GI Flashcards
(190 cards)
1
Q
Cephalosporins and clindamycin strong linked to?
A
C diff
2
Q
Kantor’s string sign?
A
Crohns
3
Q
Cancer developing in 10% of primary sclerosing cholangitis?
A
Cholangiocarcinoma
4
Q
Obese, T2Dm abnormal LFts?
A
NAFLD
5
Q
Sulphasalazine may cause what? (resp)
A
Pulmonary fibrosis
6
Q
Rose thorn ulcers?
A
Crohns
7
Q
Blue nails associated with?
A
Wilsons
8
Q
Heinz body anaemia which GI drug?
A
Sulphasalazine
9
Q
Coeliac disease linked to which other dietary problem?
A
Lactose intolerance
10
Q
What is asterixis?
A
Flapping tremor
11
Q
Lower vs upper Gi bleed blood tests?
A
Upper ↑urea
12
Q
Hypothermia may cause which Gi problem?
A
pancreatitis
13
Q
Osteoporosis may be caused by which intolerance?
A
Coeliac
14
Q
Thiamine also know as?
A
Vitamin B1
15
Q
Thiamine deficiency known as?
A
BeriBeri
16
Q
What should be given in large volume paracentesis of ascites?
A
HAS 100ml/2.5l drained
17
Q
A woman complains of lethargy, diplopia and dysphagia. She is noted to have a ptosis on examination?
A
Myasthenia gravis
18
Q
Loss of haustrations on barium enema?
A
UC
19
Q
Lead pipe colon ?
A
UC
20
Q
UC or crohns more likely to cause obstruction?
A
Crohns
21
Q
Most common form of inheritable colorectal cancer?
A
HNPCC
22
Q
Type of liver failure in paracetamol overdose?
A
Hepatocellular
23
Q
Which blood test is most sensitive and specific for liver failure?
A
Platelets ↓ <150,000 mm^3
24
Q
Ulcerative colitis, extend of disease in wall of intestine?
A
No inflammation beyond submucosa
25
Blood Diarrhoea more common in which IBD?
UC
26
Neuropsychiatric symptoms such as depression and tremor in young person with signs of liver disease?
Wilson's
27
Weight losss more common in which IBD?
Crohns
28
First line investigation suspected mesenteric ischaemia?
ABG/Lactate acidosis ↑WCC
29
Classically a history of what in mesenteric ischaemia?
AF
30
Thumbprinting on AXR?
Ischaemic colitis
31
Ischaemic colitis
More transient pain, oftne in splenic flexure area
32
SpontBP Neutrophils?
\>250 per ml
33
When do you treat sbp with HAS?
if ↑creatinine
34
Imaging of choice in mesenteric ischaemia?
CT Abdo/Angio
35
Treatment of SBP?
Life long cipro prophylaxis
36
Abdo pain severe and not in keeping with physical signs?
Acute mesenteric ischaemia
37
Serum copper in wilsons?
Low
38
Ceruloplasmin low?
Wilsons
39
Primary biliary cholangitis - the M rule
IgM anti-Mitochondrial antibodies, M2 subtype Middle aged females
40
Isoniazid may cause?
Peripheral neuropathy
41
Villous atrophy, raised intra-epithelial lymphocytes, and crypt hyperplasia
Coeliac
42
Primary sclerosing cholangitis very common amongst who?
80% of UC sufferers
43
Single strongest risk factor for barrets?
GORD
44
H.pylori eradiction?
Always PPI and clarithro +/- metro or amox
45
Inflammation in all layers of bowel?
Crohns
46
Nystagmus, Ophthalmoplegia and Ataxia
Wernickes- B1 deficiency
47
Mesalazine\> risk of what vs sulfasal?
7 x greater risk of pancreatitis
48
Metabolic acidosis elderly abdo pain?
Think ischaemia especially if lactate ↑
49
ABX for hepatic enceph?
rifaxamin
50
Colorectal cancer ↑ in which ibd?
UC
51
PPI role in acute endoscopy of bleeds?
PPIs should not be administered as part of the acute management of upper GI bleeding prior to endoscopy
52
Liver failure triad?
encephalopathy, jaundice and coagulopathy
53
Most common sites for each IBD?
Rectum- UC Terminal Ileum Crohns
54
AST:ALT ration \>2 likely cause?
Alcoholic
55
AST:ALT ration \<1 likely cause?
NAFLD or Hepatitis
56
Glasgow alcoholic score?
Scoring for
57
Blatchford score before or after endo?
Before
58
Rockall score ?
After endo risk of rebleeding
59
Prophylaxis of variceal bleeding?
Propranolol ↓portal venous pressure
60
Raised transferrin saturation and ferritin, with low TIBC?
Haemochromatosis
61
Serum albumin ascitic gradient numbers?
\>11 Transudate = liver \<11 exudate
62
Gallstones ↑ in which ibd?
Crohns
63
Right upper quadrant pain, fever and yellowing of the sclera
Ascending cholangitis
64
Investigation of choice for lover cirrhosis?
Transient elastography
65
New diagnosis cirrhosis other imaging/investigate?
Upper endo for variceals
66
Monitoring of cirrhosis imaging and bloods?
6/12 USS +/- AFP
67
Continuous disease ibd?
UC
68
Cobble-stone appearance on endoscopy
Crohns
69
Unintentional weight loss greater than ? within the last 3-6 months is diagnostic of malnutrition
10%
70
Prophylactic ABX for ascites if albumin in ascites is?
Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less until the ascites has resolved'
71
Acute SBP what is used?
Cefotaxime IV
72
Epigastric pain and diarrhoea
Zollinger ellison
73
Vomiting → severe chest pain, shock - ?
Boerhaave syndrome
74
Severe vomiting → ?
Mallory-Weiss tear
75
Hepatorenal syndrome treatment?
Terlipressin and HAS?
76
What is Hepatorenal syndrome?
\>133 creat with ascites and liver failure
77
HBsAg normally implies ?
Acute infection 1-6months
78
HBsAg is present for \> 6 months?
Chronic infective
79
Anti what implies immunity to hep B?
Anti-HBs
80
Anti-HBc implies?
Previous infection or current Igm 6 months and above is IgG C= Caught
81
HbeAg marker of ?
Infectivity
82
Painless enlarged gallbladdermild jaundice?
Pancreatic or cholangicarcinoma
83
Side effect of whipples also with gastric surgeries ?
Dumping syndrome
84
Suspected pancreatic cancer imaging of choice?
High res CT
85
Risks for pancreatic cancer?
increasing age smoking diabetes chronic pancreatitis HNPCC BRCA2 MEN
86
Pancreatic cancer type and where in pancreas?
Adeno and Head
87
Gradual onset diarrhoea can be several weeks ? infectious cause? and if bloody which?
Amoebiasis (bloody) Giardiasis (non bloody)
88
Shortest exposure to onset gastroenteritis organism?
Bacillus cereus and staph 1-6hrs
89
Flu like prodrome crampy abdo pain fever diarrhoea which may be bloody
Campylobacter
90
Complication of campylobacter?
Guillian Barré
91
What is budd-chiari syndrome?
Hepatic vein thrombosis
92
Features of Budd-Chiari?
abdominal pain: sudden onset, severe ascites tender hepatomegaly
93
Causes of Budd-Chiari?
polycythaemia rubra vera thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies pregnancy
94
Grey turners where?
Sides - turning
95
Cullens sign?
Umbilical
96
Elderly female, epigastric pain, ↑lipase ↑alt ??
Gallstone pancreatitis
97
Biliary colic associated with?
Eating
98
4 F's cholecystitis?
fat, female, 40s, fertile
99
Investigation of choice for gallstones/cholecystitis?
USS
100
Dilated bile ducts seen on USS but not stone, what investigation now?
MRCP
101
Acut cholecystitis, when do you offer cholecystectomy within ?
Ideally within 1 week of onset
102
Multiple co-morbidities but acute cholecystitis?
Cholecystotomy
103
Amylase response in chronic pancreatitis?
Often reduced Lipase more sensitive
104
USS scan in pancreatitis?
Yes to rule out stones
105
When to CT pancreatitis?
If chronic or not improving
106
ABX for pancreatitis?
