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4th year passmed > Gastro > Flashcards

Gastro Flashcards

1
Q

What is achalasia?

A

Failure of oesophageal peristalsis and lower oesophageal sphincter relaxation leading to dilatation of oesophagus and stenosis at Z junction.
Linked to degenerative lossof ganglia in Auerbach’s plexus.

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2
Q

Clinical features of achalasia?

A

Dysphagia to BOTH solids AND liquids
Regurgitation(->cough/aspiration)
Acid reflux

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3
Q

Achalasia Ix?

A 
Manometry
Barium swallow (bird's beak)
CXR (mediastinal widening)
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4
Q

Achalasia Rx?

A

Intersphincteric injection of botulinum toxin
Heller cardiomyotomy
Pneumatic dilatation

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5
Q

NAFLD Fx?

A

Usually silent
Echogenicity on USS
Hepatomegaly
ALT»AST

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6
Q

Feature of anaemia seen in Coeliac?

And why?

A

Raised RCDW due to mixed micro and macrocytic anaemia from iron and B12 malabsorption

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7
Q

Findings on duodenal biopsy of Coeliac disease?

A

Villous atrophy
Crypt hyperplasia
Intraepithelial and lamina propria lymphocyte infiltration

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8
Q

Which of the following contain gluten?
Maize
Rye
Barley

A

Barley and Rye

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9
Q

What is fetor hepaticus and what is it a sign of?

A

Sweet fecal smelling breath consistent with acute liver failure

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10
Q

Commonest cause of inherited colorectal cancer?

A

HNPCC (5%)
Sporadic 99%
FAP 1%

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11
Q

What are the Amsterdam criteria and what are they used for?

A

Aids with HNPCC diagnosis:
At least two generations affected
At least one case before the age of 50
At least 3 family members affected

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12
Q

Commonest type of oesophageal cancer? + RFs?

A 
Adenocarcinoma in middle 1/3 of oesophagus
RFs include:
Alcohol
Smoking
GORD/Barretts
Obesity
Achalasia
Plummer Vinson
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13
Q

Diagnostic test for carcinoid syndrome?

A

Urinary 24hr 5-HIAA

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14
Q

Cardiac manifestations of Carcinoid syndrome?

A

Right valve disease;
Pulmonary stenosis
Tricuspid insufficiency
TIPS

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15
Q

Fx of Carcinoid syndrome

A 
Sweating/Flushing
Diarrhoea
Hypotension
Bronchospasm
N&V
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16
Q

Rx for Carcinoid syndrome?

A

Somatostatin (octreotide)

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17
Q

Haemochromatosis inheritance pattern?

A

AR mutation of HFE gene CHR6

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18
Q

Haemochromatosis Fx?

A 
Early fatigue, erectile dysfunction, arthralgia
Bronzing
Diabetes
CLD/cirrhosis etc
Cardiac failure
Hypogonadism
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19
Q

Fx + Rx of a pharyngeal pouch?

A

Regurgitation, dysphagia, halitosis, neck lump.

Rx is by surgery

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20
Q

Fx of hepatic encephalopathy?

A

Asterixis
Confusion
Constructional apraxia
Hyperammoniaemia

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21
Q

Rx for hepatic encephalopathy?

A

First line is lactulose - works by promoting ammonia metabolism by gut flora.
Second line is Rifamixin

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22
Q

Which 3 cancers are HNPCC patients most at risk of

A
  1. Colorectal
  2. Endometrial
  3. Stomach
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23
Q

What is a common side effect of inhaled steroid use

A

Oesophageal candidiasis

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24
Q

What is charcot’s triad and what is it seen in?

A

RUQ pain, fever, jaundice

Seen in ascending cholangitis

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25
Q

In whom would you see a yellow tinge to the skin and why?

A

Pernicious anaemia - pallor due to anaemia and jaundice due to haemolysis

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26
Q

PSC Ix?

A

MRCP - shows beading

Bloods - pANCA positive

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27
Q

Classical presentation for ischaemic colitis?

