gastro Flashcards
(322 cards)
1
Q
what is a characteristic sign of gastric cancer on biopsy
A
signet ring cells
2
Q
name 4 risk factors for gastric cancer
A
H.Pylori
atrophic gastritits
diet
smoking
3
Q
give 2 signs of lymphatic spread of gastric cancer
A
left Supraclavicular lymph node - Virchow’s node
Periumbilical nodule - Sister Mary Josephs node
4
Q
3 investigations indicating alcohol hepatitis
A
macrocytic anaemia
increased GGT
AST : ALT > 2:1
5
Q
management of alcoholic hepatitis
A
glucocorticoids- prednisolone
6
Q
dyspepsia - criteria for an urgent referral
A
all patients with dysphagia
all patients with upper abdominal mass consistent with stomach cancer
patients > 55 with weight loss + upper abdo pain, reflux and dyspepsia
7
Q
t cell lymphoma is associated with an increased risk in patients with _____________?
A
coeliac disease
8
Q
what are carcinoid tumours
A
they occur when liver metastases occur and seretonin is released into the systemic circulation
9
Q
signs of a carcinoid tumour
A
flushing
diarrhoea
bronchospasm
hypotension
10
Q
what medication can be used to help manage HCC
A
Sorafenib
11
Q
how do gastric and duodenal ulcers present
A
gastric - epigastric pain worsened by eating
duodenal - epigastric pain when hungry, relieved by eating
12
Q
prophylaxis for variceal haemorrhage
A
propranolol
13
Q
how is life threatening C. Diff treated
A
oral vancomycin and IV metronidazole for 10-14 days
14
Q
what is the first line treatment of C. Difficile
A
oral vancomycin for 10 days
15
Q
which medications cause c diff
A
co-amoxiclav
cephalosporins - ceftriaxone
clindamycin
ciprofloxacin
16
Q
what are the features of c difficile ? what is a complication of severe c difficile
A
diarrhoea
abdominal pain
raised WCC
severe C.difficile can lead to toxic megacolon
17
Q
what is the second line therapy for c difficile
A
oral fidaxomicin
18
Q
what is courvoisier’s law ?
A
it states that the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones.
19
Q
what is the chief investigation for pancreatic carcinoma ? what sign may be present ?
A
high resolution CT scanning. double duct sign
20
Q
what procedure is used to treat resectable pancreatic cancer
A
whipples resection - pancreaticoduodenectomy
21
Q
A combination of liver and neurological disease points towards _________.
A
wilsons disease
22
Q
what is the nature of inheritance of wilsons disease? which chromosome does it effect?
A
Autosomal recessive. chromosome 13
23
Q
first line management of wilson’s disease
A
penicillamine = chelates copper
24
Q
which blood test confirms pernicious anaemia
A
instrinsic factor antibodies
25
what is the pathophysiology of pernicious anaemia
antibodies to intrinsic factor + /- gastric parietal cells
26
which blood test also needs to be done in addition to TTG in patients whom coeliac diseases is suspected ?
IgA
27
4 findings on endoscopy suggesting coeliac disease
villous atrophy
crypt hyperplasia
increase in intraepithelial lymphocytes
lamina propria infiltration with lymphocytes
28
liver failure post MI suggests ______.
Ischaemic hepatitis
29
which conditions can lead to budd chiari syndrome
underlying haematological disease such as -
polycythaemia rubra vera
thrombophilia
pregnancy
combined oral contraceptive
30
features of budd chiari syndrome
abdominal pain
ascites
tender hepatomegaly
31
which vitamin taken in high doses during pregnancy be teratogenic ?
Vitamin A
32
what is the management of barret's oesophagus ?
high dose PPI therapy and endoscopic surviellence
33
all patients with suspected upper GI bleed recquire ______ within ____ of admission
endoscopy within 24 hours
34
what is the pathophysiology of primary biliary cholangitis
thought to be an autoimmune condition where interlobular bile ducts are damaged by a chronic inflammatory process causing progressive cholestasis which can progress to cirrhosis.
35
what are the clinical features of primary biliary cholangitis ?
asymptomatic
RUQ pain
itching
fatigue
cholestatic jaundice
36
which antibodies are specific for primary biliary cholangitis
AMA
raised serum IgM
37
first line management of PSC
ursodeoxycholic acid
38
give microscopic features of UC
ileocoecal valve to rectum, continous disease
no inflammation beyond submucosa
crypt abscesses
39
give microscopic features of crohns disease
mouth to anus --> skip lesions
inflammation of all the levels
goblet cells
granulomas
40
which conditions are associated with UC
PSC
Uveitis
colorectal cancer
UC can cause UC
41
which test is recommended for H.Pylori post eradication therapy
urea breath test
42
signs of vitamin C deficiency
easy bruising
bleeding and receding gumbs
43
UC or Crohns - granuloma
Crohns
44
UC or Crohns - granuloma
Crohns
45
Red flag symptoms for gastric cancer includes
new-onset dyspepsia in a patient aged >55 years
unexplained persistent vomiting
unexplained weight-loss
progressively worsening dysphagia/
odynophagia
epigastric pain
46
3 characteristic markers of autoimmune hepatitis
ANA
SMA
raised IgG
47
management of autoimmune hepatitis
steroids + other immunosuppressants like azathioprine
liver transplant
48
symptoms of a pharyngeal pouch
dysphagia
regurgitation
halitosis
49
management of pharyngeal pouch
surgical resection
50
investigation for a pharyngeal pouch
barium swallow with dynamic video fluoroscopy
51
which is the most common site affected in Ulcerative colitis ?
