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conditions Flashcards

1
Q

what post operative care should be given for a liver transplant

A

12-48 hour ICU care
prophylactic antibiotics
anti rejection drugs - steroids , azathioprine, cyclosporine

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2
Q

what are risk factors for developing primary biliary cholangitis

A 
family history 
many UTIs
smoking
other autoimmune diseases 
female , 50
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3
Q

what is the prevalence of IBS

A

10-20% - age of onset <40 years

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4
Q

what diagnostic test confirms cirrhosis

A

liver biopsy

can also ultrasound, MRI, ascitic tap

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5
Q

what is malnutrition

A

state of nutrition in which a deficiency or excess of energy, protein, and other nutrients causes measurable adverse effects on tissue/ body form/ function and clinical outcome
(failure to meet nutritional requirements of individual)

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6
Q

what is the initial management for acute pancreatitis

A

analgesia, Iv fluids, oxygen
blood transfusion if low Hb
nasogastric tube for nutrition
treat underlying cause

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7
Q

what is the operative treatment for gall stones

A 
laparoscopic cholecystectomy 
(can do open/ mini )
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8
Q

what are the main symptoms of IBS

A 
abdominal pain
abdominal bloating - mucus in stools 
altered bowel habit
flatulence/ belching
weight loss
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9
Q

how is oesophageal carcinoma diagnosed

A

biopsy via endoscopy

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10
Q

what is helicobacter pylori

A

genius of spiral flagellated gram negative bacteria, found in the stomach within the mucosal layer
almost always present in gastric/ duodenal ulceration

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11
Q

what advice is given to manage the pancreatic function in chronic pancreatitis

A

low fat/ protein
pancreatic enzyme supplement s
insulin

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12
Q

what is ascites

A

accumulations fluid in the peritoneal cavity

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13
Q

what is tested in the 2007 Scottish bowel screening program

A

from age 50-74 - FOBT every 2 years

colonoscopy if positive

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14
Q

who is entitled to a liver transplant

A

CLD with poor QOL
hepatocellular carcinoma
acute liver fialure
genetic diseases

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15
Q

what are some small bowel causes of a lower GI bleed (only 5%)

A

Meckel’s diverticulum, angiodysplasia, ulceration, aorta-entero fistulation (following AAA repair)

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16
Q

what is the palliative care of jaundice

A

endoscopic stent

opiates, radiotherapy, coeliac plexus block

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17
Q

what is cyclical vomiting syndrome

A

2-3 episodes a day, 2-3 times a month for 2-3 years - need hospitalisation for rehydration

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18
Q

what are oesophageal causes of an upper GI bleed

A

oesophageal varices, mallory weiss tear, malignancy

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19
Q

what drug is given to stop nausea/ vomiting

A

anti- emetic

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20
Q

what are complications of gastritis

A

bleeding, perforation, malignancy, reduced gastric outflow, obstruction due to scarring (Stenosis)

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21
Q

how may a heptacellualr carcinoma present

A

fever, malaise, weight loss, anorexia
RUQ pain/ abdominal pain
decompensated liver function
jaundice/ hepatomegaly

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22
Q

what are the commonest causes of diarrhoea

A 
gastroenteritis
travelling 
IBS
IBD 
colorectal cancer 
laxative abuse 
antibiotic use
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23
Q

what are contraindications of liver transplant

A 
active extraheptaic malignancy 
active substance/ alcohol abuse
active infection outside hepatobiliary tree
sever cardio/ respiratory disease
psychosocial factors
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24
Q

how may you investigate a small bowel cause of a lower GI bleed

A

CT angiogram
capsule endoscopy
MEckel’s scan (scintigraphy)

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25
Q

what is the epidemiology of pancreatic cancer - sex, age, histology

A

M> F
peak at 60-80
majority adenocarcinoma

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26
Q

what does a diffuse oesophageal spasm appear like on a barium swallow

A

corkscrew

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27
Q

why is a colonoscopy gold standard for investigating colorectal cancer

A

allows tissue biopsies to be taken

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28
Q

how may acute pancreatitis present

A

severe abdominal pain - radiate to back
shock - collapse, tachycardia, pyrexia, oliguria
pleural and ascitic effusions
jaundice

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29
Q

what may be the cause of ascites if the serum ascites albumin gradient (SAAG) is <1.1 g/ dl

A

malignancy
Tb
pancreatic / biliary cause
serositis - inflammation of a serous membrane

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30
Q

how would you investigate a suspected peptic ulcer

A

upper GI endoscopy

H pylori test

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31
Q

what is a gastric dielafoy

A

submucosal arteriole vessel erodes through mucosa and bleeds. common in gastric fundus but very rare.

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32
Q

what are symptoms of radiation proctitis

A 
innefective staining to empty bowels
urgency
rectal pain 
diarrhoea
discharges blood/ mucous
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33
Q

which organ does oesophageal cancer commonly metastasise to

A

liver, brain, bone, lungs

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34
Q

what is primary sclerosing cholangitis characterised by

A

inflammation, fibrosis and strictures of the intra AND extra hepatic bile ducts
male dominant

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35
Q

what scores is used to class NAFLD and how does it work

A

NAFLD score - 3 or more categories

age >45, diabetes, BMI >30, AST: ALT ratio, platelet count <150, albumin <34

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36
Q

what is cholangiocarcinoma

A

cancer of the biliary tree

most are slow growing, are distal extra hepatic or per-hilar

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37
Q

what is the gold standard investigation for coeliac disease

A

distal duodenal biopsy

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38
Q

why is there accurate localisation of somatic abdominal pain

A

receptors in parietal peritoneum have afferent nerves that run with segmental nerves

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39
Q

how would may spontaneous bacterial peritonitis present

A

abdominal pain, fever , rights, nausea
ascites - sepsis/ tachycardia
renal impairment

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40
Q

What are inflammatory indicators in the blood

A

high ESR, CRP and platelet count
high WCC
low HB and albumin

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41
Q

what is odynophagia

A

pain on swallowing

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42
Q

what is spontaneous bacterial peritonitis

A

infection within the abdominal cavity without an obvious cause, leading to ascites
common in liver biases (portal hypertension) and nephrotic syndrome

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43
Q

what is dyspepsia

A

difficulty swallowing foods and liquids

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44
Q

what percentage of cholagniocarcinomas are inoperable

A

70% - of those that are 76% reoccur

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45
Q

is ulcerative colitis or crohns disease more common

A

ulcerative colitis

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46
Q

what is NAFLD and its entities

A

increased fat in hepatocytes visualised on USS that can’t be attributed to other causes
3 entities - steatosis, non alcoholic steatohepatitis (NASH), fibrosis

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47
Q

what motility disorders can cause dysphagia

A

achalasia
diffuse oesophageal spasm
systemic - sclerosis, MS
neuro - bulbar palsy, parkinsons, myasthenia gravis, MND

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48
Q

define ulcerative colitis

A

CONTINOUS inflammation that starts at the rectum and moves proximally but only effects the colon

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49
Q

how is a variceal haemorrhage managed

A

endoscopy + band ligation/ telipressin
blood transfusion as required
sengstaken- blakemore tube for uncontrolled bleeding

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50
Q

what does oesophageal manometry measure

A

muscle contraction of peristalsis as patient swallows

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51
Q

what investigations may you do to investigate causes of dysphagia

A

barium swallow
oesophageal ph and manometry
chest xray
endoscopy / biopsy if suspected malignancy

