Gastro Flashcards
(175 cards)
1
Q
What is achalasia?
A
Failure of oesophageal peristalsis and lower oesophageal sphincter relaxation leading to dilatation of oesophagus and stenosis at Z junction.
Linked to degenerative lossof ganglia in Auerbach’s plexus.
2
Q
Clinical features of achalasia?
A
Dysphagia to BOTH solids AND liquids
Regurgitation(->cough/aspiration)
Acid reflux
3
Q
Achalasia Ix?
A
Manometry Barium swallow (bird's beak) CXR (mediastinal widening)
4
Q
Achalasia Rx?
A
Intersphincteric injection of botulinum toxin
Heller cardiomyotomy
Pneumatic dilatation
5
Q
NAFLD Fx?
A
Usually silent
Echogenicity on USS
Hepatomegaly
ALT»AST
6
Q
Feature of anaemia seen in Coeliac?
And why?
A
Raised RCDW due to mixed micro and macrocytic anaemia from iron and B12 malabsorption
7
Q
Findings on duodenal biopsy of Coeliac disease?
A
Villous atrophy
Crypt hyperplasia
Intraepithelial and lamina propria lymphocyte infiltration
8
Q
Which of the following contain gluten?
Maize
Rye
Barley
A
Barley and Rye
9
Q
What is fetor hepaticus and what is it a sign of?
A
Sweet fecal smelling breath consistent with acute liver failure
10
Q
Commonest cause of inherited colorectal cancer?
A
HNPCC (5%)
Sporadic 99%
FAP 1%
11
Q
What are the Amsterdam criteria and what are they used for?
A
Aids with HNPCC diagnosis:
At least two generations affected
At least one case before the age of 50
At least 3 family members affected
12
Q
Commonest type of oesophageal cancer? + RFs?
A
Adenocarcinoma in middle 1/3 of oesophagus RFs include: Alcohol Smoking GORD/Barretts Obesity Achalasia Plummer Vinson
13
Q
Diagnostic test for carcinoid syndrome?
A
Urinary 24hr 5-HIAA
14
Q
Cardiac manifestations of Carcinoid syndrome?
A
Right valve disease;
Pulmonary stenosis
Tricuspid insufficiency
TIPS
15
Q
Fx of Carcinoid syndrome
A
Sweating/Flushing Diarrhoea Hypotension Bronchospasm N&V
16
Q
Rx for Carcinoid syndrome?
A
Somatostatin (octreotide)
17
Q
Haemochromatosis inheritance pattern?
A
AR mutation of HFE gene CHR6
18
Q
Haemochromatosis Fx?
A
Early fatigue, erectile dysfunction, arthralgia Bronzing Diabetes CLD/cirrhosis etc Cardiac failure Hypogonadism
19
Q
Fx + Rx of a pharyngeal pouch?
A
Regurgitation, dysphagia, halitosis, neck lump.
Rx is by surgery
20
Q
Fx of hepatic encephalopathy?
A
Asterixis
Confusion
Constructional apraxia
Hyperammoniaemia
21
Q
Rx for hepatic encephalopathy?
A
First line is lactulose - works by promoting ammonia metabolism by gut flora.
Second line is Rifamixin
22
Q
Which 3 cancers are HNPCC patients most at risk of
A
- Colorectal
- Endometrial
- Stomach
23
Q
What is a common side effect of inhaled steroid use
A
Oesophageal candidiasis
24
Q
What is charcot’s triad and what is it seen in?
A
RUQ pain, fever, jaundice
Seen in ascending cholangitis
25
In whom would you see a yellow tinge to the skin and why?
Pernicious anaemia - pallor due to anaemia and jaundice due to haemolysis
26
PSC Ix?
MRCP - shows beading
| Bloods - pANCA positive
27
Classical presentation for ischaemic colitis?
Sudden onset intermittent, diffuse, severe abdo pain, after a meal, vascular risk factors
28
Acute mesenteric ischaemia commonest underlying cause and Rx?
Embolism of SMA
| Rx: Urgent surgery
29
X-ray finding in ischaemic colitis?
Thumbprinting
30
Classical presentation of Cyclical Vomiting Syndrome
Profuse vomiting preceded by sweating and nausea in an individual with a PMH of migraines.
31
At what vertebral level does the IMA branch from the aorta?
L3
32
Causes of Budd Chiari syndrome?