Rectum
52
how should a severe flare up of UC be treated
IV Corticosteroids
53
how would you initially diagnose H.Pylori
Carbon 13 urea breath test or stool antigen test
54
what are the 3 criteria for DKA
diabetes / hyperglycaemia
ketones
acidosis
55
which medications are used to induce remission in crohns disease
glucocorticoids ( oral /topical/IV)
56
What should be measured to best assess synthetic function of the liver
PT ( prothrombin time)
57
which are the most useful investigations used for monitoring the adequacy of treatment of haemachromatosis
ferritin + transferrin saturation
58
what is the management of Alcoholic ketoacidosis
Infusion of saline and thiamine
59
which is the first line medication used in Ascites ?
Spironolactone
60
isolated rise in bilirubin is seen in which condition
Gilberts syndrome
61
which medication should be avoided in suspected bowel obstruction and why
Metoclopramide as it has pro-kinetic properties that can stimulate peristalsis and perforation
62
which serology is requires for the diagnosis of Coeliac disease ?
TTG and EMA
63
how is C.Difficile infection diagnosed
by detecting C.Difficile toxin in the stool
64
clinical feature of achalasia
dysphagia of both liquids and solids
65
what sign is seen in Achalasia on barium swallow
Birds beak appearance
66
what medication is given as prophylaxis for upper GI bleed ?
Propranolol
67
what sign is seen on abdominal xray in ischaemic colitis
thumb printing
68
which part of the bowel is typically effected by ischaemic colitis
large bowel
69
what particular risk factors tends to be present in bowel ischaemia
atrial fibrillation
70
which condition presents with crypt abscesses in the bowel
UC
71
Which condition presents with goblet cells and granulomas of the bowel
crohns disease
72
what is the characteristic iron study profile that is seen in hereditary haemachromotosis
raised transferrin sats
raised ferritin
low TIBC
73
regurgitation of foul smelling liquid is seen in which condition
pharyngeal pouch
74
which haematological condition can aminosalicyclate drugs cause
Heinz body anaemia
75
what is the M rule for primary biliary cirrhosis
- IgM
-AMA
Middle aged females
76
what is the first line management of primary biliary cirrhosis
Ursodeoxycholic acid
77
give 2 medications that are used first line in maintaining remission in crohns disease
Azathioprine
Mercaptopurine
78
which medication is used in patients with Crohns disease who develop a perianal fistula
oral metronidazole
79
when is a draining seton used?
It is used in the management of complex fistulae
80
what medication is used to manage ascites
aldosterone receptor antagonist
81
which receptors does loperamide act upon
opioid receptors
82
an isolated rise in bilirubin due to physiological stress is caused by -
gilberts syndrome
83
what is the adverse affect of aminosalicylates
agranulocytosis
84
what is the investigation of choice for suspected perianal fistula in patients with crohns disease
MRI Pelvis
85
What is the management of a perianal abscess
incision and drainage
86
give 4 causes of ulcerative colitis flare
stress
medications ( NSAIDs , antibiotics)
Cessation of smoking
87
how do you distinguish a severe UC Flare up from moderate-mild flare up ?
severe flare ups present with systemic involvement such as fever, tachycardia , anaemia, abdo tenderness etc
88
how do you manage a pharyngeal pouch?
surgical resection and repair
89
which is a common side effect of mesalazine
Acute pancreatitis
90
what are esophageal varices and what are they caused by
Dilated veins that arise due to portal HTN, secondary to cirrhosis.
91
what are the signs and symptoms of oesophageal varices ?
asymptomatic until a bleed occurs
haematemesis
melena
palpitations
syncope
hypotension
92
how are oesophageal varices investigated
endoscopy
93
which medication reduced portal HTN ?
Terlipressin
94
what are carcinoid tumours and where do they arise from
Carcinoid tumours are rare, slow growing neuroendocrine malignancies that arise from the enterochromaffin cells
most common site is appendix
95
what are the key features of carcinoid tumours ?
