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Z MD 2 > Gastro > Flashcards

Gastro Flashcards

1
Q

what are the complications of crohns not shared by UC

A

strictures, fistulae, perianal disease, small bowel obstruction

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2
Q

investigations for oropharyngeal dysphagia

A

videofluoroscopic examination of swallowing

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3
Q

new treatment of Hep C

A

direct acting antivirals

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4
Q

how does food intolerance cause diarrhoea

A

bacterial overgrowth

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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

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6
Q

what causes leuconychia

A

hypoalbuminaemia –> compression of the capillary flow by the EC fluid

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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

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8
Q

3 main causes of upper GI bleeding

A

oesohageal varices

peptic ulcer disease

gastroduodenal erosions

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9
Q

which type of CRC is particularly associated with anaemia

A

right colon (ascending)

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10
Q

is ascites exudate or transudate

A

transudate

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11
Q

symptoms of CRC

A

rectal bleeding - dark, mixed in

altered bowel habit

tenesmus,

mucus

anaemia,

pain, mass

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12
Q

management options for oesophgeal varices

A

ocreotide

banding

+/- transfusion

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13
Q

clinical features of acute bowel ischaemia

A
  • sudden severe abdominal pain out of proportion to physical findings!
  • N&V
  • bloody diarrhoea
  • bloating
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14
Q

when is methotrexate used in IBD

A

2nd line Tx for CD

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15
Q

3 general causes of hepatomegaly

A

hepatic

cardiovascular - RHF, budd-chiari

haematological - lymphoma etc

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16
Q

ALT is very high in patients with..

A

acute viral hepatitis

acute drug toxicity

ischaemia

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17
Q

where do the lymphatics of the testicles drain to

A

para-aortic nodes

(if mass - will be in the central abdomen)

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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)

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19
Q

most common pancreatic cancer is

A

pancreatic adenocarcinoma

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20
Q

if jaundice occurs suddenly in someone with CLD, consider

A
  • portal vein thrombosis
  • biliary obstruction
  • infection (esp spontaneous bacterial peritonitis)
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21
Q

complications of crohns

A

strictures

fistulae

perforation

abscess

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22
Q

DRE findings with large bowel obstruction

A

empty rectum

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23
Q

two typical liver enzyme patterns

A

hepatocellular - raised ALT and AST

cholestatic - raised GGT and ALP

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24
Q

what is the “buzz word” for the look of Barrett’s oesophagus

A

Salmon tongue oesophagus

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25
Q

most common causes of decompensation in a cirrhotic

A

sepsis (infection)

bleeding (varices)

drugs (paracetamol, alcohol)

non-compliance

hepatoma

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26
Q

explain the pain and vomiting due to foregut, midgut and hindgut pathology

A

foregut - immediate, severe vomiting, pain not prominent

midgut - every few minutes to half hourly

hindgut - infrequent exacerbation or vomitus

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27
Q

symptoms of small bowel obstruction

A

pain

N&V

diarrhoea - early

constipation - late

fever and tachycardia occur late (assoc with strangulation)

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28
Q

what is haematochezia

A

torrential upper GI bleed causing blood to be passed rectally (bright red)

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29
Q

what is the electrolyte balance associated with cirrhosis

A

HYPONATRAEMIA - but need to sodium restrict!

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30
Q

3 tumour markers for testicular cancer

A

alpha-fetoprotein

beta-hCG

LDH

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31
Q

mucosal causes of chronic diarrhoea

A

CD

food intolerance

infection

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32
Q

what is the major complication of UC

A

toxic megacolon (dilatation of the colon)

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33
Q

how do you replace the fluid you take out in a therapeutic ascitic tap

A

200ml 20% concentrated IV for each 2L drained

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34
Q

3 major TYPES of jaundice (not causes)

A

biliary obstruction

cholestasis

acholuric jaundice - haemolysis

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35
Q

2 things that can cause biliary obstruction

A

stones

strictures (benign and malignant)

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36
Q

in which, UC or crohns, is the risk of developing colon cancer greater

A

UC

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37
Q

how can you tell whether the raised ALP is due to bone/placenta/liver pathology

A

if it is raised along with a raised GGT = liver

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38
Q

what is the most common side effects of spironolactone

A

gynaecomastia

hyperkalaemia

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39
Q

describe the site, radiation, quality, severity and chronology of acute cholecystitis

A
  • right subcostal -

no radiation

  • sharp pain
  • severe
  • onset may be sudden or gradual, persistent
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40
Q

what is infliximab

A

anti-TNF antibodies

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41
Q

how do you test for synthetic functions of the liver

A

albumin INR

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42
Q

what is the defining anatomy that determines whether something is an upper or lower GI bleed

A

upper = proximal to the ligament of Treitz

lower = distal to the ligament of Treitz

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43
Q

possible side effects of a fundoplication

A
  • dysphagia (if too tight)
  • early satiety
  • inability to burp or vomit
  • increased flatus
  • bloating
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44
Q

major treatment of achalasia

A

cardiomyotomy (incision into the sphincter muscle that opens up the muscle)

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45
Q

what are the salvage therapies for mod-severe steroid refractory UC

A
  • cyclospoine
  • infliximab
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46
Q

surgical option for GORD

A

fundoplication - where the fundus of the stomach is wrapped around the oesophagus to tighten up around the lower oesophageal sphincter

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47
Q

3 signs/symptoms of hepatic encephalopathy

A

asterixis

fetor

confusion

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48
Q

bloody diarrhoea is common in which IBD

A

UC

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49
Q

main antibiotics that cause cholestasis

A

flucloxacillin

augmentin (clavulonic acid component)

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50
Q

what 3 things does the MELD system base its scoring system on

A

creatinine

bilirubin

INR

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51
Q

why is Barrett’s oesophagus bad

A

it increases the risk of adenocarcinoma

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52
Q

3 causes of encephalopathy

A

liver failure

hypercapnia

uraemia

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53
Q

treatment of severe UC

A

IV steroids

IV cyclosporine/infliximab –> AZA/MP ?surgery

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54
Q

what occurs during the immune clearance phase of Hep B

A

immune system wakes up to the virus and tries to kill all the infected hepatocytes (drop in DNA and ALT elevates)

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55
Q

weight loss and dysphagia suggests..

A

malignancy

achalasia

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56
Q

what can predispose to internal haemorrhoids

A

constipation and straining

pelvic venous obstruction (eg. pregnancy and labour)

family history

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57
Q

describe the site, radiation, quality, severity and chronology of perforated peptic ulcer

A
  • epigastrium
  • radiation to shoulder tip
  • sharp pain - severe
  • sudden onset, persistent
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58
Q

what two pieces of information can you get from a liver biopsy

A

grade (inflammation)

stage (fibrosis)

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59
Q

when is the only time you can get a hepatoma without cirrhosis

A

With Hep b

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60
Q

where is the deep inguinal ring

A

round opening in the transversalis fascia found 1cm superior to the inguinal ligament and 1cm lateral to the inferior epigastric arteries

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61
Q

most common location for crohns disease

A

distal ileum

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62
Q

what two conditions commonly cause rigid plank like abdomen

A

acute pancreatitis

perforated peptic ulcer

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63
Q

invasive diagnosis of H. pylori is done by

A

gastric biopsies for histology

rapid urease test

culture

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64
Q

treatment of anal cancer

A

chemotherapy and salvage resection if required

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65
Q

non-invasive diagnosis of H. pylori is done by

A

serology

urea breath test (measures ammonia on expiration)

stool antigen

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66
Q

presentation of orchitis

A

large and tender testes with fever

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67
Q

surgery for cancer of: transverse colon

A

extended right hemi-colectomy

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68
Q

pattern of pain for renal colic

A

renal angle pain radiates to the groin very severe worse on balotting

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69
Q

presentation of chronic infection of the scrotum

A

chronic, diffuse scrotal tenderness

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70
Q

what are the investigation options for GORD

A

oesophageal manometry - gold standard

naso-oesophageal pH monitor

Bravo pH capsule

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71
Q

what are the 4 phases of Hep B

A

immune tolerant

immune clearance

immune control

immune escape

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72
Q

what symptoms/signs show decompensated liver disease

A

jaundice

ascites

coagulopathy

variceal bleeding

hepatorenal syndrome

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73
Q

what is the immune escape phase of Hep B

A

relaxation of the immune system –> virus comes up again and then get ongoing damage here

