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Year 2 revision > Passmedicine GI > Flashcards

Passmedicine GI Flashcards

1
Q

Features of familial adenomatous polyposis (FAP)

A
  • Typically over 100 colonic adenomas
  • Cancer risk of 100%
  • 20% are new mutations
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2
Q

Screening for familial adenomatous polyposis (FAP) if known to be at risk

A
  • If known to be at risk then predictive genetic testing as teenager
  • Annual flexible sigmoidoscopy from 15 years
  • If no polyps found then 5 yearly colonoscopy started at age 20
  • Polyps found = resectional surgery
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3
Q

A 17-year-old boy is admitted to hospital with suspected appendicitis. He is found to be maximally tender at McBurney’s point. Where is this located?

A

McBurney’s point is found 2/3rds of the way along an imaginary line that runs from the umbilicus to the anterior superior iliac spine on the right-hand side.

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4
Q

Presentation of appendicitus

A

Peri-umbilical abdominal pain radiating to the right iliac fossa due to localised parietal peritoneal inflammation.

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5
Q

How is the diagnosis of appendicitis made?

A

Typically raised inflammatory markers coupled with compatible history and examination findings should be enough to justify appendicectomy.

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6
Q

Management of appendicitis

A

Appendicectomy which can be performed via either an open or laparoscopic approach. Laparoscopic appendicectomy is now the treatment of choice.

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7
Q

What is diverticulosis?

A

Diverticulosis describes the asymptomatic presence of diverticula in the colon.

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8
Q

What is diverticulitis?

A

When one of the divertiicula becomes infected

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9
Q

What is the classical presentation of diverticulitis?

A
  • left iliac fossa pain and tenderness
  • anorexia, nausea and vomiting
  • diarrhoea
  • features of infection (pyrexia, raised WBC and CRP)
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10
Q

Management of diverticulitis

A
  • mild attacks can be treated with oral antibiotics
  • more significant episodes are managed in hospital.
    • Patients are made nil by mouth, intravenous fluids and intravenous antibiotics (typically a cephalosporin + metronidazole) are given
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11
Q

Abdominal X-ray shows multiple dilated small bowel loops.

In order to see dilated small bowel loops where must the site of obstruction be?

A

distal small bowel or proximal large bowel

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12
Q

What is the most likely cause of distal small bowel obstruction?

A

small bowel adhesions

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13
Q

What is the treatment for small bowel adhesions?

A

Treatment is with laparotomy and adhesiolysis to free up the affected bowel segment.

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14
Q

What are the retroperitoneal structures?

A

SAD PUCKER

  • Suprarenal (adrenal) gland
  • Aorta/IVC
  • Duodenum (second and third part)
  • Pancreas (except tail)
  • Ureters
  • Colon (ascending and descending)
  • Kidneys
  • Esophagus
  • Rectum
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15
Q

Where does Crohn’s disease affect?

A

It commonly affects the terminal ileum and colon but may be seen anywhere from the mouth to anus.

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16
Q

Features of Crohn’s disease

A
  • presentation may be non-specific symptoms such as weight loss and lethargy
  • diarrhoea: the most prominent symptom in adults. Crohn’s colitis may cause bloody diarrhoea
  • abdominal pain: the most prominent symptom in children
  • perianal disease: e.g. Skin tags or ulcers
  • extra-intestinal features are more common in patients with colitis or perianal disease
17
Q

Extraintestinal features of Crohn’s disease

A
  • Arthritis
  • Erythema nodosum
  • Episcleritis
  • Osteoporosis
  • Clubbing
18
Q

Investigations for Crohn’s disease

A
  • raised inflammatory markers
  • increased faecal calprotectin
  • anaemia
  • low vitamin B12 and vitamin D
19
Q

What type of screening is offered for colorectal cancer?

A

The NHS offers home-based, Faecal Immunochemical Test (FIT) screening every 2 years to all men and women aged 60 to 74 years in England, 50 to 74 years in Scotland.

20
Q

What is the most common type of tumour encountered in the colon?

A

Adenocarcinoma

21
Q

Location of colorectal cancer

A
  • rectal: 40%
  • sigmoid: 30%
  • descending colon: 5%
  • transverse colon: 10%
  • ascending colon and caecum: 15%
22
Q

What is the most likely causative organism in pseudomembranous colitis following recent broad-spectrum antibiotic use?

What is the microbiology report most likely say about the causative organism?

A

Clostridium difficile

This is a gram-positive bacillus

23
Q

Features of Clostridium difficile infection

A
  • diarrhoea
  • abdominal pain
  • a raised white blood cell count is characteristic
  • if severe toxic megacolon may develop
24
Q

Clostridium difficile infection diagnosis

A
  • is made by detecting Clostridium difficile toxin (CDT) in the stool
  • Clostridium difficile antigen positivity only shows exposure to the bacteria, rather than current infection
25
Q

Clostridium difficile infection management

A
  • first-line therapy is oral metronidazole for 10-14 days
  • if severe or not responding to metronidazole then oral vancomycin may be used
26
Q

What is the arterial supply and venous drainage of the gallbladder?

A
  • Arterial supply - Cystic artery (branch of Right hepatic artery)
  • Venous drainage - Directly to the liver
27
Q

What two structures merge together to form the Ampulla of Vater?

A

The pancreatic duct and common bile duct

28
Q

What does the ampulla of Vater mark?

A

It marks the anatomical transition from the foregut to midgut.

29
Q

What is the name of the muscular valve that controls the flow of pancreatic enzymes and bile from the Ampulla of Vater into the second part of the duodenum.

A

Sphincter of Oddi

30
Q

Which ducts fuse to form the common hepatic duct?

A

The right hepatic duct fuses with the left hepatic duct to form the common hepatic duct.

31
Q

Which part of the GI tract does ulcerative colitis affect?

A

Inflammation always starts at rectum, never spreads beyond ileocaecal valve and is continuous.

32
Q

Features of ulcrative colitis

A
  • bloody diarrhoea
  • urgency
  • tenesmus
  • abdominal pain, particularly in the left lower quadrant
  • extra-intestinal features
33
Q

Extraintestinal features of ulcerative colitis

A
  • Arthritis
  • Erythema nodosum
  • Uveitis
  • Clubbing
  • Primary sclerosing cholangitis

Year 2 revision (15 decks)

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