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medicine can be fun > Gastro > Flashcards

Gastro Flashcards

1
Q

acute pancreatitis causes

A

GET SMASHED
Gallstones (female)
Ethanol (male)
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hypercalcaemia
ERCP
Drugs: azathioprine, thiazides, mesalazine

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2
Q

acute pancreatitis symptoms

A
  • severe epigastric pain radiates to back
  • nausea and vomiting
  • fever
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3
Q

acute pancreatitis signs

A
  • Grey turner’s: flank bruising
  • Cullen’s: periumbilical bruising
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4
Q

acute pancreatitis bloods

A
  • high serum amylase & lipase (more specific)
  • FBC: high WCC
  • high CRP
  • low calcium
  • LFTs: high ALT suggests gallstones
  • blood gas
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5
Q

acute pancreatitis imaging

A

CT abdomen
US for gallstones

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6
Q

acute pancreatitis severity score

A

Glasgow score: PANCREAS
PO2 < 8
Age > 55
Neutrophils (WCC > 15)
Calcium < 2
Renal (urea > 16)
Enzymes (ALT > 200)
Albumin < 32
Sugar > 10

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7
Q

acute pancreatitis management

A

IV fluids (most important)
IV antibiotics
NGT if vomiting (prefer oral nutrition)
analgesia
antiemetics
oxygen if hypoxic

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8
Q

acute pancreatitis complications

A

pancreatic pseudocyst
chronic pancreatitis
abscess
ARDS
AKI
septic shock

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9
Q

chronic pancreatitis presentation

A

diabetes (annual HbA1c)
loose floaty stools (malabsorption)

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10
Q

chronic pancreatitis causes

A

on going alcohol use

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11
Q

chronic pancreatitis investigations

A

faecal elastase
CT abdomen calcification

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12
Q

chronic pancreatitis management

A

enzyme replacement (Creon)

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13
Q

acute cholangitis causes

A

common bile duct obstruction causes E Coli infection
- gallstones
- iatrogenic strictures

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14
Q

acute cholangitis presentation

A

Charcot’s triad
1. fever
2. RUQ pain
3. jaundice (pruritus, pale stools, dark urine)

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15
Q

acute cholangitis bloods

A
  • FBC: high WCC
  • high CRP
  • LFTs: high ALP, high bilirubin
  • blood culture
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16
Q

acute cholangitis imaging

A

first line: US for all RUQ pain
diagnostic: ERCP (MRCP if uncertain)

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17
Q

acute cholangitis management

A

i) ERCP + fluids + antibiotics + analgesia
ii) elective lap cholecystectomy

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18
Q

acute cholangitis complications

A

bile duct perforation -> sepsis
ERCP complications (pancreatitis)

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19
Q

ulcerative colitis with jaundice, raised ALP?

A

primary sclerosing cholangitis

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20
Q

PSC antibodies

A

p-ANCA

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21
Q

first line management of PSC

A

ursodeoxycholic acid

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22
Q

complication of PSC

A

cholangiocarcinoma

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23
Q

PSC investigations

A

MRCP/ERCP

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24
Q

pancreatic cancer histology

A

adenocarcinoma

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25
Q

pancreatic cancer risk factors

A

old, smoking, diabetes, chronic pancreatitis
Lynch syndrome, MEN

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26
Q

pancreatic cancer presentation

A

painless jaundice
palpable gallbladder
FLAWS
steatorrhoea (difficult to flush stool)
Trousseau sign

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27
Q

pancreatic cancer cancer marker

A

Ca19-9

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28
Q

pancreatic cancer imaging

A

first line: US for jaundice
diagnostic and staging: CT abdomen

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29
Q

pancreatic cancer management

A

chemo + Whipple + enzyme replacement
palliative: ERCP stent

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30
Q

pancreatic cancer LFTs

A

high ALP, high bilirubin

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31
Q

acute cholecystitis causes

A

gallstone obstructing cystic duct

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32
Q

acute cholecystitis presentation

A

fever
RUQ pain
no jaundice
Murphy’s sign: pain with palpation on inspiration

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33
Q

acute cholecystitis bloods

A

high WCC, high CRP
normal lipase & amylase (exclude pancreatitis)
LFTs (not too bad)

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34
Q

acute cholecystitis imaging

A

no sepsis: US
sepsis: CT abdomen (gallbladder empyema, perforation)

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35
Q

acute cholecystitis management

A

fluids + antibiotics + analgesia + lap chole within 1 week

36
Q

acute cholecystitis complications

A
  • gallbladder empyema
  • perforation
  • gallstone ileus (SBO)
37
Q

cholelithiasis vs choledocholithiasis

A

cholelithiasis: stones in gallbladder
choledocholithiasis: stones in common bile duct

38
Q

gallstones risk factors

A
  • 5 Fs
    Fat (cholesterol stones)
    Forty
    Female
    Fair (haemoglobinopathy - Sickle cell)
    Fertile (pregnant, OCP)
  • Crohn’s
39
Q

biliary colic presentation

A

RUQ pain after a meal

40
Q

biliary colic investigations

A

normal LFTs
normal FBC
normal amylase & lipase
abdominal US

41
Q

biliary colic management

A

analgesia + elective lap chole

42
Q

cholestatic drugs

A

co-amoxiclav
macrolides (clarithromycin, erythromycin)
oral contraceptive
testosterone
sulphonylureas

