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Y4S2 Medicine > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Which antibiotic is most strongly associated with Clostridium difficile infections?

A

Clindamycin

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2
Q

What is ranitidine?

A

H2 receptor antagonist

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3
Q

What is the MELD score?

A

The Model for End-stage Liver Disease (MELD) score

A cirrhosis severity scoring system that predicts three-month survival

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4
Q

What is the Child-Pugh score?

A

A method of determining prognosis in liver disease, particularly cirrhosis

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5
Q

Which clinical features suggest decompensation of cirrhosis?

A

Jaundice

Ascites

Variceal haemorrhage

Hepatic encephalopathy

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6
Q

What causes ascites in liver disease?

A

Portal hypertension rather than hypoalbuminemia

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7
Q

Why do patients with liver disease have hypoalbuminemia?

A

The liver produces albumin

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8
Q

How is hepatic encephalopathy treated?

A

Lactulose

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9
Q

How does lactulose work in hepatic encephalopathy?

A

lactulose is converted to lactic acid by intestinal flora → acidification in the gut leads to conversion of ammonia (NH3) to ammonium (NH4+) → ammonium is excreted in the faeces → decreased blood ammonia concentration

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10
Q

What is the function of bile?

A

Absorption of fat and fat-soluble vitamins

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11
Q

What is Reynold’s pentad?

A

Ascending cholangitis

  1. RUQ pain
  2. Jaundice
  3. Fever
  4. Shock (low BP, tachycardia)
  5. Altered mental status
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12
Q

What is the most common benign tumour of the kidney?

A

Angiomyolipoma

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13
Q

What is a Sister Mary Joseph nodule?

A

Palpable nodule bulging into the umbilicus as a result of metastasis of malignant cancer in the pelvis or abdomen

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15
Q

What is emphysematous cholecystitis?

A

Infection of the gallbladder with gas-forming bacteria

Air is found in the gallbladder wall or lumen

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16
Q

What is the most common renal malignancy in adults?

A

Renal cell carcinoma

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17
Q

What is the triad of renal cell carcinoma?

A
  1. Haematuria (most common)
  2. Flank pain
  3. Palpable flank pass

Only 5-10% of patients present with all three components of the triad

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18
Q

What is the major complication of rapid paracentesis?

A

Paracentesis-induced circulatory shock

Fast reaccumulation of ascites

Hyponatremia

Renal impairment

Impaired survival

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19
Q

How does alpha-1-antitrypsin deficiency affect the liver?

A

Impaired secretion of alpha-1-antitrypsin by hepatocytes → intracellular accumulation of alpha-1-antitrypsin → hepatocyte destruction → hepatitis and liver cirrhosis

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20
Q

Which two antibiotics can be used for C. diff infection?

A

Metronidazole

Vancomycin (severe disease)

Only time when oral vanc is used. Vanc is not absorbed by the GI but stays in the large bowel where it can kill C diff

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21
Q

Which biomarkers can be used to diagnose and monitor IBD?

A

Faecal calprotectin and lactoferrin

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22
Q

What is cholelithiasis?

A

Gallstones

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23
Q

What is cholecystitis?

A

Inflammation of the gallbladder

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24
Q

What is cholangitis?

A

Infection of the biliary tree

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25
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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26
Q

What is charcot’s triad for cholangitis?

A
  1. Abdominal pain
  2. High fever
  3. Jaundice
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27
Q

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

A

Polycythemia vera

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28
Q

What is Budd-Chiari syndrome?

A

Hepatic venous obstruction → hepatomegaly, ascites, abdominal discomfort

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29
Q

What is the most important risk factor for AAAs?

A

Smoking

Also advancing age, atherosclerosis, hypercholesterolaemia, hypertension

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30
Q

Where is splenic pain referred to?

A

Left shoulder

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31
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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32
Q

What is Rovsing’s sign

A

Deep palpation of the LLQ causes RLQ pain

Appendicitis

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33
Q

What is the psoas sign?

A

RLQ pain with extension of the right leg against resistance

Appendicitis

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34
Q

What is the obturator sign?

A

RLQ pain with flexion and internal rotation of the right leg

Appendicitis

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35
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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36
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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39
Q

Which 3 organisms are most commonly responsible for cholecystitis?

A
  1. E. coli
  2. Klebsiella
  3. Enterococcus
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42
Q

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

A

Clostridium

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43
Q

What do Cullen’s and Grey Turner’s signs suggest?

A

Retroperitoneal bleeding

Non-specific and sensitive sign of haemorrhagic pancreatitis, but associated with a poor prognosis

Also ruptured or leaking AAA

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44
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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45
Q

What type of nociceptors are most commonly involved in visceral pain and what stimulates them?

A

Mechanoreceptors

Stimulated by stretch

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46
Q

What type of nociceptors are most commonly involved in somatic pain and what stimulates them?

A

Chemoreceptors

Stimulated by blood or inflammatory cytokines

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48
Q

What electrolyte abnormality is found in pancreatitis?