Polycythaemia rubra vera
Thrombophilia
Pregnancy
COCP
33
Ix for Budd Chiari syndrome?
Doppler USS
34
Fx of Budd Chiari?
Triad of:
Sudden onset severe abdo pain
Tender hepatomegaly
Ascites
35
What is the Blatchford score and what are its components?
Assesses severity and urgency of upper GI bleeds.
| Components include Hb, urea, BP, HR, melaena, syncope, PMH.
36
Lead piping is seen in which patients?
Chronic UC
37
PPI SFx?
Hyponatraemia
Hypomagnesaemia
Osteoporosis
C. dif infections
38
Wilson's disease Rx + MOA?
Penicillamine - copper chelation
39
Which IBD increases risk of gallstone formation and how?
Crohns - Terminal ileitis blocks bile reabsorption
40
Factors which increase risk of gallstone development?
```
Crohns
Recent sudden weight loss
Recent surgery
FHx
Oral contraception
Old age
```
41
How do you differentiate upper from lower GI bleed on blood results?
Raised urea
42
Which organs are affected in MEN-1
Parathyroid
Pituitary
Pancreas (includes insulinomas, gastrinomas, ZE synd).
43
Diagnostic test for Zollinger Ellison syndrome?
Fasting serum gastrin
| Secretin stimulation test
44
Which autoantibodies are seen in autoimmune hepatitis?
Anti SMA and ANA
45
When would you see piecemeal necrosis?
Autoimmune hepatitis
46
Biliary colic Fx and Rx
Fx: Colicky RUQ pain worse post prandially and after fatty foods.
Rx: Imaging (MRCP) and lap chole if applicable.
47
Acute cholecystitis Fx and Rx
Fx: RUQ pain, FFFF, fever, Murphy's sign, may have deranged LFTs.
Rx: USS + Lap Chole (ideally in <2 days)
48
Gallbladder abscess Fx and Rx
Fx: RUQ pain after prodromal illness, swinging pyrexia, may be systemically unwell.
Rx: USS +- CT followed by surgery.
49
Cholangitis Fx and Rx
Fx: Systemically unwell, septic picture, jaundice, RUQ pain.
Rx: Fluids, BSAs, early ERCP
50
Gallstone ileus Fx and Rx
Fx: Often has Hx of cholecystitis, may have SBO.
Rx: Laparotomy and gallstone removal, with enterotomy proximal to obstruction.
51
Acalculous cholecystitis Fx and Rx
Fx: Intercurrent illness, stystemically unwell, absence of stones, high fever.
Rx: Lap chole if fit.
52
Risks of ERCP?
Bleeding
Perforation
Pancreatitis
Cholangitis
53
Risk factors for small bowel bacterial overgrowth syndrome?
Diabetes
Neonates with congenital gastro abnormalities
Scleroderma
54
Features of haemochromatosis?
```
Early Fx: Fatigue, erectile dysfunction, arthritis
Late Fx:
Bronze skin
arthritis
dilated cardiomyopathy
cirrhosis
diabetes
hypogonadism
```
55
What should patients on PPIs/H2is do regarding their medication preceding gastroscopy?
Stop taking them two weeks before the procedure so as not to mask any underlying pathology.
56
How do you diagnose Wilson's disease?
1. Low serum copper
2. Low serum caeruloplasmin
3. Raised urinary copper
57
What are the characteristic features of Plummer-Vinson Syndrome?
1. Dysphagia
2. IDA
3. Glossitis
58
What should T1DM patients be screeened for on diagnosis?
Coeliac disease
| Autoimmune thyroiditis patients should also be screened.
59
What are the components of the Child-Pugh score and what is it used for?
```
Used to assess severity of liver cirrhosis .
Bilirubin
Prothrombin time
Albumin
Encephalopathy
Ascites
```
60
Which area of gut is most likely to be affected in ischaemic colitis?
Splenic flexure (watershed area)
61
When might you commonly see ischaemic hepatitis?
Post MI
62
Carcinoid tumours release which hormones, and how does this relate to their presentation?
Serotonin and bradykinin which cause the vomiting, flushing, diarrhoea.
Also make ACTH causing Cushingoid Fx and impaired glucose control
63
How might lung adenocarcinoma present?
Clubbing, weight loss, gynaecomastia
64
What does c.dif antigen positivity represent?
Presence of bacteria but NOT current infection, meaning oral metronidazole is not indicated.
