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1st Year Medicine > GI Disease > Flashcards

GI Disease Flashcards

(129 cards)

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1
Q

s/s IBS? (3)

A

Abdominal pain, bloating, change in bowel habit

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2
Q

Epidemiology IBS?

A

30-40 females

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3
Q

Rome III criteria IBS?

A

Improvement with defecation, increased stool form, increased stool frequency

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4
Q

Ix IBS?

A

CRP, FBC, plasma viscosity, antibody test for coeliacs, colonoscopy (Dx of exclusion)

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5
Q

Tx IBS?

A
  • Reduce fibre
  • regular meals
  • anti-spasmodics e.g. hyoscine
  • anti-diarrhoeals e.g. loperamide
  • anti-depressants e.g. amitryptiline
  • STOP OPIATES/CODEINE (narcotic bowel syndrome)
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6
Q

Crohns localised?

A

Can affect anywhere from mouth to anus

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7
Q

Epidemiology crohns?

A

Males + young people

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8
Q

S/s crohns? (6)

A
  • Colicky abdominal pain
  • Obstruction
  • anaemia
  • bleeding PR
  • diarrhoea
  • weight loss
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9
Q

Ix crohns?

A

Endoscopy + mucosal biopsy

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10
Q

Tx crohns?

A

Steroids -> immuosuppresants -> anti-TNF therapy

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11
Q

Complications of crohns? (6)

A

Malabsorption, anal disease, bowel obstruction, amyloidosis, perforation, malignancy, fistulas

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12
Q

Triggers for crohns? (4)

A

Smoking, infection, vasculitis, hygiene hypothesis

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13
Q

Localised UC?

A

Colon + rectum

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14
Q

Epidemiology UC?

A

Males + young people

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15
Q

Tx UC?

A

5ASA, steroids, immunosuppresants, anti-TNF

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16
Q

Cure UC?

A

SUBTOTAL COLECTOMY

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17
Q

Comps UC? (9)

A

Toxic megacolon, uveitis, colorectal carcinoma, hypokalaemia, primary sclerosing cholangitis, arthritis, pyoderma gangrenosum, anal fissure, erythema nodosum

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18
Q

Triggers UC?

A

smoking NOT associated with UC

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19
Q

Contrast crohns and UC

A

Crohns: fistulae, thickened bowel wall, segmentation, transmural inflammation granulomas
UC: no fistulae, thin wall, continuous, superficial inflammation, no granulomas

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20
Q

Acute liver disease?

A

rapid hepatic dysfunction WITHOUT prior liver disease (<6 months)

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21
Q

S/s acute liver disease? (7)

A

anorexia, lethargy, itching, jaundice, nausea, arthralgia, RUQ pain

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22
Q

Ax acute liver disease? (4 + 3 rare)

A
  • alcohol, viral, drugs (paracetamol), malignancy

* budd chiari, AFLP, cholestasis of pregnancy

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23
Q

Tx acute liver disease? (5)

A

Sodium bicarbonate, cholestyramine, ureodeoxycholic acid, fluids, increase calories

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24
Q

Fulminant hepatic failure?

A

rapid development of jaundice and encephalopathy in patient with previously NORMAL liver

