GI high yield - do lots of times Flashcards
(130 cards)
1
Q
Mx haemochromatosis
A
venesection first line
1
Q
investigation of haemochromatosis
A
TRASNFERRIN SATS
-then ferritin but ferritin raised in other things
2
Q
difference between SCC and adenocarcinoma of oesophagus
A
adenocarcinoma
-barrets/GORD
-lower 1/3
SCC
-achalasia, smoking, alcohol
-upper 2/3
3
Q
pancreatic cancer investigation
A
pancreatic high resolution CT scan
-will show a double duct sign
4
Q
treatment of pancreatic cancer
A
Whipples resection with chemo is done if the cancer is in the head of the pancreas
5
Q
managment of Wilson’s disease
A
pencilliamine
6
Q
blood results of wilson’s disease
A
reduced serum caeruloplasmin
reduced total serum copper
7
Q
which antibiotic causes C.diff
A
clindamycin
8
Q
diagnosis of C. diff
A
detecting the toxin in the stool
9
Q
management of first episode of C. diff
A
1) oral vancomycin for 10 days
2) oral fidaxomicin
3) oral vancomycin +/- IV metronidazole
10
Q
if you get another episode of C. diff within 12 weeks of the previous one what is the treatment
A
oral fidaxomicin
11
Q
if you get another episode of c. diff after 12 weeks of the last one what is the treatment
A
oral vancomycin or oral fidaxomicin
12
Q
treatment of life threatening c. diff
A
oral vancomycin and IV metronidazole
13
Q
what medication should be stopped in c. diff
A
Anti-peristaltic drugs such as opioids
- can predispose to toxic megacolon
14
Q
what is the most common complication of ERCP
A
pancreatitis
15
Q
bladder cancer with painless haematuria
A
transitional cell
16
Q
name some prokinetic anti emetics
A
-metoclopramide
-domperidone
17
Q
what anti-emetic in bowel obstruction
A
IM cyclizine
-because you shouldn’t use pro kinetic ones
18
Q
what is the definitive investigation of bowel obstruction
A
CT
19
Q
when can a diagnosis of acute pancreatitis be made
A
if characteristic pain + amylase/lipase > 3 times normal level
20
Q
modified glasgow score for acute pancreatitis
A
Pa02 <8kPa
Age >55 years
Neutrophilia WBC >15x10^9
Calcium <2mmol/L
Renal function -Urea >16mmol/L
Enzymes LDH >600 ; AST >200
Albumin <32g/L
Sugar Blood glucose >10mmol/L
PANCREAS
21
Q
pathophysiology of achalasia
A
Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter (LOS) due to degenerative loss of ganglia from the myenteric (Auerbach’s) plexus
22
Q
acute treatment of upper GI bleed
A
ABC
-correct clotting: FFP, vitamin K, platelets
-terlipressin
-prophylactic antibiotics
then you can do an endoscopy
-variceal band ligation
if uncontrolled: sengstaken-blakemore tube
TIPS if above measures fail
23
Q
prophylaxis of variceal haemorrhage
A
PROPANOLOL
-endoscopic variceal band ligation
-if these fail then TIPS
24
why do people with coeliac get the pneumococcal vaccine
they have hyposplenism
25
what antibody for coeliac
tissue trnasglutaminase
26
what is pernicious anaemia
autoimmune disorder affecting the gastric mucosa that results in vitamin B12 deficiency
27
what antibodies cause pernicious anaemia
antibodies to intrinsic factor +/- gastric parietal cells
28
what cancer can pernicious anaemia put you more at risk of getting
gastric cancer
29
what can give a false negative anti-TTG result in coeliacs
-IgA deficiency
must test endomyseal antibody (IgA) if this is the case
30
then what do you test for coeliac is patient is IgA deficient
IgG endomyseal antibodies
IgG deamidated gliadin peptide
IgG transglutaminate antibodies (usually IgA)
31
gold standard for coeliac
endoscopic intestinal biopsy
-villous atrophy
-crypt hyperplasia
32
ABG result for vomiting
metabolic alkalosis
33
causes of metabolic alkalosis
-vomiting/aspiration (hypokalaemia)
-diuretics
-hypokalaemia