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74
Q

smoking increases your risk for UC or CD

A

crohns

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75
Q

what fluids do you give to a patient with CLD

A

NOT NORMAL SALINE

  • concentrated albumin
  • glucose/fructose
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76
Q

complications of ERCP

A

unsuccessful

acute pancreatitis

cholangitis

perforation

mortality

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77
Q

describe the abdominal examination findings in someone with biliary colic

A

normal

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78
Q

which anatomy make up the walls of inguinal canal

A

inferior = inguinal ligament

superior = arching fibres of IO and transversus abdominus

anterior = EO aponeurosis and IO aponeurosis

posterior = transversalis fascia, conjoint tendon

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79
Q

what does HbcAb positive mean

A

you only get this if you have actually met the virus (not the vaccine)

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80
Q

what is the typical patient presentation with cholestasis

A

painless jaundice with a non-dilated biliary tree and no gall stones

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81
Q

which area of the bowel is most suceptible to diverticuli

A

sigmoid colon

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82
Q

medical management of anal fissure

A

stool softeners

internal sphincter relaxation - GTN, Botox,

CCB surgery - fissurectomy/ lateral internal sphincterotomy

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83
Q

clinical features of diverticulitis

A

LLQ pain

constipation/diarrhoiea

NV

urinary symptoms

mild fever

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84
Q

what causes low platelets in someone with CLD

A

CLD –> portal hypertension –> splenomegaly –> sequestration of platelets in the spleen

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85
Q

2 most common causes of ascites

A

portal hypertension from cirrhosis

Peritoneal malignancy

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86
Q

surgery for cancer of: mid rectum

A

low or ultralow anterior resection with loop ileostomy

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87
Q

surgery for cancer of: low rectum

A

abdomino-perineal resection with permanent colostomy

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88
Q

4 types of cells in islets

A

alpha –> glucagon

beta –> insulin

delta –> somatostatin

PP –> pancreatic polypeptide

89
Q

what are some extraintestinal manifestations of active IBD

A

mouth ulcers

erythema nodosum

episcleritis, uveitis

PSC

ankylosing spondylitis

pyoderma gangrenosum

kidney stones

gallstones

90
Q

what is the scoring system used to determine severity of pancreatitis

A

Ranson scoring system

91
Q

complications of surgery for crohns

A

stricture

fistula

abscess

perforation

92
Q

top 4 causes of small bowel obstruction

A

adhesions

hernias

cancer

crohns

93
Q

what causes colicky pain

A

blocked lumen of bowel or ureters (peristaltic movement behind the blockage)

94
Q

what are the two grading systems for cirrhosis

A

Child-Pugh

MELD

95
Q

what does an ERCP involve

A

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
Q

where does the inguinal ligament run

A

between ASIS and pubic tubercle

97
Q

presentation of internal haemorrhoids

A

bleeding, itchy lump (hardly ever painful)

98
Q

first 2 things to rule out for unintentional weight loss

A

malignancy

depression

99
Q

the more proximal the visceral pain the more …….. the peristaltic pain wave

A

frequent

100
Q

which things are associated with early morning vomiting

A

pregnancy

alcoholism

raised ICP

101
Q

explain the prophylaxis of variceal bleeding

A
  • primary = non-selective beta-blockage, endoscopic band ligation
  • secondary = regular endoscopic band ligation or injection
  • rescue - decompression shunt
102
Q

describe the site, radiation, quality, severity and chronology of acute pancreatitis

A
  • epigastrum
  • radiation through to back
  • sharp pain
  • severe
  • fairly sudden onset, persistent, sometimes recurrent
103
Q

transmission of Hep C

A

mostly blood-to-blood (IVDU)

104
Q

how does being overweight predispose you to GORD

A

puts more pressure on the abdominal cavity –> creates larger force to push acid upwards

105
Q

pneumonic for remembering the causes of acute pancreatitis in adults

A

I GET SMASHED Idiopathic Gallstones Ethanol Trauma Steriods Mumps Autoimmune Scorpion sting Hyperlipidaemia/hypercalcaemia ERCP Drugs

106
Q

surgery for cancer of: sigmoid colon and upper rectum

A

high anterior resection

107
Q

what is achalasia

A

failure of the lower oesophageal sphincter relaxation with swallowing

108
Q

reflux is aggravated by

A

alcohol

chocolate

caffeine

fat

CCBs

109
Q

which signs are caused by high oestrogen

A

palmar erythema

gynaecomastia

spider naevi

110
Q

difference between UC and Crohns in the location of the disease

A

Crohns - any part of the GI system

UC - isolated to large bowel (always rectum - moves upwards)

