GI Flashcards
1
Q
What is charcot’s triad
And what does it suggest?
A
RUQ pain
Fever
Jaundice
Suggests cholangitis
2
Q
What are some common causes of decompensated liver disease?
A
Sepsis Bleeding (H and M) HCC Meds (EtOH, paracetamol) Non-compliance Portal vein thrombosis
3
Q
which signs are caused by high oestrogen?
A
Palmar erythema
Gynaecomastia
Spider naevi
4
Q
What does raised AST and ALT suggest?
A
Hepatocellular damage
5
Q
What does presence of the HBVeAg imply?
A
Active HBV replication
6
Q
What is a typical level of ALT in acute viral hepatitis?
A
1,000
7
Q
What LFT profile is suggestive of chronic viral hepatitis?
A
AST and ALT raisedALT may be > AST
8
Q
What does ALT>AST suggest?
A
Chronic or resolving liver injury
9
Q
What LFT profile is suggestive of alcoholic liver disease?
A
AST>ALT
AST/ALT ratio typically 2:1 or more
GGT raised
Normal ALP
10
Q
What is a typical level of ALT in ischaemic hepatitis?
A
100,000
11
Q
If someone is HBsAb positive, how can you tell whether they have been previously infected or previously immunised?
A
HBcAg positive = previous infection
HBcAg negative = previous immunisation
12
Q
What does presence of the HBsAb imply?
A
Previous immunisation or infection
13
Q
What LFT profile is suggestive of acute viral hepatitis?
A
ALT and AST raised
AST may be raised ++
14
Q
What does raised ALP and GGT suggest?
A
Cholestatic problem
15
Q
If you see ALT = 10,000 in an alcoholic, what must you consider?
A
Paracetamol toxicity
16
Q
What LFT profile is suggestive of cholestasis?
A
ALP and GGT increased
AST and ALT may also be mildly increased
17
Q
What LFT profile is suggestive of ischaemic hepatitis?
A
ALT and AST raised
LDH is raised
18
Q
What does AST>ALT suggest?
A
Acute liver injury
19
Q
What does presence of the HBVsAg imply?
A
Active HBV infection
20
Q
What is a typical level of ALT in alcoholic hepatitis?
A
500
21
Q
What is a typical level of ALT in paracetamol poisoning?
A
10,000
22
Q
What does ALT = 100,000 suggest?
A
Ischaemic hepatitis
23
Q
What is Murphy’s sign and what does it suggest?
A
Pain/catch on inspiration in RUQ while palpating
Suggests cholecystitis
24
Q
What are the 5 factors that determine Child-Pugh grading of cirrhosis?
A
Albumin, Bilirubin, Prothrombin time, Ascites, Encephalopathy
25
What does TIPS stand for?
Trans-jugular intra-hepatic porto-systemic shunt
26
Which protein is a marker for hepatocellular carcinoma?
Alpha foetal protein
27
What are the 3 features of decompensated cirrhosis?
Hepatic encephalopathy,
Ascites,
Jaundice
28
What is it called when ulcerative colitis affects part of the colon?
Left-sided colitis
29
What is the treatment for steroid-refratice ulcerative colitis?
Ciclosporin or infliximab
| Colectomy
30
What is it called when ulcerative colitis is restricted to the rectum?
Proctitis
31
What are the extraintestinal manifestations of IBD?
Occular (iritis, scleritis)
Rheumatoid arthritis (large axial joints)
Dermatological (erythema nodosum and pyoderma gangranosum)
32
What is the treatment of mild Crohn's disease?
Prednisolone PO
33
Which part of the GIT does ulcerative colitis affect?
From rectum to ascending colon
34
Which part of GIT is most often affected in Crohn's disease?
Terminal ileum
35
What is the depth of lesion in ulcerative colitis?akaWhich layers of the GI wall are affected in ulcerative colitis?
Restricted to the mucosa
36
What is the treatment of severe Crohn's disease?
Admit
Hydrocortisone IV
Metronidazole
IV fluids
37
What is the treatment of mild ulcerative colitis?
Sulfasalazine or mesalazine
PLUS
Prednisilone PO and PR
38
What is the treatment of moderate ulcerative colitis?
Prednisolone PO
Sulfasalazine or mesalazine
Steroid enema
39
What is it called when ulcerative colitis affects the whole colon?
Pancolitis
40
Which part of the GIT does Crohn's affect?
Gum to bum
41
What is the depth of lesion in Crohn's disease?akaWhich layers of the GI wall are affected in Crohn's disease?
Transmural lesion
42
How many bowel motions per day are consistent with moderate ulcerative colitis?
