GI (Passmed) Flashcards
(102 cards)
1
Q
When is fluid restriction preferred over giving spironolactone for ascites
A
IF sodium levels <125
2
Q
What is the role of abdominal paracentesis
A
SYmptomatic relief to patients with tense ascites
3
Q
What is Pellagra
A
Dermatitis (rash)
Dementia
Diarrhoea
4
Q
What causes Pellagra
A
B3 deficiency
5
Q
What WBC count indicates a moderal C.difficile infection
A
WBC <15 * 10^9
6
Q
What WBC indicates severe c.difficile infection
A
More than 15*10^9
7
Q
What antigen implies Hep B acute disease
A
HBsAg
8
Q
What is the significant of Anti-HBs
A
Immunity
9
Q
What does Anti-HBc imply
A
Previous infection
10
Q
What is the investigation of choice for diagnosing primary sclerosing cholangitis
A
ERCP/MRCP
11
Q
What needs to be checked in someone taking mesalazine
A
FBC
12
Q
What is given for refractory Crohn’s disease
A
Infliximab alongside azathioprine
13
Q
When is Mesalazine given to induce remission of Chron’s
A
If steroids fail to do so
14
Q
In what disease (chron’s or UC) are granuloma’s found in
A
Chrohn’s
15
Q
What blood vessel is repsonsibly for haematemasis from a peptic ulcer
A
Gastroduodenal artery
16
Q
Management of nausea + raised WCC only
A
Non-urgent referral for upper Gi endoscopuy
17
Q
What metabolic findings is associated with gastritis
A
Metabolic alkalosis (loss of H+ ions)
18
Q
What prophylaxis is given for variceal bleeds
A
Propranolol
19
Q
Type 1 vs Type 2 hepatorenal syndrome
A
Type 1 is rapid onset
20
Q
What isthe first line investigation for acute mesenteric ischaemia
A
VBG: lactates are raised
21
Q
What vitamin deficiency can reuslt in easy bruising
A
C
22
Q
What finding is indicative of Boerhaave syndrome
A
Mild crepitus in the epigastric region
23
Q
Alcoholic ketoacidosis vs Diabetic Ketoacidosis
A
Alcohol: normal glucose
24
Q
Management of a head of pancreas cancer
A
Pancreaticoduodenectomy
25
Management of Barrett's oesophagus if dysplasia is seen on biopsy
Endoscopic mucosal therapy
26
What is Courvoisier's law
That painless jaundice is unlikely to be gallstones but pancreatic malignancy
27
How do urea levels help differentiate between an upper GI bleed and lower GI bleed
High urea levels = Upper GI Bleed
28
What is the iron study profile seen in haemochromatosis
Raised transferrin and ferritin with low TIBC
29
What stool sample specifically is needed to diagnose C.difficile infection
C.difficile toxins
30
What medication should be stopped in c.difficile infections
Oromorph
31
What shohuld paracentesis show for spontaneous bacterial peritonitis
>250 cells/ui
32
What grade of hepatic encephalopathy is a coma found in
Grade IV
33
What hsoulud be given first, B12 or folate
B12
34
What is the Child-Pugh classification
Bilirubin levels
Albumin
PTT
Encephalopathy
Ascites
35
What is the key investigation for a suspected perforated peptic ulcer
An erect Chest X-Ray
36
What Bowel disease is tenesmus commonly seen in
Ulcerative COlitis
37
Step up management of Ulcerative Colitis
Topical Aminosalicylate for distal rectal
If not achieved in 4 weeks, add oral aminosalicylate
38
Management of extensive UC disease
TOpical Aminosalicylate + high dose oral aminosalicylate
39
If extensive disease management is not managed properly by topical and oral aminosalicylate, what should be given
Oral 5-ASA and oral corticosteroid
40
Management of severe colitis
IV Steroids
41
What drug historically causes c.difficile infections
Clindamycin
42
WHat is Peutz-Jeghers Syndrome
Small bowel obstruction (dur to intussuception) + blue/yellow mucosa
43
WHen does desferrioaxamine become first line for haemachromatosis
When Venesection is not possible
44
What two factors are used to decide if glucorticoid therapy is needed for alcohol hepatitis
Prothrombin time and serum bilirubin
45
First line investigation of appendicitis
USS abdomen
46
What condition (UC or Chron's) is triggered by Stopping smoking
UC
47
What is the triad for refeeding syndrome
Hypokalaemia
Hypophosphataemia
Hypomagnesaemia
48
In what gastric disease are skin tags found
Crohn's
49
Where is a mass felt in overflow constipation
Left side
50
