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finals > Gastro > Flashcards

Gastro Flashcards

1
Q

primary biliary cholangitis M rule and path

A

raised IgM
anti mitochondrial abs (m2 subtype)
Middle aged females

Raised ALP bc obstructive ( autoimmune destruction of bile ducts in liver (chronic inflam = fibrosis of duct walls) = cholestasis and obstruction) which may lead to cirhosis

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2
Q

primary biliary cholangitis presentation and complications

A

middle aged women
fatigue, pruritis, jaundice
xanthelsma/xanthomata

Hyperpigmentation over pressure points
10% RUQ pain
clubbing n hepatosplenomegaly

late = may progress to liver failure

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3
Q

primary biliary cholangitis ix

A

immune
- AMA ABs
- IgM

LFT - Raised ALP

RUQ Ultrasound or MRCP - to exclude extrahepatic biliary obstruction

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4
Q

Primary biliary cholangitis Mx

A

1st line = ursodeoxycholic acid

itch = cholestyramine
fat soluble vitamine supplements
liver transplant if bilirubin> 100

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5
Q

PPI SE

A

hyponatramia hypomagnasaemia
osteoporisis –> inc risk of fractures
increased risk of C.diff

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6
Q

refeeding syndrome electrolytes n what do they cause

A

hypophosphataemia !!
hypokalaemia
hypomagnesaemia

hypophos = muscle weakness, myocardial ->cardiac failure, diaphragm ->resp failure
hypomag = predispose to torsades de pointes

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7
Q

coprescribed w isonizid and why

A

pridoxine (vitamin b6) to prevemt peripheral neuropath

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8
Q

pharyngeal pouch ix and def mx

A

barium swallow w dynamic vid fluroscopy

surgical myotomy and resection

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9
Q

what to give before endoscopy in pt w sustpected variceal haemorhage

A

terlipressin and abx

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10
Q

prophylaxis of variceal haemorrhage

A

propanolol
ligation (EVL) (if medium to large varicies) 2 weekly until all eradicated (+PPI to prevent evl ulceration)

all fails = Transjugular intrahepaatic portosystemic shunt (TIPSS)

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11
Q

alcoholic ketoacidosis when it happens n tx

A

chronic alcoholics after period of reduced food intake

IV fluids and thiamine

(rehydrate and prevent wernickes)

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12
Q

ascites secondary to liver cirrhosis duiretic

A

aldosterone - spironalactone

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13
Q

liver abcess tx

A

abx and image guided percutaneous drainage
if fails = surgical resection

Hydatid cyst = surgical resection 1st Differentiate from abcess by CT = better circumscribed

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14
Q

upper GI bleed vs lower GI bleed

A

drop in haem

high urea = upper GI

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15
Q

how long stop PPI before endoscopy

A

2 weeks

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16
Q

liver cirhosis dx and monitoring

also who to screen with it

A

transient elastography (measures liver stiffness)

hep C
men >50units week alcohol women > 35
people dx w alchol related liver disease

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17
Q

Further investigations in pt w new liver cirrhosis dx

A

endoscopy to check varices

liver US 6monthly =/- Alpha feta protein to check hepatocellular Ca

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18
Q

constipation and diarohea in IBS tx

A

bulk forming laxative ie isphagula husk

avoid lactulose (increases gas = worsens sx )

constipation >12 months and max doses of previous laxatives from different classes not helped = linaclotide

diahorea = loperamide

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19
Q

dont use PPI w what

A

clopidegrel = reduces efficacy

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20
Q

pancreatic Ca presentation n what type

A

painless obstructive jaundice ( cholestatic LFTs)
pale stools, dark urine, itchiness
many pt non specific ie anorexia, wt loss, epigastric pain

maybe abdo mass
loss of exocrine fxn = steatorrhea
loss of endo fxn = DM

most are adenocarcinoma of head

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21
Q

pancreatic ca ix

A

high resolution CT

double duct sign (dilitation of common bile ducts and pancreatic ducts

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22
Q

pancreatic ca mx n Ses

A

most not suitable for surg at dx (only 20%)
whipples for resectable lesions on head. SE = dumping syndrome and peptic ulcer disease
adjuvent chemo post surg

