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Gastroenterology > Extra > Flashcards

Extra Flashcards

1
Q

Vomiting that relieves pain

A

Peptic ulcer

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2
Q

Vomiting preceeded by loud gurgling

A

GI obstruction

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3
Q

Constipation + menorrhagia

A

Hypothyroidism

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4
Q

Constipation + blood PR

A

Cancer

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5
Q

Constipation, distension and active bowel sounds

A

Obstruction

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6
Q

Poor prognostic factors for GI bleeding

A 
Older
Low systolic BP
Tachycardic 
Co-morbidities 
Above = Rockall score 
Post-endoscopy Rockall score - diagnosis of upper GI malignancy (2), Malory Weiss or no lesion (0), all other diagnoses (1) 
If signs of recent haemorrhage

Poor urine output
Peripherally shut down
Low GCS

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7
Q

Stain for iron loading

A

Perls stain

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8
Q

Anti mitochondrial antibodies

A

PBC

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9
Q

Anti smooth muscle antibodies

A

Autoimmune hepatitis

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10
Q

Anti nuclear antibody

A

Autoimmune hepatitis

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11
Q

Anti endomysial

A

Coeliacs disease

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12
Q

Transglutaminase

A

Coeliacs disease

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13
Q

Alpha gliadin

A

Coeliacs disease

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14
Q

What is beri beri?

A

Thiamine - b1 deficiency

Heart failure with oedema (wet) or neuropathy (dry)

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15
Q

What is pellagra?

A

Lack of nicotinic acid
3 d’s - dementia, diarrhoea and dermatitis

Also neuropathy, depression, insomnia, other Neuro symptoms

Endemic in China and Africa

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16
Q

ALT higher than AST

A

ALTernative diagnosis to alcoholic liver dies as

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17
Q

AST higher then ALT

A

Alcoholic liver disease

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18
Q

Pabrinex

A

High dose vitamin b’s - including thiamine

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19
Q

What is acute abdomen?

A

Severe sudden abdominal pain of unknown aetiology

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20
Q

What is the cough test

A

Ask patient to cough - if in pain, flinching or a protective movement of hands to abdomen
Suspect peritonitis

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21
Q

Blunt or penetrating trauma + acute abdomen

A

Blunt - splenic rupture (can be delayed)

Penetrating - liver rupture

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22
Q

Signs of peritonitis

A

Shock, lying still, cough test, rigid abdomen, guarding, no bowel sounds

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23
Q

DDX of peritonitis

A

Acute pancreatitis has similar signs but doesn’t need laparotomy
Therefore always check amylase and can do erect X-ray - gas under diaphragm in peritonitis

24
Q

Best way of assessing shock from hypovolaemia

A

Assess perfusion of organs
Skin - cap refill
Brain - GCS
Kidney - urine output

Also do BP, pulse and RR

25
Q

Pain of appendicitis

A

Starts mid-abdomen, peri-umbilical - referred pain

Then lateralises and settles at McBurney’s point

26
Q

What is Rosvings sign

A

Pain in RIF when LIF is pressed - sign of acute appendicitis

27
Q

What is Psoas sign

A

Pain on extending hip if retrocaecal appendix

28
Q

Cope sign

A

Pain on flexion and internal rotation of hip if appendix in close relation to obturator internus

29
Q

Antibiotics in appendicitis

A

Cefuroxime and metronidazole

30
Q

Type of pain in intestinal obstruction

A

Colicky pain

31
Q

Signs of ileus aka functional obstruction

A

Bowel sounds absent - no pain

32
Q

Indications for gastric surgery

A

Cancer and pyloric or duodenal peptic ulcers

33
Q

What is murphys sign?

A

Lay two fingers over RUQ - ask patient to breathe in
Causes pain and arrest of inspiration due to inflammation
Sign of acute cholecystitis

Only +ve if same test in LUQ doesn’t cause pain

34
Q

Jaundice and RUQ pain - and fever

A

Cholangitis

No jaundice if biliary colic or acute cholecystitis

35
Q

Assessment of severity of pancreatitis

A 
PANCREAS
PaO2  55
Neutrophilia WBC >15 x109 
Calcium  16
Enzymes - LDH and AST
Albumin  10
36
Q

Raised bilirubin but normal liver enzymes

A

Gilberts syndrome - enzyme which conjugates bilirubin is dysfunctional therefore high levels or serum bilirubin - Unconjugated therefore can’t go into urine - no bilirubin in urine

37
Q

Raised ALP but normal GGT

A

Suspect bone cause of raised ALP

38
Q

Burning retrosternal pain and dysphagia

A

Erosive oesophagitis

39
Q

What drug reduces the pressure of blood coming from the liver

A

Somatostatin

40
Q

How does terlopressin work?

A

Narrows blood vessels to small intestine

41
Q

What is crigler-Najjar syndrome?

A

More extreme form of gilberts syndrome - enzyme which conjugates bilirubin is dysfunctioning - usually presents neonatally and requires transfusion

42
Q

What can exacerbate gilberts syndrome?

A

enzyme deficit is heightened in intercurrent illness (viral infection) and fasting

43
Q

What are coryzal symptoms?

A

Common cold viral infection symptoms

44
Q

Rotor syndrome

A

Rise in conjugated bilirubin - in urine

Not itchy

45
Q

Helicobacter pylori treatment

A

First line PAC or PMC for a week

Then add bismuth subcitrate for 2 weeks

46
Q

Cyclizine side effects

A

Antihistamine causes dry mouth and drowsiness

47
Q

Hyoscine butylbromide

A

Anti spasmodic

Anti muscarinic side effects eg. Dry mouth and blurred vision

48
Q

Metoclopramide side effects

A

Anti-emetic
Causes oculogyric crisis caused by blockade of central D2 receptors - uncontrollable rolling back of the eyes - also lateral neck flexion, open mouth and protruding tongue

49
Q

Side effects of omeprazole

A

Headache and GI upset

50
Q

Side effects of ondansetron

A

Anti emetic - headache and constipation

51
Q

What is Paul bunnell monospot test

A

Tests for heterophil antibodies

Develop in 90% of patients with mononucleosis

52
Q

What can giving glucose (for hypoglycaemia or dehydration) cause in an alcoholic

A

Potentially thiamine deficient therefore can precipitate encephalopathy
Therefore give pabrinex ampoules - vitamin c and b - 3x day

53
Q

Test correct position of NG tube

A

Test ph of aspirate

If

54
Q

Arthritis and conjunctivitis in setting of abdominal pain and diarrhoea

A

IBD

55
Q

What can rapid correction of hyponatraemia lead to?

A

Bulbar palsy (speech and swallowing) and central pontine myelinolysis (limb weakness)

56
Q

Coffee ground vomit

A

GI bleeding

Gastroenterology (5 decks)

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