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4th Year > Gastroenterology/ Surgery > Flashcards

Gastroenterology/ Surgery Flashcards

1
Q

What is the Ix of Carcinoid tumour?

A

Urinary 5-Hydroxyindoleacetic acid (5-HIAA)

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2
Q

What age and risk factor for NAFLD?

A

Middle aged, obese woman

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3
Q

What 4 risk factors for oesophageal candidiasis?

What is a main symptom

A

HIV, hep C and immunocompromised patients
Complication of inhaled steroid therapy
Pain on swallowing (odynophagia)

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4
Q

Symptoms of achalasia

A

Dysphagia to both liquids and solids

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5
Q

What is Zollinger-Ellison syndrome?

Which MEN?

Dx?

A

Gastroduodenal ulcers, epigastric pain, diarrhoea

Occurs as part of MEN type I
(hyperparathyroidism)

Dx: fasting gastrin levels, secretin stimulation test

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6
Q

What is the triad for Plummer-Vinson syndrome?

+ Rx

A
  • Dysphagia (secondary to oesophageal webs)
  • Glossitis
  • Iron deficiency anaemia

Rx: Iron supplementation and dilation of webs

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7
Q

Triad for Budd-Chiari Syndrome

A

1) Sudden abdominal pain
2) Ascites
3) Tender hepatomegaly

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8
Q

Triad for mesenteric ischaemia

A

1) CVD (esp AF)
2) High lactate (due to the acute infarction of tissue)
3) Soft but tender abdomen

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9
Q

What medication would you give for H.pylori eradication?

A

PPI + amoxicillin + clarithromycin

OR

PPI + metronidazole + clarithromycin

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10
Q

Standard diagnostic procedure for Primary sclerosing cholangitis

A

MRCP or ERCP

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11
Q

Patient with painless obstructive jaundice

A

Pancreatic cancer

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12
Q

ALP - indicates bile or liver issue?

A

Bile duct

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13
Q

Which blood test is a useful diagnostic marker of HCC?

A

AFP (alpha-fetoprotein)

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14
Q

What is Peutz-Jeghers syndrome?

A
  • hamartomatous polyps in GI tract (mainly small bowel)
  • pigmented lesions on lips, oral mucosa, face, palms and soles
  • Autosomal dominant condition
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15
Q

What is Sister Mary Joseph node?

A

A palpable nodule in the umbilicus due to metastasis of malignant cancer within the pelvis or abdomen

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16
Q

What will U&Es show in upper GI bleed?

A

High Urea

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17
Q

What is first line treatment for mild/moderate UC?

A

Topical (rectal) aminosalicylates

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18
Q

What is the 1st line investigation for mesenteric ischaemia?

A

Lactate

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19
Q

What is the first-line for treatment of diarrhoea in IBS?

A

Loperamide

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20
Q

What is Globus pharyngis/ globus hystericus?

A

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.

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21
Q

What will Serum Copper and Serum Caeruloplasmin be in Wilson’s disease?
Urine?

A

Serum Copper - decreased
Serum Caeruloplasmin - decreased
(serum is lower as the copper is taken into cells)
Urine Copper excretion increased

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22
Q

How many weeks should you stop taking PPT before endoscopy?

A

stopped at least 2 weeks prior to the endoscopy as it could mask serious underlying pathology such as gastric cancer.

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23
Q

Can PPI’s cause hypo or hypernatraemia

hypo or hyper magnesaemia?

A

PPIs can cause hyponatraemia

hypomagnesaemia

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24
Q

Treatment for severe alcoholic hepatitis

A

Corticosteroids (Prednisolone)

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25
Q

What is gallstones associated with?

Pick one: crohns, UC, Sudden weight gain…

A

CROHNS

Crohn’s disease can result in terminal ileitis, this is the section of the bowel where bile salts are reabsorbed. When this area is inflamed and the bile salts are not absorbed and people are prone to development of gallstones.

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26
Q

Ischaemic colitis presentation and predisposing factors

A

Ischaemic colitis is the most likely diagnosis given this man’s classic presentation (after a meal, intermittent and severe pain, pain out of proportion to clinical findings) and given his predisposing factors (prev. myocardial infarction, atrial fibrillation, hypertension).

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27
Q

What is a prophylaxis of oesophageal bleeding?

A

Propranolol- non-cardioselective B-blocker (NSBB)

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28
Q

What type of dysphagia cause has an increased risk of adenocarcinom of the oesphagous?

Squamous cell carcinoma?

A

Barrett’s oesophagus increases the risk of oesophageal adenocarcinoma AND GORD

Achalasia increases the risk of squamous cell carcinoma of the oesophagus.

29
Q

What vitamin deficiency can Isoniazid cause?

A

vitamin B6 deficiency causing peripheral neuropathy

30
Q

What is the treatment for hepatorenal syndrome?

A

Terlipressin and Albumin

31
Q

Liver cirrhosis investigation of choice

A

Transient elastography

32
Q

What abdo condition should metoclopramide be avoided in?

A

Bowel obstruction

33
Q

How many weeks before do you have to stop antibiotic and PPI use before doing a urea breath test?

A

Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks

34
Q

What is the triad for Boerhaave syndrome

And who is it more common in?

A

Vomiting, thoracic pain, subcutaneous emphysema

Alcohol abusers

35
Q

Pernicious anaemia

A

Vit B12 deficiency
ethargy, weakness
dyspnoea
paraesthesia
also: mild jaundice, diarrhoea, sore tongue
possible signs: retinal haemorrhages, mild splenomegaly, retrobulbar neuritis

The loss of vibration sense occurs due to low B12 levels, they can also cause reflex loss or weakness.

