GI Flashcards Preview

Medicine > GI > Flashcards

Flashcards in GI Deck (46):
1

What does coffee ground vomit suggest?

Dark blood that has been altered by contact with gastric acid, suggest a small bleed
Song of upper GI bleeding but less acute than haematemesis
Causes e.g. gastritis, oesophagitis

2

What are the most common causes of upper GI bleeding?

Peptic ulcer
Varices

3

What is important to ask in the history of an upper GI bleed?

Appearance of the blood
If this has happened before
Drug Hx
Alcohol Hx
Vomiting (eg Mallory Weiss tear)
Known ulcers/ varices/ liver disease
Red flags

4

What scoring systems are used for upper GI bleeds?

Rockall score
Blatchford score

5

What are some causes of gastritis?

Alcohol
NSAIDs
H Pylori
Zollinger Ellison

6

What is the Rockall score?

Scoring for upper GI bleeds pre and post endoscopy to predict risk of rebleeding and mortality

7

What is the primary diagnostic investigation for an upper GI bleed?

Endoscopy within 24 hours of admission
(If severe do after resus)

8

Which scoring system for upper GI bleeds is used pre endoscopy?

Blatchford score

9

What are oesophageal varices?

Collaterals between portal and systemic systems formed due to portal hypertension due to liver fibrosis

10

How would you manage variceal bleeding?

Stabilise (ABC, fluids/ transfusion)
IV terlipressin
Band ligation

Aspirin to prevent re bleeding

11

Dysphagia affecting both solids and liquids from the start is indicative of what condition?

Achalasia

12

What are some clinical features of achalasia?

- dysphagia of both solids and liquids
- heartburn
- some food regurgitation

13

What investigations would you do for suspected achalasia and what would they show?

- manometry would show excess tone in LOS
- barium swallow would show ‘birds beak appearance’
- CXR could show wide mediastinum

14

A combination of liver and neurological disease points towards which diagnosis?

Wilson’s disease

15

What is a useful diagnostic marker for hepatocellular carcinoma?

AFP

16

CEA is a diagnostic marker for which cancer?

Bowel cancer

17

What is the main treatment for haemochromatosis?

Regular venesection (therapeutic phlebotomy)

18

What drug can you give as prophylaxis for variceal bleeding?

Non selective beta blocker eg propanolol

19

Which type of jaundice will present with very high levels of alkaline phosphatase?

Post hepatic (due to biliary obstruction)

20

Which type of jaundice will present with pale stool?

Post hepatic jaundice
(Along with dark urine as there is increased conjugated bilirub8n and this is water soluble so enters the urine)

21

What colour will the urinebe in pre hepatic jaundice?

Normal
As there is increased levels of unconjugated bilirubin, and this is insoluble so will not enter the urine

22

What is Charcot’s triad?

RUQ
Jaundice
Fever

(Due to cholangitis)

23

What is the most common first line imaging in jaundice?

USS of liver and biliary tree

24

What are som signs of acute liver failure?

Hepatic flap
Hepatic encephalopathy
Jaundice

(If stigmata of chronic disease are present, this suggest acute on chronic liver failure?

25

What are some genetic causes of cirrhosis?

Haemachromotisis
Alpha 1 antitrypsin deficiency
Wilson’s disease

26

What are some stigmata of chronic liver disease?

Leukonykia
Dupuytrens contracture
Palmar erythema
Clubbing
Spider navai
Angular stomatitis
Gynaecomastia
Testicular atrophy
Hepatomegaly

27

What will bloods show for a patient with liver cirrhosis?

Raised LFTs (ALT, ALP, GGT, AST)
Low albumin (may have raised INR/ PTT)
Low WCC and platelets may indicate hypersplenism

28

Which diuretic is first line in liver failure?

Spironolactone +/- furesomide

29

Which organism causes pseudomembranous colitis?

Clostridium difficile

30

Which antibiotics are used for C Diff infection?

Oral metronidazole
If severe: oral vancomycin

(If NBM, IV meropenem)

31

What investigation would you do in a patient presenting with diarrhoea?

FBC: MCV reduced in coeliac, increased in alcohol abuse, B12 reduced in Crohn’s and coeliac, Raised CRP/ ESR may indicate infection or Ca or IBD
Faecal calprotectin: raised in IBD
Blood and stool culture to look for infective organism
TFT to look for thyrotoxicosis (low TSH)
U&Es to check for dehydration
Sigmoidoscopy and biopsy (IBD, Ca)
Coeliac serology (Raised transaminase antibodies)

32

How will the stools be in coeliac Disease?

Steatorrhea (foul smelling, hard to flush)

33

What pharmacological agents can be prescribed in irritable bowel syndrome?

1st line
For bloating and abdominal pain: antispasmodic
For diarrhoea: loperamide
For constipation: laxative e.g. ispaghula (avoid lactulose)

2nd line
Low dose TCA e.g. amitriptyline

34

What is coeliac Disease?

Autoimmune disease of the small bowel due to gluten intolerance
Causes villus atrophy and malabsorption

35

HLA-DQ2 is associated with 95% of patients who suffer from which condition?

Coeliac Disease

36

How may coeliac Disease present in a patient?

Steatorrhea
Weight loss
Failure to thrive (children)
Abdominal pain
Bloating
Nausea
Fatigue
Fe deficiency anaemia

37

Which antibodies are raised in coeliac Disease?

Transaminase antibodies

38

Jejenal biopsy for a patient with coeliac Disease will show what?

Villus atrophy
Crypt hyperplasia
Increase in intraepithelial lymphocytes

39

Can a patient with coeliac eat wheats, barley, rice and potato?

Wheat and barley no
Rice and potato yes

40

What condition in primary slerosing cholangitis linked with?

UC
(4% of UC px have PSC, but 80% of PSC Px will have UC)

41

What are some symptoms of primary sclerosis cholangitis?

RUQ pain
Jaundice
Fatigue
Pruritis

42

What investigation can diagnose primary sclerosing cholangitis?

ERCP will show beads on a string appearance (due to the biliary strictures from areas of fibrosis)

43

Antimitochondrial antibodies are raised in which condition?

Primary biliary cirrhosis

44

What is a typical patient with primary sclerosing cholangitis?

Middle aged male with UC

45

What is primary biliary cirrhosis?

Autoimmune condition causing chronic inflammation of interlobular bile ducts
Presents with pruritis

46

How can pruritis be treated?

Cholestyramine (eg given for primary biliary cirrhosis and primary sclerosing cholangitis)