GI Flashcards
1
Q
if active UGI bleed how many units should you Xmatch?
A
6
2
Q
what are transfusion criteria following UGI bleed?
A
Hb <70
platelets <50 and active bleeding
PTT>1.5 transfuse FFP
3
Q
which score can be done pre-endoscopy to calculate the risk of a re-bleed?
A
Blatchford score
4
Q
Which score can be done post endoscopy to predict mortality?
A
Rockall
5
Q
What is the management for a non-variceal bleed?
A
endoscopy:
either heat treatment of dual therapy (adrenaline + other)
PPI if stigmata of bleed on endoscopy
test H pylori
6
Q
What is the management of a variceal bleed
A
terlepressin and broad spectrum Abx on presentation
band ligation/ glueing in endoscopy
7
Q
If unable to contro variceal UGI bleed what tube can be used?
A
Sengstaken-Blakemore tube
8
Q
define chronic constipation
A
stools <3/52
more than 6 months
symptoms- straining/ pain on defecation
9
Q
what investigations would you send a stool sample for in acute diarrhoea?
A
MC+S
ova and parasites
cysts
c diff toxin
10
Q
Using a surgical seive list causes of chronic constipation
A
(Vascular) Inflammatory/ infective- IBS/ diverticular disease Trauma- obstruction (AI) Metabolic- pregnancy, hypercalcaemia Idiopathic/ iatrogenic- lack of fibre/ activity, opiates neoplastic- colon cancer Congenital- hirschprung degenerative- MS, Parkinsons endocrine- hypothyroid
11
Q
Using a surgical sieve list causes of diarrhoea
A
(Vascular)
Inflammatory/ infective- IBS/ diverticular disease/ infection e.g. C diff- viral, bacterial or parasitic, appendicitis
Trauma- short bowel syndrome
AI- crohns
Metabolic- anxiety, pancreatic insufficiency
Idiopathic/ iatrogenic- antibiotic colitis/ laxatives, constipation with overflow
neoplastic- colon cancer
Congenital-
degenerative-
endocrine- hyperthyroid
12
Q
what food item might you advise patients to avoid during acute diarrhoea?
A
dairy- risk of future intolerance
13
Q
when are anti-motility drugs contraindicated in acute diarrhoea?
A
blood in stool
14
Q
which pathogens causing acute diarrhoea are more likely to cause reactive complications?
A
shigella
campylobacter
salmonella
15
Q
which drug is used to treat C diff
A
metronidazole
16
Q
which pathogens cause non-bloody diarrhoea with mid-abdominal pain?
A
giardia lamblia- explosive, flatulance, dirty water
noravirus/ rotavirus
17
Q
which pathogens are more likely to cause lower abdo pain/ tenesmus/ bloody diarrhoea?
A
Campylobacter- petting zoo
shigella
salmonella- can cause TMC
E coli 0157- can cause HUS
18
Q
What should be avoided in E coli 0157?
A
antibiotics increase risk of HUS
19
Q
what is HUS?
A
haemolytic uraemic sundrome- AKI + haemolytic anaemia
20
Q
which blood test can be used to test for coelic’s?
A
anti a-gliadin, total immunoglobulin A, IgA tissue transglutaminase (ttg)
21
Q
How is hepatitis A spread?
A
faecal-oral- long incubation period so often difficult to identify cause
22
Q
investigations for Hep A
A
IgM
23
Q
who can get infected with hepatitis D?
A
anyone already infected with hep D, increases risk of HCC and cirrhosis
24
Q
what is the first line treatment for chronic hep B?
A
interferon,
if not tolerated then lifelong NRTI
25
Patient with Hep B bloods as follows:
sAg +
anti HBs -
anti HBc +
current Hep B infection (sAg marker of current infection, anti HBc not found in vaccine)
26
Patient with Hep B bloods as follows:
sAg -
anti HBs +
anti HBc +
previous Hep B infection (anti HBs marker of current immunity, anti HBc not found in vaccine)
27
Patient with Hep B bloods as follows:
sAg -
anti HBs +
anti HBc -
previously immunised against Hep B
28
what is the prognosis for hep C infection?
poor- some may clear spontaneously
20 years 15% cirrhosis
up to 20% HCC
29
Pain in RUQ, worse after eating, radiates to back, reduces spontaneously
biliary colic
30
what is murphy's sign?
