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General Flashcards

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1
Q

Murphy’s Sign

A

Pt breathe out and then place hand on right costal margin. + is pain on inspiration.
+ in cholecystitis, - in ascending cholangitis and choledocholithiasis.

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2
Q

Hepatocellular Carcinoma

A

High incidence in Asia and Africa. Predisposed by HepB/C. Also BG of cirrhosis, aflatoxin, anabolic steorids
Raised alpha FP. 25%amenable to surgery

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3
Q

Haematochezia

A

Rectal bleeding. Commonest cause is haemorrhoids, in age group over 60 it is Diverticular disease.

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4
Q

Gardner’s Syndrome

A

Rare autosomal dominant condition presence of polyposis coli, soft tissues and bony tumours.

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5
Q

Colorectal Cancer

A

3rd most commonly diagnosed cancer in the UK.

45%rectum, 25%sigmoid, 15%caecum, 10%transverce, 5%descending.

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6
Q

Right sided colon cancer

A

Weight loss, anaemia, occult bleeding, RIF mass

More advanced at presentation

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7
Q

Left colon cancer

A

Colicky pain, rectal bleeding, bowel obstruction, early change in bowel habit.
Less advanced disease at presentation.

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8
Q

Colon cancer urgent referal

A

> 40 with rectal bleed and change of bowel habit
60 with rectal bleeding persisting 6 weeks or more
60 with change in bowel habit 6 weeks or more
Any aged with right lower abdo mass
Any aged with palpable rectal mass
Any aged man with unexplained FE def anaemia, hb

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9
Q

Glucagonoma

A

Rare Neuroendocrine tumour. Overproduction of glucagon which increases blood glucose. Sx- diarrhoea with flushing. 4 Ds - diarrhoea, diabetes, DVT, depression
Tx- Octreotide

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10
Q

Toxic Megacolon

A

AXR shows dilated >6cm colon. Acute toxic colitis with colon dilatation.

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11
Q

Bloody Diarrhoea

A

Salmonella, Shigella, Campylobacter, Yersinia Enterocolitica, E.Coli, Entamoeba Histolytica

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12
Q

Ca 125

A

Ovarian Cancer

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13
Q

Ca 19-9

A

Pancreatic Cancer

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14
Q

Ca 15-3

A

Breast Cancer

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15
Q

Alpha-feto Protein

A

Hepatocellular carcinoma

Teratoma

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16
Q

CEA

A

Colorectal carcinoma

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17
Q

Gynaecomastia

A

Breast tissue development in males
Due to reduced oestrogen clearance in liver disease
Drugs- Spiro, cimetidine, digoxin, cannabis, oestrogens
Malignancy - Lung Ca, testicular Ca

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18
Q

Adenomatous polyp

A

Benign growth of lining of the bowel

Potential to become malignant

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19
Q

Metaplastic polyp

A

Benign growth of lining of the bowel

Cell change from one type to another, no malignancy risk.

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20
Q

Spider Naevi

A

Commonly in areas drained by SVC

More than 5 indicates chronic liver disease

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21
Q

Palmer Erythema

A

Reddening of palms of thenar and hypothenar eminences. Indicates hyperdynamic circulation.
In: cirrhois, RA, Pregnancy, Hyperthyroidism

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22
Q

Ascites

A

Portal vein hypertension
Hypoalbuminaemia
2nd hyperaldosteronism
Tx- Furosemide/Spiro/ paracentesis

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23
Q

Cholecystokinin

A

Secreted by endocrine cells, stimulated by fatty meals in the duodenum. Promotes bile release into duodenum.
Also promotes pancreatic lipase secretion.

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24
Q

Fetor Hepaticus

A

Sweat smelling odour on breath.