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52
Q

what are common causes of upper GI bleeding

A 
peptic ulcer
inflammation - oesophagitis, gastritis, duodenitis
abnormal clotting
malignancy 
angiodsyplasia
(oesophageal/ gastric causes also)
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53
Q

what is a peptic ulcer

A

breach in the mucosa of the GI tract caused by the actions of gastric acid and pepsin

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54
Q

what 3 scores are used to asses priority for a liver transplant

A

childs pugh - A <7, B 7-9, C>9
MELD
UKELD

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55
Q

why may you do a CXR and AXR in acute pancreatitis

A

look for effusions (pancreatic ascites)

very high amylase level

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56
Q

what is jaundice

A

yellowing of the skin, sclera and mucosa, caused by excess circulating bilirubin

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57
Q

what things may cause a cholangiocarcinoma

A

PSC, biliary cysts, hepatitis, ulcerative colitis, diabetes

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58
Q

what is a sengstaken blakemore tube

A

trans jugular intra-hepatic portosystemic shunt

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59
Q

what is the most common presentation of colorectal cancer

A

rectal bleeding

diarrhoea

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60
Q

what is diverticular disease

A

protrusion of the inner mucosal lining through the outer muscular layer forming a pouch
75% self limiting

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61
Q

what is the ROME III guideline for diagnosis of IBS

A

recurret abdominal pain/ discomfort for > 3 days of the month in the past 3 months, associated with 2 of;
relief by defecation
change in stool frequency / form

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62
Q

what are complications of a pancreatectomy

A 
pancreatic duct stenosis
cyst/ pseudocysts
biliary tract obstruction 
splenic vein thrombosis 
duodenal stenosis
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63
Q

what is the acute management of an upper GI bleed

A 
Protect airway/ give O2
IV fluids
urinary catheter
blood transfusion if Hb drop <70g/L
monitor - pulse, BP, CXR/ ECG. 
urgent endoscopy
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64
Q

how is hepatic encephalopathy graded

A

1- mild confusion

4 - coma

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65
Q

what is the treatment of sever ulcerative colitis

A

Iv hydration
IV + rectal steroids
thromboembolism prophylaxis
(mortality 3% first attack, 23% 2nd attack)

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66
Q

what may be the cause of ascites if the serum ascites albumin gradient (SAAG) is >1.1 g/ dl

A 
portal hypertension
chronic heart failure, pericarditis
budd chiarri (occluded hepatic vein)
liver mets
hypothyroid
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67
Q

how would you investigate someone with achalasia

A

barium swallow
oesophageal manometry (high P in LOS at rest)
xray
endoscopy

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68
Q

are melon and hematemesis presentation of upper GI or lower GI disease

A

upper GI

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69
Q

what may be the cause of vomiting if it is preceded by a loud gurgling

A

GI obstruction

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70
Q

what is the non operative treatment for gall stones

A

dissolution - medical drink

lithotripsy - shock waves to break up stones into urine

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71
Q

what imaging can be done in primary sclerosing cholangitis to reveal anatomy

A

ERCP and MRCP

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72
Q

what is coeliac disease

A

condition in which the small intestine sails to absorb and digest food - sensitive to gliadin fraction of gluten

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73
Q

what are complications of hepatitis C

A

glomerulonephritis

autoimmune hepatitis

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74
Q

what are the risk factors for fatty liver disease

A

obesity , diabetes, hypercholesterolaemia, hypertension

affect 25-40% of population

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75
Q

what causes Ulcerative colitis

A

inappropriate immune response against colonic flora in genetically susceptible individual

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76
Q

what is the commonest cause of liver cancer (90%) and what is its background

A

hepatocellular carcinoma
background of cirrhosis, hep B, hep C
autoimmune hepatitis, NAFLD

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77
Q

what is the 1st line therapy for induction of remission of IBD

A

aminosalicyclates (5ASA)

asacol, i-cool, mesren, salofak - stick to one brand

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78
Q

what is oesophageal cancer associated with

A

male, barrets oesophagus, smoking, alcohol, iron deficiency, anaemia

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79
Q

what are risk factors for GORD

A

pregnancy, obesity
smoking, alcohol, men, caucasian
drugs lowering LOS pressure - tricyclics, anticholinergics, nitrates

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80
Q

What may cause a hepatic encephalopathy (increase NH3 levels)

A

infection
constipation - urea broken down
drugs
GI bleed - oesophageal varices - protein breakdown in blood

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81
Q

what are the most common causes of cirrhosis

A

alcohol
chronic hepatitis B/C
NAFLD/ NASH
portal hypertension ,budd chiari

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82
Q

what are condequences to the body of an altered liver function

A

decreased plasma protein/ clotting factor synthesis

altered drug metabolism

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83
Q

what are joint manifestations of IBD

A

sacrolitis
monoarticular arthritis
ankylosing spondylitis
large joint arthritis

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84
Q

what bloods would you ask for in acute pancreatitis

A 
amylase/ lipase
FBC, U&amp;E
LFT
Ca
glucose
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85
Q

what are some hepatic causes of jaundice

A

hepatitis
hepatocyte damage
defective uptake/ conjugation / excretion

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86
Q

in which part of the pancreas are cancers most likely to occur

A

head - 60%
body - 25%
tail - 15%

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87
Q

what is the diet treatment for IBS

A

limit caffeine , alcohol, sweetener
trial for lactose/ gluten exclusion
FODMAP diet

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88
Q

what is shock

A

circulatory collapse resulting in inadequate tissue oxygen delivery leading to global hypo perfusion and tissue hypoxia

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89
Q

what environmental factors increase risk of colorectal cancer

A 
diet - low fibre, processed meat
alcohol
smoking
obesity 
diabetes
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90
Q

How would you investigate for hep B

A

HBsAg - surface antigen defines carrier status
HbeAg
if IgM acute infection, if IgG chronic infection

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91
Q

what are complications of ulcerative colitis

A 
toxic dilation (risk of perofration)
colonic cancer - give surveillance colonoscopy
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92
Q

what are complications of crohns disease

A 
small vowel ulceration 
abscess formation 
fistulae
colon cancer 
toxic dialtion
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93
Q

what is the mortality rate for GI bleeds

A

7%

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94
Q

what is visceral abdominal pain associated with

A

systemic upset - very unwell, nausea, poor localisation

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95
Q

what are liver manifestations of IBD

A

fatty change
gall stones
sclerosis cholangitis - disease of the bile ducts with multiple strictures

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96
Q

how is gastric cancer treated

A

subtotal gastrectomy

total gastrectomy with Roux en Y construction

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97
Q

how often are cirrhosis patients screened for hepatocellular carcinoma

A

6 months

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98
Q

what is the ‘test and treat’ for H pylori

A

urea breath test

PPI + 2 antibiotics (e.g. lansoprazole, clarithromycin, amoxicillin)

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99
Q

when is a prophylactic protocolectomy offered to people with FAP

A

16-25 years

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100
Q

what are unacceptable complications of IBD medical therapy

A

diabetes, psychosis, severe osteoporosis

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101
Q

what is chronic pancreatitis

A

continuing inflammatory disease of the pancreas characterised by irreversible glandular destruction leading to chronic pain / impairment of function

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102
Q

what if faecal calprotectin

A

white cell protein only present in bowel (<50 normal)

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103
Q

how may hepatocellular carcinoma be treated

A

hepatic resection (lobe grows back)
liver transplant
hormonal - tamoxifen

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104
Q

if someone <55 presents with dyspepsia what test should you give them

A

H pylori - urea breath test

peptic ulcer is most common cause

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105
Q

what psychological problems can present with GI symptoms

A

stress, anxiety, depression, somatisation, eating disorders

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106
Q

what predisposes the gastro-oesophageal reflux of stomach contents (acid/ bile)

