more GI Flashcards
1
Q
first line of moderate exacerbation of UC
A
aminosalicyclate eg mesalazine or sulfasalazine
2
Q
– are second line to mild to moderate exacerbation of UC
A
steriods eg prednisolone
3
Q
treatment for acute/ severe exacerbation of crohns/ UC for those not responding to steriods
A
infliximab
4
Q
patient with UC, suffering severe abdomen pain and fever after taking anti-diarrhoeals, should consider
A
toxic megacolon and this should be X-ray of the abdomen
5
Q
patient from India, abdominal complaints that did not respond to antibiotics, now got weightloss and anorexia,
A
intestinal tb
6
Q
what test for intestinal tb
A
ileal biopsy
7
Q
raised anti-tissue transglutaminase antibody is associated with
A
Coeliac disease
8
Q
– is a disease of the small intestine caused by gluten sensitivity
A
coeliac disease
9
Q
villous atrophy
A
coeliac disease
10
Q
anti-thyroid stimulating hormone receptor antibodies
A
graves disease
11
Q
type 1 diabetes results in destruction of
A
islet cells
12
Q
patient with end stage liver disease presents with painful abdomen, ascites, fever what should you do
A
ascitic tap- investigation
13
Q
investigation of choice for coeliac disease
A
anti- TTG
14
Q
classic presentation of primary biliay cholangitis
A
increasing jaundice, pruritus (itchy skin), arthralgia (pain in a joint). hepatomegaly, clubbing, xanthelasmata (yellow collection on skin typically around eyelid), hyperpigmentation(patches of skin become darker)
15
Q
appropriate investigation for primary biliary cholangitis
A
anti-mitochondrial antibodies
16
Q
21y/o with 2 week of jaundice, preceded by anorexia, athralgia, fever and a tender, enlarged liver
A
acute hepatitis
investigation for this Hep A immunoglobulin M (IgM)
17
Q
most common cause of acute hepatitis
A
Hep A
18
Q
Haemochromatosis presents with
A
iron overload: jaundice, hepatomegaly, arthritis, hyperpigmentation, infertility, small testes
19
Q
investigation for heamochromatosis
A
high ferritin or iron levels
20
Q
associated with human leukocyte antigen A3
A
haemochromatosis
21
Q
ascending cholangitis triad
A
pyrexia/rigours, jaundice, RUQ abdo pain
22
Q
investigatio for ascending cholangitis
A
ERCP
23
Q
increasing jaundice, breathless on exercise and recurrent lung infections,show obstructive pattern
A
alpha 1 antitryptysin
24
Q
kayser fleischer rings ( greenish-brownish rings due to copper depostition in the cornea of the eye)
A
Wilsons disease
25
children and young people, with hepatic problems and neurological symotoms such as dysarthria (speech disorder), tremor, involuntary movements
wilsons disease
26
treatment for wilsons disease
penicillamine
27
PBC typically presents
middle aged females, itching ,jaundice and sjogrens syndrome
28
bronzing of the skin
haemochromatosis
29
hereditary non-polyposis colorectal cancer syndrome has what approx liftetime risk for developing colorectal cancer
50-70%
30
patients presents with acute cholangitis and has raised CRP, what next
prompt IV antibiotics
31
suitable choice of antibiotics for acute cholangitis
piperacillin and tazobactam
32
fever, heart mumur, arthritis
infective endocarditis
33
infective endocarditis iv drug users
staph aureus
34
infective endocarditis with prosthetic heart valves or central venous access lines- surgery?
staph epidermis
35
treatment of suspected infective endocarditis w no prosthetic heart valves
amoxicillin and gentamicin
36
what can put you at increased risk of hepatotoxicity following paracetemol overdose
anorexia
37
-- commonly seen in alcohol withdrawl due to malnutrition. Need to be careful of re-feeding syndrome. alcohol can cause a metabolic acidosis
hypophosphataemia
38
seizures in alcohol withdrawl are
common
39
intermittent dysphagia, more diffult swallowing liquids than solids
neuromuscular conditions- (result in abnormal peristalsis of the oesophagus)- oesophageal dysmotility.