43
Q

3 features of Crohn’s histology seen in biopsy

A

transmural inflammation
increased goblet cells
non-caseating granulomas

44
Q

2 features of Crohn’s seen in colonoscopy

A

cobblestone appearance
skip lesions

45
Q

site affected by Crohn’s

A

anywhere from mouth to anus
commonly terminal ileum and perianal lesions

46
Q

biggest risk factor that worsens Crohns

47
Q

3 GI symptoms of Crohn’s

A

RIF pain
diarrhoea with mucus
weight loss

48
Q

4 extra-intestinal symptoms of Crohn’s

A

mouth ulcers
joint pain
erythema nodosum
pyoderma gangrenosum

49
Q

what is seen in an abdominal X-ray in Crohn’s

A

bowel dilatation

50
Q

what is seen in Barium enema single contrast in Crohn’s

A

string of Kantor
rose thorn ulcer

51
Q

how to induce remission in Crohn’s

A
  • steroids
  • IV hydrocortisone if severe
  • oral prednisolone if mild/moderate)
52
Q

3 complications associated with Crohn’s

A

gallstones
fistula & abscess
small bowel obstruction

53
Q

diagnostic investigation in IBD

A

colonoscopy and biopsy

54
Q

3 features of UC histology seen in biopsy

A

inflammation only in mucosa
crypt abscesses
goblet cell depletion

55
Q

2 features of UC seen in colonoscopy

A

continuous inflammation
pseudopolyps

56
Q

site of inflammation in UC

A

rectum and colon

57
Q

gene for UC

58
Q

smoking in UC

A

smoking is protective in UC

59
Q

3 gastrointestinal features of UC

A

bloody diarrhoea
tenesmus
LLQ pain

60
Q

4 extra-intestinal features of UC

A

ankylosing spondylitis
eyes
erythema nodosum
pyoderma gangrenosum

61
Q

abdominal X-ray in UC

A

thumbprinting

62
Q

what is seen in Barium enema double contrast in UC

A

lead pipe appearance (loss of haustrations)

63
Q

how to classify UC flares

A
  • Mild: <4 stools a day
  • Moderate: 4-6 stools a day with no systemic upset
  • Severe: systemic upset (fever, CRP)
64
Q

how to induce remission in mild/moderate UC

A

i) rectal mesalazine
ii) oral mesalazine
iii) oral prednisolone if above ineffective

65
Q

how to induce remission in severe UC

A

IV hydrocortisone in hospital

66
Q

how to maintain remission after mild/moderate UC flare

A

mesalazine

67
Q

how to maintain remission after severe UC flare

A

azathioprine

68
Q

complications of UC

A
  • toxic megacolon
  • colon cancer
  • primary sclerosing cholangitis leading to cholangiocarcinoma
69
Q

4 causes of a gastrointestinal perforation

A
  • perforated ulcer (most common)
  • perforated diverticulum
  • perforated oesophagus (Boerhaave’s)
  • perforated appendix
70
Q

features of a patient with gastrointestinal perforation

A
  • very unwell: fever, hypotension, tachycardia
  • peritonitis: severe generalised pain with distention and rigidity
71
Q

what do bloods show in gastrointestinal perforation

A

neutrophilic leucocytosis
lactic acidosis
raised urea and creatinine

72
Q

first line and diagnostic imaging in gastrointestinal perforation

A
  • first line: erect CXR air under the diaphragm
  • diagnostic: CT AP
73
Q

what will an abdominal X-ray show in someone with gastrointestinal perforation

A

Rigler’s sign: double intestine wall due to air in the peritoneum

74
Q

conservative management of a gastrointestinal perforation

A

IV fluids
broad spectrum antibiotics (tazocin)
NBM put an NG tube
IV PPI
insert a catheter

75
Q

definitive management of a gastrointestinal perforation

A

emergency surgery
omental patch in ulcers, bowel resection in bowel

76
Q

what are the three stages of alcoholic hepatitis

A
  • fatty liver (reversible)
  • alcoholic hepatitis
  • cirrhosis
77
Q

what are 3 symptoms of alcoholic hepatitis

A
  • RUQ pain
  • nausea
  • hepatomegaly
78
Q

what do LFTs show in alcoholic hepatitis

A
  • high AST and gamma-GT
  • AST:ALT ratio >2
  • high bilirubin
79
Q

what are two markers of poor liver function

A
  • low albumin (chronic)
  • prolonged PT (acute)
80
Q

what is the imaging of choice in alcoholic liver disease

A

US of liver

81
Q

what do you see in liver biopsy of alcoholic liver disease

A
  • Mallory Denk bodies
  • Ballooning
82
Q

how do you manage alcoholic liver disease

A

i) alcohol abstinence
- thiamine for Wernicke’s
- benzodiazepines for withdrawal
ii) prednisolone if severe

83
Q

what are three sources of raised ALP

A
  1. pregnancy
  2. bone mets, Pagets
  3. obstructive jaundice
84
Q

what is the classic presentation of Gilbert’s

A
  • healthy male
  • normal LFTs
  • isolated raised bilirubin
85
Q

Budd-Chiari syndrome: what is it, triad of symptoms, associations

A
  • hepatic vein thrombosis
  • triad of abdo pain, ascites, hepatomegaly
  • associated with hypercoagulation
86
Q

upper GI bleed scoring system

A

Glasgow-Blatchford

medicine can be fun (12 decks)

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