2 fingers pressed on RUQ on inspiration causes pain and arrest of inspiration
not reproducable on L
sign of cholecystitis
31
RUQ and fever, murphys sign positive
cholecystitis
32
RUQ pain, fever and jaundice, dark stools and pale urine
cholangitis`- charcots triad
33
what is the difference between MRCP and ERCP?
MRCP diagnostic, ERCP can be used for treatment too
34
when should you perform a lap cholecystectomy?
if acute pancreatitis/ recurrent within a week, otherwise 6-8 weeks after symptoms stop
35
what score can be used in cirrhosis to estimate life expectency?
child-pugh score
36
what score can be used in decompensated cirrhosis for transplant planning?
MELD score
37
how often should USS be performed in cirrhosis?
every 6 months + AFP to screen for HCC
38
What can be used for pruritus in cirrhosis?
antihistamine
39
list 3 causes of portal hypertension
pre-hepatic: portal vein thrombosis/ extrinsic tumours
hepatic causes: cirrhosis, chronic hepatitis, schistosomiasis
post-hepatic causes: RHF, budd chiari syndrome
40
what screening should be performed in pulmonary hypertension?
endoscopy for varices, if none 2-3 yearly
if small yearly
if larger prophylactic BB/ banding
screen for HCC and cirrhosis
41
how much fluid in ascites can be detected by shifting dullness?
1.5L
42
how much fluid in ascites can be setected on USS?
500ml
43
Name 3 causes of ascites
cirrhosis
malignancy
HF
44
how soon after admission should an ascitic tap be performed?
within 24 hours
45
what does a low serum ascites-albumin gradient (<11g/L) indicate?
peritoneal cause of ascites- malignancy, TB, peritonitis
46
what does a high serum ascites-albumin gradient (>11g/L) indicate?
portal hypertension cause of ascites:
| cirrhosis, HF, nephrotic syndrome
47
what is the best initial treatment for ascites?
reduced sodium diet
spironolactone
aim for 0.5-1kg wight loss/ day
48
what should be given following therapeutic paracentesis?
small (<5L) synthetic plasma expander
| large (>5L) HAS
49
which condition is associated with crypt abscesses?
UC
50
Crohn's may have what appearance?
cobblestone appearance
51
Where are Crohns lesions most commonly found?
terminal ileum
52
which form of IBD has transmural lesions?
Crohn's
53
what is faecal calprotectin a marker of?
inflammation in colon
54
what staging system can be used for Crohn's?
Crohn's disease severity index
55
which medication should be avoided in UC?
loperamide, increases risk of TMC
56
treatment for mild UC?
5-ASA
| no improvement add steroids
57
treatment for mod UC?
prednisolone + 5-ASA, +/- steroid enemas
58
treatment for severe UC (systemically unwell + 6+ bowel motions a day)?
IV + rectal steroids +5-ASA
?NBM
examine BD for TMC
if no response consider surgery/ ciclosporin or infliximab to maintain remission
59
what is used to maintain remission in UC?
5-ASAs (sulphasalazine)
60
which form of IBD is pANCA +ve?
UC
61
which form of IBD can present with a RLQ mass?