A

Sudden onset intermittent, diffuse, severe abdo pain, after a meal, vascular risk factors

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28
Q

Acute mesenteric ischaemia commonest underlying cause and Rx?

A

Embolism of SMA

Rx: Urgent surgery

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29
Q

X-ray finding in ischaemic colitis?

A

Thumbprinting

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30
Q

Classical presentation of Cyclical Vomiting Syndrome

A

Profuse vomiting preceded by sweating and nausea in an individual with a PMH of migraines.

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31
Q

At what vertebral level does the IMA branch from the aorta?

A

L3

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32
Q

Causes of Budd Chiari syndrome?

A

Polycythaemia rubra vera
Thrombophilia
Pregnancy
COCP

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33
Q

Ix for Budd Chiari syndrome?

A

Doppler USS

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34
Q

Fx of Budd Chiari?

A

Triad of:
Sudden onset severe abdo pain
Tender hepatomegaly
Ascites

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35
Q

What is the Blatchford score and what are its components?

A

Assesses severity and urgency of upper GI bleeds.

Components include Hb, urea, BP, HR, melaena, syncope, PMH.

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36
Q

Lead piping is seen in which patients?

A

Chronic UC

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37
Q

PPI SFx?

A

Hyponatraemia
Hypomagnesaemia
Osteoporosis
C. dif infections

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38
Q

Wilson’s disease Rx + MOA?

A

Penicillamine - copper chelation

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39
Q

Which IBD increases risk of gallstone formation and how?

A

Crohns - Terminal ileitis blocks bile reabsorption

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40
Q

Factors which increase risk of gallstone development?

A 
Crohns
Recent sudden weight loss
Recent surgery
FHx
Oral contraception
Old age
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41
Q

How do you differentiate upper from lower GI bleed on blood results?

A

Raised urea

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42
Q

Which organs are affected in MEN-1

A

Parathyroid
Pituitary
Pancreas (includes insulinomas, gastrinomas, ZE synd).

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43
Q

Diagnostic test for Zollinger Ellison syndrome?

A

Fasting serum gastrin

Secretin stimulation test

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44
Q

Which autoantibodies are seen in autoimmune hepatitis?

A

Anti SMA and ANA

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45
Q

When would you see piecemeal necrosis?

A

Autoimmune hepatitis

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46
Q

Biliary colic Fx and Rx

A

Fx: Colicky RUQ pain worse post prandially and after fatty foods.
Rx: Imaging (MRCP) and lap chole if applicable.

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47
Q

Acute cholecystitis Fx and Rx

A

Fx: RUQ pain, FFFF, fever, Murphy’s sign, may have deranged LFTs.
Rx: USS + Lap Chole (ideally in <2 days)

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48
Q

Gallbladder abscess Fx and Rx

A

Fx: RUQ pain after prodromal illness, swinging pyrexia, may be systemically unwell.
Rx: USS +- CT followed by surgery.

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49
Q

Cholangitis Fx and Rx

A

Fx: Systemically unwell, septic picture, jaundice, RUQ pain.
Rx: Fluids, BSAs, early ERCP

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50
Q

Gallstone ileus Fx and Rx

A

Fx: Often has Hx of cholecystitis, may have SBO.
Rx: Laparotomy and gallstone removal, with enterotomy proximal to obstruction.

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51
Q

Acalculous cholecystitis Fx and Rx

A

Fx: Intercurrent illness, stystemically unwell, absence of stones, high fever.
Rx: Lap chole if fit.

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52
Q

Risks of ERCP?

A

Bleeding
Perforation
Pancreatitis
Cholangitis

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53
Q

Risk factors for small bowel bacterial overgrowth syndrome?

A

Diabetes
Neonates with congenital gastro abnormalities
Scleroderma

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54
Q

Features of haemochromatosis?

A 
Early Fx: Fatigue, erectile dysfunction, arthritis
Late Fx:
Bronze skin 
arthritis
dilated cardiomyopathy
cirrhosis
diabetes
hypogonadism
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55
Q

What should patients on PPIs/H2is do regarding their medication preceding gastroscopy?

