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Year 6 > Gastro > Flashcards

Gastro Flashcards

1
Q

Ranking severity of UC/Crohns

A

Mild- <4 stools, minimal blood
Mod- 4-6- vary blood, no systemic
Severe- >6 bloody stools, systemic

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2
Q

Scores for Upper GI bleed

A

Blatchford- determine if managed at OP- 0
Endoscopy within 24hrs
Rockall- after endoscopy- determines mortality and risk of rebreeding

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3
Q

Mx of achalasia

A

Heller cardiomyotomy
CCB or nitrates, botox- since is a failure to relax

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4
Q

Mx of crohns fistula and abscess

A

If symptomatic Oral metronidazole
If complex- draining seton

Abscess- incision and drainage

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5
Q

Mx of crohns

A

Induce with steroids
Mild- Oral pred, severe- IV HC

Maintains with azathioprine or mecapto

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6
Q

Ix of coeliac

A

Anti TTG
Jejunal biopsy or duodenal

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7
Q

Mx of alcoholic hepatitis

A

Maddrey discriminant- benefit from Prednisilone

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8
Q

Plummer Vinson Sx

A

Triad- dysphagia, glossitis, IDA

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9
Q

Mx of UC

A

Inducing remission
Topical aminosalicylates
If not induced in 4 weeks add oral
Add CS if still not working

Extensive disease- topical and rectal 4w
CS after

Severe fulminant - IV steroids

Maintaining remission
Topical aminosalicylates- add oral
Extensive- oral

Severe or 2 or more relapses per year- azathioprine /mercaptopurine

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10
Q

Areas where you get Haemorrhoids

A

3, 7, 11

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11
Q

Signs in appendicitis

A

Rovsing- pain greater in RIF when pressure on left
Psoas- pain when extending hip

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12
Q

Colic vs cholecystitis vs cholangitis

A

Pain- colic
Pain + fever- cholecystitis
Pain + fever + jaundice- cholangitis

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13
Q

Mx of cholecystitis and cholangitis

A

IV Abx
Laparoscopic cholecystectomy within 1 week- cholecystitis
ERCP within 24-48hrs for cholangitis

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14
Q

PBC vs PSC

A

PBS- anti-mitochondrial - diagnostic
Sjogrens
Middle aged women
Jaundice

PSC- pANCA
Intra and extra
Male
UC
Dx- with MRCP

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15
Q

Chronic stable liver disease Sx

A

Palmar erythema
Dupuytrens
Clubbing
Gynaecomastia
Spider nave

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16
Q

Sx of acute decompensation liver

A

Portal hypertension SAVE
Splenomegaly
Ascites
Varices
Encephalopathy
Failes synthetic funciton

GI can precipitate this

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17
Q

Dx of SBP

A

USS to confirm ascites
Ascites tap- PMN >250

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18
Q

Mx of SBP

A

Tazocin
Cipro and propanolol prophylaxisif ascites and SAAG <15

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19
Q

Ix of Haemachromatosis

A

Raised ferritin
TIBC reduced- reduced transferrin production
TF saturation- >55% male, 50 female

Pearl stain of liver biopsy

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20
Q

Acute Pancreatitis Sx

A

Epigastric pain
Cullen, grey turner
Vomitting

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21
Q

Prognosis scoring of pancreatitis

A

PANCREAS
PaO2- <8
Age 55
Neuts- >15
Ca <2
Renal urea- >16
Enzymes- AST/ALT >200
Albumin <32
Sugar- >10

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22
Q

Sx of chronic pancreatitis

A

Pain 15-30- mins after meal
Steatorrhoea
DM- 20 yrs after

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23
Q

Ix for acute pancreatitis

A

Serum amylas, lipase
USS for stones
Contrast CT

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24
Q

Ix for chronic pancreatitis

A

USS and contrast CT
Faecal elastase- reduced

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25
Q

Ix of diverticulitis

A

CT abdomen - acute
Barium enema- chronic

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26
Q

Mx of diverticulitis

A

Acute mild- PO ABx
Severe- IV ABx, drip and suck hartmanns
Chronic- high fibre diet

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27
Q

Urgent 2ww OGD

A

Dysphagia
Upper abdo mass
AGe >55 + weight loss and dyspepsia, gord, upper abdo pain

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28
Q

Non urgent OGD

A

Haematemesis
Age >55- pain with low Hb and pain, N+V with reflux, raised Plt and wt loss nausea