4-6
43
what is the max volume of fluid the colon can absorb?
4.5L
44
which imaging technique is best at looking at the gallbladder?
U/S
45
Severe abdominal pain that is worse with moving implies what?
Peritonitis
46
causes of chronic pancreatitis
```
Alcohol
Obstruction
Autoimmune
Hereditary pancreatitis
Repeated episodes of acute pancreatitis
```
47
where is the pancreas anatomically (vertebra)
level of L2
48
the more proximal the visceral pain the more ........ the peristaltic pain wave
frequent
49
Pain with defecation associated with bleeding. Dx?
Anal fissures
50
what blood results do you expect in someone with CLD
```
Low albumin
Raised bilirubin
Raised ALT
Increased INR
Low platelets
```
51
3 things you look for in a diagnostic ascitic tap
WCC
Albumin
Cytology
52
current treatment for HBV
- oral nucleos(t)ide analogues
| - peg interferon
53
What is the triad of Budd-Chiari syndrome and what causes it?
Abdominal pain, ascites, hepatomegally
Caused by portal vein thrombosis
54
what is the major complication of UC?
Toxic megacolon
55
which ABx are commonly associated with liver toxicity?
Augmentin (amox + clavulonic acid)
Flucloxacillin
56
where are spider naevi normally found
SVC distribution
57
What two conditions commonly cause rigid plank like abdomen?
Acute pancreatitis
Perforated peptic ulcer
58
2 most common causes of ascites
Portal hypertension from cirrhosis
Peritoneal malignancy
59
presentation of epididymitis
diffuse tenderness in the epididymis, marked redness and oedema
60
Explain dukes staging for CRC
A - cancer up to/into muscularis propria
B - cancer through muscularis propria and into fat/serosa
C - lymph nodes involved
D - distant spread
61
What 3 things does the MELD system base its scoring system on?
Creatinine
Bilirubin
INR
62
Where is the pain of diverticulitis usually located?
LIF
63
What are some perianal complications in Crohn's disease?
fissures
skin tags
fistulae
64
what causes leuconychia
hypoalbuminaemia
65
What test on ascitic fluid suggests it is due to portal hypertension?
serum-ascites albumin gradient >11g/L
| =serum albumin - ascites albumin
66
definition of chronic diarrhoea
decrease in faecal consistency lasting for 4 or more weeks
67
explain TNM staging for CRC
```
T1 - cancer in submucosa
T2 - cancer in muscularis propria but not through
T3 - cancer through muscularis propria
T4 - invasion of adjacent organs
N1/2 - lymph node involvement
M1 - distant spread
```
68
treatment of ascites
salt and fluid restriction
large volume paracentesis
diuretics - first line: spironolactone
69
What is the triple therapy for H. pylori eradication?
CAP
| Clarithromycin and amoxicillin for 1 week
PPI for 2 months
70
At what vertebral levels are preganglionic sympathetic fibres for the hindgut derived from?
T12-L2
71
Which organ is just below the celiac trunk?
Pancreas
72
What is the surface landmark for the deep inguinal ring?
Exactly half way between ASIS (ant sup iliac spine) and the pubic tubercle and a fingers breadth above the inguinal ligament
73
What does the proper hepatic artery divide into?
Right and left hepatic arteries
74
Which arteries supply the greater curvature of the stomach?
Left and right gastro-epiploic arteries
75
Where is pain from the hindgut referred to?
Suprapubic
76
At what vertebral level is the transpyloric plane?
L1
77
What does the common hepatic artery branch into?
Proper hepatic artery and gastroduodenal artery
78
What does the gastroduodenal artery divide into?
Anterior superior pancreaticduodenal artery. Right gastroepiploic artery
79
Under which ribs does the spleen lie?
9-11
80
Where is the junction of the foregut and midgut?
Major duodenal papilla
81
Where will irritation of the mid-sigmoid colon to rectum be referred?
Peri-anal
82
What is behind the foramen of Winslow?
IVC
83
What forms the superficial inguinal ring?
The triangular opening in external oblique between its attachment between the pubic tubercle and the pubic crest
84
At what vertebral levels are preganglionic sympathetic fibres for the foregut derived from?
T6-T9
85
Where is pain from the midgut referred to?
Periumbillical
86
Where is McBurney's point?
1/3 of the way from the right ASIS to the umbilicus
87
What are the 3 branches off the celiac trunk?
Splenic artery. Left gastric artery. Common hepatic artery
88
At what level does the esophagus pass through the diaphragm?
T10
89
How long is the small intestine from the point of the D-J flexure?
4-6m
90
What forms the common bile duct?
