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Things I don't know, but need to know, for fourth year > GI > Flashcards

GI Flashcards

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1
Q

List some negative prognostic factors of pancreatitis.

A 
Over 55
hypocalcaemia
Hyperglycaemia
Hypoxia
Neutrophilia
increased LDH
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2
Q

How can a diagnosis of Pancreatitis be made?

A

Imaging USS or CT

Or clinical diagnosis + 3x increase in amylase or lipase

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3
Q

In Pancreatitis which is more specific Amylase or Lipase

A

Lipase - it also has a longer half life so can be used in delayed presentation.

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4
Q

How long must someone have been of PPI before having a urease breath test

A

2 weeks

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5
Q

How long must someone have not had antibiotics prior to a urease breath test?

A

4 weeks

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6
Q

What is used in the management of ascites?

A

Spironolactone

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7
Q

What is an indication for a Liver transplant in a paracetamol overdose?

A

pH <7.3 after 24 hours

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8
Q

HNPCC

A

Right sided colonic lesions

Less frequent polyps then found in FAP

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9
Q

What criteria must be met in order to be diagnosed with HNPCC?

A

3 relatives with HNPCC lesions
2 Succesive Generations
1 < 50 years old

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10
Q

Melanosis Coli

A

laxative abuse

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11
Q

Management of severe Campylobacter or someone who is immunosuppressed with mild symptoms

A

Clarithromycin

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12
Q

If someone is unable to tolerate a Colonoscopy in a suspected cancer what can be used?

A

CT

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13
Q

Once a diagnosis of Colon Cancer is given. What other investigations should be done?

A

CT Chest Abdo Pelvis - Staging

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14
Q

What is the imaging modality of choice in Rectal Carcinoma?

A

MRI or USS

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15
Q

In a perforated duodenal ulcer what artery is likely to have been affected?

A

Gastroduodenal artery

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16
Q

A serum Albumin Ascites Gradient of over 11 generally means what?

A 
Portal Hypertension
Cirrhoiss
Liver failure
Liver metastase
Budd Chiari
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17
Q

A serum albumin ascites gradient SAAG <11 means what?

A 
Nephrotic 
Malutrition
Pancreatitis
TB
Peritoneal Carcinoma
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18
Q

Management of Ascites

A

Fluid restriction if Na ,125
Spironolactone +/- loop
Drainage + albumin cover

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19
Q

In uncontrolled variceal bleeding that has failed to respond to endoscopic banding what is the next treatment?

A

Sengotaken Blakemore Tube

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20
Q

Anti Emetics - 1,2,3

A 
1 = H1 receptor antagonist Cyclizine -intracranial causes - brain tumours 
2 =  D2 receptor Antagonist Metaclopramide - Good for chemotherapy induced 
3 = 5HT-3 receptor antagonist Odansetron - good for chemically mediated nausea
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21
Q

C.Diff - management

A

Oral vancomycin -> Oral Findaxomicin -> Oral Vancomycin + IV Metronidazole

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22
Q

C. Diff reinfection - management

A

<12 weeks - Oral Findaxomycin

>12 weeks - Oral vancomycin or findaxomycin

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23
Q

Ischaemic Colitis vs Mesenteric ischaemia

A

IC - Large bowel, less severe, transient - managed conservatively, NBM, thrombolysis
MI - Small bowel, Severe acute pain - surgical emergency

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24
Q

Investigations for Ischaemic colitis

A

Serum Lactate
X ray - thumbprinting
CT scan - gold standard

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25
When is Ischaemic colitis managed surgically?
Failure of conservative methods | Perforation
26
Commonest site of ischaemia in the bowel?
Splenic flexture
27
Grading C.Diff
Mild - normal WBC Moderate - WBC <15 + 3-5 stools Severe - WBC >15 or temp >38.5 Life threatening - Hypotension, Megacolon, Ileus
28
When are azathioprine or mercaptopurine used in UC?
For remission if >2 admissions for UC in a year.
29
What is used in the secondary prevention of hepatic encephalopathy?
Lactulose | Rifaximin
30
Oesophageal cancer diagnoses
Endoscopic Biopsy USS- localised staging CT - staging
31
Oesophageal cancer diagnoses
Endoscopic Biopsy USS- localised staging CT - staging
32
Crohns Management
Flare up Steroids -> 5ASA -> Azathioprine -> Infliximab Maintain Remission Stop smoking + Azathioprine or Mercaptopurine
33
What is used in spontaneous bacterial peritonitis prophylaxis management?
Co-Trimoxazole | Ciprofloxacin
34
Management of Dyspespia with no red flags
Medication review Lifestyle changes 1 month PPI trial -> no improvement test for H.Pylori or Test for H.Pylori first -> if negative trial PPI
35
Hepatitis D
Co infects with Hepatitis B - same speed via bodily fluids Superinfection - Chronic Hep B with a new acute Hep D = fulminant hepatitis cirrhosis
36
How is hepatitis D treated?
Interferron - not very successful
37
1-6 day incubation period Headache malaise appendicitis like pain Diarrhoea +/- blood
Campylobacter
38
Virchows node - left supraclavicular | Sister Mary Joseph nodule - periumbilical node
Gastric carcinoma
39
Gold standard imaging for Pancreatitis
CT with IV contrast | x- Ray will show some calcification
40
What can be used to work out exocrine function of the pancreas
Faecal elastase
41
How long does it take most people with chronic pancreatitis to develop diabetes?
20 years
42
H. Pylori - Management
1st line Amox + PPI + Metronidazole/Clarithromycin - pen allergic - Clarithromycin + PPI + Metronidizaole 2nd line - PPI (BD) + Amoxicillin + Metronidazole/Clarithromycin ( one you didn't use last time)
43
Perianal Fistula
Crohns MRI is diagnostic investigation Oral Metronidazole -> infliximab help close Draining Seton for complex fistulae
44
Perianal Abscess
Incision and drainage is key management | Draining seton if tract is identified
45
Commonest cause of Hepatocellular carcinoma
Hep C in Europe | Hep B worldwide
46
What is the main risk factor for developing Hepatocellular carcinoma ?
Cirrhosis - hepatitis, alcohol, heamochromatosis
47
Signs and management of a hepatocellular carcinoma.
Late onset features - cirrhosis jaundice ascites RUQ pain Raised AFP Surgical excision if small -> radio frequency ablation -> embolisation -> liver transplant
48
Sweet focal smelling breath can indicate what?
Liver failure | Fetor Hepaticus
49
How can C.Diff appear on endoscopy?
Yellow plaques on wall | Pseudomembranous colitis
50
How are thrombosed haemorrhoids managed?
<72 hours since start - consider surgery | >72 hours since started - analgesia stool softener and ice pack
50
How are thrombosed haemorrhoids managed?
<72 hours since start - consider surgery | >72 hours since started - analgesia stool softener and ice pack
51
``` Middle aged woman AMA A2 +ve Anti smooth muscle antibodies +ve IgM increase Jaundice Fatigue pruritic RUQ pain ```
Primary Biliary Cholangitis
52
Management of PBC
Ursedeoxycholic acid - even in asymptomatic if LFTs show change use it Cholestyramine - use for pruritis Fat soluble vitamins supplements Liver transplant - bilirubin > 100
53
What are the two types of haemorrhoids?
External - Below dentate line - painful and thrombose | Internal - above dentate line - painless
54
How do you classify haemorrhoids?