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29
Q

Ix for dyspepsia

A

If alarm features- OGD
No alarm- breath/stool test for H pylori

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30
Q

Mx of dyspepsia

A

Review medication
Then PPI 4w
Then test H pylori

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31
Q

Anal fissure mx acute and chronic

A

Acute- laxatives
Chronic- GTN then spincterectomy if not resolved after 8 weeks

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32
Q

Prognosis scoring of alcoholic hepatitis

A

Child Pugh
ABCDE
Albumin, Bilirubin, Clotting, distention (ascites), encephalopathy

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33
Q

Budd chiari syndrome Sx and IX

A

Block of hepatic vein
Pain, ascites, tender hepatomegaly
Abdo USS

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34
Q

Sx of carcinoid syndrome

A

Flushing, diarrhoea, bronchospasm

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35
Q

Perianal abcess Sx and Mx

A

Pain worse when sitting, discharge
Drain under local

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36
Q

Boerhaaves Sx

A

Chest pain
SC emphysema- air under skin
Vommiting
Shock

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37
Q

Ischaemic colitis Sx and Ix

A

Occlusion of IMA
Pain, bloody, large intestine- splenic flexure
Sigmoidoscopy

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38
Q

Acute vs chronic ischaemia

A

Acute- sudden, pain, normal exma

Chronic- colic pain

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39
Q

Small intestinal bowel overgrowth- RF, sx and mx

A

DM- risk factor
Chronic diarrhoea, flatulence and pain
Rifampicin

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40
Q

Pellagra sx

A

Diarrhoea, dermatitis, dementia
B3

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41
Q

Index for measuring malnutrition

A

MUST

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42
Q

Wilson disease sx

A

Liver
Neuro- psychiatric

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43
Q

Haemachromatosis

A

Fatigue, ED, arthralgia
Bronze skin
DM
Liver
CF

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44
Q

Mx of ascites secondary to liver disease

A

Spironolactone

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45
Q

Pharyngeal pouch sx

A

Halitosis
Problems swallowing

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46
Q

Dysphagia causes

A

Mechanical- stricture- Plummer vinson, malignancy, pharyngeal pouch

Neuro/motility- bulbar/pseudobulbar palsy, achalasia, CREST, MG

Inflammation- oesophagitis, candida, pharyngitis, tonsilitis

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47
Q

Achalasia Ix

A

Mamometry
Barium swallow
OGD- exclude malignancy

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48
Q

Oesophageal cancer Ix

A

Endoscopy and biopsy
If barium swallow- apple core

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49
Q

GORD sx

A

Acid taste
Worse laying down
Worse after eating

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50
Q

Mx of GORD

A

Lose wt, less alcohol
Antacids then PPI

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51
Q

Sx of duodenal ulcers

A

Epigastric pain before meals and at night
Relieved by eating

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52
Q

Ix of Peptic ulcers

A

Bloods, breath test, OGD- biopsy ulcers

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53
Q

Mx of perforated ulcer

A

 DU: abdominal washout + omental patch repair
 GU: excise ulcer and repair defect

No medical mx needed apart from stop meds that might be causing

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54
Q

Gallstone ileus Sx

A

Rigler triad- pneumobillia, SBO, gallstone in RLQ

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55
Q

CT signs of pancreatitis

A

Panc has lost its defined architecture
Fat stranding- CT

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56
Q

When is MRCP used

A

If dilated duct on USS - for CBD occlusions
PSC

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57
Q

Raised amylase weeks after acute panc

A

Pseudocyst

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58
Q

Tx of pancreatic pseudocyst

A

<6- spontaneous
>6cm- drainage

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59
Q

Complications of pancreatitis

A

Early
Resp- ARDS, effusion
Shock
Renal failure
DIC
Metabolic

Late- pancreatic necrosis, infection, access, thrombosis, pseudocyst

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60
Q

Chronic cholecystitis sx

A

Abdo discomfort
Sx exacerbated by fatty foods
Nausea
Flatulence

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61
Q

RF for cholangiocarcinoma

A

PSC
UC

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62
Q

Tx of cholagiocarcinoma

A

 Poor prognosis: no curative Rx
 Palliative stenting by ERCP

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63
Q

Differentials for appendicitis

A

Diverticulitis
Meckel diverticulitis

Ectopic- preg test !!!
Cyst torsion

UTI

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64
Q

Extra abdominal sx of IBD

A

Erythema nodosum
Clubbing
Arthritis
Iritis

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65
Q

Type of ulceration in each IBD

A

UC- shallow broad

Crohsn- deep, wavy- cobblestone mucosa

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66
Q

Microscopic features of UC and crohns

A

Crohns- fibrosis, granuloma, fistulae, goblet cells
Strictures- macro

UC- crypt abcsess, pseudopolyps

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67
Q

Ix of diverticula disease

A

Contrast CT
Colonoscopy- not in acute attack
Enema

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68
Q

Complications of diverticulitis and their Tx

A

Perf- sudden pain, shock- Hartmanns

Haemorrhage- painless red PR- mesenteric angio- may stop spon

Abcess- swinging fever- abs and drainage

Fistulae- enterocoelic SB and LB, colovaingal, colovesicular- resection

Strcitutres- resection or standing

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69
Q

Types of bowel obstruction

A

Simple- 1 obstruction
Closed- 2 points- volvulus
Strangulated- localised, constant pain, peritoneum, fever, High WCC