A

dysfunction of lower oesophageal sphincter

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107
Q

what blood test results are elevated in primary biliary cholangitis

A

IgM
ALP
GGT and AST: ALT

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108
Q

is visceral abdominal pain well localised

A

no - general to forget, midgut, hindgut (nerves run with vessels)

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109
Q

what criteria is used to predict the severity of pancreatitis within 48 hours and what does it consider

A

Glasgow criteria - severe >3

glucose, WCC, Urea, AST/ALT, LDH, albumin, calcium, PaO2

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110
Q

what is the difference between nausea and vomiting

A

nausea - feeling of going to be sick

vomit - expel contents of stomach through mouth

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111
Q

what is the differential diagnosis of IBD

A

chronic diarrhoea (malnutrition/ malabsorption)
colitis - infective/ ischaemic
ileo-caecal TB - steroids make this worse

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112
Q

what biologics may be used to treat IBD

A

anti TNFa = infliximab (iv), adulimumab (sc)
a4b7 intern blockers = vedolizumab
IL12/23 blockers

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113
Q

describe Dukes staging of colorectal cancer

A

A - tumour confined to mucosa (11%)
B - tumour through mucosa to muscle layer (35%)
C - involvement of lymph nodes (26%)
D - metastatic spread (29%)

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114
Q

what are eye manifestations of IBD

A

uveitis
conjunctivitis
episcleritis

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115
Q

what causes Barretts oesophagus

A

chronic inflammation and damage from GORD or corrosive oesophagitis

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116
Q

what are the 4 F risk factors for gall stones

A

female, fertile (middle age) , fair, fat

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117
Q

what is the 5yr survival of colorectal cancer (by dukes classification )

A

A - 83%
B - 64%
C- 38%
D- 3%

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118
Q

what are gastric causes or an upper GI bleed

A

gastric varices, malignancy, dieulafoy, angiodysplasia

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119
Q

What is the MUST screening for undernutrition

A
  1. BMI
  2. unintentional weight loss
  3. eaten in 5 days
    score >2 risk of malnutrition
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120
Q

what is the gold standard investigation for gall stones

A

USS

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121
Q

how may a peptic ulcer present

A

asymptomatic
weight loss
epigastric pain - relieved by antacids

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122
Q

what is the difference in prognosis of chronic pancreatitis for people who do and son stop drinking

A

stop - 80% 10 yr

continue - 50% 10 yr

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123
Q

what are side effects of 5-ASA

A

rash, haemolysis, hepatitis, pancreatitis

worsening of colitis

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124
Q

what is the difference between a sliding and para- oesophageal hiatus hernia

A

sliding - fundus moves through oesophageal hiatus to chest, LOS becomes less competent
para-oesophageal - bit of the fundus slides up through the hiatus to the chest but junction still remains in the abdomen

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125
Q

what is ischaemic colitis and how does it normally presetn

A

disruption in blood supply to the colon (normally descending/ sigmoid)
crampy abdominal pain, bloody diarrhoea, >60

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126
Q

what are the routes to spread infection in primary peritonitis

A

perforation of the GI/ binary tract
female genital tract
Penetration of abdominal wall - knife etc
Haeamatogenous spread (blood)

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127
Q

why is it important to ask someone with dyspepsia if they had difficulty swallowing foods form the start

A

yes - motility disorder e.g achalasia/ pharyngeal cause

no - solids then liquids - could be a stricture

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128
Q

what is the differential diagnosis of jaundice (and what is the difference)

A

carotenemia - sclera aren’t discoloured

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129
Q

how may hepatic encephalopathy present

A

drowsiness/ confusion
changes in personality
coma

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130
Q

what conditions is coeliac disease associated with

A

DM 1
autoimmune thyroid, hepatitis, PBC,
downs syndrome

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131
Q

what surgical problems may be referred for colorectal surgery

A 
colorectal cancer
UC/ chrohns
diverticualr disease
abnormal function - incontinence, constipation, IBD
congenital
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132
Q

how is hepatitis A spread

A

faecal - orla route

shellfish

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133
Q

what classes of drugs can be given to alleviate GORD

A

alginates - gaviscon
antacids - magnesium trisillicate
H2RA - ranitidine
PPI - omeprazole, lansopazole

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134
Q

what percentage of hep C patients develop silent chronic infections

A

85%

25% get cirrhosis in 20 years

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135
Q

how may crohns dies present

A

diarrhoea
increased frequency
abdominal pain
systemic - malaise, weight loss, anorexia, nausea, fever

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136
Q

why must you repeat an endoscopy after treating a gastric ulcer

A

can lie over a gastric cancer

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137
Q

who is most likely to get primary biliary cholangitis

A

female 90-95%

peak at 50 years

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138
Q

how would you describe a high risk lesion for colorectal cancer

A

size, number, degree of dysplasia, villous architecture

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139
Q

what are complication of GORD

A

ulceration, oesphagitis, parrets oesophagus
stricture narrowing/ fibrosis
carcinoma

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140
Q

how is refeeding syndrome treated

A

slow correction of fluid depletion, thaiamine

feeding at 5-10 kcal/ kg/ 24 hours

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141
Q

what are indications for surgical resection of the bowel

A 
colorectal cancer
benign polyps
diverticular disease
IBD not responding to medical treatment 
perforation
ischaemic bowel
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142
Q

what are signs of chronic liver disease

A 
spider naevi, gynaecomastia
palmar erythema 
loss pf pubic/ axillary hair 
jaundice
ascites
encephalopathy
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143
Q

what is autoimmune hepatitis

A

an inflammatory liver disease of unknown cause, characterised by abnormal T cell function and autoantibodies directed against hepatocyte surface antigens

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144
Q

what drugs affect oesophageal motility

A

nitrates, anticholinergics, Ca blockers

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145
Q

what are some autoimmune causes of cirrhosis

A

autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis

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146
Q

how does hepatitis A present

A

fever, malaise, anorexia, nausua, arthralgia then moves to jaundice, hepatomegaly and splenomegaly
most common in 5-14 year olds

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147
Q

what is the management for acute abdomen

A

ABC
surgery
pain relief
restore circulating volume, ensure tissue perforation/ oxygenation, treat sepsis, decompose gut

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148
Q

what is the differential diagnosis for GORD

A 
oesophagitis
peptic ulcer
non ulcer dyspepsia
oesophageal spasms
malignancy
cardiac disease
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149
Q

what is constipation

A

increased transit time or pelvic dysfunction

Bowel passage may occur infrequently, be painful or faeces hard and small

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150
Q

what are the main symptoms of cholestasis

A

pruritus, pale stools, dark urine, pain , jaundice

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151
Q

how is hepatitis B spread

A

blood, sexual, mother to child, IV drug abuse

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152
Q

what is acute pancreatitis

A

an acute inflammatory process of the pancreas with variable involvement of other regional tissue or remote organ systems (serum amylase x4)

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153
Q

how is gastric cancer diagnosed

A

endoscopy and biopsy

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154
Q

what is the gold standard treatment for achalasia

A

endoscopic balloon dilatation of LOS

also hellers cardiomyotomy - surgical division on muscel fibres in LOS

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155
Q

what is shock staged 1-4 on

A 
volume/ % of blood lost
RR - tachypnoea
HR - tachycardia
BP - hypotension 
pulse pressure 
conscious level - anxious/ confused
urine output - oliguria
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156
Q

what anatomical abnormality commonly leads to GORD

A

hiatus hernia

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157
Q

how would you investigate IBD

A

bloods - FBC, ESR, SRP, platelet, LFT, culture, U&E
stool tests
AXR - shadows, mucosal thickening, dilatation
Lower GI endoscopy (stable) + biopsy (crohns)

