Summary Flashcards
1
Q
Most likely cause of aphthous ulcers
A
Crohn’s disease
Iron deficiency
2
Q
Causes of leukoplakia
A
Candida Systemic disease (SLE) Mechanical irritation Trauma Oral candidiasis from inhaled steroids
3
Q
What causes hairy leukoplakia?
A
EB virus
4
Q
What is erthyplakia indicative of?
A
Malignany (squamous cell carcinoma)
5
Q
Where is erythroplacia most common found?
A
lateral border of the tongue
floor of the mouth
6
Q
What is glossitis associated with?
A
Vitmain B12 & iron deficiency
7
Q
What affect can calcium channel blockers have on the mouth?
A
They can cause gingivial hyperplasia
8
Q
What affect can Nicorandil have on the mouth?
A
Can cause oral ulceration
9
Q
What affect can atni-hypertensives have on the mouth?
A
Xerostomia
lichen planus
angioedema
10
Q
How can HIV/AIDS present in the mouth?
A
Hairy leukoplakia
Kaposi sarcoma
Herpes lesions
11
Q
Causes of GORD
A
Incompetent LOS Impaired oesophageal clearancer Defective mucosal barrier Pregnancy Obesity Ca2+ blockers, nitrates
12
Q
Main complication of GORD
A
Barrett’s Oesophagus
13
Q
Treatment of GORD
A
Antacids (Gaviscon)
H2 receptor antagonists (ranitidine)
PPI (omeprazole)
14
Q
What is Barrett’s oesophagus?
A
Metaplsia of squamous epithelium to columnar epithelium
15
Q
Why is Barrett’s oesophagus pre-malignant?
A
Mucosa becomes unstable and can undergo dysplastic change easily
16
Q
Treatment of Barrett’s oesophagus
A
PPI
Argon
Endoscopic mucosal resection
Radiofrequency ablation
17
Q
What is achalasia?
A
Intermittent dysphagia + impaired relaxation go LOS
18
Q
Investigations of achalasia
A
Barium swallow (bird beak appearance)
19
Q
Symptoms of oesphageal cancer
A
Progressive dysphagia
Weight loss
Hoarse voice
Chest pain
20
Q
What is the most common cancer in the upper two thirds of the oesophagus?
A
Squamous cell carcinoma
21
Q
What is the most common cancer in the lower third of the oesophagus?
A
Adenocarcinoma
22
Q
Causes of acute gastritis
A
Chemical irritation
Trauma
Burns
Infection
23
Q
What is autoimmune gastritis?
A
Antibodies attack parietal cells + intrinsic factor
24
Q
Causes of chronic gastritis
A
Chemicals (NSAIDs, Alcohol, bile reflux) Bacterial infection (H. pylori)
25
What is gastroparesis
Delayed gastric emptying that is not due to obstruction
26
Investigations or gastroparesis
Oesophageal manometry
27
Treatment of gastroparesis
Change in diet
| Gastric pacing
28
Where do gastric adenocarcinomas tend to occur?
Proximally to the GO junction
29
How does H. pylori infection progress to adenocarcinoma?
```
H/ pylori
Chronic gastritis
Metaplasia
Dyplasia
Carcinoma
```
30
Treatment of gastric adenocarcinoma
if proximal - total resection
| if distal - partial resection
31
What are GISTs linked with?
Defect of pacemaker cells (ICC's)
32
What cells are gastric lymphomas linked with?
B-cells in lymph nodes
33
How are peptic ulcers formed?
Breach of GI mucosa and acid and pepsin attack
34
Rank in order from most common to least common; gastric ulcers, duodenal ulcers, oesophageal ulcers
Duondenal > Gastric > Oesophageal
35
Symptoms of peptic ulcers
```
Burning epigastric pain
Loss of appetite and weight
Pain when eating
Feeling of fullness
Nausea
```
36
Investigation to confirm H. pylori
C13 urea breath test
Serology (IgG)
Stool antigen
37
Treatment of peptic ulcer disease
Antacids (Gaviscon)
H2 antagonists (raitidine)
PPI (omeprazole)
H. pylori eradication
38
How is H. pylori eradicated?
Omeprazole + amoxicillin + clarithromycin (metronidazole if allergic to amoxicillin')
39
How to eradicate H. pylori infection if original attempt doesnt work?
Stop PPI for 2 weeks + retest
| Try metoclopramide or bismuth chelate
40
Causes of upper GI bleed
```
Duodenal ulcer
gastric ulcer
oesophageal varices
mallory-weiss tear
Gastric carcinoma
Reflux oesophagitis
```
41
How is severity of haematemesis measured?