40
-progressive dysphagia for liquids more than solids, severe episodes of chest pain accompanying dyspahgia, barium swallow shows birds peak, mamoetry reveal abnormally high lower oesophageal sphincter tone that fails to relax on swallowing
achalasia
41
sensation of food getting stuck
GORD
42
22y/o studying hard for exams, intermittent abdo apin and bloating, change in bowel habit and going to loo helps to relieve her abdominal pain
Irritable bowel syndrome -
43
diagnosis of irritable bowel syndrome
recurrent abdo pain or discomfort at least 1 day per week in the last 3 months with 2 or more of the following:
- improvement with defecation
- onset associated with change in frequency of stool
- onset associated with change in form (appearance) of stool
44
treatment for colicky abdo pain with irritable bowel syndrome
Mebeverine
45
widened mediastium
achalasia
46
best investigation for suspected achalasia is
oesophageal manometry study
47
most people with diverticulitis remain
asymptomatic
48
25% of people with this get symtpoms such as Left lower quadrant pain, worsened by eating and relieved after bowel emptying
diverticulitis
49
evidence of diverticular inflammation suggested by
tachycardia and fever
50
prolonged laxtive use or abuse can cause
melanosis coli
51
macrophages containing lipofuscin in the mucosa -toad back appearance
melanosis coli
52
crypt abscesses
UC
53
non caseating granuloma in the mucosa,cobblestone
crohns disease
54
crohns -
uc-
- diarrhoea( usually without blood, but not uncommonly with), abdo pain, general malaise and weight loss
bloody diarrhoea, abdo pain , malaise and weight loss
55
vitamin B -- in chronic alcohol users
1
56
all patients with altered mental status or nutritional deficiency should have
thiamine repletion
57
encephalopathy (altered mental state), oculomotor dysfunction (eye coordination) , gait ataxia (abnormal uncoordinated movements)
wernicke's encephaolpathy - alcoholics
58
prolonged vitamin b12 defiency causes
macrolytic anaemia
59
epigastric pain radiating to back, nausea and vomitting, post hepatic jaundice( indicated by severely raised ALP, mildly raised AST and raised bilirubin)
pancreatitis
60
if been vomitting since morning,
NG tube can be used for air and fluid removaland used to put liquid food into the stomach
61
treatment for pancreatitis
Admission, IV fluids, anagesia, nil by mouth, NG tube
62
expect --hepatic jaundice fromm malaria
pre
63
raised bilirubin, low haemoglobin, ALT and ALP are normal
Pre hepatic jaundice
64
young perosn drank too much alcohol and being vomitting alot. now vomitting blood
mallory -weiss tear- longitudinal mucosal laceration at the gastro-oesophageal junction or cardia as a result of repeated retching. if bp, pulse, Hb normal then can be discharged home next morning
65
most common cause of nodular hepatomegaly
liver metastases
66
Alt would be elevated
Cirrhosis
67
severe flare up of UC
Corticosteriods added to oral mesalazine
68
moderate exacerbation of uc treatment
add topical aminosalicylate to oral mesalazine
69
most common carcinoma of anal tract
squamous cell carcinoma -associated with HPV infection - transmitted by anal intercourse
70
ampullary carcinoma
v rare
- abdo pain, distended and palpable gall bladder
71
plummer vinson syndrome is associated with squamous cell carcinomas of upper GI tract especially the pharynx and oesophagus
72
features of plummer vinson syndrome
oesophageal webs, dysphagia, iron deficiency anaemia, glossitis
73
what intestinal disease requires bloof tests and small intestinal biopsy for acurate diagnosis
Coeliac disease
74
foamy macrophages containin gnumerous acid fst bacilli
myobacterium avium infection
75
had abdo surgery and now presents with malabsorption, low vitamin b12, high serum folate
Small intestinal bacterial overgrowth (SIBO)
76
gold investigation for SIBO
culture of small intestinal fluid aspirate
77
cope's sign
pain of apeendicitis is stimulated by the flexion and internal rotation of the hip
78
pembertons sign
elicted when a patient with superior vena cava obstruction raises the hands above their head