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158
Q

what is the value of circulating bilirubin for a patient to become jaundice

A

> 34umol/ L - normal 17

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159
Q

how may primary biliary cholangitis present

A

often asymptomatic

fatigue, pruritus, diarrhoea, jaundice

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160
Q

which tests can be done to investigate the pancreas exocrine function

A

Lundh, pancreolauryl

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161
Q

what is the treatment for ascites

A

diuretics , spironolactone

or large volume paracentesis

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162
Q

what are skin manifestations of IBD

A

pyoderma gangrenosum

erythema nodosum

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163
Q

what behaviours may be seen in anorexia nervosa

A 
self starvation
self induced vomiting
compulsive exercise
laxative use
diet pills 
herbal medicines
overexposure to the cold
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164
Q

what is the cardinal feature of achalasia

A

failure of LOS to relax after swallowing leading to distal obstruction of oesophagus and absent peristaltic contractions

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165
Q

how would you investigate a liver tumour

A

biopsy - histological diagnosis
imaging - US/ CT
bloods - FBC, hepatitis serology, LFTs, clotting, alpha- fetoprotein

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166
Q

what is the best diagnostic test for a hiatus hernia

A

barium swallow

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167
Q

what are complications of colorectal surgery

A 
anaesthetic related
small bowel obstruction 
wound hernia 
bleeding 
sepsis
VTE
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168
Q

how may achalasia present

A

progressive dysphagia (liquids -> solids)
chest pain - substernal cramps
regurgitation
weight loss

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169
Q

what is a liver tumour marker

A

alpha - feto protein (serology test)

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170
Q

what may be done to stage gastric cancer

A

CT chest and abdomen

171
Q

what are the main constituents of gallstones

A

50-80% cholesterol

calcium, carbonate, palmitae, phosphate, bilirubin

172
Q

how may you investigate cholagniocarcinoma

A

USS
ERCP
CT at level of obstruction
bloods - increased bilirubin/ ALP

173
Q

what are cardinal features of intestinal obstruction

A

pain, constipation, vomiting, distension

borborygmi - gurgling due to gas

174
Q

describe the heartburn related to GORD

A

burning, retrsternal discomfort, related to meals, lying down, stooping, straining, relieved by antacids

175
Q

what is a mallory weiss tear

A

linear tear at the oesophageal - gastric junction followed by protracted vomiting and retching (alcoholics)
90% heal themselves

176
Q

what is the treatment for haemorrhoids

A

Milligan morgan open haemorrhoidectomy - very painful

banding (tight band around base cuts of blood supply and they fall off)

177
Q

what are complications of liver failure

A 
sepsis
hypoglycaemia
GI bleeds/ varices
encephalopathy 
cerebral oedema - mannitol
178
Q

what is the prognosis of gastric cancer

A

very poor - 5 year <20 %

179
Q

what is required before a colonoscopy

A

bowel prep

180
Q

what is the prognosis of a liver transplant

A

1 year - 80%

5 year - 60-90%

181
Q

what are signs of alcohol withdrawal

A

raised pulse, low BP
tremor, fits
confusion, hallucinations

182
Q

why is an IgA test not reliable in coeliac disease

A

3% of coelaics don’t make IgA

HLA status - 97% are HLA DQ2/ DQ8

183
Q

what steroids may be used to treat IBD

A

prednisolone - 40mg optimal dose

budesonide - ileal/ ascending colon only, 1st pass metabolism

184
Q

What may be the cause of vomiting if it relieves pain

A

peptic ulcer

185
Q

when is an osmotic laxative good for treating

A

hepatic encephalopathy

produces osmotic diarrhoea, discouraging the growth of ammonia producing organisms

186
Q

what is stool frequency like in IBS

A

constipation alternating with diarrhoea

187
Q

what is the pyramid medical management of IBD

A 
5ASA
steroids
immunosuppresants
biologics
surgery
188
Q

define irritable bowel syndrome

A

mixed group of abdominal symptoms for which no organic cause can be found

189
Q

what stool tests would you do to investigate IBD

A

MC&S, CDT - exclude campylobacter, C difficile, salmonella, shigella, Ecoli
faecal calprotectin

190
Q

why is referring after long periods of starvation potentialy dangerous

A

major fluid and electrolyte shift - K, Ca, S, Mg, insulin

191
Q

what liver enzyme is liekly to be high in an alcoholic

A

GGT

AAT:ALT >2

192
Q

what are pre - hepatic causes of jaundice (un- conjugated bilirubin)

A

Heamolysis - increased quantity of bilirubin

Impaired transport/ liver uptake/ conjugation

193
Q

how may you investigate a jaundice patient to find the cause

A

most important - abdominal ultrasound - shows site of obstruction
liver screening test
urine - if bilirubin is present it is pre- hepatic
LFT
anemia
liver biopsy if ultrasound normal

194
Q

describe the pain presentation of IBS

A 
abdominal 
altered by bowel action 
variable - vague/ sharp/ burning
occasionally radiates to back 
rarely happens at night
195
Q

what is the accepted definition of constipation

A

passage <2 bowel motions/ week, often passed with difficulty, straining, or pain and a sense of incomplete evacuation

196
Q

what are complications of primary biliary cholangitis

A

osteoporosis
malabsorption of fat soluble vitamins
hepatocellular carcinoma

197
Q

what is classed as a sever attack of ulcerative colitis

A

> 6 stools a day +

fever, tachycardia, high ESR/ CRP/ platelet, low albumin anaemic

198
Q

what is the treatment for Dukes B/C colorectal caner

A

chemotherapy

199
Q

what is angiodysplasia

A

abnormal collection of small blood vessels found in the mucosa of the GI tract, from the degeneration of previousy healthy blood vessels

200
Q

what is achalasia characterised by

A

disorder of the oesophagus characterised by uncoordinated or abscent contracts of oesophageal smooth muscel and incomplete relaxation of LOS, leading to difficulty swallowing

201
Q

how are oesophageal and gastric varices treated

A

glue injection

IV terlipreesin - vacoconstricter of splanchnic blood supply (reduces portal pressure)

202
Q

how may oesophageal carcinoma present (usually late)

A 
progressive dysphagia
odynophagia
hematemesis 
weight loss - anorexia
cough 
vocal cord paralysis 
chest pain (heartburn)
203
Q

what % of Barretts oesophagus turn into oesophageal adenocarcinoma

A

6%

204
Q

how may a cholangiocarcinoma present

A 
obstructive jaundice (painless)
itching
fever, mailaise, weight loss
abdominal pain 
peak at 80 years
205
Q

what metabolic associations are there with NAFLD

A

diabetes mellitus, obesity, hypertension, dyslipidaemia

206
Q

how may you investigate a colonic cause of a lower GI bleed

A

flexible sigmoidoscopy

full colonoscopy

207
Q

what liver failure patients have the worst prognosis

A 
age >40 
garde 3-4 encephalopathy 
albumin <30 g/L
raised INR >1.5
drug induced
208
Q

what blood investigations may be done for liver failure

A 
FBC 
U and E
LFT
clotting - raised INR 
glucose
paracetamol level
209
Q

why may a liver transplant be needed to treat a patient with hep D

A

very resistant to treatment as patients normally have sever chronic hepatitis

210
Q

how may gastric cancer present

A

weight loss, nausea/vomiting
early satiety
iron deficiency anaemia
Gi bleeding

211
Q

what are the parameters for an upper and lower GI bleed

A

upper - oesophagus, stomach, duodenum proximal to ligament trietz
lower - distal duodenum to rectum

212
Q

what is the most used stimulant laxative

A

senna

213
Q

how is barretts oesophagus treated

A

endoscopic mucosal resection

radio frequency ablation - current strips away mucosal layer allowing squamos cells to regrow

214
Q

what are the risk factors for developing NAFLD

A 
age 
obesity 
ethnicity (hispanics)
diabetes
genetic factors
215
Q

what is the different diagnosis for dysphagia that is intermittent or constant

A

intermittent - oesophageal spasm

constant - malignant stricture

216
Q

a patient presents with dysphagia - what is your differential ?

