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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
Q

3 cancers associated with HNPCC

A

colorectal, endometrial and pancreatic

?ovarian

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26
Q

gastric cancer metastasis to periumbilical lymph nodes

A

sister mary joseph nodules

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27
Q

definition of acute diarrhoea

A

less than 14 days

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28
Q

2 medications which increase the risk of c diff

A

clindamycin and omeprazole
(any broad spec abx)

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29
Q

which blood markers measures the severity of a c diff infection

A

WCC

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30
Q

management of c diff

A

10 day PO vancomycin
recur in 12w then PO fidazomicin

severe: PO vancomycin and IV metronidazole

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31
Q

which medication increases the risk of toxic megacolon when prescribed during c diff

A

opioids

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32
Q

alternating diarrhoea and constipation with faecal incontinence in elderly

A

constipation causing overflow

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33
Q

which parasite is spread in swimming pools and reduces fat absorption causing greasy floating stool

A

giardia

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34
Q

RF and treatment for bacterial overgrowth

A

RF: DM
Treat: fiaximin

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35
Q

ABG in vomiting

A

metabolic ALKALOSIS with hypokalaemia

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36
Q

score for malnutrition

A

MUST

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37
Q

define malnutrition

A

unintentional loss of 10% weight in 3-6m

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38
Q

hypokalaemia, abnormal fluid balance and arrhythmias

A

refeeding syndrome

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39
Q

flushing, wheeze and diarrhoea caused by a GI tumour which secretes serotonin

A

carcinoid syndrome

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40
Q

treatment of carcinoid syndrome

A

octreotide

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41
Q

dysphagia, weight loss, anorexia and vomiting during eating

A

oesophageal cancer

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42
Q

most common histology of oesophageal cancer in the UK
site in oesophagus

A

adenocarcinoma
lower 1/3

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43
Q

most common histology of oesophageal cancer in the developing world
site in oesophagus

A

squamous cell
upper 2/3

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44
Q

RF for oesophageal cancer

A

GORD, Barrets, obesity, smoking, achalasia, alcohol

SSC: plummer vinson and nitrates (fish)

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45
Q

odonophagia and heartburn but systemically well

A

oesophagitis

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46
Q

history of HIV or ICS

A

oesophageal candidasis

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47
Q

dysphagia with solids and liquids, heartburn, regurgitation and cough

48
Q

barium swallow in achalasia will show what

A

dilated oesophagus

49
Q

management of achalasia

A

heller cardiomyotomy

50
Q

dysphagia, regurgitation, halitosis, aspiration, chronic cough and a gurgling midline lump in older men

A

pharyneal pouch

51
Q

painless and intermittent dysphagia which relieves on swallow with a history of anxiety

A

globus hystericus

52
Q

dysphagia of liquids and solids with extaocular weakness and ptosis

A

myasthenia gravis

53
Q

dysphagia caused by oesophageal webs, glossitis and iron deficiency anaemia

A

plummer-vinson syndrome

54
Q

differentiation between an upper and lower GI bleed

A

ligament of treitz

55
Q

urea in upper GI bleed

A

high compared to lower

56
Q

difference between duodenal and gastric ulcer

A

dudodenal ulcer is relieved by eating
gastric is worsened by eating

57
Q

investigation for perforated ulcer

58
Q

artery causing most duodenal bleeds

A

gastroduodenal artery

59
Q

sharp and sudden RUQ pain

A

perforated ulcer

60
Q

which score is done after endoscopy
what does it show

A

rockall score
risk of rebleed

61
Q

which type of ulcers increase H. Pylori risk

62
Q

abx and ppi before the urea breath test

A

no ABx for 4w
no PPI for 2w

63
Q

3 (4) medications for the eradication of h pylori

A

PPI
clarithromycin
metronidazole/amoxicillin

64
Q

which test would you do for eradication of h pylori

A

urea breath test

65
Q

MOA of terlipressin

A

vasopressin analogue

66
Q

management of oesophageal varices

A

sengstaken-blakemore tube
variceal band ligation

67
Q

when would you give a PPI in an upper GI bleed

A

after endoscopy only if non-variceal

68
Q

2 side effects of PPI

A

osteoporotic fractures
hyponatremia

69
Q

severe vomiting and pain in alcoholics resulting in haematemesis

A

mallory weiss tear (mucosal laceration)