Crohn's
62
list 3 extra-intestinal symptoms of IBD?
large joint arthritis
erythema nodosum
irisitis
pyoderma gangrenosum
63
what treatments are used in Crohn's?
only to induce remission not to maintain- no 5-ASA only steroids. No response to steroids infliximab
64
surgical management for Crohn's?
resection
65
Surgical treatment for UC?
resection + restorative protocolectomy 92 operations- 1 to create pouch out of ileus and 1 to attach to anus)
66
what is the M rule?
for primary biliary cirrhosis
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females
67
LLQ pain increased on eating, decreased on OB
divertticular disease
68
what investigation is most useful for giving a diagnosis of diverticulosis?
barium enema/ flexible sigmoidoscopy- however should not be done in acute settinng as increased risk of perforation
69
Name 5 general indications for admitting someone with GI problems
```
cant control pain
cant tolerate oral fluids
comorbidities/ frail
symptoms persisting after treatment
complications
```
70
what is management for asymotomatic diverticular disease?
increase fibre intake, avoid NSAIDs
71
what it the management for diverticulitis?
Broad spectrum antibiotics
pain relief (non-constipating)
fluids
72
what is the long term management for symptomatic diverticular disease?
analgesia (non-constipating)
laxatives - non stimulant
anticholinergics if over-active sigmoid colon
surgery to resect sigmoid if severe
73
what is Rosving's sign?
pain on palpation of LLQ increases pain in RLQ (appendicitis)
74
which score can be used for appendicitis?
Alvarado score:
<4 unlikely
5-6 observe
7+ operate
75
what is the treatment for appendicitis?
appendicectomy urgently- contraindications include Crohn's involving caecum/ very elderly
76
which is more common: small or large bowel obstruction?
small
77
Name some causes of SBO?
extrinsic- adhesions, strangulated hernia, volvulus
wall- IBD
luminal- gallstone ileus
78
name 3 causes of large bowel obstruction
extrinsic- sigmoid/ caecal volvulus, gynae cancer
wall- diverticular, strictures, cancer
luminal- faecal impaction
79
what would absent BS indicate?
peritonitis (perforation)
80
which type of bowel obstruction is more likely to present acutely?
SBO
81
What would tinkling BS indicate?
bowel obstruction
82
5 radiological findings of SBO?
```
dilatation >3cm
central location
valvulae conniventes
air fluid levels
distally no dilation
```
83
radiological appearance of LBO?
caecum >9cm/ rest >6cm
peripheral location
haustra
distally no dilation
84
management of obstruction
"drip and suck"
IV fluids, gut rest, Ryle's NG for intestinal decompression (if sigmoid volvulus requires decompression via flex sigmoidoscopy)
85
how long after surgery can you expect an ileus to take to resolve?
Small bowel 24hrs
| large bowel 3-5 days
86
Causes of an ileus
Vascular- mesenteric artery ischaemia
Inflammatory/ infective- appendicitis/ diverticular disease/ sepsis/ gatroenteritis
Trauma- surgery
(AI)
Metabolic- electrolyte abnormalities (hypo K/Na)
Idiopathic/ iatrogenic- anticholinergics/ narcotics
(neoplastic)
(Congenital)
(degenerative)
(endocrine)
87
what would differentiate an ileus from an obstruction on Xray?
ileus dilation throughout bowel
88
what criteria can be used to diagnose IBS?
ROME II criteria
89
According to the ROME II criteria, how long must symptoms be present for for a diagnosis of IBS?
6 months
90
what cancer is CA 125 a tumour marker of?
ovarian
91
where is colorectal cancer most commonly found?
1/3 rectal
1/3 L-sided colon
1/3 other
92
what other cancers are patients with HNPCC at increased risk of?
endometrial
| gastric
93
what is the most common type of colorectal cancer?
adenocarcinoma
94
which tumour marker can be used to monitor progression in colorectal cancer?
CEA
95
What staging is used for colorectal cancer?
```
Duke's staging
A- invasion not through bowel wall
B- invasion through bowel wall
C- lymph nodes
D- distant mets
```
96
what screening is available for colorectal cancer?
FOB every 2 years from 60-74
97
how does an ileostomy appear?
R sided
spouted
green liquid
98
How does a colostomy appear?