Rule of 100
| BP, HR, Hb
42
First line treatment of large upper GI bleed
ABCDE
| IV omeprazole
43
How can endoscopy intervention stop upper GI bleed?
Adrenaline injection
Heater probe coagulation
Haemospray (last resort)
Sclerotherapy for varices
44
What is coeliac disease?
Autoimmune inflamation of the small mucosa in the presence of gluten causing villi atrophy (reduces capacity for absorption)
45
Blood test results expected in coeliac disease?
tTGA
| IgA
46
Histological appearance of coeliac disease
Villous atrophy
Crypt hyperplasia
increased lymphocytes
47
Treatment of coeliac disease
Avoid gluten
| Mineral & vitamin replacement
48
What is intestinal failure?
When nutrtional needs can no loner be supported by the gut
49
Investigation results for intestinal failure
Decreased albumin (not reliable)Decreased vitamin & zinc)
50
What is the main factor to treat in intestinal failure?
Nutrition
51
Types of small bowel obstruction
Luminal obstruction
Bowel wall obstruction
Mesenteric arterial occlusions
Starngulation obstructing venous return
52
Causes of small intestinal luminal obstrruction
Gallstone ileus
Food
Bezoar (hair)
53
Causes of bowel wall obstructio
Tumour
Crohns
enteritis
54
Causes od strangulation obstructing venous return to the small bowel
Hernia
| Adhesion
55
Symptoms of small bowel obstruction
Colicky abdominal pain
Abdominal distension
Absent/ tinkling bowel sounds
Faeculent vomiting
56
Treatment of small bowel obstruction
Analgesia, fluids and K+ replacement
| Surgery
57
What is Meckel's diverticulum?
Tubular structure 0cm from ileocaecal valve
58
What is meckel's diverticulum a remnant of?
Omphaomesenteric duct from development
59
Treatment of Meckel's diverticulum
Surgery
60
What is more common in the small bowel, primary or secondary tumours?
Secondary
61
Symptoms of appendicitis
Epigastric pain that goes to RIF (McBurney's point)
Rovings sign (pain on right when press in on left)
Low grade fever
Nausea/vomiting
62
What cells are involvede in carcinoid of the appendix?
enterochromaffin cells
63
Most common cause of food poisonin
Campylobacter
64
Which causes of food poisoning cause outbreaks?
Salmonella
| E. coli 0157
65
Which virus causes expolsive vomiting?
Norovirus
66
What is the most common cause of viral diarrhoea in children
Rotavirus
67
Which organism have short incubation periods?
Staph aureus
| Bacillus cereus
68
Which organisms have medium incubation periods?
Salmonella
| Clostridium perfringens
69
What organisms have long incubation periods?
Campylobacter
| E. coli 0157
70
Which bacteria are toxin producing?
Staph aureus
Clostridium perfringens
Bacillus cereus
E. coli 0157
71
What bacteria cause bloody diarrhoea?
Campylobacter
Shigella
E. coli 0157
72
Investigation for typhoid
blood culture
73
Investigation for campylobacter, shigella, salmonella
stool culture
74
Investigation for protozoas & parasites
Stool microscopy
75
Investigation for C. diff & E. coli 0157
Stoll toxin
76
INvestigation for norovirus
Stool PCR
77
Treatment for amoebiasis & giardiasis
Metronidazole
78
Treatment of mild C. diff
Metronidazole
79
Treatment of severe C. diff
oral vancomycin +/- IV metronidazole
80
Treatment of recurrent C. diff
Fidaxomicin
81
What is smoking harmful in UC/Crohn's?
Crohn's
82
Step up treatment of UC/Crohn's
```
5-ASA (mesalazine)
Steroids (prednisolone)
Immunosupression (aathioprine, methotrexate)
Anti-TNF (infliximab)
Surgery
```
83
Features of Crohn's disease
```
Transmural inflammation
Any part of the GI tract
Skip lesions
Cobblestone appearance
Non-caseating granuloma
TH1 - mediated
Complications = fistulas
surgwery rarely curative
```
84
Features of UC
```
Mucoal/sub-mucosal inflammation
In rectum & colon
Crypt abscesses
Inflammatory cell infiltrate
TH1 and TH2 mediated
Complication - toxic megacolon
Surgery can be curative
```
85
What is diverticular disease?
Outpouching of the epithelial lining usually due to high intraluminal pressure caused by low fibre
86
Symptoms of diverticular disease
Left-sided abdominal pain
Altered bowl habit
Nausea
Sepsis
87
Complications of diverticulitis
Fistulae
Perforation
Obstruction
Harmorrhage
88
Investigations for diverticular disease
Gastrografin/barium enema
| Sigmoid/colonoscopy
89
Symptoms of colitis
Bloody diarhhoea
Cramping pain
Dehydration
Weight loss
90
Investigations for colitis
AXR
| Stool culture
91
What are colorectal polyps?
ptotrusions of epithelial surface
| either flat, stalk ot serrated
92
What are adenomas?
sometimes formed from polyps
| may form adeocarcinoma
93
What is family adenomatous polyposis (FAP)?
Autosominal dominant condition arising from mutations in the APC gene
94
How is FAP characterised?
Hundreds of colorectal + duodenal adenomas
95
What is hereditay non-polyposis colon cancer (HNPCC)?
Mutation in DNA mismatch repair gene
96
What is the Dukes staging system of colorectal cancer?
A = muscararis mucosa
B = extension through muscularis mucosa
C = regional lymph nodes
D distant metastasis
97
What stage of Dukes does chemo reduce mortality?
C
98
What is the Rome III criteria used to asses?
IBS
99
Describe the Rome III criteria
Recurrent abdominal pain for 3 days for 3 months + at least 2 of:
- improvement with defaecation
- change in stool frequency
- change in stool appearace
100
Investigations for IBS
FBC
CRP
tTGA (rule out coelic)
101
Treatment of IBS
```
Low FODMAP diet
Anti-spasmodic (mebeverine, hyoscine)
Anti-diarrhoeal (loperamide)
Anti-depressant (amitryptilline
Stop opiates and analgesia
```
102
What does albumin measure?
Synthetic function of the liver
103
At what level of bilirubin is jaundice clinically detectable?
> 50
104
What does PT time indicate?
Prolonged PT time = decreased clotting factors
105
What do AST/ALT indicate?
Hepatocyte damage (level of inflammation)
106
What do ALP, GGT indicate?
Increase = biliary damage/cholestaisi
| problem with bile flow
107
What is prehepatic jaundice?
Excess haemolysis
108
What in intrahepatic jaundice?
Defects in coagulation of bilirubin within the liver (hepatocyte damage)
109
What is post-hepatic jaundice?
Obstruction to bile flow = dilation of bile ducts = backflow of bile
110
What causes intrahepatic jaundice?
Hepatitis
Drugs
Cirrhosis
Pregnancy
111
Causes of post-hepatic jaundice
Gallstones
carcinoma
biliary stricture
sclerosing cholangitis
112
How is Hep A spread?
faeco-oral route
113
Does Hep A cause liver failure/cirrhosis?
No.
114
Pattern of hepatitis in LFT's
Increase AST/ALT
| Increased bilirubin
115
How is Hep B transmitted?
blood-blood
sexual transmission
vertical transmission
116
What does the presence of Heb B antibody in the blood indicate?
natural immunity
117
What does the presence of Heb B antigen in the blood indicate?
present in all infected individuals
118
What does the presence of Heb B e Ag in the blood indicate?
Highly infectious individual
119
Wht are the antivirals for Hep B?
adefovir
tenofovir
entecavir
peginterferon
120
What are the antivirals for Hep C?
Peginterferonj
| Ribavirin
121
Classic presentation of autoimmune hepatits
Young woman on pill
122
Blood results for autoimmune hepatits
Increase AST/ALT
Increase CRP
ANA +ve
anti-LKM +ve
123
Treatment of autoimmune hepatits
Azathiprine
prednisolone
Ursodeoxycholic acid
124
What is acute fulminant hepatic failure?
Encepathopathy + jaundice
125
Causes of fulminant hepaticfailure
```
Hepatits
EBV
Toxoplasmosis
Paracetamol
Malignancy
Wilson's
Budd-Chiari
```
126
Treatment of fulminant hepatic failure
Increase calroie intake
| Sodium Bicarbonate bath (itch)
127
Symptoms/signs of alcoholic liver disease
```
Steattorhoea
Ascites
Spider naevi
Caput medussae
Jaundice
Nausea/ vomiting
```
128
How does NAFLD lead to cirrhosis?
```
Steatosis (fat deposition)
Oxidative stress
Non-alcoholic steatohepatitis
Fibrosis
Cirrhosis
```
129
Investigation for NAFLD
Ultrasound
| Liver biopsy
130
Complications of cirrhosis
Ascites
Hepatic encephalopathy
Malnutrition
131
Treatment of cirrhosis
Manage complications and support nutitionally
(ascites - no salt + spirnonlactone/paracentesis)
Laxatives to prevent hepatic encephalopathy
LIVER TRANSPLANT
132
What is PBC?
chronic inflammation and destruction of the bie ducts leading to builf up of bile in the liver causing cirrhosis
WOMEN
133
Symptoms fo PBC
```
Jaundice
Itch
Fatigue
Arthralgia
Hepatospleomegaly
Xanthelasma
```
134
Investigations for PBC
AMA +ve
ANA +ve
increased IgM
LFTs show cholestatic pattern
135
Treatment of PBC
Urseodeoxycholic acid
Azathioprine
Prednisolone
136
Investigations for liver cancer
Ultrasound > CT scan > liver biopsy
137
What is a hemangioma?
benign well demarcated echogenic spot
138
What is focal nodular hyperplasia?
central scar, bile ducts, sinusoids + kuppfer cells
| young middle aged women
139
What are heatic adenomas associated with?
Glycogen storage disease
| Oral contraceptive pill
140
What is typically raised in hepatocellular carcinoma?
AFP
141
Who are hyatid cysts most common in?
Farmers
142
What causes polycystic liver disease?
embyronic malformation of the bile ducts
143
What is haemochromatosis?
Abnormal absoprtion of iron due to autosomal recessive mutation in HFE gene
144
Symptoms of haemochromatosis
Signs of liver disease
Hepatoegaly
Hypothyroidism
Slate-grey appearance
145
Treatment of haemochromatosis
Venesection
Low iron diet
Alcohol avoidance
146
What is Wilson's disease?
Autosomal recessive disorder due to reduced eruloplasmin (excess copper)
147
Treatment of Wilson's disease
penicillinamine
148
What is Budd-Chiari syndrome?
Hypercoagulation in the hepatic vein causes clotting - obstruction and thrombosis
149
Causes of Budd-Chiari
Oral contraceptive pill
Thromphilia
Leukaemia
150
Investigations for Budd Chiari
High protein ascetic fluid
| US/CT/MRI shows obstruction
151
Treatment of Budd-Chiari
Thrombolys (streptokinase & aspirin)
152
5 F's of gallstones
```
Fat
Fair
Forty
Fertile
Female
```
153
Symptoms of gallsontes
Nausea vomiting
| Biliary colic Radiation to shoulder
154
What is acute cholecystitis?
Infection of the gall bladder due to accumulated bile as a result of obstruction
155
What is the first line investigation for imaging the ducts?
Ultrasound
156
What is ascending cholangitis?
Gallstones impact in CBD leadsing to infection of the biliary system
157
What is Chorcoats triad?
Jundice
Fever
RUQ pain
158
What is PSC?
Progressive fibrosis and obliteration of the biliary trars
159
What is PSC associated wiht?
UC
160
Who is most affected with PSC?
Men
161
Tests for PSC
pANCA +ve
| ANA +ve
162
Treatment of PSC
prednisolone
| methotrexate
163
Investigation for cholangiocarcinoma
US
164
Treatment of cholangiocarcinoma
resection (surgery)
165
What is the progression to adenocarcinoma?
Polyps
Cholecystitis
Diffuse calcification
Adenocarcinoma
166
Causes of acute pancreatitis
```
G - gallstones
E - ethanol
T - trauma
S - steroids
M - mumps
A - autoimmune
S - scorpion bites/spider bites
H - hyperlipidaemia/hypercalceamia
E - ERCP
D - drugs
```
167
Symptom of acute pancreatits
```
Sever epigastric pain going to the back
Fever
nausea
vomting
Grey-turners sign
cullens sign
```
168
Investigations in acute pancreatitis
```
increased amylase
increased lipase
increased Ca2+
Ultrasound
Glasgow prognostic score
```
169
Treatment of acute pancreatitis
Analgesia & fluids
| ERCP
170
Investigations for chornic pancreatitis
Amylase may be normal
171
Treatment of pancreatitis
```
Stop alcohol
Address diabetes
EnzyMe supplements
Opiates/ NSAIDs for pain
Surgery
```
172
Where are the most common sites of pancreatic cancer?
Head of pancreas
| Ampulla of Vater
173
3 types of endocrine tumours
Insulinoma (hypoglycaemia)
Glucagonoma (hyperglycaemia)
Gastrinoma (acid hypersecretion)
174
How to identify a hernia?
Can get under it
| reducible/irreducible
175
What causes gastric hernias?
Malformation of linea alba
176
What is the difference in location of emoral and inguinal hernias?
Femoral - below and lateral to pubic tubercle
| Inguinal - Aove and medial to pubic tubercle
177
Which hernia is more common in old men, direct or indirect?
Direct
178
What are haemorrhoids?
prolapse of venous plexus
179
Treatment of haemorrhoids?
nothing if assymptomatic
sclerosant
band ligation
180
What is a rectal prolapse?
Protruding mucosal mass from anus usually during/due to defecation
181
What is an anal fissure?
tear in the anal margin distal to dentate line
182
What is fistula in ano?
Abnormal epthelial connection between anal canalnd perianal skin
183
Treatment of fistula in ano
DrainagE
