Gastro Flashcards
1
Q
what are the complications of crohns not shared by UC
A
strictures, fistulae, perianal disease, small bowel obstruction
2
Q
investigations for oropharyngeal dysphagia
A
videofluoroscopic examination of swallowing
3
Q
new treatment of Hep C
A
direct acting antivirals
4
Q
how does food intolerance cause diarrhoea
A
bacterial overgrowth
5
Q
explain the association between Dukes and TNM staging for CRC
A
T1 and 2 = A
T3 and 4 = B
N1/2 = C
M1 = D
6
Q
what causes leuconychia
A
hypoalbuminaemia –> compression of the capillary flow by the EC fluid
7
Q
in which phase of Hep B does cirrhosis occur
A
in the immune clearance phase - therefore the shorter the immune clearance phase the better
8
Q
3 main causes of upper GI bleeding
A
oesohageal varices
peptic ulcer disease
gastroduodenal erosions
9
Q
which type of CRC is particularly associated with anaemia
A
right colon (ascending)
10
Q
is ascites exudate or transudate
A
transudate
11
Q
symptoms of CRC
A
rectal bleeding - dark, mixed in
altered bowel habit
tenesmus,
mucus
anaemia,
pain, mass
12
Q
management options for oesophgeal varices
A
ocreotide
banding
+/- transfusion
13
Q
clinical features of acute bowel ischaemia
A
- sudden severe abdominal pain out of proportion to physical findings!
- N&V
- bloody diarrhoea
- bloating
14
Q
when is methotrexate used in IBD
A
2nd line Tx for CD
15
Q
3 general causes of hepatomegaly
A
hepatic
cardiovascular - RHF, budd-chiari
haematological - lymphoma etc
16
Q
ALT is very high in patients with..
A
acute viral hepatitis
acute drug toxicity
ischaemia
17
Q
where do the lymphatics of the testicles drain to
A
para-aortic nodes
(if mass - will be in the central abdomen)
18
Q
difference between UC and crohns in the pathology
A
Crohns - TRANSMURAL granulomatous inflammation with SKIP LESIONS
UC - continuous, diffuse mucosal inflammation +/- pseudopolyps (no skip lesions)
19
Q
most common pancreatic cancer is
A
pancreatic adenocarcinoma
20
Q
if jaundice occurs suddenly in someone with CLD, consider
A
- portal vein thrombosis
- biliary obstruction
- infection (esp spontaneous bacterial peritonitis)
21
Q
complications of crohns
A
strictures
fistulae
perforation
abscess
22
Q
DRE findings with large bowel obstruction
A
empty rectum
23
Q
two typical liver enzyme patterns
A
hepatocellular - raised ALT and AST
cholestatic - raised GGT and ALP
24
Q
what is the “buzz word” for the look of Barrett’s oesophagus
A
Salmon tongue oesophagus
25
most common causes of decompensation in a cirrhotic
sepsis (infection)
bleeding (varices)
drugs (paracetamol, alcohol)
non-compliance
hepatoma
26
explain the pain and vomiting due to foregut, midgut and hindgut pathology
foregut - immediate, severe vomiting, pain not prominent
midgut - every few minutes to half hourly
hindgut - infrequent exacerbation or vomitus
27
symptoms of small bowel obstruction
pain
N&V
diarrhoea - early
constipation - late
fever and tachycardia occur late (assoc with strangulation)
28
what is haematochezia
torrential upper GI bleed causing blood to be passed rectally (bright red)
29
what is the electrolyte balance associated with cirrhosis
HYPONATRAEMIA - but need to sodium restrict!
30
3 tumour markers for testicular cancer
alpha-fetoprotein
beta-hCG
LDH
31
mucosal causes of chronic diarrhoea
CD
food intolerance
infection
32
what is the major complication of UC
toxic megacolon (dilatation of the colon)
33
how do you replace the fluid you take out in a therapeutic ascitic tap
200ml 20% concentrated IV for each 2L drained
34
3 major TYPES of jaundice (not causes)
biliary obstruction
cholestasis
acholuric jaundice - haemolysis
35
2 things that can cause biliary obstruction
stones
strictures (benign and malignant)
36
in which, UC or crohns, is the risk of developing colon cancer greater
UC
37
how can you tell whether the raised ALP is due to bone/placenta/liver pathology
if it is raised along with a raised GGT = liver
38
what is the most common side effects of spironolactone
gynaecomastia
hyperkalaemia
39
describe the site, radiation, quality, severity and chronology of acute cholecystitis
- right subcostal -
no radiation
- sharp pain
- severe
- onset may be sudden or gradual, persistent
40
what is infliximab
anti-TNF antibodies
41
how do you test for synthetic functions of the liver
albumin INR
42
what is the defining anatomy that determines whether something is an upper or lower GI bleed
upper = proximal to the ligament of Treitz
lower = distal to the ligament of Treitz
43
possible side effects of a fundoplication
- dysphagia (if too tight)
- early satiety
- inability to burp or vomit
- increased flatus
- bloating
44
major treatment of achalasia
cardiomyotomy (incision into the sphincter muscle that opens up the muscle)
45
what are the salvage therapies for mod-severe steroid refractory UC
- cyclospoine
- infliximab
46
surgical option for GORD
fundoplication - where the fundus of the stomach is wrapped around the oesophagus to tighten up around the lower oesophageal sphincter
47
3 signs/symptoms of hepatic encephalopathy
asterixis
fetor
confusion
48
bloody diarrhoea is common in which IBD
UC
49
main antibiotics that cause cholestasis
flucloxacillin
augmentin (clavulonic acid component)
50
what 3 things does the MELD system base its scoring system on
creatinine
bilirubin
INR
51
why is Barrett's oesophagus bad
it increases the risk of adenocarcinoma
52
3 causes of encephalopathy
liver failure
hypercapnia
uraemia
53
treatment of severe UC
IV steroids
IV cyclosporine/infliximab --\> AZA/MP ?surgery
54
what occurs during the immune clearance phase of Hep B
immune system wakes up to the virus and tries to kill all the infected hepatocytes (drop in DNA and ALT elevates)
55
weight loss and dysphagia suggests..
malignancy
achalasia
56
what can predispose to internal haemorrhoids
constipation and straining
pelvic venous obstruction (eg. pregnancy and labour)
family history
57
describe the site, radiation, quality, severity and chronology of perforated peptic ulcer
- epigastrium
- radiation to shoulder tip
- sharp pain - severe
- sudden onset, persistent
58
what two pieces of information can you get from a liver biopsy
grade (inflammation)
stage (fibrosis)
59
when is the only time you can get a hepatoma without cirrhosis
With Hep b
60
where is the deep inguinal ring
round opening in the transversalis fascia found 1cm superior to the inguinal ligament and 1cm lateral to the inferior epigastric arteries
61
most common location for crohns disease
distal ileum
62
what two conditions commonly cause rigid plank like abdomen
acute pancreatitis
perforated peptic ulcer
63
invasive diagnosis of H. pylori is done by
gastric biopsies for histology
rapid urease test
culture
64
treatment of anal cancer
chemotherapy and salvage resection if required
65
non-invasive diagnosis of H. pylori is done by
serology
urea breath test (measures ammonia on expiration)
stool antigen
66
presentation of orchitis
large and tender testes with fever
67
surgery for cancer of: transverse colon
extended right hemi-colectomy
68
pattern of pain for renal colic
renal angle pain radiates to the groin very severe worse on balotting
69
presentation of chronic infection of the scrotum
chronic, diffuse scrotal tenderness
70
what are the investigation options for GORD
oesophageal manometry - gold standard
naso-oesophageal pH monitor
Bravo pH capsule
71
what are the 4 phases of Hep B
immune tolerant
immune clearance
immune control
immune escape
72
what symptoms/signs show decompensated liver disease
jaundice
ascites
coagulopathy
variceal bleeding