79
murphys sign
inspiration during palpitation of the right upper quadrant elicits pain if the gallbladder is inflamed
80
Psoas sign
test for appendicitis
81
rovsing sign
another test for appendicitis, palpitation in the left iliac fossa reproduces pain in the right iliac fossa
82
MRI appropriate for
pelvic floor dysfunctions
- feeling of incomplete defaecation
- straining
83
weight loss and painless jaundice, repeated admissions of pancreatitis
pancreatic cancer
84
risk factors for pancreatic cancer
chronic pancreatitis, alcohol, smoking, diabetes,
85
the patient has dyspepsia ( epigastric pain during and after eating), most likely due to peptic ulcer disease (----)
as it wakes her up at night
86
one of the causes of peptic ulcer disease is primary hyperparathyroidism which results in excess gastric acid secretion by inducing
hypercalcaemia (elevated serum calcium)
87
redcurrant jelly in nappy
meckels diverticulum suspected
88
in meckels diverticulum,
two or more types of tissue can be present
89
rectal involvement is associated with
UC
90
transmural inflammation, fistulae and ---are typical of crohns
abscesses
91
--- affects only the mucosa and submucosa so is less prone to forming fistuale and abscesses
UC
92
most important medication for variceal bleeds is
terlipressin
93
severe epugastri pain and vomitting bright red blood, cool extremities, asicitc abdo, spider naevi on neck
oesophageal variceal blled
94
if suspect inflammatory bowel disease what investigation is essential
Plain abdominal film - to exclude dilatation of the colon. crohns may exhibit small bowel dilatation of abdo xray
95
not do -- if moderate to sever inflammatory bowel disease as there is a high risk for perforation and this would be considered after resolution of the flare
colonscopy
96
recommended that all patients presenting with diarrhoea undergo
rigid sigmoidoscopy
- however perform abdo film/xray before this invasive invesigation
97
why is urseodeoxycholic acid given to patients with PBC, when treatment of choice is liver transplant
reduces the rate of liver failure in paitents with PBC
98
patient has NGT tube inserted and and what precaution before starting enetral feeding
Chest radiograph - confirm NGT placement
99
How should NGT tube be placed
down the midline,past the carina (bifurcation of the trachea), past the level of the diaphragm, deviates to the left with the tip seen in the stomach
100
2 jobs of ngt
enteral feeding/ medication administation
decompression of the stomach
101
what hormone inhibits gastrin secretion
somatostatin
102
-- and -- aggrevates irritable bowel syndrome
caffeinated and fizzy drinks
103
PBC- lethargy, weakness and increasing itch -alkaline phosphatase raised
autoimmune hepatitis-
PSC- ASMA and ANCA may be positive- diagnosis MRCP or ERCP - beaded appearance
fever, rash, malaise, arthrirtis
104
can develop peptic ulcers secondary to
corticosteriod and naproxen use
105
peptic ulceration usually due to
h.pylor(gram negative)
NSAIDs
106
patient with peptic ulcer disease tends to present with
dyspepsia
107
what test is used in the diagnosis of helicobacter infection
rapid urease test
108
h.pylor produces the enzyme --- that converts urea to ammonia and carbon dioxide
urease
109
extra intestinal features of Inflammatory Bowel disease
athralgia (joint pain without inflammation), arthritis(without inflammation), Polyarthritis, sacroiliitis
110
severe epigastric pain that radiates to back
acute pancreatitis
111
amylase raises after onset of --- and returns to normal in approx 5 days
acute pancreatitis
in severe alochols this is not the case
112
palpable gall bladder, RUQ itch,
cholangiocarcinoma
113
features of cholangiocarcinoma
raised CA 19-9 and CEA, normal AFP
114
middle aged women, intense itching and fatigue
Primary biliary cholangitis
115
dilated oesophagus
achalasia
116
achalasia: disorder of motility caused by failure of the
oesophageal sphincter to relax
117
what can be used to relax the sphincter in achalasia
calcium channel blockers and nitrates
118
unstable observations , a tender abdomen with history of ulcerative colitis is concerning for
