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Yr 4 - ACC > Corrections - GI > Flashcards

Corrections - GI Flashcards

1
Q

What is a useful investigation for stable young females with suspected appendicitis?

A

US: rule out ovarian pathology.

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2
Q

What must be excluded in any elderly gentleman that presents with back pain?

A

AAA (do US)

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3
Q

What is the definitive diagnostic investigation for small bowel obstruction?

A

CT abdomen

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4
Q

What is autosomal dominant polycystic kidney disease (ADPKD) ?

A

The most common inherited condition of the kidneys.

Characterised by the formation of renal cysts and extrarenal manifestations e.g. hepatic cysts, intracranial aneurysms and aortic root dilatation.

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5
Q

What are the most common presenting symptoms of ADPKD?

A
  • haematuria
  • loin pain
  • HTN
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6
Q

Features of ADPKD?

A
  • hypertension
  • recurrent UTIs
  • flank pain
  • haematuria
  • palpable kidneys
  • renal impairment
  • renal stones
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7
Q

What is the most common extra-renal manifestation of ADPKD?

A

Liver cysts (may cause hepatomegaly).

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8
Q

What type of cranial aneurysms can ADPKD cause?

A

Berry aneurysm (can cause SAH)

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9
Q

What is added to IV fluids given in SBO?

Why?

A

IV fluids with additional potassium.

When the bowel segment becomes occluded, the proximal segment of the bowel will enlarge and undergo more peristalsis. This will lead to the secretion of electrolytes in the bowel, most importantly, potassium, causing hypokalemia.

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10
Q

How can AXRs distinguish between SBO and LBO?

A

Haustra –> found in large bowel obstructions

Valvulae conniventes –> found in small bowel obstruction

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11
Q

What does the AAA screening programme consist of?

A

A single abdominal ultrasound for males aged 65

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12
Q

Ischaemic colitis vs acute mesenteric ischaemia?

A

Colonic ischemia: refers to ischemia that affects the colon

Mesenteric ischemia: refers to ischemia that affects the blood vessels of the small intestine

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13
Q

What is acute mesenteric ischaemia?

A

Typically caused by an embolism resulting in the occlusion of an artery which supplies the small bowel, e.g: super mesenteric artery.

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14
Q

What do patients with acute mesenteric ischaemia classically have a history of?

A

AF

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15
Q

Presentation of acute mesenteric ischaemia?

A

Severe & sudden onset abdo pain, out of keeping with physical exam findings.

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16
Q

Management of acute mesenteric ischaemia?

A

Immediate laparotomy is usually required, particularly if signs of advanced ischemia e.g. peritonitis or sepsis.

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17
Q

What is intussusception?

A

The invagination of one portion of the bowel into the lumen of the adjacent bowel, most commonly around the ileo-caecal region.

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18
Q

Who is most commonly affected by intussusception?

A

Infants aged 6-18 months old.

Boys are affected 2x.

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19
Q

Features of intussusception?

A

1) intermittent, severe, crampy, progressive abdominal pain

2) inconsolable crying

3) during paroxysm the infant will characteristically draw their knees up and turn pale

4) vomiting

5) bloodstained stool - ‘red-currant jelly’ - is a late sign

6) sausage-shaped mass in the right upper quadrant

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20
Q

What is the preferred diagnostic test for chronic pancreatitis?

A

CT pancreas.

May show:
- pancreatic calcificatio
- atrophy
- pseudocysts

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21
Q

What test is offered to patients with chronic pancreatitis to screen for diabetes?

A

Annual HbA1c

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22
Q

Are patients required to be kept nil by mouth in acute pancreatitis?

A

No - unless reason e.g. vomiting

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23
Q

Symptoms of viral hepatitis?

A
  • N&V
  • anorexia
  • myalgia
  • lethary
  • RUQ pain

Ask about foreign travel & IVDU.

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24
Q

What is gallstone ileus?

A

This describes small bowel obstruction secondary to an impacted gallstone. It may develop if a fistula forms between a gangrenous gallbladder and the duodenum.

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25
Q

Features of gallstone ileus?

A
  • abdo distension
  • abdo pain
  • vomiting
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26
Q

Describe pain in biliary colic

A
  • RUQ pain, intermittent, usually begins abruptly and subsides gradually.
  • Attacks often occur after eating
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27
Q

Does amylase have diagnostic or prognostic utility in acute pancreatitis?

