Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Year 3 Medicine > Amir Sam: GI Med/Surg > Flashcards

Amir Sam: GI Med/Surg Flashcards

1
Q

Causes of hepatomegaly

A

3 C’s plus infiltration:

Cancer (primary or secondary deposits)

Cirrhosis (early, usually alcoholic- otherwise shrunken)

Cardiac: Congestive cardiac failure OR Constrictive pericarditis

Infiltration: fatty infiltration, haemochromatosis, amyloidosis, sarcoidosis, lymphoproliferative diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of liver disease

A

Alcohol

Autoimmune

Drugs

Viruses

Biliary disease (not affecting hepatocytes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Patient with ALT of 300 (high)

A

Liver cell damage: Alcohol, Autoimmune, Drugs, Viruses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of splenomegaly

A

2 Hs, 2 Is:

H (portal Hypertension- chronic liver disease)

H (Haemotological- cancers, lymphoma)

Infection (UK: IE, Infectious mononucleosis (EBV), TB, brucelosis. Abroad: malaria, schistosomiasis, leishmaniasis)

Inflammation (sarcoidosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Chronic liver disease signs:

A

A-J ABCDE in hands:

A: asterixis

B: bruising

C: clubbing

D: Dupuytren’s contracture

E: palmar Erythema

F: fetor hepaticus (pear drops)

G: gynaecomastia

H: hair loss (over chest)

I/J: Icterus/Jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes of abdominal distension

A

Lots of F’s

Flatus (air, obsturction)

Fluid (ascites)

Foetus

Faeces

Fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Casues of Diarrhoea

A

Infection (colitis)

Inflammation (IBD)

Malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Casues of Diarrhoea

A

Infection (colitis)

Inflammation (IBD)

Malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Framework for abdominal pain 2 Q’s

A

Location (9 areas or 4 quadrants)

Character: Intermittent (obstruction), Constant (inflammation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

75 year old man

Epigastric pain

Back pain

PR: 130 bpm

BP: 80/50 mmHg

A

Ruptured Aortic Aneurysm

epigastric pain

back pain

tachycardic and hypotensive (blood loss)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Causes of epigastric pain (not stomach/pancreas):

A

Above, below, left right:

Heart: MI, pericarditis

Aorta: ruptured aortic aneurysm

Liver/gall bladder: cholecystitis, hepatitis

Spleen: splenic rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Presentation of acute pancreatits

A

pain

high amylase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pain

High amylase

A

Acute pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Chronic pancreatitis

A

Pain weight loss

loss of exocrine function

loss of endocrine function

Normal amylase

Faecal elastase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

5 causes of epigastric pain (things there):

A

2 organs there:

Stomach:

  • PEPTIC ULCER (NSAID use)
  • GORD (better with antacids)
  • Gastritis (retrosternal, alcohol) - malignancy

Pancreas:

-Acute pancreatitis (gallstones, alcohol, high amylase)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Epigastric pain

High amylase

A

Acute pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Chronic pancreatitis

A

Chronic epigastric pain

weight loss

loss of exocrine function

loss of endocrine function

Normal amylase

Faecal elastase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

5 causes of epigastric pain (things there):

A

2 organs there:

Stomach: - PEPTIC ULCER (NSAID use)

  • GORD (better with antacids)
  • Gastritis (retrosternal, alcohol)
  • malignancy

Pancreas:

-Acute pancreatitis (gallstones, alcohol, high amylase)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

50 year old man

history of excess alcohol

chronic epigastric pain

losing weight

On insulin

On creon

A

chronic pancreatitis (creon is pancreatic enzymes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

50 year old man

history of excess alcohol

chronic epigastric pain

losing weight

On insulin On creon

Which investigation?

A

Fecal elastase (will be low in chronic pancreatitis- measure elastase in stool)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

50 year old man history of excess alcohol

chronic epigastric pain

losing weight

On insulin On creon

Which investigation?

A

Fecal elastase (will be low in chronic pancreatitis- measure elastase in stool)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Causes of RUQ pain:

A

Liver: Hepatitis Abscesses Malignancy (HCC)

Gall bladder: Cholecystitis Cholangitis Gallstones

Above: Lung (Basal pneumonia)

Left: Stomach/pancreas (peptic ulcer/pancreatitis)

Below: Appendicitis (long appendix- retrocaecal)

Right: Kidney (pyelonephritis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Causes of RUQ pain:

A

Liver: Hepatitis Abscesses Malignancy (HCC)

Gall bladder: Cholecystitis Cholangitis Gallstones

Above: Lung (Basal pneumonia)

Left: Stomach/pancreas (peptic ulcer/pancreatitis)

Below: Appendicitis (long appendix- retrocaecal)

Right: Kidney (pyelonephritis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Causes of RIF pain:

A

Bowel:

Appendicitis

Colitis (IBD)

Malignancy (some dull pain- not PC)

Mesenteric adenitis (in children- infective)

Gynaecological:

Ectopic pregnancy (pregnancy test- urinary hCG)

Ovarian cyst: rupture, tortion or bleed Pelvic inflammatory disease (PID)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Causes of suprapubic pain:
Bladder: Cystitis (inflammation) Urinary retention (stones, clot, malignancy, neurological, constipation)
26
Causes of LIF pain:
Bowel: Diverticulitis Colitis (IBD) Malignancy Gynaecological: Ectopic pregnancy (pregnancy test- urinary hCG) Ovarian cyst: rupture, tortion or bleed
27
5 causes of epigastric pain (things there):
2 organs there: Stomach: - PEPTIC ULCER (NSAID use) - GORD (better with antacids) - Gastritis (retrosternal, alcohol) - malignancy Pancreas: -ACUTE PANCREATITIS (gallstones, alcohol, high amylase)
28
Causes of RIF pain:
Bowel: APPENDICITIS Colitis (IBD) Malignancy (some dull pain- not PC) Mesenteric adenitis (in children- infective) Gynaecological: Ectopic pregnancy (pregnancy test- urinary hCG) Ovarian cyst: rupture, tortion or bleed Pelvic inflammatory disease (PID)
29
Causes of suprapubic pain:
Bladder: Cystitis (inflammation) Urinary retention (stones, clot, malignancy, neurological, constipation)
30
Causes of LIF pain:
Bowel: DIVERTICULITIS Colitis (IBD) Malignancy Gynaecological: Ectopic pregnancy (pregnancy test- urinary hCG) Ovarian cyst: rupture, tortion or bleed
31
Causes of LIF pain:
Bowel: DIVERTICULITIS Colitis (IBD) Malignancy Gynaecological: Ectopic pregnancy (pregnancy test- urinary hCG) Ovarian cyst: rupture, tortion or bleed
32
Causes of diffuse abdominal pain:
Obstruction Infection: peritonitis, gastroenteritis (viral or bacterial) Inflammation: IBD Ischaemia: mesenteric ischaemia (clot in a mesenteric artery) Medical causes: DKA (may be first presentation of T1 diabetes) Addison's disease (adrenal insufficiency) Hypercalcaemia Porphyria (rare) Lead poisoning (rare)
33
65 year old man AAA repair 2 days ago Diffuse abdominal pain PR: 120bpm RR: 30 Blood tests are likely to show: A. Normal lactate B. High amylase C. High bicarbonate D. High sodium E. High Calcium
B. High amylase Amylase can go up in any cause of acute abdomen!! (not specific to pancreatitis) Lactate wont be normal (lactic acidosis will occur as he's sick and hypotensive (tachycardic)) Won't have high bicarb as lactic acidosis (low bicarb) High sodium is very rare (only in diabetes insipidus or people who can't drink) Nothing to suggest high calcium
34
Mesenteric ischaemia: affecting stomach, spleen, liver, gallbladder, duodenum
Coeliac artery
35
Mesenteric ischaemia: Small intestine, right colon
Superior mesenteric artery
36
Mesenteric ischaemia: Left colon
Inferior mesenteric artery
37
55 year old man Excess ETOH use Cirrhosis Confused Abdominal pain Abdominal distension O/E: Ascites, liver flap Consistent with? Investigation?
Spontaneous Bacterial Peritonitis Ascitic tap: measure neutrophils Microbiology: Gram stain and cell count (urgent cell count to start treatment) Cytology: malignant cells Biocheem: protein If \>250 neutrophils/mm3--\> Start treatment: ciprofloxacin
38
55 year old man Excess ETOH use Cirrhosis Confused Abdominal pain Abdominal distension O/E: Ascites, liver flap Which of the following is consistent with SBP: A. Ascites neut ≥ 25 cells/mm3 B. Ascites neut ≥ 50 cells/mm3 C. Ascites neut ≥ 100 cells/mm3 D. Ascites neut ≥ 250 cells/mm3 E. Ascites neut ≥ 500 cells/mm3
D. Ascites neut ≥ 250 cells/mm3
39
Abdominal distension: Clues of fluid
Ascites: shifting dullness, features of liver disease
40
Abdominal distension: Clues of flatus (gas)
Obstruction: - N&V - Not opened bowel - High-pitched tinkling BS - Previous surgery (adhesions) - ?Tender irreducible femoral hernia in the groin
41
Difference between ischaemic colitis and mesenteric ischaemia?
Ishcaemic colitis: blockage of small vessels in colon. Presents with bloody diarrhoea. Colonoscopy- look at mucosa. Mesenteric ischaemia: involves large vessels (coeliac, SMA, IMA). Present with Pain from ischaemia (particularly after eating). CT angiogram- to find blockage
