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Yr 3 ALS > GI & Surgery > Flashcards

GI & Surgery Flashcards

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1
Q

Features of UC

A
  • Continous disease
  • Distorted crypt architecture - bifid crypts
  • Absesses
  • No inflammation beyond submucosa
  • Drainpipe colon
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2
Q

Epidemiology of UC

A

More common in women slightly

Smoking is protective

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3
Q

Features of CD

A
  • Affect anywhere from mouth to anus
  • Skip lesions
  • Transmural inflammation
  • Granulomas
  • Cobblestoning
  • Rose thorn ulcers
  • Goblet cells
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4
Q

Epidemiology of CD

A

More common in females slightly

More common in smokers

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5
Q

Index to assess CD Activity

A

Harvey-Bradshaw index

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6
Q

Radiological finding for mucosal oedema

A

Thumb-printing

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7
Q

Monitoring colonic inflammation

A

Fecal-Calcoprotectin

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8
Q

4 Extra-colonic manifestations of IBD

A
  • Erythema Nodosum = tender lumps on both shins
  • Pyoderma Gangrenosum = Tissue necrosis on legs
  • Arthritis
  • Occular Inflammation
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9
Q

First Line for IBD remission

A

Oral Aminosalicylates

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10
Q

Azothioprine

  • MOA
  • Active metabolite
  • SE
  • Interaction
A
  • Affects Purine (A+G) synthesis decreases T cells
  • 6-Mercaptopurine to 6-TGN = immunosupressive
  • Neutropenia
  • Allopurinol
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11
Q

Cyclosporin

  • Clinical Indication
  • MOA
A
  • Rescue therapy

- Calcineurin inhibitor reduces T cell activation

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12
Q

Methotrexate

  • MOA
  • SE
A
  • Folate antimetabolite

- Fibrosis, mylosupression and hepatotoxic

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13
Q

Ab elevated in autoimmunity and the main target for biological therapies (cytokine inhibitors)

A

TNF-alpha

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14
Q

3 opiate based anti-motility agents

A
  • Codeine phosphate
  • Loperamide
  • Diphenoxylate (Pethidine)
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15
Q

2 Antispasmodics

A
  • Mebevarine

- Peppermint oil

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16
Q

2 Anticholonergics for IBS

A
  • Dicycloverine

- Hyacine

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17
Q

The pro-drug combination used for bowel prep

A

-Sodium Picosulphate + Magnesium citrate

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18
Q

Protein requirements for men and women

A
  • Men = 9g/day

- Women = 7.5g/day

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19
Q

3 types of enteral feeding method and requirements

A

-NG
-NJ
-PEG - percutaneous endoscopic gastrostomy
A functioning GIT, PEG used for <4-6wks

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20
Q

Refeeding syndrome pathophysiology and risk factors

A
  • Increased insulin secreted=increased PO4 causes coma

- Alcohol and lower BMI

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21
Q

Manage non variceal bleed

A
  • ABCD
  • Scope within 24hrs (4hrs in emergancy)
  • No PPI
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22
Q

Manage variceal bleed

A
  • Terlipressin
  • Cautery
  • Consider IV broad spec Ab’s
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23
Q

MOA Terlipressin and main contraindication

A
  • Vasopressin anologue and vasoconstricter

- Pregnancy

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24
Q

Diverticulosis and area most affected

A

Multiple diverticulum within the bowel (protrusions of conlonic mucosa through muscularis externa)
-Sigmoid