A

Useful for diagnosis only.

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28
Q

What may be seen on an AXR in chronic pancreatitis?

A

Multiple small calcific foci

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29
Q

What is Budd-Chiari syndrome?

A

A condition characterised by obstruction to hepatic venous outflow.

Also knownas hepatic vein thrombosis.

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30
Q

What is the main risk factor for Budd-Chiari syndrome?

A

An underlying haematological disease or another procoagulant condition:

1) polycythaemia rubra vera

2) thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies

3) pregnancy

4) combined oral contraceptive pill: accounts for around 20% of cases

5) antiphospholipid syndrome

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31
Q

What triad of features is typically seen in Budd-Chiari syndrome?

A

1) abdo pain: sudden onset and severe

2) ascites –> abdo distension

3) tender hepatomegaly

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32
Q

1st line investigation in Budd-Chiari syndrome?

A

US with Doppler flow studies

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33
Q

What is the most common cause of chronic pancreatitis?

A

Alcohol excess

34
Q

What scoring system is used as an indicator of pancreatitis severity?

A

Glasgow criteria

35
Q

What are the indicators of pancreatitis severity?

A

1) Hyperglycaemia

2) Leucocytosis (raised WBC)

3) Raised urea

4) Age >55 years

5) PaO2 <7.9 kPa

6) Hypocalcaemia

7) Raised LDH

8) Low albumin

36
Q

Initial management of pancreatic pseudocyst?

A

Conservative

37
Q

Presentation of Hep A?

A

flu-like prodrome

abdominal pain: typically right upper quadrant

tender hepatomegaly

jaundice

deranged liver function tests

38
Q

What is a key investigation in a suspected perforated peptic ulcer?

A

CXR

39
Q

What cancer does primary sclerosing cholangitis predispose to?

A

1) cholangiocarcinoma (in 10%)

2) increased risk of colorectal cancer

40
Q

What sign may be seen on MCRP in pancreatic cancer?

A

Double duct sign –> where there is dilatation of both the common bile duct and the pancreatic duct,

41
Q

What is the best test to confirm a diagnosis of an acute haemolytic reaction?

A

Direct Coombs test: can confirm haemolysis

42
Q

Features of a Transfusion Related Acute Lung Injury (TRALI)?

A

1) hypotension
2) pyrexia
3) normal/unchanged JVP

43
Q

In any case of acute abdomen in a female of child-bearing age, what test is MANDATORY (i.e. regardless of what woman says)?

A

Pregnancy test

44
Q

What management is indicated in patients with an ongoing acute bleeding ulcer despite repeated endoscopic therapy?

A

Surgical exploration and repair of the ulcer at laparotomy.

45
Q

Features of portal HTN?

A
  • ascites
  • splenomegaly
  • caput medusae
  • rectal varices (can cause lower GI bleeding)
  • oesophageal varices
46
Q

What 3 conditions can ischaemia to the lower GI tract be separated into?

A

1) acute mesenteric ischaemia

2) chronic mesenteric ischaemia

3) ischaemic colitis

47
Q

What are the common predisposing factors in bowel ischaemia?

A

1) increasing age

2) atrial fibrillation - particularly for mesenteric ischaemia

3) other causes of emboli: endocarditis, malignancy

4) CVS disease risk factors: smoking, hypertension, diabetes

5) cocaine: ischaemic colitis is sometimes seen in young patients following cocaine use

48
Q

Investigation of choice in bowel ischaemia?

A

CT

49
Q

How can BP be used to differentiate between TACO and TRALI?

A

TRALI - hypotension

TACO - hypertension

50
Q

Should an anaphylactic reaction to blood transfusion be immediately treated with IM or IV adrenaline?

A

IM adrenaline

51
Q

What is graft vs host disease (GVHD)?

A

A multi-system complication of allogeneic bone marrow transplantation.

52
Q

What is acalculous cholecystitis?

A

Gallbladder inflammation without gallstones.

It’s less common, but usually more serious.

53
Q

What is primary biliary cholangitis?

A

A chronic liver disorder. Thought to be autoimmune.

Interlobular bile ducts become damaged by a chronic inflammatory process causing progressive cholestasis which may eventually progress to cirrhosis.

54
Q

Who is primary biliary cholangitis typically seen in?

