GI Flashcards
(122 cards)
1
Q
Name 2 causes of pre-hepatic jaundice?
A
Thalassaemia, Malaria, Sickle Cell Disease
2
Q
Which 3 components make up charcot’s traid?
A
Fever, Right Upper Qudarant pain and jaundice
3
Q
What is Leukonchyia?
A
White discolouration on nails due to hypoalbuminaemia
4
Q
Name 4 clinical presentations of cirrhosis?
A
LACS - Leuconchyia, ascites, clubbing, spider naevi
5
Q
Name the two most common intra-hepatic causes of portal hypertension?
A
Cirrhosis
Schistomiasis
6
Q
Name 3 post-hepatic causes of portal hypertension?
A
IVC obstruction
Constrictive pericarditis
Right heart failure
7
Q
Where are the most common sites for varices to form?
A
Gastro-oesaphgeal junction, rectum, left renal vein, diaphram, anterior abdominal wall via umbilical vein
8
Q
At what pressure do varices tend to rupture?
A
About 12mmHg
9
Q
What is the clinical presentation of a ruptures varicies?
A
Shock
Fresh Rectal bleeding
Vomitting fresh blood
10
Q
What is given to treat G-O varices and how does this drug work?
A
Banding OR IV Terlipressin (causes splanchnic vasoconstriction)
11
Q
Name a sign that can be seen in a patient with portal hypertension?
A
Splenomegaly
12
Q
Name two methods to treat alcohol withdrawal ?
A
Lorazepam
Diazepam
IV thiamine prevent werknickes encephalopathy
13
Q
Name 4 reasons why patients with chronic liver disease are vulnerable to infections?
A
- Impaired reticula-endothelial function
- Reduced opsonic activity
- Leucocyte function
- Permeable gut wall
14
Q
Which drugs should you avoid in prescribing in liver damage?
A
ACE- Inhibitors
Aminoglycosides
Short acting benzodiazepines with care
15
Q
Name a treatment method for encephalopathy caused by liver disease?
A
Lactulose
16
Q
Name 5 causes of peritonitis?
A
- Spontaneous bacterial peritonitis
- Surgical
- Secondary to peritoneal dialysis
- TB
- Pelvic inflammatory disease
17
Q
Name 3 organisms which cause peritonitis?
A
Staph aureus, E.coli and klebsiella
18
Q
Name 3 complications of peritonitis?
A
Septicaemia
Toxaemia
Paralytic Ileus
19
Q
What does serum amalayse -ve exclude?
A
Pancreatitis
20
Q
What are the main causes of chronic liver disease?
A
Alcohol Non alcoholic steatohepatitis Metabolic (wilsons, alpha q , haemachromatosis) Vascular (budd-chiari) Immune (autoimune hepaitis, PBC, PSC)
21
Q
Which drug do you used to prevent Wernicke- Korsakoff?
A
IV thiamine
22
Q
Name an exudate cause of ascites?
A
Peritonitis, surgery, TB, neoplasia, sepsis
23
Q
Name a transudate cause of ascites?
A
Hypoalbuminaemia, nephrotic syndrome and malnutrition
24
Q
Name a cause of ascites associated with low flow due to obstruction?
A
Budd-Chiari
25
Name 3 management strategies in a patient with ascites?
Paracentesis
Spironalactone
Trans-jugular portosytemic shunts
26
Which serum antibody is found in almost all patients with PBC?
AMA
27
Name the three most common symptoms of PBC?
Pruritis, lethargy and fatigue, jaundice
28
How do you treat pruritits?
Cholestyramine
29
How do you treat fatigue?
Modafinil
30
How do you reduce rate of vatical development?
Ursodeoxycholic acid
31
Which auto-antibodies are present in autoimmune hepatitis?
ANA and ASMA
32
Where is the gene mutation in haemachromatosis?
Chromosome 6
33
Name the diagnosis and treatment of haemachromatosis?
Raised serum ferritin and transferrin saturation
| Treated with regular removal of blood and desferoxamine
34
In Wilson’s Disease, what is the name of the rings that encircle the iris of the eye?
