GI Flashcards
(108 cards)
1
Q
Mx Variceal Upper GI bleed
A
- 2mg IV Terlipressin
- Ciprofloxacin 200mg
- Variceal band ligation
- Propanolol
2
Q
Mx Non-Variceal Upper GI Bleed
A
- H. Pylori +ve:
- PPI
- Clarithromycin
- Amox/Metronidazole
3
Q
Kwashiorkor Malnutrition cause and feature
A
- Normal energy intake
- Poor Protein
- Pot belly, moon faces, oedematous
4
Q
What is small intestine bacterial overgrowth syndrome?
A
- Normal Vit. K
- Reduced Mg2+
- In presence of fat malabsorption
5
Q
Which vitamins are fat soluble?
A
- DAKE
6
Q
When do you give Vit K?
A
- Reverse Warfarin
- PT >13.5
7
Q
When do you give FFP?
A
PT 20
2-4 units
8
Q
When do you give platelets?
A
<50
9
Q
When do you give Blood?
A
Hb <70 - aim for >80
10
Q
What are ALARMs?
A
- Anaemia
- Loss of weight
- Anorexia
- Recent onset of Sx
- Meleana/haematemesis
- Swallowing difficulty
11
Q
What is a surgical treatment for severe reflux?
A
Nissen Fundoplication
12
Q
When do you do an urgent referral for Oesophagitis?
A
- Dysphagia OR
- Dyspepsia + 1 ALARMS OR
- Dyspepsia >55 + continuous symptoms, <1yr OR
- Dyspepsia with other significant medical Hx relating to GI
13
Q
When do you get pain with a duodenal ulcer?
A
When Hungry
14
Q
When do you get pain with a gastric ulcer?
A
When eating
15
Q
How do you test for H. Pylori?
A
C13 breath test
16
Q
What type of bacteria is H. Pylori?
A
Gram negative
17
Q
How long do you treat H. Pylori for?
A
7 day Abx course
18
Q
What classification is used for gastritis?
A
Sydney classification
19
Q
Which vitamin deficiency causes pernicious anaemia?
A
B12
20
Q
What is achalasia?
A
Degeneration of myenteric plexus causing impaired relaxation of lower oesophageal sphincter
21
Q
Mx Achalasia?
A
Endoscopic balloon dilatation
Botulinum toxin injection
Calcium channel blockers/nitrates to relax sphincter
22
Q
What measures lower oesophageal sphincter function?
A
Manometry
23
Q
Cause of sliding hiatus hernia
A
GORD
24
Q
Cause of Rolling hiatus hernia
A
Obstruction, volvulus, ischaemia
25
Mx hiatus hernia
Laparoscopuc fundoplication
26
Main Sx of indirect inguinal hernia
Pain in scrotum
| 'dragging' sensation
27
Path of inguinal hernia - indirect
Lateral to inferior epigastric vessels
Protrude at deep inguinal ring
Common in children
28
Path of inguinal hernia - direct
```
Medial to inferior epigastric vessels
Protrude medial to inferior epigastric artery within Hesselbach's triangle:
- Inguinal ligament
- Inferior epigastric
- Rectus abdominus
```
29
What is an omphalocele?
Congenital umbilical herna
30
Cullen's sign
Peri umbilical
31
Grey Turner's
Flanks
32
How is pancreatitis relieved?
Sitting forward
33
Causes of acute pancreatitis
```
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpoin venom
Hypothermia/hypercalcaemia/hyperlipidaemia
Emboli/ERCP
Drugs
```
34
Causes of chronic pancreatitis
Chronic alcohol
CF, haemochromotosis, obstruction
Drugs - azathioprine, sulfonamides, loop diuretcs
35
Diagnosis of acute pancreatitis
```
>3 in first 48hrs:
PaO2 <8
Age >55
Neutrophils >15
Calcium <2
Renal function - urea >16
Enzymes - LDH >600, AST >200
Albumin <32
Sugars >10
```
36
Mx of acute pancreatitis
```
ABCDE
Pethidine analgesia
Cyclizine
Cefuroxime
NBM
ERCP - gallstones
```
37
Mx of chronic pancreatitis
DAKE vitamins
38
What is Courvoisier's sign?
Palpable gallbladder in presence of painless jaundice
39
What surgical procedure is associated with pancreatic cancer?
Whipple's
40
Where are the most common areas for peritonitis?
Suphepatic, pelvic and parabolic gutters - abscesses
41
How would you differentiate between lower and upper GI bleed via urea?
Upper GI bleed = high urea, low Hb
| Lower GI bleed = low urea
42
How do you diagnosis cholecystitis?
Inflammatory markers up
| Murphy's sign - press 2 fingers in RUQ and ask pt to inspire - pain. Positive if no pain in LUQ
43
What can be given to prevent cholecystitis in high risk patients?
Ursodexycholic acid
44
Reynold's pentad
```
- Lethargy/confusion
Shock
Fever
Jaundice
Abdominal pain
```
45
Charcot's triad
Jaundice
Fever
RUQ pain
46
Mx of cholangitis
- Abx
- MRCP then ERCP
- T-tube drainage - definitive = surgery
- Tx of organ failure
47
What is Budd-Chiari syndrome?
Hepatic vein opstruction
48
Mx of portal HTN
B-blockers
| Nitrates
49
Infective causes of hepatitis
- EBV
- CMV
- Malaria
- Q-fever
- Syphilis
- Yellow fever
50
Incubation period of Hep A
2-6weeks
51
Icteric phase of Hep A
```
- Dark urine, pale stools
Jaundice
Pain
Itch/pruritis
Arthalgia/skin rash
```
52
Ix for Hep A
AST and ALT - rise 22-40days after exposure
IgM - positive form onset of Sx
IgG - soon after IgM, persists for many years
53
Incubation Hep B
1-6months
54
How is Hep B different to Hep A?