A

peptic ulcer/ non ulcer dyspepsia
Oesophagitis/ gastritis/ duodenitis
GORD
gastric malignancy

217
Q

what is the treatment for gastritis

A

lifestyle - smoking and lcohol
H pylori eradication (PPI + 2 antibiotics)
drugs to reduce acid - PPIs, H2RA

218
Q

what is the main treatment for NAFLD

A

lifestyle
diet , exercise, weight reduction
no alcohol
control risk factors

219
Q

what are complications of pancreatitis

A 
abscess 
fluid collection 
pseudocsyst (fluid collection without a lining) 
pancreatic necrosis 
biliary obstruction
chronic - cancer, cirrhosis
220
Q

what is a variceal haemorrhage

A

back flow of blood due to portal hypertension

- oesophageal, gastric, rectal, skin (caput medusa)

221
Q

what is oesophageal squamous cell carcinoma associated with

A

achalasia, strictures, fistulas (trachea - pneumonia)

222
Q

which type of IBD is more likely to have goblet cell depletion and crypt abscesses

A

Ulcerative colitis

223
Q

what are signs of pancreatic cancer

A 
painless obstructive jaundice
thrombophlebitis migrans
hepatomegaly/ splenomegaly 
abdominal mass
supraclavicular lymphadenopathy
224
Q

what are surgical indications of crohns

A

failure of medical management
relief for obstructive symptoms
management of fistula/ anal conditions
anal crohns - tempora stoma to allow chance to heal

225
Q

which drugs, used to treat osteoporosis, are corrosive to the oesophagus

A

bisphosphonates

226
Q

what contrast imaging can be used to investigate the bowel

A

barium enema

227
Q

what investigations may be used to stage oesophageal cancer

A

CT
endoscopic ultrasound
PET scan for mets

228
Q

what is Meckel’s diverticulum

A

sac/ puch formed at weak points in the walls of the GI tract due to a congenital abnormality in the ileum with gastric remnant mucosa
Meckel’s scan - nuclear scintigraphy

229
Q

at what BMI can physical impairment and severe consequences occur

A

physical impairment - <18

sever consequences - <16

230
Q

what are advantages of laparoscopic surgery

A

less scarring
less pain
faster recovery
shorter hospital stay

231
Q

what drug is give to help with pruritus (PBC, PSC)

A

colestyramine

232
Q

what are key questions to ask someone with dysphagia

A

difficulty swallowing solids and liquids form the start?
difficult to initiate swallowing? (bulbar palsy)
Odynophagia?
intermittent or constant?
does neck bulge or gurgle on swallowing? (pharyngeal pouch)
associated features - weight loss

233
Q

what gene is mutated in 95% of pancreatic cancers

A

KRAS2

234
Q

how would you confirm Barretts oesophagus

A

appearance on endoscopy must be confirmed by biopsy

235
Q

what is the blatchford score

A

pre endoscopy score
> 6 - need investigation
(blood urea, haemoglobin, systolic BP. hepatic disease, cardiac failure)

236
Q

how is the pain described in chronic pancreatitis

A

epigastric pain - radiate to back
relieve by sitting forward or hot water bottles
exacerbated by food and alcohol

237
Q

what are risk factors for developing a peptic ulcer

A
  • h. pylori - produces urease/ ammonia that buffer gastric acid to increase production
  • NSAID use - reduced mucus and bicarbonate excretion
  • alcohol excess/ smoking
  • impaired coagulation (anticoagulants/ antiplatelets)
238
Q

where does crohns disease commonly affect

A

small intestine - 30%
ileo- coeacal - 40% - appendicitis
colon/ rectum - 30%

239
Q

what is the main cause of acute <2 weeks diarrhoea

A

gastroenteritis

240
Q

what imaging may you use for pancreatitis and why

A

ERCP
USS - gallstones, pancreatic oedema
CT scan (4-10 days) necrosis, abscess

241
Q

what is crohns disease

A

patchy disease anywhere form mouth to anus, which may skip lesions leaving unaffected bowel between areas of active disease

242
Q

what are the main 2 diseases that make up inflammatory bowel disease

A

crohns disease

ulcerative colitis

243
Q

what investigatiion can be done to look at the portal and hepatic vein (budd-chiari)

A

doppler flow studies

244
Q

what is HNPCC

A

autosmal dominant condition causing DNA micro satellite instability / frequent mutations
early onset - 40s

245
Q

what is Courvoisers sign in a jaundice patient

A

palpable gall bladder - obstruction beyond cystic duct (normal malignant)

246
Q

what are the 3 most common causes of small intestine malabsorption

A

coeliac disease
crohns disease
chronic pancreatitis

247
Q

what infection is strongly associated with gastric cancer

A

H pylori

248
Q

If someone has any of the ALARM features, what should you do?

A

refer for an endoscopy

249
Q

what may cause and intestinal obstruction

A

hernias, adhesions, tumours, strictures, anatomical abnromality

250
Q

what are complications of portal hypertension

A

ascites
spenomegaly
oesophageal varices
caput medusa

251
Q

describe the CAGE alcohol screening

A 
2 or more of;
feel need to CUT down
have you been ANNOYED by being told to stop drinking
ever felt GUILTY 
ever had an EYE opener
252
Q

what is the rockall score

A

upper GI bleed - risk of mortality and risk of further bleeding
(age, shock, co-morbidity, diagnosis, recent haemorrhage)

253
Q

what is the NICE guideline for diagnosing IBS

A

abdominal pain relieved by defeacation or associated with altered stool form/ frequency plus 2 of;

  • altered stool passage
  • abdominal bloating
  • symptoms made worse by food
  • passage of mucus
254
Q

what is the clinical course of hepatitis A

A

presents after 2/3 weeks with fever –> jaundice and settles in 2-3 months (usually self limiting)

255
Q

what are complications of a colonscopy

A

perforation, bleeding

256
Q

how is autoimmune hepatitis diagnosed

A

liver biopsy

elevated IgG 1, 2, 3 +ve autoantibodies

257
Q

how does gall stone most commonly present

A

asymptomatic - found accidentally on scans

258
Q

what is constructional apraxia (sign of liver failure)

A

can’t copy 5 pointed star

259
Q

what result should you get for foecal calprotectin in IBS

A

negative

260
Q

what may cause oesophagitis

A 
reflux oesophagitis - regurgitate acid and peptic juice
alcohol
infection
hiatus hernia
bisphosphonates - corrosive
261
Q

what is dyspepsia

A

indigestion - non specific group of symptoms related to the upper GI tract

262
Q

who is GORD due to para- oesophageal hiatus hernia common in

A

obese >50

treat with lifestyle management

263
Q

what are signs of a decompensated liver function

A

ascites, vatical haemmorhage, hepatic encephalopathy, jaundice

264
Q

what is the surgical treatment of oesophageal cancer

A

oesophagectomy (stomach as conduit)
must be localised and <70
10% mortality - long post op recovery and require nutritional support