Abdominal pain
Diarrhoea
flushing
wheezing
pulmonary stenosis
96
how are carcinoid tumours managed ?
pharmacological therapy such as Octreotide to inhibit tumour products
97
what is the difference between carcinoid syndrome and carcinoid tumour
in a carcinoid syndrome, liver metastases impairs hepatic excretion of serotonin increase serotonergic symptoms whereas in carcinoid tumours there is a neuro-endocrine tumour.
98
what are the key investigations for carcinoid tumours ?
hormone level assessments - 5 HIAA ( breakdown product of serotonin in urine)
imaging
tissue biopsy
99
give 2 dermatological, 2 ocular and 2 musculoskeletal manifestations of crohn's disease
dermatological
erythema nodosum
pyoderma gangrenosum
ocular
anterior uveitis
episcleritis
MSK
arthritis
sacro-iliitis
100
what is the '' string sign of Kantour''
string like appearance of contrast filled narrowed terminal ileum and is suggestive of crohn's disease
101
give 4 features of crohns on colonoscopy
skip lesions
cobblestone mucosa
rose thorn ulcers ( fistulae or abscesses)
Non-caseating granulomas
102
what is the first line management of crohn's to induce remission ?
what can be added ?
what is used to maintain remission ?
Monotherapy with glucocorticoids ( prednisolone / IV Hydrocortisone)
Azathioprine or Mercaptopurine may be added on to induce remission.
Azathioprine or Mercaptopurine should be offered first line to maintain remission.
103
what is pre-hepatic jaundice? what are its causes ?
high levels of unconjugated bilirubin which is not water soluble so it can't enter the urine.
causes include -
gilbert's disease
haemolysis ( malaria / haemolytic anaemia)
drugs ( Rifampicin)
104
what is hepatic jaundice ? what are its causes ?
conjugated hyperbilirubinemia
viruses ( Hepatitis)
alcohol
cirrhosis
malignancy
haemochromatosis + A1AT
drugs ( pctmol, valproate, statins, TB drugs)
105
what is post-hepatic jaundice ? what are its causes ?
Impaired excretion of conjugated bilirubin making urine dark and stools pale
v high ALP
primary biliary cirrhosis
primary sclerosing cholangitis
bile duct gallstones / mirizzi's syndrome
drugs ( nitrofurantoin, steroids, co amoxiclav, flucloxacillin)
malignancy ( pancreatic, cholangiocarcinoma)
biliary atresia
106
which patients should undergo urgent endoscopy in 2 weeks
ALARMS signs
Anaemia
Loss of weight
Anorexia
Recent onset of symptoms
melena / haematemesis
swallowing difficulties ( dysphagia)
( epigastric mass / difficulty swallowing)
107
which antibodies are positive in primary biliary cholangitis ?
AMA ( Anti mitochondrial antibodies)
108
give 4 long term complications of ulcerative colitis
colorectal cancer
cholangiocarcinoma
colonic strictures
primary sclerosing cholangitis
109
give 3 features of ulcerative colitis
diarrhoea containing blood / mucus
tenesmus / urgency
pain in LIF
110
acute exacerbation of UC can be assessed using _________
Truelove and Witt's severity index
111
what signs are seen on imaging in UC
Colonoscopy -->continuous inflammation
loss of haustral markings
pseudo-polyps
Biopsy --> loss of goblet cells , crypt abscess, inflammatory cells
Barium enema --> lead pipe inflammation, thumb printing
112
what does positive HBsAg mean ?
positive hepatitis B surface antigen signifies current infection , either acute or chronic.
113
what do antiHBs and anti HBc signify?
Anti HBs -->previous infection/ previous vaccination
Anti HBc --> past infection/current infection
114
what is porphyria ? how does it present ? how is it diagnosed and treated ?
group of disorders resulting from defects in haem synthesis.
presents as abdominal pain, nausea, confusion and HTN
diagnosis = urinary porphobilinogen levels
supportive management
115
summarise melanosis coli
prolonged laxative abuse leading to dark brown pigmentation of macrophages in lamina propria
116
what are the four stages of hepatic encephalopathy
1. altered mood, behaviour and disturbance of sleep
2. drowsiness, confusion, slurred speech
3. incoherence, asterix,restlessness,rousable
4. coma
117
what is the management of giardiasis
Metronidazole
118
what is the management of upper GI bleed due to varices
Resuscitation + blood transfusion involving FFP
Terlipressin
IV Abx
variceal band ligation
sengstaken blakemore tube for severe
119
what is the long term prevention of variceal bleeding
non selective beta blockers and variceal band ligation
transjugular intrahepatic portosystemic shunt ( TIPSS)
120
how to manage mild - moderate disease in UC
Topical ASA
consider switching to oral ASA
121
how to manage severe UC
IV hydrocortisone
122
how does primary sclerosing cholangitis present ? what antibodies are positive
abnormal LFT's
Juandice
RUQ pain
fatigue, weight loss, fevers and sweats
UC association
ANCA positive
123
what condition is trousseau syndrome associated with
Pancreatic cancer
124
how does entamoeba histolyca present ?
