GI Flashcards by Lisa Azizi

cirrhosis - end stage / late stage

compared to compensated cirrhosis

compensated - enough healthy cells

decompensated not longer enough healthy cells
hepatic encephalopathy ascites and esophageal / gastric variceal haemorrhage

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compensated cirrhosis symptoms

loss of appetite
fatigues
muscle cramps
bruising and excessive bleeding as not enough clotting factors produced

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why do caput medusae occur in cirrhosis?

cirrhosis > portal hypertension > engorged paraumbilical veins on abdomen wall

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can gastroenteritis cause metabolic acidosis?

yes but ketones are not elevated

but alcholic ketoacidosis can also occur when glucose is not too low

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why do alcoholics risk ketoacidosis?

treatment?

not reguarly eating / body breaks down body fat

also episodes of vomit
met acidosis > elevated anion gap> elevated serum ketones > normla or low glucose concentartion

infusion of saline and thiamine
avodi wernicke encephalopathy

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IBD key differences

crohns has _____ _, _______,_______

crohns : skip lesions , granulomas, mucosa ro serosa all layers impacted, cobblestone appearance

UC: only upto sub mucosa is inflammed
crypt abscess
pseudopolyps

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most common causative agent for peritonitis

what would be the neutrophil count on paracentesis ?

e.coli
>250 cells/uL
cefotaxime

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Primary sclerosing cholangitis

hx
o/e
presents with what disease?
blood test results?

management

presents UC
pruritism - bilirubin

alt, ggt raised - biliary tree involvement

MRCP

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PSC

Associations

Features
Investigation

UC
Crohns
HIV

jaundice, RUQ pain, bili raised and alp, fatigue

p-anca +
beaded appearance of biliary tree

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where does mesenteric ischaemia present?

due to ?

pain?/ presentation

small bowel
embolic event
sudden onset, severe pain

urgent surgery
high mortality

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ischaemic colitis

presents?

large bowel

thumbprinting

transient less severe symptoms / bloody diarrhoea

conservative management

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bowel ischaemia risk factors

features

blood test finding

investigation?

atrial fibrillation
endocarditis
malignancy
smoking, htn, DM

cocaine

rectal bleed
diarrhoea
fever
elevated wcc and lactic acidosis

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why is thumbprinting seen in ischaemic colitis ?

abdominal xray sign due to mucosal oedema and haemorrhage

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management of crohns- remission

azathioprine / mercaptopurine

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first line treatment for UC

mesalazine

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what is serious complication of mesalazine

how would this come up in an mcq

agranulocytosis

sore throat, fever w taking this drug for uc

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A patient who is taking aminosalicylates and becomes unwell with a sore throat, fever, fatigue or bleeding gums needs an ?

urgent full blood count to rule out agranulocytosis.

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Primary biliary cholangitis is associated with _____ ________ does / does not result in progressive obstructive jaundice.

such as Sjogren’s and does not result in progressive obstructive jaundice.

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zollinger - ellison syndrome

excessive levels of gastrin
men type 1 syndrome

duodenal ulcers
diarrhoea
malabsorption

fasting gastrin levels
secretin stimulation test

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budd chiari syndrome

hepatic vein thrombosis
haematological disease; polycythaemia vera / pregnancy, cop

TRIAD- sudden abdo pain, ascites, tender hepatomegaly

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portal vein thrombosis

no hepatomegaly
thrombus before liver

affects vein supplying liver

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pseudomembranous colitis which abx

ceftriaxone

co-amoxiclav
ciprofloxacin
clindamycin

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crohns disease

perianal fistulae
investigation of choice

MRI pelvis

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Treatment - Crohns
remission
ongoing

what needs to be assessed before giving dmards?

remission - prednisalone / dexamethasone
enteral feeding

2nd line :5-asa drugs / aminosalicylates : MESALAZINE

maintaining remission : azathiopurine

TPMT activity - thiopurine methytransferase activity

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how if TPMT assessed

blood test | if your TPMT is low you should not receive aza

hepatitis screen results for someone that has immunity from a vaccine? HBsAg anti-HBc anti-HBs

HBsAg- anti hbc - anti hbs +

HBsAg anti-HBc anti-HBs what do these mean?

HBsAG - hepatitis b surface antigen- suggests current infection / infectious can be either acute / chronic infection Hepatitis core antibody : this would be present in an actual infection not vaccine hepatitis surface antibody - vaccine / natural infection dependant on other results

HBsAg anti-HBc anti-HBs what do these mean?

acute / chronic infected w Hep B ?

