Gastroenterology Flashcards
(183 cards)
1
Q
What are the common causes of upper gastrointestinal (GI) bleed?
A
Peptic ulcer disease, oesophageal varices, oesophagitis, Mallory-Weiss tear, Boerhaave syndrome.
2
Q
What are the symptoms of upper GI bleed?
A
Haematemesis, coffee-ground emesis, melena
3
Q
How is upper GI bleed diagnosed?
A
OGD (oesophageo-gastro-duodenoscopy)
4
Q
What is the risk assessment for upper GI bleed?
A
Blatchford score (at first assessment) and Rockall score (after endoscopy).
5
Q
What is the treatment for PUD causing upper GI bleed?
A
Endoscopic therapy ± blood transfusion + IV PPI.
6
Q
What is the primary treatment for esophageal varices causing upper GI bleed?
A
Terlipressin IV + endoscopic therapy (EVL) + antibiotic.
7
Q
How is GORD diagnosed?
A
Endoscopy (if normal, 24h oesophageal pH monitoring ± manometry).
8
Q
What are the risk factors for GORD?
A
Older age, smoking, alcohol, obesity, hiatus hernia, LOS tone-reducing drugs.
9
Q
What are the complications of GORD?
A
Oesophagitis, benign stricture, Barrett’s oesophagus.
10
Q
What is Barrett’s oesophagus and how is it managed?
A
Metaplasia from stratified squamous to simple columnar epithelium; high-dose PPI, regular endoscopic surveillance if metaplasia.
11
Q
What are the types of oesophageal cancer?
A
Adenocarcinoma (lower ⅓), Squamous cell carcinoma (upper ⅔).
12
Q
What are the symptoms of oesophageal cancer?
A
Dysphagia, odynophagia, weight loss.
13
Q
How is oesophageal cancer diagnosed?
A
Endoscopy with biopsy, staging CT.
14
Q
What are the ‘ALARM Signs’ for peptic ulcer disease (PUD)?
A
Anaemia, loss of weight, anorexia, recent onset/progressive symptoms, melaena/haematemesis, swallowing difficulty.
15
Q
When is endoscopy indicated for PUD?
A
If >55y and presenting with ‘ALARM Signs’.
16
Q
What are the risk factors for duodenal ulcers?
A
H. pylori, NSAIDs, steroids, smoking.
17
Q
What is the primary symptom of duodenal ulcers?
A
Right epigastric pain, better on eating, night pain.
18
Q
How is H. pylori infection diagnosed in PUD?
A
Endoscopy + H. pylori test (13C-urea breath test or stool antigen).
19
Q
What is the treatment approach for H. pylori-positive PUD?
A
Stop PPI for 2w, antibiotics for 4w (PAC500 triple therapy).
20
Q
What is the primary symptom of gastric ulcers?
A
Left epigastric pain, worse on eating, weight loss.
21
Q
What is the diagnostic approach for gastric ulcers?
A
Endoscopy with biopsy + H. pylori test.
22
Q
What are the symptoms of gastric cancer?
A
Epigastric pain, weight loss, dyspepsia, N&V.
23
Q
What is the treatment for gastric cancer?
A
Surgery (endoscopic mucosal resection > subtotal gastrectomy > total gastrectomy).
24
Q
What is Plummer-Vinson syndrome?
A
Oesophageal webs + iron deficiency anaemia + glossitis; increased risk of SCC oesophagus.
25
What is achalasia?
Failure of oesophageal peristalsis and LOS relaxation; increased risk of SCC oesophagus.
26
What are the symptoms of achalasia?
Dysphagia to both solids and liquids, regurgitation, retrosternal pain.
27
How is achalasia diagnosed?
Endoscopy, barium swallow, oesophageal manometry.
28
What is the treatment for achalasia?
Heller cardiomyotomy.
29
What is CREST syndrome?
Calcinosis, Raynaud’s, oEsophageal dysmotility, Sclerodactyly, Telangiectasia; associated with systemic sclerosis causing dysphagia, retrosternal pain.
30
What are the symptoms of appendicitis?
Colicky → constant periumbilical → RIF pain, pyrexia, anorexia, N&V, may have diarrhea or constipation, worse on moving, dysuria, oliguria.
31
What is Murphy’s triad in appendicitis?
Pain + Vomiting + Fever.
32
What is McBurney’s sign in appendicitis?
Pain over McBurney’s point (⅓ distance between ASIS and umbilicus).
33
How is appendicitis diagnosed?
Bloods (WCC, neutrophils, CRP) + USS or CT.
34
What is the treatment for uncomplicated appendicitis?
Co-amoxiclav IV + Laparoscopic > Open appendectomy.
34
What is Crohn's disease?
Inflammatory bowel disease affecting the entire gastrointestinal tract, with skip lesions, and inflammation involving all layers of the bowel wall.
35
What are the common symptoms of Crohn's disease?
Non-bloody diarrhea, weight loss, perianal disease, abdominal tenderness or mass in RIF.
36
What is diverticulosis?
The presence of asymptomatic diverticula in the colon.
37
What are the risk factors for diverticulosis/diverticular disease?
>50y, low dietary fiber.
38
What is diverticulitis?
Inflammation of the diverticula in the colon.
39
How is diverticulitis diagnosed?
Bloods (WCC, CRP) + AXR + CT.
40
What is the primary treatment for uncomplicated diverticulitis?
Conservative - trial of conservatism for 48h (indications below) - NBM, fluids IV, NG tube, catheter.
41
What are the common complications of Crohn's disease?
Abscesses, strictures, fistulas, anemia, small bowel cancer, colorectal cancer, osteoporosis.
42
What is the diagnostic approach for Crohn's disease?
Colonoscopy with biopsy, faecal calprotectin (pos), barium enema (Kantor’s string sign), ASCA.
43
How is ulcerative colitis diagnosed?
Colonoscopy (ulceration, pseudopolyps) with biopsy, faecal calprotectin (pos), barium enema (lead pipe colon), p-ANCA.
44
What are the common extraintestinal manifestations of IBD?
Bones - pauciarticular arthritis, osteoporosis; Skin - pyoderma gangrenosum, erythema nodosum; Eyes - uveitis, episcleritis, scleritis; Other - clubbing, anemia.
45
What are the symptoms of IBS?
Abdominal pain related to defecation, altered stool frequency, and form, with at least two of: Bloating, Mucus, Worsened by eating, Altered stool passage.
46
How is celiac disease diagnosed?
tTG (positive) + Duodenal biopsy (villous atrophy, crypt hyperplasia, lymphocytic infiltration), need gluten for 6w prior.
47
What are the symptoms of celiac disease?
Persistent or unexplained GI symptoms, failure to thrive or faltering growth in children, prolonged fatigue, unexpected weight loss, mouth ulcers.
48
What is Meckel's diverticulum?
A congenital diverticulum, found in the ileum.
49
What is the treatment for caecal volvulus?
Laparotomy.
50
What is the treatment for sigmoid volvulus?
Rigid sigmoidoscopy.
51
What are the signs of appendicitis on physical examination?
Psoas sign (pain in RIF on right hip extension), Rovsing’s sign (pain in RIF on palpation of LIF), Obturator sign (pain in RIF on internal rotation of right hip).
52
What are the layers of the bowel wall affected in Crohn’s disease?
Mucosa, submucosa, muscularis propria, and serosa.
52
What antibodies are associated with Crohn's disease?
ASCA
52
What is the lead pipe colon in ulcerative colitis seen on imaging?
A smooth colon appearance without haustral markings, seen on barium enema.
52
What is the severity classification for ulcerative colitis based on stool frequency and systemic disturbance?
Mild (<4 stools/d + no systemic disturbance), Moderate (4-6 stools/d + minimal systemic disturbance), Severe (>6 stools/d + systemic disturbance).
53
What is the primary treatment for inducing remission in severe ulcerative colitis?
Steroids IV.
54
What is the treatment approach for isolated perianal disease in Crohn's disease?
Metronidazole PO.
55
What is the diagnostic criteria for irritable bowel syndrome (IBS)?
Symptoms present for ≥6 months, with abdominal pain related to defecation and associated with altered stool frequency and/or form.
56
What blood tests are done for diagnosing celiac disease?
IgA tTGA (tissue transglutaminase antibody), IgA endomysial antibody.
57
What is the mainstay of treatment for uncomplicated diverticulosis?
Increase dietary fiber.
58
What are the symptoms of Meckel's diverticulum complications?
Haemorrhage, bowel obstruction, diverticulitis.
59
How is Crohn’s disease diagnosed on colonoscopy?
Cobblestoning, deep ulcers, skip lesions.
60
What is the primary treatment for complicated diverticulitis with abscess?
Co-amoxiclav PO/IV, managed at home for 72h with PO, admission needed after 72h for IV if persistent.
61
What is the mainstay treatment for maintaining remission in Crohn's disease?
Azathioprine PO.
62
What is the treatment for refractory or fistulating Crohn's disease?
Infliximab PO.
63
What are the extraintestinal manifestations of Crohn's disease in the skin?
Pyoderma gangrenosum, erythema nodosum.
64
What are the two main causes of acute mesenteric ischemia, and which is the most common?
Arterial embolism (#1) and arterial thrombosis.
65
What is the classic presentation of chronic mesenteric ischemia?
Postprandial pain, weight loss, and vascular comorbidities.
66
Which part of the colon is most commonly affected in ischaemic colitis?
Splenic flexure.
67
What is the significance of CEA in colorectal cancer?
Carcinoembryonic Antigen (CEA) is a tumor marker for monitoring colorectal cancer. Elevated levels can indicate the presence or recurrence of adenocarcinoma.
68
What is the recommended screening test for colorectal cancer in individuals aged 60-74, and how often is it done?
Faecal Immunochemical Test (FIT) every 2 years.
69
What is the primary treatment for a patient with rectal cancer?
High anterior resection/sigmoid colectomy (colo-rectal).
70
What grading system is used for internal haemorrhoids, and what does Grade IV signify?
- Grade I: Do not prolapse
- Grade II: Prolapse, reduce spontaneously
- Grade III: Prolapse, reduce manually
- Grade IV: Prolapse, cannot be reduced.
71
What is the primary treatment for Grade IV internal haemorrhoids?
Excisional haemorrhoidectomy.
72
What are the complications of untreated vitamin B3 (niacin) deficiency?
Pellagra - Diarrhoea, dementia, dermatitis.
73
What is the common causative agent of C. difficile colitis, and what drugs are often implicated?
Clostridium difficile; Drugs - Clindamycin, 2nd or 3rd generation cephalosporins.
74
What is the diagnostic role of urinary 5-HIAA in carcinoid syndrome?
It confirms the diagnosis of carcinoid syndrome by detecting serotonin release from a carcinoid tumor.
75
What is lactulose used for in the management of hepatic encephalopathy?
Reduction of ammonia levels
76
What is the most common cause of hepatocellular carcinoma (HCC)?
Liver cirrhosis secondary to hepatitis B worldwide or hepatitis C in the UK.
77
What is the main purpose of CD antigen and C. diff toxin in the diagnosis of C. difficile colitis?
DT (C. diff toxin) indicates current infection, while C. diff antigen indicates past exposure.
78
What are the typical symptoms of a patient with fulminant liver failure?
Rapid onset of liver dysfunction, specifically synthetic function and hepatic encephalopathy, in a patient without known liver disease.
79
Which tumour marker is elevated in hepatocellular carcinoma
Alpha-fetoprotein (AFP)
80
What are the three classic symptoms of haemorrhoids, and what is their grading based on?
Symptoms: Bleeding, pruritis, pain. Grading is based on the extent of prolapse.
81
What is the characteristic presentation of sigmoid volvulus?
Abdominal pain, distension, constipation, and a visible "coffee bean" sign on imaging.
82
What is the primary treatment for internal haemorrhoids that prolapse but can be reduced manually?
Rubber band ligation.
83
What is the primary diagnostic tool for diverticulitis, and why is colonoscopy not recommended?
CT scan is the primary diagnostic tool; colonoscopy is not recommended due to the risk of perforation.
84
What is the most common cause of bowel obstruction in the large bowel?
Colorectal cancer.
85
In dynamic (mechanical) bowel obstruction, what is the classic symptom indicating small bowel involvement?
Colicky abdominal pain.
86
What are the key symptoms of acute mesenteric ischaemia?
Severe abdominal pain out of proportion to clinical findings, patient very ill.
87
What is the primary screening method for colorectal cancer in individuals aged 55?
Flexible sigmoidoscopy.
88
What are the two main types of vitamin B12 deficiency?
Dietary deficiency and pernicious anaemia.
89
What are the complications of untreated vitamin C deficiency?
Scurvy - bleeding and poor healing.
90
What is the classic presentation of carcinoid syndrome?
Flushing and diarrhoea.
91
What is the acronym used to remember the components of MEN-1?
Parathyroid tumours, Pituitary tumours, Pancreatic hormone-secreting tumours.
92
What is the characteristic sign of sigmoid volvulus on imaging?
"Coffee bean" sign.
93
Define Liver Cirrhosis.
Irreversible liver damage with loss of normal hepatic architecture
93
What is Hepatorenal Syndrome (HRS)?
Renal failure in chronic liver failure
94
Name the risk factors for Liver Cirrhosis
Hepatitis B, hepatitis C, autoimmune hepatitis, alcoholic hepatitis, Wilson’s disease, hemochromatosis, A1AT deficiency, Budd-Chiari syndrome
95
What are the complications of Liver Cirrhosis?
Chronic liver failure, portal hypertension, malnutrition, vitamin deficiencies, impaired immunity, HCC, HRS
96
How is Liver Cirrhosis diagnosed?
Transient elastography (fibroscan), thrombocytopenia (sensitive), Child-Pugh score
96
What is the treatment for Alcoholic Hepatitis?
Abstinence, benzodiazepine-reducing protocol, supportive care.
97
How is Hepatitis A transmitted?
Faecal-oral transmission.
98
Define Gilbert’s Disease.
Autosomal recessive disorder. Leading to jaundice during intercurrent illness
99
What is Wilson’s Disease?
Autosomal recessive disorder with copper accumulation, affecting the liver, brain, and cornea.
100
Name the complications of Hemochromatosis.
Liver disease, joint symptoms, skin bronzing, fatigue, diabetes, hypogonadism.
101
What is Spontaneous Bacterial Peritonitis (SBP)?
Ascites infection with no identifiable cause, commonly seen in liver cirrhosis.
102
Describe Acute Cholecystitis.
Inflammation of the gallbladder, often due to gallstones, with symptoms of RUQ pain, Murphy’s sign, and pyrexia.
103
What does SAAG measure in Ascites?
Serum Ascites Albumin Gradient; helps differentiate between portal and non-portal hypertension.
104
What are the classifications of Jaundice?
Pre-hepatic, hepatic, post-hepatic; unconjugated vs. conjugated bilirubinemia.
105
What are the symptoms of Ascending Cholangitis?
RUQ pain, fever, jaundice, part of Charcot’s triad.
106
How is Hepatitis B serology interpreted?
HBsAg indicates current infection, anti-HBs indicates recovery and immunity.
107
What is the primary treatment for Primary Biliary Cholangitis (PBC)?
Ursodeoxycholic acid ± prednisolone PO.
108
What is Primary Sclerosing Cholangitis (PSC) associated with?
Ulcerative colitis.
109
What is the primary cause of Pre-hepatic Unconjugated Bilirubinaemia?
Haemolysis.
110
What is the primary risk factor for Hepatocellular Carcinoma (HCC)?
Liver cirrhosis, especially secondary to hepatitis B or C.
111
What is the mainstay treatment for hepatic encephalopathy
Lactulose
111
Differentiate between Hepatitis A and Hepatitis B transmission
Hepatitis A is transmitted faecal-orally, while Hepatitis B transmission can be parenteral, sexual, or perinatal
111
What are the diagnostic criteria for Acute Cholecystitis?
RUQ pain, Murphy’s sign, abdominal mass, right shoulder tip pain, pyrexia, anorexia, N&V.
112
What is the primary treatment for Wilson’s Disease affecting the liver?
Penicillamine or trientine + zinc + dietary management
113
How is Hemochromatosis diagnosed?
Transferrin (>45%), ferritin (high), TIBC (low), and genetic testing are used for diagnosis.
114
What is the primary treatment for Spontaneous Bacterial Peritonitis (SBP)?
Cefotaxime IV
115
How is Hepatitis E primarily transmitted, and what is its prognosis in pregnancy?
Faecal-oral transmission; high mortality in pregnancy.
116
What are the common causes of Acute Pancreatitis?
Gallstones, alcohol, and drugs.
117
Provide the mnemonic 'I GET SMASHED' for Acute Pancreatitis causes
Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion bites, Hyperlipidaemia/Hypercalcaemia/Hypothermia, ERCP, Drugs (mesalazine > sulfasalazine, sodium valproate).
118
Describe Cullen’s sign in Acute Pancreatitis.
Bruised umbilicus.
119
Explain the significance of Grey-Turner’s sign in Acute Pancreatitis.
Bruised flanks.
120
What is the diagnostic importance of lipase and CCT in Acute Pancreatitis?
Lipase and CCT (contrast-enhanced computed tomography) are crucial for diagnosis.
121
Outline the treatment approach for Acute Pancreatitis caused by gallstones without cholangitis.
Cholecystectomy.
122
What is the primary treatment for Acute Pancreatitis caused by alcohol?
Benzodiazepine reducing dose protocol.
123
What is the leading cause of Chronic Pancreatitis?
Alcohol
124
List the risk factors for abdominal aortic aneurysms
Smoking, family history, increasing age, male sex, connective tissue disorders
125
Explain the concept of 'Courvoisier’s law' in Pancreatic Cancer.
Palpable gallbladder + painless obstructive jaundice suggests it is unlikely to be gallstones.
126
Differentiate between Inguinal Hernias - Direct and Indirect.
Direct hernias pass directly forwards through a defect in the posterior wall, while indirect hernias pass indirectly through the deep ring.
127
What is the primary risk factor for Femoral Hernias?
Female sex
128
What is the preferred treatment for Abdominal Aortic Aneurysms if indicated?
EVAR (Endovascular Aneurysm Repair).
129
How is severity assessed in Chronic Pancreatitis?
CT scan.
130
Describe the primary diagnostic marker for Pancreatic Cancer.
CA 19-9
131
Provide the genetic basis and clinical features of Wilson's Disease.
Autosomal recessive; features include liver disease (in children), neurological/psychiatric symptoms (in young adults), and Kayser-Fleisher rings.
132
Define Alpha-1 Antitrypsin (A1AT) Deficiency, its inheritance, and clinical manifestations.
Autosomal recessive or co-dominant; manifestations include emphysema and liver cirrhosis.
133
Outline the characteristics and causes of Budd-Chiari Syndrome.
Hepatic venous outflow tract obstruction; causes include polycythaemia vera, thrombophilia, pregnancy, and OCP use.
134
Explain the classification of Jaundice based on bilirubin levels and causes.
Pre-hepatic (increased unconjugated), hepatic (increased both), post-hepatic (increased conjugated).
134
Describe the bilirubin metabolism process and its key enzymes.
Formation from RBCs, conversion to unconjugated bilirubin, conjugation in the liver, and excretion through bile.
134
Provide examples of causes for Unconjugated Bilirubinaemia.
Hemolytic anaemia, Gilbert's syndrome
135
List common causes of both Unconjugated and Conjugated Bilirubinaemia.
Viral hepatitis, autoimmune hepatitis, alcoholic hepatitis, Wilson's disease, hemochromatosis, A1AT deficiency, etc.
136
Which enzyme is used to monitor pancreatic exocrine function in pancreatic cancer?
Faecal elastase
137
What causes epiglottitis?
Haemophilius influenza
138
What causes croup ?
Parinfluenza virus
139
What causes Slapped cheek syndrome?
Parvovirus 19
140
What causes hand, foot and mouth disease?
Coxsackie virus
141
What causes bronchiolitis?
