GI/liver Flashcards
(47 cards)
1
Q
Coeliac D - Serum Ab testing
A
- Endomysial Ab (IgA)
- Tissue transgultaminase Ab (IgA)
- Correlate w severity
- Indications = pers D, folate/iron deficiency and fam history or associated autoimmune D
2
Q
Large bowel obstruction (volvulus) vs small bowel obstruction
A
Large =
- S present later - can distend to greater extent (large lumen, circular + longitudinal M)
- More constant abdo pain
- short = colicky then diffuse and higher in abdo - Late V - more faecal like
- short = earlier and follows pain
3
Q
Irritable Bowel Syndrome - Pharmacology
A
- Anti-spasmodic (Mebeverine) - pain/bloating
- Laxative (Mavicol) - constipation
- Linaclotide - C >12mths
- Anti-motility agents (loperamide) - diarrhoea
- Tricyclic antidepressants (amitriptyline) - dampen gut sensitivity
4
Q
lBD vs IBS
A
IBD
- Abnormal Ix
- Fever
- S outside GI tract
- Blood in stools (Meleana - black poo - bleeding higher up)
- Weight loss
- Mouth ulcers
- Nocturnal diarrhoea
5
Q
Ascending cholangitis- presentation
A
Reynold’s pentad
- Biliary colic
- Fever
- Rigor
- Jaundice - cholestatic - dark urine, pale stools + itching
- Right upper quadrant pain
- Murphy’s sign - pain on taking deep breath and two fingers on RUQ (gallbladder location)
6
Q
Hepatitis - DNA or RNA
A
A = RNA B = DNA C = RNA D = Incomplete RNA - needs B E = RNA
7
Q
Haemochromatosis - definition
A
Inherited disorder of iron metabolism
Increased intestinal iron absorption
Iron deposition in joints / liver / heart / pancreas / pit / adrenals / skin
8
Q
H pylori eradication (peptic ulceration)
A
Triple therapy
- PPI for acid suppression (Lansoprazole/Omeprazole)
- Clarithromycin
- Amoxicillin
- Quinolone (ciprofloxacin) - rescue therapy
9
Q
Colorectal carcinoma - Duke’s Classification
A
A = limited to muscularis mucosae B = Extend through muscularis mucosae (not lymph) C = Regional lymph nodes D = Distant mets
10
Q
Colorectal carcinoma - Epidemiology
A
- Majority in distal colon
2. Familial adenomatous polyposis (FAP) and Hereditary Non-Polyposis Colon Cancer (Lynch S) = genetic risk factors
11
Q
Cancer - Red flags
A
- Weight loss
- Anaemia
- Dysphagia
- Upper abdo mass
- Persistent V
- Upper GI bleed (Melaena)
12
Q
Coeliac Disease - Histology
A
- Villous atrophy
- Crypt hyperplasia
- Intraepithelial lymphocytes
- Proximal smal bowel
13
Q
IBS - Rome III diagnostic criteria
A
1. Abdo pain >3days/mth for >3mths \+ 2 of 2. Relief w defecation 3. Change in freq of stool 4. Change in form of stool
14
Q
Helicobacter pylori
A
- Gastritis and peptic ulcer disease
2. Increased risk of gastric cancer
15
Q
Ascitic tap
A
- Raised WCC - bacterial peritonitis
- Gram stain and culture
- Cytology - malignancy
- Amylase - pancreatic ascites
- Protein measurement - transudate (low protein) vs exudate (high protein)
16
Q
UC vs Crohn’s disease
A
UC vs C
- Only colon vs whole GI tract
- No skip lesions vs skip lesions
- Circumferential and cont inflammation vs scattered
- C = cobble stoning
- Lower left quadrant pain vs abdo pain mimics appendicitis
- Mucosa only vs transmural
- No granuloma vs granuloma (non-caseating)
- 70% ANCA vs 70% ASCA
17
Q
Ascites - Presentation
A
- Abdo swelling + distended abdo
- Fullness in flanks
- Shifting dullness
- Mild abdo pain
- Peripheral oedema
18
Q
Alcohol unit
A
AU = % (strength) x ml / 1000
19
Q
Diarrhoea - Antibiotic associated
A
- rule of C
- Clostridium difficile
- result in pseudomembranous colitis (pathogen replaces normal gut flora)
20
Q
Primary Biliary Cirrhosis - Presentation
A
- Pruritus (itching)
- Lethargy
- Jaundice
- Pigmented xanthelasma (yellow fat deposits under skin - eyelids)
- Hepatomegaly
21
Q
Paracetamol overdose - Metabolic changes
A
- Raised ALT/AST
- Hypoglycaemia (inhibit gluconeogenesis)
- Raised creatinine
- Metabolic acidosis
- Prolonged prothrombin time
22
Q
Wernicke-Korsakoff encephalopathy
A
- Neurological symptoms (ataxia, confusion and nystagmus)
- From alcohol withdrawal
- IV thamine
23
Q
Appendicitis - perforation
A
Peritonitis
- Sudden onset
- Acute severe abdo pain
- General collapse
- Shock
- Lying still + hands on abdo
24
Q
Duodenal ulcer - Clinical presentation
A
- Recurrent burning epigastric pain (specific, night and hungry)
- N
- Anorexia and weight loss
25
Hernia - Common sites
1. Inguinal
2. Femoral
3. Hiatus
4. Incisional (site of prev excision)
26
Obstruction - Bowel sounds
1. Increased bowel sounds
| 2. Tympanic percussion (air/gas)
27
Operation?