Bloody diarrhoea
Liver Abscess
RUQ pain
125
which gene mutation is responsible for Gilberts syndrome
UDP Glucuronosyltransferase 1
126
how long should patients with C.Difficile have to isolate ?
at least 48 hours
127
what is Courvoisier's law in the context of pancreatic cancer?
In the context of painless obstructive jaundice, a palpable gallblader is unlikely to be caused by gallstones.
128
what are the symptoms of haemochromatosis ?
fatigue
erectile dysfunction
arthralgia of the hands
bronze skin pigmentation
liver disease
cardiac failure
129
which vessels do a TIPS connect ?
Hepatic vein and portal vein
130
what is the first and second line management of constipation
-first-line laxative: bulk-forming laxative first-line, such as ispaghula
=second-line: osmotic laxative, such as a macrogol
131
what class of medication is terlipressin
vasopressin analogue
132
what is the characteristing iron study profile seen in haemochromatosis ?
raised transferrin
raised ferritin
low TIBC
133
what is a common side effect of trans jugular intrahepatic portosystemic shunt
exacerbation of hepatic encephalopathy
134
what is the most likely cause of acute gastroenteritis caught from swimming pool
Giardia Lamblia
135
_____________ needs to be assessed before offering azathioprine or mercaptopurine therapy in crohns disease
TPMT or Thioprine methyltransferase activity
136
what medications cause pseudomembranous colitis
Co-amoxiclav
Ciprofloxacin
Clindamycin
Cephalosporin ( Ceftriaxone)
137
what are the Glascow-Blatchford score and the Rockall score
Glascow Blatchford : used before endoscopy to assess patients with upper GI bleeds
Blatchford Before
Rockall score : Used after endoscopy to assess risk of rebleeding and mortality
Rockall repeat
138
at what level of Hb should a blood transfusion take place in management of upper GI bleed
Hb < 70 g / l
139
what is the management of Barret's oesophagus ?
High dose PPI
metaplasia : Endoscopic surveillance with biopsies
dysplasia of any kind : endoscopic intervention
low grade : radiofrequency ablation
high grade : endoscopic mucosal resection
140
what is the first and second line management of Hepatic encephalopathy
first line : Lactulose
add Rifaximin
141
what are the grades of hepatic encephalopathy
grade 1 : irritability
grade 2 : confusion, inappropriate behaviours
grade 3 : incoherent, restless
grade 4 : coma
142
what can precipitate hepatic encephalopathy ?
infection
GI bleed
constipation
drugs : sedatives, diuretics
hypokalaemia
renal failure
increased dietary protein
143
what are the adverse effects of PPI
Hyponatraemia
hypomagnesaemia
osteoporosis
microscopic colitis
increased risk of c. diff
144
what is Acalculous cholecystitis
gallbladder dysfunction caused by something other than gallstones - can occur in patients on total parental nutrition or having long periods of fasting where the gallbladder is not being stimulated properly by food to regularly empty leading to a build up of pressure
145
how to differentiate between biliary colic, acute cholecystitis and cholangitis ?
Biliary colic : colicky abdominal pain worse after a meal with fatty foods
Acute cholecystitis : RUQ pain, fever, Murphy's sign,
Cholangitis : severely, septic, jaundice and unwell patient
146
how does a gallbladder abscess present
Prodromal illness and RUQ pain with swinging pyrexia.
Systemically unwell patient
147
which 2 tests are best to accurately represent the synthetic function of the liver
prothrombin time and albumin level - with PT being more accurate
148
what features can be seen in a patient with acute liver failure
Jaundice
Coagulopathy : raised PT
Hypalbuminaemia
hepatic encephalopathy
renal failure
149
what is Plummer Vinson syndrome and how does it present
triad of -
dysphagia
glossitis
IDA
150
what antibody is positive in primary sclerosing cholangitis
p-ANCA
151
what are the complications of primary sclerosing cholangitis
cholangiocarcinoma
increased risk of colorectal cancer
152
how does Budd-Chiari syndrome present ? what is the initial investigation
sudden onset abdominal pain
ascites
tender hepatomegaly
Ultrasound with doppler flow studies
153
what are the general features of hepatorenal syndrome ? How is it managed ?
doubling of serum creatinine to > 221 umol / L or halving of the creatinine clearance to less than < 20 ml/min over a period of < 2 weeks
treat with vasopressin analogues such as terlipressin
154
how does Boerhaave syndrome present
severe vomiting thoracic pain and subcutaneous emphysema
= leads to alcoholic rupture
presents in middle aged men with a background of alcohol abuse
155
what is the guidance around use of PPis before Upper Gi endoscopy
stop taking 2 weeks before endoscopy
156
give 3 complications of constipation
overflow diarrhoea
acute urinary retention
haemorrhoids
157
what is the first and second line management of overflow diarrhoea ?
