Gastrointestinal Flashcards
(115 cards)
1
Q
Signs of acute porphyria
A
Intermittent worsening abdo pain, nausea, lethargy
Recent course of nitrofuratoin (UTI)
2
Q
Treatment of acute alc withdrawal
A
Reducing regimen of chlordiazepoxide and Pabrinex
3
Q
Vit defic causing Wernicke’s encephalopathy
A
B1
4
Q
High/Low SAAG caused by…
A
High - Portal HT
Low - Peritoneal cancers
5
Q
First line ascites treatment
A
Spironolactone
6
Q
Absolute contraindications to ascitic tap
A
Disseminated intravasc coag (bleeding gums, raised D-dimer, low fibrinogen)
7
Q
First line for AI hepatitis
A
Immunosuppressants (azathioprine!!!!!!)
8
Q
Management for Barrett’s w high-grade dysplasia
A
Endoscopic ablation/resection
9
Q
Oeso cancer most assoc w Barrett’s
A
Adenocarcinoma
10
Q
Treatment of carcinoid crisis
A
Octreotide
11
Q
Abrupt onset watery diarrhoea
A
Cholera
12
Q
Cholera treatment
A
Doxycycline or co-trimoxazole
13
Q
Chronic pancreatitis on AXR/CT
A
Pancreatic calcification
14
Q
Name for scratches from constant itching
A
Excoriations
15
Q
First line for C.diff
A
Oral vancomycin
16
Q
Colonoscopy appearance of pseudomembraneus colitis from C. diff
A
Raised yellow plaques across mucosa
17
Q
What type of cancer are Coeliacs most at risk of?
A
Small bowel lymphoma
18
Q
In which disease must you also test for Coeliac?
A
Grave’s (thyroid)
19
Q
What can you see on buttocks in Coeliac?
A
Pruritic papulovesicular lesions
20
Q
What is alpha-feto protein a marker of?
A
Hepatocellular cancer
Also testicular/germ cell cancer
21
Q
Management of fistulae
A
Trans-sphincteric - drainage seton
Low/submucosal - fistulotomy
Perianal - insertion of fistula plug
22
Q
Crohn’s on endoscopic biopsy
A
Non-caseating granulomas
23
Q
Test to definitively distinguish Crohn’s and UC
A
Ileocolonoscopy and biopsy
24
Q
Investigation for sepsis in Crohn’s
A
Urgent MRI pelvis
25
What drugs can commonly cause dyspepsia?
Clarithromycin
| Risedronate
26
New onset dyspepsi + WL + >55 + H.pylori pos = which investigation?
Endoscopy within 2w
27
Liver foci and bloody diarrhoea from gastroenteritis?
Entamoeba histolytica
28
Campylobactor (gm- rod) treated w...
Erythromycin (macrolide)
29
What gastroenteritis pathogen is GBS associated with?
Campylobacter jejuni
30
What is the cause of abdo discomfort, bloating and flatulence after giardia treatment?
Lactose intolerance
31
Hep B serology seen w previous vaccination?
HbSAg negative, Anti-HbS positive, Anti-HbC negative
32
Pharma treatment for haemochromatosis
Desferrioxamine
33
Diag of hernia
Barium swallow !!!!!!
Endoscopy
Oeso manometry
34
Management of hernia
Conservative (WL, raise bed head, avoid large meals before sleep, avoid alc/acid foods/smoking/spec drugs etc)
Meds (PPI for 4-8w then review)
Surgery (Nissen's fundiplication if med-resistance, urgent is haem/necrosis/volvulus/obs)
35
What drugs can affect hernia?
Calcium channel blockers e.g. amlodipine
| Beta blockers
36
Drugs causing diarrhoea
```
Magnesium
Antibiotics - penicillins
Chemotherapy
Omeprazole
Cimetidine
Ranitidine
NSAIDs
Metformin
```
37
Drugs causing constipation
```
Anti-depressant agents
Anti-psychotic agents
Levodopa
Aluminium
Iron
Opiates
```
38
Inv for flow over diarrhoea
Rectal exam
39
Indication for TIPSS
Secondary prophylaxis for oesophageal variceal bleeding
Treatment of refractory ascites
Treating portal hypertension in Budd-Chiari syndrome
40
How can TIPSS cause hepatic encephalopathy?
Diverts blood flow away from liver and reduces ammonia breakdown
41
When is pain relieved in IBS?
After defaecation
42
Mirrizi's disease
Causes obs jundice due to compression of common bile duct secondary to gallstones
Produces conjugated hyperbilirubinaemia
43
Features of primary sclerosing cholangitis
Fatigue, itch etc
Deranged LFTs
AMA +ve
44
Hepatic jaundice LFTs...
