Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

yr3 > gastro DPD > Flashcards

gastro DPD Flashcards

1
Q

40 year old mother of 5 complains of abdo pain after eating fish and chips. What is the likely diagnosis?

A

Gallstones – immediate pain post-fatty meal.
n.b. here there is no inflammation/infection as there is no fever, jaundice (cholecystitis or cholangitis).

RFs for gallstones: overweight, Caucasians, female, fertile, ~40years)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

40 year old man drinks a bottle of vodka every night is known to have chronic liver disease, developed severe abdo pain with extreme tenderness. Examination revealed a rigid abdomen. What is the likely diagnosis?

A

Acute pancreatitis -
leakage of pancreatic enzymes into peritoneum causes rigidity and peritonitis

DDx: peptic ulcer disease is also common in alcoholics. PUD will not present with fever.
Pneumonia can also cause upper abdo pain but look for other resp abnormalities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Diagnostic confirmatory blood investigation for acute pancreatitis

A

Serum amylase

n.b. some places use lipase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of splenomegaly

A 
Portal HTN
Haematological
CCF
Infection (TB, malaria, schistosomiasis, infective endocarditis)
Inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

70yr old breathless man O/E has splenomegaly. He drinks heavily and had an anterior MI previously

A

Think about causes of splenomegaly.

Here the most likely DDx = portal HTN secondary to liver cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

35 year old male IVDU with a 3 day history of jaundice, flu-like symptoms and nausea. O/E: he is cachectic and jaundiced, with smooth, tender hepatomegaly.

A
  1. Hepatitis C
  2. HIV
    These are likely in IV drug abusers

DDx: alcoholic hepatitis, paracetamol overdose (=acute liver failure), Gilbert’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Gilbert’s syndrome definition
When is it worse?
What drug makes it better?

A

Asymptomatic hyperbilirubinaemia

Worse on starving
Better with phenobarbital
Needs no specific treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Porto-systemic anastomoses

A

Oesophageal varices
Rectal varices
Umbilical vein recanalising
Spleno-renal shunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Features of portal HTN

A

ascites
splenomegaly
caput medusae

(encephalopathy, SBP, variceal bleed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

A 65 year old man had a triple AAA repair 2 days ago. He has now got diffuse abdominal pain with HR 120 and RR 30. DDx is a surgical leak. What are blood tests likely to show

A

High amylase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Decompensated liver disease results in

A

Jaundice
Encephalopathy
Ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

50 year old man with painless jaundice and palpable gallbladder presents. He has weight loss, dark urine and pale stools. This is pancreatic cancer, blood tests are likely to show elevated levels of…?

A

Ca19-9

ALP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of bloody diarrhoea

A 
Infection - infective colitis (CHESS pathogens)
Inflammation - IBD colitis
Ischaemia
Malignancy
Diverticulitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Ascites Rx

take an ascitic tap to exclude SBP

A 
Diuretics (spironolactone ±furosemide)
Dietary Na+ restriction
Fluid restrict hypoNa+ pts
Monitor weight daily
Therapeutic paracentesis (with IV human albumin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Albumin gradient equation =

A

serum albumin - ascites albumin

> 11g/L - high gradient i.e. transudate
<11g/L - low gradient i.e. exudate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Encephalopathy Rx

A

Lactulose
Phosphate enemas
Treat infections
Exclude GI bleeds

Avoid sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Presentations of the following post-op complications:

  • Wound infection
  • Anastomotic leak
  • Pelvic abscess e.g. post-appendicetomy
A
  • Wound infection -> erythematous, discharge
  • Anastomotic leak -> diffuse abdo tenderness, guarding, rigidity, hypotensive, tachy
  • Pelvic abscess -> fever, pain, sweats, mucous, diarrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Peri-anal abscess = tender red swelling. its treatment…

A

incision and drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Anal fissure = pain on defaecation. Stool is coated with blood. its treatment…

A

Advice re diet and fibre

GTN cream

20
Q

IBS - recurrent abdo pain with bloating. Improves with defaecation. Change in frequency/form of stool. No FLAWS or nocturnal symptoms. Important to exclude Coeliac. Rx:

A 
Diet and lifestyle modification
Symptomatic treatment:
abdo pain - anti-spasmodics
prokinetic agents - metoclopramide
constipation - laxatives
anti-diarrhoeas
low dose TCAs - lowers visceral awareness
21
Q

Patient presents with dyspepsia and weight loss. What is the most important investigation?