111
Q

what is the association with pain that worsens with fatty meals

A

reflux

112
Q

most common cause of tenesmus

A

vaginal prolapse

113
Q

definition of chronic diarrhoea

A

decrease in faecal consistency lasting for 4 or more weeks

114
Q

what are the “red flag” upper GI symptoms

A

dysphagia

odynophagia

haematemesis

melaena

weight loss

age >50

115
Q

what causes ascites in CLD

A

combination of reduced oncotic pressure (due to low albmin) and increased portal pressure

116
Q

common causes of upper GI bleeding

A

peptic ulcer disease

varices

oesophagitis

Mallor-Weiss tear

117
Q

what perianal things can patients with Crohn’s get

A

fissures

skin tags

fistulae

118
Q

treatment of PSC

A

ERCP +/- stent or balloon dilatation (not treating the primary pathology)

119
Q

sites of referred pain for foregut, midgut and hindgut

A

foregut - epigastric

midgut - periumbilical

hindgut - suprapubic

120
Q

4 stages of internal haemorrhoids

A

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
Q

where is the pancreas anatomically (vertebra)

A

level of L2

122
Q

how do gallstones cause pancreatitis

A

blocks the CBD –> increases intrapancreatic duct pressure –> lipase is secreted –> fat necrosis –> inflammatory oedema –> acinar cell damage

123
Q

what is dyspepsia

A

pain or discomfort in the upper abdomen

124
Q

how to differentiate clinically between an indirect and direct hernia

A

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
Q

what is waterbrash

A

excessive secretion of saliva in the mouth

126
Q

describe the site, radiation, quality, severity and chronology of peptic ulcer

A
  • epigastrium
  • no radiation
  • aching pain
  • variable severity
  • intermittent, often at night
127
Q

what three things in blood tests should you look at in someone with jaundice

A

LFTs - can point to whether cholestatic or hepatic

haematology- want to know platelet count

coagulation profile

128
Q

what does a MRCP involve

A

contrast injected/swallowed –> biliary system MRI to look at the biliary tree (Diagnostic only)

129
Q

when would you do a barium swallow

A

when achalasia or pharyngeal pouch is suspected as the cause of oesophageal dysphagia

  • achalasia will show “birds peak” sign
130
Q

treatment of eosinophilic oesophagitis

A

topical fluticasone

elimination diets may have a role

131
Q

how do you tell between between ascites caused by portal hypertension and spontaneous bacterial peritonitis

A

PH = SAAG >11g/L

SBP = PMN >250cells/mm3 with detectable growth on culture with SAAG

132
Q

what is Budd-Chiari

A

hepatic vein thrombosis

133
Q

achalasia investigations

A

gastroscopy

manometry

barium study

134
Q

where is the ligament of Treitz

A

band of tissue that goes around the junction between the 4th part of the duodenum and the jejenum

135
Q

what causes hepatorenal syndrome

A

portal hypertension –> less blood flowing to kidneys

136
Q

complications of diverticulitis

A

abscess

fistula

colonic obstruction - due to scarring from repeated inflammation

perforation

peritonitis

137
Q

6 stages of crohns management

A
  • nutritional therapy
  • 5-ASA (anti-inflammatory drug used specifically for IBD)
  • corticosteroids
  • immunosuppression
  • immunomodulators
  • experimental therapy or surgery
138
Q

causes of chronic pancreatitis

A

alcohol

obstruction

autoimmune

hereditary pancreatitis

repeated episodes of acute pancreatitis

139
Q

what level of lipase is diagnostic for pancreatitis

A

2x upper limit of normal

140
Q

how do you determine the phase of chronic hepB

A

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
Q

surgery for cancer of: caecum and ascending colon

A

right hemi-colectomy

142
Q

3 GI causes of clubbing

A

cirrhosis

IBD

Celiac

143
Q

common places for CRC to metastasise to

A

lungs and liver

144
Q

describe the site, radiation, quality, severity and chronology of small bowel obstruction

