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AMK > Gastro > Flashcards

Gastro Flashcards

1
Q

what is mesenteric ischaemia

A

sudden decrease in the blood supply to the bowel

  • patient will be acutely unwell
  • raised lactate - IMPORTANT AS THIS IS A SIGN OF ISCHAEMIA
  • diarrhoea and painful

abdo will be soft

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2
Q

symptoms of small bowel ishaemia

A

severe abdo pain
shock
nausea
vomiting
metabolic acidosis

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3
Q

what is mcburneys point

A

point where the appendix lies

draw a line from the anterior superior iliac spine to the umbilicus

it is 1/3 of the way along the line from he ASIL

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4
Q

Metabolic acidosis can be due to?

A

Diabetic ketoacidosis

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5
Q

What does aspirin overdose present as

A

High rates of salicylic acid
Causes respiratory alkalosis
then goes onto causing metabolic acidosis

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6
Q

Which test checks for cortisol levels

A

Synacthen test

Can check for addisonian crisis

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7
Q

Low cortisol levels are found in?

A

Sepsis

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8
Q

4 symptoms of diabetic ketoacidosis

A
  1. Hyperglycaemia
  2. High anion gap
  3. Metabolic acidosis
  4. Abdomen pain
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9
Q

Iron is best absorbed in?

A

Proximal small bowel
Duodenum

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10
Q

Where does PICC catheter line go

A

Basilic vein

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11
Q

what are calcified gallstones and why do they form

A
  • pigment stones
  • form due to raised bilirubin levels + altered PH levels
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12
Q

what is hepatitis

A

inflammation of the liver can be due to infections

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13
Q

features of hepatitis

A

fatigue
nausea and vomiting
diarrhoea
jaundice

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14
Q

what is hepatitis A and presentation

A

transmitted by fecal-oral route
dark urine
abdo pain
jaundice

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15
Q

which test is best used to investigate hiatal hernia

A

barium swallow

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16
Q

what is variceal bleeding

A

arises through portal hypertension
veins get dilated and are more likely to bleed

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17
Q

what is the best prevention method for variceal bleeding

A

give non-selective beta blockers and edoscopic ligation band

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18
Q

what are carcinoid tumours

A

rare, slow growing malignant tumours that develop in the neuroendocrine system

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19
Q

what are carcinoid tumours

A

rare, slow growing malignant tumours that develop in the neuroendocrine system

the tumour releases serotonin

effects of that are: flushing, diarrhea, wheezing, abdominal pain, and heart palpitations

also causes pellagra

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20
Q

management of carcinoid tumours

A

octreotide

they inhibit the secretion of serotonin by the tumours which cause symptoms like flushing and abdo pain

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21
Q

what is crohns disease

A

chronic relapsing inflammatory bowel disease
inflammation of the GI tract - mostly the ileum

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22
Q

symptoms of crohns disease

A

crampy abdo pain and diarrhoea
weight loss and fever

abdo will be swollen and distended and severe guarding

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23
Q

symptoms of diverticulitis

A

left lower quadrant abdomen pain and nausea

pain, fever, nausea, vomiting, constipation or diarrhea, and a change in bowel habits

common in low fibre diets

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24
Q

what is diverticulitis

A

inflammation and out pouching of the mucosa in the sigmoid colon

these pouches get infected and inflammed

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25
Q

what is achalasia

A

failure of the oesophageal sphincter to relax
makes it hard for food to go to the stomach

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26
Q

symptoms of achalasia

A

regurgitation of food
aspiration
retrosternal pain

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27
Q

treatment for achalasia

A

hellers cardiomyotomy

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28
Q

best investigation for mesenteric ischaemia

A

CT abdo

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29
Q
A
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30
Q

what can this patient be at risk for?

he has had a change in bowel habit,
losing weight
more frequency when passing stool

A

colorectal cancer

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31
Q

what is achalasia

A

failure of the oesophageal peristalsis and relaxation of the Lower oesophageal spincter

