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Finals > Gastro + HPB > Flashcards

Gastro + HPB Flashcards

1
Q

Triad of symptoms associated with ascending cholangitis

A

Fever
RUQ pain
Jaundice

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2
Q

Cullens sign

A

Periumbilical discolouration in acute pancreatitis

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3
Q

Grey-Turner’s sign

A

Flank discolouration in acute pancreatitis

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4
Q

Causes of unconjugated hyperbilirubinaemia

A

Haemolysis - sickle cell, G6PD deficiency, thalassaemia
Medications - Rifampicin, Sulphonamides
Impaired conjugation by the liver - hepatitis, cirrhosis, Wilsons, Gilberts

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5
Q

Intrahepatic/hepatocellular causes of conjugated hyperbilirubinaemia

A 
Hepatitis 
Cirrhosis
Primary biliary cirrhosis
TB
Sarcoidosis/amyloidosis
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6
Q

Extrahepatic/obstructive causes of conjugated hyperbilirubinaemia

A

Gallstones - cholecystitis, cholangitis
Pancreatic cancer
Primary sclerosing cholangitis
Pancreatitis

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7
Q

Colour of stool and urine in unconjugated hyperbilirubinaemia

A

Dark stools

Pale urine

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8
Q

Colour of stool and urine in conjugated hyperbilirubinaemia

A

Pale stools

Dark urine

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9
Q

Antibodies associated with PBC

A

Anti-mitochondrial

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10
Q

Antibodies associated with PSC

A

ANA and anti-smooth muscle

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11
Q

Typical presentation of Gilberts syndrome

A

Unconjugated hyperbilirubinaemia

Mild jaundice during times of stress

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12
Q

Blood test markers of haemolysis

A

Raised LDH
Raised unconjugated bilirubin
Low haptoglobin

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13
Q

Consequences of impaired liver function

A

Bleeding
Ammonia build up + hepatic encephalopathy
Ascites (low albumin)
Less bile - less fat soluble vitamin absorption
Raised estrogen
Impaired medication metabolism
Low vitamin D

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14
Q

Classification system for liver cirrhosis

A

Child-Pugh score

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15
Q

Blood results for Hep A - acute and chronic

A

Acute: IgM anti-HAV
Chronic: IgG anti-HAV

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16
Q

Blood results for HBV vaccination only

A

Antibody to HBV surface antigen only

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17
Q

Blood results for acute HBV infection

A

Surface antigen
IgM anti-core
HBV DNA

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18
Q

Blood results for chronic HBV infection

A

Surface antigen
IgG anti-core
HBV DNA

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19
Q

Which blood test can be used to screen for hepatocellular carcinoma

A

AFP (alpha fetoprotein)

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20
Q

Blood results for previous exposure to HCV

A

HCV antibody positive

RNA negative

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21
Q

Blood results for chronic HCV infection

A

HCV antibody positive

RNA positive

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22
Q

Blood results for HAV prior infection/acquired immunity

A

IgG anti-HAV positive

23
Q

Blood results for acute HAV infection

A

IgM anti-HAV positive

24
Q

Which viral hepatitis is particularly severe in pregnancy?

A

Hepatitis E

25
Q

Causes of acute pancreatitis

A

Gallstones
Alcohol
Idiopathic

High triglycerides, high calcium, ERCP, meds (steroids, azathioprine), mumps, trauma, autoimmune, CF

26
Q

Clinical features of acute pancreatitis

A

Constant severe epigastric pain, radiates to back, worse after meals and lying down, improves leaning forward
Nausea and vomiting
Shock - tachycardia, hypotension, oliguria/anuria
Jaundice if biliary
Abdo tenderness, distention, guarding
Cullens and Grey Turner’s sign

27
Q

Management of acute pancreatitis

A 
Fluid resuscitation (third space losses)
Analgesia - usually IV opioids
Nil by mouth until pain subsides
Abx if infected necrosis
Consider ERCP
28
Q

What test can you do to confirm that steatorrhoea is due to pancreatic lipase insufficiency

A

Fecal elastase (low)

29
Q

What criteria can you use to diagnose IBS

A

Rome criteria

30
Q

What parts of the bowel does Crohn’s disease affect

A

Terminal ileum/ileocaecal region mainly but can be anywhere from mouth to anus but rectum is spared

31
Q

Which classification system is used to grade severity of UC

A

Truelove and Witts

32
Q

What parts of the bowel does UC affect

A

Ascending beginning in the rectum and spreading proximally. Rectum is always involved.

33
Q

Which IBD is transmural and which is just mucosal + submucosal

A 
Crohn's = transmural
UC = mucosal + submucosal
34
Q

Which biliary condition is strongly associated with UC

A

Primary sclerosing cholangitis

35
Q

How can you test for H.pylori

A

Urea breath test

Biopsy from OGD (rapid urease test)

36
Q

What is H.Pylori eradication therapy (triple and quadruple)

A 
A PPI (usually twice normal dose) and two different antibiotics
Omeprazole + 2 of amoxicillin/clarithromycin/metronidazole

Quadruple therapy adds Bismuth - raises pH so HP divides more so abx work better

37
Q

Main underlying mechanism that causes GORD

A

Transient lower oesophageal sphincter relaxations

38
Q

What is Barrett oesophagus

A

Squamous epithelium of the esophagus gets replaced by columnar epithelium of the stomach - due to chronic reflux damage

39
Q

Which type of cancer affects the upper 1/3 of the oesophagus and which affects the lower 2/3

A

Adenocarcinoma upper 1/3

Squamous cell carcinoma lower 2/3

40
Q

Diarrhoea is considered chronic if it continues for how long?

A

> 4 weeks

41
Q

Common viral causes of diarrhoea

A

Norovirus
Rotavirus
CMV

42
Q

Common bacterial causes of diarrhoea

A 
Campylobacter
Shigella
Salmonella
E.coli
C.diff
43
Q

Which bacterial cause of diarrhoea should you be wary of treating with antibiotics and why

A

E.Coli 0157 because it can increase the risk of HUS

44
Q

Name a stimulant laxative

A

Senna

45
Q

Name a stool softener laxative

A

Docusate

46
Q

Name an osmotic laxative

A

Movicol
Lactulose
Mannitol

47
Q

What are the two hereditary disorders that predispose to colorectal cancer

A

Familial adenomatous polyposis (FAP)

Hereditary non-polyposis colorectal cancer (HNPCC)

48
Q

What is the inheritance pattern of FAP and HNPCC

A

Autosomal dominant

49
Q

Describe the screening programme for colorectal cancer in the UK

A

Fecal occult blood test

2 yearly from the age of 60/62

50
Q

What type of cancer are most colorectal cancers

A

Adenocarcinoma

51
Q

What part of the colon is most commonly affected by colorectal cancer

A

Rectosigmoid

52
Q

What is the name of the staging classification system used for colorectal cancer

A

Dukes criteria

53
Q

Which tumour marker is used to assess response to treatment of colorectal cancers

A

CEA (carcinoembryonic antigen)

54
Q

How do you calculate units of alcohol

A

ml X % then divide by 1000

Finals (32 decks)

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