A

Hypocalcaemia

Lipase breaks down peripancreatic and mesenteric fat → release of free fatty acids that bind calcium →hypocalcaemia

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49
Q

What is the most common cause of acute pancreatitis?

A

Gallstone

Distal to the ampulla of Vater, impeding the flow of pancreatic secretions

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50
Q

Which organs are retroperitoneal?

A

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

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51
Q

What are the pancreatic enzymes?

A

Lipase

Amylase

52
Q

What type of inguinal hernia herniates lateral to the inferior epigastric vessels?

A

Indirect

53
Q

Which type of inguinal hernia involves protrustion of tissue through the internal inguinal ring, external inguinal ring and into the scrotum

A

Indirect inguinal hernia

54
Q

What are the boundaries of Hesselbach’s triangle?

A

Superior: inferior epigastric vessels

Lateral: inguinal ligament

Medial: rectus abdominis

55
Q

What is the most common cause of large bowel obstruction?

A

Colorectal cancer

56
Q

Where does pain from nephrolithiasis radiate?

A

Upper ureteral or renal pelvic obstruction: flank pain or tenderness

Lower ureteral obstruction: pain that may radiate to the ipsilateral testicle or labium

57
Q

What is the most common type of renal calculi?

A

Calcium oxalate

58
Q

Which type of renal calculi is radiolucent?

A

Uric acid

59
Q

What are the risk factors for uric acid stones?

A

Gout and hyperuricemia

High purine diet

60
Q

What causes struvite renal calculi?

A

Upper urinary tract infections with urease-producing bacteria

(Proteus mirabilis, Klebsiella,

Pseudomonas, Providencia, Enterobacter)

61
Q

What are gallstones characteristically made of?

A

Cholesterol

62
Q

What causes black gallstones?

A

Bilirubin

63
Q

What is the characteristic US sign of appendicitis?

A

Target sign

Inflammation and oedema of the appendiceal wall causes hyperechoic and hypoechoic layers

66
Q

What are the x-ray features of a SBO?

A
  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
67
Q

What are the x-ray features of a LBO?

A
  1. Air-fluid levels in the colon
  2. Bowel distention before obstruction
  3. Kidney bean/coffee-bean appearance of bowel e.g. volvulus
68
Q

What are the xray features of a paralytic ileus?

A
  1. Uniform distribution of gas in the small bowel, colon and rectum
  2. Obliteration of the psoas muscle outline
69
Q
A

Large: haustra

Small: valvulae conniventes/plicae circulares

70
Q

What is the most common cause of lower GI bleeding in adults?

A

Diverticulosis

71
Q

Draw the 9 regions of the abdomen

A
72
Q

What is diverticulosis?

A

Asymptomatic diverticula

73
Q

What is the definition of overwhelming post-splenectomy infection?

A

A bacterial infection that rapidly progresses to fulminant, overwhelming sepsis in the setting of anatomic or functional asplenia

74
Q

When is the peak incidence of appendicitis?

A

10-19 years of age

75
Q

What precipitates appendicitis?

A

Obstruction of the appendiceal lumen e.g. faecal material, undigested food, enlarged lymphoid follicle

76
Q

Why do patients with appendicitis initially have diffuse periumbilical pain?

A

Obstruction of the appendiceal lumen stimulates mechanoreceptors (visceral)

77
Q

What finding on a FBC is classical of appendicitis?

A

Mild leukocytosis with left shift

(not required for diagnosis)

78
Q

Which antibody is most strongly associated with coeliac disease?

A

IgA anti-tissue transglutaminase

80
Q

What is the classic x-ray finding of gastrointestinal perforation?

A

Free intraperitoneal air

Image: pneumoperitoneum secondary to PUD

84
Q

Why might a urinalysis be performed when investigating appendicitis? What are the expected findings

A

Evaluate DDx e.g. acute UTI, nephrolithiasis

Mild pyuria may be present because of the close proximity between the right ureter and appendix

86
Q

Where does subdiaphragmatic abdominal pain radiate?

A

Shoulder

87
Q

What can cause hyperoxaluria?

A

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)

88
Q

What is more common, gastric or duodenal ulcers?

A

Duodenal (3:1)

89
Q

What is the most common cause of peptic/duodenal ulcers?

A

H. pylori (80-90% of all ulcers)

90
Q

What is the history of pain in patients with a perforated peptic ulcer?

A

Sudden onset, intense, stabbing pain followed by diffuse abdominal pain and distention

91
Q

Which type of peptic ulcer is associated with weight gain?

A

Duodenal - pain is worst on an empty stomach

92
Q

Which type of peptic ulcer is associated with weight loss?

A

Gastric ulcer

Pain is worst post-prandial

93
Q

Which bacteria commonly causes mesenteric adenitis, mimicking appendicitis (pseudoappendicitis)?

A

Yersinia enterocoliticia

94
Q

How long following the onset of appendicitis does perforation tend to occur?

