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Finals Questions > GI > Flashcards

GI Flashcards

1
Q

Mx Variceal Upper GI bleed

A
  • 2mg IV Terlipressin
  • Ciprofloxacin 200mg
  • Variceal band ligation
  • Propanolol
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2
Q

Mx Non-Variceal Upper GI Bleed

A
  • H. Pylori +ve:
  • PPI
  • Clarithromycin
  • Amox/Metronidazole
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3
Q

Kwashiorkor Malnutrition cause and feature

A
  • Normal energy intake
  • Poor Protein
  • Pot belly, moon faces, oedematous
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4
Q

What is small intestine bacterial overgrowth syndrome?

A
  • Normal Vit. K
  • Reduced Mg2+
  • In presence of fat malabsorption
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5
Q

Which vitamins are fat soluble?

A
  • DAKE
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6
Q

When do you give Vit K?

A
  • Reverse Warfarin

- PT >13.5

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7
Q

When do you give FFP?

A

PT 20

2-4 units

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8
Q

When do you give platelets?

A

<50

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9
Q

When do you give Blood?

A

Hb <70 - aim for >80

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10
Q

What are ALARMs?

A
  • Anaemia
  • Loss of weight
  • Anorexia
  • Recent onset of Sx
  • Meleana/haematemesis
  • Swallowing difficulty
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11
Q

What is a surgical treatment for severe reflux?

A

Nissen Fundoplication

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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
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13
Q

When do you get pain with a duodenal ulcer?

A

When Hungry

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14
Q

When do you get pain with a gastric ulcer?

A

When eating

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15
Q

How do you test for H. Pylori?

A

C13 breath test

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16
Q

What type of bacteria is H. Pylori?

A

Gram negative

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17
Q

How long do you treat H. Pylori for?

A

7 day Abx course

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18
Q

What classification is used for gastritis?

A

Sydney classification

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19
Q

Which vitamin deficiency causes pernicious anaemia?

A

B12

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20
Q

What is achalasia?

A

Degeneration of myenteric plexus causing impaired relaxation of lower oesophageal sphincter

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21
Q

Mx Achalasia?

A

Endoscopic balloon dilatation
Botulinum toxin injection
Calcium channel blockers/nitrates to relax sphincter

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22
Q

What measures lower oesophageal sphincter function?

A

Manometry

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23
Q

Cause of sliding hiatus hernia

A

GORD

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24
Q

Cause of Rolling hiatus hernia

A

Obstruction, volvulus, ischaemia

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25
Q

Mx hiatus hernia

A

Laparoscopuc fundoplication

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26
Q

Main Sx of indirect inguinal hernia

A

Pain in scrotum

‘dragging’ sensation

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27
Q

Path of inguinal hernia - indirect

A

Lateral to inferior epigastric vessels
Protrude at deep inguinal ring
Common in children

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28
Q

Path of inguinal hernia - direct

A 
Medial to inferior epigastric vessels
Protrude medial to inferior epigastric artery within Hesselbach's triangle:
- Inguinal ligament
- Inferior epigastric
- Rectus abdominus
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29
Q

What is an omphalocele?

A

Congenital umbilical herna

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30
Q

Cullen’s sign

A

Peri umbilical

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31
Q

Grey Turner’s

A

Flanks

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32
Q

How is pancreatitis relieved?

A

Sitting forward

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33
Q

Causes of acute pancreatitis

A 
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpoin venom
Hypothermia/hypercalcaemia/hyperlipidaemia
Emboli/ERCP
Drugs
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34
Q

Causes of chronic pancreatitis

A

Chronic alcohol
CF, haemochromotosis, obstruction
Drugs - azathioprine, sulfonamides, loop diuretcs

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35
Q

Diagnosis of acute pancreatitis

A 
>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
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36
Q

Mx of acute pancreatitis

A 
ABCDE
Pethidine analgesia
Cyclizine
Cefuroxime
NBM
ERCP - gallstones
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37
Q

Mx of chronic pancreatitis

A

DAKE vitamins

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38
Q

What is Courvoisier’s sign?

A

Palpable gallbladder in presence of painless jaundice

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39
Q

What surgical procedure is associated with pancreatic cancer?