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32
Q

features of achalasia

A

dysphagia
heart burn
regurgitation of food

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33
Q

investigation for achalasia

A

barium swallow test

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34
Q

oesophageal cancer features

A

dysphagia
anorexia
weight loss
vomiting
hoarseness

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35
Q

two types of oesophageal cancer

A

adenocarcinoma
squamous cell carcinoma

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36
Q

adenocarcinoma - oesopagheal cancer

A

most cmmm in UK
risk factor : GORD
smoking

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37
Q

squamous cell carcinoma of oesophageal cancer

A

most common in the developing world
smoking
aclohol

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38
Q

investigation of oesophageal cancer

A

upper GI endoscopy
CT chest, abdo and pelvis

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39
Q

management of oesophageal cancer

A

surgical resection
Ivor-Lewis oesophagectomy

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40
Q

coeliac disease what is it

A

autoimmune condition where gluten causes a reaction

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41
Q

presentation of coeliac disease

A

failure to thrive
diarrhoea
fatigue
weight loss
nausea and vomiting
dermatitis herpertiformis - pink rash on children
anaemia

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42
Q

what is the investigation of coeliac disease

A

check for TTG antibodies
IgA antibodies - deficiency of can cause a false negative result

  • patient has to be on gluten diet in order to carry out the tests
    always check diabetic patients
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43
Q

what are uncomplicated peptic ulcers

A

ulceration of the stomach mucosa

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44
Q

risk factors of uncomplicated peptic ulcers

A

h pylori
drugs - NSAIDS
increased acid

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45
Q

factos that increase acid secretion in stomach

A

alcohol
caffeine
spicy food
smoking
stress

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46
Q

presentation of uncomplicated peptic ulcers

A

epigastric pain
nausea and vomiting
dyspepsia - indigestion

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47
Q

features of duodenal ulcers

A

pain when hungry
pain goes away when eating

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48
Q

features of gastric ulcer

A

painful after eating

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49
Q

investigation for uncomplicated peptic ulcers

A

test for h pylori - stool test

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50
Q

management of uncomplicated peptic ulcers

A

if there is no H pylori - then give PPI
if there is H pylori - eradication therapy

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51
Q

eradication therapy for uncomplicated peptic ulcers

A

PPI and amoxicillin and clarithromycin

give methroniazaole instead of amoxicillin if patient is allergic to penicillin

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52
Q

what are LFT markers

A

serum markers of liver cell damage
help localise site of damage

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53
Q

hepatic picture - LFT markers in this?

A

raised ALT and AST

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54
Q

cholestatic picture - LFT markers in this?

A

raised ALP and GGT

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55
Q

what is ALT

A

enzyme found in the hepatocytes that is involved in amino acid and group transfer

damage to heptaoctes causes raised ALT

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56
Q

where is ALT found

A

liver
heart
pancreas
kidneys

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57
Q

hepatic causes of raised ALT

A

hepatitis
liver ishaemia
paracetamol OD

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58
Q

extrahepatic causes of raised ALT

A

MI
pancreatitis
kidney disease

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59
Q

what is AST

A

enzyme involved in amino acid and group transfer
raised when hepatocytes are damaged

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60
Q

if AST:ALT RATIO IS AST>ALT then what is the cause?

A

alcohol is the cause

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61
Q

what is ALP

A

elevated obstructive jaundice and bile duct damage

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62
Q

what is the biliary cause of raised ALP

A

gallstones - causes jaundice
pancreatic cancer - painful

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63
Q

extra biliary causes of raised ALP

A

pagets disease
low vitamin D

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64
Q

what is GGT - when is it raised

A

liver enzyme and is raised In chronic alcohol use and gallstone diseases

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65
Q

what are gallstones

A

blockage of of the bile duct which causes stones

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66
Q

4 Fs for gallstones

A

Fat
Fertility
Female
Forty

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67
Q

common complications of gallstones

A

biliary colic - the stones are outside the bile duct
cholecystitis
cholangitis

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68
Q

biliary colic - what is it

A

when a gallstone blocks the bile duct

colicky abdo pain
worse after fatty meals
lasts 15mins to 5 hours

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69
Q

acute cholecystitis

A

inflammation of the gall bladder
right upper quadrant pain
fever and murpheys sign

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70
Q

complications of cholecystectomy

A

bleeding
infection
pain
stones left in the bile duct

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71
Q

what is acute cholangitis

A

patient will be unwell with a fever
jaundice
right upper quadrant pain

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72
Q

management of acute cholangitis

A

iv antibiotics
analgesia

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73
Q

what is acute pancreatitis

A

rapid inflammation of the pancreas

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74
Q

presentation of acute pancreatitis

A

severe epigastric pain
radiates to the back
vomitng
abdo tenderness

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75
Q

charchots triad - what is it:

A

bilary colic - RUQ pain
cholecystis - RUQ pain and Fever
Cholangitis - RUQ pain and fever and jaundice

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76
Q

causes of acute pancreatitis

A

acronym (I GET SMASHED)

IDIOPATHIC

GALLSTONES
ETHANOL (ALCOHOL)
TRAUMA
STEROIDS
MUMPS
AUTOIMMUNE
SCORPION STING
HYPERLIPIDEAMA
ERCP
DRUGS

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77
Q

investigation for acute pancreatitis

A

amylase
lipase
CRP
gallstones
FBC and LFTs

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78
Q

why does fatty cause pain in biliary colic

A

CCK is released from the duodenum when fatty foods are eaten
this contracts the gall bladder
if there is stones there then it will hurt

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79
Q

management of acute pancreatitis

A

Iv fluids
analgesia
treatment of the gallstones
antibiotics

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80
Q

complications of acute pancreatitis

A

necrosis
fluid collection
pancreatitis

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81
Q

what is small bowel obstruction

A

blockage in passing stool fluid and gas in the bowel

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82
Q

which bowel obstruction is more common

A

small

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83
Q

presentation of small bowel obstruction

A

central abdo pain
nausea and vomiting
constipation and no flautence
abdo distention

TINKLING BOWEL SOUNDS

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84
Q

causes of small bowel obstruction

A

hernia
adhesions
malignancy

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85
Q

x ray findings of small bowel obstruction

A

dilated small bowel

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86
Q

investigations for small bowel obstruction

A

CT and erect chest x ray

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87
Q

what is C difficile

A

gram positive rod

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88
Q

causes of C difficile

A

clindamycin
PPIs
co-amox

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89
Q

management of small bowel obstruction

A

iv fluids
emergency managemt
surgery
NG tube

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90
Q

features of C difficile

A

diarrhoea
abdo pain
raised WCC

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91
Q

diagnosis of C difficile

A

test for the bacteria in stool

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92
Q

management of C difficile

A

1st line oral vancomycin (if its the first episode)
life threatening - oral vancomycin and iv metronidazole

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93
Q

crohns disease - what is it

A

can be anywhere in the GI tract
more common in terminal ileum
cobble stone appearance
increased goblet cells

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94
Q

colorectal cancer

A

sporadic - runs in family
unexplained weight loss
rectal bleeding
addo pain
change on bowle habits
iron deficiency anaemia

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95
Q

what is HNPCC

A

Lynch syndrome
autosomal dominant
proximal colon

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96
Q

what is the Amsterdam criteria

A

3 family members had some similar cancer

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97
Q

what is FAP

A

autosomal dominant
2 types - clasic and attenuated
polyps that form
due to mutations APC

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98
Q

features of crohns disease

A

weight loss
diarrhoea
RUQ pain
perianal disease

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99
Q

investigations for crohns disease

A

bloods
colonoscopy
history
small bowel enema

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100
Q

management of crohns disease

A

stop smoking

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101
Q

what is ulcerative colitis

A

rectum to ileocecal valve
bloody diarrhoea
urgency and tenesmus
abdo pain LLQ
arthritis

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102
Q

investigation of ulcerative colitis

A

barium meal

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103
Q

mild ulcerative colitis

A

<4stools daily
ESR AND CRP are all normal

104
Q

moderate ulcerative colitis

A

4-6 stools a day
systemic disturbance

105
Q

severe ulcerative colitis

A

> 6 stools a day
blood in stool

106
Q

management of mild to moderate ulcerative colitis

A

corticosteroids

107
Q

what is IBD

A

inflammation of the GI tract

108
Q

what is diverticulosis

A

presence of many outpouchings of the bowel wall
most common in sigmoid

109
Q

risk factors for diverticulosis

A

increasing age
low fibre diet

110
Q

features of diverticulosis

A

LIF pain
nausea and vomiting
diarrhoea
features of infection

111
Q

management of diverticulosis

A

admit
NBM
IV fluids
Iv antibiotics

112
Q

anorectal abcess - what is it?

A

perianal swelling and pain
it has to be immediately drained under local anaesthetic in A&E to stop it from spreading and becoming septic

113
Q

what is Gilbert syndrome

A

when the liver produces bile very slowly

114
Q

what is a Mallory-Weiss tear

A

superficial tear in the oesophageal lining that occurs after a long period of vomiting.