42
50 year old man Jaundice RUQ pain Dark urine Pale stool What is the cause of his pale stool? 1. Low biliverdin 2. High unconjugated bilirubin 3. High conjugated bilirubin 4. Low urobilinogen 5. Low stercobilinogen
5. Low stercobilinogen (makes stool brown- so lack makes a pale stool) Caused by CBD blockage
43
Types of causes of jaundice:
Pre-hepatic: (haemolysis, defective conjugation of bilirubin) Hepatic: (damage to hepatocytes- 4 causes alcohol, autoimmune, drugs, viruses) Post-hepatic: CBD obstruction
44
Bilirubin pathway and metabolism:
Normal breakdown of RBCs in spleen --\> release of unconjugated bilirubin (from metabolism of haem) ---\> conjugated in the liver by Glucuronyltransferase ---\> secreted in the bile ---\> converted to urobilinogen then stercobilinogen (Brown- makes stool brown) in the gut
45
Pre-hepatic jaundice causes:
Excess haemolysis (Haemolysis) or reduced glucoronidation (Gilbert's disease- deficiency of glucronyltransferase enzyme) Anaemic plus jaundiced (with increased reticulocyte count)--\> Haemolysis
46
Jaundiced Anaemic (low Hb) Increased reticulocyte count
Haemolysis
47
Hepatic causes of jaundice:
Hepatitis (4 causes) alcohol, autoimmune, drugs, viruses (leakage of conjugated bilirubin out of hepatocytes into blood- excreted in urine- dark urine)
48
Well man Isolated increased bilirubin Jaundice Possibly starved/dieting
Gilbert's disease
49
Jaundice Dark urine Pale stool
Post hepatic jaundice: CBD blockage Blockage of flow of bile- so leakage of conjugated bilirubin in blood (dark urine) Low/no stercobilinogen in bowel: pale stool
50
Post hepatic jaundice
Blockage of flow of bile by: Gallstones in CBD Stricture Cancer in head of pancreas
51
Differentiation between post hepatic causes of jaundice (jaudnice, dark urine, pale stool)
Pain Colicky pain: Gallstones in CBD Painless: pancreatic Ca
52
Causes of trasudative ascites:
cirrhosis cardiac failure nephrotic syndrome
53
Causes of exudative ascites:
Malignancy (abdominal, pelvic, peritoneal mesothelioma) Infection (TB, pyogenic) Hepatic vein thrombosis (Budd-Chiari syndrome), portal vein thrombosis
54
50 year old man Painless Jaundice Wt loss Dark urine Pale stool O/E: Thrombophlebitis- tracking nodules Blood tests most likely to show elevated: 1. ALP, Ca19-9 2. AST, CA 125 3. ALP, alfa-fetoprotein 4. ALT, alfa-fetoprotein 5. ALP, CEA
1. ALP, Ca19-9 ALP- sign of obstructive jaundince Ca19-9 tumour marker for pancreatic cancer (alpha-fetoprotein AFP is HCC marker- hepatic) Thromboplebitis: Trousseau's sign of malignancy
55
Post hepatic jaundice blood test:
Raised bilirubin Raised AlkPhos and raised GGT
56
Hepatic jaundice blood test (hepatic damage):
Raised bilirubin Raised ALT and raised AST
57
Raised ALT, AST (trasnaminases)
Hepatic damage (alcohol, autoimmune, drugs, virus)
58
Raised AlkPhos (ALP) DDx
Obstructive jaundice (raised GGT) Bone (fracture, bony mets) Others
59
Raised ALP, Raised GGT
CBD obstruction
60
Bilirubin raised ALT very raised ALP raised slightly
Hepatitic jaundice: ALT is more increased than ALP so it is hepatitic not obstructive)
61
Bilirubin raised ALT very raised ALP raise slightly
Hepatitic jaundice: ALT is more increased than ALP so it is hepatitic not obstructive)
62
Ca19-9
Pancreatic cancer
63
alpha-fetoprotein (AFP)
Liver cancer (eg- HCC) Also- testicular cancer
64
CA 125
ovarian cancer
65
CA 125
ovarian cancer
66
Causes of bloody diarrhoea:
Bloody diarrhoea (loss of epithelial integrity): Infective colitis (CHESS) Inflammatory colitis (young, extra-GI manifestations) Ishcaemic colitis (elderly) Diverticulitis Malignancy
67
Infective causes of bloody diarrhoea
Infective colitis: CHESS Campylobacter Haemorrhagic E. coli Entamoeba histolytica Salmonella Shigella
68
Bloody diarrhoea with extra-GI manifestations
Inflammatory colitis Extra-GI manifestations (arthritis, erythema nodosum, uveitis)
69
Question to differentiate between IBS and IBD
Do you have to get up in the night to go to the toilet (nocturnal
70
Management of Acute GI bleed:
- ABC - IV access - Fluids - G&S, cross-match blood- give blood - OGD After: IV PPIs (usually peptic ulcer) Variceal blead (caused by portal hypertension): also give Antibiotics for spread of infection (tazocin), Terlipressin (splanchnic constriction)
71
Investigations of acute abdomen (general)
Ix: Blood: FBC (Hb bleeding, WCC infection), U&Es, LFTs, CRP, clotting, G&S, X-match Erect CXR (air under diaphragm- perforation) CT
72
Management of acute abdomen (general):
Nil By Mouth Fluids 3 A's: Analgesics, Antiemetics, Antibiotics: Cef and Met Monitor vitals and urine output
73
Abx for abdominal surgery
cef and met cephalosporin (to cover Gram +ve and -ve) Metronidazole (to cover anaerobes)
74
Antiemetics
Ondansetron, cyclosisne, metorocloparamide,
75
Jaundice: Investigations
Bloods: FBC (Hb) LFTs: raised ALT, AST (hepatitic), raised ALP, GGT (post-hepatic) CRP Abdominal USS (if raised ALP): after a fast (gallbladder distended and bile-filled so stones visualised better)
76
Dysphagia, weight loss: Investigations
OGD & Biopsy
77
PR bleed, weight loss
Colonoscopy
78
Management of ascites:
- Diuretics (spironolactone +/- furosemide- furosemide only if peripheral oedema) - Fluid restriction in patients with hyponatraemia - Ascitic tap: Micro (cell count, infection), Protein, Cytology (tummour cells) - Monitor weight daily - Therapeutic paracentesis (with IV human albumin) (Treat for encephalopathy if present) (NB. people with cirrhosis have low kidney perfusion and so triggers RAAS, so high aldosterone. Spironolactone is aldosterone inhibitor)
79
50 year old man chronic alcoholic liver disease Ascites Confused Management steps:
- Diuretics (spironolactone +/- furosemide- furosemide only if peripheral oedema) - Fluid restriction in patients with hyponatraemia - Ascitic tap: Micro (cell count, infection), Protein, Cytology (tummour cells) - Monitor weight daily - Therapeutic paracentesis (with IV human albumin)
80
Management of encephalopathy:
Lactulose (10-20ml TDS) Phosphate enemas Avoid sedation Treat underlying cause (GI bleed or infection): Treat infections (SBP- tazocin) Exclude a GI bleed (FBC) Lactulose (reduces transit time in colon- less time for contents to be metabolised by bacteria)
81
Cause of encephalopathy in liver failure:
Bacteria in colon produce toxic metabolites that are removed by the liver
82
Wound infection post op
Erythematous Discharge
83
Anastomotic leak post op
Diffuse abdo tenderness Guarding, rigidity Hypotensive/tachycardic
84
Pelvic abscess postappendicectomy
pain, fever, sweats, mucous diarrhoea
85
Perianal abscess: Presentation and treatment
Tender, red swelling Incision & drainage
86
Anal fissure: Presentation and treatment
Rectal pain (defaecation) Stool coated with blood (not mixed) Advice on diet (fluids, fibre) GTN cream
87
Recurrent pain, bloating (improves with defaecation) Change in the frquency/form of stool No PR bleed, anaemia, wt loss or nocturnal symptoms Most likely diagnosis:
IBS But need to exclude coeliac disease first.
88
Recurrent pain, bloating (improves with defaecation) Change in the frquency/form of stool Very stressed No PR bleed, anaemia, wt loss or nocturnal symptoms Most likely diagnosis:
IBS But need to exclude coeliac disease first (coeliac test)
89
IBS treatment:
- Diet & lifestyle modification - Symptomatic treatment: abdo pain (antispasmodics- buscopan); constipation (laxatives); diarrhoea (anti-diarrhoeals- loperamide)
90
Recurrent pain, bloating (improves with defaecation) Change in the frquency/form of stool Very stressed No PR bleed, anaemia, wt loss or nocturnal symptoms Most likely diagnosis:
IBS But need to exclude coeliac disease first (coeliac test) Diagnosis of exclusion: need to exclude coeliac, IBD, cancer
91
What does the X-ray show?
Thumbprinting (thick haustral folds- inflammation). Thickening of the bowel wall.
92
What does this X-ray show?
Featureless abdo X-ray. Ulcerative Colitis.
93
What does this X-ray show?
Toxic megacolon (\>6cm). Systemic illness
94
Patient presented with diarrhoea. What does this X-ray show? Diagnosis?
Shows faecal loading (but patient has diarrehoea). Therefore: Overflow (spurious) diarrhoea due to faecal loading.

Year 3 Medicine (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions