GI

Question 1

if you see an elderly patient with painless jaundice what must you think of?

Answer 1

pancreatic cancer until proven otherwise.
(head of pancreas grows and blocks liver tubes)

Question 2

what is the window for alcohol withdrawal?

Answer 2

mostly within 72 hours of last drink

Question 3

how could you treat alcohol withdrawal?

Answer 3

clordazopoxide (benzo)
paprunex (vit b complex infusion you give alcoholics-need to make sure they’ve eaten something and are eating for this bc it relies on using glucose)

Question 4

what are the risk factors for gallstones?

Answer 4

female
obesity
age
pregnancy
drugs

Question 5

how do gallstones cause cholecystitis (acute and chronic)?

Answer 5

acute-stones compress blood supply
chronic-due to repeated mechanical trauma from stones

Question 6

what are the risk factors for gallbladder carcinoma?

Answer 6

previous gallstones
chronic cholecystitis
female

Question 7

what is Ranson’s score?

Answer 7

clinical prediction rule for prognosis and mortality risk of acute pancreatitis.

Question 8

why can PR bleeding give you diarrhoea?

Answer 8

blood is a laxative

Question 9

what is a sign of peritonitis o/e?

Answer 9

patients’ muscles contract and their abdomen is rigid to touch, they can’t move bc it hurts too much.

Question 10

what organism is the most common cause of bloody diarrhoea?

Answer 10

shigella dysenteriae

Question 11

what are some clinical signs of hypovalaemia?

Answer 11

orthostatic hypotension
supine hypotension
increased cap refill
resting tachycardia

Question 12

where are bile salts reabsorbed in the GIT?

Answer 12

terminal ileum

Question 13

what is an important blood finding in upper GI bleed?

Answer 13

increased urea-urea is product of protein breakdown so increased protein breakdown from RBCs=increased urea.

Question 14

what are the 2 things gastrograffin does?

Answer 14

radioopaque-can see whether it can pass through
is osmotically active-draws out oedema.

Question 15

what are 4 common causes of small bowel obstruction?

Answer 15

adhesions (fibrous bands)
hernias
cancer
volvuli

Question 16

what are 3 common causes of large bowel obstruction?

Answer 16

phlegmon -inflammatory mass-secondary to diverticulitis
swelling secondary to diverticulitis
cancer

Question 17

what is the glasgow blatchford score?

Answer 17

screening tool to assess the likelihood that a person with an acute upper gastrointestinal bleeding will need to have medical intervention such as a blood transfusion or endoscopic intervention.

Question 18

what are the 4 key features of peritonism on exam?

Answer 18

Cough tenderness – localising pain with cough
Involuntary guarding
Percussion tenderness – localising tenderness with percussion
Rebound tenderness – transient worsening pain following immediately release after deep palpation

Question 19

what are the 5 Fs for cholecystitis risk factors?

Answer 19

fat
female
fertile
forty
family history

Question 20

what is charcot’s triad?

Answer 20

for cholangitis:
fever
jaundice
RUQ pain

Question 21

what are some signs of uraemia on examination?

Answer 21

bruising due to platelet dysfunction
uraemic encephalopathy-asterixis, confusion, seizures

Question 22

what is a PEG tube?

Answer 22

percutaneous endoscopic gastrostomy-tube that connects stomach to outside world

Question 23

what does UGIB stand for?

Answer 23

upper GI bleed

Question 24

what does UGIB stand for?

Answer 24

upper GI bleed

Question 25

what's a way of dealing with a stomach ulcer?

Answer 25

injecting adrenaline into it-it vasoconstricts.

Question 26

which artery can a gastric ulcer erode into, causing big bleeds?

Answer 26

gastro-duodenal artery

Question 27

if someone has suspected GI cancer based on bloods, what's the next investigation?

Answer 27

urgent 2ww colonoscopy

Question 28

what situations are the faecal occult blood test used for?

Answer 28

population screening-not when they have suspected cancer but for the every day population.

Question 29

what is the single criteria for an urgent liver transplant post paracetomol overdose?

Answer 29

arterial pH <7.3 more than 24 hours after ingestion.

Question 30

what is the triple criteria for an urgent liver transplant post overdose?

Answer 30

heptic encephalopathy creatinine >300 PT >100 seconds

Question 31

what are 2 examples of stimulant laxatives?

Answer 31

senna bisacodyl

Question 32

what type of laxative is lactulose?

Answer 32

osmotic

Question 33

how does oesophageal spasm present?

Answer 33

intermittent dysphagia +severe restrosternal chest pain 'corckscrew' appearance

Question 34

what is achalasia?

Answer 34

failure of oesophageal peristalsis and abnormally increase tone of LOS, resulting in narrowing of lower oesophagus-looks like bird beak on barium swallow

Question 35

what are the causes of asterexis?

Answer 35

hypercapnia hepatic encephalopathy uraemia

Question 36

what is curling's ulcer?

