GI Flashcards
(101 cards)
1
Q
what is important to remember about dysphagia
A
red flag symptom - requires urgent OGD to investigate
2
Q
Hx of oesophagitis
A
May be history of reflux/heartburn.
Patient systemically well.
3
Q
Hx of oesophageal cancer
A
Often progresses from solids liquids
Often gives history of weight loss, anorexia, vomiting
4
Q
Hx for oesophageal candidiasis
A
May be history of steroid use/immunocompromised e.g. HIV
5
Q
Hx for achalasia
A
Dysphagia of both solids and liquids from the start, regurgitation (some people may do this to relieve pain)
Barium swallow – ‘bird’s beak oesophagus’
6
Q
Hx for pharyngeal pouch
A
More common in older men
Typical symptoms include dysphagia, regurgitation, halitosis, aspiration, chronic cough
7
Q
Hx for globus hystericus
A
Symptoms are usually intermittent.
Often have history of anxiety
Sensation of “lump in throat”
8
Q
causes of upper GI bleeding
A
peptic ulcer
gastric erosions (due to NSAIDs)
oesophageal varices
mallory-weiss tear
9
Q
which ulcer is relieved by eating and which is worseneed
A
Duodenal ulcers = RELIEVED by eating
Gastric ulcers = Worsened by eating
10
Q
Tx for oesophageal varices
A
band ligation [propanolol can be given as prophylaxis of variceal haemorrhage]
11
Q
what LFT results suggest hepatic causes
A
ALT and AST raised
12
Q
what LFT results suggest biliary causes
A
GGT and Alk Phos raised
13
Q
what is Hx of biliary colic
A
RUQ pain radiating to right shoulder LFTs normal (unless stone in CBD which will produce cholestatic picture)
14
Q
Hx of cholecystitis
A
Murphy sign positive
Different from biliary colic as history of fever/raised WCC
15
Q
Hx of Cholangitis (triad)
A
Charcot Triad
- Jaundice, Fever, RUQ pain
Raised WCC and CRP
16
Q
Tx for gallstones
A
ERCP
17
Q
what is murphy’s sign and what is it associated with
A
patient stops breathing when press on RUQ
cholecystitis
18
Q
what is cholecystis
A
inflammation of gallbladder
19
Q
what is Cholangitis
A
inflammation of bile duct
20
Q
what is not seen in a cirrhotic liver
A
hepatomegaly
21
Q
what causes hepatic encephalopathy and how can it be treated
A
ammonia build up
laxatives
22
Q
complications of chronic liver disease
A
Portal hypertension (oesophageal varices, caput medusae) Ascites Encephalopathy Oedema Sepsis Clotting abnormalities Spider naevi/Gynaecomastia
23
Q
causes of CLD
A
NAFLD PBC PSC Haemochromatosis Wilson's disease Autoimmune Hepatitis
24
Q
how does NAFLD present
A
Usually part of metabolic syndrome e.g. obesity, type 2 diabetes, hypertension, high cholesterol
USS = steatosis
25
how does PBC present
90% are females, peak presentation at 50
Lethargy/itch/jaundice
Positive anti-mitochondrial antibodies, cholestatic LFTs
26
what are cholestatic LFTs
ALP raised markedly compared to ALT
27
how does PSC present
Common in men, especially those with ulcerative colitis
USS shows biliary strictures giving a ‘beaded appearance’
Increased risk of cholangiocarcinoma
Associated with pANCA
28
how does Haemochromatosis present
Primary (autosomal recessive) vs secondary (iron therapy/blood transfusion)
Tiredness, arthralgia, impotence, “slate-grey skin pigmentation” and “bronzed diabetic"
29
how does Wilson's disease
Autosomal recessive with accumulation of copper
Present with liver disease (hepatitis, cirrhosis) and neurological/psychiatric problems (e.g. PD due to deposition in basal ganglia).