115
Q

causes of upper GI bleeds

A

Oesophageal/gastric varices
Peptic ulcer disease (H. pylori, NSAID use, smoking)
Malignancy
Aorto-enteric fistula (previous abdominal aortic aneurysm or an aortic graft)
Mallory Weiss tear

116
Q

symptoms of Boerhaave’s syndrome

A

rupture of the oesophageal due to vomiting

patient has retrosternal chest pain and vomiting

117
Q

ruptured oesophageal varices - symtoms

A

seen in patients with portal hypertension due to chronic liver disease and cirrhosis

118
Q

what is niacin

A

vitamin b3

119
Q

what is niacin deficiency seen as?

A

Diarrhoea
Dermatitis
Dementia

120
Q

what is pellagra?

A

Diarrhoea
Dermatitis
Dementia

121
Q

who is vitamin b3 deficiency common in?

A

common in underdeveloped countries

122
Q

vitamin c deficiency features

A

spontaneous bleeding
bruising
coiled hairs
teeth loss

123
Q

vitamin b1 deficiency features

A

wernicke’s encephalopathy (confusion, ataxia)
high output cardiac failure
peripheral neuropathy

124
Q

vitamin a deficiency

A

developing countries
night blindness
corneal ulceration

125
Q

what is nicotinamide used for

A

treatment for vitamin b3 deficiency

126
Q

what is Zollinger-ellison syndrome

A

several ulcerations develop in the stomach and duodenum

uncontrolled release of gastrin

127
Q

symptoms of Zollinger Ellison syndrome

A

abdo pain
diarrhoea
ulceration of duodenum
GI bleeding
don’t respond to PPIs

128
Q

raised faecal cal protein is raised in what?

A

ulcerative colitis

129
Q

colonoscopy findings of ulcerative colitis

A

surface inflammation with loss of goblet cells and crypt abscess

130
Q

colonoscopy findings of diverticulosis

A

constipation and left lower abdo pain

colonic diverticula with central lumen and surrounding mucosa

131
Q

colonoscopy findings of crohns disease

A

transmural inflammation with non-caveating granulomas

132
Q

colonoscopy findings of infective colitis

A

multiple polymorphic nuclear leukocytes extending into the lamina

133
Q

sub-total vilous atrophy and crypy hyperplasisia - seen in what?

A

coeliac disease

134
Q

signs of oesphageal cancer

A

progressively worse dysphagia - due to cancerous growth

odynophagia - painful swallowing

135
Q

red flag symptoms for bowel cancer?

A
  • weight loss
  • change in bowel habits
  • anaemia
  • loss of appetite
136
Q

inflammatory bowel conditions cause what to be found in the stool?

A

mucus

137
Q

hyperparathyroidism can cause increased CA levels - how?

A

it brings Ca into the circulation from the bones
- Ca comes out of the bones and into the blood
- it can suck up the fluid and cause tiredness, constipation and thirst

138
Q

symptoms of hypercalcaemia

A

bones - increased bone pain and fragility
stones - renal stones
moans - depression
groans - constipation/anorexia

139
Q

alcoholic liver injury - what is it

A

alcohol is a common cause behind liver injury
there is an increase in the metabolism of fatty acids
this causes the sinusoid cells to be replaced with collagen
- they cannot do their role
- cirrhosis

140
Q

acute biliary obstruction - what is it

A

when the bile duct gets blocked - mainly due to gallstones
- causes colicky pain and jaundice
- if the ducts get inflamed then it is called CHOLANGITIS
- this would cause a fever too
- bile builds up into the liver
- if this ruptures and releases = bile infarct

141
Q

what happens to the liver after repeated acute biliary obstruction

A

secondary biliary cirrhosis
- damage to the liver due to fibrosis because of the frequent bile release

142
Q

chronic hepatitis

A

hepatitis that has been lasting longer than 6 months
- very severe inflammation
- cause high levels of liver enzymes

143
Q

iron overload and the liver

A
  • liver goes dark brown
    can be in two forms
  • heamosiderosis or haemochromatasosis
144
Q

what is heamosiderosis

A

too much iron in the liver but no damage to the actual liver
- in patients with aplastic anaemia, blood transfusion are given
- this means this iron is accumulated in Kupffer cells
- can cause liver damage

145
Q

primary heamochromatasosis

A

too much iron in the liver with cirrhosis

it is due to a genetic abnormality - it causes more absorption of iron
- iron becomes too much
- starts to involve other cells too
- causes hepatic fibrosis

146
Q

secondary heamochromatasosis

A
  • this is when there is too much iron in the diet
  • or in patients who receive multiple blood transfusions
147
Q

what is Wilsons disease

A

too much copper in the blood
- autosomal recessive disorder
- too much copper builds up in the liver and basal ganglia of the brain
- coper cannot be then released from the bile
- this can then cause hepatitis and then cirrhosis
- in the brain it can cause disability

148
Q

autoimmune liver disease

A
149
Q

primary biliary cirrhosis

A

autoimmune disease of the liver
females > males
- causes slow destruction of the bile duct
- this is when the toxins build up in the liver = this is called cholestatis
- it causes further damage and fibrosis
- causes copper to build up too

150
Q

autoimmune hepatitis

A

more common in females than males
- swollen liver cells
- anti nuclear antibodies are present

151
Q

sclerosing cholangitis

A

acute inflammation of the bile ducts
- at first the ducts get surrounded with inflammatory cells
- overtime these get replaced with fibrotic cells

152
Q

cirrhosis - what is it

A
  • liver is really good at restoring damaging
  • despite liver damage, the liver cells can be resorted and normal function can be maintained
  • cirrhosis happens when the liver cells are damaged repeatedly
153
Q

what is cirrhosis characterised by

A

fibrosis
nodular regeneration

  • the liver cells that get replaced with fibrosis cannot carry normal function
  • it is characterised by the size of the nodules
  • most common cause is alcohol
  • hypoalbuminaemia and oedema
  • clotting factors deficiency,
  • bruising
154
Q

complications of liver cirrhosis

A

liver failure
portal hypertension
liver cell carcinoma

155
Q

hepatic encephalopathy

A

failure of the liver to excrete toxins so they build up
- can cause renal failure
- not removing steroid hormone causes too much aldosterone in the blood
- too much sodium and water
- in males can cause gynaecomastia

156
Q

portal hypertension

A

common cause - cirrhosis
- increased BP in the hepatic portal vein
- due to more hepatic resistance and portal blood flow
- this can cause oesophageal varices - enlarged veins which can bleed
- can cause ascites
-

157
Q

why does oedema happen in the liver

A

less synthesis of albumin so there is less levels of it

158
Q

why do ascites happen

A

too less albumin which causes less aldosterone
- this causes sodium and water to be retained

159
Q

why does it haematesmesis happen

A

portal hypertension can cause oesophageal varies which can bleed

160
Q

liver cell adenoma

A

benign tumour
cause swelling of the liver

161
Q

malignant tumours

A
  • present with jaundice and fevers and weight loss
  • most common place of metastasises is GI tract, pancreas and bowel and breast
162
Q

liver cell carcinoma markers

A
  • the foetal liver produces alpha feta-protein
  • when the baby is born this production declines and albumin is made
  • so in liver cancer, alpha fetoprotein is produced
  • this is an important tumour marker
163
Q

cholangiocarcinoma

A

adenocarcinoma of the bile duct
- found more commonly in this with ulcerative colitis

symptoms
- pale stools
-itchy skin
- jaundice

164
Q

bile pathway

A

produced by the liver
travels via the left and right bile ducts - these fuse to make the common bile duct
- contains: cholesterol, phopholipid and bilirubin
- bile is stored in the gall bladder
- when fatty foodsa are eaten the gall bladder releases the bile into the duodenum to digest it

165
Q

cholelithiasis - what is it

A

gall stones
risk factors:
female
obesity
diabetes

the stones form from excessive cholesterol

166
Q

acute cholecystitis

A

gallbladder is inflamed - can be due to gallstones

  • the gall bladder wall lining can get infected and filled with pus
  • the gall bladder wall may rupture and stones may pass along to the duodenum
  • these can block the intestine - gallstone ileus
167
Q

gall stone filled with pus is called?

