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AMK > Gastro > Flashcards

Gastro Flashcards

1
Q

Where is most water absorbed in digestive system?

A

Jejunum

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2
Q

Cause of ascending cholangitis

A

E.coli infection and gallstones

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3
Q

Where is blockage ascending cholangitis

A

Biliary tree = jaundice

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4
Q

Sx ascending cholangitis

A

Charcot’s triad - RUQ pain, fever and jaundice

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5
Q

Tx ascending cholangitis

A

Biliary drainage and cefotaxime

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6
Q

Sx primary sclerosis cholangitis

A

Jaundice
Increased bilirubin and ALP
RUQ pain
Fatigue
Itchy

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7
Q

Ix primary sclerosis cholangitis

A

ERCP
+ PANCA

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8
Q

Associations primary sclerosing cholangitis

A

UC and Crohn’s

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9
Q

Tx primary sclerosis cholangitis

A

Liver transplant and antibiotics

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10
Q

Risk factors primary biliary cholangitis

A

Female, forty, fat, fertile

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11
Q

Ix primary biliary cholangitis

A

AMA M2 ABs
MRCP

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12
Q

Sx primary biliary cholangitis

A

Jaundice
Hyperpigmentation
RUQ pain
hepatosplenomegaly

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13
Q

Tx primary biliary cholangitis

A

Ursodeoxycholic acid
Cholestyramine for itch

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14
Q

What is biliary colic?

A

Blockage in bile duct = intermittent RUQ pain

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15
Q

Treatment biliary colic

A

Morphine and surgery

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16
Q

Investigations biliary colic

A

US and inflammation markers

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17
Q

Risk factors biliary colic

A

Female, fat, fertile, forty

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18
Q

Symptoms biliary colic

A

Colicky RUQ pain that radiates to shoulder
Pain worse after eating
N + V
+/- jaundice

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19
Q

What is cholecystitis

A

Gallstones in cystic duct = no jaundice

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20
Q

Treatment cholecystitis

A

Cholecystectomy
Metronidazole
Cefuroxime

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21
Q

Investigations cholecystitis

A

US and contrast imaging - GB not always seen

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22
Q

Symptoms cholecystitis

A

RUQ pain -> shoulder
Fever
+ve Murphy
Increased WCC and inflammatory markers

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23
Q

Cause of peptic ulcers

A

Helicobacter Pylori infection

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24
Q

Symptoms of peptic ulcers

A

Pain, haematemesis, melaena, hypotension, tachycardia

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25
Q

Treatment for peptic ulcers

A

2x ABx and 1x PPI
Endoscopic intervention is first line

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26
Q

Investigations peptic ulcers

A

Breath test for H.pylori
Endoscopy

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27
Q

Gastric ulcers

A

Reduced effectiveness of gastric mucosal repair = worse pain with food
Occur in lesser curve/antrum

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28
Q

Duodenal ulcers

A

Anterior/1st part of duodenum
Pepsin/acid action on normal lesion
Pain when hungry/better with food

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29
Q

What is liver cirrhosis?

A

Fibrosis of liver caused by inflammation

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30
Q

Causes of liver cirrhosis

A

Alcoholic liver disease
NAFLD
Hep B and C

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31
Q

Sx liver cirrhosis

A

Jaundice
Organomegaly
Spider naevi

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32
Q

Treatment stable varices

A

TIPS

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33
Q

Treatment bleeding oesophageal varices

A

Terlipressin and sengstacken

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34
Q

Stages of alcoholic liver disease

A

Alcohol related fatty liver - fat in liver, reversible
Alcoholic hepatitis - inflammation of liver, can be reversed
Cirrhosis: scar tissue, irreversible

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35
Q

How is hep A transmitted

A

Foeco-oral route (contaminated food and water)

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36
Q

Sx hep A

A

Nausea, anorexia, vomiting, jaundice
Cholestasis

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37
Q

Treatment hep A

A

Self-resolving 1-3 months

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38
Q

Spread of hep B

A

Direct contact with blood/bodily fluids (sex, needles, toothbrushes)

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39
Q

notifiable disease to PHE

A

hep a and b

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40
Q

What is haemochromatosis?

A

Excessive total iron and deposition in tissues

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41
Q

Cause of haemochromatosis

A

Mutation in HFE protein in chr 6- autosomal recessive

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42
Q

Sx haemochromatosis

A

Tiredness, joint pain, pigmentation, ED

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43
Q

Tx haemochromatosis

A

Venesection
Avoid alcohol

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44
Q

What is Wilson’s disease

A

Too much copper

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45
Q

Sx Wilson’s

A

Psychiatric problems
Concentration difficulties
Dysarthria

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46
Q

Disease causing Kayser-Fleischer rings in cornea on slit lamp exam

A

Wilson;s

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47
Q

Ix Wilson’s

A

Liver biopsy

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48
Q

Mx Wilson’s

A

Penicillamine

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49
Q

Ulcerative colitis sx

A

pANCA +ve, Just colon, continuous inflammation, mucosa and submucosa, bloody stool
Depleted goblet cells