1st line : disimpaction regime with osmotic laxatives such as lactulose or macrogol ( with macrogol being first line)
2nd line : add stimulant laxative such as senna
158
what is the first and second line management of constipation ?
1st line : bulk forming laxative such as isphagula husk
2nd line : osmotic laxative such as macrogol
159
investigation of choice for suspected pharyngeal pouch
Barium swallow combined with dynamic video fluoroscopy
160
What is the formula for alcohol units
Alcohol units = volume x ABV/1000
161
What medications are used first line to induce remission in crohns disease
Glucocorticoids ( oral, topical or IV)
162
what medications are used to maintain remission for Crohns disease
stop smoking
azathioprine / mercaptopurine
2nd line methotrexate
163
what needs to be assessed before commencing methotrexate to maintain remission in crohns
+TPMT activity
164
what are the long term complications of crohns disease
small bowel cancer
colorectal cancer
osteoporosis
165
how would you distinguish IDA vs Anaemia of chronic disease
TIBC : high in IDA, low / normal in Anaemia of chronic disease
Ferritin : decreased in IDA, normal / increased in AOCD
Serum iron : decreased in both
166
what is the biochemical marker of melena
raised urea
167
what are the symptoms of perforated peptic ulcer
how would you investigate this
epigastric pain , later becoming more generalised
syncope
investigated with upright / erect CXR
168
how would you distinguish alcoholic ketoacidosis from diabetic ketoacidosis
alcoholic ketoacidosis : normal / low glucose concentration
diabetic ketoacidosis : high glucose
169
how do you manage alcoholic ketoacidosis
Infusion of saline and thiamine
170
how does hepatomegaly present in
1. cirrhosis
2. malignancy
3. right heart failure
1. cirrhosis : early disease , decreases in size later, non tender firm liver
2. malignancy = metastatic spread or primary : hard, irregular liver edge
3. Right heart failure : firm, smooth tender liver edge - might be pulsatile
171
what is the nature of inheritance of hereditary haemochromatosis
autosomal recessive
172
what kind of picture does non alcoholic fatty liver disease present on LFT's
obesity + abnormal LFTS ( abnormal ALT generally greater than AST ,GGT)
173
what LFTs are abnormal in alcoholic liver disease
GGT characteristically raised
AST : ALT generally >3 suggests acute alcoholic hepatitis >2 generally
174
what is the management of alcoholic hepatitis
Glucocorticoids ( prednisolone)
pentoxyphylline
175
what is the eradication regime of H.pylori
PPI + amoxicillin + ( ciarithromycin / metronidazole) for 7 days
176
what method is use to screen patients with liver cirrhosis ? who is offered screening
Transient elastography / Fibroscan
screening is suggested to be offered to
- Hep C infection
-men drinking > 50 units / week. women > 35 units / week
- diagnosis of alcohol related liver disease
177
what investigations are recommended in patients newly diagnosed with cirrhosis
upper endoscopy to check for varices
liver ultrasound every 6 months +/- alpha fetoprotein to check for HCC
178
what is gallstone ileus and how does it present ?
small bowel obstruction that is secondary to an impacted gallstone. It may develop if a fistula forms between a gangrenous gallbladder and the duodenum
It presents with abdominal pain, distension and vomiting
pain abdominal film shows small bowel obstruction and air in the biliary tree
179
what is Mirizzi's syndrome and how does it present
gallstone within the bladder compresses the bile duct to cause an obstructive jaundice
180
how does a cholangiocarcinoma present ?
persistent biliary colic symptoms associated with anorexia, jaundice and weight loss
181
which antibodies are +ve in Auto-immune hepatitis
ANA/SMA/LMKA2 antibodies
182
how is autoimmune hepatitis treated
Steroids
liver transplantation
183
which is an important raised finding in auto-immune hepatitis
IgG
184
what conditions are associated with coeliac disease ?
I Don't Take Apples, I take Oranges
IgA deficiency
Down syndrome
Turner's syndrome
Autoimmune thyroid disease and auto-immune hepatitis
IgA nephropathy
T1DM
other auto-immune conditions ( Sjogrens, MG, Addison's disease)
185
which disease should t1dm and autoimmune thyroid disease patients be screened for
Coeliac disease
186
what is the investigation of choice for pancreatic cancer
High resolution CT
187
what is the gold standard diagnosis for coeliac disease and which part does it focus on ?
Endoscopic intestinal biopsy is the gold standard for coeliac disease and focuses mainly on the duodenum and also on the jejunum
188
what findings on biopsy are suggestive of coeliac disease
villous atrophy
crypt hyperplasia
increase in ILE
lamina propria infiltration with lymphocytes
189
how does Ulcerative Colitis present on Barium enema ?