65
What should be given pre appendicectomy?
IV antibiotics
66
Which vitamin is teratogenic in high doses?
A
67
What is the impact of a patient having achalasia on the likelihood that they have adeno or SCC of the oesopahgus?
Achalasia means SCC is more likely than adenocarcinoma.
68
How does Budd Chiari syndrome present acutely?
Sudden onset abdo pain
Ascites
Tender hepatomegaly
69
What does a raised SAAG indicate?
That the ascites is secondary to portal hypertension
70
What is the link between hepatic encephalopathy and opiates?
Opiates cause constipation which can precipitate hepatic encephalopathy
71
Which blood finding is the most specific and sensitive finding for diagnosing cirrhosis in those with CLD?
Thrombocytopaenia
72
What are the features of Peutz-Jeghers syndrome?
Multiple hamartomatous GI polyps (non malignant)
Pigmented freckles on face and palms/soles
GI bleeding
73
What are two common haematological side effects of PPIs?
Hyponatraemia
| Hypomagnesaemia
74
What constitutes an urgent referral for dyspepsia?
Anyone with dysphagia
Anyone with an upper GI mass
Anyone over 55 with weight loss AND 1 of:
Epigastric pain
Reflux
Dyspepsia
75
What is the commonest surgical intervention performed in Crohn's patients?
Ileocaecal resection
76
What ABG picture is seen in mesenteric ischaemia?
Metabolic acidosis
77
Crypt abscesses are associated with which form of IBD?
UC
78
How would you differentiate between IDA and AoChronic disese?
IDA: TIBC high, transferrin high
AoCD: TIBC low/normal, transferrin low
79
What is the commonest causative agent of SBP?
E. coli
80
What are the LFT findings in a paracetamol OD?
Raised ALT and AST but normal ALP
81
What should be assessed before offering azathioprine or mercaptopurine therapy?
Thiopurine methyltransferase (TPMT) activity
82
Aside from antiemesis, what are some other uses of metoclopramide?
GORD
| Prokinetic agent used for gastroparesis in diabetics
83
What are the side effects of metaclopromide?
Extrapyramidal
Hyperprolactin
Tardicve dyskinesia
Parkinsonisms
84
What is the first line anti-motility agent for IBS?
Loperamide
85
Increased goblet cells are seen in which form of IBD?
Crohn's
86
True or false, PPIs increase risk of fractures.
True
87
Which histological finding is a feature of gastric adenocarcinoma?
Signet ring cells
88
What is the best investigation to assess extramural invasion in upper GI cancer?
Endoscopic ultrasound
89
What is the first line investigation for acute mesenteric ischaemia?
Serum lactate
90
How many grades of hepatic encephalopathy are there and what is the top grade?
Four - Coma
91
Which portion of bowel is most commonly affected in ischaemic colitis?
Splenic flexure - SMA/IMA watershed
92
What differences in presentation might aid distinction between mesenteric ischaemia and ischaemic colitis?
Mesenteric ischaemia affects the small bowel with high mortality and sudden onset severe symptoms.
ischaemic colitis affects the large bowel and tends to have less severe symptoms as well as bloody diarrhoea.
93
When should patients be given antibiotic prophylaxis to SBP?
Those who have had a prior SBP
Those with ascitic protein <15
Ciprofloxacin
94
What is the mechanism of action of loperamide?
Opioid receptor agonist
95
What is the management of Barrett's oesophagus?
High dose PPI therapy with endoscopic surveillance
96
What are the causes of dysphagia?
Extrinsic, wall, intrinsic, neuro
Extrinsic: Mediastinal mass, cervical spondylosis
Wall: Achalasia, spasm
Intrinsic: Tumours, strictures, web, Schatzki rings
Neuro: CVA, PD, MS, myaesthenia
97
What is Plummer Vinson syndrome?
```
Dysphagia
IDA
Glossitis
Cheilosis
Oesophageal webs
```
98
Give some causes of iatrogenic pancreatitis
```
Azathioprine
Mesalazine
Bendroflumethiazide
Furosemide
Valproate
ERCP
```
99
What is a Sister Mary Joseph's node?
Metastatic umbilical lesion seen in advanced abdominal malignancy
100
What is the Modified Glasgow scale used for?
Pancreatitis severity
101
True or false; Coeliac patients should be given the pneumococcal vaccine
True - as they are at risk of overwhelming pneumococcal sepsis due to hyposplenism
102
Which drugs can cause a cholestatic picture?