In severe hepatocellular disease

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25
Courvoisier's Law
If the pt is jaundiced and gall bladder palpable cause likely to be malignancy rather than gallstones
26
Meckel's Diverticulum
Small bulge in SI (congenital). 2% population, 2inches, 2 feet from Iliocecal valve, 2%symptomatic, 2x in men, 2 age of presentation
27
Troisier's sign
Presence of large left supraclavicular node in association with carcinoma of the stomach.
28
Rovsing's Sign
if palpation of LLQ results in more pain in RLQ then positive sign for appendicitis.
29
Charcot's Triad
RUQ pain, Fever, jaundice. Seen in Acute cholangitis.
30
Hepatitis A
``` Most common. Children/young adults. Faecal-oral route. Incubation 2-7weeks. Raised AST and ALT, raised bili if jaundice Leucopenia and high ESR No specific MX ```
31
Hepatitis B
``` Africa, Middle and Far East. (only DNA virus) IV route, Sex, vertical. 1% get fulminant liver failure 3-5% get chronic Hep B Tx- IFN (S/c), Lamivudine, Adefovir (PO) ```
32
Hepatitis C
Common S.Europe, Africa, Egypt. Blood and blood products Acute infection mild, jaundice in 10%. Most get chronic liver disease, present years later. Tx- Pegylated IFNalpha and ribavirin
33
Hepatitis D
Only works with HepB Mainly IVDU. IgM anti D in serum
34
Grading of Hep Encephalopathy
1 - daytime sonnolence, asterixis 2 - confusion, agitation and impaired coordination 3 - drowsiness, stupor, no communication 4 - coma, increased rigidity, extensor plantar (up)
35
Fulminant hepatic failure
Hep failure with encephalopathy in less than 2 weeks with prior normal liver Common causes- hepatitis and Para OD Complications - cerebral oedema, hypoglycamia, infection, hypotension, renal failure
36
Autoimmune Hepatitis
Common young middle aged women Signs of chronic liver disease High IgG, autoantibodies Prednisolone and azathioprine
37
AST:ALT
More than 2:1 = Alcoholic liver disease Less than 2:1 = Hepatitis 4 = Wilsons
38
AMA
Antimitochondrial antibody | PBC
39
Monometry
Diagnostic test for achalasia | Excesive LOS tone, doesn't relax on swallow
40
TIPS
Transjugular Intrahepatic Portosystemic shunt | Channel from portal vein to hepatic vein
41
Riglers sign
Double wall sign on AXR, sign of bowel perf
42
Kehr's sign
Left shoulder tip pain on ruptured spleen | Blood in peritoneal cavity, pain on raising foot off bed
43
Serum Amylase
High in perf dudodenal ulcer and intestinal infarction | >5x normal in pancreatitis
44
Ramstedt's opertation
Pyloromyotomy | Incision in muscle of pylorus to tx hypertrophic P.stenosis
45
Whipple Operation
For Ca head of pancreas | Remove - head, bile duct, gallbladder, duodenum, part of stomach
46
Chronic SBO
Severe colicky abdo pain (gut claudication) PR Bleeding, Wt loss (food hurts) ix - angiography tx - angioplasty
47
PBC
Progressive destruction of intrahepatic b.duct causing cholestasis ->cirrhosis Inherited, autoimmune, F>M 50yrs old Pruritis w/o jaundice, lethargy, signs of cholst Ix- high AMA, IgM and Alk Phos Tx- Ursodil, colestyramine, Vit ADEK.
48
Primary Sclerosing Cholangitis
Chronic chol. liver disease, inflm destruction of intra&extra hepatic bile ducts->cirrhosis age40, 2:1 M:F.assoc UC and cholangcarcinoma High ALP, ANCA, onion skin fibrosis Tx-Vitamins, abx, balloon dilation/stenting
49
Volvulus
Rotation of gut on its mesenteric axis commonly sigmoid, then caecum, elderly/psy Coffee bean appearance on CT Tx- flatus tube, laparotomy
50
Acute Mesenteric Ischaemia
AF with abdo pain, no abdo signs, shock
51
Zollinger Ellison Syndrome
Gastrinoma in head of pancreas, inc gastric, increase peptic ulcers. ix- inc serum gastrin tx- PPI, surgery
52
Cirrhosis
Micronodular - alcohol and bil damage | Macro- hepatitis (variable size nodules)
53
Ulcerative Colitis
IBD of colon or rectum. Crypt abscesses
54
Crohns
Any part of GI tract from mouth to anus.
55
Barrett's Oesophagus
Metaplasia of cells due to chronic acid exp Inc risk of oes Ca. Tx- PPI and regular endoscopy
56
Osler-Weber Rendu
Inherited disorder of blood vessels that bleed excessively. Epistaxis and teleangiectasis
57
Mallory Weiss
Bleed from tears at jnct of stomach and oes | Assoc alcohol, eating disorder, vomiting
58
Boerhaeve Syndrome
More fatal oesophageal tear than M.Weiss. Rupture DX- gastrograffin swallow Tx- fluids, abx, surgical repair
59
Leptospirosis
(Weil's Disease) Bacterial zoonotic disease caused by spirochaetes Transmitted by urine of infected animals Biphasic - 1 Flu like sx 2. RF,liver damage, meningitis Tx - abx
60
Alpha 1 Antitripsin