1. Medically fit
2. Resectable
3. Metastasis
28
Steroids - SE
1. Osteoporosis
2. Immunosuppression
3. Hyperglycaemia
4. Growth in kids
5. Skin thinning
29
Functions of stomach
1. Store food
2. Digest food
3. Defence against pathogens
4. Secrete intrinsic factor - B12 absorption
5. Regulate emptying into duodenum
30
Malabsorption - definition
Failure to fully absorb nutrients - destruction of epi or problem in lumen.
Food undigested
31
Haemochromatosis - gross iron overload
```
Classic triad
1. Bronze skin pigmentation (melanin deposition)
2. Hepatomegaly
3. DM
Raised serum ferritin
```
32
Appendicitis - Pain
1. Peri-umbilical
2. Migrates to R iliac fossa (McBurney's point)
- Parietal peritoneum
3. No somatic innervation in visceral peritoneum
4. No laterality to visceral unmyelinated C fibre pain signals
33
Malaria - Jaundice
1. Pre-hepatic Jaundice
2. Unconjugated bilirubin
3. Normal stool
4. Normal urine
34
Hepatitis - faeco-oral transmission
1. A
| 2. E
35
Coeliac D - Pathophysiology
1. Prolamin alpha gliadin
- resitant to digestion due to high glutamine + proline
2. Pass through epi - deaminated by tissue transglutamase - increase immunogenicity
3. BInd to APC - DQ2 or DQ8 activate T cells
4. Inflammatory cascade
36
Coeliac D - Clinical presentation
1. Stinking stools / steatorrhoea (poor fat absorption)
2. Bloating
3. Abdo pain
4. Osteomalacia (soft) --> osteoporosis
5. Diarrhoea
37
Primary Biliary Cirrhosis - Blood
1. High alkaline phosphate
2. High serum cholesterol
3. Anti-mitochrondrial antibodies (AMAs)
4. High serum IgM
38
Functions of liver
1. Glucose and fat metabolism
2. Detoxification and excretion
3. Protein synthesis
4. Defence against infection
39
Haemochromatosis - Liver biopsy
Perl's stain --> identify iron
40
Alcoholic Liver Disease - Diagnosis
1. Fatty liver
- High MCV
- High ALT and AST
- Ultrasound/CT = fatty infiltration
2. Alcoholic hep
- Leucocytosis
- High serum bilirubin / ALT / AST / alkaline phosphate
- Raised GGT
41
Crohn's Disease - S outside GI tract
1. Peri-anal abcess
2. Skin tags
3. Anal strictures
4. Aphthous oral ulcerations
5. Clubbing
42
Prednisolone - action
1. Upregulate anti-inflammatory genes
| 2. Down regulate pro-inflammatory genes
43
Prednisolone - SE
1. Immunosuppression
2. Hypertension
3. Thin skin
4. Mood disturbance
5. Adrenal suppression
44
GORD - risk factors
1. Hiatus hernia
2. Loss of oesophageal function
3. Central obesity
4. Gastric acid hypersecretion
5. Slow gastric emptying
45
GORD - Alarm bell signs
Endoscopy
1. Weight loss
2. Haematemesis (vomit blood)
3. Dysphagia
4. Melaenia
5. Recent onset
46
GORD - Diagnosis
1. Only if alarm bell signs
2. Endoscopy
3. Ba swallow
47
GORD - Treatment
1. Antacids (Mg trisilicate mixture)
2. Alginates (gaviscon)
3. Proton pump inhibitor (lansoprazole)
4. H2 receptor antagonist (cimetidine)
