GI Flashcards
(227 cards)
1
Q
amylase level greater than what is considered to be diagnostic of pancreatitis
A
1000u/l
2
Q
can raised serum amylase levels diagnose pancreatitis
A
no but can suggest it as other things also raise it and in severe pancratitis serum amylase can be normal
3
Q
sudden osnet abdo pain, vomitting profusely and pain in epigastric region that radiates to back , drank alot of alcohol
A
pancreatitis
4
Q
symptoms of exacerbation of crohns
A
bloody bowel motions, fatigue, tachycardia, elevated inflammatory markers
5
Q
chrons disease exacerbation and acutely unwell treatment?
A
IV hydration, electrolyte replacement and corticosteriods
6
Q
macrocytic anaemia results from
A
increased utilisation of vitamin B12 by colonised bacteria
7
Q
steatorrhoea is caused by
A
reduced conc. of conjugated bile acids
8
Q
— can convert conjugated bile acids to unconjugated bile acids, which results in impaired micelle formation
A
bacteriodes
9
Q
diarrhoe is due to
A
steatorrhea
10
Q
Bacterial overgrowth syndrome constitutes a group of disorders characterised by
A
diarrhoea, steatorrhoea and macrocytic anaemia
11
Q
anatomic stasis due to duodenal or jejunal diverticula can result in the development of
A
bacterial overgrowth syndrome
12
Q
acquired deficiency of intrinsic factor is seen in
A
pernicious anaemia
13
Q
pernicious anaemia does not have
A
diarrhoea or steatorrhoea
14
Q
calcification of the pancreas
A
chronic pancreatitis
15
Q
chronic pancreatic insufficiency is most commonly associated with chronic pancreatitis caused by
A
high alcohol intake or cystic fibrosis
16
Q
Fish tapeworm infestation cause
A
vitamin b12 deficiency,but steatorrhoea, diarrhoea, jejuna diverticula make bacterial overgrowth syndrome more likely
17
Q
history of HIV, white mass on lateral aspect of tongue which cannot be scraped off
A
oral hairy leukplakia
18
Q
first line treatment for oral hairy leukoplakia
A
antivirals
19
Q
oral hairy leukplakia
A
a non- premaliganant Epstein-barr virus manifestation
20
Q
oral candiasis can typically be
A
scraped off with a tongue blade
21
Q
white lacy patches
A
oral lichen planus
22
Q
what deficincey is common in alcoholics
A
B1 (thiamine)
23
Q
thiamine deficiency causes
A
Wernicke’e encephalopathy - confusion, coma, ataxia, nystagmus, with the preservation of pupillary responses
24
Q
vitamin b3 deficiency (niacin) causes
A
pellagra characterised by diarrhoea, dermatitis and dementia
25
vitamin A deficiency causes
photophobia, dry conjunctiva, dry cornea, dry scaly skin, anaemia and growth retardation- it is essential for retinal pigments, epithelial maturation and bone development
26
Vitamin --- deficincy may present in patients with alcholic cirrhosis
K
27
acute abdo pain, rapidly developing asictes, elevated liver enzymes, enlarged caudate lobe,
hepatous venous outflow obstruction or Budd Chairi syndrome
28
In Budd -chairi syndrome, venous thrombosis forms anywhere from the hepatic venules up to the entrance of the
Inferior vena cava
29
Most commonly in budd-chiari syndrome, the venous thrombosis is with the
hepatic vein
30
firts line diagnostic investigation for hepatic venous obstruction
Ultrasound doppler
31
Management steps for budd-chairi syndrome
initially- anticoagulation
secondly- angioplasty with/out stenting or thromlysis
third line- Transjugular intrahepatic portosystemic shunt ( TIPSS)
- liver transplant
32
treatment for Budd chairi syndrome , if AST \>1000
liver transplantation
33
features of crohns disease
anorexia, fatigue, perianal and perioral ulceration, joint pain, rashes such as erythema nodosum
34
typically presents with bloody diarrhoea and mucus
ulcerative colitis
35
epigastric pain and heartburn symptoms
peptic ulcer disease
36
right upper quadrant pain and symptoms may be aggravated bu eating foods high in fat
gall stones
37
left iliac fossa abdominal pain - common in elderly
diverticulitis
38
corkscrew appearance on oesophagus
oesophageal spasm
39
barium swallow- post cricoid web , iron deficiency anaemia and dysphagia
Plummer vinson syndrome
40
spontaneous rupture of the oesophagus after forceful and severe vomitting. classically occur after excessive overeating and alcohol consumption. left sided pleural effusions is often an early finding on a CXR
boerhaave syndrome
41
bloody diarrhoea, tenesmus (feeling as though he needs to empty his bowels) and left lower quadrant tenderness point to
inflammatory bowel disease (Uc or crohns)
42
flu-like illness, anorexia, nausea and vomitting, general malaise followed by acute hepatitis with __ tenderness, jaundice pale stools and dark urine if cholestasis develops and on palpatation hepatomegaly will likely be present
= acute hepatitis A infection ]-common in north africa
RUQ
43
is there a significant risk of acute hepatitis A infection progressing to cirrhosis
NO!