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25
Ax FHF? (7)
Paracetamol, mushrooms, viral, AFLP, malignancy, Wilsons, Budd chiari
26
Tx FHF? (5)
Inotropes, fluids, renal replacement, management of raised intra-cranial pressure, transplant
27
Name chronic liver diseases (>6 months) (10)
* NAFLD * Primary biliary cirrhosis * Auto-immune hepatitis * Primary sclerosing cholangitis * Haemochromatosis * Wilsons disease * Alpha-1 anti-trypsin deficiency * Budd-chiari * Methotrexate * Cardiac cirrhosis
28
Tx NAFLD?
Weight loss + exercise
29
Epidemiology PBC?
Middle-aged women
30
S/s PBC?
Can be asymptomatic | s/s: fatigue, itch, xanthelasma
31
Dx PBC?
AMA+, LFT, liver biopsy
32
Tx PBC?
Urseo deoxycholic acid, transplant
33
O/E auto-immune hepatitis?
Hepatomagaly, splenomegaly, jaundice
34
s/s auto-immune hepatitis? (4)
anorexia, fatigue, RUQ pain, nausea
35
Dx auto-immun hep?
elevated AST/ALT, biopsy
36
Tx auto-immune hep?
Corticosteroids (pred), azathioprine (immunosuppressant), transplant
37
Epidemiology PSC?
Males, associated with UC
38
Dx PSC?
AMA- but ANA, SMA, ANCA + Increased ALP and bilirubin ERCP DEFINITIVE DX
39
Comp PSC?
cholangiocarcinoma
40
s/s haemochromatosis?
No erections, "bronzed diabetic" - diabetes, liver cancer
41
Haemochromatosis?
Iron deposited in liver
42
Tx haemochromatosis?
Venesection
43
Wilsons disease?
Loss of function of caeruloplasmin (Cu binding protein)
44
s/s Wilsons? (4)
chorea-atheitoid movements, depression, changed libido/personality, KAISER-FLEISHER RINGS
45
tx wilsons?
Copper chelating drugs
46
A1ATD?
Excess tryptic activity resulting in lung emphysema + A1AT deposition in liver
47
Budd-chiari?
Thrombosis of hepatic veins
48
s/s budd chiari?
Acute: jaundice, tender hepatomegaky Chronic: ascites
49
Dx budd chiari?
US of hepatic veins
50
Tx budd chiari?
TIPS
51
Methotrexate?
Tx in RA and psoriasis that can lead to liver fibrosis
52
Cardiac cirrhosis?
CCF with ascites/liver impairment
53
Ax cirrhosis? (7)
alcohol, HBV, HCV, haemochromatosis, autoimmune, gallstones, NAFLD
54
s/s cirrhosis?
Oesophageal varices, haemorrhoids, caput medusa, ascites, encephalopathy
55
Tx cirrhosis?
Lactulose, nutrition, transplant
56
s/s jaundice? (7)
Yellow skin/sclera, pale stools, dark urine, weight loss, abdo pain, ascites, itch
57
Ix jaundice? (4)
US, CT, ERCP, FBC
58
Hep A factfile? (3)
* Faecal-oral * Acute hepatitis, NOT chronic * controled via hygiene, VACCINE
59
Hep B factfile? (3)
* Sex, mother -> child, blood * Can be chronic but uncommon * Vaccine
60
Hep C factfile? (3)
* Sex, mother -> child, blood * CHRONIC * NO VACCINE
61
Hep D factfile?
ONLY WITH HEP B, exacerbates hep B infection
62
Hep E factfile?
* Faecal-oral, zoonosis, tropics * Not chronic * NO VACCINE
63
Tx for hepatitis?
NO ANTIVIRALS if ACUTE!! If chronic, give antivirals + vaccination
64
Risk factors cholelithiasis?
Five F's: fat, fair, female, forty, fertile
65
Comps gallstones? (7)
Cholecystitis, mucocoele, empyema, cholangitis, onstructive jaundice, gallstone ileus, pancreatitis
66
Cholecystitis?
Inflam of gallbladder ass. with gallstones
67
Acute cholecystitis? Chronic?
* Acute: gallstones obstruct cystic duct + become infected | * Chronic: wall thickened due to fibrosis but not distended
68
Dx cholecystitis?
US, CT, MRCP
69
TX cholecystitis?
IV antibiotics, fluids, nil by mouth, cholecystectomy (laparoscopically)
70
Biliary colic?
Stone impacts in cystic duct
71
S/s biliary colic?
RUQ pain, radiates to back/shoulder, nausea
72
Gallstone ileus?
Small bowel obstruction -> gallstones impact in distal ileum
73
Tx gallstone ileus?
Urgent enterotomy, interval cholecystectomy in 3 months
74
Tx gallstone in CBD?
ERCP
75
S/s acute pancreatitis? (5)
epigastric pain, anorexia, nausea, grey turner's sign, cullen's sign
76
Ax pancreatitis?
I GET SMASHED * Idiopathic, gallstones, ERCP, trauma, scorpion sting, mumps, autoimmine, steroids, hyperlipidaemia/calcaemia, ethanol, drugs
77
Acute pancreatitis?
Autodigestion of acini due to release of pancreatic enzymes
78
Dx pancreatitis?
CXR (pleural effusion, sentinel loop), CT, MRI, ERCP, FBC, AMYLASE, CRP, Ca ALL PATIENTS WITH AP, U/S within 24 HOURS admission
79
Ax chronic pancreatitis? (2)
Cystic fibrosis, ALCOHOL
80
Epidemiology small bowel ischaemia?
Eldery + arteriopaths
81
s/s SB ischaemia? (4)