May have Kayser-Fleischer ring.
30
how does autoimmune hepatitis present
F>M.
Often associated with other autoimmune conditions
May present with non-specific symptoms e.g. malaise, fatigue, nausea, abdominal pain
Presence of anti-smooth muscle antibodies and elevated IgG
31
what organisms have a 1-6 hour incubation period
Staph Aureus
| Bacillus cereus
32
what organisms have a 12-48 hour incubation period
Salmonella
| E. Coli
33
what organisms have a 48-72 hour incubation period
Shigella
| Campylobacter
34
what organisms have an incubation period longer than 7 days
Giardia
| Amoebiasis
35
who is E. Coli associated with and what is a complication of it
common amongst travellers
associated with HUS
36
how does campylobacter present
abdominal pain, fever, diarrhoea
can be due to chicken/turkey
common cause of family outbreaks
most common cause of outbreaks in UK labs
37
how does bacillus cereus present
due to rice being left out at room temperature
"chinese takeaway"
38
how does giardiasis present
presents with abdo pain, flatulence, bloating and non-bloody diarrhoea
39
how does cholera present
profuse severe watery diarrhoea
describes as "rice-water" diarrhoea
associated with dehydration
40
how does Amoebiasis present
Profuse bloody diarrhoea and abdominal pain. May present as liver abscess --> fever, RUQ pain
41
what are symptoms of IBD
abdo pain
diarrhoea
PR bleeding
weight loss
```
clubbing
mouth ulcers
erythema nodosum
pyoderma gangrenosum
arthritis
```
42
what are features of Crohns
location
- anywhere in GI tract
- skip lesions
pathology
- thickened bowel and stricture
- transmural inflammation
- granulomas present
moderate cancer risk
Symptoms
- fistulae common
- extra GI rare
43
Tx for Crohns
Steroids
Immunosuppressant (eg azathioprine 1st line)
Anti-TNF
44
what are features of UC
location
- colon and rectum
- rarely skips
pathology
- mucosal ulceration and thin wall
- superficial inflammation
- no granulomas
high cancer risk
Symptoms
- fistulae rare
- extra GI common
45
Tx for UC
1st line = 5ASA eg Mesalazine
Steroids
Immunosuppressants
Anti-TNF
46
Treatment for IBS
Reduce fibre, exercise, reduce caffeine intake
1st line = according to predominant symptom
Anti spasmodics e.g. mebeverine, buscopan
Anti diarrhoeals e.g. loperamide
2nd line = Anti depressants e.g. amitriptyline
47
Sx of coeliac
Abdominal pain
Abdominal bloating
Fatigue, weight loss
Anaemia, vitamin deficiencies (iron, folate, B12)
48
Ix for coeliac disease
1st line = anti TTG antibodies
Gold Standard = duodenal biopsy
49
A 75 year old man presents with his wife to the GP with a 2 year history of intermittent problems with swallowing. His wife has noticed halitosis and a cough at night. He has hypertension as his past medical history. There are no red flag symptoms such as weight loss. What is the most likely diagnosis?
Pharyngeal pouch
50
A 53 year old woman presents to the GP with fatigue and itch. These symptoms have been going on for 10 months. Routine blood tests reveal the following. What is the likely diagnosis?
Raised Bilirubin
Raised ALP
Raised ALT
ALP much higher than ALT
Primary Biliary Cirrhosis
51
A 28 year old woman with chronic left iliac fossa pain and alternating bowel habit is diagnosed with irritable bowel syndrome. Despite treatment with antispasmodics, laxatives and anti-motility agents, there has been no significant improvement in her symptoms. What is the most appropriate next step?
Low Dose TCA
52
A 40 year old man is admitted to hospital with decompensated liver disease of unknown aetiology. As part of a liver screen the following results are obtained. What is this man’s hepatitis B status?