Loss of Haustrations
superficial ulceration , ''pseudopolyps''
long standing disease : colon is narrow and short ''drainpipe colon''
190
what cancers are HNPCC associated with
CEO
Colorectal
Endometrial
Ovarian
CP - males
colorectal
pancreatic
191
what is the first line treatment of campylobacter
self limiting
clarithromycin if severe
192
how do thrombosed haemorrhoids present ? how are they managed?
typically present with significant pain and a tender lump
examination reveals a purplish, oedematous, tender subcutaneous perianal mass
if patient presents within 72 hours then referral should be considered for excision. Otherwise patients can usually be managed with stool softeners, ice packs and analgesia. Symptoms usually settle within 10 days
193
how is cholecystectomy managed
early laparoscopic surgery
194
Antibiotic prophylaxis should be given to patients with ascites if:
which one
patients who have had an episode of SBP
patients with fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome
ciprofloxacin / norfloxacin
195
management of spb
IV Cefotaxime
196
diagnosis of SPB
neutrophil count > 250 cells/ ul
197
how does an inguinal hernia present?
groin lump
superior and medial to pubic tubercle
198
how to differentiate between indirect and direct hernia ?
if it protrudes after reducing - direct
199
mx of inguinal hernia
treat patients even if asymptomatic
200
features of campylobacter
prodrome: headache malaise
diarrhoea: often bloody
abdominal pain: may mimic appendicitis
201
where are diverticula most commonly found
sigmoid colon
202
pigmented gallstones are associated with
SCD
203
what is the management of an acute anal fissure
stool softening
dietary advice, bulk forming laxatives
204
what is the management of a chronic anal fissure
GTN
sphincterotomy
205
2 medications used in management of alcoholic liver disease
glucocorticoids
pentoxyphylline
206
diagnosis of auto-immune haemolytic anaemia
positive direct antiglobulin test (Coombs' test).
207
Irreducible, painful lump inferolateral to the pubic tubercle → ?
strangulated femoral hernia
208
how to differentiate femoral vs inguinal hernia
femoral hernias, which are inferolateral to the pubic tubercle, from inguinal hernias which are supermedial to the pubic tubercle;
209
what factors indicate severe pancreatitis
age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST
210
how to distinguish incarcerated vs strangulated hernias
incarcerated= not painful
211
what is renyolds pentad
Reynold's pentad = Charcot's triad plus hypotension and confusion
212
features of primary biliary cholangitis
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females
213
Lateral anal fissure?
look for other causes
214
most sensitive test for hiatus hernia
barium swallow
215
what are the two kinds of hiatus hernia
sliding : 95% of hiatus hernias where the gastroesophageal junction moves above the diaphragm
rolling : gastroesophageal junctions remains below the diaphragm but a separate part of the stomach herniates through the oesophageal hiatus
216
management of hernias
all patients benefit from conservative management e.g. weight loss
medical management: proton pump inhibitor therapy
surgical management: only really has a role in symptomatic paraesophageal hernias
217
how often are patients with coeliac disease given the pneumococcal vaccine
every 5 years
218
what is the management of biliary colic
elective laparoscopic cholecystectomy
219
investigation of choice for pancreatic cancer
high resolution CT Scan of the pancreas
220
what is the management of acute cholecystitis
early laparoscopic cholecystectomy - within 1 week of diagnosis
221
most appropriate antibody to aid diagnosis of pernicious anaemia
intrinsic factor antibodies
222
which laxative should be avoided in ibs
lactulose
223
achalasia increases the risk of which type of cancer
squamous cell carcinoma of oesophagus
224
which deficiencies are coeliac disease associated with
iron
folate
vitamin B12
225
what is Richter hernia and how does it present?
absence of symptoms of obstruction even if there is strangulation , metabolic acidosis present with a firm mass on abdominal wall and central abdominal pain
226
how does staph aureus gastroenteritis present
severe vomiting and short incubation period
227
how to manage congenital inguinal hernia
Should be surgically repaired soon after diagnosis as at risk of incarceration
228
how to manage infantile umbilical hernia
The vast majority resolve without intervention before the age of 4-5 years
229
anaemia of chronic disease
normocytic anaemia with low serum iron, low TIBC but raised ferritin in a patient with a chronic illness
230
what is the diagnostic investigation for necrotising enterocolitis ?
abdominal xray
231
what is the most common cause of ascending cholangitis ?
E coli
232
what is the management of ascending cholangitis ?