HBsAG - positive

hep b serology

HBsAg [acute disease1-6mo] - first marker > production of anti-hbs anti-HBs always suggests immunity so if your hep is chronic / not resolving - CHRONIC disease anti-HBc -caught the disease / core previous / current IgM - current / 6mo IgG- older HbeAg- breakdown of core antigen so marker of infectivity

coeliac disease what condition is it associated with? what condition can occur as a complication?

type 1 diabetes autoimmune thyroid disease dermatitis herpetiformis itchy blistering skin manifestation

a rash that occurs on extensor surfaces like knees , elbows the rash is itchy, vesicular what is this rash diagnosis? and what is the cause?

dermatitis herpetiformis | caused by coeliac disease

what is the most common intra abdominal abscess

sub phrenic

anti emetics | cyclizine

h1 receptor antagonist

d2 receptor antagonist - anrti emetic

meoclopramide

5ht3 receptor antagonist

ondansetron

autoimmune hepatitis

ama and ana antibodies

cholera management

fluid replacement | abx doxycycline

anal fissure >6 weeks

chronic

painful ictal bleeding?

anal fissure

acute anal fissure mx?

soften stool high fibre high fluid intake laxatives > lactulose vaseline before defecating topical anaesthetics analgesia

chronic anal fissure?

topical GTN or surgery or botulinum toxin

haemorrhoids

Location: 3, 7, 11 o'clock position Internal or external Treatment: Conservative, Rubber band ligation, Haemorrhoidectomy

external haemorrhoids

prone to thrombosis | and painful

internal haemorrhoids

painless | above dentate line

examination reveals a purplish, oedematous, tender subcutaneous perianal mass

Acutely thrombosed external haemorrhoids

outpatient treatment for haemorrhoids

rubber band ligation | injection sclerotherapy

Patients may describe pain around the anus, which may be worse on sitting; They may have also discovered some hardened tissue in the anal region; There may be pus-like discharge from the anus; If the abscess is longstanding, the patient may have features of systemic infection what is it caused by commonly?

perianal abscess e coli

gold standard in imaging anorectal abscesses

MRI and transperineal ultrasound can be useful tools, with the former being the

perianal abscess treatment

incision and drainage

appendicitis scoring system?

alvarado

haematemesis scoring system?

Blatchford - >6 Rockall

coeliac disease - derm condition?

dermatitis herpetiformis | Mx: dapsone: abx

definitive test for coeliac?

duodenal biopsy

Diverticular complication?

localised perforation= abscess faecal peritonitis stricture per rectum bleeding

investigation for diverticular disease?

CT scan

painless jaundice with a palpable mass in RUQ | what is investigation of choice

CT is the investigation of choice

in a RUQ pain / jaundice what is imaging of choice?

USS always in MRCP

how do you differentiate between large and small bowel obstruction?

in small bowel vomiting precedes abdominal distension

UC risk factor for which cancer? what if pt also has microcytic anaemia

right sided colon cancer

gastrograffin | use?

diagnostic and therapeutic | opens up small bowel obstruction

alarm bells for colonoscopy

per rectum - mixed with stool , tenesemus , urgency weight loss iron deficiency recent change in bowel habits

young pt intermittent not progressive both solids/ fluids with a short hx?

achalasia

fluid challenge

IV bolus 250-500mL / 30 mins | REASSESS

maintenance fluids?

restore 2.5l fluid 100mM na+ 70mM K+ Bag 1: 1 L of normal saline (=1 L of H O, 154 mM Na+, 154 mM Cl−) plus 20 mM K+, IV over 8 hours. 2 − Bag 2: 1 L of 5% dextrose (=1 L of H O, 50 g of dextrose), plus 20 mM K+, IV over 8 hours. 2 − Bag 3: 1 L of 5% dextrose (=1 L of H O, 50 g of dextrose), plus 20 mM K+, IV over 8 hours. 2 − Total: 3 L of H O, 154 mM Na+, 60 mM K+ over 24 hours.

replacement fluids

Fever: febrile patients need an extra 500 mL of fluid for every 1oC above 37oC. − Burns patients: patients with burns need extra fluids and this can be calculated using the Parkland formula: Fluids (mL) = 4 × weight (kg) × % surface area burnt

GI Flashcards

(66 cards)