A

Middle aged females

The classic presentation is itching in a middle-aged woman.

55
Q

What condition is primary biliary cholangitis often associated with?

A

Sjogren’s syndrome (a condition that affects parts of the body that produce fluids e.g. dry eyes, dry mouth).

56
Q

What 4 conditions is primary biliary cholangitis associated with?

A

1) Sjogren’s syndrome (seen in up to 80% of patients)

2) rheumatoid arthritis

3) systemic sclerosis

4) thyroid disease

57
Q

Clinical features of primary biliary cholangitis?

A
  • early: may be asymptomatic (e.g. raised ALP on routine LFTs) or fatigue, pruritus
  • cholestatic jaundice
  • hyperpigmentation, especially over pressure points
  • around 10% of patients have RUQ pain
  • xanthelasmas, xanthomata
  • also: clubbing, hepatosplenomegaly
  • late: may progress to liver failure
58
Q

Immunology results in primary biliary cholangitis?

A

1) anti-mitochondrial antibodies (AMA) M2 subtype are present in 98% of patients and are highly specific

2) smooth muscle antibodies in 30% of patients

3) raised serum IgM

59
Q

What serology result is highly specific for primary biliary cholangitis?

A

AMA

60
Q

1st line management of primary biliary cholangitis?

A

ursodeoxycholic acid (slows disease progression and improves symptoms)

61
Q

What does a positive surface antigen (HBsAg) indicate in hep B infection?

A

Implies active infection (either acute or chronic).

62
Q

What does anti-HBs indicate in hep B infection?

A

Anti-HBs indicates immunity and is therefore negative in acute infection.

63
Q

Jaundice following abdominal pain and pruritus during pregnancy - what condition?

A

Acute fatty liver of pregnancy

64
Q

Primary biliary cholangitis - the M rule:

A
  • IgM
  • anti-Mitochondrial antibodies, M2 subtype
  • Middle aged females
65
Q

Symptoms of vitamin C deficiency?

A
  • Follicular hyperkeratosis and perifollicular haemorrhage
  • Ecchymosis, easy bruising
  • Poor wound healing
  • Gingivitis with bleeding and receding gums
  • Sjogren’s syndrome
  • Arthralgia
  • Oedema
  • Impaired wound healing
  • Generalised symptoms such as weakness, malaise, anorexia and depression
66
Q

What may be used to stop an uncontrolled variceal haemorrhage?

A

A Sengstaken-Blakemore tube.

This has oesophageal and gastric balloons which can be inflated to tamponade the variceal bleeding. It is inserted through the nose.

67
Q

What is important investigation in patient with UC flare who has developed abdominal pain and a low grade pyrexia?

A

AXR - rule out toxic megacolon

68
Q

What is the diagnostic investigation of choice for pancreatic cancer?

A

High resolution CT

69
Q

What is most common organism causing watery travellers diarrhoea?

A

E. coli

70
Q

What is the double duct sign?

What condition does it indicate?

A

The combined dilatation of the common bile duct and pancreatic duct –> often indicates pancreatic cancer.

Seen on imaging e.g. ERCP, MRI, US, CT

71
Q

In pregnant women with jaundice following abdo pain and pruritus, what is likely condition?

A

Acute fatty liver of pregnancy

72
Q

What may be deficient in patients with easy bruising?

A

Vitamin C

73
Q

What condition causes classic ‘beaded’ strictures on ERCP?

A

UC

74
Q

Management of alcoholic ketoacidosis?

A

1) 0.9% saline infusion - to hydrate patient and normalise ketones

2) add thiamine - due to alcohol history

75
Q

What is a common presenting complaint of Peutz-Jegher’s syndrome?

A

Small bowel obstruction (due to growth of multiple benign polyps within the GI tract).

76
Q

1st line medication for primary biliary cholangitis?

A

Ursodeoxycholic acid

77
Q

Which Abx is a well recognised cause of cholestasis?

A

Co-amoxiclav

78
Q

Roughly how long after pancreatitis can a pancreatic pseudo-cyst occur?

A

roughly 4 weeks after

79
Q

What is the mainstay of management of a COPD exacerbation?

A

5 day course of oral prednisolone.

Only consider Abx if purulent sputum or clinical signs of pneumonia.

80
Q
A

Yr 4 - ACC (73 decks)

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