Gastro Flashcards
Where do inguinal hernias occur?
Vs femoral hernias?
Inguinal = higher up, IN LINE WITH Inguinal ligament between anterior iliac spine and pubis
Femoral = BELOW inguinal ligament, LATERAL & INFERIOR to pubic tubercle
Out of femoral and inguinal hernias, which is more likely to strangulate?
Femoral hernia has much higher risk (only 50% patients aware of hernia before strangulation!)
Definition of peptic ulcer?
Break in mucosal lining of stomach or duodenum >5mm (smaller would be called erosions)
Most common stomach cancer?
Adenocarcinoma
What is Troisier’s sign?
Enlarged left supraclavicar node (Virchow’s node)
What is Courvoisier’s law?
In presence of palpable gallbladder, painless jaundice is unlikely to be caused by gallstones (more likely to be malignancy)
What is Claybrook sign?
Heart & breath sounds transmitted through abdo wall on auscultation - result of ruptured abdominal viscus
What is a Sister Mary Joseph nodule?
Rare nodule above umbilicus from abdominal/pelvic malignancy ie stomach
Where are Cullen’s & Grey Turner’s signs found and what are they a sign of?
Cullen’s - periumbilical
Grey Turner’s - flank (‘turn over’ to see)
Sign of retroperitoneal haemorrhage
Blumberg’s sign?
Rebound tenderness - indicates peritonitis (ie appendicitis)
Causes of pre-hepatic portal hypertension?
Things that block the portal vein before liver:
-congenital atresia/stenosis
-portal vein thrombosis
-splenic vein thrombosis
-extrinsic compression eg tumours
Causes of intrahepatic portal hypertension?
-Pre-sinusoidal - schistosomiasis, hepatic fibrosis, primary biliary cholangitis, sarcoidosis, hepatitis, toxins
-Sinusoidal - cirrhosis, alcoholic hepatitis, vit A intoxication, cytotoxic drugs
-post-sinusoidal - sinusoidal obstruction, veno-occlusive disease
Posthepatic causes of portal hypertension?
At level of heart ie constructive pericarditis, or hepatic vein ie Budd-Chiari syndrome, or IVC ie stenosis/thrombosis/tumour invasion
Most common cause of portal hypertension in western world? Vs African continent?
-Liver cirrhosis
-Africa = schistosomiasis
Prominent abdominal wall veins - difference between caput-medusae and IVC obstruction
Caput-Medusae - blood flow away from umbilicus (run away from the snake!)
IVC obstruction - blood flow towards umbilicus - may hear a ‘hum’
Drugs that cause pancreatitis?
Steroids
HIV drugs - pentamidine
Diuretics - furosemide
Chemotherapeutic agents
Oestrogen
3 different scores for severity of pancreatitis?
Glasgow
Ranson
APACHE
Woman with hx gallstones, severe RUQ pain after eating takeaway pizza. Apyrexial, not jaundiced. Likely Dx?
Biliary colic
Difference between small and large bowel on xray ?
Small bowel - more central, complete concentric rings of mucosal folds - valvulae conniventes
Colon - more peripheral, haustral folds (extend partially across lumen)
Man with 2 month hx of dyspepsia. Soft abdomen on examination. Most appropriate INITIAL investigation?
Breath test for H pylori!
SBO causes?
Most commonly - Adhesions. Also malignancy, hernias
Difference in symptoms between small and large bowel obstruction?
Vomiting - SBO
Abdo distension - more distal
Red cracked lips, angular cheilitis, bloodshot itchy eyes - which vitamin deficiency?
Vitamin B2
Gallstones LFT changes?
Cholestatic picture:
Raised bilirubin, ALP and GGT
Cause of isolated raised ALP
ALP is released from bone, liver and placenta
-pregnancy
-Paget’s disease
-Growth spurts (adolescents)
-Drugs ie nitrofurantoin, erythromycin
What is Gilbert’s syndrome?
What is on bloods?
Common, benign, hereditary disorder -decreased activity of UDP-glucuronyl transferase, causing increase in unconjugated bilirubin
-normal LFTs other than raised bilirubin
Older lady with 2/7 hx bright red rectal bleeding. Before this had 1/52 constipation and L lower abdo pain. Most likely Dx?
Diverticular disease
Most common cause of lower GI bleeding in adults requiring hospital admission?
Diverticular disease
Commonest cause of abnormal LFTs & chronic liver disease in the UK?
NAFLD
In alcoholic hepatitis, which is characteristic finding on LFTs?
AST is significantly raised (>2 x ALT)
Most common, and other causes of travellers diarrhoea ?
Bacteria:
Most common - E Coli
Others - Campylobacter jejuni, Salmonella, Shigella
Viruses:
rotavirus, norovirus
Commonest cause of gastroenteritis in England/Wales?
Norovirus
How is Haemachromatosis inherited?
Autosomal recessive
Charcot’s triad - what 3 symptoms?
Suggestive of what condition?
-RUQ pain
-fever
-jaundice
Acute cholangitis
Complications of acute cholangitis?
Septic shock and multi organ dysfunction
(Therefore acute cholangitis is considered an emergency)
Antibodies in autoimmune hepatitis?
Antinuclear antibodies (ANAs)
Smooth muscle autoantibodies (SMA)
Symptoms of haemachromatosis?
Arthralgias - most commonly small joints of hands
Hepatomegaly
Diabetes Mellitis
Hypogonadism (impotence/loss of libido)
Skin pigmentation
Jalan’s diagnostic criteria for toxic megacolon say the colon has to be how big (diameter)?
Over 6cm
40 y/o with fatigue, pruritis, steatorrhoea, dry eyes and mouth. RUQ pain. Enlarged liver and spleen, jaundice.
-condition?
-antibody test?
-PRIMARY BILIARY CIRRHOSIS
-antimitochondrial antibodies
Grades of rectal haemorrhoids and how to differentiate?
1 - do not prolapse out of anal canal
2 - prolapse on defecation, reduce spontaneously
3 - require manual reduction
4 - cannot be reduced
Management for reflux?
- Simple antacids ie alginates and lifestyle advice
- PPI for 1 month then review
- 13C breath test (? h pylori)
Triple therapy for H pylori eradication?
-PPI
-CLARITHROMYCIN
-AMOXICILLIN or METRONIDAZOLE (use whichever one hasn’t been used to treat other infections in this patient!)
Carcinoid tumour causes which vitamin deficiency?
Niacin (vitamin B3)
What type of tumour is the most common neuroendrocrine tumour?
Carcinoid tumour
Where do neuroendocrine tumours occur?
2/3 in GI tract
Most commonly small intestine
Also stomach, appendix, rectum
And lungs!
Treatment for salmonella?
Ciprofloxacin
Marker for colorectal cancer?
CEA (carcinoembryonic antigen)
Tumour marker for hepatocellular carcinoma?
AFP (Alpha-fetoprotein)
How many units in:
A pint of 4% lager
A standard size glass of wine (12%)
2 units in both!
Commonest site for colorectal carcinoma?
Rectum (followed by sigmoid colon)
Most commonest type of bowel cancer?
ADENOcarcinoma
What is Gilbert’s disease?
-how does it present?
-bloods show?
-treatment
Benign, mildly symptomatic, non-haemolytic unconjugated hyperbilirubinaemia
-failure of uptake of albumin-bound bilirubin into hepatocytes
-presents with mild jaundice and malaise
-raised bilirubin, normal other LFTs
-NO TREATMENT REQUIRED!
What is Budd-Chiari syndrome?
How does it present
Who typically gets it?
-Obstruction to hepatic venous outflow
-HEPATOLMEGALY, ASCITES & ABDOMINAL PAIN
-Slightly more common in women. 3rd-4th decade of life.
Investigations for Budd-Chiari syndrome?
CT/MRI show prominent caudate lobe
Liver biopsy - centrilobar congestion
Bowel regions Crohn’s commonly affects?
Terminal ileum and perianal region
Classic presenting symptoms of Crohn’s ?
Weight loss, diarrhoea, right lower quadrant pain (can mimic appendicitis!)
Stool sample to diagnose Crohn’s?
Bowel cancer?
Crohn’s - faecal calprotectin (90% positive predictive value)
Bowel cancer - FIT test (faecal immunochemical test)
Older man, struggling with swallowing - first mouthful ok but then unable to swallow more and regurgitates food. Likely Dx?
IVX to confirm?
Pharyngeal pouch!
Barium swallow!
Surveillance for bowel cancer, in patients with UC?
Colonoscopy and multiple biopsies (every 1-5 years)
Surveillance for bowel cancer, in patients with UC?
Colonoscopy and multiple biopsies (every 1-5 years)
Cardinal symptom of UC?
Bloody diarrhoea!
Management options for UC?
Aminosalicylates ie Mesalazine
Corticosteroids (induce remission)
Azathioprine
Cyclosporin
Infliximab
Serological tests for Coeliac disease?
-tTGA (IgA tissue transglutaminase antibody)
-EMA (IgA endimysial antibody)
NB NEEDS TO HAVE EATEN GLUTEN-CONTAINING DIET FOR AT LEAST 2 MEALS A DAY OVER 6 WEEKS
What 5 things does Rockall score include for upper GI bleeds?
Age
Co-morbidity
Shock
Diagnosis ie MV tear, malignancy
Stigmata of acute bleeding
Where does Crohn’s affect
Where is most common place?
Anywhere from mouth —> Anus (skip lesions!)
TERMINAL ILEUM
Risk factors for Crohn’s?
-smoking
-family history
-infectious gastroenteritis
-appendicectomy
-drugs (NSAIDs, oral contraceptives)
Extra-intestinal manifestations of Crohn’s?
-MSK - ARTHRITIS, metabolic bone disease (osteopenia, osteoporosis, osteomalacia)
-Skin - erythema nodosum, pyoderma gangrenosum, psoriasis
-Eyes - episcleritis, uveitis
-Hepatobiliary - primary sclerosing cholangitis, autoimmune hepatitis, gallstones, steatosis, cirrhosis)
Younger person with difficulty swallowing both liquids and solids. Dx?
Achalasia (spasm of oesophageal muscles, do not relax as they should)
Risk factors for gastric carcinoma?
Increasing age
Male sex
H pylori
Diet - high salt/preservative, low fresh fruit and veg
Smoking
Familial risk
Blood group A
HypOgammaglobulinaemia
6 causes of bloody diarrhoea?
Acronym: bloody diarrhoea doesn’t sound sexy/SEECSY!
S - salmonella
EE - E Coli / Entamoeba
C - Campylobacter
S - Shigella
Y - Yersinia Enterocolitica
Best imaging for biliary colic?
Ultrasound
What is a Zenker diverticulum?
Another word for pharyngeal pouch!
40 y/o with raised bilirubin (40, normal range 3-17) otherwise normal LFTs. What is the most appropriate Mx plan?
Recheck unconjugated and conjugated bilirubin levels in 1-3 months!
(Likely Dx = Gilbert’s (bili <3x normal and otherwise normal LFTs)
Complications of gallstones?
-Gallbladder (biliary colic, cholecystitis, empyema, mucocoele, carcinoma
-Bile ducts (obstructive jaundice, pancreatitis, cholangitis)
-Gut (gallstone ILEUS)
What is Peutz-Jeghers syndrome?
Autosomal dominant condition:
-PIGMENTED LESIONS ON BUCCAL MUCOSA
-GI POLYPS
For X linked dominant conditions:
-when a female is affected, each pregnancy has a ?% chance of inheriting disease allele
-when a males is affected ?% chance of daughters and ?% sons will be affected?
-50%
100% daughters, 0% sons
Ie
NO MALE TO MALE TRANSMISSION
ALL DAUGHTERS OF MALE HAVE TRAIT
SONS can ONLY GET TRAIN IF MOTHER HAS TRAIT
Hallmark antibodies of primary biliary cirrhosis?
Antimitochondrial antibodies