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50
Q

Crohn’s disease

A

Any part of GIT, skip lesions, deeper layers of mucosa

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51
Q

UC management

A

Aminosalicylate
Corticosteroids

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52
Q

Drugs causing haemolytic

A

Primaquine, ciproflaxacin and sulph- containing drugs (sulphasalazine etc)

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53
Q

Pathway for haemoglobin breakdown

A

Hb - hame - biliverdin - bilirubin - liver (conjugation) - bile duct - gut - glucuronic acid removed - stercobilinogen - stercobilin

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54
Q

Dubin Johnson

A

Autosomal recessive
Mutation in protein MRP2
Causes increased conjugated bilirubin

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55
Q

Rotor syndrome

A

Autosomal recessive
Defect in bilirubin uptake and storage
Increased conjugated bilirubin

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56
Q

Hereditary spherocytosis

A

Autosomal dominant
North European affected
Sx = neonatal jaundice, gallstones, spherocytes
Dx = EMA binding

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57
Q

G6PD deficiency

A

Mediterranean/african heritage
X-linked recessive
Sx = neonatal jaundice, gallstones, splenomegaly, Heinz bodies
Dx = G6PD measure
Presents within first 24h of life

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58
Q

How does G6PD normally act?

A

G6PD produces NADPH, which produces glutathione
Glutathione protects RBCs from oxidative stress

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59
Q

Gilbert’s syndrome

A

Decreased UGT = increased unconjugated bilirubin
Autosomal recessive
Occurs on stress e.g. exercise

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60
Q

Newborn jaundice

A

Normally physiological (e.g. hepatic immaturity) and occurs when baby is <24h old
Normally resolves in 14 days

61
Q

Crigler-Najjar syndrome

A

No UGT so no conjugation = increased UCB
type 1 is most severe and no survival
type 2 is less severe and some survive

62
Q

Pre-hepatic jaundice

A

Increased UCB
Issue occurs before liver
E.g. haemolysis, anaemias
Normal stools and urine
Normal ALP and AST

63
Q

Hepatic jaundice

A

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
Q

Post-hepatic jaundice

A

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
Q

Which cells secrete intrinsic factor?

A

Parietal

66
Q

Where is gastrin secreted?

A

G-cells (stomach)

67
Q

Function of gastrin

A

G cell stimulated by stomach distension
Gastrin acts on ECl to increase HCl production

68
Q

Function of cck

A

bile movement for digestion

69
Q

Where is cck secreted?

A

I cells (small intestine)

70
Q

where is secretin produced

A

s cells of small intestine

71
Q

function of secretin

A

released bicarbonate and decreases gastric acid when pH is high

72
Q

where is HCl released

A

parietal cells

73
Q

where is histamine released

A

enterochromaffin cells

74
Q

where is somatostatin produced

A

D cells

75
Q

function of somatostatin

A

inhibits HCl

76
Q

where is pepsinogen released

A

chief cells

77
Q

function of pepsinogen

A

protein digestion

78
Q

where is VIP produced

A

small intestine

79
Q

function of VIP

A

inhibits acid and pepsinogen - activates somatostatin

80
Q

Antibiotic causing c.diff infection

A

ceftriaxone

81
Q

antibiotic for treating c.diff

A

oral vancomycin

82
Q

What is Wilson’s disease

A

Autosomal recessive condition resulting from a defective ATP7B gene on chromosome 13 leading to copper deposits in tissues

83
Q

Sx Wilson’s

A

liver - hepatitis and cirrhosis
basal ganglia degeneration
green/brown rings around iris

84
Q

tx wilson’s

A

penicillamine

85
Q

prophylaxis variceal haemorrhage

A

propanolol and banding

86
Q

treatment of acute variceal haemorrhage

A

terlipressin

87
Q

rovsing’s sign

A

Rovsing’s sign: more pain in RIF than LIF when palpating LIF

88
Q

where is most iron reabsorbed

A

duodenum

89
Q

Acute mesenteric ischaemia

A

Embolism occludes SMA - after history of AF

Abdo pain is severe, sudden onset and no other sx

90
Q

risk factor for mesenteric ischaemia

A

AF

91
Q

what is Barrett’s oesophagus?