265
Q

how dosecondary peritionitis occur

A

rupture of perforation of an abdominal organ

266
Q

when and what immunosuppressants may be used in IBD

A

maintenance of remission/ steroid sparing

azathioprine, methotrexate, ciclosporin

267
Q

what are haemorrhoids

A

enlargement of the normal spongy blood filled cushions in the wall of the anus
nomally caused form straining - not painful

268
Q

what are coeliacs allergic to

A

gliadin fraction of gluten - found in wheat rye and barley but not rice, maize or oats

269
Q

what drug can cause an anal ulceration

A

nicorandil (stop and ulcers heal)

270
Q

what percentage of GI bleeds occur in already hospitalised patients

A

26%

271
Q

what may cause blood diarrhoea

A

campylobacter/ e.coli
IBD
colorectal cancer
colonic polyps

272
Q

what are haemorrhoids

A

enlarged vascular cushions around the anal canal - associated with straining, constipation or low fibre diet

273
Q

when does crohns disease peak

A

20- 40 M=F

>60 - F>M

274
Q

what is the treatment of an anal fissure

A

vasodilator - topical NO, GTN paste, stool softener

surgical - internal spincterotomy (cut muscle of anal sphincter)

275
Q

what is steatorrhea characterised by (fat malabsorption)

A

increased gas, oily/ floating stools, offensive smell

consider pancreatic insufficiency or biliary obstruction

276
Q

what is gastritis and how may it present

A

inflammation of the lining (mucosa) of the stomach

presents epigastric pain and vomiting

277
Q

what is the prognosis for a patients with alcoholic hepatitis if they stop or continue drinking

A

continue - 50% at 1 year

stop - 90% at 1 year

278
Q

how may peritonitis present

A

diffuse abdominal pain, fever, swelling

279
Q

which type of peptic ulcer is most common

A

duodenal over gastric

280
Q

what is the diagnostic test for hepatitis C

A

antibody against HCV

HCV- PCR confirms ongoing infection

281
Q

what is a cutaneous manifestation of coeliac disease

A

dermatitis herpetiformis - blistering and intensely itchy, on scalp, shoulders, elbows and knees

282
Q

in primary biliary cholangitits, what happens to the interlobular bile ducts

A

interlobular bile ducts are damaged by chronic granulomatous inflammation causing progressive cholestasis, fibrosis, cirrhosis and portal hypertension

283
Q

what imaging can be done to investigate colorectal cancer

A

barium enema
CT colonography (3D colonoscopy) - can’t tolerate bowel prep
CT abdome, pelvis
PET scan

284
Q

what are complications of a liver transplant

A

acute rejection
sepsis (esp. gram -ve)
hepatic artery thrombosis
disease recurrence

285
Q

what 2 scores are used to assess the risk of an upper GI bleed

A

rockall score

Blatchford score

286
Q

what symptoms will be seen with choledolithiasis (gall stones in bile duct)

A

obstructive jaundice - painful, dark urine, pale stool, pruritus, steatorrhoea

287
Q

how is angiodysplasia treated

A

endoscopic coagulation with ;
embolisation on angiography
argon plasma coagulation

288
Q

what is the criteria for pancreatic surgery

A

tumour <3 cm , no mets
good respiratory / cardiac function - CXR, ECG, respiratory function tests
psychological scoring system

289
Q

where do squamous cell oesophageal carcinomas occur

A

proximal and middle 1/3

290
Q

what staging is used for colorectal cancer

A 
Dukes classification (A- D)
TNM
291
Q

how is coeliac disease treated

A

lifelong gluten free diet

292
Q

how may primary sclerosing cholangitis present

A

pruritis and fatigue

if advanced - jaundice, cirrhosis, hepatic failure

293
Q

what does vomiting in the morning suggest

A

pregnancy - do test

294
Q

what causes the oesophageal tissue to become resistant to acid/ bile in GORD (erosive)

A

increased relaxation of LOS –> delayed oesophageal emptying –> decreased acid clearance –> mucosa exposed to acid/ pepsin/ bile

295
Q

what modes are used to screen for colorectal cancer

A

foecal occult blood test (FOBT)
foecal immunochemical test (FIT)
flexible sigmoidoscopy (2/3 occur in left bowel)

296
Q

what is a whipples procedure

A

anastomoses of duodenum, pancreas and stomach

297
Q

what mechanical blocks can cause dysphagia

A

malignant stricture (pharyngeal, oesophageal, gastric)
extrinsic pressure - lung cancer, lymph nodes, goitre
pharyngeal pouch

298
Q

what are pathological types of pancreatic cancer

A

75% adenocarcinoma (duct cell mutinous)
carcinosarcoma
cystadenocarcinoma
acinar cell

299
Q

what is the most common histological diagnosis of colorectal cancer

A

adenocarcinoma

75% tubular, 10% villous, 15% tubulovillous

300
Q

how is pancreatic cancer pain relieved

A

sitting forward

301
Q

what is the symptomatic treatment for dyspepsia

A

PPIs, H2R antagonist, lifestyle factors

302
Q

what is an anal fissure

A

break or rent of the mucosa of the anal canal, which commonly presents with anal pain during and immediately following defecation and the passage of bright red fresh blood (more common in young)

303
Q

what drugs can be used to treat alcohol dependence

A

Acamprosate - anxiety/ craving

Disulifiram - unpleasant side effects to any alcohol

304
Q

why is nutrition vital in alcoholic hepatitis

A

100% are malnourished, 33% severe

305
Q

what is familial adematous polyposis (FAP)

A

autosomal dominant mutation causing >100 adenomas throughout colon with a high risk of malignant change in early adulthood (<40)
50% by 15 , 95% by 35

306
Q

how may you want to investigate diarrhoea

A 
FBC , ESR, CRP (anaemia/ infection)
U&amp; E - low K in sever diarrhoea
coeliac serology 
foecal calco-rotino - IBS/ IBD
lower GI endoscopy
examination - dehydration, low skin turgor, long capillary refil
307
Q

what are consequences of malnutrition

A 
impaired immune response
reduced muscle strength 
impaired wound healing 
impaired recovery from illness
more GP appointments
308
Q

where are the commonest liver tumours metastases from

A

breast, bronchus, GI tract

309
Q

what are disadvantages of laparoscopic surgery

A

longer operation time
can’t have had previous abdominal surgery
must be consented for open surgery

310
Q

what are colonic causes of a lower GI bleed

A

diverticular disease, haemorrhoids, polyps, ischamic colitis, IBD, radiation proctitis

311
Q

how may ulcerative colitis present

A

diarrhoea - episodic or chronic
abdominal pain - cramps
increased bowel frequency
systemic - weight loss, fear, malaise, anorexia

312
Q

what can cause pancreatitis

I GET SMASHED O

A 
idiopathic (10%)
gall stones - raised duct pressure 
ethanol (alcohol)
trauma
steroids
malignancy/ mumps and other infections 
autoimmune
scorpion bite 
hyperlipidaemia/ hyper Ca (metabolic)
ERCP
drugs 
obstruction of duct - sphincter of oddi dysfunction/ duodenal obstruction
313
Q

what is bilirubin and its metabolism

A

breakdown product of haemoglobin - conjugated with glucuronic acid by hepatocytes, secreted into bile and passes out into the gut

314
Q

what are magenta stools

A

red/ purple stools - typically from right colon or distal small bowel

315
Q

if someone with colorectal cancer has iron deficiency anaemia, where is the malignancy most likely to be

A

right sided

316
Q

what is the difference between water brash and acid brash (GORD)