Intravenous antibiotics
ERCP after 24-48 hours
233
what is the presentation of anal fissures? What is the most common site that they occur on ?
painful, bright red rectal bleeding
90% of anal fissures occur on the posterior midline
alternative location - consider alternative diagnosis like crohns disease
234
what is the management of an acute anal fissure ?
stool softening - dietary advice and bulk forming laxatives
lubricants
topical anaesthetics and analgesia
presents under 1 week
235
what is the management of a chronic anal fissure
topical GTN
not effective after 8 weeks ? consider secondary care referral : sphincteromy
236
what is the definition of travellers diarrhoea ? what is the most common cause ?
at least 3 loose to watery stools in 24 hours with or without one of : abdominal cramps, fever, nausea, vomiting or blood
most common cause - E. Coli
237
which bacteria causes acute food poisoning ? under what time limit does this usually happen?
staph. aureus and bacillus cereus
1-6 hours
238
which bacterial causes diarrhoea after consumption of rice
bacillus cereus
239
what are the features of campylobacter diarrhoea ? What are its complications?
flu like prodrome : followed by crampy abdominal pains, fever and diarrhoea
mimics appendicitis
complications - GBS
240
which bacteria's cause diarrhoea with an incubation period beyond 7 days ? how do you distinguish between them ?
Giardiasis and amoeba
giardiasis = prolonged non bloody diarrhoea
amoebiasis = gradual onset non bloody diarrhoea
241
how does cholera present
profuse watery diarrhoea
severe dehydration
242
what bacterias causing gastroenteritis have an incubation period of -
12-48 h
48-72
salmonella, E.Coli
shigella, campylobacter
243
what is the first line management of constipation in IBS
Isphagula husk
244
which is the most prominent symptom of crohns in kids
abdominal pain
245
which IBD are gallstones associated with?
crohns disease
246
what is a rare ocular feature associated with pancreatitis
Ischaemic Purtscher retinopathy - causing temporary or permanent blindness
247
diagnostic test for acute pancreatitis
serum lipase
248
how to identify the cause of acute pancreatitis
trans-abdominal ultrasound
249
difference between incarcerated and strangulated hernia
incarcerated -cannot be reduced
strangulation - pain + not haemodynamically stable
250
what is the management of an inguinal hernia ?
treat medically fit patients even if asymptomatic
hernia truss - for patients not fit for surgery
mesh repair - unilateral inguinal hernias : open approach
bilateral and recurrent : laparoscopic repair
251
what is the medical management of campylobacter jejuni
clarithromycin
252
how do you assess an inguinal hernia
press on deep inguinal ring and ask patient to cough
253
what is the picture of biliary colic in gallstones on LFT's
No fever and LFT's , inflammatory markers and normal
254
what white cell might be seen in acute appendicitis
neutrophil predominant leukocytosis
255
diagnostic sign of alcoholic hepatitis
AST: ALT > 2
256
What i s the manahement of haemorrhoids
soften stools - increase dietary fibre and fluid intake
topical local anaesthetics and steroids
outpatient - rubber band ligation
257
what is the presentation and management of acutely thrombosed external haemorrhoids
significant pain
purplish, oedematous tender subcutaenous perianal mass
within 72 h - consider referral for excision
post 72 h : consider referral for exision and manage with stool softeners, ice packs and analgesia
258
how to prevent spread of c diff
side room , wear disposable gloves + aapron 48 h
259
what organisms cause post splenectomy sepsis
Streptococcus pneumoniae
Haemophilus influenzae
Meningococci
260
what are the complications of acute pancreatitis
peripancreatic fluid collections
pseudocysts
pancreatic necrosis
pancreatic abscess
261
what is ischaemic hepatitis
acute hypoperfusion that usually follows an inciting event such as a cardiac arrest and causes a marked increase in aminotransferases
262
which anatomical landmark allows the categorisation of a bleed during urgent endoscopy
ligament of Treitz
263
what investigation can be useful for diagnosing and monitoring severity of liver disease
transient elastography
264
what is the management of achalasia
pneumatic balloon dilation is the first option
Heller cardiomyotomy if recurrent or persistent symptoms
265
what happens to serum ceruloplasmin and total serum copper in wilsons disease
reduced
266
plummer vinson syndrome
triad of iron deficiency anaemia, dysphagia due to oesophageal webs
atrophic glossitis
267
management of barrets dysplasia
endoscopic intervention
268
what are the features of budd chiari syndrome ? how is investigated
abdominal pain - sudden onset and severe
ascites - abdominal distension
tender hepatomegaly
investigation : ultrasound with doppler flow studies
269
side effects of metoclopramide
extra-pyramidal
diarrhoea
hyperprolactinaemia
tardive dyskinesia
parkinsonism
270
autoimmune hepatitis on blood tests
raised ALT:AST, AMA negative
271
c/i to metoclopramide
bowel obstruction
272