Sepsis, shock, poorly localised pain, increased amylase (often confused with pancreatitis)
82
Tx SB ischaemia?
Revascularise intestine + remove dead tissue
83
Diverticular disease?
Mucosal herniation through muscle coat (affects sigmoid colon)
84
Ax diverticular disease?
Low fibre, increased intraluminal pressure
85
s/s diverticular disease?
LIF pain, altered bowel habit, septic
86
Dx diverticular disease?
Ba enema, sigmoidoscopy
87
Tx diverticular disease?
* uncomplicated - IV antibiotics | * complex - percutaneous drainage
88
Meckel's diverticulum?
Incomplete regression if the vitello-intestinal duct
89
s/s meckel's diverticulum?
Normally asymptomatic, but can mimic appendicitis
90
Small bowel cancer types?
* Primary (rare): lymphomas, carcinoid (found in appendix - carcinoid syndrome), carcinoma * Secondary (common)
91
Oesophageal cancer (benign vs malignant)
* Benign: squamous, papilloma | * Malignant: squamous cell, adenocarcinoma (barrett's)
92
Oral cancer?
Squamous cell carcinoma
93
A/x oral cancer?
Tobacco, alcohol, oral sex
94
S/s oral cancer?
Ulcer (>2 weeks), numbness, pain, voice change, dysphagia
95
Stomach cancer? Benign vs malignant
Benign: polyps Malignant: carcinoma, lymphoma, GI stromal tumours, maltoma (ass. w H.pylori)
96
A/x gastric cancer? (3)
H.pylori, pernicious anaemia, Lynch syndrome (HNPCC)
97
Colorectal cancer? benign vs malignant
* Benign: adenoma (must be removed as can become adenocarcinoma), lipoma * Malignant: adenocarcinoma, sarcoma
98
Tx colorectal cancer?
Surgery
99
Inherited colorectal carcinoma? (2)
HNPCC (Lynch): DNA mismatch repair | FAP: defect in tumour suppressor gene
100
Liver lesions? Benign vs malignant
Primary (rare) * Benign: adenoma (ass. with contraceptive), hemangioma, focal nodular hyperplasia (ass. w hemangioma), cysts Malignant: HCC (alfa fetoprotein marker), fibro-lamellar carcinoma, hepatoblastoma, intrahepatic cholangiocarcinoma
101
Gallbladder cancer?
Adenocarcinoma (ass. w gallstones)
102
Bile duct cancer?
Cholangiocarcinoma (ass. w UC and PSC), adenocarcinoma
103
Pancreatic cancer?
Exocrine: adenocarcinoma Endocrine: gastrinoma, insulinoma, gluconoma
104
Ax appendicitis? (5)
Faecoliths (dehydration), parasites, tumours, lymphoid hyperplasia
105
s/s appendicits? (4)
Vomiting, WCC, RIF pain, abdo pain
106
Coeliac disease?
Type IV hypersensitivity to gliadin, associated with HLA gene defect
107
s/s coeliacs? (9)
dermatitis herpetiformis, childhood diabetes, flatulence, abdominal discomfort, weight loss, bloating, anaemia, steatorrhoea
108
Dx coeliacs?
Duodenal biopsy, transglutaminase (tTGA) test
109
Comps coeliacs? (3)
T cell lymphoma, small bowel carcinoma, gallstones
110
s/s sepsis? (7)
Fever, chills, rigors, nausea/vomiting, constipation/diarrhoea, malaise, anorexia
111
Tx sepsis?
BUFALO * Blood culture * Urine output (hourly) * Fluid resuscitation (IV) * Antibiotics (IV) * Lactate and FBC * Oxygen high flow
112
Antibiotics for strep and enterococci?
Amoxicillin/vancomycin
113
Antibiotics for ve- coliforms?
Gentamicin
114
Antibiotics for ve- anaerobes?
Metronidazole
115
Histo of oesophagus?
Stratified squamous epithelium with glands in submucosa (unlike rest of GI tract EXCEPT duodenum)
116
Ax reflux oesophagitis? (4)
Defective sphincter, hiatus hernia, pregnancy, OBESITY
117
Barrett's oesophagus?
replacement of stratified squamous epithelium with columnar (intestinal metaplasia) * red velvety lower oesophagus
118
Tx Barrett's? (2)
PPI, aspirin
119
Allergic oesophagitis?
Corrugated (spotty) oesophagus | * Males, young, asthma
120
Tx allergic oesophagitis?
Steroids, cromoglycate, montelukast
121
Ax gastritis?
Autoimmune, bacterial (H.pylori), chemical
122
Ax peptic ulcers? (2)
H.pylori, NSAIDs
123
Tx peptic ulcers?
* Duodenal require no follow-up | * Gastric require follow up due to risk of malignancy
124
Dx H.pylori? (4)
* Urease breath test, biopsy, culture, faecal Ag test
125
Dyspepsia s/s? (3)
* Epigastric pain/burning * Post-prandial fullness * Early satiety
126
Tx dyspepsia?
PPI
127
s/s upper bowel obstruction?
Vomit larg evolumes
128
s/s large bowel obstruction? (2)
Colociky abdo pain, vomiting (possibly faeculent)
129
s/s bowel obstruction in general? (5)
Distention, visible peristalsis, lack of abdo tenderness, centre of abdo is resonant, high pitched tinkling sound

1st Year Medicine (3 decks)

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