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70
Q

Tx of Bowel obstruction

A

Medical- Drip and suck
NBM
Fluids
Catheterise- monitor UO
Analagesia
ABx
Gastrogaffin study

Surgical- if closed, strangulated

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71
Q

Colorectal cancer Ix

A

Bloods
 FBC: Hb
 LFTs: mets
 Tumour Marker: CEA

Imagining- CXR, CT and MRI- better for rectal and liver

Endoscopy + biopsy

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72
Q

TNM staging of colorectal cancer

A

TIS: carcinoma in situ
T1: submucosa
T2: muscularis propria
T3: subserosa
T4: through the serosa to adjacent organs
N1: 1-3 nodes
N2: >4 nodes

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73
Q

Dukes staging

A

A- bowel wall- 90% 5 yr
B- through wall no LN- 60%
C- regional LN- 30%
D- distant- <10%

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74
Q

Differentials for anal pain

A

Proctalgia fugax- crampy anal pain in young men at night
Anal fissure - pain when defacating, fresh bleed, constipated
Thrombosed haemorrhoid
Fistula- discharge persistent
Peri anal abscess- worse on sitting, fever

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75
Q

Surgery for Femoral hernia

A

Need surgery ASAP

Elective- Lockwood- herniotomy and herniorrharpy

Emergency- McEvedy- allows resection of non viable bowel

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76
Q

How anal fistulas are treated

A

Low- fistulotomy- heals as flat scar

High- suture- tighten it over months

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77
Q

Inducing remission UC

A

Topical mesalazine
Mod- add oral
Sev- Add CS

> /= 2 relapses or severe- azathioprine or mercaptopurine

78
Q

Maintaining remission UC

A

Mild-mod- topical /+ oral
Extensive- oral

Severe/ >2 in a year- oral azathioprine or mercapto

79
Q

What type of oesophageal cancers are found where

A

Adeno- bottom 1/3
Squamous- middle 1/3

80
Q

Prophylaxis of variceal bleed

A

Beta blockers- propanolol
Endoscopic variceal band ligation

81
Q

Acute tx of variceal bleed

A

ABC
FFP, Vit K
Terlipressin
IV ABx

During endoscopy- band ligation

If uncontrollable bleed and too long for endoscopy- sengstaken Blakemore tube

After- propanolol

82
Q

Wilsons disease Sx

A

Neuro- incoordination basal, psychiatric
Liver - cirrhosis
Kayser Fleischer
Blue nails