hepatorenal syndrome
73
what is the immune escape phase of Hep B
relaxation of the immune system --\> virus comes up again and then get ongoing damage here
74
smoking increases your risk for UC or CD
crohns
75
what fluids do you give to a patient with CLD
NOT NORMAL SALINE
- concentrated albumin
- glucose/fructose
76
complications of ERCP
unsuccessful
acute pancreatitis
cholangitis
perforation
mortality
77
describe the abdominal examination findings in someone with biliary colic
normal
78
which anatomy make up the walls of inguinal canal
inferior = inguinal ligament
superior = arching fibres of IO and transversus abdominus
anterior = EO aponeurosis and IO aponeurosis
posterior = transversalis fascia, conjoint tendon
79
what does HbcAb positive mean
you only get this if you have actually met the virus (not the vaccine)
80
what is the typical patient presentation with cholestasis
painless jaundice with a non-dilated biliary tree and no gall stones
81
which area of the bowel is most suceptible to diverticuli
sigmoid colon
82
medical management of anal fissure
stool softeners
internal sphincter relaxation - GTN, Botox,
CCB surgery - fissurectomy/ lateral internal sphincterotomy
83
clinical features of diverticulitis
LLQ pain
constipation/diarrhoiea
NV
urinary symptoms
mild fever
84
what causes low platelets in someone with CLD
CLD --\> portal hypertension --\> splenomegaly --\> sequestration of platelets in the spleen
85
2 most common causes of ascites
portal hypertension from cirrhosis
Peritoneal malignancy
86
surgery for cancer of: mid rectum
low or ultralow anterior resection with loop ileostomy
87
surgery for cancer of: low rectum
abdomino-perineal resection with permanent colostomy
88
4 types of cells in islets
alpha --\> glucagon
beta --\> insulin
delta --\> somatostatin
PP --\> pancreatic polypeptide
89
what are some extraintestinal manifestations of active IBD
mouth ulcers
erythema nodosum
episcleritis, uveitis
PSC
ankylosing spondylitis
pyoderma gangrenosum
kidney stones
gallstones
90
what is the scoring system used to determine severity of pancreatitis
Ranson scoring system
91
complications of surgery for crohns
stricture
fistula
abscess
perforation
92
top 4 causes of small bowel obstruction
adhesions
hernias
cancer
crohns
93
what causes colicky pain
blocked lumen of bowel or ureters (peristaltic movement behind the blockage)
94
what are the two grading systems for cirrhosis
Child-Pugh
MELD
95
what does an ERCP involve
endoscope into duodenum at ampulla of Vater inject contrast into ampulla fluoroscope looks at the biliary system can insert instruments into ampulla to remove stones for eg (Diagnostic and therapeutic)
96
where does the inguinal ligament run
between ASIS and pubic tubercle
97
presentation of internal haemorrhoids
bleeding, itchy lump (hardly ever painful)
98
first 2 things to rule out for unintentional weight loss
malignancy
depression
99
the more proximal the visceral pain the more ........ the peristaltic pain wave
frequent
100
which things are associated with early morning vomiting
pregnancy
alcoholism
raised ICP
101
explain the prophylaxis of variceal bleeding
- primary = non-selective beta-blockage, endoscopic band ligation
- secondary = regular endoscopic band ligation or injection
- rescue - decompression shunt
102
describe the site, radiation, quality, severity and chronology of acute pancreatitis
- epigastrum
- radiation through to back
- sharp pain
- severe
- fairly sudden onset, persistent, sometimes recurrent
103
transmission of Hep C
mostly blood-to-blood (IVDU)
104
how does being overweight predispose you to GORD
puts more pressure on the abdominal cavity --\> creates larger force to push acid upwards
105
pneumonic for remembering the causes of acute pancreatitis in adults
I GET SMASHED Idiopathic Gallstones Ethanol Trauma Steriods Mumps Autoimmune Scorpion sting Hyperlipidaemia/hypercalcaemia ERCP Drugs
106
surgery for cancer of: sigmoid colon and upper rectum
high anterior resection
107
what is achalasia
failure of the lower oesophageal sphincter relaxation with swallowing
108
reflux is aggravated by
alcohol
chocolate
caffeine
fat
CCBs
109
which signs are caused by high oestrogen
palmar erythema
gynaecomastia
spider naevi
110
difference between UC and Crohns in the location of the disease
Crohns - any part of the GI system
UC - isolated to large bowel (always rectum - moves upwards)
