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Medicine Year 5 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

abdominal pain that does not wake patients at night with bloating and a mixture of constipation and diarrhoea alongside lethargy and nausea

A

IBS

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2
Q

1st line laxative for IBS

A

ispaghula husk

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3
Q

1st line medication for diarrhoea in IBS
MOA

A

loperamide
opioid agonist that reduces gastric motility

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4
Q

non-bloody diarrhoea with crampy abdominal pain

associated with weight loss, mouth ulcers, perianal disease, obstruction, skin tags, malabsorption, fistula, gallstones and renal stones

A

crohn’s

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5
Q

difference in the site of lesions between crohns and UC

A

crohns: skip lesions from the mouth to the anus
uc: continuous disease from rectum to ileocaecal valve

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6
Q

bloody diarrhoea with abdo pain in LLQ

associated with uveitis, proctitis, tenesmus, primary sclerosing cholangitis and colon cancer

A

UC

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7
Q

difference in histology between crohns and UC

A

crohns: mucosa to serosa associated with goblet cells and cobblestone appearance
uc: inflammation to submucosa only associated with crypt abscesses, ulceration and polyps

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8
Q

reduced haustra on enema

A

UC

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9
Q

kantors ring, strictures and rose thorn ulcers on enema

A

crohns

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10
Q

difference between mild, moderate and severe IBD

A

mild: less than 4 stools, normal CRP, ESR
moderate: 4-6 stools, minimal systemic upset
severe: more than 6 stools mixed with blood and systemic upset (fever)

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11
Q

medications to induce remission in mild to moderate UC

A

rectal aminoacylate (oral if extensive / more than 4w)
topical or oral steroid

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12
Q

medications to induce remission in severe UC

A

IV steroid
IV ciclosporin if persist for more than 72 hours

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13
Q

medication to maintain remission in mild to moderate

A

rectal/oral aminoacylate

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14
Q

medication to maintain remission in severe

A

oral azathioprine (check TMPT)

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15
Q

side effect of aminosalicyclate

A

agranulocytosis (check FBC)

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16
Q

2 blood markers for coeliac

A

anti-TTG and IgA

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17
Q

presentation of coeliac in child v adult

A

child: FTT, diarrhoea
adult: lethargy, diarrhoea, weight loss

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18
Q

3 things found on histology in coeliac

A

villous atrophy, crypt hyperplasia, epithelial lymphocytes

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19
Q

how long before biopsy do patients have to eat gluten

A

6w

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20
Q

can coeliac patients eat maize

A

yes

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21
Q

why is pneumococcal given every 5 years in coeliac

A

hyposplenism

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22
Q

anaemia in coeliac

A

iron folate and B12

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23
Q

cancer associated with coeliac

A

enteropathic associated T cell lymphoma

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24
Q

diarrhoea, rectal bleeding, anaemia, weight loss and anorexia

A

colorectal cancer

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25
3 cancers associated with HNPCC
colorectal, endometrial and pancreatic ?ovarian
26
gastric cancer metastasis to periumbilical lymph nodes
sister mary joseph nodules
27
definition of acute diarrhoea
less than 14 days
28
2 medications which increase the risk of c diff
clindamycin and omeprazole (any broad spec abx)
29
which blood markers measures the severity of a c diff infection
WCC
30
management of c diff
10 day PO vancomycin recur in 12w then PO fidazomicin severe: PO vancomycin and IV metronidazole
31
which medication increases the risk of toxic megacolon when prescribed during c diff
opioids
32
alternating diarrhoea and constipation with faecal incontinence in elderly
constipation causing overflow
33
which parasite is spread in swimming pools and reduces fat absorption causing greasy floating stool
giardia
34
RF and treatment for bacterial overgrowth
RF: DM Treat: fiaximin
35
ABG in vomiting
metabolic ALKALOSIS with hypokalaemia
36
score for malnutrition
MUST
37
define malnutrition
unintentional loss of 10% weight in 3-6m
38
hypokalaemia, abnormal fluid balance and arrhythmias
refeeding syndrome
39
flushing, wheeze and diarrhoea caused by a GI tumour which secretes serotonin
carcinoid syndrome
40
treatment of carcinoid syndrome
octreotide
41
dysphagia, weight loss, anorexia and vomiting during eating
oesophageal cancer
42
most common histology of oesophageal cancer in the UK site in oesophagus
adenocarcinoma lower 1/3
43
most common histology of oesophageal cancer in the developing world site in oesophagus
squamous cell upper 2/3
44
RF for oesophageal cancer
GORD, Barrets, obesity, smoking, achalasia, alcohol SSC: plummer vinson and nitrates (fish)
45
odonophagia and heartburn but systemically well
oesophagitis
46
history of HIV or ICS
oesophageal candidasis
47
dysphagia with solids and liquids, heartburn, regurgitation and cough
achalasia
48
barium swallow in achalasia will show what
dilated oesophagus
49
management of achalasia
heller cardiomyotomy
50
dysphagia, regurgitation, halitosis, aspiration, chronic cough and a gurgling midline lump in older men
pharyneal pouch
51
painless and intermittent dysphagia which relieves on swallow with a history of anxiety
globus hystericus
52
dysphagia of liquids and solids with extaocular weakness and ptosis
myasthenia gravis
53
dysphagia caused by oesophageal webs, glossitis and iron deficiency anaemia
plummer-vinson syndrome
54
differentiation between an upper and lower GI bleed
ligament of treitz
55
urea in upper GI bleed
high compared to lower
56
difference between duodenal and gastric ulcer
dudodenal ulcer is relieved by eating gastric is worsened by eating
57
investigation for perforated ulcer
erect CXR
58
artery causing most duodenal bleeds
gastroduodenal artery
59
sharp and sudden RUQ pain
perforated ulcer
60
which score is done after endoscopy what does it show
rockall score risk of rebleed
61
which type of ulcers increase H. Pylori risk
duodenal
62
abx and ppi before the urea breath test
no ABx for 4w no PPI for 2w
63
3 (4) medications for the eradication of h pylori
PPI clarithromycin metronidazole/amoxicillin
64
which test would you do for eradication of h pylori
urea breath test
65
MOA of terlipressin
vasopressin analogue
66
management of oesophageal varices
sengstaken-blakemore tube variceal band ligation
67
when would you give a PPI in an upper GI bleed
after endoscopy only if non-variceal
68
2 side effects of PPI
osteoporotic fractures hyponatremia
69
severe vomiting and pain in alcoholics resulting in haematemesis
mallory weiss tear (mucosal laceration)
70
mackler triad of vomiting, thoracic pain and emphysema in male alcoholics
boohaave syndrome
71
investigation for boohaave syndrome
CT contrast swallow
72
small arterial lesions in the submucosa 6cm from the O-G junction
dieulafoy lesion
73
TIBC in iron deficiency anaemia and anaemia of chronic disease
iron deficiency: increased chronic disease: reduced or normal
74
reduced serum copper and calcluplasmin with increased ALT and AST
wilsons disease
75
medication to treat wilsons disease
penicillamine
76
pathophysiology of pernicious anaemia
reduced B12 absorption from intrinsic autoantibodies
77
presentation of pernicious anaemia
peripheral neuropathy, neuropsychiatric disorders and subacute combined degeneration of the cord
78
frequency of IM B12
8-12w
79
medication which caused B6 deficiency and management
isoniazid - give with pridoxine
80
autosomal recessive disorder causing fatigue, arthralgia and ED
haemachromatosis
81
ferritin, transferritin saturation, TIBC and iron in haemachromatosis
increased ferritin and transferritin saturation reduced TIBC and iron
82
autosomal dominant condition causing pigmented freckles on the lips, face, palms and soles and polyps in the GI tract that cause obstruction
peutz jeghers syndrome
83
mucocutaneous lesions and iron defieincy anaemia
hereditary haemorrhagic telangiectasia
84
management of dysplasia on biopsy in barretts
endoscopic intervention
85
difference in prognosis between type 1 and 2 hepatorenal syndrome
T1: rapidly progressive and poor prognosis T2: slower progression and poor prognosis (live longer)
86
marker in hepatorenal syndrome
creatinine
87
RUQ pain, nausea, vomiting, anorexia, myalgia and lethargy in patient with recent travel or IVDU
viral hepatitis
88
marker for hepatocellular carcinoma
AFP
89
most common cause of hepatocellular carcinoma in europe and worldwide
europe: hep c worldwide: hep b
90
HBsAg
indicates acute disease (1-6m) persists for more than 6m then chronic disease
91
anti HBS
immunity through disease or vaccination -ve in chronic disease
92
anti HBC
infection IgG acute (6m) IgM persists
93
HbeAg
marker of replication and infection
94
how many types of autoimmune hepatitis are there
three
95
ALT/AST in autoimmune hepatitis
increased
96
management of autoimmune hepatitis
steroid, azathioprine, transplant
97
heart failure causing a stretched liver, pain and necrosis presenting with a firm, smooth, tender and pulsatile liver edge
congestive hepatomegaly
98
triad in budd chiari
sudden abdo pain tender hepatomegaly ascites
99
how do you calculate alcohol units
volume (mls) x ABV / 1000
100
ferritin levels in alcoholic
increased
101
ABG in alcoholic ketoacidosis
metabolic acidosis with low glucose
102
which medication is prescribed to every alcoholic
thiamine
103
AST/ALT ratio in alcoholic liver disease
2:1
104
management of severe alcoholic hepatitis
corticosteroids
105
which medication reduces mortality in variceal bleed
ABx
106
SAAG gradient above 11 in ascites indicates what
portal hypertension
107
management of ascites with a protein above 15
PO ciprofloxacin as prophylaxis for spontaneous bacterial peritonitis
108
most common organism in spontaneous bacterial peritonitis
e coli
109
treatment of ascites
paracentesis with albumin cover
110
what is TIPS
transjugular intrahepatic portosystemic shunt connects the hepatic and portal vein
111
SE of TIPS
exacerbates hepatic encephalopathy
112
test for non alcoholic fatty liver disease
enhanced liver fibrosis (ELF) test
113
what can trigger decompensation in cirrhotic patients
constipation
114
sweet and faecal breath in liver failure
fetor hepaticus
115
liver enzymes in paracetamol
hepatocellular high ALT and ALT/ALP ratio normal ALP
116
which marker should you check in acute liver failure after paracetamol overdose
prothrombin time
117
drugs which cause liver disease
-

Medicine Year 5 (27 decks)

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