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25
Diverticular Disease
- Bleeding (most common cause LGI bleed) | - Painless
26
Diverticulitis
- Inflammation of diverticulum or whole sections of bowel | - Absesses and perforation can occur
27
Acute Mesenteric Ischaemia (Ischaemic colitis) and main risk factor
- Inadequate perfusion through mesenteric vessels | - AF
28
Most common cause LGI bleed in under 50's
Anorectal causes eg Heammorhoids
29
Histological type of anal cancer and main risk factor
- Squamus cell carcinoma | - HPV
30
Where are gastric ulcers most commonly found
Lesser curvature of the stomach
31
Where duodenal ulcers most commonly found
First part of the duodenum (cap)
32
H.Pylori - Mechanism of survival - Site of colonisation - Gram stain
Produces Urease to buffer the acid to survivable conditions - Antrum - Gram -
33
2 main tests of H.pylori
- C13 Breath test | - Ag stool test
34
Triple therapy and duration for H.pylori
-Amoxicillin, Clarithromycin + Metronidazole
35
Drug interaction with Clarithromycin
Statins = increased myositis risk
36
Zollinger Ellison syndrome
Pancreatic gastrinoma hypersecretes causing multiple ulcers
37
3 Crystalloid fluids used in recuss
- 0.9% Nacl - 5% Dextrose - Hartmanns
38
Why are Colloids less commonly used for fluid replacement
Anaphylaxis
39
Oesophageal Varices
Dilated collateral vessels secondary to portal hypertension, running through the oesophageal mucosa
40
Most common causes of gastroenteritis in adults and children | -Gram staining
- Campylobacter-adults - E.Coli-kids - Gram - (like most GI bacteria)
41
5 Causative antibiotics for C.diff infection
- Clindamycin - Cephalosporin - Co-Amoxiclav - Ciproflucloxacin - Penicillins
42
Diagnostics and management of C.diff infection
- Stool sample (within 24hrs) - Isolate - Vancomycin + Metronidazole
43
3 Main risks of using Vancomycin
- Nephrotoxic - Ototoxic - Rapid Infusion can cause: Red Man Syndrome - Histamine overelease
44
3 Diagnostic measures for coeliac disease
- Total IgA - IgA-tTg - EMA - less specific
45
Coeliac associated conditions
- Increased cancer risk - Hyposplenism - IgA Deficiency - Dermatitis herpatiformis
46
Define volvolus its most common site, risks and a possible cause
Loop of bowel most commonly in the sigmoid that can cause obstruction and ischaemia. -Constipation
47
Define intussusception and give the USS sign most associated with this
Retraction/telescoping of the bowel (most common ileocecally). -Bulls eye sign
48
Barretts - Site - Transformation (HINT: B before C) - Risk
- Bottom 3rd of the eosophagus - Squamus cell epithelium turns to columnar. Metaplasia - Transformation to Adenocarcinoma
49
Oesophageal Adenocarcinoma - Frequancy - Site
Most common oesophageal malignancy | -Bottom 3rd of the oesophagus
50
Oesophageal Squamus cell carcinoma - Site - Associated infection
- Upper third of oesophagus | - HPV
51
Feature of malignant dysphagia over benign cause (strictures)
Progressive dysphagia (solid to liquid)
52
TNM staging (number levels)
- T1-T4 - N0-N3 - M0-M1
53
Gatric cancer - Histological subtype - Genetic factor - Most common site affected - Treatment
- Adenocarcinoma - P53 tumor supression loss, asian population - Antrum - Gastrectomy with neoadjuvant chemo
54
Colon Cancer - Histological subtype - Barium signs - Most common sites - Metastasis site - Treatment
- Adenocarcinoma - Apple Core sign - Sigmoid and Rectum - Liver - Surgical resection and neoadjuvant chemo
55
Where do rectal cancers commonly metastasise
Lungs
56
Why use a CT over a colonoscopy for malignany investigations
Elderly patient may be too frail to tolerate bowel prep or colonoscopy.
57
Reason for ALT/AST elevation
Hepatocellular inflammation
58
Reasons fo GGT elevation
- Alcohol - Fatty Liver disease - Biliary disease
59
3 Immunoglobulins and their marker function | HINT: A-A, G-GemmaIC
- IgG = Autoimmune hepatitis - IgM = Primary Biliary Cirrhosis - IgA = Alcoholic Liver disease
60
3 signs of liver disease associated with excess oestrogen
- gynaecomastia - spider nevi - palmar erythema
61
Process of alcoholic liver disease
steatosis - steatohepatitis (alcoholic hepatitis) - cirrhosis
62
Markers for alcoholic liver disease
- High ALT/AST - High GGT - Mallory Bodies (damaged hepatocytes from hepatitis)
63
Manage Ascites
- Salt restriction | - Diuretics
64
Wilsons disease Diagnostics Treatment
Copper deposition - 24hr copper excretion and serum copper - Copper chelation
65
Haemachromatosis Diagnositics Treatment
Increased iron absorption - Serum ferritin - Bloodletting and decreased dietary iron
66
Markers of pre hepatic Jaundice - Blood bilirubin (C) - Blood bilirubin (U) - ALP - Pruritis - Splenomegaly - Urine Bile salts - Urine and stool features
``` Normal (C) Blood bilirubin ++ (U) Blood bilirubin -ALP -No Pruritis -Splenomegaly -No urine bile salts -Normal stool and urine ```
67
Causes Pre-hepatic (hemolytic) jaundice
- Hemolytic anemias - HUS - Transfusion rections
68
Markers of hepatic Jaundice - Blood bilirubin (C) - Blood bilirubin (U) - ALP - Pruritis - Splenomegaly - Urine Bile salts - Urine and stool features
``` ++ (C) Blood bilirubin ++ (U) Blood bilirubin High ALP No Pruritis Spenomegaly No urine bile salts Normal stool, Dark urine ```