A

Stop taking them two weeks before the procedure so as not to mask any underlying pathology.

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56
Q

How do you diagnose Wilson’s disease?

A
  1. Low serum copper
  2. Low serum caeruloplasmin
  3. Raised urinary copper
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57
Q

What are the characteristic features of Plummer-Vinson Syndrome?

A
  1. Dysphagia
  2. IDA
  3. Glossitis
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58
Q

What should T1DM patients be screeened for on diagnosis?

A

Coeliac disease

Autoimmune thyroiditis patients should also be screened.

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59
Q

What are the components of the Child-Pugh score and what is it used for?

A 
Used to assess severity of liver cirrhosis .
Bilirubin
Prothrombin time
Albumin 
Encephalopathy
Ascites
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60
Q

Which area of gut is most likely to be affected in ischaemic colitis?

A

Splenic flexure (watershed area)

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61
Q

When might you commonly see ischaemic hepatitis?

A

Post MI

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62
Q

Carcinoid tumours release which hormones, and how does this relate to their presentation?

A

Serotonin and bradykinin which cause the vomiting, flushing, diarrhoea.
Also make ACTH causing Cushingoid Fx and impaired glucose control

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63
Q

How might lung adenocarcinoma present?

A

Clubbing, weight loss, gynaecomastia

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64
Q

What does c.dif antigen positivity represent?

A

Presence of bacteria but NOT current infection, meaning oral metronidazole is not indicated.

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65
Q

What should be given pre appendicectomy?

A

IV antibiotics

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66
Q

Which vitamin is teratogenic in high doses?

A

A

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67
Q

What is the impact of a patient having achalasia on the likelihood that they have adeno or SCC of the oesopahgus?

A

Achalasia means SCC is more likely than adenocarcinoma.

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68
Q

How does Budd Chiari syndrome present acutely?

A

Sudden onset abdo pain
Ascites
Tender hepatomegaly

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69
Q

What does a raised SAAG indicate?

A

That the ascites is secondary to portal hypertension

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70
Q

What is the link between hepatic encephalopathy and opiates?

A

Opiates cause constipation which can precipitate hepatic encephalopathy

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71
Q

Which blood finding is the most specific and sensitive finding for diagnosing cirrhosis in those with CLD?

A

Thrombocytopaenia

72
Q

What are the features of Peutz-Jeghers syndrome?

A

Multiple hamartomatous GI polyps (non malignant)
Pigmented freckles on face and palms/soles
GI bleeding

73
Q

What are two common haematological side effects of PPIs?

A

Hyponatraemia

Hypomagnesaemia

74
Q

What constitutes an urgent referral for dyspepsia?

A

Anyone with dysphagia

Anyone with an upper GI mass

Anyone over 55 with weight loss AND 1 of:
Epigastric pain
Reflux
Dyspepsia

75
Q

What is the commonest surgical intervention performed in Crohn’s patients?

A

Ileocaecal resection

76
Q

What ABG picture is seen in mesenteric ischaemia?

A

Metabolic acidosis

77
Q

Crypt abscesses are associated with which form of IBD?

A

UC

78
Q

How would you differentiate between IDA and AoChronic disese?

A

IDA: TIBC high, transferrin high
AoCD: TIBC low/normal, transferrin low

79
Q

What is the commonest causative agent of SBP?

A

E. coli

80
Q

What are the LFT findings in a paracetamol OD?

A

Raised ALT and AST but normal ALP

81
Q

What should be assessed before offering azathioprine or mercaptopurine therapy?

A

Thiopurine methyltransferase (TPMT) activity

82
Q

Aside from antiemesis, what are some other uses of metoclopramide?

A

GORD

Prokinetic agent used for gastroparesis in diabetics

83
Q

What are the side effects of metaclopromide?

A

Extrapyramidal
Hyperprolactin
Tardicve dyskinesia
Parkinsonisms

84
Q

What is the first line anti-motility agent for IBS?

