Gastro Flashcards
1
Q
Where is most water absorbed in digestive system?
A
Jejunum
2
Q
Cause of ascending cholangitis
A
E.coli infection and gallstones
3
Q
Where is blockage ascending cholangitis
A
Biliary tree = jaundice
4
Q
Sx ascending cholangitis
A
Charcot’s triad - RUQ pain, fever and jaundice
5
Q
Tx ascending cholangitis
A
Biliary drainage and cefotaxime
6
Q
Sx primary sclerosis cholangitis
A
Jaundice
Increased bilirubin and ALP
RUQ pain
Fatigue
Itchy
7
Q
Ix primary sclerosis cholangitis
A
ERCP
+ PANCA
8
Q
Associations primary sclerosing cholangitis
A
UC and Crohn’s
9
Q
Tx primary sclerosis cholangitis
A
Liver transplant and antibiotics
10
Q
Risk factors primary biliary cholangitis
A
Female, forty, fat, fertile
11
Q
Ix primary biliary cholangitis
A
AMA M2 ABs
MRCP
12
Q
Sx primary biliary cholangitis
A
Jaundice
Hyperpigmentation
RUQ pain
hepatosplenomegaly
13
Q
Tx primary biliary cholangitis
A
Ursodeoxycholic acid
Cholestyramine for itch
14
Q
What is biliary colic?
A
Blockage in bile duct = intermittent RUQ pain
15
Q
Treatment biliary colic
A
Morphine and surgery
16
Q
Investigations biliary colic
A
US and inflammation markers
17
Q
Risk factors biliary colic
A
Female, fat, fertile, forty
18
Q
Symptoms biliary colic
A
Colicky RUQ pain that radiates to shoulder
Pain worse after eating
N + V
+/- jaundice
19
Q
What is cholecystitis
A
Gallstones in cystic duct = no jaundice
20
Q
Treatment cholecystitis
A
Cholecystectomy
Metronidazole
Cefuroxime
21
Q
Investigations cholecystitis
A
US and contrast imaging - GB not always seen
22
Q
Symptoms cholecystitis
A
RUQ pain -> shoulder
Fever
+ve Murphy
Increased WCC and inflammatory markers
23
Q
Cause of peptic ulcers
A
Helicobacter Pylori infection
24
Q
Symptoms of peptic ulcers
A
Pain, haematemesis, melaena, hypotension, tachycardia
25
Treatment for peptic ulcers
2x ABx and 1x PPI
Endoscopic intervention is first line
26
Investigations peptic ulcers
Breath test for H.pylori
Endoscopy
27
Gastric ulcers
Reduced effectiveness of gastric mucosal repair = worse pain with food
Occur in lesser curve/antrum
28
Duodenal ulcers
Anterior/1st part of duodenum
Pepsin/acid action on normal lesion
Pain when hungry/better with food
29
What is liver cirrhosis?
Fibrosis of liver caused by inflammation
30
Causes of liver cirrhosis
Alcoholic liver disease
NAFLD
Hep B and C
31
Sx liver cirrhosis
Jaundice
Organomegaly
Spider naevi
32
Treatment stable varices
TIPS
33
Treatment bleeding oesophageal varices
Terlipressin and sengstacken
34
Stages of alcoholic liver disease
Alcohol related fatty liver - fat in liver, reversible
Alcoholic hepatitis - inflammation of liver, can be reversed
Cirrhosis: scar tissue, irreversible
35
How is hep A transmitted
Foeco-oral route (contaminated food and water)
36
Sx hep A
Nausea, anorexia, vomiting, jaundice
Cholestasis
37
Treatment hep A
Self-resolving 1-3 months
38
Spread of hep B
Direct contact with blood/bodily fluids (sex, needles, toothbrushes)
39
notifiable disease to PHE
hep a and b
40
What is haemochromatosis?
Excessive total iron and deposition in tissues
41
Cause of haemochromatosis
Mutation in HFE protein in chr 6- autosomal recessive
42
Sx haemochromatosis
Tiredness, joint pain, pigmentation, ED
43
Tx haemochromatosis
Venesection
Avoid alcohol
44
What is Wilson's disease
Too much copper
45
Sx Wilson's
Psychiatric problems
Concentration difficulties
Dysarthria
46
Disease causing Kayser-Fleischer rings in cornea on slit lamp exam
Wilson;s
47
Ix Wilson's
Liver biopsy
48
Mx Wilson's
Penicillamine
49
Ulcerative colitis sx
pANCA +ve, Just colon, continuous inflammation, mucosa and submucosa, bloody stool
Depleted goblet cells
50
Crohn's disease
Any part of GIT, skip lesions, deeper layers of mucosa
51
UC management
Aminosalicylate
Corticosteroids
52
Drugs causing haemolytic
Primaquine, ciproflaxacin and sulph- containing drugs (sulphasalazine etc)
53
Pathway for haemoglobin breakdown
Hb - hame - biliverdin - bilirubin - liver (conjugation) - bile duct - gut - glucuronic acid removed - stercobilinogen - stercobilin
54
Dubin Johnson
Autosomal recessive
Mutation in protein MRP2
Causes increased conjugated bilirubin
55
Rotor syndrome
Autosomal recessive
Defect in bilirubin uptake and storage
Increased conjugated bilirubin
56
Hereditary spherocytosis
Autosomal dominant
North European affected
Sx = neonatal jaundice, gallstones, spherocytes
Dx = EMA binding
57
G6PD deficiency
Mediterranean/african heritage
X-linked recessive
Sx = neonatal jaundice, gallstones, splenomegaly, Heinz bodies
Dx = G6PD measure
Presents within first 24h of life
58
How does G6PD normally act?
G6PD produces NADPH, which produces glutathione
Glutathione protects RBCs from oxidative stress
59
Gilbert's syndrome
Decreased UGT = increased unconjugated bilirubin
Autosomal recessive
Occurs on stress e.g. exercise
60
Newborn jaundice
Normally physiological (e.g. hepatic immaturity) and occurs when baby is <24h old
Normally resolves in 14 days
61
Crigler-Najjar syndrome
No UGT so no conjugation = increased UCB
type 1 is most severe and no survival
type 2 is less severe and some survive
62
Pre-hepatic jaundice
Increased UCB
Issue occurs before liver
E.g. haemolysis, anaemias
Normal stools and urine
Normal ALP and AST
63
Hepatic jaundice
Increased conjugated and unconjugated bilirubin
Issue lies in liver - either damaged hepatocytes (hepatitis/cirrhosis) or can't conjugate (Gilbert's/Crigler Najjar)
Dark urine/pale stool
Increased ALP and AST
64
Post-hepatic jaundice
Increased CB but normal UCB
Impaired movement to intestines
E.g. cholecystasis, carcinoma of pancreatic head
Dark urine/pale stool
Increased ALP and AST
65
Which cells secrete intrinsic factor?
Parietal
66
Where is gastrin secreted?
G-cells (stomach)
67
Function of gastrin
G cell stimulated by stomach distension
Gastrin acts on ECl to increase HCl production
68
Function of cck
bile movement for digestion
69
Where is cck secreted?
I cells (small intestine)
70
where is secretin produced
s cells of small intestine
71
function of secretin
released bicarbonate and decreases gastric acid when pH is high
72
where is HCl released
parietal cells
73
where is histamine released
enterochromaffin cells
74
where is somatostatin produced
D cells
75
function of somatostatin
inhibits HCl
76
where is pepsinogen released
chief cells
77
function of pepsinogen
protein digestion
78
where is VIP produced
small intestine
79
function of VIP
inhibits acid and pepsinogen - activates somatostatin
80
Antibiotic causing c.diff infection
ceftriaxone
81
antibiotic for treating c.diff
oral vancomycin
82
What is Wilson's disease
Autosomal recessive condition resulting from a defective ATP7B gene on chromosome 13 leading to copper deposits in tissues
83
Sx Wilson's
liver - hepatitis and cirrhosis
basal ganglia degeneration
green/brown rings around iris
84
tx wilson's
penicillamine
85
prophylaxis variceal haemorrhage
propanolol and banding
86
treatment of acute variceal haemorrhage
terlipressin
87
rovsing's sign
Rovsing's sign: more pain in RIF than LIF when palpating LIF
88
where is most iron reabsorbed
duodenum
89
Acute mesenteric ischaemia
Embolism occludes SMA - after history of AF
Abdo pain is severe, sudden onset and no other sx
90
risk factor for mesenteric ischaemia
AF
91
what is Barrett's oesophagus?
Metaplasia of lower oesophageal mucosa with squamous epithelium replaced by columnar epithelium
92
which type of cancer does Barrett's oesophagus increase the risk of
oesophageal adenocarcinoma
93
what is budd-chiari syndrome
blockage of hepatic veins which causes back up of blood into liver
94
sx budd-chiari
- Abdo pain = severe and sudden onset
- Ascites and abdo distension
- Hepatomegaly
95
c.diff infection
Gram +ve rod bacilli infection developing when gut flora are suppressed by cephalosporins
96
Sx c diff infection
- Diarrhoea
- Abdo pain
- Raised WCC
97
tx c diff infection
oral vancomycin 10 days
98
treatment haematemesis
A-E
stop NSAIDs/anti-coagulants
2 units of crossmatched blood
99
what is a mallory Weiss tear
tear of mucous membrane of oesophagus
100
sx, ix, tx renal colic
severe loin to groin colicky pain (10/10)
Ix CT KUB
tx diclofenac
101
most common renal stone
calcium oxalate
102
struvite stones
recurrent UTIs, staghorn appearance
103
functional constipation
persistent stomach pain that doesn't resolve with typical treatment - may come and go
104
gastroenteritis
infection of the GIT caused by rotavirus - normally self limiting
105
sx coeliac disease
abdo pain + bloating + cramping + diarrhoea
dermatitis herpetiformis
primary biliary choloantitis
106
ix coeliac
iron deficiency anaemia, raised IgA tTG
crypt hyperplasia, atrophy of villi
107
side effect PPI
hyponatraemia and hypokalaemia (prevents H+/K+ ATPase pump)
108
What is pernicious anaemia?
Anti - IF antibodies - no IF means no B12 absorbed
109
Sx pancreatic cancer
painless jaundice, pale stools, dark urine
110
what type of cancer is pancreatic cancer most commonly
adenocarcinoma of pancreatic head
111
tx pancreatic cancer
Whipple's
112
What is Mallory-Weiss syndrome
lots of vomiting -> lacerations -> haematemesis
common in alcoholics
113
most common type of oesophageal cancer
adenocarcinoma
114
What is achalasia?
Failure of oesophageal peristalsis due to degenerative loss of Auerbach’s plexus
115
Sx achalasia
both food and liquid dysphagia
heartburn
116
Tx achalasia
balloon dilation
117
Roving's sign for appendicitis
Pressing LIF gives pain on right
118
how to calculate alcohol units
(ml x ABV) / 1000
119
risk factor for c.diff
clindamycin and PPIs
120
treatment for c diff infection
vancomycin 10 days
121
which vaccine is it that people with Coeliac disease have?
pneumococcal
122
tx c.diff
PPI, amoxicillin and clindamycin for 7d
123
sx IBS
- Abdo pain
- Bloating
- Change in bowel habit
124
Tx IBS
- Antispasmodics
- Laxative - NOT LACTULOSE
- Loperamide
125
Rovsing's sign
Palpating LIF = pain in RIF
126
vitamin A deficiency
night blindness
127
vitamin B1 deficiency
Wernicke-Korsakoff
128
vitamin B12 deficiency
peripheral neuropathy
129
vitamin C deficiency
scurvy (bleeding and poor wound healing)
130
most common extra-intestinal symptom of IBD
arthritis
131
induce and maintain remission Crohn's
glucocorticoids
azathioprine
132
induce and maintain remission UC
aminosalicylate for both
133
what is pernicious anaemia?
Autoimmune condition caused by antibodies against intrinsic factor
No IF means no B12 absorbed from parietal cells
134
sx pernicious anaemia
anaemia sx
peripheral neuropathy
subacute combined degeneration of the spinal cord
135
management pernicious anaemia
IM B12
136
what is a pharyngeal pouch?
posterior diverticulum through Killian's dehiscence
137
Sx pharyngeal pouch
dysphagia, regurgitation, aspiration, halitosis
138
Ix pharyngeal pouch
barium swallow
139
what is diverticulitis?
Diverticulae: outpouchings of the sigmoid colon
Diverticulosis: the asymptomatic presence of diverticulae
Diverticular disease: the patient gets symptoms from diverticulosis
Diverticulitis: one of the diverticulae becomes infected
140
sx diverticulitis
- LIF pain
- Anorexia
- N and V
- Diarrhoea
141
mx diverticulitis
metronidazole + cephalosporin
142
thumb printing on x-ray
ischaemic colitis
143
ileus vs mechanical obstruction
ileus: peristalsis stops but no structural problem, no bowel sounds
mechanical obstruction: physical blockage, tinkling bowel sounds
144
colorectal cancer screening programme
Male and female, 60-74, every 2 years
145
coffee bean sign on abdo xray
sigmoid volvulus
146
embryo sign on abdo X-ray
caecal volvulus
147
what is liver cirrhosis?
fibrosis of the liver from chronic inflammation
portal hypertension -> varices -> bleeding
148
Symptoms liver cirrhosis
jaundice
hepatomegaly
spider nave
ascites
child-push score
149
mx liver cirrhosis
treat varies - if stable do TIPS, if unstable escalate