ERCP with stenting for palliation

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23
Q

spontaneous bacterial peritonitis (SBP) what is it n sx

A

Ascitic fluid infection
peritonitis in pt w ascites 2ndy to liver cirrhosis

= ascites abdo pain and fever

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24
Q

SBP dx, mc organism mx

A

dx = paracentesis neutrphils > 250
E.coli

Mx = Iv cefotaxime

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25
Q

when to give proph abx in ascites

A

prevous episode of SBP
fluid protein< 15g/l and (childpugh>9 or hepatorenal syndrome)

oral cipro or norfloxacin

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26
Q

UC flare severity

A

mild = <4stools a day small blood
mod = 4-6, varying blood no system upset
sever= >6 bloody a day + system upset

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27
Q

small bowel bacterial overgrowth syndrome (SBBOS)
RFs, sx,

A

RFS =
neonates w congen GI abnormal
scleroderma
DM
crohns

features overlap w IBS
chronic diarrhoea
bloating flatulence
abdo pain

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28
Q

SBBOS dx and mx

A

dx
hydrogen breath test
if inconclusive = small bowel aspirate n culture
clinicans sometimes give abx course as diagnostic trial

mx
corection of underlying disorder
abx = rifaximin 1st (also coamox and metroni)

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29
Q

gastric ulcer presentation

A

pain during or after eating bc stomach produces acid to food

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30
Q

duodenal ulcer presentation

A

pain when stomach empty ie several hours after food
improved by eating

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31
Q

prolonged vomiting electrolytes n why

A

metabolic acidosis (inc pH and bicarb =)
hypokalaemia

too much vom = fluid loss = RAAS activated = more Na resorb at DCT (water follows) to inc blood vol = therfore by exchanging K –> too much k lost

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32
Q

crohns flare isolated peri anall disease

A

metronidazole

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33
Q

inducing remision in crohns

A

glucocorticoids
2nd line = mesalazine
add on aziathioprine/mercaptopurine or methotrex

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34
Q

when to use infliximab in crohns flare

A

refractory disease
fistulating crohns

pt typically continue on azath or methotre

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35
Q

maintaining crohns remission

A

stop smoking
1st line = azathioprine or mercaptoprurine (CHECK TPMT)

2nd = methotrexate

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36
Q

acalculous cholecystitis

A

inflammation of gallbladder with no stones

pt w underlying comorb eg DM, vasculitis, organ failure SLE

systemically unwell high fever RUQ pain, no jaundice

mx
pt fit = cholesystectomy
unfit = percut cholecystostomy

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37
Q

Crohns features NESTS

A

N no blood or mucus
E entire GI tract (mouth to anus)
S Skip lesions endoscopy
T terminal ileum most affected + Transmural inflam (full thickness)
S smoking risk factor

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38
Q

UC features CLOSEUP

A

C Continuous inflam
L limited to colon and rectum
O only superficial mucosa affected
S smoking protective
E Excrete blood and mucus
U Use aminosalicytes
P Primary sclerosing cholangitis

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39
Q

child with tracheooesphageal fistula followinf repair may develop

A

benign oesophageal fistulas

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40
Q

proctitis meaning

A

inflammation of anus and lining of rectum

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41
Q

chronic mesenteric ischaemia triad

A

intestinal angina

severe colicky post prandial abdo pain
weight loss
abdominal bruit

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42
Q

Budd chiari syndrome what is it, triad and ix

A

hepatic vein thrombosis usually seen in context of underlying procoagulant condition (inc preg and COCP)

triad
sudden onset sever abdo pain
ascites and abdo distension
tender hepatomegaly