A
  • site - central
  • no radiation
  • colicky

usually severe

  • may be recurrent
145
Q

pattern of pain for pancreatic problem

A

steady, radiates to the back, relieved by sitting up and leaning forwards

146
Q

what is the gold standard to find diverticulitis

A

CT

147
Q

what are the 5 causes of oesophageal dysphagia due to a structural problem

A

oesophagitis

strictures

webs, rings

tumours

extrinsic compression

148
Q

what are the common complications with both UC and crohns

A

perforation

haemorrhage/bleeding

dilatation of the colon

149
Q

2 most common causes of motility caused diarrhoea

A

IBS

thyrotoxicosis

150
Q

what is the treatment for torsion of the testicular appendage

A

NSAIDs

151
Q

which imaging technique is best at looking at the gallbladder

A

percutaneous ultrasound

152
Q

common causes of large bowel obstruction

A

Top 3 - cancer, diverticulitis and volvulus

others: constipation, stricture (IBD, radiation), adhesions

153
Q

what is “cobblestoning”

A

typical of Crohns - islands of oedematous mucosa interspersed by deep linear ulcers

154
Q

Investigations for oesophgeal dysphagia

A

gastroscopy

barium swallow

oesophageal manometry

CT scan

155
Q

what does eosinophilic oesophagitis cause

A

rings and vertical furrows in the oesophagus –> dysphagia

156
Q

lifestyle treatment of GORD

A

stop smoking, coffee, alcohol weight loss raise head of the bead

157
Q

symptoms associated with Coeliac disease

A

food trigger

bloating

diarrhoea

tiredness

158
Q

what is the difference between cholelithiasis and choledocholithiasis

A

cholelithiasis = stone in gall bladder

choledocholithiasis = stone in Common bile duct

159
Q

which ABs are commonly associated with liver toxicity

A

augmentin

flucloxacillin

160
Q

difference between indirect and direct hernias

A

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
Q

what is the hallmark feature of UC

A

rectal bleeding

162
Q

endocrine causes of chronic diarrhoea

A

hyperthyroidism

hypothyroidism

addison’s disease

diabetes mellitus

163
Q

enzymes involved in fat metabolism

A

bile

pancreatic lipase

164
Q

medication options for GORD

A

PPI

histamine 2 receptor antagonist

pro-motility drugs

165
Q

what disease is mneumonic for a nut-cracker or corkscrew oesophagus appearance on barium swallow

A

oesophageal spasm

166
Q

what do you see on Abdominal Xray with small bowel obstruction

A

erect - lots of air fluid levels

supine - distention of the small bowel

167
Q

what does the following suggest? Pain radiating to:

  • back
  • shoulder
  • neck
A

back - pancreatic or deep peptic ulcer

shoulder - diaphragmatic irritation

neck - reflux

168
Q

who is the typical patient to get eosinophilic oesophagitis

A

young men with history of atopy

169
Q

definition of acute severe colitis

A

blood stool frequency >6/day

PLUS >1 of:

  • pulse >90bpm
  • temp >37.8
  • Hb 30mm/hr
170
Q

What does HBeAg positive mean

A

active disease - within the first 2 phases

171
Q

basic treatment options for small bowel obstruction

A

virgin abdomen = operate!

previous abdominal surgery = conservative management (might resolve) - if it doesn’t - surgery

SBO + strangulation = urgent surgery and fluid resus

172
Q

which signs on abdominal xray should you look for when investigating for IBD

A

thumbprinting

toxic megacolon

173
Q

which endocrine problem can cause constipation

A

hypothyroidism

174
Q

what are the 2 ducts of the pancreas called and where do they empty into (papilla)

A

main = duct of Wirsung (inferior) –> ampulla of Vater

accessory = duct of Santorini (superior) –> minor duodenal papilla

175
Q

what are the typical symptoms of achalasia

A

progressive dysphagia

odynophagia

regurgitation

profound weight loss

malnutrition

176
Q

what is odynophagia

A

pain on swallowing

177
Q

what does HbsAg positive mean

A

marker of current infection (acute or chronic)

178
Q

describe the site, radiation, quality, severity and chronology of choledocholithiasis

A
  • 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
Q

which endocrine disorder can be associated with increased appetite an weight loss

A

hyperthyroidism

180
Q

where are spider naevi normally found

A

SVC distribution

181
Q

explain TNM staging for CRC

A

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
Q

treatment of mild UC

A

5-ASA or sulfasalazine (oral and/or rectal)

