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Theme III > Gastro > Flashcards

Gastro Flashcards

1
Q

Common features of IBS?

A
  1. Abdominal pain - relieved by defecation?
  2. Bloating - distension, tension or hardness
  3. Change in bowel habits
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2
Q

Red flags that don’t point to IBS:

A

Rectal Bleeding
unexplained weight loss
Fam hx of bowel or ovarian cancer
onset after 60yrs of age

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3
Q

Is episcleritis more common in UC or CD?

A

CD

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4
Q

Is Primary sclerosing cholangitis more common in UC or CD?

A

UC

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5
Q

Is Uveitis more common in UC or CD?

A

UC

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6
Q

22 yo with a 3 wk history of diarrhoea. Occasionally bleeding. has urgency and tenesmus (feeling he hasn’t completely emptied). Has uveitis

A

UC

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7
Q

A barium enema on a patient with UC would show:

A

Loss of haustrations
Superficial ulceration - pseudopolyps
Drainpipe colon

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8
Q

18yo with raised intra-hepatic markers. Family history of liver disease. Patient presents with tremor and dyskinesia and dysarthria

A

Wilson’s disease

May also have Renal tubular acidosis - Fanconi Syndrome

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9
Q

How to diagnose Wilson’s disease?

A

Reduced serum Caeruloplasmin and increased 24hr urinary copper excretion

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10
Q

How do you manage Wilson’s disease?

A

Penicillamine (Chelates copper) has been the traditional first line management.

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11
Q

How do you induce remission in Crohn’s disease?

A
  1. Prednisolone (Try for 3-7days)
  2. Budesonide ( pt.s with diabetes)
    if severe:
  3. Hydrocortisone or Methylprednisolone
  4. If patient can’t tolerate Corticosteroids then:
    a. Azathioprine or Mercaptopurine

or 5. Methotrextae (with folic acid)

  1. Consider infliximab
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12
Q

What do you use for maintenance therapy of Crohn’s disease?

A

A) QUIT SMOKING

  1. Azathioprine or Mercaptopurine
  2. Methotrexate (with folic acid)
  3. Infliximab.
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13
Q

How would you manage Perianal and fistulising disease in CD?

A
  1. metronidazole
  2. Ciprofloxacin

And consider surgical exploration and local drainage.

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14
Q

What is courvoiser’s sign?

A

Painless, enlarged gallbladder and mild jaundice - unlikely to be gallstones. More likely to be malignancy of pancreas or biliary tree

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15
Q

Painless jaundice in an alcoholic with palpable gallbladder,

A

Pancreatic cancer - can also have epigastric pain and weight loss

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16
Q

How to differentiate Hep A and Hep E?

A

Hep E is more severe and if pregnant women. Or if Hep A excluded.. Hep A more common

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17
Q

Flu like prodrome + jaundice + hepatosplenomegaly in a traveller

A

Hep A

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18
Q

What does Zollinger Ellison syndrome present with?

and is associated with MEN I or II?

A

Multiple gastroduodenal ulcers causing abdominal pain and diarrhoea.
Associated with MEN I

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19
Q

Three endocrine things associated with MEN I?

A
  1. Parathyroid (Hyper) (95%)
  2. Pituitary (70%)
  3. Pancrease (50% e.g. insulinoma, gastrinoma)
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20
Q

Women with fever, malaise and jaundice. Positive for anti-smooth muscle antibody and anti-nuclear antibody. Negative for anti-mitochondrial antibodies:

A

Autoimmune hepatitis

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21
Q

Positive for anti-mitochondrial antibodies

A

Primary Biliary Cirrhosis

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22
Q

Anti-liver/kidney microsomal type 1 antibodies (LKM1). In children

A

Auto-immune hepatitis Type II

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23
Q

Man with ulcerative colitis, biliary colic and comes in Jaundice, itchy and with abdominal pain. Raised ALP and positive ANCA:

A

Primary Sclerosing cholangitis

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24
Q

Arthralgia, deranged ALT and very high ferritin are highly suggestive of….

A

Haemachromatosis.

Other symptoms include: ED, hypogonadism, cardiac failure (dilated cardiomyopathy)

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25
Q

In _______ inflammation is limited to the submucosa, with inflammatory cell infiltrates in the lamina propria.
Neutrophils migrate through the walls of the glands to form _______. Granuloma’s are more common in _____

A

UC. We get formation of crypt abscesses. Granuloma’s more common in CD.