A

acid brash - acid or bile regurgitation

water brash - excessive salivation

317
Q

what are common presentations of anorectal disease

A

pain - sharp or dull
haemorrhage - black or red
dysfunction - constipation or diarrhoea
altered frequency - night , caught short

318
Q

what are the risk factors for developing gastritis

A 
alcohol
NSAIDs
H pylori
hiatus hernia 
Granulomas - crohns, sarcoidosis
319
Q

how may a primary liver tumour present

A 
very rare
fever, fatigue, weight loss, anorexia, RUQ pain/ mass
jaundice is late 
hepatomegaly 
decompensated liver function
320
Q

what are symptoms of pancreatic cancer

A

upper abdominal pain - radiate to back

weight loss, anorexia, nausea, fatigue

321
Q

how is hepatic encephalopathy treated

A

underlying cuase
laxatives to clear out bowel
reduce protein/ salt intake
antibiotics

322
Q

how would you treat spontaneous bacterial peritonitis

A

Iv antibitoics

drain ascites fluid

323
Q

what are the symptoms of diffuse oesophageal spasm

A

intermittent dysphagia and severs episodic chest pain (may be confused with ACS)

324
Q

what is oesophageal adenocarcinoma associated with

A

Barretts oesophagus / GORD

325
Q

what is a common history for a fistula in ano

A

abscess in rectum - never healed/ burst creates hole

crohns disease - between adjacent loops of bowel or bladder/ vagina/ skin

326
Q

which enlarged node suggests an intrabdominal malignacny

A

VIrchows - (dysphagia)

327
Q

what does chronic liver failure result from

A

massive necrosis of liver cells leads to severe impairment of function

328
Q

what criteria is used to diagnosis HNPCC

A

amsterdam / bethesda

genetic testing

329
Q

what may be a differential diagnosis for hepatic encephalopathy

A

infection
hypoglycaemia
intra- cranial bleed form fall
delirium

330
Q

how is autoimmune hepatitis treated

A

immunosuppressant - prednisone or long term azathioprine

331
Q

how would you treat hepatitis B

A

pegylated interferon alpha

oral antiviral drugs

332
Q

what percentage of colorectal cancers have a familial risk

A

10 %
5% inheritable conditions - HNPCC/ FAP
(85% sporadic)

333
Q

what are some acquired anorectal disorders

A 
haemorrhoids
fissure
abscess (drain)
fistula - in - ano 
ulceration 
cancer
334
Q

what are signs of liver disease on the body

A 
spider nave
xanthelasma 
loss of body hair
gynaecomastia 
ascites 
hepatomegaly/ splenomegaly
335
Q

what clues in history may lead to jaundice

A 
alcohol
IV drug use
anaemia 
risk factors for liver disease
family history 
blood transfusion
336
Q

what are risk factors for developing pancreatic cancer

A

smoking/ alcohol
chronic pancreatitis
type II diabetes
hereditary FAP

337
Q

what are the risk factors for gastroenteritis

A

travel, diet change, contact with D&V, on PPI,

338
Q

what is the common pain for appendicitis

A

midgut colic –> local right flank

339
Q

what is radiation proctitis

A

previous history of radiotherapy causes inflammation of the rectum

340
Q

which classification system is used for IBD and how does it distinguish the two types

A

Montreal
crohns - age, location, behaviour
uc - extent and severity

341
Q

how can gastric cancer spread

A

direct - surrounding structures
lymphatic
blood - liver
transcoelomic spread - within peritoneal cavity, can lead to rapid dissemination of tumour cells

342
Q

Why can hepatitis D only be present with hepatitis B

A

needs HBsAg to activate core

343
Q

if there is faecal calprotectin in the stool what does this indication (>200)

A

inflammation

344
Q

what are 2 common benign tumours of the liver

A

haemangiomas

adenomas

345
Q

how is hep E transmitted

A

pigs

highest mortality in pregnancy

346
Q

how does a fatty liver appear on ultrasound

A

area of brightness

347
Q

what surgery is done to treat ulcerative colitis

A

sub total colectomy with rectal preservation and an ileostomy

348
Q

if someone presents with epigastric pain, what should you ask if it relates to

A

hunger, specific foods, time of day, aggravating, intermittent or constant

349
Q

what are causes of ascites

A 
infections 
cirrhoiss
portal hypertension
heart failure
cancers in abdomen - liver and ovarian
350
Q

what should you suspect if a patient has odynophagia

A

ulceration - malignancy, oesophagi’s, viral infection, poor steroid inhaler technique

351
Q

what is the presentation of hepatitis B

A

fever, mailasia, anorexia, nausea

incubation period of 1-6 months

352
Q

what LFT would you expect to see in cirrhosis

A

raised bilirubin, AST, ALT, ALP , GGT

353
Q

what is the lifestyle treatment for GORD

A

diet, exercise, stop smoking, small regular meals

avoid hot drinks and alcohol, eating 3 hours before bed

354
Q

what is a functional GI disorder and what diseases does the term include

A

diseases with no detectable pathology but have symptoms related to function
oesophageal spasm, non-ulcer dyspepsia , IBS, slow transit constipation, biliary dyskinesia

355
Q

what are risk factors for developing oesophageal adenocarcinoma

A

obesity, male, middle age, causcasian

356
Q

what is the difference between IBS-C and IBS- D

A

c- muscualr contractions are stronger and more frequency (triggers include walking and eating)
d - muscular contractions are reduced with reduced response to tiggers

357
Q

which drug can cause a GI bleed

A

NSAIDs

also anti coagulants / antiplatelets

358
Q

what drug can be used in sever cases of IBS

A

linaclotide - for bloating and constipation

359
Q

why does pre- hepatic jaundice give normal coloured urine

A

unconjugated bilirubin is insoluble so doesn’t enter urine

360
Q

what are common causes of constipation

A 
poor diet/ fluid intake
IBS
colorectal cancer (+ rectal bleeding) 
stricture/ gi obstruction (+ active bowel sounds)
hypothyroid (+ mennorhagia) 
opiates 
neuromuscular conditions - slow transit 
chronic laxitive abuse
361
Q

what is the medical term for a black stool

A

melena

362
Q

what are the age guidelines of how frequently an IBD patient should have a colonoscopy

A

8-20 years - 3 years
3-40 years - 2 years
40+ - annual

363
Q

what is the most common liver disorder in western industrialised countries

A

Non alcoholic fatty liver disease (NAFLD) - 20%

364
Q

what is the name of the disease caused by tropheryma whippelii that leads to small intestine malabsorption

A 
whipples disease
(skin, brain, joint, cardiac manifestation)
365
Q

what is the difference between mild and sever pancreatitis

A

mild - minimal organ dysfunction and uneventful recovery

sever - organ failure or local complication (15% mortality)

366
Q

what organs are affected in anorectal cancer

A

skin AND adenocarcinoma of bowel

367
Q

what percentage of pancreatic caners are inoperable

A

<10 % - advanced disease + metastases

368
Q

what does heartburn feel like

A

retrosternal pain with acid reflux

369
Q

in blood tests for chronic pancreatitis , what would you expect to be raised and low?