A

After 72 hours of symptom onset

95
Q

What is the most common cause of appendicitis in children?

A

Lymphoid hyperplasia

96
Q

What is the most common cause of appendicitis in adults?

A

Faecalith

Other: fibrosis, neoplasia

98
Q

What is Fitzhugh-Curtis syndrome?

A

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

99
Q

What findings are found on auscultation of a bowel obstruction?

A

Hyperactive “tinkling” bowel sounds early in the obstruction

Later bowel sounds are reduced or absent, often in combination with a markedly distended abdomen

100
Q

Which cause of an acute abdomen classically has increased polymorphonucleocytes? (>75%, normal (50-65%)

A

Appendicitis

101
Q

What is the “pointing sign”?

A

Patients will point to the spot of pain in peptic ulcer disease

102
Q

A patient in pain and moving around unable to find a comfortable position is characteristic of which condition?

A

Renal colic

103
Q

What imaging is used for diverticular disease?

A

Contrast enema and colonoscopy

104
Q

What imaging is used for acute diverticulitis?

A

CT

105
Q

What are some complications of diverticular disease?

A

Haemorrhage

Abscess

Perforation

Peritonitis

Fistula

Stricture

Obstruction

106
Q

Which bile ducts does primary biliary cholangitis (PBC) affect?

A

Small intralobular bile ducts (part of the hepatic portal triad)

107
Q

Which antibody test is most specific for primary biliary cholangitis (PBC)?

A

AMA (98%)

ANA also commonly positive

108
Q

Which immunoglobulin tends to be raised in PBC?

A

IgM

109
Q

Who gets primary biliary cholangitis (PBC)?

A

Middle aged women (95%)

35-60 years old

110
Q

What is the classic presentation of primary biliary cholangitis (PBC)?

A

Usually asymptomatic and diagnosed based on deranged LFTs

If symptomatic:

  • Fatigue
  • Pruritis
  • Skin hyperpigmentation/dryness
  • Xanthelasma/xanthomata
  • RUQ discomfort

Can progress to chronic liver disease (jaundice, hepatomegaly, portal HTN)

111
Q

Which diseases are classicaly associated with primary biliary cholangitis (PBC)?

A
  • Sjogrens (65-80% of people with PBC)
  • Thyroid disease (10-15%)
  • Limited cutaneous scleroderma (5-15%)
  • Classic rheumatoid arthritis (5-10%)
112
Q

What do you expect the LFTs to be in a patient with primary biliary cholangitis (PBC)?

A

Cholestatic picture

ALP > 1.5 upper limit of normal

Mild transaminitis (elevated AST and ALT)

113
Q

How are patients with primary biliary cholangitis (PBC) treated?

A

Ursodeoxycholic acid

Supportive for itch: antihistamines, cholestyramine

114
Q

What screening should you do in a patient with primary biliary cholangitis (PBC)?

A

TSH - annual

Lipids

DEXA - 6 months

Vitamin D (A and K also if bilirubin > 20) - annual

115
Q

What can misoprostol be used for in gastroenterology?

A

Peptic ulcer disease

Prostaglandin analogue → increases mucous secretion

116
Q

When might bilirubin be positive on urinalysis?

A

Failure of conjugated bilirubin to reach the intestines → bilirubin is not converted to urobilinogen

Biliary obstruction

Hepatic disease; hepatocellular disease, cirrhosis, hepatitis

117
Q

What might cause an elevated urobilinogen on urinalysis?

A

Conjugated hyperbilirubinaemia; extravascular haemolysis, malaria

Impaired hepatic reabsorption of urobilinogen; liver disease

Absent or decreased in obstructive jaundice

118
Q

What causes steatorrhoea?

A

Pancreatic e.g., chronic pancreatitis, CF

Malabsorption e.g., coeliac, giardiasis, Whipple’s disease, Crohn’s

Biliary e.g., PBC, PSC

119
Q

What are the two main diagnostic laboratory tests for coeliac disease?

A

IgA anti-tissue transglutaminase antibody

IgG deamidated gliadin peptide (test of choice for children < 2)

120
Q

Do perianal fistulae or abscesses suggest UC or CD?

A

Crohn’s disease

121
Q

What are the classic features of IBS?

A

ABC

A - abdominal pain

B - bloating

C - change in bowel habit

122
Q

How is portal hypertension identified as the cause of a patient’s ascites?

A

A serum-to-ascites albumin gradient (SAAG) > 11g/L

Requires paracentesis

123
Q

What extraintestinal manifestation of IBD is common in UC but not CD?

A

Primary sclerosing cholangitis

126
Q

What are the adverse effects of PPI use?

A

N&V, constipation, diarrhoea

Hypomagnesemia (malabsorption)

Hypocalcemia (malabsorption)

Low B12 (malabsorption)

Increased risk of C. diff

Speculation: pneumonia, CKD progression, fractures

127
Q

In which part of the intestines is the B12-intrinsic factor complex absorbed?

A

Distal ileum

Y4S2 Medicine (18 decks)

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