Common hepatic duct and cystic duct
91
Where does the foregut begin?
Abdominal oesophagus
92
What forms the common hepatic duct?
Left and right hepatic ducts
93
What vertebral levels do the kidneys span?
T12-L3
94
Which muscles from the roof of the inguinal canal?
Internal oblique and transversus abdominis
95
At what level does the inferior mesenteric artery branch off the aorta?
L3
96
At what level does the aorta end?
L4
97
At what vertebral levels are preganglionic sympathetic fibres for the midgut derived from?
T8-T12
98
Which arteries supply the lesser curvature of the stomach?
Left and right gastric arteries
99
What is formed by an opening in the transversalis fascia?
Deep inguinal ring
100
At what level does the superior mesenteric artery branch off the aorta?
L1
101
Where is visceral pain from the foregut referred to?
Epigastric
102
Where is visceral pain from the midgut referred to?
Peri-umbillical
103
At what vertebral level does the esophagus begin?
C6
104
At what vertebral level is the celiac trunk?
T12
105
What artery supplies the head of the pancreas?
Anterior superior pancreaticduodenal artery
106
From which artery does the splenic artery arise?
Celiac trunk
107
At what vertebral levels are preganglionic sympathetic fibres derived from?
T6-L2
108
What is an approximate radiological landmark for the descent of the ureters?
Tips of lumbar transverse processes
109
Which artery does the left gastroepiploic artery branch from?
Splenic artery
110
The rami of which spinal nerves contribute to the lumbar plexus?
L1-4
111
Which arteries supply derivatives of the fore-, mid- and hind-gut?
Celiac trunk, superior mesenteric artery, inferior mesenteric artery
112
How long is the large intestine?
1.5 m
113
Which receptors should be targetted for treatment of nausea associated with motion sickness?
Muscarinic and H1
114
What percentage of regular IVDUs are HCV positive?
50-60%
115
What do parietal cells of the stomach produce?
HCl and intrinsic factor
116
Name two D2 antagonists used to treat nausea
Metoclopramide (maxolon)
| Prochlorperazine (stemetil)
117
Which zone of the acinar model is most vulnerbale to paracetemol toxicity?
Zone 3
118
What liver pathology is seen in alcoholic hepatitis?
Mallory bodies and hepatocyte swelling
119
Which enzyme conjugates bilirubin?
Glucuronyl transferase
120
What do chief cells of the stomach produce?
Proteases eg pepsinogen
121
Broad spectrum antibiotics can cause overgrowth of what in the gut?
Clostridium difficile
122
What % of gastric ulcers are due to Helicobacter pylori?
70%
123
Define cirrhosis
Diffuse nodules of regenerating hepatocytes surrounded by bands of fibrosis
124
What is the average incubation period for HBV?
60-90 days
125
Which zone of the acinar model is most vulnerable to ischaemia?
Zone 3
126
When does colon cancer become invasive?
When it breaches muscularis mucosae
127
Which receptors should be targetted for treatment of nausea associated with exposure to toxins?
D2 and 5HT3
128
Which bacteria typically causes traveller's diarrhoea?
ETEC
129
What type of drug is ranitidine?
H2 antagonist
130
Which nerve mediates peristalsis along the esophagus?
Vagus
131
What % of gastric ulcers are due to NSAIDs?
25%
132
What are the important receptors for the chemoreceptor trigger zone?
D2 and 5HT3
133
Familial adenomatous polyposis is due to a mutation in which gene?
APC
134
What % of people infected with HCV will clear the virus?
30%
135
Oral rehydration mixtures typically contain what?
NaCl, KCl, NaHCO3, glucose
136
What % of duodenal ulcers are due to Helicobacter pylori?
92%
137
What are the American (more stringent) criteria for Barrett's esophagus?
Evidence of columnar epithelial lining in esophagus; AND
Evidence of goblet cells in esophagus
138
What is the average incubation period for HCV?
6-7 weeks
139
What is the pathological hallmark feature of steatohepatitis?
Hepatocellular ballooning degeneration
140
Pharmacologically, what are the two most important inputs to the vomit centre?
Chemoreceptor trigger zone (CTZ)
| Vestibular input
141
Pain from an ulcer in the duodenum is made _______ with eating
Better
142
Pain from an ulcer in the stomach is made _______ with eating
Worse
143
What causes pellagra?
Insufficient VitB3 (niacin)
144
If a patient presents with haematemesis, where must the source of blood be from?
Proximal to the ligament of Treitz (junction of D3/D4)
145
If a patient presents with melaena, where must the source of blood be from?
Proximal to the ileocaecal valve