How do we retain remissino in proctitis and proctosigmoiditis
Topical azathioprine (with or without oral azathioprine)
The rest is normally oral azathiioprine
51
What are indications for enteral nutrition (tube feeding)
Head or neck trauma
Surgery
Coma
Dementia
Tumours of the head, neck or oesophagus
52
Investigations for perianal fistulas
MRI Pelvis
53
Management of a perianal fistula
Oral Metronidazole
54
What is the treatment of choice for small bowel bacterial overgrowth syndrome
Rifaximin
55
Risk Factors for SBBOS
Diabetes Mellitus and Scleroderma
56
What should be given to reduce mortality risk during paracentesis
IV human albumin solution
57
Management of asymptomatic gallstones
Re-assurance
58
What hepatitis is usually transmitted through anal-oral sex
Hepatitis A
59
How is Hepatitis B commonly spread
Sexual Transmission
60
How is Hep C typically spread
Through exposure to contaminated blood or needles
61
When should adults be refrred for GI cancer pathway
Occult test shows blood
40+ AND unexplained weight loss + abdo pain
50+ AND unexplained rectal bleeding
60+ AND iron deficiency anaemia or changes in bowel habit
62
Management of someone with rectal bleeding + abdominal pain and under 50
Refer to hospital
63
Where are ileostomies usually placed
Right iliac fossa
64
Where are colostomies typically placed
Left iliac fossa
65
Management of a diverticular bleed
Active surveillance - usually heal spontaneously
66
How to detect fistulas in the gut
CT abdomen
67
Where do anal fissures typically arise
Posterior margin of the anus
68
Management of an anal fissure
Laxatives (bulking)
69
What is Hartmann's proceedure
Sigmoiectomy + stoma bag
70
When are loop ileostomies used
rectal cancers (diverts bowel contents away from the distal anastomoses)
71
What type of cancers are rectal cancers
Adenocarcinomas
72
What symptom is present in small bowel obstruction but not large bowel obstruction
Vomiting - no vomiting in large bowel obstruction
73
When are hartmann's proceedure indicated
Emergency: Perforation or obstruction
74
Indication for anterior resection
upper rectal tumours (near sigmoid colon)
75
What is a common complication of a laproscopy
Pulmonary Emphysema
76
What is the daignostic test for pancreatitis
CT contrast
77
COmplication of acute pancreatitis
ARDS
78
Blockage of what duct does not cause jaundice
Cystic duct
79
Scending cholangitis vs cholecystitis
Ascending has dranged LFTs vs no deranged lfts in cholecystitis
80
First line management of an SAH
Coiling
81
Ferritin levels in alcohol excess
Raised
82
What defines mild UC
<4 stoools a day
83
What defines moderate UC
4-6 stools a day
84
What defines severe UC
>6 stools a day
85
Primary screening done for suspected bowel cancer
Faecal immunochemical test
86
When should someone be offered bowel screening
60-74
87
When is a sigmoidoscopy chosen over a colonoscopy for checking for colorectal cancer
If there is rectal bleeding
88
If someone is unfit for sigmoidosocpy or colonoscopy, what is the investigation of choice
CT colonography
89
Diagnosis of acute cholecystitis if USS is uncertain
HIDA scan
90
What is the most common cause of small bowel obstruction
Adhesions
91
Describe Duke A
Cancer in boeel lining NOt muscle
92
Define Sukes' B
Cancer grown into muscle layer of bowel
93
Define Dukes' C
Cancer spread to lymph node
94
Define Duke's D
Cancer spread to another organ
95
Indirect vs direcvt inguinal hernia
Indirect: Lateral to the inferior epigastric artery
Direct: Medial to the inferor epigastric artery
96
Management of an epigastric hernia
Lose weight/ supportive
97
Management for umbilical hernias
Use of a truss
98
Management of a unilateral inguinal hernia
Open repair with mesh (routinely)
99
When is a hernia truss indicated for hernias
Only when surgery is not an option (second line)
100
What happens in an indirect inguinal hernia when you cover the deep inguinal ring
It stops the reappearance of the lump when asked to cough
If it re-appears = direct inguinal hernia
101
Investigation for a hiatus hernia
Endoscopy
Barium Swallow - diagnostic
102
Management of Achalasia
Endosocpic injection with botulinum toxin