Emphysema and Cirrhosis | Alpha1AT inhibits proteolytic enzyme elastase
61
Budd Chiari Syndrome
Hepatic vein occlusion leading to stasis and hypoxic damage and necrosis of hepatocytes Causes - polycythaemia, pregnancy, contraceptives, cancer Tx - Thrombolysis, angioplasty, TIPS
62
Portal Hypertension
When pressure in portal vein >14mmHG Collaterals in G-O junction, ant abdo wall, renal, rectal Sx- Ascites, splenomegaly Tx - Transfusion, bblockers, terlipressin, TIPS, transplant
63
Pyoderma Gangrenosum
Painful skin ulceration on skin usually legs Causes- IBD, arthritis, liver disease TX- steroids
64
Whipple's Disease
Rare bact infection of SI by T.whipplei. Damage to vili Wt loss, arthralgia, anaemia, p.oedema Causes PLE. Ix- endoscopy, eosinophillia. Tx- ceftriaxone, penicillin
65
Gastroparesis
Delayed gastric emptying due to vagus nerve damage or autonomic neuropathy
66
Peutz-Jeghers Syndrome
Hereditary intestinal polyposis, autosominal dom | 1. Polyps in GI tract 2. Hyperpigmented macules on lips and oral mucosa
67
Hirschsprung's Diseas
Congenital condition where rectum and lower colon fail to develop normal nerve network Causes enlarged colon and bowel obstruction Sx - delay in passing meconium, constipation. Dx - biopsy, Tx- surgical
68
Alport's Syndrome
X-linked disorder of tubointestinal nephritis causing RF | Also causes deafness. Commonly in children with heamaturia
69
Coeliac Disease
Intolerance to gluten in wheat, rye, barley. Classically 9-18months. Antigliadin, antiendomysial,tissue glutaminase Villous atrophy, inc lymphocytes IDA and dermatitis herpetiformis
70
Mirrizi's syndrome
Rare complication of stone impacted in cystic duct Causes swelling of cystic duct and gall bladder Compresses CBD leading to obst jaundice
71
Malrotation
Presents at 1-3days of life with int obstruction. at duodenojejunal flexure or caecum. Sx- bilious or bloody vomit, abdo pain, shock, blood pr. Ix- Ladd's bands on AXR. Needs contrast study. Tx- Laparotomy
72
Intussusception
Telescoping of prox bowel into distal segment Commonly ileum into caecum and colon into IC valve 2months -2 years old. Sausage shaped pal mass, RUQ Blood stained mucus, redcurrent jelly stools. Tx- rectal air inflation, surgery
73
Haemorrhoids
1. Piles bleed but do not prolapse 2. Prolapse but reduce spontaneously 3. Prolapse and myst be reduced manually 4. Remain constantly prolapsed Tx- infrared coag, sclerosants, rubber band lig, surgery
74
Anul fissure
Tx- lidocaine, GTN ointment, botulinum toxin. (relax muscles and increase blood supply for repair)
75
Plummer Vinson Syndrome
Formation of oesophageal web in women with IDA | Middle to upper oesophagus with pain and dysphagia
76
Oesophageal atresia
Associated with tracheo-oesophageal fistula Congenital, blind ending oesophagus Chocking, cyanotic spells, aspiration of saliva, milk Tx- surgery
77
Diffuse Oesophageal Spasm
Nutcracker Oesophagus. Intermittent uncontrolled spasm Distal part, no structural stenosis. Ix- Ba swallow - corkscrew, manometry. Tx- nitrates, botulinum toxin, surgery
78
Haemochromatosis
Autosomal recessive disease, Fe deposition, fibrosis, organ failure.. DM, cirrhosis, cardiomyopathy,HCC. IX- high serum Fe, low TIBC, liver bx Tx- blood letting 500ml twice a week. Desferin.
79
Wilson's Disease
Failure of copper excretion, accum in liver, BG, cornea, kidneys. Kayser Feisher rings. Ix- high serum and urinary Cu, bx liver, low ceruloplasmin Tx- Penicillamine
80
Ischaemic Colitis
Low flow in IMA territory Clinical - LLQ pain, bloody diarrhoea, , peritonitis Ix- Ba enema, MR angio Tx- fluids and abx, angio/stent. Watershed areas - splenic flexure, sup renal artery
81
Achalasia
Oesophageal motility disorder, difficulty with solid&liq Ba swallow - bird beak appearance Tx- myotomy
82
Angiodysplasia
AV malformations that present with fresh PR bleeding in the elderly. Commonly right side of colon. Dx- angio Tx- embolisation,resection
83
Galactomsemia
Rare genetic metabolic disorder Affects ability to metabolise galactose, common in irish Sx- hepatomegaly, cirrhosis, RF, brain damage. Tx- eliminate lactose and glucose from diet
84
Carcinoid Tumours
Neoplasm from endocrine cells, secretes serotonin. Common sites- appendix, ilium, rectum. Sx-bronchoconstriction, flushing, diarrhoea, abdo cramps, CCF DX- 5HIAA Tx- octreotide
85
Metabolic Causes of Constipation
Hypercalcaemia Hypokalaemia Hypothyroidism
86
IgA tissue Transflutaminase
tTGA - first choice test of coeliac

Gastroenterology (1 decks)

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