COCP
Abx
Anabolic steroids
103
What is the tumour marker for HCC?
AFP
104
Which is the tumour marker for pancreatic cancer?
Ca19-9
105
Kocher's incision
Under right subcostal margin
| Open cholecystectomy
106
Lanz
RIF
| Appendicectomy
107
Gridiron
Oblique incision over McBurney's point
| Appendicectomy
108
Pfannensteil's
Transverse supra pubic
| C section
109
Gable/Rooftop incision
Across subcostal margin
Liver transplant
Whipples procedure
110
McEvedy's
Groin incision
| Emergency repair of strangulated femoral hernia
111
Rutherford Morrison
Extraperitoneal approach to left or right lower quadrants
| Renal transplantation
112
What haematinic profile is seen in haemochromatosis?
Raised transferrin saturation
raised ferritin
Low TIBC
113
What are the features of systemic sclerosis?
CREST
```
Calcinosis
Raynauds
Oesophageal dysmotility
Sclerodactyly
Telangectasia
```
114
Number of bowel movements in mild, moderate and severe UC flares/
Mild: <4 with or without blood
Mod: 4-6
Sev: >6 with blood
115
What are the component parts of the Blatchford scoring system to assess severity of upper GI bleeds?
```
Urea
Hb
Systolic BP
Pulse
Melaena
Syncope
Liver disesae
Cardiac failure
```
116
What are the causes of acute pancreatitis?
GET SMASHED
```
Gallstones
EtOH
Trauma
Steroids
Mumps
Autoimmune (polyarteritis nodosa)
Scorpions
Hyperfatanythingaemia
ERCP
Drugs - Azathioprine, mesalazine, valproate, furosemide, steroids)
```
117
What is the single most common extra GI feature of IBD?
Arthritis
118
What is the 'M' rule of PBC?
IgM
AMA
Middle aged females
119
How does PBC typically present?
A middle aged female with lethargy and pruritis with deranged extrahepatic LFTs (ALP, GGT). They will have AMA antibodies
120
What is the management for PBC?
Cholestyramine for pruritis
ADEK supplementation
Ursodeoxycholic acid
Liver transplant if bilirubin >100
121
What are the complications of PBC?
Cirrhosis
Osteomalacia/porosis
HCC
122
What is Murphy's sign and when is it seen?
Arrest of inspiration on RUQ palpation
| Ascending cholangitis
123
What is the classic triad of chronic mesenteric ischaemia?
Weight loss
Post prandial colicky abdo pain
Abdominal bruits
124
What effect might constipation have on a patient with liver cirrhosis?
May cause an acute decompensation with confusion
125
How might PSC present, how is it investigated and what are the complications>
Jaundice, pruritis, RUQ pain, fatigue
ERCP/MRCP showing beading
Cholangiocarcinoma, CRC
126
What is the management of an acute variceal bleed?
```
Rescuscitate
Correct clotting, FPP, vit k
Terlipressin
Abx prophylaxis
Endoscopy with band ligation
TIPSS if above fails
```
127
What is the definition of malnutrition?
Unintended weight loss of greater than 10% in 3-6 months
128
What are the two most common causes of lower abdo pain in young men?
Appendicitis
Testicular infection/torsion
Must examine the scrotum in any young man with lwoer abdo pain
129
Where are oesophageal adenocarcinomas and squamous cell carcinomas typically found?
Adeno - near O-G junction
| SCC - Middl third
130
WHich of the following is HNPCC known to be associated with?
Lung cancer
Medulloblastoma
Pancreatic cancer
Thyroid cancer
Pancreatic cancer
131
Which of the following is likely to indicate a poor prognosis in cirrhosis?
```
ALT >200
Caput medusae
Ascites
Gynaecomastia
Splenomegaly
```
Ascites
132
What is the most important thing to do to prevent relapses in Crohn's disease?
Stop smoking
133
What test is used to diagnose gall stones?
Abdo ultrasound
134
Other than antibiotics, what class of medication is known to increase risk of C. dif infection?
PPIs
135
With which IBD are perianal skin tags associated?
Crohn's
136
What SAAG value indicates portal hypertension?
>11
137
What is the classical presentation of Hep D?