toxic megacolon
- abdo x ray should be ordered to assess for this- transverse colon will typically be dilated \>6cm which is diagnostic of TM
119
what criteria is used for morphological classification of intestinal biopsy in coeliac disease
Marsh criteria
120
crypt abscesses are typical for
ulcerative colitis
121
stricturing of bowel wall and fistula formation is in UC or crohns
crohns
122
is the risk of malignancy significantly lower in. crohns disease or UC
crohns disease
123
student binge drinks every weekend for past year and now vomitting has a bit of blood
Barrets oesophagus
- short history of alcohol excess so unlikely to present with varices or ulcers
- can give PPI
124
24hrs of vomitting and now has blood
mallory-weiss syndrome - tear in the mucosa as a result fo prolonged vomiting episode
125
diclofenac and other non-steriodal anti-inflammatory medications increase the risk of -- by inhibiting the production of prostaglandins
peptic ulceration
126
epigastric pain afetr meals , black tarry stools, coffe ground vomitting
upper GI heamorrhage secondary to bleeding peptic ulcer
127
long history of excess alcohol, massive haematemesis, jaundice, hypotensive and tachycardic
oesophageal varices
128
most common cuase of oesophageal or gastric varices is
alcohol
129
intermittent haemoptysis, small amounts of haematemesis, telangiectasia(dilated or broken blood vessels) on face
Osler-weber -rendu syndrome
130
in IV drugs users there is a high incidence of
Human immunodeficiency virus(HIV), hepatitis viruses or tb
131
cryptospordium is an infection that can be acquired by immunocomprised ie drug users and thos who have had tb
profuse watery diarrhoea, abdo cramps, fever
132
student w 12 hours of vomitting, abdo pain, watery diarrhoea
food poisoning
133
most common cause of diarrhoea in young people
food poisioning or acute gastroenteritis
134
diagnosis of UC
endoscopic biopsies
135
Almost always a consequence of chronic alcohol misuse. steatorrhoea( pale, foul-smelling stool that is hard to flush away). abdo pain, diarrhoea
Chronic pancreatitis
- not always present with epigastric pain that radiates to back and relieved on sitting forward and worse on eating
136
change in bowel habit and blood in the stool should immediately be referred for 2 week pathway of suspicion of
colorectal carcinoma
137
12 cm dilatation of the transverse colon and has UC
Toxic megacolon
138
medications for toxic megacolon
IV corticosteriod (hydrocortisone), LMWH ( as high risk of venous thromboembolism) , fluids, reassess after 72 hrs
139
Iv infliximab is secodn line for severe active -- in patients who fail to respond to IV steriod treatment.
UC
140
-- is characterised by tachycardia, fever, hypotension, dilatation usually of the transverse colon greater tham 6cm
toxic megacolon
141
most specific antibody for autoimmune hepatitis
anti-smooth muslce antibodies
142
antibody associated with primary biliary cholangitis
anti-mitochondrial antibodies
143
test that h. pylori has been eradicated following treatment
13C urea breath test
144
red flag symptoms suggesting organic cause of abdo pain rather than irritable bowel sydnrome
unintentional weight loss, rectal bleeding, family history of bowel or ovarian cancer, older than 60 with a change in bowel habit
145
plummer vinson syndrome is a disease characterised by
dysphagia, iron deficiency anaemia, glossitis
146
what is it that causes dysphagia in plummer vinson sydrome
oesophageal web
147
treatment of plummer-vinson syndrome
iron supplements
148
dysphagia to both solids and liquids, PPI therapy failing and upper endoscopy normal. CXR normal. ECG normal. what investigation
oesophageal manometry
-consistent with achalasia
149
what is barium swallow helpful for
obstruction, evidence of reflux, or strictures in the oesophagus
150
associations of gastric cancer
pernicious anaemia, blood group A, smoking diet, H.pylori
151
H. pylori is not a risk for ---cancer
Gastric cardia
152
hep B is more common in what countries
sub-saharan africa and east asia
153
hep c is more common in what countries