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26
Q

Jejunal biopsy shows deposition of macrophages containing Period Acid Schiff (PAS) granules:

A

Whipple’s disease

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27
Q

Whipple’s disease is a rare multi-system disorder caused by _____. Mx with _____

A

Tropheryma whippeli. Mx with Co-trimoxazole

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28
Q

What are important prognostic markers for paracetamol overdose?

A

Increased PT time
increased Creatinine
Decreased Arterial pH
grade II or IV encephalopathu

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29
Q

How do you manage paracetamol overdose?

A

Acetylcysteine

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30
Q

Upper abdominal pain that develops after ERCP. Pt is apyrexial…

A

Acute Pancreatitis

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31
Q

Classic triad in Ascending cholangitis?

A

Fever (Rigor), RUQ pain, Jaundice

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32
Q

How does Gall stone ileus present (3 symptoms)? and what is it?

A

A small ball obstruction secondary to impacted gallstone.

presents with abdominal pain, distension and vomiting.

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33
Q

Key features for Viral hepatitis:

A

Traveller or IVDU + N/V + myalgia (Flu like prodrome) + RUQ

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34
Q

Congestive hepatomegaly occurs in the case of __________ or severe cases of cirrhosis.

A

Congestive heart failure

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35
Q

Biliary colic presents with intermittent RUQ pain that begins abruptly and subsides gradually. Attacks occur ______ eating.

A

After eating - because the gallbladder contracts and the gallstones block this

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36
Q

Biliary colic symptoms (except more severe) + pyrexial + positive murphy’s signs =

A

Acute cholecystitis

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37
Q

patient with anorexia/jaundice/weight loss with:
A palpable mass in the RUQ (Courvoiser’s sign) + Periumbiliac lymphadenopathy (Sister Mary Joseph nodes) and left supraclavicular adenopathy (Virchow’s node) =

A

Cholangiocarcinoma

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38
Q

Cullens sign and grey-Turner’s sign in Acute pancreatitis:

A

Cullen’s sign =Periumbilical discoloration

Grey-Turner’s sign = Flank discoloration

39
Q

If Oral flucloxacillin leads to ______ because of _____ use ______.

A

leads to diarrhea because of Clostridium Difficile use Clindamycin!

40
Q

Diarrhea, abdominal pain, raised WBC, severe toxic megacolon

After using antibiotics

A

Diarrhea because of Clostridium Difficile

41
Q

What biochemical is used to monitor colorectal cancer?

A

Carcinoembryonic antigen

42
Q

When do you do a loop ileostomy?

A

When you want to defunction the colon e.g. following rectal cancer - does not decompress colon and can reverse it later

43
Q

When do you do end ileostomy?

A

following complete excision of the colon or where the ileo colic anastomosis is not planned. Reversal is difficult.

44
Q

______is a last resort where loop resort is not possible

A

Caecostomy

45
Q

Which Gastro bug?

Common amongst travellers - watery stools, Abdominal cramps and nausea

A

E. Coli

46
Q

Which Gastro bug?

Prolonged non-blood diarrhea? Dirty water

A

Giardiasis

47
Q

Which Gastro bug?

Profuse water rice water stools - severe dehydration resulting in weight loss

A

Cholera

48
Q

Which gastro bug?

Bloody diarrhea - after visiting a brothel

A

Shigella

49
Q

Which Gastro bug?

Gasto with a flu like prodrome followed by crampy abdominal pain. Complications include Gullian barre Syndrome…

A

Campylobacter

50
Q

Which Gastro bug?

Vomitting within 6 hours, stereotypically seen after eating rice. Diarrhoeal illness occurs after 6hrs.

A

Bacillus Cereus

51
Q

Embolic pain with sudden pain and forceful evacuation. Acute on chronic events usually have a longer history and previous weight loss.
On examination the pain is typically greater than the physical signs would suggest

A

Mesenteric Infarction

52
Q

What are the most helpful tests for Mesenteric infarction?

A

Arterial pH and lactate. Arterial phase CT scanning is the most sensitive scanning

53
Q

How do you manage gastro Clostridium dificcile

First episode?
Second or subsequent episode?

A

First episode - Metronidazole

Second or subsequent - Vancomycin

54
Q

How do you manage gastro due to Campylobacter enteritis?

A

Clarithromycin

55
Q

How do you manage Gastro due to Salmonella?

A

Ciprofloxacin

56
Q

And how do you manage gastro due to Shigellosis?

A

Ciprofloxacin

57
Q

Two blood markers of upper GI bleed?

A

Increased urea and decreased Hb

58
Q

Anti-phospholipid syndrome is related to which liver disease?

A

Budd-Chiari syndrome

59
Q

A 32-year-old woman presents with a 12 hour history of abdominal pain, vomiting and jaundice. On examination she has tender hepatomegaly, ascites and a BMI of 35 kg/m². She has a past medical history of antiphospholipid syndrome. She drinks approximately 18 units of alcohol per week.

A

Budd-Chiari Syndrome

60
Q

What is the distribution pattern for UC?

A

Continuous lesions starting from the rectum..

61
Q

Primary Sclerosing cholangitis is more common in UC or CD?

A

UC

62
Q

Best test for diagnosing H. Pylori Infection and eradication (after 4 weeks of treatment)

A

Urea Breath test - asked to swallow a drink and then urea concentration in breath measured

63
Q

String sign on Barium Swallow?

A

CD

64
Q

Bloody diarrhoea may be seen. Crampy abdominal pain and weight loss are also common. Faecal urgency and tenesmus may be seen

A

Ulcerative Colitis

65
Q

Symptoms depend on the site of the lesion but include diarrhoea, rectal bleeding, anaemia and constitutional symptoms e.g. Weight loss and anorexia

A

Colorectal cancer

66
Q

Some note-able foods which are gluten free:

A

Rice, Potatoes and corn/Maize

67
Q

Parathyroid, Pituitary and Pancreatic tumour.

Common presentation - hypercalcaemia

A

MEN type 1

68
Q

Medullary thyroid cancer, Parathyroid and Phaeochromocytoma

A

MEN Type II

69
Q

Carcinoid syndrome usually occurs when metastases are present in the ____ and release _____ into the systemic circulation

A

Present in the liver and release serotonin into the systemic circulation

70
Q

Signs of chronic severe diarrhea, flushing, abdominal pain, LOW, hepatomegaly

A

Carcinoid syndrome

71
Q

Dysphagia may be associated with weight loss, anorexia or vomiting during eating
Past history may include Barrett’s oesophagus, GORD, excessive smoking or alcohol use

A

Oesophageal cancer

72
Q

May have history of heartburn, Odynophagia but no weight loss and systemically well

A

Oesophagitis

73
Q

There may be a history of HIV or other risk factors such as steroid inhaler use

A

Oesophageal candidiasis

74
Q

Dysphagia of both solids and liquids from the start. May have history or regurgitation of food - which presents as cough (aspiration), heartburn

A

Achalasia

75
Q

Older man. Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough. Halitosis may occasionally be seen

A

Pharngeal pouch - midline lump that gurgles on palpation

76
Q

May be history of anxiety
Symptoms are often intermittent and relieved by swallowing
Usually painless - the presence of pain should warrant further investigation for organic causes

A

Globus Hystericus

77
Q

Bloatin with abdominal pain and funny stools with classically:
Anaemia, low ferritin/folate levels are all characteristic of _________

A

Coeliac disease

78
Q

Primary biliary sclerosis has the 3 M rule:

A

IgM
anti-Mitochondrial
Middle Aged female

79
Q

Primary Biliary cirrhosis is associated with which syndrome?

A

Sjogren’s syndrome

80
Q

Wilson’s disease happens due to a decreased _______ and hence increased_____ deposition in tissues

A

Decreased Caeruloplasmin and hence increased copper deposition in tissues

81
Q

Most common cause of traveller’s diarrhea?

A

E. Coli

82
Q

What are the five things looked at in the Child-Pugh score?

A 
Bilirubin
Albumin
PT time
Encephalopathy
and Ascites
83
Q

Medication to prevent variceal bleeding?

A

Propanolol

84
Q

Lead pipe colon - loss of haustra

A

UC

85
Q

Diarrhoea due to fried rice:

A

Bacilus Cereus

86
Q

Diarrhoea due to Antibiotics (Ciprofloxacin)

A

Clostridium Difficile

87
Q

Diarrhoea after travelling =

A

E. Coli

88
Q

Diarrhoea after drinking groundwater

A

Giardia

89
Q

Brothel + Bloody Diarrhoesa?

A

Shigella

90
Q

Diarrhoea with Ovum + HIV??

A

Cryptosporidum

91
Q

Diarrhoea after chicken

A

Salmonella (Can progress to Typhoid with the presence of Rose spots)

92
Q

Diarrhoea with GB?S (ascending muscle weakness)

A

C. Jejuni

93
Q

Rice water stools Diarrhea?

A

Cholera

94
Q

Lump on straining, Blood and mucousy Diarrhoea

A

Faecal incontinence

Theme III (15 decks)

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