-primary hyperaldosteronism
-cushing's syndrome
-bartter's syndrom
| activation of RAAS is a key factor
aldosterone causes reabsorption of N
34
presenting symptoms of meckel's diverticulum
rectal bleeding and abdominal pain
35
urinalysis of appendicitis
leucocytes can be seen as appendix lies close to urinary tract
36
what should be given before an appendicectomy
prophylactic IV antibiotics
37
positive HBsAg
current infection with hep B
38
positive IgM anti-HBc
acute or recent hepatitis infection (present for 6 months)
C= Caught (negative if immunized)
39
positive IgG anti-HBc
it persists, indicates chronic infection
40
anti-Hbs positive
previous immunisation
41
immunology tests of PBC
B = babies = Mum = M
AMA antibodies
raised IgM
Middle aged females
42
what LFT is raised in PBC
ALP
43
management of PBC
ursodeoxycholic acid
pruritus: cholestyramine
44
which cancer is associated with PBC
hepatocellular cancer massively
45
investigation for a fistula in crohns
MRI
46
inducing remission in Crohn's disease
1) glucocorticoids
2) 5-ASA (mesalazine)
3) may add on azathioprine/mercaptopruine or methotrexate
4) infliximab for fisutalting crohn's
5) metronidazole for isolated peri-anal disease (like a fistula)
47
maintaining remission in crohn's
stopping smoking is a priority
1) azathioprine or mercaptopurine (must assess TMPT activity first)
2) methotrexate
48
management of a perianal absess in Crohn's
incision and drainage with antibiotic therapy
49
what score is used to predict rebleeding after endoscopy (upper GI bleed)
Rockall score
50
what score is used to assess patients with GI bleed prior to endoscopy
glasgow-blatchford score
51
upper GI bleed, when should patients get endoscopy
within 24 hours
52
when is spontaneous bacterial peritonitis usually seen
patients with ascites secondary to liver cirrhosis
53
diagnosis and management of SBP
Dx
-paracentesis: neutrophil count >250
-ascitic fluid culture: E.coli usually
Mx
- IV cefotaxime
- must give antibiotic prophylaxis on discharge (ciprofloxacin or norfloxacin)
54
characteristic presentation of acute mesenteric ischaemia
sudden onset severe abdominal pain thats out of proportion to findings
55
what does SAAG > 11g/L indicate
in ascites, indicates portal hypertension
56
management of ascites
-reduce dietary sodium
-fluid restriction is sodium < 125
-aldosterone antagonists: spironolactone
-drainage if tense (requires albumin cover)
-prophylactic antibiotics if due to cirrhosis and <15 g/l of protein
57
treatment of familial adenomatous polyposis
prophylactic colectomy
58
what type of bleed does high urea indicate
upper GI bleed
59
following a cholecystectomy: pain, fever and billious drainage from surgical drain
bile leak
60
fever, jaundice, RUQ pain
ascending cholangitis
61
how can pancreatic exocrine function be assessed
faecal elastase
62
what cancer causes migratory thrombophelbitis (Trousseau's sign)
pancreatic cancer
63
epigastric pain that's relieved by eating
duodenal ulcer
64
epigastric pain thats worsened by eating
gastric ulcer
65
what condition is most associated with PSC
ulcerative colitis
66
LFTs for PSC
raised bilirubin and ALP
67
investigation for PSC
ERCP or MRCP are diagnostic
pANCA
68
what cancer is associated with PSC
cholangiocarcinoma
69
AST/ALT ratio in alcoholic hepatitis
2:1
70
management of acute alcoholic hepatitis
glucocorticoids
-prednisolone
70
maintaining remission in UC
mild/mod
proctitis/sigmoiditis
- rectal aminosalicylate +/- oral aminosalicylate
left sided + extensive
- oral aminosalicylate
severe or >=2 in one year
-oral azathioprine or oral mercaptopurine
71
when do you stop PPI before endoscopy
2 weeks
72
serum copper levels in wilson's disease
reduced!