Anti HBs = positive
Anti HBc = negative
HBs antigen = negative
Previous immunisation to hepatitis B
53
A 30 year old woman develops severe vomiting 4 hours after having lunch at a local restaurant. What is the most likely causative organism?
Staph Aureus
54
diarrhoea in HIV/AIDS
crytosporidum
55
thumb printing at splenic flexure
ischaemic colitis
56
examples of 5-HT3 Receptor Antagonist anti-emetics
Dolasetron
Odansetron
Mirtazipine
57
examples of Dopamine Antagonist anti-emetics
Olanzapine
Metoclopramide
Haloperidol
58
examples of anti-histamine anti-emetics
cyclizine
59
examples of Anti-Cholinergics anti-emetics
Hyoscine
60
Tx of ascites
spironolactone
61
ix for chronic pancreatitis
CT Pancreas with contrast
62
difficulty swallowing, painful swallowing, heart burn, but no Sx of systemic upset
oesophagitis
63
diagnostic Ix for PSC
MRCP as non invasive
64
treatment of h pylori
amox/metronidazole + clarithromycin + PPI for 7 days
65
what is seen on x-ray in haemochromatosis and what do the blood results show
chondrocalcinosis
raised serum transferrin and ferritin
66
what is seen on investigation in wilsons disease
reduced serum caeruloplasmin
reduced serum copper
increased urinary copper
67
what is the first marker of Hep B infection
HBsAg
| [causes production of anti-HBs]
68
what implies current infectious disease of Hep B
HBsAg
69
the presence of what implies immunity in Hep B
Anti-Hbs
70
what does anti Hbc imply
previous or current infection
71
what is a marker of infectivity
HbeAg
72
what results imply immunisation
Anti-Hbs + ve
| all other negative
73
what results imply previous Hep B infection, and NOT a carrier
Anti-Hbc +ve
| HbsAg -ve
74
what results imply previous Hep B infection, and a carrier
Anti-Hbc +ve
| HbsAg +ve
75
mx of gallstones
laparoscopic cholecystectomy
76
tx of acute cholecystitis
cholecystectomy within 48 hours
IV Cefuroxime
77
tx for acute cholangitis
IV piperacillin-tazobactam
| ERCP
78
blood test that if rasied most suggestive of pancreatitis
serum lipase
79
surgical treatment for pancreatic cancer if person fit enough
Whipple procedure
80
what can you not eat / drink when on warfarin
green leaf veg
| cranberry juice
81
what can you not drink on a statin
grapefruit juice
82
tx of ascities caused by liver cirrhosis
spironolactone
83
what do D cells secrete and what is the function of that chemical
somatostatin
| inhibits HCL secretion
84
what do G cells secrete and what is the function of that chemical
gastrin
| stimulates HCL secretion
85
what do ECL cells secrete and what is the function of that chemical
histamine
| stimulates HCL secretion
86
what do parietal cells secrete and what is the function of that chemical
HCL, intrinsic factor
87
what do chief cells secrete and what is the function of that chemical
pepsinogen
88
Ix for salmonella
stool culture
89
Ix for ecoli
stool culture
90
Ix for norovirus
stool PCR
91
Ix for shigella
stool culture
92
Ix for campylobacter
stool culture
93
Ix for giardia
stool microscopy
94
Ix for C. Diff
stool toxin
95
Ix for cholera
stool culture [and microscopy]
96
what is treatment for bloody diarrhoea
ciprofloxacin
97
Ix and tx for malaria
ix = serial thick and thin blood film
tx = chloroquine, primaquine
98
what is most common cause of encephalitis
HSV - 1
99
what is most common cause of genital warts
HSV - 2
100
CT shows ring lesions ? and person has cat
Toxoplasma Gordii
101
what food are the common microbiology causing gastroenteritis associated with
```
staph aureus = meat
bacillus = rice
salmonella = poultry, dairy
campylobacter = poultry
listeria = cheese
e coli = raw meat
crytosporidum = cows
```