A

OGD gastroscopy

22
Q

Superior mesenteric artery supplies

A

Small intestine and R colon

23
Q

Inferior mesenteric artery supplies

A

L colon

24
Q

Causes of diffuse abdominal pain

A 
Obstruction
Infection (peritonitis, gastroenteritis)
Inflammation (IBD)
Ischaemia (mesenteric)
Metabolic causes (DKA, addison's, hyperCa2+, porphyria, lead poisoning)
25
Q

Acute abdomen investigations

A

Bloods: FBC, U+Es, LFTS, CRP, clotting, group and save, cross match
Erect CXR
CT

26
Q

Acute abdomen management

A 
NBM
IV fluids
Analgesia
Antibiotics
Anti-emetics
Monitor vitals + UO

acute GI bleed: similar ABC approach. Ix HAVE to include group+save, cross-match and OGD!!!! Variceal bleeds give terlipressin + b-blockers too.

27
Q

van den Bergh test

Direct reaction results vs indirect reaction results mean…

A

Direct reaction = conjugated BR

Indirect reaction = unconjugated BR

28
Q

Gilbert’s syndrome mode of inheritance

A

Autosomal recessive

n.b. 50% of population are carriers

29
Q

Alcoholic hepatitis:
Defining histological features
± Associated features

A

Hepatocyte damage
Inflammation (neutrophils)
Fibrosis

±Fatty change
±Megamitochondria

30
Q

Caput medusae cause

A

Visible vein on anterior abdominal wall. Occurs because of pressure in umbilical vein - a sign of severe portal hypertension.

31
Q

Liver failure is a failure of….

A

Synthetic function
Clotting factor and albumin
Clearance of bilirubin
Clearance of ammonia (= encephalopathy)

32
Q

Pruritis in liver disease is due to

A

Bile salts

33
Q

A 50 year old man presents with a 2hr Hx sudden onset of severe epigastric pain that is now generalised. O/E: pyrexic 37.8oC, rigid abdomen and absent bowel sounds. WCC is raised at 18.09/l. Serum amylase is raised at 450IU/L. AXR shows opacities in R hypochondrium and gas under the diaphragm. What is the likely diagnosis?

A

Perforated peptic ulcer

34
Q

A 67 year old man presents to his GP complaining of lethargy + weight loss. Rectal examination revealed a palpable irregular mass in the rectum. What is the likely cause of this patient having anaemia?

A

Chronic blood loss

35
Q

An 82 year old female presents with a large lump which appears at the anus after defecation, & spontaneously on coughing. The lump is uncomfortable & the patient has tenesmus. She also has incontinence + has noticed mucus PR. What is the likely diagnosis?

A

Rectal prolapse

36
Q

A 20 year old male presents with painful defecation which persists for 30mins afterwards. The stool is smeared with blood, + he has noticed recent constipation. What is the likely diagnosis?

A

Anal fissure

37
Q

A 50 year old female presents with a purulent discharge from the anal region + has recurrent episodes of pain, which is intense + throbbing. O/E pruritis ani. What is the likely diagnosis?

A

Abscess

38
Q

40 male presents with PR bleeding & a palpable lump from anus, with associated mucus discharge. There is blood splashed around lavatory pan. What is the likely diagnosis?

A

Haemorrhoids

39
Q

Ways to diagnosis H.pylori

A

Breath test
Serology (IgG antibody against H.pylori)
Stool antigen test

40
Q

Commonest causes of small bowel obstruction

A

Adhesions (post-op, surgery)

Hernias

41
Q

Commonest causes of large bowel obstruction

A

Malignancy

Volvulus

42
Q

Ulcerative colitis presents with abdo pain and jaundice - likely diagnosis is….

A

Always consider primary sclerosing cholangitis.

LFTs may be slightly raised/normal. ALP will be the most raised but even still it can be normal.

43
Q

E.coli (0157:H7 toxin) is a common cause of

A

HUS

44
Q

Oesophageal varices Rx

A
  1. terlipressin
  2. propranolol
  3. surgery - rubber band ligation, sclerotherapy, balloon therapy
45
Q

C diff Rx

A

ciprofloxacin + metronidazole or vancomycin

46
Q

Triple AAA of 5.2cm on USS, what is the next investigation step?

A

3 month USS follow-up

47
Q

Causes of onycholysis

A

Trauma
Thyrotoxicosis
Psoriasis
Fungal infection

yr3 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions