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Year 3 Semester 2 > Gastroenterology > Flashcards

Gastroenterology Flashcards

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1
Q

Which biomarkers can be used to diagnose and monitor IBD?

A

Faecal calprotectin and lactoferrin

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2
Q

What is cholelithiasis?

A

Gallstones

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3
Q

What is cholecystitis?

A

Inflammation of the gallbladder

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4
Q

What is cholangitis?

A

Infection of the biliary tree

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5
Q

What are the risk factors for cholelithiasis?

A

Fat, Female, Fertile (multiple children or pregnant), Forty (or older), Fair-skinned, Family history

6 F’s

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6
Q

What is charcot’s triad for cholangitis?

A
  1. Abdominal pain
  2. High fever
  3. Jaundice
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7
Q

What is the most common cause of Budd-Chiari syndrome?

A

Polycythemia vera

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8
Q

What is the pathophysiology of Budd-Chiari syndrome?

A

Obstruction of hepatic blood outflow → hepatic venous congestion → increased sinusoidal pressure and cellular hypoxia → liver cell damage

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9
Q

What is Murphy’s sign?

A

Ask the patient to take a deep breath while palpating the right subcostal area

If pain occurs when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive

Acute cholecystitis

https://www.youtube.com/watch?v=2T0XUQ1M-x0

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10
Q

What is the most important risk factor for AAAs?

A

Smoking

Also advancing age, atherosclerosis, hypercholesterolaemia, hypertension

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11
Q

Where is splenic pain referred to?

A

Left shoulder

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12
Q

What are five clinical signs which suggest appendicitis?

A
  1. Blumberg’s sign (rebound tenderness)
  2. McBurney point tenderness
  3. Rovsing’s sign
  4. Psoas sign
  5. Obturator sign
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13
Q

What is McBurney’s sign?

A

Point tenderness in the area one-third of the distance from the right anterior superior iliac spine to the umbilicus

Suggests appendicitis

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14
Q

What is Rovsing’s sign

A

Deep palpation of the LLQ causes RLQ pain

Appendicitis

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15
Q

What is the psoas sign?

A

RLQ pain with extension of the right leg against resistance

Appendicitis

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16
Q

What is the obturator sign?

A

RLQ pain with flexion and internal rotation of the right leg

Appendicitis

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17
Q

Which 3 organisms are most commonly responsible for cholecystitis?

A
  1. E. coli
  2. Klebsiella
  3. Enterococcus
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18
Q

Name 3 of the most common organisms found in abdominal sepsis from the stomach or duodenum

A

1. Streptococcus

  1. Candida
  2. Lactobacilli
  3. Fungi
    * Aerobic species predominate*
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19
Q

Name 3 of the most common organisms found in abdominal sepsis from the bowel and appendix

A

1. E. coli

2. Bacteroides fragilis

  1. Clostridium
  2. Peptostreptococcus
  3. E. faecalis

Anaerobes predominate

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20
Q

Bowel ischaemia dramatically increases the risk of sepsis from which organism?

A

Clostridium

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21
Q

What is the empirical treatment for intra-abdominal infections of the lower GI tract e.g. diverticulitis, appendicitis

A

Gentamicin PLUS amoxicillin/ampicillin PLUS metronidazole

  • Metronidazole provides anaerobe cover*
  • G + A provide Gram -ve cover*
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22
Q

What is the empirical treatment for intra-abdominal infections originating from the biliary system?

A

Gentamicin PLUS amoxicillin/ampicillin

G + A provide Gram -ve cover

Anaerobe cover not needed

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23
Q

An increased proportion of immature neutrophils in the blood is known as a right or left shift?

A

Left shift

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24
Q

What are 4 causes of elevated LFTs in a febrile patient?

A
  1. Ascending cholangitis
  2. Bacteraemia
  3. Drug reaction
  4. Viral hepatitis (rare)
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25
What type of nociceptors are most commonly involved in visceral pain and what stimulates them?
Mechanoreceptors Stimulated by stretch
26
What type of nociceptors are most commonly involved in somatic pain and what stimulates them?
Chemoreceptors Stimulated by blood or inflammatory cytokines
27
List 3 places in the abdomen with somatic chemoreceptors
1. Skin 2. Muscle (abdominal wall) 3. Parietal peritoneum 4. Mesenteric attachment
28
List 2 places in the abdomen with visceral chemoreceptors
1. Muscular lumen 2. Organ capsules
29
How do signals from abdominal visceral nociceptors enter the dorsal horn?
Sympathetic and parasympathetic efferent nerves Via splanchnic nerve
30
What do Cullen's and Grey Turner's signs suggest?
Retroperitoneal bleeding Non-specific and sensitive sign of haemorrhagic pancreatitis, but associated with a poor prognosis Also ruptured or leaking AAA
31
What electrolyte abnormality is found in pancreatitis?
Hypocalcaemia Lipase breaks down peripancreatic and mesenteric fat → release of free fatty acids that bind calcium →hypocalcaemia
32
What is the most common cause of acute pancreatitis?
Gallstone Distal to the ampulla of Vater, impeding the flow of pancreatic secretions
33
Which organs are retroperitoneal?
SAD PUCKER S: suprarenal (adrenal) gland A: aorta/IVC D: duodenum (second and third part) P: pancreas (except tail) U: ureters C: colon (ascending and descending) K: kidneys E: (o)esophagus R: rectum
34
What are the pancreatic enzymes?
Lipase Amylase
35
What is the most common cause of small bowel obstruction?
Adhesions
36
What is the most common cause of large bowel obstruction?
Colorectal cancer
37
Where does pain from nephrolithiasis radiate?
Upper ureteral or renal pelvic obstruction: flank pain or tenderness Lower ureteral obstruction: pain that may radiate to the ipsilateral testicle or labium
38
What is the most common type of renal calculi?
Calcium oxalate
39
Which type of renal calculi is radiolucent?
Uric acid
40
What are the risk factors for uric acid stones?
Gout and hyperuricemia High purine diet
41
What causes struvite renal calculi?
Upper urinary tract infections with urease-producing bacteria (Proteus mirabilis, Klebsiella, Pseudomonas, Providencia, Enterobacter) *Staghorn stones*
42
What are gallstones characteristically made of?
Cholesterol
43
What causes black gallstones?
Bilirubin
44
What type of inguinal hernia herniates lateral to the inferior epigastric vessels?
Indirect
45
Which type of inguinal hernia involves protrustion of tissue through the internal inguinal ring, external inguinal ring and into the scrotum
Indirect inguinal hernia
46
What are the boundaries of Hesselbach's triangle?
Superior: inferior epigastric vessels Lateral: inguinal ligament Medial: rectus abdominis
47
What is the most common cause of lower GI bleeding in adults?
Diverticulosis
48
What is diverticulosis?
Asymptomatic diverticula
49
When is the peak incidence of testicular torsion?
First 30 days of life or during puberty
50
What is Prehn's sign?
Relief of pain during elevation of the testes and suggests epididymitis rather than torsion
51
What is the definition of overwhelming post-splenectomy infection?
A bacterial infection that rapidly progresses to fulminant, overwhelming sepsis in the setting of anatomic or functional asplenia
52
When is the peak incidence of appendicitis?
10-19 years of age
53
What precipitates appendicitis?
Obstruction of the appendiceal lumen e.g. faecal material, undigested food, enlarged lymphoid follicle
54
Why do patients with appendicitis initially have diffuse periumbilical pain?
Obstruction of the appendiceal lumen stimulates mechanoreceptors (visceral)
55
How does an obstruction of the appendiceal lumen cause bacterial overgrowth?
Obstruction → breakdown of mucosal barrier → bacterial invasion
56
What is the characteristic US sign of appendicitis?
Target sign Inflammation and oedema of the appendiceal wall causes hyperechoic and hypoechoic layers
57
What finding on a FBC is classical of appendicitis?
Mild leukocytosis with left shift | (not required for diagnosis)
58
Which antibody is most strongly associated with coeliac disease?
IgA anti-tissue transglutaminase
59
What are the x-ray features of a SBO?
1. Dilated loops of small or large bowel 2. Air-fluid levels proximal to the obstruction 3. Distal bowel collapse 4. Minimal or no gas in colon
60
What are the x-ray features of a LBO?
1. Air-fluid levels in the colon 2. Bowel distention before obstruction 3. Kidney bean/coffee-bean appearance of bowel e.g. volvulus
61
What are the xray features of a paralytic ileus?
1. Uniform distribution of gas in the small bowel, colon and rectum 2. Obliteration of the psoas muscle outline
62
Large: haustra Small: valvulae conniventes/plicae circulares
63
Why might a urinalysis be performed when investigating appendicitis? What are the expected findings
Evaluate DDx e.g. acute UTI, nephrolithiasis Mild pyuria may be present because of the close proximity between the right ureter and appendix
64
Draw the 9 regions of the abdomen
65
Where does subdiaphragmatic abdominal pain radiate?
Shoulder
66
What can cause hyperoxaluria?
Dietary: beets, beans, dark green vegetables Vitamin C supplements Bile malabsorption and/or chronic diarrhoea Low calcium (calcium is required for oxalate absorption, and a decrease in absorption increases renal excretion)
67
When do people with an ectopic pregnancy present?
4-6 weeks after last period
68
What is more common, gastric or duodenal ulcers?
Duodenal (3:1)
69
What is the most common cause of peptic/duodenal ulcers?
*H. pylori* (80-90% of all ulcers)
70
What is the history of pain in patients with a perforated peptic ulcer?
Sudden onset, intense, stabbing pain followed by diffuse abdominal pain and distention
71
Which type of peptic ulcer is associated with weight gain?
Duodenal - pain is worst on an empty stomach
72
Which type of peptic ulcer is associated with weight loss?
Gastric ulcer Pain is worst post-prandial
73
Which bacteria commonly causes mesenteric adenitis, mimicking appendicitis (pseudoappendicitis)?
Yersinia enterocoliticia
74
How long following the onset of appendicitis does perforation tend to occur?
After 72 hours of symptom onset
75
What is the most common cause of appendicitis in children?
Lymphoid hyperplasia
76
What is the most common cause of appendicitis in adults?
Faecalith Other: fibrosis, neoplasia
77
What is the classic x-ray finding of gastrointestinal perforation?
Free intraperitoneal air *Image: pneumoperitoneum secondary to PUD*
78
What is Fitzhugh-Curtis syndrome?
Perihepatitis (extension of inflammation to the liver capsule and adjacent peritoneal surfaces) Seen in PID ***Right upper quadrant pain** or pleuritic pain, no liver enzyme abnormalities*
79
What findings are found on auscultation of a bowel obstruction?
Hyperactive "tinkling" bowel sounds early in the obstruction Later bowel sounds are reduced or absent, often in combination with a markedly distended abdomen
80
Why is serum lactic acid measured in the acute abdomen?
Elevated in mesenteric ischaemia
81
Which cause of an acute abdomen classically has increased polymorphonucleocytes? (\>75%, normal (50-65%)
Appendicitis
82
Which is a more useful clinical sign of appendicitis, migrating pain or RLQ tenderness/pain?
RLQ pain ## Footnote *Very unlikely if RLQ pain is not present*
83
What is the "pointing sign"?
Patients will point to the spot of pain in peptic ulcer disease
84
What are the 4 Ds of endometriosis?
1. Dysmenorrhoea (unrelieved by NSAIDs) 2. Dysuria 3. Dyschezia 4. Dyspareunia
85
When does pain from endometriosis occur?
2 days before the onset of menses Can last for several days
86
What activities are associated with rupture of an ovarian cyst?
Strenuous physical activities e.g. exercise or intercourse
87
What is the most common cause of intestinal obstruction in patients without a history of abdominal surgery?
Incarcerated hernia
88
A patient in pain and moving around unable to find a comfortable position is characteristic of which condition?
Renal colic
89
What imaging is used for diverticular disease?
Contrast enema and colonoscopy
90
What imaging is used for acute diverticulitis?
CT
91
What are some complications of diverticular disease?
Haemorrhage Abscess Perforation Peritonitis Fistula Stricture Obstruction
92
Through which nerve do somatic pain signals travel from the liver capsule/falciform ligament/biliary system/central diaphragmatic peritoneum?
Phrenic nerve
93
Through which nerve do somatic pain signals travel from the peripheral diaphragmatic peritoneum?
Lower 6 thoracic nerves
94
Through which nerve do somatic pain signals travel from the parietal peritoneum lining the anterior abdominal wall?
Lower six thoracic and first lumbar nerves
95
Through which nerve do somatic pain signals travel from the parietal peritoneum?
Obturator nerve (branch of the lumbar plexus)

Year 3 Semester 2 (7 decks)

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