A

empyema

168
Q

chronic cholecystitis

A
  • may happen due to repeated episodes of gall stones
  • the wall of the gall bladder has been replaced by fibrosis
  • so it is thicker and rigid
  • stone is found its HARTMANNS POUCH
169
Q

most common bile duct and gall bladder cancer

A

adenocarcinoma

170
Q

biliary obstruction

A

obstruction can be for many reasons
- causes jaundice
- pale stools
dark urine
if this becomes infected then can cause cholangitis too

171
Q

effects of cystic fibrosis on the pancreas

A

the mucus clogs the pores of the pancreas
- so then exocrine secretions cannot be made

172
Q

pancreatitis

A

infllammation of the pancreas
- mainly due to alcohol
- amylase is released into the blood
- obstruction of the pancreatic duct
- epigastric pain that radiates to the back
- when the organ is obstructed, enzymes are released into the blood that can cause shock
- nausea and vomiting

173
Q

effects of pancreatitis due to gall stones

A
  • when the gall stone obstructs the pancreas or if there is biliary reflux into the pancreas
  • it damages the pancreatic duct
  • this can cause leakage of pancreatic enzymes
174
Q

effects of pancreatitis due to less vascular supply:

A
  • lack of oxygenated blood
  • pancreatic enzymes are released
  • causes more damage
  • organ can bleed due to blood vessel break down
  • amylase is released
  • fatty acids that are released from the pancreas bind calciums = hypocalacaemia
  • hyperglycaemia occurs
175
Q

chronic pancreatitis

A

relapsing pancreatitis
- due to alcohol
- abdo pain with back pain and weight loss
x ray will show calcification
malabsorption of fat so faeces will contain more fat

176
Q

which syndromes is associated with pancreatic cancer

A

trousseau syndrome - blood clotting disorder which causes inflammation of a vein due to a blood clot
- this is due to the tumour releasing contents into the blood

features:
DVT
endocarditis
and also pulmonary embolisms

177
Q

what medication is used for typhoid fever

A

ceftriaxone

178
Q

how does ranitidine work?

A

it is a H2 receptor antagonist
this inhibits histamine on the parietal cells - this reduces the secretion of hydrochloric acid from the parietal cells - so they release it less

  • it can also mask the symptoms of gastric cancer
179
Q

what do chief cells in the stomach release

A

pepsinogen

180
Q

what do delta cells in the stomach release

A

somatostatin - this inhibits stomach acid production

181
Q

what do g cells in the stomach do

A

they release gastrin which stimulates the release of stomach acid

182
Q

what type of laxatives should be avoided in elderly patients who are frail

A

bulk laxatives like isphagula - it increases the risk of bowel obstruction

183
Q

what is the side effect of long term omeprazole?

A

hypomagnesia

184
Q

what is a cyclizine?

A

it is an antihistamine which can also be used to manage nausea and vomting

185
Q

which laxatives can make IBS worse?

A

lactulose which causes more gas and bloating in the stomach

186
Q

how do oesophageal varicose develop

A

when normal blood flow to the liver is blocked
this causes ALP to be raised

187
Q

what medications are used in crohns disease

A

corticosteroids
they reduce the inflammation in the mucosa

188
Q

what is the colposcopy findings of crohns disease

A

rose thorn ulcers
cobble stone mucosa

189
Q

what is elevated in acute pancreatitis

A

serum amylase

190
Q

which part of the colon does crohns disease effect that causes bile stones

A

the terminal ileum
the terminal ileum is responsible for the reabsorption of bile and have terminal ileitis can affect this

191
Q

what is primary biliary cholangitis

A

it is an autoimmune condition which causes scarring and inflammation of the bile ducts

this can cause
tiredness
itchy skin\
common in women younger than 40

is the scarring of the small ducts

192
Q

primary sclerosing cholangitis

A

scarring of the medium to larger sized bile ducts

causes tirendess
jaundice and itching
more common in men
and those with IBD

193
Q

what is a risk factor for gallbladder carcinoma

A

ulcerative colitis - due to its association with primary scleoring cholangitis
- chronic inflammation that leads to cancer

194
Q

what is the likely diagnosis

nephritic syndrome after an infection with blood in urine and high blood pressure and oedema

A

post strep a glomerulonephritis

195
Q

what is bacterial perontinitis

A

it is the infection of the ascites
most common cause is Ecoli

196
Q

what is the Cullens sign?

A

it is when there is bruising behind the umbilicus in acute pancreatitis

197
Q

what ion abnormality is seen in metabolic acidosis

A

hyperkalaemia
due to H+ ions being transported into cells for the exchange of potassium

198
Q

what is given to patients with acute severe dehydration?