69
Causes Hepatic jaundice
- Hepatocellular disease - Hepatitis - Cirrhosis - Hepatotoxicity - Gilberts
70
Gilberts sydrome
Familial decreased enzyme activity causing painless jaundice
71
Markers of post-hepatic Jaundice - Blood bilirubin (C) - Blood bilirubin (U) - ALP - Pruritis - Splenomegaly - Urine Bile salts - Urine and stool features
``` ++ (C) Blood bilirubin Normal (U) Blood bilirubin -Very high ALP -Pruritis -No splenomegaly -Urine Bile salts -Dark urine and pale stools ```
72
Causes of post-hepatic Jaundice
- Bile duct deformity - Choleliathiasis - Bile duct tumors - Pancreatic cancer - CF - Pregnancy
73
Hepatitis A (commonest hepatitis) - Transmission - Acute or Chronic - Diagnostics
- Fecal-oral - Acute - HEPAIgm, High ALT NB (Causes extrahepatic symptoms e.g. joint paint and pancreatitis)
74
Hepatitis B - Transmission - Acute or Chronic - Diagnostics - Microscopic features
- Sex,blood,childbirth - Acute & Chronic - HBsAg, High ALT - Ground-glass hepatocytes
75
Antibodys of Hepatitis B clinical relevance: - HBsAg - anti-HBs - anti-HBc - HBvDNA
- Hallmark of active infection - Immunity (vaccination) - Previous infection - Viral load
76
Hepatitis C - Transmission - Acute or Chronic - Diagnostics - Marked complication
- Sex, blood, drug use - Acute and chronic - HEPCAb - Cryoglobulinemia: cold sensitive Ab's causing tissue damage
77
Hepatitis D - Transmission - Acute or Chronic
- Can only co-infect with hepatitis B - Sex, blood, childbirth, iv drug use - Acute
78
Hepatitis E - Transmission - Acute or Chronic - Diagnostics (HINT M-has 1 A in it)
- Fecal-oral (seafood) - Acute - HEVIgM: Active - HEVIgG: Recovery
79
Which hepatitis has no current vaccine
Hepatitis C
80
Which forms of hepatitis are linked closely to hepatocellular carcinoma
B and C
81
What is the mainstay antiviral treatment for hepatitis C
Ribavarin
82
Presenting features of autoimmune hepatitis and diagnostics
- Middle aged women - Amenorrhea - Jaundice - Rash - AutoAb's = ANA,AMA,SMA,LKM1/2/3
83
What is the active ingrediant of paracetamol and its toxic bi product
- Acetaminophen | - NAPQI
84
How do we treat paractamol toxicity
- Activated charcoal | - Acetylcistine
85
How does oestrogen link to development of hepatocellular carcinoma
Elevated oestrogen is linked to hepatocellular adenoma wich can ocassionally develop into cancer
86
3 systemic side effects of portal hypertension
- Oesophageal varices - Haemmorhoids - Caput Medusa
87
Choleliathisis - Risk factors - Formation - LFT's
- Women, over 50 - Cholesterol increases stone production - Often normal but may show mild +ALP/ALT and bilirubin
88
Diagnostics and sign
- USS | - Murphys sign - gallbladder pain on palpation (inspiration)
89
Cholestasis | -Diagnostics
Biliary obstruction - from anything, eg tumor, stones, cholangitis, alcohol +ALP +GGT +5-Nucleotidase (obtruction marker)
90
Cholecystitis - Mechanism - Diagnostic signs/symptoms
-Inflammation caused by blockage - different to colic as the stones are stuck in the cystic dut or neck of the gallbladder -Murphys sign, pain, fever +WCC, +CRP, +ALP, +Bilirubin
91
Cholangitis - Ascending vs Sclerosing (HINT: A next to B in the alphabet) - Mechanism - Charcots triad
- Ascending=Bacterial infection, Sclerosing=autoimmune - Obstruction causes bacterially contaminated bile to back up intot the blood when its usually flushed out - Fever, Jaundice, Pain
92
3 Risk Factors for cholangiocarcinoma
- Primary Sclerosing Cholangitis - IBD - Liver disease
93
Diagnositics for pancreatitis (acute and chronic)
``` Acute: -serum amylase -serum lipase (more specific) Chronic -Fecal elastase ```
94
Grey turners sign and Cullens sign
Grey Turners = Flank bruising | Cullens = Peri-umbilical bruising
95
Give a therapeutic intervention for steatorrhea with chronic pancreatitis
Pancreatin replacement enzymes
96
Pancreatic CA - Histopathology - Main area affected - Symptoms early and late
- Adenocarcinomas - Head of pancreas - Painless jaundice and then back pain
97
Rarer types of pancreatic tumor and associated genetic defect
Neuroendocrine tail tumors = insulomas | MEN-1 syndrome
98
Tumor marker for colorectal cancer
CEA
99
Tumor marker for liver cancer
AFP
100
Tumor marker for Biliary cancer
CA19-9
101
Budd-Chiari syndrome - Mechanism - Diagnostics
Blockage of hepatic veins via tumors/Polycythemia vera | -USS
102
What is a major side effect of Metocloperamide and how do you revers it
- Extra-pyramidal | - Anti-cholinergic: Procyclidine
103
Causes of acute pancreatitis
``` I = Ideopathic G = Gallstones E = Ethanol T = Trauma S = steroids M = Mumps A = Autoimmune S = Scorpion stings H = Hyperlipidemia, hypercalcemia and hypothermia E = ERCP D = Drugs ```
104
How are COPD, pancreatitis, choleliathisis, cholangitis. autoimmune hepatitis and malignancy related
Alpha-1-antitrypsin deficiency
105
3 Features of Ileostomy | -Placement
- Liquid waste - Spout - Electrolyte imbalance common -R Iliac fossa
106
3 Features of Colostomy | -Placement
- Solid waste - Flush - Electrolytes more stable -L iliac fossa
107
Big SE of IV acetylcystine and how to overcome this
- Vomiting and nausea | - Add Ondansetron

Yr 3 ALS (10 decks)

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