Raised bilirubin
Raised AST and ALT
Maybe slightly raised ALP
Low albumin
45
Classification of cirrhosis w Child-Pugh score
A <7 points
B 7-9 points
C >9 points
46
Cirrhosis complications
```
Ascites
SBP
Liver failure
Hepatocellular carcinoma
Oeso varices +/- haemorrhage
Renal failure
```
47
Features of Budd-Chiari
Hepatic vein obs in patients w underlying haem conditions or pro-coag state e.g. polycythaemia rubra vera
Classic triad of abdo symptoms (pain, ascites, tender hepatomegaly)
Abdo US or Doppler
48
SBP Presentation
Background of cirrhosis
Generally unwell w tense ascites!!!!
Infection symptoms like fever
49
What is an essential first line test for patients w chronic liver disease?
Cap blood glucose
| They are esp susceptible to hypoglycaemia
50
High AST:ALT ratio plus high GGT...
Alchohol related liver disease
51
Jaundice, plus SOB and wheeze, plus lack of benefit from inhalers?
Alpha-1 antitrypsin defic
52
3 key features of Budd-Chiari
Hepatomegaly
Hypercoagulability
Worsening ascites
53
Caus eof gynaecomastia in cirrhosis
Altered oestrogen metabolism
54
Management of perforated peptic ulcer w signs of peritonitis
Laparotomy
55
What drug is indometacin?
NSAID
56
Risk factor for types oeso cancer
Squamous - achalasia, genetics, smoking, alcohol
| Adenocarcinoma - GORD, obsety and reflux, caucasian
57
Signet rings on biopsy...
Stomach cancer
58
Phases of gastric acid secretion
Cephalic (smell/taste of food) - secretion of HCl and gastrin
Gastric (stomach distension) - low pH/peptides cause gastrin release
Intestinal (food in duodenum) - inhibits secretion via enterogastrones
59
Pale stool and dark urine...
Obs cholestasis (confirmed by ALP and GGT)
60
Pos AMA plus deranged LFTs
Primary biliary cholangitis/cirrhosis
61
Absent urobilirubin + strong pos bilirubin
Obs jaundice - panc e.g. adenocarcinoma
62
White cells in SBP
White cells >250
| Neutrophils >40%
63
INR suitable for liver biopsy
<1.5
63
INR suitable for liver biopsy
<1.5
64
Rise n which enzyme indicates pancreatitis
Usually serum lipase/amylase
65
How can sickle cell affect the gallbladder?
Sickle cell anemia leads to hemolysis with increased bilirubin that favors formation of pigmented gallstones
66
4 stages of hepatic encephalopathy
1. Altered mood and behaviour, disturbance of sleep pattern and dyspraxia
2. Drowsiness, confusion, slurring of speech and personality change
3. Incoherency, restlessness, asterixis
4. Coma
67
Drug to reduce cerebral oedema in encephalopathy
IV mannitol
68
Criteria for paracetamol liver transplant
Arterial pH <7.3 24h after ingestion OR
Pro-thrombin time >100s
AND creatinine >300µmol/L
AND grade III or IV encephalopathy.
69
Criteria for non-paracetamol liver failure
```
Prothrombin time >100s OR
Any three of:
Drug-induced liver failure
Age under 10 or over 40 years
1 week from 1st jaundice to encephalopathy
Prothrombin time >50s
Bilirubin ≥300µmol/L.
```
70
Asterixis (hepatic flap) in liver failure is sign of...
Grade 2/3 hepatic encephalopathy
| Dute to paracetamol induced failure
71
What condition causing grey skin pigmentation, joint pains, erectile dysfuncton in middle aged men can cause liver failure?
Haemochromatosis
| test for ferritin and transferrin
72
Oral or IV lactulose for hepatic encephalopathy
Oral - it can alter gut environment and reduce ammonia
73
Common resp infection causing harsh breath sounds after liver failure
Pneumonia - treat w IV antibios
74
Cancer assoc w H. pylori, chronic inflam and AI conditions
MALT
| - treat w H. pylori eradication and if this fails then chemo/radio
75
What can cause different oral lesions?