44
HEP A and E transmitted by the
fAEcal -oral route
hep b and c by blood products and sexual intercourse and other ways
45
raised neutrophil count in ascites fluidin patient with cirrhosis of the liver and asictes
Spontaneous bacterial peritonitis
- serious complicatio and occur in approx 8% of cases of cirrhosis with ascites
- high mortality rate and high recurrence rate
46
most reflective of synthetic liver function
- pro-thrombin time and albumin
(pro-thrombin timw increases and is an indicator of acute sythetic function, albumin gives an indication of synthetic liver function over a longer period, given the half life 20 days in serum)
47
ALP would be raised in
cholestatic disease
48
ALT and AST represent liver
parenchymal function
49
hepatic portal vein is formed by the union of the
superior mesenteric and spenic veins
50
liver in patient is cirrhotic and and --- vein is obstructed, this is the cause of caput medusae
hepatic portal
51
tropical sprue presents with
chronic dirarrhoea, weight loss, vitamin b12 and folate deficiencies- seen in tropical countires like india
52
predominant mononuclear cell infiltration and less villous atrophy throughout the intestine
tropical sprue
53
treatment of tropical sprue
broad spectrum antibiotics
54
presentation of somatostatinoma
gallstones, weight loss, diarrhoea and diabetes mellitus
55
Glucagonoma typically presents with
diabetes mellitus, weight loss, anaemia, and classical rash is necrolytic migratory erythema
56
insulinoma presents with
sweating, weight gain, light-headedness and loss of consciousness- exacerbated by exercise or fasting
57
gastrinoma characterised by
peptic ulceration, gastric acid hypersecretion, non B cell islet tumour of the pancreas
58
VIPoma presents with
severe watery diarrhoea, which therefore gives significant hypokalemia, and achlorhydria
59
abdo pain which radiates to the back, significant elevation in amylase levels following endoscopic retrograde cholangiopancreatography (ERCP)
Post ERCP pancreatitis
60
vomitted bright red blood twice, palpable spleen tip, spider naevi over the check neck and arms
oesophageal varices
61
spleonmegaly and spider narvi are suggestive of
chronic liver failure with portal hypertension
62
immediate management of oesophageal varices
resuscitation, PPI, urgent endoscopy to diagnose and treat teh source of bleeding
63
Mallory-weiss tear classicaly occurs after severe
retching and vomitting or coughing
64
red flags for malignancy
appetite and anaemia
65
red flags for malignancy and luminal obstruction what investigation
colonoscopy
66
most common causes of exudative ascites are
infection or malignancy
67
causes of transudative ascites
-cardiac failure, portal hypertension, fulminant hepatic failure, budd-chairi syndrome
68
relatively common in elderly, muscle and joint pain, fatigue, red dots on the skin (perifollicular heamorrhages), bleeding and inflammation of the gums (gingivitis) ,easy brusing
scurvy (VITAMI C DEFICIENCY)
69
hypothyroidism is more likely to do what to weight
weight gain
and dry, coarse skin
70
lead posioning
abdo pain, confusion, headaches
71
while vitamin K deficiency may cause bleeding and easy brusing, it is much less common than
vitamin C defiency
72