A

Loperamide

85
Q

Increased goblet cells are seen in which form of IBD?

A

Crohn’s

86
Q

True or false, PPIs increase risk of fractures.

A

True

87
Q

Which histological finding is a feature of gastric adenocarcinoma?

A

Signet ring cells

88
Q

What is the best investigation to assess extramural invasion in upper GI cancer?

A

Endoscopic ultrasound

89
Q

What is the first line investigation for acute mesenteric ischaemia?

A

Serum lactate

90
Q

How many grades of hepatic encephalopathy are there and what is the top grade?

A

Four - Coma

91
Q

Which portion of bowel is most commonly affected in ischaemic colitis?

A

Splenic flexure - SMA/IMA watershed

92
Q

What differences in presentation might aid distinction between mesenteric ischaemia and ischaemic colitis?

A

Mesenteric ischaemia affects the small bowel with high mortality and sudden onset severe symptoms.

ischaemic colitis affects the large bowel and tends to have less severe symptoms as well as bloody diarrhoea.

93
Q

When should patients be given antibiotic prophylaxis to SBP?

A

Those who have had a prior SBP
Those with ascitic protein <15

Ciprofloxacin

94
Q

What is the mechanism of action of loperamide?

A

Opioid receptor agonist

95
Q

What is the management of Barrett’s oesophagus?

A

High dose PPI therapy with endoscopic surveillance

96
Q

What are the causes of dysphagia?

A

Extrinsic, wall, intrinsic, neuro

Extrinsic: Mediastinal mass, cervical spondylosis

Wall: Achalasia, spasm

Intrinsic: Tumours, strictures, web, Schatzki rings

Neuro: CVA, PD, MS, myaesthenia

97
Q

What is Plummer Vinson syndrome?

A 
Dysphagia
IDA
Glossitis
Cheilosis
Oesophageal webs
98
Q

Give some causes of iatrogenic pancreatitis

A 
Azathioprine
Mesalazine
Bendroflumethiazide
Furosemide
Valproate
ERCP
99
Q

What is a Sister Mary Joseph’s node?

A

Metastatic umbilical lesion seen in advanced abdominal malignancy

100
Q

What is the Modified Glasgow scale used for?

A

Pancreatitis severity

101
Q

True or false; Coeliac patients should be given the pneumococcal vaccine

A

True - as they are at risk of overwhelming pneumococcal sepsis due to hyposplenism

102
Q

Which drugs can cause a cholestatic picture?

A

COCP
Abx
Anabolic steroids

103
Q

What is the tumour marker for HCC?

A

AFP

104
Q

Which is the tumour marker for pancreatic cancer?

A

Ca19-9

105
Q

Kocher’s incision

A

Under right subcostal margin

Open cholecystectomy

106
Q

Lanz

A

RIF

Appendicectomy

107
Q

Gridiron

A

Oblique incision over McBurney’s point

Appendicectomy

108
Q

Pfannensteil’s

A

Transverse supra pubic

C section

109
Q

Gable/Rooftop incision

A

Across subcostal margin
Liver transplant
Whipples procedure

110
Q

McEvedy’s

A

Groin incision

Emergency repair of strangulated femoral hernia

111
Q

Rutherford Morrison

A

Extraperitoneal approach to left or right lower quadrants

Renal transplantation

112
Q

What haematinic profile is seen in haemochromatosis?

A

Raised transferrin saturation
raised ferritin
Low TIBC

113
Q

What are the features of systemic sclerosis?

A

CREST

Calcinosis
Raynauds
Oesophageal dysmotility
Sclerodactyly
Telangectasia
114
Q

Number of bowel movements in mild, moderate and severe UC flares/

A

Mild: <4 with or without blood
Mod: 4-6
Sev: >6 with blood

115
Q

What are the component parts of the Blatchford scoring system to assess severity of upper GI bleeds?

A 
Urea
Hb
Systolic BP
Pulse
Melaena
Syncope
Liver disesae
Cardiac failure
116
Q

What are the causes of acute pancreatitis?