what is small bowel bacterial overgrowth syndrome
excessive amounts of bacteria in the small bowel causing GI symptoms
Risk factors -
congenital GI abnormalities
scleroderma
DM
273
management of small bowel bacterial overgrowth syndrome
correct disorder
rifaximin ( antibiotic therapy)
274
management of hepatic encephalopathy
lactulose
add rifaximin
275
diagnostic investigation for primary sclerosing cholangitis
ERCP/MRCP
276
Stopping medications before OGD (1-4):
1 day = gaviscon
2 weeks = PPIs
3 days = ranitidine
4 weeks = antibiotics
277
Testing for H. pylori infection
carbon-13 urea breath test or a stool antigen test
278
Mx of acute phosphotaemia
IV infusion of potassium
279
causes of budd chiari syndrome
polycythaemi rubra vera
thrombophilia
pregnancy
cocp
280
Child-Pugh score
A - albumin
B - bilirubin
C - clotting
D - distention (ascites)
E - encephalopathy
281
differentiating between perforated ulcer and bleed
perforation would have signs of peritonitis, rigidity and gaurding
282
The combination of deranged LFTs combined with secondary amenorrhoea in a young female strongly suggest
autoimmune hepatitis
283
The best test to see whether iron overload is present is
transferrin saturation
284
signs of acute liver failure
jaundice
raised PT
hypoalbuminaemia
hepatic encephalopathy
renal failure
sweet fecal breath
285
what is peutz Jeghers syndrome
autosomal dominant condition characterised by hamartomatous polyps in the GI tracted and associated with pigmented freckles on the lips, face, palms and soles
286
presenting feature of peutz jeghers syndrome
small bowel obstruction due to intussuception
287
globus pharyngis
Globus pharyngis (also known as globus hystericus) is the persistent sensation of having a 'lump in the throat', when there is none. Symptoms are often intermittent and relieved by swallowing food or drink. Swallowing of saliva is often more difficult.
288
ppi adverse effects
hyponatraemia, hypomagnasaemia
osteoporosis → increased risk of fractures
microscopic colitis
increased risk of C. difficile infections
289
Patients with GORD being considered for fundoplication surgery require
oesophageal pH and manometry studies
290
management of bleeding ulcers despite endoscopic therapy
laparotomy and surgical exploration
291
riboflavin ( vitamin B2) Deficiency
angular cheilitis - cracking, itching crusting
292
triggers for liver decompensation
constipation
infection
electrolyte disturbances
dehydration
upper GI bleeds
increased alcohol intake
293
Type 1 hepatorenal syndrome
rapidly progressive
doubling of serum creatinine
294
type 2 hepatorenal syndrome
slowly progressive
poor prognosis
295
cause of hepatorenal syndrome
splanchnic vasodilation which reduces systemic vascular resistance
296
mx of hepatorenal syndrome
vasopressin analogues - terlipressin
297
patients requiring non urgent endoscopy
treatment resistant dyspepsia
raised platelets
haematemesis
298
_________________is the single strongest risk factor for the development of Barrett's oesophagus
GORD
299
what picture does paracetamol overdose cause on LFT's
hepatocellular -
high ALT, normal ALP, ALT/ALP high
300
what liver condition can COCP cause
gallstones
301
strongest association for h pylori
duodenal ulceration
302
appropriate test for small bowel overgrowth syndrome
hydrogen breath testing
303
Zollinger ellison syndrome
excessive levels of gastrin secondary to gastrin secreting tumour.
MEN1
multiple gastroduodenal ulcers
diarrhoea
malabsorption
fasting gastrin levels and secretin stimulation test
304
results for wilsons disease
ALT raised, urinary copper raised, serum ceruloplasmin raised
305
what are the cardiac effects of carcinoid syndrome
pulmonary stenosis and tricuspid insufficiency
306
how does C. diff present on colonoscopy
yellow plaques on the intra-luminal wall
307
Primary sclerosing cholangitis can have positive
p-ANCA
308
viral hepatitis
nausea, vomiting, anorexia, myalgia, lethargy
RUQ pain
foreign travel
IVDU
309
peutz jeghers syndrome
AD
polyps in gi tract and pigmented freckles on the lips, face, palms and soles
310
Ongoing diarrhoea in Crohn's patient post-resection with normal CRP
Cholestyramine
311
A recurrent episode of C. difficile within 12 weeks of symptom resolution should be treated with
oral fidaxomicin
312
Surgical treatment of achalasia -
Heller cardiomyotomy
313
pathophysiology of hepatic encephalopathy
Ammonia crossing the blood-brain barrier
314
In young men the two most common causes of lower abdominal pain are
appendicitis and testicular problems (infection and torsion).
315
HBeAg is a marker of
viral replication and infectivity
316
complication of transoesophageal fistula
benign oesophageal stricture
317
long term complication of omeprazole
hypomagnesaemia
318
refeeding syndrome definition
metabolic abnormalities which occur on feeding a person following a period of starvation.
319
Plummer Vinson:
Plummers DIE: Dysphagia, Iron deficiency anemia, Esophageal webs
320
which is the only test recommended for h.pylori eradication
urea breath test
321
which antibiotics cause cholestasis
co-amoxiclav, erythromycin, flucloxacillin
322