A

Whipple’s

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40
Q

Where are the most common areas for peritonitis?

A

Suphepatic, pelvic and parabolic gutters - abscesses

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41
Q

How would you differentiate between lower and upper GI bleed via urea?

A

Upper GI bleed = high urea, low Hb

Lower GI bleed = low urea

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42
Q

How do you diagnosis cholecystitis?

A

Inflammatory markers up

Murphy’s sign - press 2 fingers in RUQ and ask pt to inspire - pain. Positive if no pain in LUQ

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43
Q

What can be given to prevent cholecystitis in high risk patients?

A

Ursodexycholic acid

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44
Q

Reynold’s pentad

A 
- Lethargy/confusion
Shock
Fever
Jaundice
Abdominal pain
45
Q

Charcot’s triad

A

Jaundice
Fever
RUQ pain

46
Q

Mx of cholangitis

A
  • Abx
  • MRCP then ERCP
  • T-tube drainage - definitive = surgery
  • Tx of organ failure
47
Q

What is Budd-Chiari syndrome?

A

Hepatic vein opstruction

48
Q

Mx of portal HTN

A

B-blockers

Nitrates

49
Q

Infective causes of hepatitis

A
  • EBV
  • CMV
  • Malaria
  • Q-fever
  • Syphilis
  • Yellow fever
50
Q

Incubation period of Hep A

A

2-6weeks

51
Q

Icteric phase of Hep A

A 
- Dark urine, pale stools
Jaundice
Pain
Itch/pruritis
Arthalgia/skin rash
52
Q

Ix for Hep A

A

AST and ALT - rise 22-40days after exposure
IgM - positive form onset of Sx
IgG - soon after IgM, persists for many years

53
Q

Incubation Hep B

A

1-6months

54
Q

How is Hep B different to Hep A?

A

More arthalgia and urticaria

Decompensated liver disease

55
Q

Previous Hep B vaccination

A

Anti-HBsAg

56
Q

Previous Hep B infection

A

Anti-HBcAg

57
Q

Most infectious Hep B

A

HBsAg + HBeAg

58
Q

Mx Hep B

A

Supportive

Chlorphenamine for itching

59
Q

What Mx can prevent chronic Hep C infection if given when in acute phase

A

Interferon alpha

60
Q

Diagnosis Hep C

A

Anti-HCV antibody

liver biopsy

61
Q

What precaution needs to be taken for Hep C

A

Cirrhosis –> HCC

6 monthly USS

62
Q

How can you diagnose alcoholic hepatitis?

A

AST : ALT

2:1

63
Q

Which blood marker can help to diagnose HCC?

A

Alpha feto-protein

64
Q

Blood markers for Coeliac disease

A 
Transglutaminase - IgA tTG
HLA-DQ2
Reduced B12 and ferritin
Low Hb
Iron deficiency anaemia
65
Q

Which 4 diseases are associated with HLA-B27

A

Psoriasis
Ankylosing spondylitis
IBD - UC more
Reactive arthritis

66
Q

How do you test for UC?

A

p-ANCA positive

Faecal calprotectin

67
Q

How do you test for Crohn’s?

A

p-ANCA negative
Faecal calprotectin
Histology - granulomatous inflammation
Colonoscopy - skip lesions, fistulas, crypt architecture

68
Q

Mx UC

A

Aminosalicylate
Azathioprine for mod-severe flare ups in last 3 years
Surgery - subtotal colectomy with end ileostomy is common

69
Q

Mx Crohn’s acute

A

30-60mg Pred
Enteral nutrition
Infliximab for immunosuppressed

70
Q

Mx of Crohn’s remission

A

Azathioprine
6-mercaptopurine
Mycophenolate mofetil
Methotrexate

71
Q

Sx of diverticular disease

A
  • Altered bowel habit
  • +/- left sided colic relieved by defecation
  • Nausea and flatulence
72
Q

Main Ix to diagnose diverticular disease

A
  • CT abdo - shows acute best

- AXR may show obstruction/free air

73
Q

Ix post acute diverticular attack

A

6 week flexi sig to show perforation

74
Q

Mx of diverticular disease

A
  • Antispasmodics - mebeverine

- Occasionally surgery if peritonitis/fistula/obstruction

75
Q

Mx of diverticulitis

A
  • Sx control

- Co-amoxiclav

76
Q

Cx of diverticular disease

A
  • Perforation
  • Haemorrhage
  • Fistulae
  • Abscesses
  • Post infective strictures
77
Q

What is the Hinchey Classification?