Kayser-Fleischer
35
What is the difference in presentation between adults and children in wilsons disease?
Children = hepatic problems eg cirrhosis
| Adults present with CNS problems eg tremor and dysphasia
36
What is the difference in presentation between adults and children in alpha-1-antitrypsin deficiency?
Children present with liver disease eg jaundice
| Adults present with respiratory problems eg dyspnoea
37
Which is the only DNA virus in viral hepatitis?
Hepatitis B
38
Name 2 organisms which cause chronic diarrhoea?
Giardiasis
| Cryptosporidiosis
39
Which organism is the most common cause of bacterial diarrhoea?
Camplylobacter jejuni
40
What is the definition of travellers diarrhoea?
3 or more unformed stool per day and at least one of pain/cramps/nausea/vomiting/dysentry
41
Name 3 organism causes of bloody diarrhoea?
E.coli, salmonella, shigella
42
Name 3 protozoa that cause diarrhoea?
Giardia, cryptosporidium and microsporidiea and entamoeba histolytica
43
Name 2 helminths causes of diarrhoea?
Schistosomiasis
| Strongyloides
44
Which 4 antibiotics commonly cause C. difficle?
Clindamycin, co-amoxiclav, cephalosporin, ciprofloxacin
45
What is the treatment of c. difficile?
Oral vancomycin and metronidazole
46
What is Hirschprungs disease?
Neonates born without complete innervation of colon to rectum
47
What are the 4 main symptoms of bowel obstruction?
1. Pain -colicky -poorly localised
2. Billous vomitting
3. Constipation
4. Abdominal distension
48
What are the main causes of small bowel obstruction in a) adults and b) children?
a) Adhesions, hernia, malignancy
| b) Appendicitis, intersussuption, volvulus
49
Name 3 differences in presentation of small and large bowel obstruction?
1. Early vomiting suggests SBO
2. Constipation suggest LBO
3. Less distension in SBO
50
Where is the mutation in FAP?
Mutation in APC gene which is a tumour suppressor gene
51
What are the 2 genetic predispositions that lead to colorectal cancer?
FAP
| Hereditary Non-Polyposis colon cancer
52
Where do most colon cancers arise?
Sigmoid colon
53
What is GOLD standard diagnosis for colorectal cancer ?
Colonoscopy with biopsy
54
In the elderly if you can't perform a colonoscopy, what would you do?
CT colonoscopy
55
Name the stages of Duke's classification?
```
A= limited to muscularis mucosae
B = Extension through muscularis mucosae
C = Involvement of regional lymph nodes (chemo useful)
D= Distant metastases
```
56
Which type of oesophageal cancer is more commonly found in patients with GORD?
Adenocarcinoma
57
Where does squamous cell carcinoma of the oesaphagus occur?
Middle and upper third of the oesophagus
58
What are the main causes of gastric cancer?
H. pylori infection (1st), pernicious anaemia, dietary factors eg high salt, lower social economic class, polyps and loss of P53
59
Name 2 chronic liver diseases which increase chance of developing hepatocellular carcinoma?
Hepatitis B and C
| Haemochromatosis
60
What is the Rome III diagnostic criteria in IBS?
Recurrent abdominal pain or discomfort at least 3 days a month in the past 3 months, associated with 2 or more of the following:
1. Improvement with defecation
2. Onset with change in frequency of stool
3. Onset with a change in form of stool
61
Give an example of a laxititve which can be used in constipation for IBS?
Mavicol
62
Which drug could you use for pain and bloating in IBS?
Meberverine
63
What is often seen in IBD but not specific?
Faecal caprotectin
64
What is the histology of ulcerative colitis?
Only affects colon, continuous ulceration with no skip lesions and not full thickness
65
Where is pain often felt in patient with ulcerative colitis?
Pain in left lower quadrant
66
Which drug acts on the colonic lumin in ulcerative colitis?
Aminosalicylate (5ASA) in mild/moderate UC and to maintain remission
67
Name 5 extra-articular complications of Ulcerative colitis?