No!
107
Fluid type for pancreatitis?
Hartmanns, aggressive resuscitation
108
24 hr mortality from pancreatitis reduced by doing what?
aggressive resuscitation
109
Score for severity of pancreatitis?
PANCREAS - glasgow score Pa02 ↓, Age, Neutrophils ↑, Calcium↓ Renal ↑urea, Enzymes ↑, Albumin \<32, Sugars \>11
110
Cholangiocarcinoma increased risk with?
Primary sclerosing cholangitis
111
Most appropriate management of achalasia?
Balloon dilatation
112
NICE says offer urgent upper GI endoscopy assess for oesophageal cancer in those with ...
Dysphagia or if \>55 with weight loss and any of abdo pain, reflux or dyspepsia
113
Dysphagia differentials?
achalasia, pharyngeal pouch, oesophagitis, carcinoma
114
Barrets oesophagus risk for which cancer?
Junctional, Adenocarcinoma
115
Mid oesophagus associated with smoking and achalasia?
Squamous carcinoma
116
Gold standard for oesophageal cancer investigation?
Endoscopy + brushings
117
Asplenic patients need which vaccines?
pneumococcus, h. influenza, meningitis MMR
118
Important next investigation when patient presents with colorectal cancer symptoms?
PR examination 30% in rectum and can be felt
119
Most appropriate diagnostic investigation for colorectal cancer?
Urgent Colonoscopy with biopsy
120
Tenesmus more common in cancer of with gi area?
Rectum
121
When is faecal occult blood testing offered?
Every 2 years 60-74yrs
122
Lower 3rd of rectum cancer which op?
Abdomino-perineal resection end colostomy
123
Upper 2/3 rectum cancer op?
Anterior resection (take rectum and sigmoid) temp ileostomy or anastamosis
124
When is hartmanns op used what is it?
left hemicolectomy + end colostomy (emergency obstruction open op usually cancer)
125
Anastamosis types?
Colorectal usually end to end, side to side and end to side ileocolic or rectal
126
Spouted usually on right stoma, liquid contents?
Ileostomy
127
Flush to skin can be anywhere almost faeculent content stoma?
Colostomy
128
Stoma points to remember?
Say would digitate if contipated, involve stoma nurses. Output monitoring important
129
Anal fissure treatment?
Fluids, fibre, analgesia, GTN BD, diltiazem in secondary care
130
Perianal abscesses more likely in who?
IBD and diabetes
131
Grading of haemmhoroids
1- no prolapse 2- prolapse straining but reduce alone 3- prolapse manually reduced 4- Irreducible
132
Grade 2 haemorrhoids what can be done?
Band ligation
133
Small bowel should be
3cm
134
LArge bowel should be less than ?cm
6cm
135
Caecum should be less than ?cm
9cm
136
Line across diameter of bowel likely to be which one?
Small venae commitantes
137
Lines that do not cross entire width of bowel liekly to be which type of bowel?
Large due to haustra
138
Lack of haustra may indicate?
Chronic colitis, lead pip/drainpipe
139
SBO symptoms?
Vomiting early, may still pass stool
140
LBO symptoms?
Constipation and then faeculent vomititng
141
Causes of SBO?
Adhesions Hernias Tumours Strictures (IBD)
142
Causes of LBO?
Usually cancer, can be diverticularl or volvulus
143
Diagnosis of diverticular imaging?
Flexi sig, non acute phase
144
Primary biliary cholangitis treated with?
urodeoxycholic acid
145
Antibodies and LFTs in primary biliary cholangitis?
IgM and anti antimitochondrial. ALP GGT and bilirubin also raised
146
Worsening dysphagia, weight loss and changes in voice diagnosis?
Oesophageal carcinoma
147
Dysphagia associated with eye problems and ptosis?
Myasthenia gravis
148
Most common organism for SBP?
E.coli
149
Gilbert’s syndrome is a rise in what?
Unconjugated hyperbillirubinaemia
150
What disease most likely to increase risk of liver cancer?
Hep B is carcinogenice without cirrhosis
Hep C rarely causes HCC without cirrhosis
151
Which antibodies specifically for coeliac?