183
Q

explain dukes staging for CRC

A

A - cancer up to/into muscularis propria

B - cancer through muscularis propria and into fat/serosa

C - lymph nodes involved

D - distant spread

184
Q

what are the different terms of the extent of UC

A

proctitis - only affects rectum l

eft sided colitis - up to beginning of descending colon

pancolitis - all of the colon to the iliocoecal junction

185
Q

what kind of bowel sounds are made by a bowel obstruction

A

high pitched frequent bowel sounds

186
Q

what is the best way to work out the prognosis in someone with liver disease

A

Child-Pugh Score

187
Q

what causes rebound tenderness

A

peritonitis

188
Q

treatment of PBC

A

urso-deoxycholic acid

189
Q

how does coffee and alcohol affect GORD

A

they both cause relaxation of the lower oesophageal sphincter –> GORD

190
Q

what is Barrett’s oesophagus

A

transformation of stratified squamous epithelium to columnar epithelium of the distal oesophagus

191
Q

describe the site, radiation, quality, severity and chronology of ruptured AAA

A
  • central
  • radiation to back
  • tearing pain
  • severe
  • sudden onset
192
Q

describe the site, radiation, quality, severity and chronology of diverticulitis

A
  • usually LIF
  • no radiation
  • colicky
  • variable severity
  • progressive
193
Q

what is the association between large and small volume diarrhoea and small and large intestine

A

large volume = small bowel disease

and secretory diarrhoea small volume = large bowel

194
Q

peak age of onset for IBD

A

between 15-30

195
Q

which specific sign on gastro examination is specific for alcoholism

A

parotidomegaly

196
Q

what 5 things does the Child-Pugh system base its scoring system on

A

encephalopathy

ascites

INR

Albumin

bilirubin

197
Q

complications of UC

A

toxic megacolon –> perforation –> sepsis

198
Q

what are the 3 causes of oesophageal dysphagia due to a motor disorder

A

achalasia

scleroderma

diffuse oesophageal spasm

199
Q

current treatment for HBV

A
  • oral nucleos(t)ide analogues
  • peg interferon
200
Q

what occurs during the immune control phase of Hep B

A

virus changes a little bit (immune system dampens) and then catches up -> backwards and forwards - will stop producing the antigen

201
Q

what is the triple therapy for H. pylori eradication?

A

omeprazole, amoxicillin, and clarithromycin

202
Q

how do you get fistulae and strictures in crohns

A

deep penetrating fissures and ulcers –> fistulae submucosal fibrosis –> strictures

203
Q

what is ileus

A

hypomotility of the GIT in the absence of mechanical bowel obstruction

204
Q

management of biliary colic

A

cholecystectomy

205
Q

what are the 12 things that cause cirrhosis

A

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
Q

what are curling’s and cushing’s ulcers

A

curlings = due to burns/severe stress

cushings = post head injury/head surgery

207
Q

most common causes of constipation

A

low fibre diet

neglecting the urge to go –> stretching of rectum and sigmoid –> chronic retention and constipation

208
Q

3 things you look for in a diagnostic ascitic tap

A

WCC

albumin

cytology

209
Q

what is the management for ascites

A
  • treat underlying disease
  • avoid NSAIDs and ACE I
  • Sodium restriction
  • Fluid restriction
  • Diuretics
  • spironolactone +/- frusemide
  • therapeutic ascitic tap
210
Q

treatment of autoimmune hepatitis

A

prenisolone +/- azithioprine/mercaptopurine

211
Q

what is hepatic hydrothorax

A

ascites which tracks into the pleural space

212
Q

what occurs during the immune tolerant phase of Hep B

A
  • lots of virus but no immune response yet (ALT normal)
  • produce e antigen to prevent the immune system removing the virus
213
Q

what do you see in histology for Crohns

A

transmural inflammtion infiltration of lymphocytes and macrophages granulomas in 50% of cases

214
Q

common presenting complain with Crohns vs UC

A

crohns - abdo pain and weight loss

UC - rectal bleeding and diarrhoea

215
Q

what blood results do you get in someone with CLD

A

low albumin

raised bilirubin

AST>ALT

increased INR

low platelets

216
Q

transmission of hep B

A

perinatal - common in developing world

child-to-child

sexual transmission

IVDU

217
Q

most common management of varices

A

band ligation or injection of glue

218
Q

which type of diarrhoea improves with fasting

A

osmotic

219
Q

how is faecal calprotectin useful in investigating for IBD

A

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

Z MD 2 (15 decks)

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