83
Q

Ix for Wilsons

A

Reduced caeruloplasmin
Reduced copper

84
Q

Tx of Wilsons

A

Penicillamine

85
Q

Flare up with chronic Hep B infection

A

Hep D superinfection
Jaundice, fever, pruritus

86
Q

Mx of C diff

A

Oral vancomycin
2nd- fidaxomicin
3rd- Oral Vancomycin +/- iv met

87
Q

Which artery can be damaged and caused massive GI bleed with ulcers

A

Gastroduodenal ulcer

88
Q

Most common cause of chronic pancreatitis

A

Alcohol abuse

89
Q

Haemachromatosis iron studies

A

TS- high
Ferritin- high- correlate to iron storage
TIBC- low

90
Q

Travellers diarrhoea organism

A

ETEC

91
Q

Dull ache of RUQ with mildly raised ALT with HF

A

Congestive hepatomegaly

92
Q

Which anti-emetic to avoid in bowel obstruction

A

Metoclopramide

93
Q

Deficiency in what causes wernickes encephalitis

A

Thiamine
B1

94
Q

SE of PPI

A

OP and fractures

95
Q

Puetz jeghers sx

A

Obstruction
Freckles on lips

96
Q

Met Bowel cancer causing obstruction, what drugs in syringe driver

A

Hyoscrine and morphine

97
Q

Drugs to prevent hepatic encephalopathy

A

Lactulose and riftximin

98
Q

Mx of massive variceal bleed

A

Terlipressin
Sengstaken Blakemore tube
Endoscopic ligation

99
Q

Niacin deficiency sx

A

Dermatitis
Dementia
Diarrhoea

Pellagre

100
Q

Small bowel overgrowth syndrome sx

A

Chronic diarrhoea
Bloating, flatulence
Abdo pain

101
Q

SBOS dx

A

Hydrogen breath test

102
Q

Tx of haemachromatosis

A

Venesection 1st
Desferrioxamine 2nd

103
Q

What can exacerbate NAFLD

A

Sudden weight loss

104
Q

SE clindamycin that patients should be made aware of

A

C diff

105
Q

Triad of Budd chiari

A

Sudden severe abdo pain
Ascites
Tender hepatomegaly

106
Q

Ix of Budd chiari

A

US with doppler flow

107
Q

What is prescribed with large paracentesis

A

IV Human albumin solution

108
Q

Sx of achalasia

A

Dysphagia of food and liquids from the start
Heartburn

109
Q

What is the most specific and sensitive lab marker for CLD turning into cirrhosis

A

Plt <150

110
Q

Screening for PCKD

A

US

111
Q

What is used to monitor tx in haemachromatosis

A

Ferritin
Transferrin saturation

112
Q

Vaccine for coeliac

A

Pneumococcal
Due to hyposplenism

113
Q

Haemachromatosis inheritance

A

AR

114
Q

Mx of chronic anal fissure

A

Topical GTN if not effective after 8 weeks
Consider surgery or botulism

115
Q

When should you refer urgent 2ww colorectal

A

> 40 with unexplained wt loss and abdo pain
50 unexplained rectal bleeding
60 with IDA or bowel habit change

116
Q

Refeeding syndrome sx

A

Low phosphate, potassium, Mg, abnormal fluid balance, arrhythmia

117
Q

Tx of ascites medically

A

Spironolactone

118
Q

Grading hepatic encephalopathy

A

1- irritable
2- confusion
3- incoherent
4- coma

119
Q

Tx of H pylori with pen allergy

A

Clarithro, metronidazole, omeprazole

120
Q

Skin signs in abdo exam

A

Erythema nodosum- on shins- IBD
Pyodeerma gangrenosum- ulcer- IBD
Jaundice- liver
Slate grey- Haema

121
Q

Scars in abdo exam and uses

A

Kocher- biliary
Rutherford morrison- kidney transplant
Nephrectomy- lower midline
Laparotomy- AAA, Hartmans
Xanthelasma- PBC

122
Q

Signs in chronic liver diases

A

Hands- dupuytrens, clubbing, leuconychia, erythema
Asterixis, ascites - decomp
Spider naevi, gynaecomastia
Jaundice
Splenomegaly

123
Q

Causes of cirrhosis

A

Alcohol
Hep B and C
AI Hep
PBC, PSC
Wilsons
Haemachromatosis
NAFLD
Budd chiari
A1AT