111
what is the association with pain that worsens with fatty meals
reflux
112
most common cause of tenesmus
vaginal prolapse
113
definition of chronic diarrhoea
decrease in faecal consistency lasting for 4 or more weeks
114
what are the "red flag" upper GI symptoms
dysphagia
odynophagia
haematemesis
melaena
weight loss
age \>50
115
what causes ascites in CLD
combination of reduced oncotic pressure (due to low albmin) and increased portal pressure
116
common causes of upper GI bleeding
peptic ulcer disease
varices
oesophagitis
Mallor-Weiss tear
117
what perianal things can patients with Crohn's get
fissures
skin tags
fistulae
118
treatment of PSC
ERCP +/- stent or balloon dilatation (not treating the primary pathology)
119
sites of referred pain for foregut, midgut and hindgut
foregut - epigastric
midgut - periumbilical
hindgut - suprapubic
120
4 stages of internal haemorrhoids
primary - bleeding with no prolapse
secondary - prolapse with spontaneous reduction
tertiary - prolapse but can be pushed back up
quaternary - prolapse unable to be pushed back up
121
where is the pancreas anatomically (vertebra)
level of L2
122
how do gallstones cause pancreatitis
blocks the CBD --\> increases intrapancreatic duct pressure --\> lipase is secreted --\> fat necrosis --\> inflammatory oedema --\> acinar cell damage
123
what is dyspepsia
pain or discomfort in the upper abdomen
124
how to differentiate clinically between an indirect and direct hernia
reduce the hernia, and then place the index and middle fingers over surface marking of the deep ring and ask patient to cough
- no hernia = indirect
- hernia = direct
125
what is waterbrash
excessive secretion of saliva in the mouth
126
describe the site, radiation, quality, severity and chronology of peptic ulcer
- epigastrium
- no radiation
- aching pain
- variable severity
- intermittent, often at night
127
what three things in blood tests should you look at in someone with jaundice
LFTs - can point to whether cholestatic or hepatic
haematology- want to know platelet count
coagulation profile
128
what does a MRCP involve
contrast injected/swallowed --\> biliary system MRI to look at the biliary tree (Diagnostic only)
129
when would you do a barium swallow
when achalasia or pharyngeal pouch is suspected as the cause of oesophageal dysphagia
- achalasia will show "birds peak" sign
130
treatment of eosinophilic oesophagitis
topical fluticasone
elimination diets may have a role
131
how do you tell between between ascites caused by portal hypertension and spontaneous bacterial peritonitis
PH = SAAG \>11g/L
SBP = PMN \>250cells/mm3 with detectable growth on culture with SAAG
132
what is Budd-Chiari
hepatic vein thrombosis
133
achalasia investigations
gastroscopy
manometry
barium study
134
where is the ligament of Treitz
band of tissue that goes around the junction between the 4th part of the duodenum and the jejenum
135
what causes hepatorenal syndrome
portal hypertension --\> less blood flowing to kidneys
136
complications of diverticulitis
abscess
fistula
colonic obstruction - due to scarring from repeated inflammation
perforation
peritonitis
137
6 stages of crohns management
- nutritional therapy
- 5-ASA (anti-inflammatory drug used specifically for IBD)
- corticosteroids
- immunosuppression
- immunomodulators
- experimental therapy or surgery
138
causes of chronic pancreatitis
alcohol
obstruction
autoimmune
hereditary pancreatitis
repeated episodes of acute pancreatitis
139
what level of lipase is diagnostic for pancreatitis
2x upper limit of normal
140
how do you determine the phase of chronic hepB
LFTs: abnormal ALT may indicate HBC activity (1,2,4)
e serology - will determine phase (1 or 2)
HBV DNA - quantifies viral load and phase
141
surgery for cancer of: caecum and ascending colon
right hemi-colectomy
142
3 GI causes of clubbing
cirrhosis
IBD
Celiac
143
common places for CRC to metastasise to
lungs and liver
144
describe the site, radiation, quality, severity and chronology of small bowel obstruction
- site - central
- no radiation
- colicky
usually severe
- may be recurrent
145
pattern of pain for pancreatic problem
steady, radiates to the back, relieved by sitting up and leaning forwards
146
what is the gold standard to find diverticulitis
CT
147
what are the 5 causes of oesophageal dysphagia due to a structural problem
oesophagitis