36
Q

Drugs that can cause cholestasis

A

COCP
antibiotics: flucloxacillin, co-amoxiclav, erythromycin
Sulphonylureas

Cholestatic jaundice, evidenced by her liver function tests (LFTs), dark urine and pruritis.

Oestrogens in the combined oral contraceptive pills (COCP) reduce the excretion of bile acids and conjugated bilirubin from the hepatocytes into the canaliculi, resulting in a build-up within the hepatocytes and diffusion into the bloodstream and what is known as intra-hepatic jaundice.

37
Q

What medications increases the risk of C.diff infection?

A

Clindamycin, cephlosporins (cef), PPIs

38
Q

Mechanism of how loperamide works

A

Stimulation of μ-opioid receptors in the submucosal neural plexus of the intestinal wall. This, in turn, reduces peristalsis of the intestines decreasing gastric motility.

39
Q

What would you see in histology for gastric cancer?

A

Signet ring cells

40
Q

In autoimmune hepatitis type 1, what antibodies will be present?

What is the management?

A

Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA)

Steroids

41
Q

Fetor hepaticus, sweet and fecal breat - is a sign of?

A

Liver failure

42
Q

Treatment for hepatic encephalopathy

A

Lactulose [1st line] + with rifaximin for the secondary prophylaxis of hepatic encephalopathy

lactulose is thought to work by promoting the excretion of ammonia and increasing the metabolism of ammonia by gut bacteria

antibiotics such as rifaximin are thought to modulate the gut flora resulting in decreased ammonia production

43
Q

Mild UC with a colonoscopy showing inflammatory changes in the ascending, transverse and descending colon - what is the management

A

In a mild-moderate flare of ulcerative colitis extending past the left-sided colon, oral aminosalicylates should be added to rectal aminosalicylates, as enemas only reach so far

44
Q

Pigment laden macrophages suggestive of melanosis coli

on histology is indicative of?

A

Laxative abuse

45
Q

Patients who are elderly, have neurological conditions, or chronic constipation are at higher risk of recurrent …

A

sigmoid volvulus

46
Q

Ix for acute pancreatitis

A

Serum Lipase

47
Q

Treatment of Gastric MALT lymphoma

A

Eradicate H. pylori

48
Q

What is Charcot’s cholangitis triad?

A

fever, jaundice and right upper quadrant pain

49
Q

How does biliary colic present?

A

colicky right upper quadrant abdominal pain
worse postprandially, worse after fatty foods
the pain may radiate to the right shoulder/interscapular region
nausea and vomiting are common

50
Q

Scoring system for pancreatitis prognostic factor

A

P - PaO2 <8kPa

A - Age >55-years-old

N - Neutrophilia: WCC >15x10(9)/L

C - Calcium <2 mmol/L

R - Renal function: Urea >16 mmol/L

E - Enzymes: LDH >600iu/L; AST >200iu/L

A - Albumin <32g/L (serum)

S - Sugar: blood glucose >10 mmol/L

51
Q

What is the intervention of choice in patients with malignant distal obstructive jaundice due to unresectable pancreatic carcinoma?

A

Biliary stenting

52
Q

What is Acute cholecystitis treatment?

A

Intravenous antibiotics + early laparoscopic cholecystectomy within 1 week of diagnosis

53
Q

What biliary condition is Crohn’s associated with?

A

Gallstones

54
Q

What is the most common causative agent of ascending cholangitis?

A

E.coli

55
Q

What is Pigmented gallstones most associated?

A

Pigmented gallstones are primarily made of bilirubin and are associated with hemolytic anemia (e.g. sickle cell anaemia) and liver cirrhosis

56
Q

What is the preferred diagnostic test for chronic pancreatitis?

A

CT pancreas - looking for pancreatic calcification

57
Q

Acute cholecystitis vs Acute cholangitis

A

Right upper quadrant (RUQ) pain, fever and raised inflammatory markers suggests acute cholecystitis or ascending cholangitis. The abnormal liver function tests (LFTs) suggest ascending cholangitis rather than cholecystitis (according to Charcot’s triad of RUQ pain, fever and jaundice for cholangitis).

58
Q

Are ileostomy sprouted or not?

A

An ileostomy is spouted to prevent the surrounding skin from coming into contact with the alkaline enzymes in the small intestine, whilst colostomies are flat

59
Q

painful, bright red, rectal bleeding

A

anal fissure

60
Q

Anal verge cancer

A

Abdomino-perineal excision of rectum

61
Q

How to treat sigmoid volvulus

A

rigid sigmoidoscopy with rectal tube insertion

62
Q

Diverticular disease symptoms

A

Altered bowel habit
Bleeding
Abdominal pain

63
Q

cancer in the rectum: what type of surgery

A

Anterior resection

64
Q

Cancer of Sigmoid colon: what type of surgery

A

High anterior resection

65
Q

Distal transverse, descending colon cancer: what type of surgery

A

Left hemicolectomy

66
Q

Caecal, ascending or proximal transverse colon cancer: what type of surgery

A

Right hemicolectomy

67
Q

What are most colorectal cancers?

A

adenocarcinoma

68
Q

What is loop ileostomy?

A

Loop ileostomy is a method to divert bowel contents away from a distal anastomosis. It is often indicated in rectal cancers. Reversal of the ileostomy restores bowel continuity and improves the patient’s overall quality of life.

4th Year (8 decks)

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