Ix - US w doppler flow studies

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43
Q

ascites tap serum acistic albumin gradient (SAAG) <11g/l

A

hypoalbunaemia: nephrotic, severe malnut (kwashiorkor)

malignancy; peritoneal carcinomatosis

Infections; tuberculous peritonitis

others; pancreatitis, bowel obs. biliary ascites

post op lymphatic leak, serositis in connective tissue disease

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44
Q

ascites tap serum acistic albumin gradient (SAAG) >11g/l

A

indicates portal htn

liver: cirhossis, acute failure, liver mets
Cardiac: RHF, constrictive pericarditis
Other: budd chiari, portal vein thromb, veno occlusive disease, myxoedema

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45
Q

liver decompensation what is it and trigger factors ABCDI

A

significant decline in cirrhosis pts (jaundice and confusion)

Alcohol
bleeding
constipation
drugs (sedatives) or dehydration
infection

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46
Q

upper GI bleed score post endoscopy

A

Rockall score used after endoscopy and provides a percentage risk of rebleeding and mortality

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47
Q

investigation for perianal fistulae in pt w crohns

A

MRI pelvis

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48
Q

achalasia investigations

A

oesophageal manometry
- excessive LOS tone which doesn’t relax on swallowing

barium swallow
- grossly expanded oespgagus
- BIRDs beak appearence

Chest xray
- wide mediastinum n air fluid level (bc lack of peristalsis)

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49
Q

primary sclerosing cholamngitis asx w which IBD

A

UC

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50
Q

TIPSS tx for osephageal varcies can cause what

A

excerbation of hepatic encephalopathy

bc shunt = blood bypasses liver into systemic cirulation w/o metabolism of nitrogenous waste products = build of ammonia which crosses BBB

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51
Q

haemorrhoids grading

A

grade 1 - do not prolapse out of anal canal

grade 2 - prolapse on defecation but reduce spontaneously

grade 3 - manually reduced

grade 4 cannot be reduced

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52
Q

mallory weiss tear

A

superficial tear of mucosa
post binge vomitting ie night out
self limiting

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53
Q

boerhaaves syndrome path signs, ix, tx

A

transmural spontanous rupture of oesphagus into chest

pt chronic wreching ie alcoholic or bulimic
fever dyspnea severe onset chest pain

air in mediatinum (sc emphysema) cxr and physical

IX - CT contrast barium swallow

tx - thoracotomy and lavage <12 hrs

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54
Q

acute mesenteric ischaemia

A

embolism in artery supplying small bowel

usually hx of AF

severer sudden onset abdo pain out of keeping with physical exam

increased lactate

immediate laparotomy

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55
Q

chronic mesenteric ischaemia

A

‘GI angina’

colicky intermittent abdo pain w eating = avoid eating n wt loss

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56
Q

Ischaemic colitis

what is it
where
pt
ix
tx

A

acute transient compromise in blood flow to large bowel –> leading to inflam, ulceration and haemorhage

watershead areas ie splenic flexure

pt maybe hypotensive bc something else then == Painful bright red blood per rectum

abdo XR = thumbprinting

tx supportive unless too bad (peritonitis, perf etc) = surgery

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57
Q

mesalazine complication

A

pancreatitis
less so in sulfasalazine

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58
Q

associations with h.pylori

A

1 peptic ulcer disease (duo>gastric)
2 gastric adenocarcinoma
3 B cell lymphoma
4 atrophic gastritis

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59
Q

how to calculate units of alcohol

A

(ml x %)/1000

ie 25ml spirit (ABV 40%) = 25x40/1000 = 1unit

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60
Q

Vitamin C defiiciency

A

scurvy

easy bruising, gum bleeding, lethary, joint pain
poor diet ie nutrional deficiency

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61
Q

crohns sign on exam

A

abdo mass palpable in right iliac fossa (terminal ileum)

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62
Q

anaemia of chronic disease blood

A

serium iron low

total iron binding capacity = dec/normal
serum ferritin = Normal/ increased

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63
Q

iron def anaemia blood

A

serum iron low

TIBC = increased
serum ferritin = decreased

64
Q

pancreatic cancer Ix and dx

A

USS first

High res CT for definitive
double duct sign ie common bile and pancreatic duct dilatation