Candida/leucoplakia - age/diabetes/immunosuppression/corticosteroids/malig/antibios (treat w anti-fungual e.g. fluconazole)
Hairy leukoplakia - HIV, EBV
Oral ulcers - defic incl iron/B12/folate - e.g. Crohn's
Glossitis/chelitis - iron defic
76
Courvoisier's sign
Painless palpable gallbladder with jaundice
77
Panc cancer inv
CT abdo/pelvis
78
Management of paracetamol overdose
>1h - activ charcoal
Staggered/>15 - N-acetylcysteine
<4h - wait 4h to take level and then N-ace
4-15h - take immediate level then decide treatment (bloods and consider liver unit)
79
Incr risk of paracetamol toxicity
Patient on long-term enzyme inducers
Regular alcohol excess
Pre-existing liver disease
Glutathione-deplete states: eating disorders, malnutrition and HIV.
80
Signs of pernicious anaemia
```
Low B12
Low Hb
High MCV and MCH
Normal MCHC
Low/normal folic acid
Low reticulocyte
```
81
Management of pernicious anaemia
Test for anti-intrinsic factor antibodies
| Treat w life-long cobalamin
82
Key inv in primary biliary cholangitis
Positive AMAs
| Liver biopsy also shows fibro-obliterative bil tree scarring
83
Key feature of PSC on MR cholangiopancreatography
Multiple beaded biliary strictures
84
Pellagra and its treatment
```
B3 Defic (the 3 Ds)
Nicotinamide
```
85
Common causative org in diabetic foot ulcers
Gm +
e.g. staph areus, enterococcus
Gm-
e.g. pseudomonas, E coli
86
Diabetes diag if symptomatic
Random blood glucose =11.1mmol/l
Fasting plasma glucose =7mmol/l
2 hour glucose tolerance =11.1mmol/l
HbA1C =48mmol/mol (6.5%)
87
Treatment of typhoid
Fluoroquinolones or third generation cephalosporins
88
Inv findings in UC
Colonoscopy - continuous inflam, red mucosa, loss of haustral markings, pseudopolyps
Biopsy - loss of goblet, crypt abscess, inlam cells
89
Ca19-9 tumour marker of which cancer assoc with UC
Cholangiocarcinoma
90
Surgery indication in UC with toxic megacolon
Failure to respond to intravenous steroids within 48-72 hours
91
Observations indicating levels of blood loss
Resting tachy <15% lost
Ortho hypoT >15%
Supine hypoT >40%
92
Initial man of upper GI bleed
IV fluid resus and blood transfusion
Nil by mouth and supplemental O2
Perhaps IV PPI
If variceal, IV terliprssion (to reduce pressure for endo)/antibios
93
Rockall score
>0 inpatient OGD
| 0 urgent outpatient OGD
94
Upper GI bleed liver related
Oeso varices
95
Prophylaxis of variceal bleed
Beta blocker e.g. propanolol
96
Prophylaxis of variceal bleed
Beta blocker e.g. propanolol
97
First line Whipple inv
Jejunal biopsy
97
First line Whipple inv
Jejunal biopsy
98
Wilson's disease causes which anaemia?
Coomb's negative haemolytic anaemia, with transient episodes of low-grade haemolysis and jaundice
99
Inv findings for Wilson's
Normally low ceruruloplasmin and serum copper
High urinary copper
Diag confirmed by genetic analysis of ATP7B
100
Wilson's treatment
Penicillamine and trientine
Zinc salts
Mandatory screening
101
Which drug enhances gastric emptying?
Metoclopramide
102
What drug is used to manage alcohol addicted patients in hospital to prevent withdrawal?
Clordiazepoxide
103
Which score is used to assess pancreatitis severity?
Modified Glasgow score
104
Paraneoplastic syndrome assoc with pacreatic cancer
Trousseau syndrome
(aka migratory thrombophlebitis)
105
Hyposplenism associated with anaemia and malabsorption?
Coeliac
- anti-TTG antibodies
106
High SAAG in ascites
Raised portal pressure
e.g. caused by liver cirrhosis, pericarditis, HF, Budd-Chiari etc
107
Describe Courvoisier's sign
Painless jaundice with palpable gallbladder
- suggests obs pancreatic/biliary neoplasm until proven otherwise
108
Rose coloured spots on abdomen assoc with abdominal pain/constipation and history of South Asia travel
Salmonella typhi
- when someone gives you ROSES say thank you (TY)
109
Immediate management of oesophageal varicaeal bleed
Terlipressin (vasopressin)
110
Which substances are secreted by G, enterochromaffin, and Chief cells?
G = gastrin
Enterochromaffin = histamine
Chief = pepsinogen
111
FL management ascites
Spironolactone
112
Targets for diuretic agents
*A*scites - *A*ldosterone *A*ntagonists: e.g. spironolactone
Heart *F*ailure - *F*urosemide
Hyper*T*ension - *T*hiazide diuretics
113