A

IV Hartman’s solution

199
Q

presentation of cholera

A

watery diarhhoea
dehydration
vomiting
drowsiness

200
Q

how does Cholestyramine help with itching in Primary biliary cholnagitis

A

it binds to the bile salts in the GI tract and prevents them from being reabsorbed

201
Q

why do you get itching in primary biliary cholnagitis

A
202
Q

what is good pasture syndrome

A

many antibodies that attack the Type iV collagen
in the lungs and kidneys
causes blood in vomit and urine
nephritic syndrome blood and proteins in the urine

203
Q

what is whipples disease

A

bacterial infection that affects the joints and digestive system
- causes diarrhoea
- joint pain
- hyper pigmentation
can cause endocarditis

do jejunal biopsy as investigation

204
Q

Fournier’s gangrene - what is ti

A

it is an infection of the the deep fascia
it causes blackening of the skin

205
Q

what happens in oesophageal spasm

A

pain when eating and drinking
do barium swallow

206
Q

symptoms of spleen rupture

A

abdo pain
shoulder pain due to blood irritating the diaphragm - Kehr’s sign

207
Q

what is seen on colonoscopy in ulcerative colitis

A

pseudopylps

208
Q

Why do NSAIDS Pose a risk for GI bleeds

A

They inhibit prostaglandin, which is produced by the stomach to protect the lining of the stomach

209
Q

what is gastric paresis

A

weakness of the stomach muscles
- delayed gastric emptying
- it is associated with type 2 diabetes
- presents with vomiting of undigested foods

210
Q

what does metoclopramide do

A

Metoclopramide: This medication can increase the contractions of the stomach and intestines, helping to move food through the digestive system more quickly.

211
Q

What is a good measure of liver failure

A

Prothrombin is a clotting factor synthesised in the liver. When there is liver failure then less prothrombin is released. It has a shorter half life, then albumin and so is a better marker for acute liver failure

212
Q

what is a contraindication for laparoscopic surgery

A

raised intracranial pressure

213
Q

why does pancreatitis lead to diabetes

A

it causes the breakdown of the beta langerhans cells which release insulin - it can cause diabetes

214
Q

symptoms of irritable bowel syndrome

A

Abdominal pain, Bloating and Change in bowel habit are classic features of irritable bowel syndrome
and mucus in the stool

215
Q

what is Lynch syndrome

A

an autosomal dominant condition, is the most common form of inherited colon cancer

due to mixmatched genes
so also holds a risk of endometrial cancer

216
Q

what are the findings of Intussusception

A
  • baby presents with vomit
    abdo pain
    abdo mass
    baby keeps legs up to help with the pain
    sausage shaped mass
217
Q

what condition does H.pylori increase the chances of getting?

A

duodenal ulcer
and gastric carcinoma

218
Q

what is management for cystic fibrosis

A

Creon supplement - aids digestions for pancreatic insufficiency

219
Q

symptoms of Irritable bowel syndrome

A
  • abdo pain and bloating
  • it is better on defeacation
  • worse by eating
  • flares up worse during times of stress etc
220
Q

what is Hereditary haemochromatosis

A

a disorder in which there is increased absorption of iron so food items containing vitamin C should be avoided as vitamin C increases the absorption levels of iron.

can cause liver cirrhosis

221
Q

what is Pharyngeal pouch

A

herniation of the pharyngeal mucosa through a point of weakness

symptoms:
dysphagia
regurgitation of food
bad breath
lump in neck
weight loss

222
Q

investigation for pharyngeal pouch

A

barium swallow

223
Q

what are the risks of ERCP

A

acute pancreatitis

224
Q

which tumour marker is used for pancreatic cancer

A

CA19-9

225
Q

how long after last drinking alcohol does delirium tremens present

A

48-72 hours

226
Q

peritonitis

A

it is the inflammation and infection of the peritoneum -
can cause fever and cloudy ascitic tap appearance

common in end stage liver diease

227
Q

what is Gilberts syndrome

A

inherited condition that affects how the liver processes bilirubin

Bilirubin is a yellow pigment produced when red blood cells break down - normally processed by the liver and excreted in bile.
have a deficiency in an enzyme called UDP-glucuronosyltransferase, which is responsible for processing bilirubin.
As a result, bilirubin levels in the blood can become elevated, leading to jaundice (yellowing of the skin and eyes).
Gilbert’s syndrome is usually asymptomatic, but some people may experience fatigue, abdominal discomfort, or other mild symptoms.
Gilbert’s syndrome is usually diagnosed based on blood tests that show elevated levels of bilirubin, particularly after fasting or during illness.