Answer 36

stress-driven ulcers that develop in the gastrointestinal (GI) tract when a person experiences a significant physical injury, specifically a burn. most common symptom=haematemesis

Question 37

what is the most common cause of elevated ALT and AST in the 10,000s?

Answer 37

paracetomol overdose

Question 38

what does alcohol usually do to LFTs?

Answer 38

causes a greater elevation in AST than ALT

Question 39

what is the difference between the main use of metoclopramide and ondansetron for nausea?

Answer 39

metoclorpramide-often prescribed for N+V related to gastric motility ondansetron-often used for N+V related to chemotherapy

Question 40

what is the drug treatment for h.pylori?

Answer 40

PPI +clarithromycin +amoxicillin or metronidazole

Question 41

what is a common side effect of hookworms that would show on blood tests?

Answer 41

iron deficiency anaemias

Question 42

what is the key differential diagnosis of appendicitis?

Answer 42

ectopic pregnancy ovarian cysts meckel's diverticulum appendix mass

Question 43

what is meckel's diverticulum and how does it present?

Answer 43

congenital small pouch in small intestine mostly asymptomatic but can release acid which can cause ulcers to develop in small intestine which can bleed and show as blood in poo. can also cause volvulus and intussusception.

Question 44

what is mesenteric adenitis and how does it present?

Answer 44

inflamed abdominal lymph nodes abdo pain esp in young children, often associated with tonsilitis or URTI, no specific treatment needed.

Question 45

what is sister mary joseph's node?

Answer 45

palpable nodule in umbilicus due to metastases of malignant cancer within pelvis or abdomen

Question 46

what is virchow's node and its relevance?

Answer 46

enlarged left supraclavicular node seen in various intrabdominal malignancies

Question 47

what is the gold standard investigation for perianal fistulae in crohn's disease?

Answer 47

MRI pelvis -can enable visualisation of course and can be used to plan surgical management.

Question 48

what is the treatment for severe c diff?

Answer 48

PO vancomycin +IV metronidazole

Question 49

what is boerhaave's syndrome?

Answer 49

spontaneous rupture of the oesophagus due to repeated episodes of vomiting -usual history=severe chest pain and severe vomiting. diagnosis =CT contrast swallow emergency -needs surgery asap

Question 50

what is nitazoxanide?

Answer 50

broad spectrum anti-parasitic/viral

Question 51

what is choledocholithiasis?

Answer 51

where gallstones obstruct the common bile duct

Question 52

when is ERCP used?

Answer 52

choledocholithiasis and acute cholangitis

Question 53

what is ursodeoxycholic acid, how does it work, and what is it used for?

Answer 53

secondary bile acid works by replacing hydrophobic and toxic bile acids in bile acid pool with itself, protecting liver and gallbladder cells from bile acid induced damage used for dissolution of gallstones (if contraindications to definitive treatments) and primary biliary cirrhosis

Question 54

elderly patient with large amounts of painless red blood PR -top differential?

Answer 54

diverticulosis

Question 55

what is the tumour marker most commonly associated with colorectal cancer?

Answer 55

CEA (carcinoma embryonic antigen)

Question 56

what happens in cholangitis?

Answer 56

infection of biliary tree due to biliary outflow obstruction (eg gallstone) causing bile flow to stop or slow, providing an ideal growth medium for bacteria.

Question 57

what is charcot's triad and what is it for?

Answer 57

cholangitis -fever, RUQ pain, jaundice

Question 58

what can charcot's triad progress to and what's in that?

Answer 58

reynolds pentad -add confusion and hypotension

Question 59

if they get gallstone sx a few weeks after a cholecystectomy what is the likely cause?

Answer 59

gallstones being left in the CBD

Question 60

what is the presentation of failure of surgical anastamoses post cholecystectomy?

Answer 60

bile leaking into abdo cavity, presents in 1st week post op abdo pain diaphragm irritation peritonitis

Question 61

which condition shows a 'double bubble' on AXR?

Answer 61

duodenal atresia

Question 62

what are the bowel sounds in bowel obstruction?

Answer 62

'tinkling' earlier on absent later on

Question 63

what is the classic presentation of acute mesenteric ischaemia? and what is it

Answer 63

embolism resulting in occlusion of an artery supplying the small bowel classic =severe sudden onset abdo pain, classic patient has AF

Question 64

what happens in ischaemic colitis?

Answer 64

acute but transient compromise to blood flow of large bowel -can lead to inflammation, ulceration, and haemorrhage can see thumbprinting on AXR same as UC -mucosal oedema/haemorrhage

Question 65

what is melanosis coli?

Answer 65

abnormal pigmentation of large bowel, most commonly due to laxative abuse

Question 66

what is an important blood test to do when someone is on aminosalicylates and why?

Answer 66

FBC they can cause agranulocytosis

Question 67

which acid base disturbance does diarrhoea cause?

Answer 67

metabolic acidosis

Question 68

what do you give for prophylaxis of oesophageal varices bleeding?

Answer 68

non cardioselective beta blocker eg propranolol