L sided
flush to skin
faecal content
99
what surgery can be done for rectal cancer?
upper- anterior resection
| lower- abdominal perineal resection (permanent stoma needed)
100
what symptoms may suggest rectal prolapse?
tenesmus/ feeling of incomplete emptying
chronic constipation
slight bleed/ mucus on defecation
101
what is a complication of rectal prolapse?
ulcers
102
what may you tell a pregnant lady presenting with haemorrhoids?
they will resolve after delivery
103
what is the dentate line and why is it important?
2cm above anal verge, haemorrhoids above painless (unless srtangulated) below are lined with squamous cells so will be painful and itchy
104
what is a primary haemorrhoid?
internal- some bleed but not visible externally
105
what is a second degree haemorrhoid?
prolapsing- bleed and may pop out but retract spontaneously
106
what is a third degree haemorrhoid?
prolapsed- requiring manual replacement
107
what management can be used for haemorrhoids?
non-surgical (grade 2+) sclerotherapy/ band ligation via protoscopy
surgical- haemorrhoidectomy under GA
108
name a risk factor for perianal abscesses?
immunocompromise/ DM
MSM
IBD
109
where is 12 o'clock on anal examination?
anterior
110
which are more common primary or secondary anal fissures?
primary, secondary can be due to IBD
111
what is the first line management for anal fissures?
analgesia, topical GTN ointment, stool softeners
112
how do you calculate BMI?
Weight (kg)/ height (m)2
113
when should nutritional support be offered?
BMI <18.5, loss of >10% body weight in <6 months, reduced absorption, eaten little for 5+ days
114
what score for malnutrition should be calculated on admission
Malnutrition universal screening tool- should be repeated weekly
115
if eaten little/ nothing for 5+ days what should be done to avoid refeeding syndrome?
include dietician, start at 50% daily calorie allowance and slowly build up
116
what deficiency may present with night blindness and immune deficiency?
vitamin a
117
what deficiency may present with bleeding gums and reduced wound healing?
vitamin C (scurvy)
118
what deficiency may present with osteoporosis and bow legs?
vitamin D (rickets)
119
what deficiency may present with anaemia and neuro symptoms?
B12- subacute degeneration of spinal cord
120
What is GORD?
reflux of gastric contents causing pathological changes in oesophagus (note not just occasional feeling of heartburn)
121
what happens in Barrett's oesophagus?
squamous epithleium replaced by columnar, increased risk of adenocarcinoma
122
what are the 2 most common type of oesophageal cancer?
adenocarcinoma (western countries- Barretts) and squamous cell carcinoma (developing countries- smoking and hot drinks)
123
where in the oesophagus does SCC occur?
upper 2/3
124
where in the oesophagus does adenocarcinoma occur?
lower 1/3
125
what is the most common site of metastasis for oesophageal cancer?
adenocarcinoma- liver
| SCC- lung, brain, bone, liver
126
how would you recognise a hiatus hernia on CXR?
retrocardiac fluid level
127
what is a complication of hiatus hernias?
ulcer formation-> upper GI bleed
128
which type of peptic ulcer is more common?
duodenal> gastric
129
how might a gastric ulcer typically present?
pain soon after food, not reduced by eating
| anorexia and weight loss
130
how might a duodenal ulcer typically present?
pain 2-3 hours after food, relieved by eating therefore often maintain or increase weight
131
name 3 causes of peptic ulcers?
h pylori infection, NSAID use, stress
132
what is the test for H pylori?
carbon B urea breath test
| stool antigen test
133
what age of patient presenting with a peptic ulcer would you do an endoscopy in?
>55/ red flags (including Fe deficiency anaemia)/ epigastric mass
134
what is the eradication regime for H pylori
PPI+ 2 Abx eg amoxicillin and clarythromycin 7 days
135
If caused by NSAID use and H pylori negative what is the treatment for peptic ulcers?
PPI 2 months
136
what is the most common type of gastric cancer?
adenocarcinoma
137
name 3 risk factors for gastric cancer?