you would expect a raised plasma urea level in
gastric ulcer
73
urea is produced as a by-product from the digestion of
blood
74
epigastric pain, which ususally occurs before meals or at night, relieved by eating or drinking milk
duodenal ulcer
75
duodenal ulcers usually occur in the presence of oversecretion of gastric acid
76
causes of duodenal ulcer:
HELICOBACTER PYLORI,NSAIDS, STERIODS AND ASPIRIN
77
GASTRIC ULCERS ARE LESS COMMON THAN DUODENAL ULCERS AND PATIETNS WITH GASTRIC ULCERS TEND TO HAVE
NORMAL OR LOW SECRETION OF GASTRIC ACID
78
solitary, well defined painful lesion in mouth
aphthous ulcer - benign oral lesion found in approx 20% of the population
- common triggers coffee and chocolate
79
first line management of aphthous ulcer
topical steriods and topical lidocaine for pain control
80
shaggy, white patch on the lateral aspect of the tongue
oral hairy leukoplakia
81
oral steriods should eb used cautiously in patietns with daiebets as they can cause
hyperglycaemia
82
treatment for oesophageal varices in patient with known alcoholic liver disease
non-specific beta blockers- nadolol and propanolol
83
blood and tender iliac fossa hint
UC
84
Ulcerative colitis is strongly associated with
primary sclerosing cholangitis
85
UC raised
ALP, ASMA, isolated ALP is often observed
86
what reduces surface mucus secretion
Aspirin
87
taking aspirin with --- has been shown to reduce the risk of GI bleeding and peptic ulceration
PPI
88
aspirin causes increased acid production from gastric parietal cells as --- normally inhibit acid secretion
prostaglandins
89
first line treatment for Hep C
Direct acting antivirals
90
diarrhoea, wheezing, flushing, weight loss
Neuroendocrine tumour
91
most common site for gastrin secreting tumours that cause zollinger- ellison syndrome
First/ second parts of duodenum
92
what is infectious mononucleosis
glandular fever
93
20y/o student w fever, sore throat, tender cervical lymphadenopathy and enlarged tender liver
glandular fever - enlarged over or spleen in 10% of cases - causative organism - epstein barr virus
94
glandular fever patients should avoid what in the first month
contact sports or heavy lifting
95
diagnosis for glandular fever
MONOSPOT TEST( PAUL BUNNELL)
96
Altered bowel habit and has lost weight recently
colorectal cancer with liver metastasis
97
liver metastases commonly arise from
bowel and breast cancer
98
abdominal swelling, hepatomegaly, lower limb oedema, SOB, past history of rheumatic fever and has hypertension
Congestive cardiac failure
(right heart failure is often a forgotten cause of ascites and hepatomegaly)
In tric regurg the enlarged liver may be pulsatile
99
feeling tired and diarrheoa, brusing tendency, large beefy tongue, lymphadenopathy and hepatomegaly
Amyloidosis
100
lumps and generalised symptoms- unintentional weight loss, fever, night sweats, involvement of liver, spleen, bone marrow
101
lymph node pain on drinking alcohol is said to be a feature of
hodgkin's disease
102
around 70-90% of patients with PSC (primary sclerosing cholangitis) have
inflammatory bowel disease
103
gold invstigation for PSC
ERCP
104
beaded appearance of biliary ducts, and liver biopsy showing -- skin appearance
onion
105
PSC - posive