65
Q

life threat C diff

A

oral vanc
IV metronidazole

66
Q

autoimmune hepatitis
antibodies
pt
ix
tx

A

anti smooth muscle
ANA
(Type2 kids only = antiliver/kidney LKM1)

young female
amenorhea
deranged LFTs
signs of chronic liver disease or acute hep ie fever jaundice

ix = liver biopsy, piecemeal necrosis and bridging necrosis

mx = steroids and azathioprine (immunosup)
liver transplant

67
Q

haemochromatosis genetic

A

autosomal recessive

68
Q

drug induced cholestatic +/- hepatitis

A

COCP
abx - fluclox. coamx, erthryro
anabolic steroids, testosterone
sulfonurea

69
Q

coeliax disease associated Ca

A

enteropathy-associated T cell lymphoma

70
Q

abx causing c diff

A

clindamycin
ceftriaxone

71
Q

Peutz jeghers syndrome

A

autosomal dominant condition
hamartomous polyps in GI (mainly small bowel)
- ie common PC is small bowel obstruction bc intussusception
age 10-15
pigmented lesions on lips, oral mucosa, face palms and soles

72
Q

predict mortality in liver cirrhosis pt

A

child pugh score

73
Q

what blood marker to use to asses severity of liver cirrhosis

A

albumin

74
Q

hepatic encephalopathy tx

A

lactulose and rifaximin

75
Q

loperamide mechanism and indication

A

opioid receptor agonist (only on gut)

anti diarhoea

76
Q

1st line IBS accordind to sx

A

pain = anti spasmodic

constipation = laxatives (avoid lactulose) ( if nothing works or constipated>12mths = 2ndline linaclotide)

Diarhorea = loperamide

77
Q

barium enema UC

A

lead pipe colon in distal paart

ie loss of haustral markings

78
Q

caused of increased ferritin without iron overload (ie normal transferrin saturation)

A

inflammation
alcohol excess
liver disease
ckd
malignancy

79
Q

best measure of liver function in acute liver failure

A

prothombin

bc shorter half life than albumin sp changes more suddenly

80
Q

initial screening test for haemochromatosis

A

general pop: transferrin sat> ferritin
family members: genetic testing

81
Q

alcoholic hepatitis liver enzymes

A

AST/ALT 2:1 ratio
raised GGT

82
Q

NAFLD found incidentally on uss

A

enhanced liver fibrosis (ELF) blood test
to check for fibrosis

83
Q

lymphatic spread of gastric ca

A

left supraclavicular node (virchows)
periumbilical nodule (sister may joseph)

84
Q

diagnosis of gastric ca

A

OGD with biopsy
signet ring cells –> more of them = worse prog

CT for staging

85
Q

pt on aminosalicylate becomes unwell soar throat fatigue bleeding guma

A

agranulocytosis CHECK FBC

86
Q

surgucak tx of achalasia if recurrent sx post pneumatic balloon dilation

what if high surgical risk?

A

heller cardiomyotomy

intra-sphincteric botox injection

87
Q

NAFLD LFTs

A

ALT>AST - Lard = NAFLD

can also have mild elevations of ferritn

88
Q

alcoholic hepatitis LFTS

A

AST>ALT - Spritis = alocholic hepatitis

89
Q

Differentiating betweem primary bilary cholangitis
and
primary sclerosing cholangitis

A

PBC = +ve anti mitochond

PSC = +ve anti smooth muscle and ANA
Asssociated w UC

90
Q

wilsons age path

A

autosomal recessive
faulty gene = liver can excrete copper = build up in all tissues

91
Q

wilsons disease deposits where n also other fx

A

liver
brain
cornea
kidneys

haemolysis
blue nails

92
Q

wilsons disease neuro deposition where and manifestaions

A

basal ganglia degen bc deposits in it esp putamin and globus pallidus

speech behavour psych problems (usually 1st manifestations)

asterixes chorea dementia parkinsonim

93
Q

copper deposition in cornea in wilsons

A

= keiscer fleicher rings in around iris bc accum in descement membrane

94
Q

copper deposition in kidneys wilsons

A

renal tubular acidosis (esp fanconi syndrome)