Type 1 - don't prolapse Type 2 - prolapse out but spontaneously reduce Type 3 - prolapse out but need manually reducing Type 4 - None reducible haemorrhoids
55
Management of non thrombosed haemorrhoids.
Stool softener -> topical anaesthetic + steroid Outpatient clinic - Band ligation is better that scleropathy Surgical - large symptomatic that haven't responded to treatment.
56
Pain in duodenal ulcers
Worse on hunger | Relieved by eating
57
Globus + no red flags + occasional hoarse voice + Posterior pharynx erythema + cough + heartburn
Laryngopharyngeal reflux - silent reflux | Lifestyle advice + PPI + gaviscon
58
``` Younger woman Amenorrhoea Hepatitis picture - chronic or acute Raised IgG Piecemeal necrosis on biopsy ```
Autoimmune hepatits
59
Management of autoimmune hepatitis
Steroid + immunosuppression | Liver transplant
60
What antibodies may be positive in autoimmune hepatitis
ANA | Anti smooth muscle antibody
61
Hamartomatous Polyps in small Bowel - obstruction, intususseption, bleeding Pigmented lesions on lips hands and feet
Peutz Jeghers syndrome Conservative management only Polyps don't have malignant potential once formed, but increase cell turn over increases risk of cancer developing.
62
A positive psoas sign (pain on hip extension) in a query appendicitis may indicate what?
Retrocaecel appendix
63
Management of acute cholecystitis
IV antibiotics + analgesia +fluids + anti emetic | Laparoscopic cholecystectomy within a week
64
Ground glass cytoplasm in hepatocytes indicates what?
Chronic Hepatitis B
65
If someone has not eaten anything in over five days how should there nutrition be managed?
Start off with less than 50% of calories and protein.
66
What is first line for constipation in IBS?
Isphagula Husk
67
History of farming Middle East Increased eosinophils USS shows daughter cysts
Hydatid cyst | Surgery to remove capsule whole
68
Why is a CT important if you aren't certain on the diagnosis in liver cysts?
As rupturing the cyst, during USS guided biopsy, in a hydatid cyst can result in anaphylaxis.
69
What is the most commonly used indicator that an NG tube is placed correctly?
Aspirate pH is below 5.3
70
Obstructive defecation with a normal PR and barium enema. | History of childbirth
Rectal Intussusception | Defecating proctogram is imaging of choice
71
What is the most sensitive indicator of liver failure seen on bloods?
Thrombocytopenia
72
What management is sometimes used in children with a crohns flair up?
Enteral feeding with an elemental diet - avoid the side effects of steroids
73
Primary Sclerosing Cholangitits
Raised ALP and Bilirubin, RUQ pain, Fatigue USS-> MRCP or if unable to tolerate MRCP i.e metal plates ERCP is diagnostic Looking for a beaded appearance
74
Reasons for an urgent 2 week cancer referral.
>40 + unexplained weight loss and abdominal pain >50 + unexplained rectal bleeding >60 + iron deficiency anaemia or change in bowel habits
75
FIT test
Screening 50-74 years every two years. Can be requested over 75 FIT test should be used if you are suspicious but they don't meet the criteria for the 2 week cancer referral.
76
Diagnosis in acute IBD
Due to increased risk of perforation CT or flexible sigmoidoscopy is used ( no bowel prep) Abdo and chest X ray needed swell
77
Acute Pancreatitis management
``` Aggressive fluid resuscitation Analgesia is opiods Nutrition - not Nil By Mouth - enteral nutrition if moderate or severe -> parenteral if needed Antibiotics - no prophylaxis is given ```
78
Budd Chiari - diagnosis
Sudden Abdominal pain + Ascites + Tender hepatosplenomegaly | USS doppler is first line
79
Investigation of choice in Boerhaaves
CT contrast swallow
80
Where is folate absorbed?
Duodenum and proximal jejunum
81
Where is B12 absorbed?
Distal Ileum
82
What is used to monitor someone at risk of developing Type 2 DM?
Yearly Hb1AC
83
Management of pancreatic pseudocyst
Conservative is first line | Endoscopic or open surgery if - infected, mass effect, >12 week duration