PBS-positive
(antibody)
ANCA
AMA
106
ascending cholangitis triad
jaundice, abdo pain and fever
107
High serum amylase and serum lipase levels may indicate --- -induced pancreatitis
hypertriglyceridaemia
108
invstigation to check if a peptic ulcer has perforated
erect CXR
(show air under the diaphragm if a peptic ulcer has perforated)
109
hyper/hypocalcaemia in acute pancreatitis
HypOcalcaemia
110
symptoms that change at different points in the menstrual cycle is not an unusual finding in
IBS
111
much older than 26, acute onset lower abdo pain, altered bowel habit, rectal bleeding and fever
diverticulitis
112
advacned disease of chronic pancreatitis has
steatorrhoea
113
upper abdominal discomfort related to eating, without any consistent disturbance of bowel habit
peptic ulcer disease
114
what needs to be avoided ebefore doing the hydrogen breath test
smoking
avoid carbs the night before
115
post partum, on the pil, RUQ painn, nausea and vomiting, hepatosplenomegaly, ascites
Budd-chairi syndrome
116
budd-chiarai syndrome commonly results in
hepatosplenomegaly and ascities
-associated with pregnancy and being post partum- use of pill can increase risk
117
rise in bilirubin, young, no liver disease, jaundiced
gilberts syndrome
118
death or jaundice in neonate
Crigler Najjar
119
accumulate copper
wilsons disease
120
recurrent episodes of cholangitis
caroli's syndrome
121
elevated ferritin points towards a diagnosis of
Haemochromatosis
122
bronze diabetes
haemochromatosis
123
low ceruloplasmin, along with high urinary copper is typical of
Wilson's disease
124
positive AMA
PBC
125
high transferrin saturation
haemochromatosis- iron overload leading to liver cirrhosis, bronze colour to the skin
126
positive ANA or anti-SMA
autoimmune hepatitis
127
history of travel, lack of drug use, blood transfusion and unprotected sex , what hep
A
- eating shellfish, water contaminated by sewage, crowded, poor sanitation
128
hep B and -- are cotransmitted
D
129
hep C is contacted by
saliva and blood
130
Hep B is contracted by
blood, saliva, sexual contact
131
yellow fever assoiated with travel to
tropical rainforests
132
young person, flu like symptoms, mild janudice, raised bilirubin
gilberts syndrome
133
RUQ pain and fever, but no jaundice
Cholecystitis
134
HIV patient, pain affectid right side of face and got a rash affecting right cheek and right side of his palate
Shingles (herpes zoster)
135
most common cause of mouth ulcers particularly in young people
recurrent apthous stomatitis
136
behcet disease is common in asian and mediterranean countries eg
turkey
137
recurrent orogenital ulceration plus any no. of systemic manifestations eg joint pain, acne like lesions
behcets disease
138
associated with HLA-B51
behcets disease
139
common drugs that cause stevens johnson sydrome
allopurinol, antiepileptics, trimethoprim
140
lesions on skin, oral ulceration, crusting of the lips
stevens johnson sydrome
141
small pale papule on upper lip which develops into a large, painless indurated ulcer
syphillis
142
spleonmegaly and spider naevi are suggestive of chronic liver failure with portal hypertension. portal hypertension can lead to ---- which can rupture, causing severe bleeding, manifested as heamatemesis.