strictures
webs, rings
tumours
extrinsic compression
148
what are the common complications with both UC and crohns
perforation
haemorrhage/bleeding
dilatation of the colon
149
2 most common causes of motility caused diarrhoea
IBS
thyrotoxicosis
150
what is the treatment for torsion of the testicular appendage
NSAIDs
151
which imaging technique is best at looking at the gallbladder
percutaneous ultrasound
152
common causes of large bowel obstruction
Top 3 - cancer, diverticulitis and volvulus
others: constipation, stricture (IBD, radiation), adhesions
153
what is "cobblestoning"
typical of Crohns - islands of oedematous mucosa interspersed by deep linear ulcers
154
Investigations for oesophgeal dysphagia
gastroscopy
barium swallow
oesophageal manometry
CT scan
155
what does eosinophilic oesophagitis cause
rings and vertical furrows in the oesophagus --\> dysphagia
156
lifestyle treatment of GORD
stop smoking, coffee, alcohol weight loss raise head of the bead
157
symptoms associated with Coeliac disease
food trigger
bloating
diarrhoea
tiredness
158
what is the difference between cholelithiasis and choledocholithiasis
cholelithiasis = stone in gall bladder
choledocholithiasis = stone in Common bile duct
159
which ABs are commonly associated with liver toxicity
augmentin
flucloxacillin
160
difference between indirect and direct hernias
indirect - hernia comes through deep inguinal ring accompanying the spermatic cord towards the scrotum due to failure of the processes vaginalis to obliterate
direct - hernia protrudes directly through the posterior wall of the inguinal canal
161
what is the hallmark feature of UC
rectal bleeding
162
endocrine causes of chronic diarrhoea
hyperthyroidism
hypothyroidism
addison's disease
diabetes mellitus
163
enzymes involved in fat metabolism
bile
pancreatic lipase
164
medication options for GORD
PPI
histamine 2 receptor antagonist
pro-motility drugs
165
what disease is mneumonic for a nut-cracker or corkscrew oesophagus appearance on barium swallow
oesophageal spasm
166
what do you see on Abdominal Xray with small bowel obstruction
erect - lots of air fluid levels
supine - distention of the small bowel
167
what does the following suggest? Pain radiating to:
- back
- shoulder
- neck
back - pancreatic or deep peptic ulcer
shoulder - diaphragmatic irritation
neck - reflux
168
who is the typical patient to get eosinophilic oesophagitis
young men with history of atopy
169
definition of acute severe colitis
blood stool frequency \>6/day
PLUS \>1 of:
- pulse \>90bpm
- temp \>37.8
- Hb 30mm/hr
170
What does HBeAg positive mean
active disease - within the first 2 phases
171
basic treatment options for small bowel obstruction
virgin abdomen = operate!
previous abdominal surgery = conservative management (might resolve) - if it doesn't - surgery
SBO + strangulation = urgent surgery and fluid resus
172
which signs on abdominal xray should you look for when investigating for IBD
thumbprinting
toxic megacolon
173
which endocrine problem can cause constipation
hypothyroidism
174
what are the 2 ducts of the pancreas called and where do they empty into (papilla)
main = duct of Wirsung (inferior) --\> ampulla of Vater
accessory = duct of Santorini (superior) --\> minor duodenal papilla
175
what are the typical symptoms of achalasia
progressive dysphagia
odynophagia
regurgitation
profound weight loss
malnutrition
176
what is odynophagia
pain on swallowing
177
what does HbsAg positive mean
marker of current infection (acute or chronic)
178
describe the site, radiation, quality, severity and chronology of choledocholithiasis
- Right subcostal
- radiation to the right side of back or scapula
- sharp, pushing pain (NOT COLICKY)
- variable intensity but often severe
- intermittent, fairly sudden onset, lasts at least 15 minutes up to several hours EXACTLY THE SAME FOR BILIARY COLIC
179
which endocrine disorder can be associated with increased appetite an weight loss
hyperthyroidism
180
where are spider naevi normally found
SVC distribution
181
explain TNM staging for CRC
T1 - cancer in submucosa
T2 - cancer in muscularis propria but not through
T3 - cancer through muscularis propria
T4 - invasion of adjacent organs
N1/2 - lymph node involvement
M1 - distant spread
182
treatment of mild UC
5-ASA or sulfasalazine (oral and/or rectal)
183
explain dukes staging for CRC
A - cancer up to/into muscularis propria
B - cancer through muscularis propria and into fat/serosa
C - lymph nodes involved
D - distant spread
184
what are the different terms of the extent of UC
proctitis - only affects rectum l
eft sided colitis - up to beginning of descending colon
pancolitis - all of the colon to the iliocoecal junction
185
what kind of bowel sounds are made by a bowel obstruction
high pitched frequent bowel sounds
186
what is the best way to work out the prognosis in someone with liver disease
Child-Pugh Score
187
what causes rebound tenderness
peritonitis
188
treatment of PBC
urso-deoxycholic acid
189
how does coffee and alcohol affect GORD
they both cause relaxation of the lower oesophageal sphincter --\> GORD
190
what is Barrett's oesophagus
transformation of stratified squamous epithelium to columnar epithelium of the distal oesophagus
191
describe the site, radiation, quality, severity and chronology of ruptured AAA
- central
- radiation to back
- tearing pain
- severe
- sudden onset
192
describe the site, radiation, quality, severity and chronology of diverticulitis
- usually LIF
- no radiation
- colicky
- variable severity
- progressive
193
what is the association between large and small volume diarrhoea and small and large intestine
large volume = small bowel disease
and secretory diarrhoea small volume = large bowel
194
peak age of onset for IBD
between 15-30
195
which specific sign on gastro examination is specific for alcoholism
parotidomegaly
196
what 5 things does the Child-Pugh system base its scoring system on
encephalopathy
ascites
INR
Albumin
bilirubin
197
complications of UC
toxic megacolon --\> perforation --\> sepsis
198
what are the 3 causes of oesophageal dysphagia due to a motor disorder
achalasia
scleroderma
diffuse oesophageal spasm
199
current treatment for HBV
- oral nucleos(t)ide analogues
- peg interferon
200
what occurs during the immune control phase of Hep B
virus changes a little bit (immune system dampens) and then catches up -\> backwards and forwards - will stop producing the antigen
201
what is the triple therapy for H. pylori eradication?
omeprazole, amoxicillin, and clarithromycin
202
how do you get fistulae and strictures in crohns
deep penetrating fissures and ulcers --\> fistulae submucosal fibrosis --\> strictures
203
what is ileus
hypomotility of the GIT in the absence of mechanical bowel obstruction
204
management of biliary colic
cholecystectomy
205
what are the 12 things that cause cirrhosis
big 3 - HepB, HepC, alcohol
autoimmune 3 - AIH, PBC, PSC
metabolic 3 - haemochromatosis, Wilson's disease, alpha1AT def
other 3 - NASH, Budd-Chiari, chronic biliary obstruction
206
what are curling's and cushing's ulcers
curlings = due to burns/severe stress
cushings = post head injury/head surgery
207
most common causes of constipation
low fibre diet
neglecting the urge to go --\> stretching of rectum and sigmoid --\> chronic retention and constipation
208
3 things you look for in a diagnostic ascitic tap
WCC
albumin
cytology
209
what is the management for ascites
- treat underlying disease
- avoid NSAIDs and ACE I
- Sodium restriction
- Fluid restriction
- Diuretics
- spironolactone +/- frusemide
- therapeutic ascitic tap
210
treatment of autoimmune hepatitis
prenisolone +/- azithioprine/mercaptopurine
211
what is hepatic hydrothorax
ascites which tracks into the pleural space
212
what occurs during the immune tolerant phase of Hep B
- lots of virus but no immune response yet (ALT normal)
- produce e antigen to prevent the immune system removing the virus
213
what do you see in histology for Crohns
transmural inflammtion infiltration of lymphocytes and macrophages granulomas in 50% of cases
214
common presenting complain with Crohns vs UC
crohns - abdo pain and weight loss
UC - rectal bleeding and diarrhoea
215
what blood results do you get in someone with CLD
low albumin
raised bilirubin
AST\>ALT
increased INR
low platelets
216
transmission of hep B
perinatal - common in developing world
child-to-child
sexual transmission
IVDU
217
most common management of varices
band ligation or injection of glue
218
which type of diarrhoea improves with fasting
osmotic
219
how is faecal calprotectin useful in investigating for IBD
it is a protein released from inflamed intestinal epithelial cells - can be useful in differentiating between IBD and IBS and also in monitoring patients with known IBD