70
Q

mackler triad of vomiting, thoracic pain and emphysema in male alcoholics

A

boohaave syndrome

71
Q

investigation for boohaave syndrome

A

CT contrast swallow

72
Q

small arterial lesions in the submucosa 6cm from the O-G junction

A

dieulafoy lesion

73
Q

TIBC in iron deficiency anaemia and anaemia of chronic disease

A

iron deficiency: increased
chronic disease: reduced or normal

74
Q

reduced serum copper and calcluplasmin with increased ALT and AST

A

wilsons disease

75
Q

medication to treat wilsons disease

A

penicillamine

76
Q

pathophysiology of pernicious anaemia

A

reduced B12 absorption from intrinsic autoantibodies

77
Q

presentation of pernicious anaemia

A

peripheral neuropathy, neuropsychiatric disorders and subacute combined degeneration of the cord

78
Q

frequency of IM B12

79
Q

medication which caused B6 deficiency and management

A

isoniazid - give with pridoxine

80
Q

autosomal recessive disorder causing fatigue, arthralgia and ED

A

haemachromatosis

81
Q

ferritin, transferritin saturation, TIBC and iron in haemachromatosis

A

increased ferritin and transferritin saturation
reduced TIBC and iron

82
Q

autosomal dominant condition causing pigmented freckles on the lips, face, palms and soles and polyps in the GI tract that cause obstruction

A

peutz jeghers syndrome

83
Q

mucocutaneous lesions and iron defieincy anaemia

A

hereditary haemorrhagic telangiectasia

84
Q

management of dysplasia on biopsy in barretts

A

endoscopic intervention

85
Q

difference in prognosis between type 1 and 2 hepatorenal syndrome

A

T1: rapidly progressive and poor prognosis
T2: slower progression and poor prognosis (live longer)

86
Q

marker in hepatorenal syndrome

A

creatinine

87
Q

RUQ pain, nausea, vomiting, anorexia, myalgia and lethargy in patient with recent travel or IVDU

A

viral hepatitis

88
Q

marker for hepatocellular carcinoma

89
Q

most common cause of hepatocellular carcinoma in europe and worldwide

A

europe: hep c
worldwide: hep b

90
Q

HBsAg

A

indicates acute disease (1-6m)
persists for more than 6m then chronic disease

91
Q

anti HBS

A

immunity through disease or vaccination
-ve in chronic disease

92
Q

anti HBC

A

infection
IgG acute (6m)
IgM persists

93
Q

HbeAg

A

marker of replication and infection

94
Q

how many types of autoimmune hepatitis are there

95
Q

ALT/AST in autoimmune hepatitis

96
Q

management of autoimmune hepatitis

A

steroid, azathioprine, transplant

97
Q

heart failure causing a stretched liver, pain and necrosis presenting with a firm, smooth, tender and pulsatile liver edge

A

congestive hepatomegaly

98
Q

triad in budd chiari

A

sudden abdo pain
tender hepatomegaly
ascites

99
Q

how do you calculate alcohol units

A

volume (mls) x ABV / 1000

100
Q

ferritin levels in alcoholic

101
Q

ABG in alcoholic ketoacidosis

A

metabolic acidosis with low glucose

102
Q

which medication is prescribed to every alcoholic

103
Q

AST/ALT ratio in alcoholic liver disease

104
Q

management of severe alcoholic hepatitis

A

corticosteroids

105
Q

which medication reduces mortality in variceal bleed

106
Q

SAAG gradient above 11 in ascites indicates what

A

portal hypertension

107
Q

management of ascites with a protein above 15

A

PO ciprofloxacin as prophylaxis for spontaneous bacterial peritonitis

108
Q

most common organism in spontaneous bacterial peritonitis

109
Q

treatment of ascites

A

paracentesis with albumin cover

110
Q

what is TIPS

A

transjugular intrahepatic portosystemic shunt

connects the hepatic and portal vein

111
Q

SE of TIPS

A

exacerbates hepatic encephalopathy

112
Q

test for non alcoholic fatty liver disease

A

enhanced liver fibrosis (ELF) test

113
Q

what can trigger decompensation in cirrhotic patients

A

constipation

114
Q

sweet and faecal breath in liver failure

A

fetor hepaticus

115
Q

liver enzymes in paracetamol

A

hepatocellular

high ALT and ALT/ALP ratio
normal ALP

116
Q

which marker should you check in acute liver failure after paracetamol overdose

A

prothrombin time

117
Q

drugs which cause liver disease

Medicine Year 5 (27 decks)

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