124
Q

Cause of ascites

A

Chronic liver disease
Malignancy
Nephrotic syndrome

125
Q

Areas where hepatitis is prevalent

A

Africa
Asia

126
Q

Anal fissure tx

A

Laxatives and high fibre
Chronic- topical GTN
Resistant- sphincterotomy

127
Q

If dysplasia on endoscopy in barrels what is mx

A

EMR- resection

128
Q

Electrolyte imbalance caused by diarrhoea

A

Metabolic acidosis with low K

129
Q

Organism in ascites

A

E coli

130
Q

Blood results of upper GI bleed

A

High urea
Anaemic

131
Q

Description of NAFLD on USS

A

Increased echogenicity

132
Q

What is dx of malnutrition

A

> wt loss than 10% in 3-6 months

133
Q

Tx of IBS diarrhoea

A

Loperamide

134
Q

Maintaining remission with crohns

A

Mercaptopurine or azathioprine

135
Q

If TMPT + in crowns what should be used in remission

A

Methotrexate

136
Q

Tx of C diff if repeat episode within 12 weeks

A

Fidoxomicin

137
Q

Intestinal angina/ chronic mesenteric ischaemia sx

A

Triad- colicky pain, weight loss, abdominal bruit

138
Q

When to stop statins

A

When 3x ULN LFTs

139
Q

Peritonitis secondary to peritoneal dialysis organism

A

Staph epidermis

140
Q

Tx of fistula in crohns

A

Seton

141
Q

Which drug is a RF for C diff that’s not an AB

A

PPI

142
Q

Women with deranged LFTs and secondary amenorrhea ant tx

A

AI Hepatitis
Steroids- liver transplant

143
Q

If pernicious anaemia which cancer predisposed to

A

Gastric

144
Q

What changes the efficacy of hydrogen breath test

A

Antibiotics in last 4 weeks
PPIs in last 2

145
Q

Appendicitis symptoms what ix

A

USS

146
Q

How TIPS works, what it treats and its complications

A

Shunt from portal vein to hepatic to bypass liver for variceal bleeds

As bypassing liver- can cause build up of nitrogen waste products

147
Q

Puetz Jeghers sx

A

Hamartomas
Freckled lips

148
Q

Ix for liver cirrhosis

A

Transient elastography

149
Q

When to ix for liver cirrhosis

A

Hep C infection
>50 units men, 35 women
Alcohol related LD

150
Q

Ix of ascites

A

USS then tap
confirm for SBP

151
Q

Lymphoma associated with coeliac

A

Enteropathy T cell lymphoma

152
Q

Diarrhoea causes what metabolic disturbance

A

Acidosis normal anion gap

153
Q

Cause of highly pigmented colon

A

Laxative abuse
Melanosis coli

154
Q

Tx of AI hepatitis

A

Steroids

155
Q

If going for diagnostic biopsy for coeliac what should the patient continue to do

A

Eat gluten

156
Q

Dysentry after long incubation

A

Amoebi

157
Q

Nicorandil SE

A

GI ulceration

158
Q

Most common complaint of peutz jegher syndrome

A

Small bowel obstruction

159
Q

How does pseudomembranous colitis look on sigmoidoscopy

A

Yellow plaques in lumen

160
Q

Cause of IDA returning from India

A

Hookworm

161
Q

If H pylori + but have ALARMD sx what do you do

A

Endoscopy- main - if ALARMD sx or >55
Treat H pylori too- usually if <55

ALARMD- anaemia, Loss of weight, anorexia, recent, Selena, dysphagia

162
Q

Prev severe UC remission tx

A

Azathioprine

163
Q

Ix for mesenteric ischaemia

A

VBG- lactate

164
Q

Life threatening C diff infection

A

Hypotension
Toxic megacolon

Then treat with oral vans and IV met

165
Q

Gluten free common foods

A

Rice, maize/corn, potatoes

166
Q

Tx of campylobacter

A

Clarithromycin

167
Q

Dx of carcinoid

A

Urinary 5 HIAA

168
Q

Main causes of pruitis

A

IDA
Lymphoma
Polycythaemia
Liver failure
CKD

169
Q

Hepatocellular carinoma marker

A

AFP

170
Q

Floating stools coming back from Egypt/Russia

A

Giardia- long incubation period
Long lasting

171
Q

Tx of PSC

A

Observe
?liver transplant

172
Q

Good indication alcoholic hepatitis needs steroids

A

High PT and Bilirubin
In Maddrey Discriminant

173
Q

What is caecal volvulus associated with

A

Malignancy

174
Q

Gastrectomy complications

A

Dumping sydrome- sugar moves too fast into bowel

Casues- distention, flushing, fainting, sweating

175
Q

Hep A tx and cancer lieklehood

A

No increase in chance of cancer
Supportive tx

176
Q

Tx of Hep B

A

Peginterferon alfa-2a

177
Q

Foul smelling discharge at old age and constipated

A

Diverticulitis- fistula

178
Q

What is CI in bowel obstruction

A

Laparascopic surgery

179
Q

How should total parenteral nutrition be administered

A

Through central vein

180
Q

Spider nevi vs telangiectasia

A

SN- fill centrally

181
Q

What causes dupytres contraction

A

Alcoholic liver disease

182
Q

Bloody supply of each section in gut

A

Foregut- coeliac- until 2nd duodenum
Mindgut- SMA- 2/3 along transverse
Hindgut- IMA- rectum

183
Q

What can cause decompensation of cirrhosis

A

Alcohol, Bleeding, Constipation, drugs, infection

184
Q

AB in AI Hepatitis

A

Anti Smooth muscle
ANA
Raised IgG

ALKM- types 2

185
Q

UC on barium enema

A

whole colon, without skip lesions, is affected by an irregular mucosa with loss of normal haustral markings

186
Q

Checking NG tube is in correct position

A

If pH <5.5
If unable to get aspirate or pH isn’t acidic- get CXR

187
Q

Smoking in IBD

A

Increases relapse in Crohns
Decreases in UC

188
Q

UC on x ray

A

Lead pipe

189
Q

What to do with PPI before endoscopy

A

Stop 2 weeks before

190
Q

Liver transplant guidance for paracetamol

A

Arterial pH < 7.3, 24 hours after ingestion

or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

191
Q

Pedunculated polyps colon cancer

A

Adenoma

Year 6 (28 decks)

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