Patients with Hep B who are IVDUs presenting with a cholestatic picture and RUQ pain
138
What are the features of autoimmune hepatitis/
Signs of CLD
Jaundice/fever (in 25%)
Amenorrhoea is v common
139
What triad is seen in acute liver failure/
Encephalopathy
Jaundice
Coagulopathy
140
What is the first step in managing a mild/moderate UC flare?
Rectal mesalazine
141
In which form of IBD might pseudopolyps be seen on endoscopy/
UC
142
In which form of IBD are granulomata seen?
Crohns
143
What is the investigation of choice to diagnose liver cirrhosis?
Transient elastography (/fibroscan)
144
Which artery is commonly the source of significant GI bleeding as a complication of PUD?
Gastroduodenal artery
145
Whta is the causative agent in watery travellers diarrhoea/
Enterotoxigenic E. Coli
146
What is the Mackler triad for Boerhaave syndrome?
Vomiting
Chest pain
Subcutaneous emphysema
147
What would a plain abdo film show in gallstone ileus?
SBO
| Air in the biliary tree
148
Whta are the commonest causes of pyogenic liver abscesses?
S. aureus
| E. coli
149
Which single investigation is most useful in distinguishing between IBS and IBD?
Faecal calprotectin
150
What should be trialed if mesalazine fails to induce remission in UC?
oral pred
151
What treatment is most important for acute severe alcoholic hepatitis?
Prednisolone
152
What treatment should be given for ascites secondary to liver cirrhosis?
Spironalactone
153
What is the management of hepatorenal syndrome/
Terlipressin
20% albumin
TIPSS
154
What therapy is recommended for acute Crohn's flare up should IV hydrocortisone fail to cause improvements after 5 days?
Infliximab
155
Which two vessels are anastamosed in a TIPSS procedure?
Hepatic vein and portal vein
156
What are the featuers of Zollinger Elison Syndrome?
Multiple PUs
Diarrhoea
FHx of Men
157
What is the difference between type 1 and type 2 hepatorenal syndome?
peed of onset - Type 1 comes on in under 2 weeks
158
What electrolyte abnormalities might indicate risk of refeeding syndrome?
Hypophosphataemia
Hypokalaemia
Hypomagnesaemia
159
Whta is the first line management of hepatic encephalopathy/
Lactulose
160
What must happen before patients can be tested for Coeliac disease/
Must have been eating gluten for >6 weeks
161
What is the management of a mild-moderate flare of UC extending past the left sided colon?
Oral and rectal mesalazine
162
Why should opioids be stoped in C.dif infection?
Antiperistaltic drugs can predispose to toxic megacolon
163
What are the red flag symptoms for gastric cancer?
```
New onset dyspepsia in >55 year olds
Unexplained persistent vomiting
Unexplained weight loss
Progressively worsening dysphagia/odynophagia
Epigastric pain
```
164
What would you use to test for H.pylori post eradication usccess/
Urea breath test
165
What is the commonest cause of melanosis coli?
Laxative abuse
166
What is a CLO test used for ?
Diagnosis of H.pylori gastritis
167
What investigation is advised in patients with NAFLD?
Enhanced liver fibrosis blood test
168
What medication should be added to mesalazine in a UC patient with severe relapse or >=2 exacerbations in the past year?
Azathioprine or mercaptopurine
NB - First measure TPMT
169
Which drugs other than NSAIDs can predispose to PUD?
SSRIs
Corticosteroids
Bisphosphonates
170
What are the side effects of Clindamycin?
C dif
Jaundice
Vomiting
Hyypotension
171
According to Truelove and Witts, what are the features o a severe UC flare?
```
More than 6 bloody stools a day with at least one of the following:
Fever
Tachycardia
Anaemia
ESR > 30
```
172
What are some causes of a raised ferritin/
With and without iron overload:
With
Haemochromatosis
Following repeat transfusions
```
Without
Inflammation
EtOH excess
liver disease
CKD
Malignancy
```
173
A 56-year-old gentleman presents with vomiting, severe crampy abdominal pain, loss of appetite. Patient has not had a bowel movement or passed gas in the last three days. On examination the abdomen is distended and generalised tenderness is present.
What medication should be avoided in this patient and why?
```
Cyclizine
Metoclopramide
Morphine
Ondansetron
Phosphate enema
```
Metoclopramide - as prokinetic agents could cause a perforation in bowel obstruction
174
How is oesophageal SCC treated?
Radiotherapy
175
What is the diagnostic test for PSC?
ERCP/MRCP - beading