african countries such as egypt, easter european adn latin america
154
Liver cirrhosis causes:
DR- DRUGS- AMIODARONE, METHYLDOPA, METHOTREXATE
H-HEPATITIS - B AND C
E- ENZYME DEFICIENCY- alpha 1 antitrypsin deficiency
P-primary biliary cirrhosis/ primary sclerosing cholangitis
A- alcohol abuse -chronic
T- tyrosinosis
I-indian childhood
Cryptogenic/CF/ copper deposition; wilsons disease/ haemoChromatosis
Autoimmune hepatitis
DR HEPATICA
155
how does haemochromatosis present
cirrhosis, hyperpigmentation, arthritis, diabetes
156
inflammatory infiltrates with plasma cells, lymphocytes and eosinophils in the lamina propria and thick subepithelial collagen band
collagenosu colitis
treatment- anti-diarrhoeal- Loperamide
157
period acid -schiff (PAS) positive macrophages
whipples disease
-treatment- ceftriaxone or penicillin V
158
motile spiral shaped bacteria
campylobacter, most common cause of acute diarrhoea in UK - usually from poultry or dairy products
159
treatment of severe acute diarrhoea of campylobacter
erthyromycin
(ciprofloxacin or azithromycin as alternatives)
- if not severe then rehydrate
160
most common mode of transmission of Hep C
exposure of infected blood
161
hep c is what kind of virus
RNA
162
diarrhoea, facial flushing, bronchospasm
carcinoid syndrome - raised 5 -HIAA is suggestive
163
important medication for variceal bleed is
terlipressin
164
haematemesis of bright red blood, alcoholic, cool extremities, guardin gover the epigastric rehion, ascitic, spider naevi on chest and neck
variceal bleed
165
follwing terlopressin for variceal bleed what is next
band ligation and if this does not control the bleed, intra-hepatic portosystemic shunt (TIPS)
166
50% of those with hep B develop
jaundice
167
most people 65-75% of hep c are
assymptomatic
168
when --is greater than 1000, the most likeley cause is hepatitis
ALT
169
hep --- =ASIA
B
170
thickened small bowel folds on barium swallow
tropical sprue
171
Giardia lamblia is a flagellated
protozoan - contaiminaetd water or poor cooking -street stalls
172
diagnosis of trpoical sprue
indentifying cysts or trophozoites in stool sample
173
treatment for giardiasis
rehydration and oral metronidazole
174
been travelling and diarrhoea more than a week
giardiasis
175
symtoms improves if eats fewer dairy products
lactose intolerance
176
used to decrease diarrhoea in chronic pancreartitis/CF
pancreatin
177
anti diarrhoeal used in acute
loperamide
178
anti-diarrhoeals used in chrons, PBC, pruritus, hypercholestolaemia
colestyramine
179
oesophagus hiatus at what level
T10
180
inferioru vena cava at diaphgram
T8
181
aorta at diaphragm
T12
182
T12
aorta, azygous vein, thoracic duct
183
what is commonly graded on the LA classification
oesophagitis
184
colon malignancy is staged by
dukes staging system /TNM
185
cirrhosis of the liver staging system
Child-pugh
186
peptic ulcers classification system is
johnson
187
glossitis (beefy red tongue)
vitamin b12 deficiency
188
vitamin b12 is found in
meat, fish and dairy products
- absorbed in the terminal ileum
- strict vegans likely to present with this
189
antibody present in some crohn's patietns
saccharomyces cerevisiae
190
pANCA is associated with
UC
191
triad for pellagra
diarrhoea, dermatitis (could be rash on hand), dimentia
192
pellagra is
niacin (vitamin b3) deficiency
193
scurvy can present with red dots on the skin but also with
bleeding gums adn joint pain
194
SLE presents with
painful swollen joints and red butterfly rash over the face
fevers and mouth ulcers are also common
195
abdo pain that raidates to back or worse lying down
pancreatitis
196
bruising around umbillicus is classical of
retroperitoneal haemorrhaeg(cullens sign)
197
if coeliac trunk is obstructed this will affect the stomach...
duodenum, gallbladder, pancreas, spleen, liver , abdominal portion of the oesophagus
198
jejunum and ileum are supplied by
superior mesenteric arteries
199
what supplies the transverse colon
proximal 2/3rds = right and middle colic arteries
distal 1/3=left colic artery
200
what supplies the descending colon
left colic artery
201