95
Q

wilsons IX

A

serum caeruloplasmin (reduced)
serum copper (reduced)
24hr urinary copper (increased

confirm dx genetic test of ATP7B gene

96
Q

wilsons gene

A

ATP7B

97
Q

wilsons tx

A

penicillamine
trientine hydrochloride

98
Q

King’s College Hospital criteria for liver transplantation (paracetamol liver failure)

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

99
Q

used to monitor haemochromatosis

A

ferritin and transferrin saturation

100
Q

mc cause hypopitruitrism

A

non secretetory pitruatry macroadenoma

101
Q

early signs haemochromatosis

A

fatigue, erectile dysfunction and arthralgia

102
Q

wilsons blood

A

reduced caeruloplasmin

103
Q

anaemia of chronic disease bloods

A

normocytic
low serum iron
low TIBC
raised ferritin

pt w chronic illness

104
Q

iron studies in haemochromatosis

A

raised transferrin saturation
raised ferritin
low TIBC

105
Q

haemochromatosis fertility complication

A

non reversible
hypogonadotrophic hypogonadism

bc pitruatry dysfunction

106
Q

gluten free foods

A

rice
pottatos
corn (maize)

107
Q

gluten avoid food

A

wheet = bread pasta pastry
barley = beer
rye
oats

108
Q

primary biliary cholangitis complications

A

complications;
- cirhosis -> portal HTN -> ascites, variceal haemorhage
- osteomalacia and porosis
- inc risk of hepatocellular ca

109
Q

barrets oesphagus

A

metaplasia ie from squamous to columnar

may resemble that of stomach/small intest ie
goblet cells
brush border
paneth cells

110
Q

barrets mx

A

PPI
if metaplasia = endoscopy 3-5yrs

dysplasia of any grade identified =
endoscopic radiofrequency ablation
endoscopic mucosal resection

111
Q

volvulus types and ix

A

sigmoid
caecal

abdo xr

112
Q

sigmoid volvulus signs associations n tx

A

large bowel obstruction coffee been sign on xr

older
chronic constipation
chagas disease
neuro - parkinsons, duchennes
shizophrenia

flatus tube (thru rectum)

113
Q

caecal volvulus associations n tx

A

all ages
adhensions
pregnancy

small bowel obstruction on xr

right hemicolectomy

114
Q

hep A sx

A

flu ike sx
RUQ pain
tender hepatomegaly
deranged LFTs

raised billirubin
raised ALT/AST
normal/slight raised ALP

115
Q

anal fistula investigation

A

MRI pelvis

116
Q

Hep E
spread
incubation
place

A

feaco oral
3-8 weeks
central n south east asia, north n west africa, mexico

significant mortality during pregnancy

117
Q

hepatitis spread

A

A and E spead faecally

B-D spell BlooD

118
Q

diarohea and wt loss differentials

A

IBD
IBS
colorectal ca
coeliac
thyrotoxicosis
chronic panc

119
Q

crohns histology

endoscopy

A

inflammation all layers from mucoas to serosa
inc goblet cells
granulomas

skip lesions
cobblestoning
deep ulcers
mouth to anus

120
Q

extraintestinal fx crohns

A

erythema nodosum
iritis/conjuctivitis/episcleritis
larg joint arthritis
Ankspond
apthous ulceration

121
Q

how doesinfliximab work in cohns

A

TNF inhib

tumor necrosis factor imporant in establishing inflammation and granulomatos inflammation

122
Q

upper GI bleed causes

A

oesphageal varices
peptic ulcer
mallory weiss tear
gastric ca
oesphagitis
aortic enteric fistula
bleeding disorders