-its all deposited in tissues
73
treatment of symptoms in IBS
pain, cramping and bloating: antispasmodic agents (e.g. mebeverine)
constipation: laxatives but avoid lactulose
diarrhoea: loperamide is first-line
74
do you give antibiotics in acute pancreatitis
NO
-only if evidence of pancreatic necrosis
75
diverticulitis investigation
CT with contrast
76
diverticulitis management
uncomplicated
-co-amoxiclav for 5 days
-avoid NSAIDs and opiates
complicated
-hartmann's procedure
-drain abscess
77
spread of Hep A
faecal oral spread
A = Anal
78
hep E spread
faecal-oral
E = Eat poo
79
spread of hep B
blood, babies and banging
80
spread of hep C
same as B
C= child, cock
81
investigation for cirrhosis
transient elastography and acoustic radiation
82
what's budd chiari
hepatic venous outflow obstruction
-sudden onset abdominal pain
-ascites
-tender hepatomegaly
83
gold standard for assessing severity of portal hypertension
hepatic venous pressure gradient
-more than 5 = portal hypertension
-more than 12 = risk fo variceal rupture
84
procedure to reduce portal pressure
tips
85
elevated AFP
hepatocellular cancer
86
investigation for achalasia
1) oesophageal manometry
2) barium swallow
3) chest x-ray
87
first line treatment of achalasia
1) pneumatic (balloon) dilation
2) surgical - heller cardiomyotomy
88
gastroenteritis that causes watery diarrhoea
-c. diff
-listeria
-cholera
-bacillus cereus
89
gastroenteritis that causes bloody stool and fever
-campylobacter
-salmonella
-shigella
-e.coli
90
what parasites can cause gastroenteritis
amoebiasis
giardiasis
91
classic triad for chronic mesenteric ischaemia
-colicky abdo pain after eating
-weight loss
-abdo bruit heard on auscultation
92
treatment of H. pylori
PPI + amoxicillin + clarithromycin/metronidazole
if ongoing symptoms then PPI + amoxicillin + clarithromycin/met (whichever wasn't used before)
93
first line investigation for ascending cholangitis
US
94
management of ascending cholangitis
ERCP
-give fluids, antibiotics and get blood cultures before
95
tumour marker for cholangiocarcinoma
CA 19-9
(brooklyn 99 - eats donuts - gallbladder)
96
management of bowel obstuction
fluids and gastric decompression
-ryles tube is a NG tube
97
management of paediatric hernias
inguinal: repair asap
umbilical: manage conservatively
98
how can you tell the difference between strangulated and incarcerated hernias
strangulated - painful
incarcerated - painless
being strangled is painful but being in jail isnt
99
what cancer is associated with coeliac disease
T-cell lymphoma of small intestine
100
colostomy features
- usually left sided
- flushed to the skin
- solid output
101
ileostomy features
- RIF
- spouted appearance
- liquid output
102
severe UC flare management
in hospital
IV steroids
after 72 hours no improvement = add IV ciclosporin or consider surgery
103
what defines a severe flare of UC
| like one u need hospital admission and IV steroids
>6 bloody stools a day
+
features of systemic upset
104
what is ischaemic colitis
ischaemia to the large bowel
- (mesenteric is small bowel)
- leads to inflammation, ulceration and haemorrhage
105
where is ischaemic colitis likely to happen
splenic flexure
106
blatchford score 0 after upper GI bleed
discharge
107
in pancreatitis, how is nutrician managed
- patients should not be made nil by mouth
- enteral nutrition should be offered
108
patients > 60 with new iron deficiency anaemia ?
FIT testing
- think cancer
109
management of anal fissure < 1 week
soften stool
dietary advice: high-fibre diet with high fluid intake
bulk-forming laxatives are first-line - if not tolerated then lactulose should be tried
lubricants such as petroleum jelly may be tried before defecation
topical anaesthetics
analgesia
110
chronic anal fissure treatment
topical GTN
- not effective after 8 weeks thrn secondary care for sphincterotomy
111
TIBC in haemochromatosis
LOW
- nae room for iron
112
crypt absesses
UC!!!!
113
histology for crohns
goblet cells
granulomas
inflammation of all layers
114
most common cause of large bowel obstruction, "dilated loops of large bowel on X-ray"
malignancy
115
post endoscopy Mx for an upper GI bleed due to gastric ulcers
IV PPI
116
what are curling's ulcers
stress induced ulcers of the stomach
- in burns patients for example
117
chest pain after drinking a cold drink
oesophageal spasm
118
when can patients eat/drink before endoscopu
drink clear fluids - 2 hours
eat - 6 hours
119
ulcers in the duodenum. oesophagus and stomach?
zollinger-ellison syndrome
- excessive gastric acid secretion from these gastrinomas
120
test for zollinger-ellison syndrome
serum gastrin
121
can't swallow and recurrent chest infections
achalasia
- aspiration pneumonia
122
if someone returned from holiday, SE Asia, ate street food, what hepatitis
A
123
RUQ pain, jaundice and high ALP
gallstones in bile duct
- choledocholethiasis
124
first line imaging for choledolethiasis
ultrasound
125
elevated fecal calprotectin
IBD
126
dysphagia, glossitis and iron deficiency anaemia
plummer vinson syndrome
127
ANCA positive IBD
Crohn's
128