IgA ttg
152
Abdo pain nothing better or worse, blood and Leuko on urine which investigation?
CT non contrast, likely stones
153
Barretts oesophagus dysplasia not metaplasia management?
Endoscopic intervention regardless of dysplasia grade, ablation or resection
154
ANCA ALP and UC ?
Primary sclerosing cholangitis
155
Inferior mesenteric artery at which vertebral level?
L3
156
Toxic mega colon features axr?
Transverse colon dilated massively and v unwell
157
Typical LFTs in autoimmune hepatitis
Autoimmune hepatitis is more likely to show predominantly raised ALT / AST on LFTs than ALP Anti smooth muscle antibody
158
Risk of refeeding syndrome electrolytes?
Hypophosphataemia
159
A history of heartburn Odynophagia but no weight loss and systemically well
Oesophagitis
160
Steroid use and pain on swallowing?
Likely candidiasis
161
SSRI major risk for which gi problem?
Duodenal ulcer
162
Which hepatorenal syndrome worse?
Type 1 rapid onset
163
Investigation of choice in primary sclerosing cholangitis
ERCP
164
Dysphagia, iron deficiency and glossitis.
Plummer Vinson
165
Signet ring cells gi biopsy?
Gastric adenocarcinoma
166
First line treatment of UC?
Aminosalycylate
167
Methotrexate used in which ibd?
Crohns
168
Triad of mesenteric ischaemia?
Soft abdo, Acute severe pain, rapid hypovolaemia
169
Treatment of mesenteric ischaemia?
ABX, LMWH, Fluids and laparotomy
170
Causes of GI bleed?
Oesophagitis Oesophageal varices Mallor Weiss tear Gastritis Gastric ulcer Gastric malignancy Duodenal ulcer Angiodysplasia
171
Score to calculate GI bleed before endoscopy?
Glasgow Blatchford
172
Hb threshold for transfusion in upper GI?
\<7 aim for 8 or more
173
Platelets and vit k in upper gi bleed?
\<50plts and PT\>13.5
174
ANy bleed what will you do?
Set of obs Oxygen, suction Cannula and bloods Fluid challenge Catheter GB score score Senior help 72 hour PPI infusion
175
Additional steps if suspected variceal bleed?
Terlipressin 2mg IV stat Ciprofloxacin 200mg IV BD
176
Post endoscopy treatment for variceal bleeding?
Terlipressin 2mg QDS for 5 days Cipro for 72hrs continue PPI Propranolol repeat ligation of varices
177
Triple therapy for H.pylori? When?
Clarithromycin + metro or amox +PPI usually causes duodenal ulcers
178
What must be done in gastric ulcers post endoscopy?
Re-scope- much higher chance of cancer
179
Glasgow score meaning?
0 likely ok consider for discharge, 1 or greater probs needs scoping \>6 50% bad
180
Wernickes encephalopathy triad?
Ataxia, confusion ophthalmoplegia
181
Treatment of wernickes?
2 pairs of IV pabrinex tds for 5 days prevent korsakoffs
182
Ulcer most likely to perforate?
Anterior duodenal ulcer
183
Unconjugated bilirubin is what cause of jaundice?
Pre-hepatic
184
Causes of jaundice- Pre- intra and post hepatic?
Pre- gilberts,haemolysis Intra- Hepatitis, alcohol, medication, psc Gallstones carcinoma
185
Intra-luminal, mural and extra mural causes of jaundice?
Intra-Stones Mural- Stricture of carcinoma Extra mural pancreatic cancer or abdo mass
186
Dark urine what type of bilirubin?
Conjugated as can be excreted
187
What is shown ?
oesophagitis
188
What is this investigation what does it show?
Barium swallow, Achalasia
189
Histology of coeliac? Where is the biopsy taken from?
Presence of intra-epithelial lymphocytes, villous atrophy, and crypt hyperplasia
Taken from duodenum
190
Most common symptoms and signs of coeliac?
IDA, Folate and rarely b12 deficiency.
Iga deficiency, Diarrhoea, Bloating, Pain and discomfort, dermatittis herpetiformis, weight loss, fatigue