H pylori infection
high salt/ preserved food diet
FAP/ HNPCC
138
what imaging would you use for gastric cancer?
CT and endoscopy for diagnosis
| no PET for staging as does not pick up intra-peritoneal seedlings well therefore laparoscopy
139
what is the most common type of pancreatic cancer?
ductal adenocarcinoma- may be cystic/ endocrine
140
where is the most common site for pancreatic cancer?
head of pancreas
141
which tumour marker can be used for pancreatic cancer?
Ca19.9- also raised in obstructive jaundice
142
what imaging is used for diagnosis/ staging of pancreatic cancer?
USS for diagnosis- endoscopic USS allows stenting until staging
spiral contrast CT for staging
143
Whast foods should coeliacs avoid?
wheat, rye and barley
144
where should biopsies be taken for coeliac's diagnosis?
4 from distal duodenum
145
what does I GET SMASHED stand for?
```
Idiopathic
gallstones
ethanol
trauma
steroids
mumps
autoimmune
scorpion stings
hyperlipidaemia/ hypothyroidism
ERCP
drugs (azathioprine, diuretics)
```
146
what level of amylase is significant for acute pancreatitis?
>3x normal/ ?1000U/L
147
which imaging should be done in acute pancreatitis?
AXR if ?obstruction
CXR for pleural effusion
USS if ?gallstones
contrast CT at 48hrs for necrosis (+ raised CRP)
148
name 3 other causes of raised amylase
renal failure
ectopic
DKA
perforated duodenal ulcer
149
treatment of acute pancreatitis
```
analgesia (NSAIDs good, avoid morphine)
NBM+ IVI (Hartmann's ? colloids)
NG if vomitting/ NJ
if necrosis Abx
involve ICU early, may need surgical debridement
```
150
What is primary and secondary peritonitis?
primary due to SBP
| secondary due to perf
151
are inguinal hernias more common in men or women?
men
152
which is more common- indirect or direct inguinal hernia?
indirect
153
where does an indirect inguinal hernia pass?
through internal inguinal ring and inguinal canal
154
which hernia should always be repaired?
femoral
155
where does a femoral hernia pass?
femoral canal (in sheath with femoral artery and vein)
156
what is an anal fistula?
communication between the anal canal and perianal skin, commonly caused by Crohn's/ diverticulitis. treated surgically
157
What is a perianal haematoma?
collection of blood under perianal skin, presents as swelling and pain. Cannot be reduced (ddx= haemorrhoids) conservative management/ surgical evacuation
158
What is a risk factor for anal cancer?
HPV 16/18
159
what is FAP?
familial adenomatous polyposis- many polyps, increased risk of adenomas. Autosomal dominant inheritance therefore regular colonoscopies for screening
160
what is petuz- jeghers syndrome?
autosomal dominant disorder characterised by mucosal pigmentation of lips and gums + intestinal polyps
161
what might indicate a patient is in hepatic failure?
coagulopathy (INR>1.5)
encephalopathy
Jaundice
ascites
162
name 3 risk factors for hepatocellular carcinoma?
HBV/ HCV infection
alcoholism
genetic haemochromatosis
163
what is the most common cause of liver abscesses in the developed world?
secondary to infection in abdomen- Crohns, diverticulitis, appendicitis etc
164
how might a liver abscess present?
RUQ pain, swinging fever, night sweats, pyrexia unknown origin, jaundice
165
what is a subphrenic abscess?
accumulation of fluid between diaphragm, liver and spleen often following surgery.
166
what is the most common cause for chronic pancreatitis?
mostly alcohol use, can be CF or obstruction of pancreatic duct (benign/ malignant)
167
what are 3 causes of gastritis?
excess alcohol
H Pylori
bile reflux
NSAID use
168
whata is achalasia?
an oesophageal motility disorder, whereby the bottom of the oesophagus may not relax properly during swallowing. causes dysphagia, regurgitation and chest pain. commonly occurs spontaneously but also after surgery/ as a result of gastric carcinoma.