oesophageal varices
143
occurs in patients after severe coughing, vomitting or retching
mallory weiss tear
144
sudden onset large volume of blood
oesophageal varices
145
oesophagitis is very
painful
146
symptoms of delirium tremens
agitation, hyperthermia, visual hallucinations
147
first line therapy for delirium tremens
Lorazepam
148
-- lies at the severe end of the alcohol withdrawl spectrum
delirium tremens
149
histology shows acive inflammation
Helicobacter pylori gastritis
150
progressive painless jaundice. more common in men over 50, gives rise to hepatomegaly, stools paler than normal and urine darker,
cholangiocarcinoma
151
in acute cholecystitis you would expect
marked abdominal pain and pyrexia
152
haemolytic anaemia gives rise to
pre-hepatic jaundice, colour of urine and stool remains unchanged
153
if suspect obstruction , first line investigation is --- of the abdomen
ultrasound
154
LFTs of an obstructive/ cholestatic
ALP and GGT raised more than AST or ALT
155
common causes of obstructive jaundice
gallstones within the comon bile duct
cancer within the head of the pancreas
certain autoimmune liver diseases (PSC or PBC)
156
what investigation after upper GI endoscopy, colonscopy and small bowel contrast study
capsule endoscopy- not if got swallowing disorder, stricture or fistula, suspected small bowel stenosis
157
malaena is due to GI bleeding so what investigation
endoscopy
158
what would you inject a bleeding ulcer withbefore it is clipped to prevent re-bleed
adrenaline
159
hepatocytes differentiate from the
endoderm
160
Mallory bodies are seen in
injured hepatocytes
161
what is the precursor of cirrhosis
bridging fibrosis
162
small dilated blood vessels on face and trunk, palmar erythema, dilation of the superificial abdominal veisn
cirrhosis or irreversible liver injury
163
triple therapy for H.pylor (common cause of peptic ulceration)
PPI including omeprazole, clarithromycin and amoxicillin
164
treatment for h.pylori if allergic to pencillin
PPI, clarithromycin and metronidazole
165
second line eradication fro h.pylori
Metronidazole or clarithromycin, bismuth, tetracycline and PPI
166
investigatio for non alcoholic fatty liver disease
ultrasound liver
167
-raised ALT, impaired glucose regulation referenced by teh thickened folds of skin in the axilla, high BMI
168
HBsAg indicates
current infection
169
HBeAg indicates
current infection (suggests highly active HBV)
170
if patients had HBeAb and not HBeAG this would suggest
chronic carrier state of low infectivity
171
presence of --- would indicates immunity to HBV
HBV surface antibody
172
what region of the stomach is closest to the oesophagogastric junction
cardia
The cardia of the stomach surrounds the opening of the oesophagus into the stomach
173
duodenal ulcer is a type of
peptic ulcer disease
174
risk factors for peptic ucler disease
smoking, H.pylori infection, NSAIS, zollinger ellison syndrome
175
appendicitis
central abdominal pain that localises to the right iliac fossa with associated anorexia, fevers and peritonism
176
chronic mesenteric ischaemia
severe, colicky, post prandial abdo pain, weight loss, abdominal bruit
177
diverticulitis
left iliac fossa pain with rectal bleeding, fevers and tachycardia
178
pancreatitis
central abdominal pain radiating to the back in patients who have a history of gallstones, alcoholism, or abdominal trauma
179
hip pain more common in -- than crohns
UC
180
Primary sclerosing cholangitis is a condition in which
inflammation, fibrosis and strictures of the intra and extra hepatic bile ducts occur
(MRCP shows multiple strictures in the biliary tree adn a characteristic 'beaded' appearance. Around 80% of patients with PSC will have UC)
181
cholangitis is
ascending infection of the biliary tree
182
cholecystitis refers to
inflammation of the gallbladder, most commonly caused by gallstones
183
findings of strictures on MRCP is more suggestive of
Primary sclerosing cholangitis
184
Primary biliary cholangitis is an
autoimmune disorder causing destruction of the small interlobular bile ducts, subsequent intrahepatic choleostasis causes fibrosis and ultimately cirrhosis of the liver
185
glasgow severity score is used for
severity stratification (within 48hrs of admission)
score of 3 or above indicates intensive care unit
186
not a parameter in glasgow severity scoring
serum amylase
- may be normal in severe pancreatitis and may be elevated in many other conditions.
187
first line method to confirm safe placement of NG tube before commencing feeding
Aspirate 10ml and check the pH
if less than 5.5 then NG tube can be safely used
188
red flag of cancer
subacute first onset dysphagia which is limited to solids
189
painless jaundice, weight loss, epigastric discomfort, development of diabetes
pancreatic carcinoma
painless jaundice is significantly associated with pancreatic carcinoma
190
progressively worsening jaundice, weight loss, strong alcohol history
pancreatic cancer
191
presenting symptoms of cholangiocarcinoma
jaundice, abdominal pain, itching
192
nail clubbing, palmar erythema, spider naevi- no jaundice
chronic liver disease
193
first line treatments for autoimmune hepatitis
Azathioprine and prednisolone
194
deranged liver function tests, jaundice, itching and chronic fatigue
PSC
195
white lesion in mouth that can be easily scraped off treatment
Oral candidiasis - nystatin suspension- like mouth wash
196
RUQ pain, fever, elevated white cell count
acute cholecystitis
197
RUQ pain, fever, elevated white cell count
acute cholecystitis
198
management of acute cholecystitis
laparoscopic cholecystectomy
199
--- classicaly presents gradually with difficulty swallowing both solids and liquids over time as the lower oesophageal sphincter fails to relax
achalasia
200
Long term reflux causes damage to the oesophageal epithelium, which is replaced by fibrosis and results in a stricture. This in itself leads to dysphagia but can also predispose to malignancy through a pre-malignant stage known as
Barret's metaplasia
201
previously investigated for anaemia and now complains of dysphagia
Plummer-vinson sydrome
-occurs in pre-menopausal women
202
fibrosis resulting in disruption of normal liver architecture
alcoholic cirrhosis
203
deposition of excess lipids in hepatocytes
NAFLD
204
increase in portal blood pressure
portal hypertension - sequelae of alcoholic liver disease.
205
sclerosis of the intra and extrahepatic bile ducts
PSC- causes inflammation, fibrosis, and strictures of the bile ducts. Strong association with UC
206
investigations would best distinguish pernicious anaemia from otehr causes of malabsorption as the cause of low b12
intrinsic factor antibodies
207
PERNICIOUS ANAEMIA IS CAUSED BY
ANTIBODIES WHICH TARGET EITHER INTRINSIC FACTOR OR THE GASTRIC PARIETAL CELLS
208
C14 BREATH TESTS ARE USED IN THE IDENTIFICATION OF
H.PYLORI, A CAUSE OF PEPTIC ULCERS
209
TREATMENT FOR SEVERE TREATMENT RESISTANT C. DIFFICILE
IV METRONIDAZOLE OR FACEAL TRANSPLANT
NEEDS TO BE IV METRONIDAZOLE
210
CLASSIC SYMPTOMS OF HAEMORRHOIDS
fresh red blood and mucous after passing stool, pruritic anusm soreness around anus
211
risk factors for heamorrhoids
obesity, chronic constipation, coughing
212
Diverticulitis is characterised by passing fresh red blood per rectum, other associated symptoms are
nausea and vomitting, pyrexia and abdo pain
213
anal fissures associated with
sharp anal pain when stools are passed
214
blood supply to the stomach originates from the
coeliac trunk
215
coeliac trunk 3 main divisions:
Left gastric artery(oesophageal and stomach branch), common hepatic arery (proper hepatic artery, right gastric artery, gastroduodenal artery), splenic artery (short gastric arteries, branches to the pancreas)
216
In haemochromatosis there is increased risk of
hepatocellular carcinoma
217
is associated with haemochromatosis
arthropathy
218
p-ANCA is elevated in patients with
UC and or PSC
219
ASMA are markers for
autoimmune hepaitis
220
increased ASCA is associated with
crohns disease
221
elevated levels of Anti-dsDNA is found in
SLE
222
what nerves supply the muscularis externa of the oesophagus
vagus nerve
223
vagus nerve has a parasympathetic action and stimulate --- and supply teh smooth muscle
peristalsis
224
At the gastro-oesophageal junction there is the lower oesophageal sphincter, that under the influence of the vagus nerve, relaxes to allow food to enter the stomach. In ---- , there is increased tone of the lower oesophageal sphincter, incomplete relaxation ans lack of peristalsis. as a result has dysphagia and regurg
oesophageal achalasia
225
greater splanchnic nerves supply
enteric nervous system and the adrenals
226
--- nerves supply msucles for swallowing
glossopharyngeal (parasympathetic)
227
are rice and potatoes gluten free
yes