228
Q

signs of B12 deficiency

A

glossitis - swollen tongue
bleeding gums
and perphipheral neuropathy - tingling of the hands and feet

229
Q

what is choledocholithiasis

A

the presence of a gallstone in the bile duct

230
Q

presentation of choledocholithiasis

A

Abdominal pain in the upper right quadrant
Nausea and vomiting
Jaundice (yellowing of the skin and eyes)
Dark urine and pale stools
Fever and chills

231
Q

what is ascending cholangitis

A

when the bile duct gets infected

presents with chariots triad - RUQ pain, fever and jaundice

232
Q

what is acute cholecystitis

A

inflammation of the gall bladder

presents with RUG pain and fever

233
Q

what is biliary colic

A

when a gall stone blocks the bile duct and the contraction of the bile duct causes pain

RUQ pain

234
Q

what is gall stone pancreatitis

A

gallstone blocks the pancreatic duct

severe abdominal pain, nausea, vomiting, and fever.

235
Q

what is gallstone ileus

A

gall stone blocks the small intestine and causes constipation and obstruction

236
Q

presentation of small bowel obstruction

A

Cannot pass gas or stool and very painful

237
Q

Presentation of large, bowel obstruction

A

Lower abdominal pain blood in the stool

238
Q

Investigation and imaging for acute cholecystitis

A

Use ultrasound to see the stone
MRCP, for imaging of the gallstones and ER CP, for treatment of the gallstones to give IV fluids and cholecystectomy

239
Q

What is the most common cause of ascending cholangitis?

A

E. coli

240
Q

What analgesia do you get for gallstones?

A

NSAIDs, but more specifically diclofenac

241
Q

In what condition do you not give NSAIDS

A

If the patient has ulcers

242
Q

Presentation and features of appendicitis

A

Rovsing sign is positive Murphy. Sign is positive is the information of the appendix common in young/teenagers characterised by pain in the centre that radiates to the right side right iliac fossa pain colicky in nature.

243
Q

What is the management of appendicitis?

A

Surgical removal if the appendix has ruptured, then do emergency operation, as can spread bacteria to the blood and cause sepsis

244
Q

What is the pathophysiology of pancreatitis?

A

Trypsinogen is a precursor to trypsin, and is found in the pancreas and is released in the in active form

In pancreatitis, it can become active and turn into trypsin and attack the pancreas and caused it to break down

245
Q

What is the investigation for pancreatitis?

A

Always check for lipase and amylase, as they are released when trypsin breaks down the pancreas

246
Q

Why does pancreatitis cause hypocalcaemia?

A

On the breakdown of the pancreas, due to the trypsin free fatty acid is released, which binds to calcium causing hypocalcaemia

247
Q

What are the symptoms of pancreatitis?

A

Epigastric pain that radiates to the back fever, nausea and vomiting. Pale stools increase in fatty acids.

248
Q

What is an importer differential to rule out from a cute pancreatitis

A

AAA abdominal aortic aneurysm at present with epigastric/chest pain, make sure to do an ECG to rule this out

249
Q

What is the management for AAA?

A

If the aneurysm is 4.5 to 5.5 but asymptomatic, then measure again in three months, if we aneurysm is symptomatic or more than 5.5 do surgery

250
Q

What is primary biliary cholangitis?

A

It is an inflammation of the biliary ducts, autoimmune common.

In FAT FORTY Females
It causes cirrhosis of the bowel duct and jaundice severe itching

It is due to IgM antibodies

AMA antibodies
raised ALP
Associated with rheumatoid arthritis/thyroid disease/other autoimmune conditions

251
Q

What is primary sclerosing cholangitis?

A

Inflammation of the right and left hepatic ducts of autoimmune cause

Caused by IgG antibodies and associated with IBD, so Crohn’s or ulcerative colitis

252
Q

What is the presentation of primary sclerosing cholangitis?

A

Viva, jaundice figure, hepatic duct, itchiness, and liver problems

253
Q

Investigation for primary sclerosing cholangitis

A

ERCP

254
Q

Investigation for primary biliary cholangitis

A

MRCP and ultrasound to rule out anything else

255
Q

Management of primary biliary cholangitis

A

urosodeoxycholic acid

and cholestyramine for the itching

AMK (27 decks)

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