More arthalgia and urticaria
| Decompensated liver disease
55
Previous Hep B vaccination
Anti-HBsAg
56
Previous Hep B infection
Anti-HBcAg
57
Most infectious Hep B
HBsAg + HBeAg
58
Mx Hep B
Supportive
| Chlorphenamine for itching
59
What Mx can prevent chronic Hep C infection if given when in acute phase
Interferon alpha
60
Diagnosis Hep C
Anti-HCV antibody
| liver biopsy
61
What precaution needs to be taken for Hep C
Cirrhosis --> HCC
| 6 monthly USS
62
How can you diagnose alcoholic hepatitis?
AST : ALT
| 2:1
63
Which blood marker can help to diagnose HCC?
Alpha feto-protein
64
Blood markers for Coeliac disease
```
Transglutaminase - IgA tTG
HLA-DQ2
Reduced B12 and ferritin
Low Hb
Iron deficiency anaemia
```
65
Which 4 diseases are associated with HLA-B27
Psoriasis
Ankylosing spondylitis
IBD - UC more
Reactive arthritis
66
How do you test for UC?
p-ANCA positive
| Faecal calprotectin
67
How do you test for Crohn's?
p-ANCA negative
Faecal calprotectin
Histology - granulomatous inflammation
Colonoscopy - skip lesions, fistulas, crypt architecture
68
Mx UC
Aminosalicylate
Azathioprine for mod-severe flare ups in last 3 years
Surgery - subtotal colectomy with end ileostomy is common
69
Mx Crohn's acute
30-60mg Pred
Enteral nutrition
Infliximab for immunosuppressed
70
Mx of Crohn's remission
Azathioprine
6-mercaptopurine
Mycophenolate mofetil
Methotrexate
71
Sx of diverticular disease
- Altered bowel habit
- +/- left sided colic relieved by defecation
- Nausea and flatulence
72
Main Ix to diagnose diverticular disease
- CT abdo - shows acute best
| - AXR may show obstruction/free air
73
Ix post acute diverticular attack
6 week flexi sig to show perforation
74
Mx of diverticular disease
- Antispasmodics - mebeverine
| - Occasionally surgery if peritonitis/fistula/obstruction
75
Mx of diverticulitis
- Sx control
| - Co-amoxiclav
76
Cx of diverticular disease
- Perforation
- Haemorrhage
- Fistulae
- Abscesses
- Post infective strictures
77
What is the Hinchey Classification?
Used to used to describe perforations of the colon due to diverticulitis
78
Rovsig's sign
Pain in RIF when palpating LIF
79
Psoas sign
Pain on extending hip if retrocaecal
80
Cope sign
Pain on flexion and internal rotation of right hip if appendix in close relation to obturator internus
81
Dx of appendicitis
Usually clinical
Pregnancy test to exclude ectopic
USS
82
Mx appendicitis
```
ABCDE
Metoclopramide
Morphine
Appendecotomy - NBM
Met + Cef
```
83
Which electrolyte imbalance can cause paralytic ileus
Low K+ and Na+
84
How do you treat pseudo-obstruction
Neostigmine
85
Ix for small bowel obstruction
Urgent CT if >3.8cm dilated
86
What Ix would you do in a pt presenting with IBS to differentiate if it's IBD?
Faecal calprotectin
87
What diet advice can yo give for IBS?
- Regular meals - avoid long gaps
- Lots of fluids - coffee/tea restriction
- Reduce fizzy drinks
- Limit high fibre foods and resistant starches
88
Mx for IBS
- Loperamide for diarrhoea
- Antispasmodics - buscopan
- Peppermint oil
89
What is colonic polyposis?
- Widespread development of adenomas in colon and rectum
90
Gardner's syndrome
- Colonic polyposis with osteomas and soft tissue tumours
91
Peutz-Jegher's syndrome
Autosomal dominant
| Mucosal pigmentation of lips and gums with multiple intestinal hamartomatous polyps
92
Screening for colon cancer
55yrs - flexi sig
60-74 - faceal occult every 2 years
>75 - can ask for test kit every 2 years
93
Sx of right sided colon cancer
- LoW
- Anaemia
Mass in RIF
More advanced at presentation
94
Sx of left sided colon cancer
```
- Colicky pain
Rectal bleed
Tenesmus
Mass in LIF
Less advanced at presentation
```
95
Tumour marker for Colon cancer
CEA
96
Mx for haemorrhoids
- Topical anaesthetic
- Non-bulk forming laxatives
- Avoid caffeine
- Good hygiene
- Rubber band ligation for grade 2+
97
Mx for Anal Fissue
- Fluid, fibre, simple analgesia
- Topical GTN BD to reduce tone
- Topical diltiazem
- Surgery - sphincterectomy/botox
98
Mx of anal fistula
- Surgery - allow drainage
| - Repair
99
What typeof abscess causes hiccups
Subphrenic
100
What is Hartmann's procedure
Emergency open left semi and end colostomy
101
Which side is an ileostomy?
Right
102
Which side is a colostomy?
Left or right
103
Differences between ileostomy and colostomy
- Ileostomy - spouted and green
| - Colostomy - Flush to abdomen with faceulent contents
104
Mx of C.diff
- IV fluids
- No loperamide or opiates
- Met and vanc
105
Which Abx is strongly associated with increased risk of c.diff?
Clindamycin - cephalosporins
106
What is Reynold's pentad?
```
Lethargy/confusion
Shock
Fever
Jaundice
Abdominal pain
```
107
What grading system is used for liver cirrhosis?
Child-Pugh
108
Which sign is associated with Cholecystitis?
Murphy's sign - Pain over RUQ when pt breathes in