A

GET SMASHED

Gallstones
EtOH
Trauma
Steroids
Mumps
Autoimmune (polyarteritis nodosa)
Scorpions
Hyperfatanythingaemia
ERCP
Drugs - Azathioprine, mesalazine, valproate, furosemide, steroids)
117
Q

What is the single most common extra GI feature of IBD?

A

Arthritis

118
Q

What is the ‘M’ rule of PBC?

A

IgM
AMA
Middle aged females

119
Q

How does PBC typically present?

A

A middle aged female with lethargy and pruritis with deranged extrahepatic LFTs (ALP, GGT). They will have AMA antibodies

120
Q

What is the management for PBC?

A

Cholestyramine for pruritis
ADEK supplementation
Ursodeoxycholic acid
Liver transplant if bilirubin >100

121
Q

What are the complications of PBC?

A

Cirrhosis
Osteomalacia/porosis
HCC

122
Q

What is Murphy’s sign and when is it seen?

A

Arrest of inspiration on RUQ palpation

Ascending cholangitis

123
Q

What is the classic triad of chronic mesenteric ischaemia?

A

Weight loss
Post prandial colicky abdo pain
Abdominal bruits

124
Q

What effect might constipation have on a patient with liver cirrhosis?

A

May cause an acute decompensation with confusion

125
Q

How might PSC present, how is it investigated and what are the complications>

A

Jaundice, pruritis, RUQ pain, fatigue

ERCP/MRCP showing beading

Cholangiocarcinoma, CRC

126
Q

What is the management of an acute variceal bleed?

A 
Rescuscitate
Correct clotting, FPP, vit k
Terlipressin
Abx prophylaxis
Endoscopy with band ligation
TIPSS if above fails
127
Q

What is the definition of malnutrition?

A

Unintended weight loss of greater than 10% in 3-6 months

128
Q

What are the two most common causes of lower abdo pain in young men?

A

Appendicitis
Testicular infection/torsion

Must examine the scrotum in any young man with lwoer abdo pain

129
Q

Where are oesophageal adenocarcinomas and squamous cell carcinomas typically found?

A

Adeno - near O-G junction

SCC - Middl third

130
Q

WHich of the following is HNPCC known to be associated with?

Lung cancer
Medulloblastoma
Pancreatic cancer
Thyroid cancer

A

Pancreatic cancer

131
Q

Which of the following is likely to indicate a poor prognosis in cirrhosis?

ALT >200
Caput medusae
Ascites
Gynaecomastia
Splenomegaly
A

Ascites

132
Q

What is the most important thing to do to prevent relapses in Crohn’s disease?

A

Stop smoking

133
Q

What test is used to diagnose gall stones?

A

Abdo ultrasound

134
Q

Other than antibiotics, what class of medication is known to increase risk of C. dif infection?

A

PPIs

135
Q

With which IBD are perianal skin tags associated?

A

Crohn’s

136
Q

What SAAG value indicates portal hypertension?

A

> 11

137
Q

What is the classical presentation of Hep D?

A

Patients with Hep B who are IVDUs presenting with a cholestatic picture and RUQ pain

138
Q

What are the features of autoimmune hepatitis/

A

Signs of CLD
Jaundice/fever (in 25%)
Amenorrhoea is v common

139
Q

What triad is seen in acute liver failure/

A

Encephalopathy
Jaundice
Coagulopathy

140
Q

What is the first step in managing a mild/moderate UC flare?

A

Rectal mesalazine

141
Q

In which form of IBD might pseudopolyps be seen on endoscopy/

A

UC

142
Q

In which form of IBD are granulomata seen?

A

Crohns

143
Q

What is the investigation of choice to diagnose liver cirrhosis?

A

Transient elastography (/fibroscan)

144
Q

Which artery is commonly the source of significant GI bleeding as a complication of PUD?

A

Gastroduodenal artery

145
Q

Whta is the causative agent in watery travellers diarrhoea/

A

Enterotoxigenic E. Coli

146
Q

What is the Mackler triad for Boerhaave syndrome?