123
Q

site of portosystemic shunts (bc liver cirhossis) and sx

A

superior rectal vein shunt –> haemorrhoids

paraumbilical vein shunt –> caput medusae

124
Q

traumatic tap

A

blood makes way into LP

125
Q

disease inc risk of berry aneurysms ie SAH

A

polycystic kidneys
ehlers danlos
coarctation of aorta

126
Q

kernigs sign

A

bend hip and knee to 90degrees
pain when straightening knee =positive sign

=meningeal irritation

127
Q

why is pain in appendicitis first felt in the periumbilical region before mcburneys point

A

Irritation of the visceral peritoneum by the inflamed appendix is felt in the T10 dermatome, which corresponds to the periumbilical region. This is because the visceral peritoneum has no somatic innervation, so the brain perceives visceral signals as being from the same dermatome as where the visceral signals enter the spinal cord. As the appendix is found in the midgut, the corresponding dermatome is T10 .

As the disease progresses, the parietal peritoneum becomes affected. As this receives somatic innervations, the pain is well
localised to the area o f inflammation. (1)

128
Q

ALARMS sx dyspepsia

A

anaemia
loss of weight
anorexia
recent onset progressive sx
malena/haemetasis
swalling difficulty

virchows node

129
Q

whats mc duo or gastric ulcer

A

duo = 4x more common

130
Q

why do u get noctural asthma (wheeze) in GORD

A

inhalation of small amouns of gastric contents

131
Q

indications for nisse fundo in gord

A

all 3 of
severe sx
refractory to medical therapy
confirmed reflux by ph monitering

132
Q

hiatus herna types

A

sliding (MC) GOJ slides into chest
rolling
mixed

133
Q

which hernia to repair

A

rolling bc may strangulate

134
Q

post hep juaundice urine stools and why

A

dark urine
pale stools

billirubin that has conjugated with gluconuride in hepatocytes = water soluble

dissolves in urine

135
Q

post hep jaundice ix

A

urine inc billirubin
bloods
abdo USS

ercp

136
Q

panc ca therapeutic tx

A

ercp w stenting

137
Q

cx persistent jaundice

A

inc suscept to infexn
pruritis
liver dysfxn
aki

138
Q

hepatitis at risk groups

A

IVDU
sex workers
health workers
haemophiliacs

139
Q

distaste for cigarrettes hep

A

viral hep A

140
Q

viral hepatitis mx

A

supportive
no alcohol
or hepatotoxic dx ie aspirin

anti viral
indicated in chronic disease

hep b = PEGinterferon
hep C = PEGinterferon n ribvarin

141
Q

hep b n c cx

A

chronic hep
cirhossis
hepatocell ca

142
Q

hep b may also be infected w

A

hep c and d
HIV

143
Q

blood for synthetic liver fxn

A

albumin
PT/INR

144
Q

cirhossis cx

A

ascites
SBP
coagulopathy
encephalopathy
hypoglycaemia

145
Q

portal htn sequelae cx

A

SAVE
splenomeg
ascites
varices (oesp,caput med, worsens existing piles)
encephalop

146
Q

ascites mx

A

fluid restirct low na
ascitic tap
duiretics - spiro
albumin infusion

147
Q

why lactulose in hepatic enceph

A

inc bowel transit
= reduce nitrogen producing bact in gut which contribute to hepatic enceph

148
Q

coeliac path

A

autoimmune abs againt gluten
= modifed and presented to T cells
= inflam of small bowel

149
Q

mc source gluten

A

wheat

150
Q

why might anti endomysial abs be -ve inceoliacs

A

seevre malabsorb = Iga and other protein deficiency

151
Q

coeliac histo

A

crypt hyperplasia
villous atrophy
lymphocytic infiltration

152
Q

ca associated w coeliax

A

GI T cell lymphoma
gastric
oesphageal

153
Q

unexplained iron def anaemia

A

colonscopy

id right sided colonic tumor

154
Q

COLON ca rf

A

IBD
neoplastic polyps
HNPCC
low fibre

155
Q
A

finals (28 decks)

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