenocarcinoma

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25
pancreatic cancer risk factors
old, smoking, diabetes, chronic pancreatitis Lynch syndrome, MEN
26
pancreatic cancer presentation
painless jaundice palpable gallbladder FLAWS steatorrhoea (difficult to flush stool) Trousseau sign
27
pancreatic cancer cancer marker
Ca19-9
28
pancreatic cancer imaging
first line: US for jaundice diagnostic and staging: CT abdomen
29
pancreatic cancer management
chemo + Whipple + enzyme replacement palliative: ERCP stent
30
pancreatic cancer LFTs
high ALP, high bilirubin
31
acute cholecystitis causes
gallstone obstructing cystic duct
32
acute cholecystitis presentation
fever RUQ pain no jaundice Murphy's sign: pain with palpation on inspiration
33
acute cholecystitis bloods
high WCC, high CRP normal lipase & amylase (exclude pancreatitis) LFTs (not too bad)
34
acute cholecystitis imaging
no sepsis: US sepsis: CT abdomen (gallbladder empyema, perforation)
35
acute cholecystitis management
fluids + antibiotics + analgesia + lap chole within 1 week
36
acute cholecystitis complications
- gallbladder empyema - perforation - gallstone ileus (SBO)
37
cholelithiasis vs choledocholithiasis
cholelithiasis: stones in gallbladder choledocholithiasis: stones in common bile duct
38
gallstones risk factors
- 5 Fs Fat (cholesterol stones) Forty Female Fair (haemoglobinopathy - Sickle cell) Fertile (pregnant, OCP) - Crohn's
39
biliary colic presentation
RUQ pain after a meal
40
biliary colic investigations
normal LFTs normal FBC normal amylase & lipase abdominal US
41
biliary colic management
analgesia + elective lap chole
42
cholestatic drugs
co-amoxiclav macrolides (clarithromycin, erythromycin) oral contraceptive testosterone sulphonylureas
43
3 features of Crohn's histology seen in biopsy
transmural inflammation increased goblet cells non-caseating granulomas
44
2 features of Crohn's seen in colonoscopy
cobblestone appearance skip lesions
45
site affected by Crohn's
anywhere from mouth to anus commonly terminal ileum and perianal lesions
46
biggest risk factor that worsens Crohns
smoking
47
3 GI symptoms of Crohn's
RIF pain diarrhoea with mucus weight loss
48
4 extra-intestinal symptoms of Crohn's
mouth ulcers joint pain erythema nodosum pyoderma gangrenosum
49
what is seen in an abdominal X-ray in Crohn's
bowel dilatation
50
what is seen in Barium enema single contrast in Crohn's
string of Kantor rose thorn ulcer
51
how to induce remission in Crohn's
- steroids - IV hydrocortisone if severe - oral prednisolone if mild/moderate)
52
3 complications associated with Crohn's
gallstones fistula & abscess small bowel obstruction
53
diagnostic investigation in IBD
colonoscopy and biopsy
54
3 features of UC histology seen in biopsy
inflammation only in mucosa crypt abscesses goblet cell depletion
55
2 features of UC seen in colonoscopy
continuous inflammation pseudopolyps
56
site of inflammation in UC
rectum and colon
57
gene for UC
HLA B27
58
smoking in UC
smoking is protective in UC
59
3 gastrointestinal features of UC
bloody diarrhoea tenesmus LLQ pain
60
4 extra-intestinal features of UC
ankylosing spondylitis eyes erythema nodosum pyoderma gangrenosum
61
abdominal X-ray in UC
thumbprinting
62
what is seen in Barium enema double contrast in UC
lead pipe appearance (loss of haustrations)
63
how to classify UC flares
- Mild: <4 stools a day - Moderate: 4-6 stools a day with no systemic upset - Severe: systemic upset (fever, CRP)
64
how to induce remission in mild/moderate UC
i) rectal mesalazine ii) oral mesalazine iii) oral prednisolone if above ineffective
65
how to induce remission in severe UC
IV hydrocortisone in hospital
66
how to maintain remission after mild/moderate UC flare
mesalazine
67
how to maintain remission after severe UC flare
azathioprine
68
complications of UC
- toxic megacolon - colon cancer - primary sclerosing cholangitis leading to cholangiocarcinoma
69
4 causes of a gastrointestinal perforation
- perforated ulcer (most common) - perforated diverticulum - perforated oesophagus (Boerhaave's) - perforated appendix
70
features of a patient with gastrointestinal perforation
- very unwell: fever, hypotension, tachycardia - peritonitis: severe generalised pain with distention and rigidity
71
what do bloods show in gastrointestinal perforation
neutrophilic leucocytosis lactic acidosis raised urea and creatinine
72
first line and diagnostic imaging in gastrointestinal perforation
- first line: erect CXR air under the diaphragm - diagnostic: CT AP
73
what will an abdominal X-ray show in someone with gastrointestinal perforation
Rigler's sign: double intestine wall due to air in the peritoneum
74
conservative management of a gastrointestinal perforation
IV fluids broad spectrum antibiotics (tazocin) NBM put an NG tube IV PPI insert a catheter
75
definitive management of a gastrointestinal perforation
emergency surgery omental patch in ulcers, bowel resection in bowel
76
what are the three stages of alcoholic hepatitis
- fatty liver (reversible) - alcoholic hepatitis - cirrhosis
77
what are 3 symptoms of alcoholic hepatitis
- RUQ pain - nausea - hepatomegaly
78
what do LFTs show in alcoholic hepatitis
- high AST and gamma-GT - AST:ALT ratio >2 - high bilirubin
79
what are two markers of poor liver function
- low albumin (chronic) - prolonged PT (acute)
80
what is the imaging of choice in alcoholic liver disease
US of liver
81
what do you see in liver biopsy of alcoholic liver disease
- Mallory Denk bodies - Ballooning
82
how do you manage alcoholic liver disease
i) alcohol abstinence - thiamine for Wernicke's - benzodiazepines for withdrawal ii) prednisolone if severe
83
what are three sources of raised ALP
1. pregnancy 2. bone mets, Pagets 3. obstructive jaundice
84
what is the classic presentation of Gilbert's
- healthy male - normal LFTs - isolated raised bilirubin
85
Budd-Chiari syndrome: what is it, triad of symptoms, associations
- hepatic vein thrombosis - triad of abdo pain, ascites, hepatomegaly - associated with hypercoagulation
86
upper GI bleed scoring system
Glasgow-Blatchford

medicine can be fun (12 decks)

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