A

Used to used to describe perforations of the colon due to diverticulitis

78
Q

Rovsig’s sign

A

Pain in RIF when palpating LIF

79
Q

Psoas sign

A

Pain on extending hip if retrocaecal

80
Q

Cope sign

A

Pain on flexion and internal rotation of right hip if appendix in close relation to obturator internus

81
Q

Dx of appendicitis

A

Usually clinical
Pregnancy test to exclude ectopic
USS

82
Q

Mx appendicitis

A 
ABCDE
Metoclopramide
Morphine
Appendecotomy - NBM
Met + Cef
83
Q

Which electrolyte imbalance can cause paralytic ileus

A

Low K+ and Na+

84
Q

How do you treat pseudo-obstruction

A

Neostigmine

85
Q

Ix for small bowel obstruction

A

Urgent CT if >3.8cm dilated

86
Q

What Ix would you do in a pt presenting with IBS to differentiate if it’s IBD?

A

Faecal calprotectin

87
Q

What diet advice can yo give for IBS?

A
  • Regular meals - avoid long gaps
  • Lots of fluids - coffee/tea restriction
  • Reduce fizzy drinks
  • Limit high fibre foods and resistant starches
88
Q

Mx for IBS

A
  • Loperamide for diarrhoea
  • Antispasmodics - buscopan
  • Peppermint oil
89
Q

What is colonic polyposis?

A
  • Widespread development of adenomas in colon and rectum
90
Q

Gardner’s syndrome

A
  • Colonic polyposis with osteomas and soft tissue tumours
91
Q

Peutz-Jegher’s syndrome

A

Autosomal dominant

Mucosal pigmentation of lips and gums with multiple intestinal hamartomatous polyps

92
Q

Screening for colon cancer

A

55yrs - flexi sig
60-74 - faceal occult every 2 years
>75 - can ask for test kit every 2 years

93
Q

Sx of right sided colon cancer

A
  • LoW
  • Anaemia
    Mass in RIF
    More advanced at presentation
94
Q

Sx of left sided colon cancer

A 
- Colicky pain
Rectal bleed
Tenesmus
Mass in LIF
Less advanced at presentation
95
Q

Tumour marker for Colon cancer

A

CEA

96
Q

Mx for haemorrhoids

A
  • Topical anaesthetic
  • Non-bulk forming laxatives
  • Avoid caffeine
  • Good hygiene
  • Rubber band ligation for grade 2+
97
Q

Mx for Anal Fissue

A
  • Fluid, fibre, simple analgesia
  • Topical GTN BD to reduce tone
  • Topical diltiazem
  • Surgery - sphincterectomy/botox
98
Q

Mx of anal fistula

A
  • Surgery - allow drainage

- Repair

99
Q

What typeof abscess causes hiccups

A

Subphrenic

100
Q

What is Hartmann’s procedure

A

Emergency open left semi and end colostomy

101
Q

Which side is an ileostomy?

A

Right

102
Q

Which side is a colostomy?

A

Left or right

103
Q

Differences between ileostomy and colostomy

A
  • Ileostomy - spouted and green

- Colostomy - Flush to abdomen with faceulent contents

104
Q

Mx of C.diff

A
  • IV fluids
  • No loperamide or opiates
  • Met and vanc
105
Q

Which Abx is strongly associated with increased risk of c.diff?

A

Clindamycin - cephalosporins

106
Q

What is Reynold’s pentad?

A 
Lethargy/confusion
Shock
Fever
Jaundice
Abdominal pain
107
Q

What grading system is used for liver cirrhosis?

A

Child-Pugh

108
Q

Which sign is associated with Cholecystitis?

A

Murphy’s sign - Pain over RUQ when pt breathes in

Finals Questions (8 decks)

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