RSV
142
1st line investigation in Budd-Chiari syndrome
ultrasound with Doppler flow
143
Investigation of choice in acute cholecystitis
Abdominal USS
144
Which test is used in diagnosing and monitoring the severity of liver cirrhosis
Transient elastography
145
Treatment of choice for biliary colic
Elective laparoscopic cholecystectomy
146
Preferred imaging modality for suspected perforated peptic ulcer
Erect CXR
147
How do we differentiate between ascending cholangitis and acute cholecystitis on LFTs
Normal LFTs in acute cholecystitis, deranged in ascending cholangitis
148
Most common causative pathogen of ascending cholangitis
E coli
149
Histological findings in Crohn's disease
Increased goblet cells, granuloma, transmural inflammatory cell infiltrate
150
Histological findings in UC
Inflammatory cell infiltrate is limited to the mucosa and submucosa only, focal crypt accesses, depletion / no goblet cells
151
Which antibiotic is used in Crohn's peri-anal abscess/disease?
Metronidazole
152
Which medication is used as prophylaxis for Spontaneous Bacterial Peritonitis?
Ciprofloxacin
153
Which medications cause c.difficile?
CLINDAMYCIN, 2nd and 3rd generation cephalosporins, PPIs
154
Histology of c.difficile
Gram positive rod
155
Pathophysiology of c.difficile
Infection with the gram positive rod following decrease / change to normal gut flora (subsequent to clindamycin/cephalosporin/PPIs) which leads to entotoxin release. This causes pseudomembranous colitis
156
What is seen in severe c.difficile infection
Toxic megacolon / severely raised WCC
157
When is oral fidaxomicin used in c.diff?
If recurrence of infection within 12 weeks of infection / if oral vancomycin fails
158
Most common cause of traveller's diarrhoea
E coli
159
Investigation of choice in colorectal cancer
Rigid sigmoidoscopy +/- biopsy
160
Biopsy changes in ulcerative colitis
Continuous Inflammation / Goblet Cell Depletion / Ulceration / Pseudopolyps / focal crypt abscesses
161
Biopsy changes in coeliac disease
Villous Atrophy / Crypt Hyperplasia / Intraepithelial Lymphocytes
162
Imaging of choice for primary sclerosing cholangitis (UC complication)
MRCP
163
Triple therapy in H pylori infection
PPI + amoxicillin + clarithromycin
164
Causes of upper GI bleed
- Perforated PUD
- Variceal haemorrhage / portal hypertension
- Mallory Weiss Tear
- Malignancy
- Oesophagitis
- Gastritis
165
Which vessel causes upper GI bleed in perforated PUD?
Gastroduodenal artery
166
Immediate interventions as an FY1 in upper GI bleed / major haemorrhage
- Call the on-call surgeons / endoscopist / your senior
- Protect the airway
- High flow oxygen through trauma mask / non-rebreather marks
- Large bore IV access
- Urinary catheter
- Fluid resuscitation
- O negative blood
- ABG / VBG
- CXR
- ECG
- Make NBM
- FBC, U&E, Cross match / group and save
167
How do we differentiate between ileostomy and colostomy on examination?
- Ileostomy is spouted vs colostomy flushed to skin
- Ileostomy has liquid contents vs colostomy contents more solid
168
Which type of anal fissure should make you suspect colorectal cancer?
Lateral anal fissure
169
Treatment of choice for diarrhoea in IBS
Loperamide
170
Which type of laxative do we avoid in opiate-caused constipation?
Bulk-forming
171
Which type of laxative do we use in opiate-caused constipation?
Stimulant / osmotic laxative
172
Pathophysiology of Mirzzi syndrome
Common hepatic duct obstruction
Caused by extrinsic compression from an impacted stone In the cystic duct or infundibulum of the gallbladder
173
Causes of acute confusion in liver cirrhosis
Hepatic Encephalopathy, Intracerebral bleed, Electrolyte or Vitamin Deficiency, Alcohol Withdrawal (Wernicke’s Encephalopathy), Sepsis (eg. Spontaneous Bacterial Peritonitis), GI Bleeding (varices), Drugs