1. Skin erythema nodosum and pyoderma gangrenosum
2. Liver- primary sclerosing cholangitis
3. Joints ankylosing spondylitis
4. eyes uveitis
5. Colon - colorectal cancer
6. Clubbing
68
What is the histology of Chron's?
Skip lesions affecting anywhere from mouth to anus, goes through full thickness of the bowel wall
Organises into granulomas- cobblestone appearance
69
Which genetic mutation is associated with Chron's?
NOD2 gene mutation
70
Name 4 diagnostic methods for ulcerative colitis?
a) FBC = pANCA, ESR, CRP
| b) Pr = blood, c) Stool sample (exclude), d) sigmoidoscopy + biopsy, barium swallow
71
What drug is used to treat chron's?
Glucocorticoids, in severe attacks IV hydrocortisone
72
What is used to maintain remission in chrons?
Anti-TNF antibodies Infliximab
73
What would you see on a biopsy in a patient with coeliac?
Villous atrophy and crypts hyperplasia
74
What part of the GI tract is affected in coeliac?
Proximal small bowel
75
Why is anaemia a common sign of coeliac?
Mucosal damage means B12, folate and iron cannot be absorbed - resulting in anaemia
76
Name three markers seen in the blood which would lead to a diagnosis of coeliac?
EMA - endomysial antibody
tTG - Tissue transglutaminase antibody
Alpha Gliadin
77
Is IBD or IBS associated with nocturnal diarrhoea?
IBD
78
Name three common presentations of dyspepsia?
1. Postprandial (after eating) fullness
2. Early satiation
3. Epigastric pain
4. Reflux when lying flat
79
Name the 6 red alarm signs for GI cancer?
1. unexplained weight loss
2. Anaemia
3. evidence of GI bleeding
4. Dysphagia
5. Upper abdominal mass
6. Persistant vomitting
80
How is H.pyroli pathogenic?
Produces ureas which converts urea to ammonia and Co2 which is toxic, since ammonia and H+ form ammonium which is toxic to gastric mucosa
81
What are 3 treatment methods for H.pylori?
1. Omeprazole
Amoxicllin
Clarithromycin
82
How do you detect H.pylori?
Urea breath test
| Stool antigen test
83
Name 5 causes of gastritis?
1. H.pylori infection
2. Autoimmune gastritis
3. Herpes simplex virus
4. Duodenogastric reflux
5. NSAIDS
6. Mucosal Ischameia
84
What is the clinical presentation of peptic ulcer disease?
Recurrent burning epigastric pain - radiating to shoulder
| Nausea, anorexia and weight loss, fulness after meal
85
Name 5 causes of GORD?
1. Lower oesophageal sphincter hypotension
2. Hiatus hernia
3. Loss of oesophageal peristaltic function
4. Gastric Acid hyper-secretion
5. Abdominal obesity
86
Which peptic ulcer is worse when hungry and which is worse on eating?
Duodenal worse on hungry and at night
| Gastric is worse on eating
87
Patient presents with RUQ pain, jaundice, night sweats and travel history?
Enateomaba histolytica
| causing amoebic liver abscess
88
How do you treat amoebic liver abcess?
Metronidazole
89
What is a treatment used in chronic viral hepatitis?
Pegylated interferon
90
What are the criteria of the child-pugh classification?
```
Prothrombin time
Ascites
Bilirubin
Albumin
Encephalopathy
Each given score of 1-3
```
91
Give 3 risk factors of GORD?
1. Pregnancy
2. Smoking
3. Abdominal Obesity
92
Give 4 complications of GORD?
1. Barrets oesopahgus - adenocarcinoma of oesophagus
2. Oesopahgitis
3. Ulcers
4. Benign strictures
93
Name 2 investigations you could perform in GORD?
Endoscopy if red flag symptoms
| Barium swallow to show hiatus hernia
94
What are the red flag symptoms for GI cancer?
Unexplained weight loss, anaemia, evidence of GI bleeding, upper abdominal mass, dysphagia, persistent vomitting
95
In peptic ulcer disease and GORD, when would you perform an endoscopy?
>55, symptoms despite treatment, weight loss, GI bleeding, vomiting, iron deficiency, palpable mass, symptoms for 4 weeks
96
Give a) 3 non-pharmacological and b) pharmacological treatments of GORD?
a) weight loss, smoking cessation, a void alcohol/cholcolate, small regular meals
b) Antacids, alginates and PPI
97
What is a Mallory Weiss tear?
Persistent vomiting leads to hanemtemesus via oesophageal mucosal tear
98
Give 3 symptoms of GORD other than heartburn?
Belching, painful swallowing, increased salivation, nocturnal asthma
99
What are the 3 most common causes of peptic ulcer disease?
H. pyrlori infection, Drugs eg NSAIDS, and increased gastric acid secretion, smoking
100
Name 4 investigations you would perform in peptic ulcer disease?
Stool antigen, urea breath test, endoscopy (>55), serum IgG antibodies and FBC = anaemia
101
Give a) 2 non-pharmacological and b) pharmacological treatments of Peptic ulcer disease?
a) Stress, alcohol and aggravating foods
| b) PPI (triple therapy) and H2 blockers (ranitidine)
102
What is often given alongside NSAIDS to prevent gastritis?
PPI eg omeprazole
103
Name 3 diseases which cause malabsorption?
Coeliac, Chrons, chronic pancreatitis
104
Give 3 signs of malabsorption?
Anaemia, bleeding disorders and oedema, metabolic bone disease
105
Name 4 investigations you would carry out to diagnose malabsorption?
1. FBC - anaemia, low ferritin, low B12/folate
2. Stool for fat globules and stool microscopy
3. Barium - may show Chrons
4. Endoscopy and small bowel biopsy
106
Name 4 complications of diverticular disease?
Perforations, fistula formations, haemorrhage, ileum, peritonitis
107
What are the common causes of large bowel obstruction?
Colorectal cancer, volulus, diverticular stricture, constipation
108
What is the most common cause of mesenteric ischaemia?
Superior mesenteric artery thrombosis
109
Name 3 investigations and what you'd see on a patient with mesenteric ischaemia?
```
AXR= Gas-less
Laparotomy = necrotic bowel
FBC = increased HB
```
110
In severe relapse of UC what drug would you use?
IV hydrocortisone
111
What is it called in UC when proximal to ileocaecal valve is affected?
Backwash ileitus
112
Give 4 complications of chrons?
Obstruction due to fibrosis, adenocarcinoma, osteoporosis and fistulas
113
What is the most common extra-intestinal feature of chrons?
Mouth Ulcers
114
Give 4 non-pharmacological management steps for IBS?
Ensure water and fibre intake, avoid caffeine, alcohol, FODMAP, behavioural therapy, increase physical exercise
115
Give 4 management steps for a patient with coeliac?
1. Gluten free diet
2. manage anaemia
3. Pneumococcal vaccine
4. Vitamin supplementation
116
What are the risk factors for colorectal cancer?
Red meat diet, overweight, alcoholic, ulcerative colitis, decreased fibre in diet, FAP and lynch syndrome
117
Name 2 symptoms of a)right sided colon cancer and b) left sided colon cancer?
a) Abdominal mass, iron deficient anaemia and perforation
| b) Change of bowel habit, mucus stools and bloody stools
118
At what age and how does the NHS bowel cancer screening programme work?
Screening every 2 years if 60-75 by focal occult blood test
119
What are the main risk factors for oesophageal cancer?
diet, alcohol excess, smoking, achalasia, obesity, Barret's oesophagus
120
How do you diagnose oesophageal cancer?
Oesopahgostomy with biopsy
121
Name 5 questions you would ask when taking a history for diarrhoea?
1. Travel history
2. Drinking water/food
3. Pets/animal contact
4. Immunocompromised
5. Malaria
122
Give 4 risk factors of C.difficle?
Age and co-morbidities, long hospital admissions, NG tube feeing, immunocompromised eg HIV, anti-cancer drugs