A

Vomiting
Chest pain
Subcutaneous emphysema

147
Q

What would a plain abdo film show in gallstone ileus?

A

SBO

Air in the biliary tree

148
Q

Whta are the commonest causes of pyogenic liver abscesses?

A

S. aureus

E. coli

149
Q

Which single investigation is most useful in distinguishing between IBS and IBD?

A

Faecal calprotectin

150
Q

What should be trialed if mesalazine fails to induce remission in UC?

A

oral pred

151
Q

What treatment is most important for acute severe alcoholic hepatitis?

A

Prednisolone

152
Q

What treatment should be given for ascites secondary to liver cirrhosis?

A

Spironalactone

153
Q

What is the management of hepatorenal syndrome/

A

Terlipressin
20% albumin
TIPSS

154
Q

What therapy is recommended for acute Crohn’s flare up should IV hydrocortisone fail to cause improvements after 5 days?

A

Infliximab

155
Q

Which two vessels are anastamosed in a TIPSS procedure?

A

Hepatic vein and portal vein

156
Q

What are the featuers of Zollinger Elison Syndrome?

A

Multiple PUs
Diarrhoea
FHx of Men

157
Q

What is the difference between type 1 and type 2 hepatorenal syndome?

A

peed of onset - Type 1 comes on in under 2 weeks

158
Q

What electrolyte abnormalities might indicate risk of refeeding syndrome?

A

Hypophosphataemia
Hypokalaemia
Hypomagnesaemia

159
Q

Whta is the first line management of hepatic encephalopathy/

A

Lactulose

160
Q

What must happen before patients can be tested for Coeliac disease/

A

Must have been eating gluten for >6 weeks

161
Q

What is the management of a mild-moderate flare of UC extending past the left sided colon?

A

Oral and rectal mesalazine

162
Q

Why should opioids be stoped in C.dif infection?

A

Antiperistaltic drugs can predispose to toxic megacolon

163
Q

What are the red flag symptoms for gastric cancer?

A 
New onset dyspepsia in >55 year olds
Unexplained persistent vomiting
Unexplained weight loss
Progressively worsening dysphagia/odynophagia
Epigastric pain
164
Q

What would you use to test for H.pylori post eradication usccess/

A

Urea breath test

165
Q

What is the commonest cause of melanosis coli?

A

Laxative abuse

166
Q

What is a CLO test used for ?

A

Diagnosis of H.pylori gastritis

167
Q

What investigation is advised in patients with NAFLD?

A

Enhanced liver fibrosis blood test

168
Q

What medication should be added to mesalazine in a UC patient with severe relapse or >=2 exacerbations in the past year?

A

Azathioprine or mercaptopurine

NB - First measure TPMT

169
Q

Which drugs other than NSAIDs can predispose to PUD?

A

SSRIs
Corticosteroids
Bisphosphonates

170
Q

What are the side effects of Clindamycin?

A

C dif
Jaundice
Vomiting
Hyypotension

171
Q

According to Truelove and Witts, what are the features o a severe UC flare?

A 
More than 6 bloody stools a day with at least one of the following:
Fever
Tachycardia
Anaemia
ESR > 30
172
Q

What are some causes of a raised ferritin/

A

With and without iron overload:

With
Haemochromatosis
Following repeat transfusions

Without
Inflammation
EtOH excess
liver disease
CKD
Malignancy
173
Q

A 56-year-old gentleman presents with vomiting, severe crampy abdominal pain, loss of appetite. Patient has not had a bowel movement or passed gas in the last three days. On examination the abdomen is distended and generalised tenderness is present.

What medication should be avoided in this patient and why?

Cyclizine
Metoclopramide
Morphine
Ondansetron
Phosphate enema
A

Metoclopramide - as prokinetic agents could cause a perforation in bowel obstruction

174
Q

How is oesophageal SCC treated?

A

Radiotherapy

175
Q

What is the diagnostic test for PSC?

A

ERCP/MRCP - beading

4th year passmed (28 decks)

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