extra gastro Flashcards

1
Q

what deficiencies cause angular chelitis

A

iron,
zinc
vitamins from the B group
- riboflavin (B2),
- niacin (B3),
- pyridoxine (B6),
- folate (B9)
- cyanocobalamin (B12)

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

if a pt is having a UC flare up and isn’t improving on oral and topical ASA what do you do

A

ADD oral prednisolone to the ASA

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

what are the components used to work out child pugh score for liver cirrhosis

A

bilirubin (high)
albumin (low)
PT (prolonged)
encephalopathy (marked)
ascites (marked)

(indicate poor prognosis of the liver cirrhosis)

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

what is small bowel overgrowth syndrome and what is the initial ix for it, in which pts shield you consider it

A

increase in number of bacteria in the small bowel
hydrogen breath test
consider in diabetic pts with symptoms of IBS

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

dull RUQ pain and raised Alanine aminotransferase in a pt with congestive fear failure

A

congestive hepatomegaly

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

what does raised alanine aminotransferase indicate

A

liver damage

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

what class of antibodies are raised in PBC

A

IgM (IgG is raised in AI hepatitis)

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

This middle-aged woman presents with itch along with clinical evidence of ascites (shifting dullness) and xanthelasma. Blood testing demonstrated deranged liver function tests with an obstructive pattern
diagnosis

A

PBC

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

what is the cause of Pigment laden macrophages suggestive of melanosis coli in the intestine

A

laxative abuse

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

which 2 meds are given for oesophageal varicose

A

terlipressin
prophylactic abx

then do endoscopic variceal band ligation and can give propanolol to reduce rebreeding

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

alcoholic pt with haematemsis and epigastric pain
likely diagnosis

A

oesophageal varicies

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

endoscopic intestinal biopsy showed villous atrophy, crypt hyperplasia, and an increase in intraepithelial lymphocytes
diagnosis

A

coeliac

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

pt with liver cirrhosis and ascites presents with abdo pain and fever
diagnosis?

A

SBP

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

pt has haematemesis several Horus after eating, what type of peptic ulcer is it and which artery is impacted

A

duodenal ucler
gatsroduodenal artery

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

which lung cancer presents with clubbing and gynaecomastia

A

adenocarcinoma

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

which lung cancers can cause flushing, and how to differentiate between them

A

carcinoid - not related to smoking
small cell lung cancer - heavily related to smoking

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

which typo of asthma med can cause cushingoid features

A

ORAL steroids - not inhaled, rare

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

difference between stool c diff antigen test vs stool c diff toxin test

A

antigen - shows exposure to the bacteria, past or present
toxin - shows current infection

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

urine copper, and serum caerulopasmin levels in Wilsons

A

urine copper raised
serum caerulopasmin reduced

(In Wilson’s disease, copper is instead deposited in tissue, thereby reducing the apparent need for caeruloplasmin, thereby reducing its levels in the blood)

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

how long should c diff pts be isolated for

A

until they’ve had no diarrhoea for 48 hrs

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

mx for hugh grade dysplasia in oesophagus

A

endoscopic intervention

oesophagectomy reserved for if dysplasia invaded submucosa/supporting tissues

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

M rule for PBC

A

Primary biliary cholangitis - the M rule
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

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

abdominal distension, discomfort, and evidence of transudative ascites, alongside a SAAG of 12 g/L
diagnosis

A

portal htn

  • not Budd chiari, would be more pain and would present with signs of liver failure eg jaundice, encephalopathy, coagulopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is a jejunal biopsy used for

A

coeliac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

tx for c diff which presents with sepsis or grossly dilated colon, or if to doesn’t respond to just the oral vancomycin

A

oral vancomycin (standard c diff tx) AND IV metranidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

tx for acute alcoholic hepatitis

A

prednisolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

which IBD has crypt abscess and only mucosa inflammation

A

uc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

how many bowel movements for mild uc and for moderate uc

A

less than 4 - mild
4 to 6 - moderate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is the stool pattern for overflow diarrhoea and how do you treat it

A

type 7 stools with intermittent hard stools.
Treat with faecal disimpaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

smooth enlarged firm tender liver with pulsatile edge
cause

A

right heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

diagnostic test for psc

A

MRCP

the antibodies are not specific so not diagnostic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

gold standard ix to diagnose pancreatic cancer

A

HRCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

management of psc and pbc

A

ursodeoxycholic acid - all pts should be started on

but only defective tx for if they develop end stage liver failure is liver transplant

but can give symptomatic relief eg
cholestyramine for priorities
lifestyle mods for fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

why could oxycodone result in urinary retention

A

its an opioid which can cause constipation, which in turn causes urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

how soon before upper GI endoscopy should PPIs be stopped

A

Proton pump inhibitors should be stopped 2 weeks before an upper GI endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what does monopsony test check for

A

glandular fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

main side effect of aminosalicylates and how to check for it

A

agranulocytosis
FBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what is hepatorenal syndrome and what is used to treat it

A

a type of functional kidney impairment that occurs in patients with advanced liver disease
key features include
- ascites
- low urine output
- significant increase in serum creatinine

Terlipressin is the recommended first-line treatment for HRS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

reduced libido, erectile dysfunction, muscle pain, suntan colour of skin
diagnosis

A

haemochromatosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

H pylori eradication meds

A

PPI + amoxicillin + clarithromycin
or
PPI + metronidazole + clarithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

common side effect of PPIs

A

hyponatraemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what do pts recovering from SBP need to be discharged with

A

ciprofloxacin - abx prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

which alcohol cessation med cant be given to pts with liver cirrhosis

A

naproxen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

DOAC advice regarding upper GI endoscopy

A

low-risk endoscopic procedures
- the morning dose of DOAC on the day of the procedure should be omitted
high-risk endoscopic procedures
- the last dose of DOAC be taken ≥ 48 hours before the procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

main side effect of long term PPI usage

A

osteoporosis - fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

first and second line tx for haemochromatosis

A

1st - venesection
2nd - desferrioxamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

which skin condition is a risk factor for small bowel bacterial overgrowth syndrome

A

scleroderma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

tx for small bowel bacterial overgrowth syndrome

A

rifaximin antibiotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Proliferation of ductal epithelial cells without evidence of basement membrane invasion

A

ductal carcinoma in situ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What drug will you administer to reduce the risk of isoniazid induced peripheral neuropathy?

A

Pridoxine (vitamin B6)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what is pseudomembranous colitis, cause of it and how it appears on sigmoidoscopy

A

swelling or inflammation of the large intestine (colon) due to an overgrowth of Clostridioides difficile (C difficile) bacteria
looks like yellow plaques on sigmoidoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What feature should be used to determine the severity of c diff infection?

A

WCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

A barium swallow shows a dilated oesophagus that tapers at the lower oesophageal sphincter.
diagnosis

A

achalasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

diet recommendation for pts being tested for coeliac disease with upper GI endoscopy

A

Patients must eat gluten for at least 6 weeks before they are tested

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

A 54-year-old female presents one week following a hip replacement with profuse diarrhoea. What is the most likely diagnosis?

A

c Diff
(patient would have been given broad-spectrum antibiotics at the time of the operation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

most common site for UC

A

RECTUM
NOT SIGMOID COLON

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

prophylaxis tx for oesophageal varices

A

beta blockers
(terlipressin + abx is used in acute bleeding to treat it )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what medications need to be stopped before the urea breath test for H pylori, and how long before do they need to be stopped

A

no antibiotics in past 4 weeks,
no antisecretory drugs (e.g. PPI) in past 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

triad of intestinal angina

A

severe, colicky post-prandial abdominal pain,
weight loss,
abdominal bruit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what is secondary peritonitis

A

occurs when a patient develops an peritoneal infection secondary to another infection, such as diverticulitis or appendicitis.
This is less frequently associated with ascites and a more obvious focus of infection would be noted.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what is a key differential for abdominal pain and fever in patients with cirrhosis and portal hypertension

A

SBP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what nail changes can be seen in coeliac

A

koilonychia
Coeliac disease is associated with iron, folate and vitamin B12 deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

what condition causes nail pitting

A

psoriasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

what condition causes Onycholysis

A

psoriasis or fungal nail infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

what condition causes Subungual keratosis

A

psoriasis or fungal nail infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

what does hoarseness of voice indicate in a pt with dysphagia

A

oesophageal carcinoma - tumour compresses recurrent laryngeal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

what is the time frame for endoscopy for pts suspected of upper GI bleed

A

All patients with suspected upper GI bleed require an endoscopy within 24 hours of admission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

give 2 other cancers caused by HNPCC aside from colorectal cancer

A

endometrial cancer - 2nd most common
pancreatic cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

which cancer does pernicious anaemia predispose to

A

gastric cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

triad of sudden onset abdominal pain, ascites, and tender hepatomegaly

A

Budd chiari

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

fatigue, erectile dysfunction and arthralgia in a man

A

haemachromatosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

tx for suspected variceal haemorrhage

A

terlipressin and IV antibiotics
THEN endoscopy and band ligation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

4 main adverse effects of PPI use

A

hyponatraemia, hypomagnasaemia –> muscle aches
osteoporosis → increased risk of fractures
microscopic colitis
increased risk of C. difficile infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

which abx classically cause c diff

A

clindamycin
or 3rd generation cephalosporins eg cefotaxime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

first line laxative for IBS

A

bulk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

recommended anti emetic for migraine

A

metoclopramide

77
Q

PPI used in pts on clopidogrel

A

lansoprazole
(omeprazole interacts with clopidogrel)

78
Q

what 2 things are monitored during haemachormatosis tx

A

Ferritin and transferrin saturation

79
Q

which antibodies are used to diagnose pernicious anaemia

A

Intrinsic factor antibodies

80
Q

first line test for coeliac

A

ttg abs

81
Q

train of Plummer Vinson syndrome

A

iron deficiency anaemia, dysphagia due to esophageal webs, and atrophic glossitis

82
Q

presents before adolescence with progressive gait instability (ataxia), dysarthria, loss of deep tendon reflexes and hypertrophic cardiomyopathy
diagnosis

A

Friedreichs ataxia

83
Q

in which condition is Metaplastic columnar epithelium seen in the oesophagus

A

barrets oesophagus

84
Q

diagnostic UC investigation during an acute flare up

A

would usually be colonoscopy
but during flare up you would confirm its UC by doing a FLEXIBLE SIGMOIDOSCOPY instead

85
Q

diagnostic ix for suspected Mallory weiss tear vs boerrhaves

A

suspected Mallory weiss: endoscopy
suspected boerrhaves: CT contrast swallow

(if they have haematomesis and are haemodynamically stable its more likely to be mallory weiss)

86
Q

non bloody prolonged history of diarrhoea, normal CRP, low calcium and vit D
diagnosis

A

coeliac

(IBD HAS RAISED CRP)

87
Q

which condition is a major risk factor for cholangiocarcinoma

A

PSC

88
Q

common side-effect of metoclopramide

A

Diarrhoea

89
Q

what is sweet and fecal breath a sign of

A

it is fetter hepatics and a sign of acute liver failure

90
Q

when do you test for h pylori in a pt with upper GI discomfort or bloating

A

testing for Helicobacter pylori is done if symptoms persist despite treatment with a proton pump inhibitor
so start PPI tx first then if sx continue, a 2 week washout period is recommended after stopping the proton pump inhibitor prior to testing for Helicobacter pylori

91
Q

what is a CLO test

A

CLO stands for Campylobacter-like organism and is also known as the Rapid Urease Test. This diagnostic test is used for the detection of Helicobacter pylori by finding the presence of urease.

92
Q

what grade on hepatic encephalopathy is coma

A

grade IV

93
Q

which IBD is associated with gallstones

A

crohns
- Crohn’s disease can result in terminal ileitis, this is the section of the bowel where bile salts are reabsorbed. When this area is inflamed and the bile salts are not absorbed and people are prone to development of gallstones.

94
Q

iron, transferrin, TIBC and MCV in anaemia of chronic disease

A

decreased iron
normal or decreased transferrin
decreased TIBC
normocytic or microcytic

(Anaemia of chronic disease is the body’s physiological response to a danger, such as a potentially harmful pathogen. Like humans, pathogens require iron for metabolism and survival. Therefore, in ACD, the body reduces iron available for pathogens by circulating less around the blood. This means that transferrin decreases.

TIBC measures the number of binding sites on transferrin available for iron. It therefore also increases in ID and decreases in ACD)

95
Q

A 56-year-old man is admitted with a profuse upper gastro intestinal haemorrhage. He is relatively malnourished and has evidence of gynaecomastia
cause of bleeding

A

Oesphageal varices

Patients presenting with gastrointestinal bleeding and evidence of established liver disease may have portal hypertension and develop variceal haemorrhage. The patient may have evidence of jaundice, gynaecomastia, spider naevia, caput medusae and ascites. The bleeding is usually profuse and painless.

96
Q

what is a Dieulafoy lesion

A

single large tortuous arteriole in the sub mucosa of GI system
small lesions of the artery cause GI bleeding

97
Q

what investigation is done to diagnose and monitor liver cirrhosis after their is suspicion of them from the bloods and history

A

transient elastography, often known by the trade name Fibroscan

liver biopsy is only done if aetiology is unclear from non invasive testing

98
Q

what type of anaemia causes a lemon tinge to the skin and why

A

pernicious anaemia
combination of pallor and mild jaundice - due to haemolysis

99
Q

if a pt had H pylori and their symptoms resolve after the 2 week course of tx, do you need to repeat the urea breath test after

A

no
there is no need to check for H. pylori eradication if symptoms have resolved following test and treat

100
Q

what dies swinging fever indicate

A

abscess

101
Q

25 yr old female presents with secondary amenorrhoea and jaundiced sclera. On examination spider naevi are present along with tender hepatomegaly
diagnosis

A

autoimmune hepatitis

102
Q

which condition presents with dysphagia to both solids and liquids simultaneously from the onset

A

achalasia

103
Q

intermittent dysphagia (difficulty swallowing), halitosis (bad breath), and nocturnal coughing
diagnosis

A

pharyngeal pouch / zenkers diverticulum

104
Q

which part of colon inmost like to be affected by ischaemic colitis

A

splenic flexure

105
Q

cause of Liver failure following cardiac arrest

A

ischaemic hepatitis

106
Q

what is diversion colitis

A

a nonspecific inflammatory disorder that occurs in segments of the colon and rectum that are diverted from the fecal stream by surgery (eg, creation of a loop colostomy/ileostomy or an end colostomy/ileostomy with closure of the distal colon segment [eg, Hartmann’s procedure

107
Q

what can cause abnormal fluid balance (peripheral and pleural oedema) and arrhythmias

A

refeeding syndrome

108
Q

when are biologics used for uc

A

inducing remission in people with severe active disease which has not responded to conventional therapy

109
Q

how does diverticulitis present

A

severe left lower quadrant pain,
guarding
fever,
elevated white blood cell count
constipation and less commonly diarrhoea
N&V
bloody faeces
abdominal pain worsens post prandially and is relieved by defecation

110
Q

positive anti-nuclear and/or anti-smooth muscle antibodies in a female with malaise, fever, jaundice
likely diagnosis

A

AI hepatitis

111
Q

how should a recurrent episode of C. difficile within 12 weeks of symptom resolution be treated

A

oral fidaxomicin

112
Q

common drug associated with drug-induced cholestasis

A

oral contraceptive pill

113
Q

which vitamin is teratogenic in high doses

A

vit A

114
Q

a 55-year-old woman presents with swallowing difficulties for the past 5 weeks. She has also noticed some double vision
diagnosis

A

myasthenia gravis

115
Q

what is kaposi’s sarcoma

A

disease in which cancer cells are found in the skin or mucous membranes that line the gastrointestinal (GI) tract, from mouth to anus, including the stomach and intestines. These tumors appear as purple patches or nodules on the skin and/or mucous membranes and can spread to lymph nodes and lungs.

116
Q

problems with dysphagia to only solids, no weight loss, no abnormality on endoscopy, but small mass felt in neck
diagnosis

A

pharyngeal pouch

117
Q

diagnostic ix for pharyngeal pouch

A

barium swallow with fluoroscopy

118
Q

slate grey appearance of skin + joint issues/oseteoarthiritis
diagnosis

A

haemachromatosis

119
Q

how to calculate units of alcohol

A

Alcohol units = volume (ml) x ABV / 1,000

ABV = alcohol by volume eg if its 5% then ABV = 5, not 0.05

120
Q

T2DM with abnormal LFTs (high AST and ALT –> hepatic picture)
likely diagnosis?

A

non alcoholic fatty liver disease

121
Q

Ulcerative colitis + cholestatis (e.g. jaundice, raised ALP)

A

PSC

122
Q

what is is the investigation of choice for suspected carcinoid tumours

A

urinary 5-HIAA

After confirming elevated urinary 5-HIAA levels, further investigations such as colonoscopy and CT abdomen should be considered for localisation of the primary carcinoid tumour and staging of disease. They would not be diagnostic of a carcinoid in the absence of a positive urinary 5-HIAA.

123
Q

describe testing for coeliac disease

A

pt must eat gluten for 6 weeks
then can test for IgA and for ttg antibodies *
and then can do upper GI endoscopy and duodenal biopsy

*This is because TTG antibodies are IgA type, but IgA deficiency is very common. Therefore, without confirming that overall IgA levels are normal, it would not be possible to exclude coeliac disease.

124
Q

what is watery green diarrhoea post cholecystectomy is caused by and what medication can treat it

A

bile acid malabsorption
cholestryramine - bile acid sequestrant

125
Q

pain in RUQ radiates to her back and tip of her right shoulder
diagnosis
and first line ix

A

acute cholecystitis if fever
biliary colic if no fever
ascending cholangitis if fever with jaundice

abdo US

126
Q

what type of drug is terlipressin

A

vasopressin analogue

127
Q

how does co amoxiclav cause jaundice

A

causes cholestasis

128
Q

how is alcoholic ketoacidosis treated

A

infusion of saline and thiamine

129
Q

when does alcoholic ketoacidosis happen

A

This occurs in chronic alcoholics following an episode of reduced intake of food
Once the person becomes malnourished, after an alcohol binge the body can start to break down body fat, producing ketones. Hence the patient develops a ketoacidosis

130
Q

what is the mackler triad for boerrhaves

A

vomiting, thoracic pain, subcutaneous emphysema

131
Q

what does it indicate of CT shows simultaneous dilatation of the common bile duct and pancreatic ducts

A

double duct sign —> pancreatic cancer

132
Q

c diff tx algorithm

A

oral vancomycin
if doesn’t respond - oral fidaxomicin instead
if still doesn’t respond - oral vancomycin + IV metranidazole

or

life threatening c diff: oral vancomycin + IV metranidazole straight away

133
Q

what does thumb prying of small bowel on AXR indicate

A

ischaemic colitis

134
Q

gold standard ix for ischaemic colitis

A

CT

135
Q

ABG for ischaemic colitis

A

metabolic acidosis with raised lactate

136
Q

what is the eye manifestation of Wilsons called

A

Kayser-Fleischer ring

137
Q

what is ALP level usually in a hepatocellular disease

A

normal ALP

138
Q

liver abscess mx

A

drainage and abx

139
Q

what is meckers diverticulum and how does it present

A

congenital abnormality of small bowel
presents before the age of 2
presents as GI bleeding

140
Q

small bowel obstruction and pt has multiple small dark brown and blue macules in his buccal mucosa
diagnosis

A

Peutz Jeghers syndrome

141
Q

mx and prophylaxis of oesphageal varices

A

terlipressin and IV. abx
then endoscopic band ligation
then propanolol prophylaxis

if propanolol or repeat endoscopic banding aren’t helping, can do TIPS procedure

142
Q

what is given to mainsail remission in a uc patient with proctitis and protcosigmoiditis

A

topical mesalazine

143
Q

what is given when the pt has had 2 or more uc flare ups within the last year

A

oral azathioprine

144
Q

triad of CVD, high lactate and soft but tender abdomen

A

mesenteric ischasemia

145
Q

what is the tx for severe alcoholic hepatitis

A

corticosteroids

146
Q

what one thing would you test for if you wish to screen a patient for hepatitis B infection

A

HBsAg

147
Q

what is refractory ascites

A

ascites that does not recede or that recurs shortly after therapeutic paracentesis, despite sodium restriction and diuretic treatment
often due to portal htn

148
Q

what is hepatorenal syndrome and what is type 1 vs type 2

A

hepatic failure then renal failure
type 1 = acute onset (<2 weeks), after acute event eg upper GI bleed
type 2 = more gradual, associated wit refractory ascites - portal htn

149
Q

what is a CLO test

A

CLO testing is a rapid urease test that is done during endoscopy to detect Helicobacter pylori
so is an invasive test and is not recommended for eradication testing unless a patient requires an endoscopy.

150
Q

important side effect of clindamycin

A

diarrhoea
Clindamycin treatment is associated with a high risk of C. difficile

151
Q

if a pt has lower abdo what are the 2 most common causes you must rule out

A

appendicitis
testicular torsion –> EXAMINE THE STCROTUM

152
Q

what should its with new diagnosis of type 1 diabetes or autoimmune thyroid disease be tested for

A

coeliac

153
Q

for which pts is ESWL used fr gallstones

A

pts with symptomatic gallstones who are not suitable for surgery or other txs have failed

154
Q

what ratio of AST:ALT indicates alcholic hepatitis

A

2:1

155
Q

describe the LFTs in hep A

A

high ALT, AST, ALP, bilirubin

It causes liver damage, but at the same time, it also causes cholestasis, which presents as posthepatic jaundice (dark urine, pale stools, moderate hepatomegaly). Hence, you would expect elevated ALP, AST and ALT, in addition to bilirubin,

156
Q

first line mx for NAFLD

A

weight loss
- statins have NOT been shown to slow down progression of NAFLD

157
Q

pt complains of lump in their throat and finds more discomfort on swallowing saliva compared to food or drink
diagnosis?

A

globus hystericus aka globus pharyngis

158
Q

what type of drug is spironolocatone

A

aldosterone receptor antagonist

159
Q

which veins does TIPS connect

A

hepatic vein
portal vein

160
Q

what ix is recommended to confirm diagnosis of NAFLD

A

enhanced liver fibrosis (ELF) testing

161
Q

is ALT a reflection of extent of liver cirrhosis

A

NO

162
Q

which deficiencies is coeliac associated with

A

iron, folate and vitamin B12 deficiency

163
Q

which infection does seafood such as shellfish predispose to

A

hepatitis A infections

164
Q

which infections can present as triad of sore throat, pyrexia and lymphadenopathy

A

infectious mononucleosis
and CMV - but less common, presents in immunocompromised pts

165
Q

how does portal hypertension affect the size of the liver

A

causes liver cirrhosis NOT hepatomegaly

166
Q

what is the next investigation if a PPI dose has failed to stop symptoms of reflex and heartburn but the patient has not red flags

A

tets for H Pylori

167
Q

when is a fistulotomy done instead of seton placement

A

fistulotomy - if fistula doesn’t pas through sphincter muscles or only passes through a small part of it
seton placement - can be done if fistula passes through sphincter muscle

168
Q

what is a possible cause of 12 hour history of very severe abdo pain and bloody diarrhoea, but no infective sx or fever

A

acute mesenteric ischaemia

169
Q

which IBD are pseudo polyps seen in

A

UC

170
Q

first line ix if suspected upper GI bleed eg mallory Weiss tear

A

upper GI endoscopy within 24 hrs

171
Q

first line ix if suspected perforated peptic ulcer

A

erect CXR

172
Q

which ulcers cause pain when hungry, and are relieved by eating

A

duodenal uclers

173
Q

A 4-year-old boy is investigated for chronic diarrhoea, abdominal bloating and failure to thrive
diagnosis

A

coeliac

174
Q

three week history of diarrhoea and crampy abdominal pains and has perianal skin tags on examination
diagnosis

A

crohns

175
Q

which cancer presents with cholestatic LFTs (eg high ALP) and osbtructive jaundice

A

pancreatic cancer
(not hepatocellular carcinoma)

176
Q

ABG for prolonged diarrhoea

A

Normal anion gap metabolic acidosis is

177
Q

ABG for ketoacidosis

A

Raised anion gap metabolic acidosis

178
Q

ABG for Addisons

A

hyperkalaemic metabolic acidosis

179
Q

ABG for opioid toxicity

A

hypercapnic respiratory acidosis (due to hypoventilation)

180
Q

what landmark separates lower and upper GI bleeding

A

ligament of Treitz

181
Q

what is the lifestyle modification recommended for ascites due to liver

A

REDUCE dietary sodium intake

182
Q

low levels of which ion can cause tornadoes des pointes

A

magnesium - hypomagnesaemia

183
Q

which meds should be stopped in c diff infection

A

opioids

184
Q

what is seen in the colon in PSJ

A

HAMARTOMAS

185
Q

when is vitamin K given for bleeding

A

if pt is on warfarin

186
Q

pt has haematemsis due to variceal bleeding, has been given terlipressin and is awaiting OGD, but bleeding continues. what can be done in the meantime whilst awaiting OGD

A

inset a Sengstaken-Blakemore tube to control the bleeding

187
Q

cause of neurological sx + raised ALT + normal bilirubin/albumin

A

Wilsons disease
(normal bilirubin/albumin show that its not acute liver failure so not hepatic encephalopathy)

188
Q

what is oesophageal atresia

A

birth defect where upper and lower oesophagus dont connect