A

raised - LFT, glucose, prothrombin time

low - albumin, Ca, Mg, vitB12

370
Q

when should you investigate constipation

A

weight loss, abdominal mass, anemia, post rectal bleeding

371
Q

what are high risk features for a patient with rectal bleeding

A

persistant changes in bowel habit >6 weeks
persistent rectal bleeding without anal symptoms
right sided abdominal mass
palpable rectal mass
unexplained iron deficiency anaemia

372
Q

what is the criteria for high risk of refeeding syndrome

A

1 or more of - BMI <16, weight loss >15%, no intake in > 10 days, low K, P, Mg
2 or more of - BMI <18.5, weight loss >10%, no intake in >5 days, drug/ alcohol abuse

373
Q

what scores are used to asses alcohol history

A

CAGE

FAST

374
Q

what investigations can be used to see the anatomy of the pancreas

A

EUS, US, CT

size, cysts, duct diameter, tumour

375
Q

what occurs in Barretts oesophagus

A

intestinal metaplasia due to prolonged acid exposure in the distal oesophagus (stratified squamous –> simple columnar, mucus secreting, gastric epithelium)

376
Q

what major surgery is given to those with cholangiocarcinoma

A

major hepatectomy + extra hepatic bile ducts + caudate lobe resection
(stenting biliary trees improves quality of life)

377
Q

what are clinical signs of ascites

A 
dullness in flanks / shifting dullness
spider navei 
palmar erythema
abdominal ven distension 
factor hepaticas (smell)
378
Q

what is the differential diagnosis for duodenal ulcers

A

non ulcer dyspepsia
duodenal Chrohns
pancreatic caner

379
Q

what is the treatment for Dukes A colorectal cancer/ polyps

A

endoscopic resection

380
Q

what is the treatment for H pylori

A

1 week eradication therapy - PPI + 2 antibiotics

381
Q

how is hepatitis A diagnosed (RNA virus)

A

rise in IgM antibodies or AST/ ALTs

382
Q

what is the major haemorrhage protocol for a GI bleed

A 
A 
Breathing - O2 sats
C - Iv fluids, blood transfusion
D
Endoscope once stable
383
Q

how may someone with a peptic ulcer present

A

dyspepsia (indigestion), weight loss, collapse, decreased urine output, melena/ hematemesis

384
Q

how may alcoholic hepatitis present

A

fever, malaise, anorexia, diarrhoea and vomiting

signs of decompensating liver

385
Q

what is an alcoholic

A

someone whose problematic pattern of alcohol use leads to significant impairment or distress, manifested by multiple psychological, behavioural or physiological features

386
Q

how is hepatitis C spread

A

blood transfusion, IV drug abuse, sexual contact

387
Q

what drugs are hepatotoxic

A 
paracetamol
methotrexate
isoniazid
oestrogen 
salicyclates
388
Q

what are side effects of azathioprine (immunosuppressant)

A 
leukopenia
pancreatitis
hepatotoxity - blood monitoring 
lymphoma/ skin cnacer
up to 285 intolerant
389
Q

what is the difference between steatosis and steatohepatisi

A

steatosis - fat deposited in the liver

steatohepatitis - fatty liver with inflammation

390
Q

when does UC peak

A

20-40 , F>M

391
Q

what are complications of hepatitis B

A

cirrhosis, ESLD, hepatocellular carcinoma, polyarteritis nodosa

392
Q

what is the final treatement for GORD

A

anti- reflux surgery fundoplication (increases LOS pressure)

393
Q

how is hepatitis C treated

A

IFN free combination of direct acting anti- viral drugs

394
Q

what is the treatment for primary biliary cholangitis

A

symptomatic - pruritus, diarrhoea, osteoporosis
vitamin prophylaxis A D E K
UDCA - bile acid flushes out bile salts from liver

395
Q

how do you decide when to investigate someone for colorectal cancer if they are >60 or >40

A

> 60 - 1 symptoms

>40 - more than 1 symptom

396
Q

what is diarrhoea defined as

A

increased stool frequency and volume with decreased consistency

397
Q

what is the mean survival of inoperable pancreatic cancer and 5yr survival

A

mean - <6 months

1% 5 year survival

398
Q

what are signs of liver disease on the hands and nails

A 
leukonychia - white spots (hypoalbuminaemia)
terrys nails - distal 1/3 reddened 
clubbing
palmar erythema 
dupuytrens contracture
399
Q

what is hepatic encephalopathy

A

condition in which brain function is impaired by the presence of toxic substances (NH43), absorbed from the colon, which are normally removed/ detoxified by the liver

400
Q

how should all patients with ascites be investigated

A 
ultrasound 
diagnostic paracentesis (needle aspiration ) for cell count, protein and albumin concentration (SAAG)
401
Q

what symptoms may be seen in jaundice

A

biliary colic - RUQ pain, nausea/vomiting, self limiting in a few hours
dyspepsia symptoms

402
Q

what are the alarm symptoms

A 
A - anorexia (lack of appetite)
L-  loss of weight (unintentional)
A - anaemia  (iron deficiency)
R - recent onset (> 55 years or persistent without treatment)
M - maleana/ haematemesis or mass 
S - swallowing problems (dysphagia)
403
Q

in post hepatic/ obstructive jaundice / why is urine dark and stools pale

A

conjugated bilirubin is water soluble so makes urine dark but as less conjugated bilirubin enters the gut the faeces become pale

404
Q

how may coeliac disease present

A 
diarrhoea/ stetorhea
abdominal pain/ bloating 
weight loss
anaemia - angular stomatitis 
fatigue 
dermatitis herpetiformis
405
Q

when may someone with primary biliary cholangitis receive a transplant

A

end stage disease

intractable pruritus

406
Q

what are risk factors for developing cholangiocarcinoma

A

Primary scelrosing cholangiits
congenital cystic disease
hepatolithisasis

407
Q

what is the overall 5 year survival for cirrhosis

A

~50%

408
Q

which type of IMD is more likely to have fistulas and granulomas

A

Crohns

409
Q

how may you investigate a anorectal cancer

A

digital rectal examination

410
Q

what are varices (oesophageal/ gastric)

A

abnormally dilated collateral vessels secondary to portal hypertension that can lead to life threatening bleeding

411
Q

what is the aetiology of IBD

A

mostly unknown
environmental - western?
genetically susceptible

412
Q

how are peptic ulcers treated

A

endoscopy with endotherapy - adrenaline injection + mechanical clip
lifestyle

413
Q

what factors are considered in the Childs Pugh scoring system for liver disease

A 
bilirubin
albumin
prothrombin time
encephalopathy 
ascites
414
Q

what is the difference between acute erosive gastritis and chronic gastritis

A

acute erosive - caused by alcohol excess, NSAIDs, major surgery, burns
chronic - H pylori (smoking, chronic alcohol, binary reflux)

415
Q

what imaging would you do to investigate a pancreatic cancer

A

abdominal ultrasound
endoscopic ultrasound - show mass, distended biliary tree, hepatic masses (biopsy)
CT
ERCP if jaundice

416
Q

what is the 5 year survival for oesophageal cancer

A

<10%

417
Q

what is Mirrizi’s syndrome

A

obstructive jaundice secondary to compression of the common hepatic duct

418
Q

what are high risk groups for colorectal cancer and how often are they given colonscopies

A 
FAP - annual for 10-12 years
HNPCC- 2 years from 25
IBD - 10 years post diagnosis 
family risk (high is 3 FDR< 50/ 3 FDR <60) - 5 years from 50 
previous CRC - 5 yearly
419
Q

what are some post hepatic/ obstructive causes of jaundice

A

gall bladder - obstruction/ blockage of ducts, gallstones, PBC, PSC
pancreatic cancer

420
Q

what is cirrhosis

A

irreversibel liver damage - liver replaces damaged tissue with fibrous nodules (knobbly appearnace)

421
Q

what liver enzymes are raised in alcoholic hepatitis

A

bilirubin, GGT, AlkP

422
Q

what is the medical term for vomiting blood

A

haematemesis

423
Q

what are complications of achalasia

A

aspiration pneumonia

increased risk of squamous cell carcinoma

alimentary system (2 decks)

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