84
Management of sterile pancreatic necrosis
Conservative
85
Drug Induced Pancreatitis | FATSHEEP
``` Furosemide Azathioprine Thiazide/Tetracyline Statins Sulphonamides Sodium Valproate Hydrochlorothian Estrogen Ethanol Protease inhibitors ```
86
Why should B12 be given before folate in someone who is deficient?
As giving it the other way around can trigger subacute combined degeneration of the spinal chord
87
Progressive renal failure in those with liver cirrhosis - generally triggered by an acute event i.e variceal bleed.
Hepatorenal syndrome Type 1 = rapidly progressive <2 weeks - very poor prognosis Type 2 = Slowly progressive >2 weeks - poor prognosis
88
``` Ascites Jaundice AKI No proteinuria or haematuria Hx of liver cirrhosis ```
Hepatorenal syndrome
89
Management of hepatorenal syndrome
Management - terlipressin and volume expansion with 20% albumin Liver transplant - usually to ill to undergo the surgery
90
Small Bowel Overgrowth Syndrome - managment
Rifaximin
91
What is the characteristic sign of a pancreatic cancer on CT or USS
Double Duct sign | Both ducts are dilated
92
What criteria make it a severe UC flair up?
>37.8 degrees >90bpm anaemia <105 ESR >30
93
Long term management of pernicious anaemia
life long replacement with Cobalamin (B12)
94
Prophylaxis in ascites
Oral Ciprofloxacin or Norfloxacin SAAG <15 1 episode of SBP Hepatorenal syndrome
95
Chronic ascites
Restrict dietary sodium | Repeat therapeutic ascitic drains
96
Pigmented gallstones could indicate what?
Increased haemolysis i.e sickle cell G6PD etc
97
Indications for dialysis in a patient with a high urea
Encephalitis - signs of confusion reduced consciousness etc | Uraemic pericarditis
98
Genes associated with FAP and HNPCC
FAP - APC | HNPCC - MSH2 MLH1
99
Sigmoid Volvulus Management
Flexible sigmoidoscopy + rectal tube insertion | Laparoscopy if peritonitis or failure of sigmoidoscopy
100
Caecal Volvulus
Any age - link to adhesions and pregnancy Presents with small bowel obstruction Surgical management - right hemicolectomy
101
Autoimmune hepatitis
Type 1 - IgG increased | Type 2 - IgG increased IgA decreased + children only
102
Salmonella incubation time
12-48 hours
103
Shigella incubation time
48-72 hours
104
Campylobacter incubation time
48-72 hours
105
Amoebesis incubation time
Long incubation time Profuse bloody diarrhoea Trophozotes
106
Modified Glasgow Score - negative prognosis for pancreatitis
``` Pa02 < 8 Age >55 Neutrophilia >15 WCC Calcium <2 Renal urea >16 Elevated liver enzyme - AST >200 LDH >600 Albumin <32 Sugar >10 ``` PANCREAS
107
When testing someones Anti TTG if they are deficient in IgA what is the next test that should be used?
IgG Anti TTG
108
Management of barrets oesophagus
PPI | Plus endoscopic monitoring every 3-5 years
109
2 week referral to oral surgery
Unexplained oral ulceration >3 weeks Unexplained one sided pain within head + ear ache + > 4weeks + normal otoscopy Unexplained persistent or sore throat.
110
Management of diverticulitis
Home with oral antibiotics -> A and E if no improvement in 3 days IV ceftriaxone + metronidazole in hospital
111
Management of UC - proctitis and proctosigmoiditis
Topical ASA -> oral prednisolone -> Tacrolimus after 2 weeks if no improvement
112
Management of UC - left sided or extensive
High dose oral ASA -> prednisolone -> tacrolimus if no improvement after 2 weeks
113
Management of UC - Severe
IV corticosteroid -> 72 hours no change = IV ciclosporin or surgery or infliximab
114
In a GI bleed due to a peptic ulcer what is required once treatment has been started?
6-8 week endoscopy to ensure healing is occurring
115
Indications for an inpatient alcohol withdrawal.
``` >30 units a day Previous seizures, epilepsy, DT Medical or psych co morbidities Vulnerable <18 ```

Things I don't know, but need to know, for fourth year (31 decks)

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