A

Metaplasia of lower oesophageal mucosa with squamous epithelium replaced by columnar epithelium

92
Q

which type of cancer does Barrett’s oesophagus increase the risk of

A

oesophageal adenocarcinoma

93
Q

what is budd-chiari syndrome

A

blockage of hepatic veins which causes back up of blood into liver

94
Q

sx budd-chiari

A
  • Abdo pain = severe and sudden onset
  • Ascites and abdo distension
  • Hepatomegaly
95
Q

c.diff infection

A

Gram +ve rod bacilli infection developing when gut flora are suppressed by cephalosporins

96
Q

Sx c diff infection

A
  • Diarrhoea
  • Abdo pain
  • Raised WCC
97
Q

tx c diff infection

A

oral vancomycin 10 days

98
Q

treatment haematemesis

A

A-E
stop NSAIDs/anti-coagulants
2 units of crossmatched blood

99
Q

what is a mallory Weiss tear

A

tear of mucous membrane of oesophagus

100
Q

sx, ix, tx renal colic

A

severe loin to groin colicky pain (10/10)
Ix CT KUB
tx diclofenac

101
Q

most common renal stone

A

calcium oxalate

102
Q

struvite stones

A

recurrent UTIs, staghorn appearance

103
Q

functional constipation

A

persistent stomach pain that doesn’t resolve with typical treatment - may come and go

104
Q

gastroenteritis

A

infection of the GIT caused by rotavirus - normally self limiting

105
Q

sx coeliac disease

A

abdo pain + bloating + cramping + diarrhoea
dermatitis herpetiformis
primary biliary choloantitis

106
Q

ix coeliac

A

iron deficiency anaemia, raised IgA tTG
crypt hyperplasia, atrophy of villi

107
Q

side effect PPI

A

hyponatraemia and hypokalaemia (prevents H+/K+ ATPase pump)

108
Q

What is pernicious anaemia?

A

Anti - IF antibodies - no IF means no B12 absorbed

109
Q

Sx pancreatic cancer

A

painless jaundice, pale stools, dark urine

110
Q

what type of cancer is pancreatic cancer most commonly

A

adenocarcinoma of pancreatic head

111
Q

tx pancreatic cancer

A

Whipple’s

112
Q

What is Mallory-Weiss syndrome

A

lots of vomiting -> lacerations -> haematemesis
common in alcoholics

113
Q

most common type of oesophageal cancer

A

adenocarcinoma

114
Q

What is achalasia?

A

Failure of oesophageal peristalsis due to degenerative loss of Auerbach’s plexus

115
Q

Sx achalasia

A

both food and liquid dysphagia
heartburn

116
Q

Tx achalasia

A

balloon dilation

117
Q

Roving’s sign for appendicitis

A

Pressing LIF gives pain on right

118
Q

how to calculate alcohol units

A

(ml x ABV) / 1000

119
Q

risk factor for c.diff

A

clindamycin and PPIs

120
Q

treatment for c diff infection

A

vancomycin 10 days

121
Q

which vaccine is it that people with Coeliac disease have?

A

pneumococcal

122
Q

tx c.diff

A

PPI, amoxicillin and clindamycin for 7d

123
Q

sx IBS

A
  • Abdo pain
  • Bloating
  • Change in bowel habit
124
Q

Tx IBS

A
  • Antispasmodics
  • Laxative - NOT LACTULOSE
  • Loperamide
125
Q

Rovsing’s sign

A

Palpating LIF = pain in RIF

126
Q

vitamin A deficiency

A

night blindness

127
Q

vitamin B1 deficiency

A

Wernicke-Korsakoff

128
Q

vitamin B12 deficiency

A

peripheral neuropathy

129
Q

vitamin C deficiency

A

scurvy (bleeding and poor wound healing)

130
Q

most common extra-intestinal symptom of IBD

A

arthritis

131
Q

induce and maintain remission Crohn’s

A

glucocorticoids
azathioprine

132
Q

induce and maintain remission UC

A

aminosalicylate for both

133
Q

what is pernicious anaemia?

A

Autoimmune condition caused by antibodies against intrinsic factor

No IF means no B12 absorbed from parietal cells

134
Q

sx pernicious anaemia

A

anaemia sx
peripheral neuropathy
subacute combined degeneration of the spinal cord

135
Q

management pernicious anaemia

A

IM B12

136
Q

what is a pharyngeal pouch?

A

posterior diverticulum through Killian’s dehiscence

137
Q

Sx pharyngeal pouch

A

dysphagia, regurgitation, aspiration, halitosis

138
Q

Ix pharyngeal pouch

A

barium swallow

139
Q

what is diverticulitis?

A

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
Q

sx diverticulitis

A
  • LIF pain
  • Anorexia
  • N and V
  • Diarrhoea
141
Q

mx diverticulitis

A

metronidazole + cephalosporin

142
Q

thumb printing on x-ray

A

ischaemic colitis

143
Q

ileus vs mechanical obstruction

A

ileus: peristalsis stops but no structural problem, no bowel sounds
mechanical obstruction: physical blockage, tinkling bowel sounds

144
Q

colorectal cancer screening programme

A

Male and female, 60-74, every 2 years

145
Q

coffee bean sign on abdo xray

A

sigmoid volvulus

146
Q

embryo sign on abdo X-ray

A

caecal volvulus

147
Q

what is liver cirrhosis?

A

fibrosis of the liver from chronic inflammation
portal hypertension -> varices -> bleeding

148
Q

Symptoms liver cirrhosis

A

jaundice
hepatomegaly
spider nave
ascites
child-push score

149
Q

mx liver cirrhosis

A

treat varies - if stable do TIPS, if unstable escalate

AMK (33 decks)

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