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Year 6 Cross Section > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

principles of managing ascites

A
  • diet: restrict ETOH, fluids, daily weights
  • diuretics: spironolactone
  • prophylaxis for SBP: ciprofloxacin and propanolol
  • refractory disease: TIPPS/transplant
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2
Q

IBD staging aspects

A

Truelove and Witts
HR
Temp
Bowel Movements
PR bleeding
Hb
ESR

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3
Q

inflammation in Chron’s vs UC

A

Chrons: skip lesiosn, rose thorn ulcers, cobblestoning, narrow ileum stricture
UC: lead pipe, pseudo-polyps, thumb-printing

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4
Q

Alvarado score

A

signs: RLQ tenderness, fever, rebound tenderness
symptoms: anorexia, N/V, pain migration to RLQ
lab: leucocytosis , left shift

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4
Q

Alvarado score

A

signs: RLQ tenderness, fever, rebound tenderness
symptoms: anorexia, N/V, pain migration to RLQ
lab: leucocytosis , left shift

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5
Q

Glasgow score

A

PANCREAS
PaO2 < 8
Age > 55
Neutrophils > 15
Calcium < 2
Renal urea > 16
Enzymes (LDH >600, AST/ALT > 200)
Albumin < 32
Sugar > 10

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6
Q

early complications of acute pancreatitis

A

haemorrhage
SIRS/ARDS
hyperglycaemia
hypocalcaemia

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7
Q

Mackler’s triad

A

Boerhaave’s syndrome
- chest pain
- vomiting
- subcutaenous emphysema

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8
Q

causes of ascites

A

portal HTN
constrictive pericarditis
ovarian malignancy

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9
Q

grades of hepatic encephalopathy

A
  1. irritability
  2. confusion
  3. incoherent
  4. coma
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10
Q

osmotic diarrhoea causes

A

laxatives, malabsorption
may be relieved by gasting

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11
Q

secretory diarrhoea causes

A

enterotoxins, systemic (hormones, neuroendoocrine)
not relieved by fasting

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12
Q

inflammatory diarrhoea causes

A

UC, Chrons

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13
Q

abnormal motility causes of diarrhoea

A

hyperthyroidism
autonomic neuropathy
stimulant laxatives
IBS

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14
Q

appropriate investigations in IBS

A

FBC, CRP, coeliac disease Abs

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15
Q

Chron’s inflammation

A

transmural
non caseating granuloma
fissures and fistulas

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16
Q

causes of colitis

A

infection (campylobacter, shigella, C diff, CMV)
radiation
medications
ischaemic (acute, chronic)

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17
Q

causes of sub total villous atrophy

A

coeliac
infectious enteritis
giardia
Whipple’s
lactose intolerance

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18
Q

ALT rise

A

liver dysfunction
acute phase reactant

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19
Q

Hep B antigens and what they mean?

A

HBsAg: surface/viral envelope protein
HBeAg: pre core protein = marker for acute replication
HBcAg: core protein = role in replication

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20
Q

Hep B treatment

A

entecavir
tenofavir
lamivudine
interferon

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21
Q

PBC pathological changes

A

progressive destruction of small intrahepatic bile ducts

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22
Q

PSC pathological changes

A

inflammation and scarring of bile ducts

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23
Q

calculating SAAG

A

serum albumin - albumin level of ascitic fluid

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24
Q

causes of SAAG > 1.1 mg/dL

A

cirrhosis
alcoholic hepatitis
cardiac asicitis
portal vein thrombosis

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25
Q

causes of SAAG < 1.1. mg/dL

A

peritoneal carcinomatosis
bowel obstruction
nephrotic syndrome

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26
Q

causes of hepatomegaly

A

ALD
NAFLF
Cancer (mets, hepatocellular Ca)
viral hepatitis
CCF

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27
Q

causes of splenomegaly

A

haemotological (myelofibrosis, CML)
infection (TB, malaria)
portal HTN
infiltrative (sarcoidosis)
AI (SLE, Felty’s)

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28
Q

causes of large kidney

A

PCKD
cyst
renal Ca
infiltrative

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29
Q

investigations in IBD

A

bloods (FBC, U&Es, CRP, LFTs, pANCA)
Stool (culture, calprotectin)
Scope (colonoscopy, endoscopy)

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30
Q

investigations in IBD - acute

A

CT AP

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31
Q

Chron’s acute nutritional management to induce remission

A

replace diet with whole protein molecular diet (excessively liquid) for 6-8 weeks

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32
Q

what to check if starting azathioprine/mercatopurine?

A

check TPMT levels

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33
Q

hemorrhoid’s main investigation and finding

A

do DRE
most commonly at 3,7,11 o clock

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34
Q

coeliac genetics

A

DQ2, DQ8

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35
Q

diagnosing coeliac

A

anti-TTG is most sensitive
jejunal/duodenal biospy

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36
Q

acute cholecystitis complications

A

chronic diarrhoea
vitamin malabsorption (A, D, E, K)
Jaundice

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37
Q

antibodies if the different types of AI hepatitis and who it affects

A

T1: ANA, AMSA (adults, children)
T2: anti-LKM-1,2,3 (children)
T3: anti-soluble-liver antigen (middle-aged adults)

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38
Q

CLD S/S

A

palmar erythema
Dupuytren’s
Clubbing
Gynaecomastia
Axillary hair loss
Spider naevi

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39
Q

Enhanced Liver Panel aspects

A

hyaluronic acid
procollagen III
tissue inhibitor of metalloproteinase 1

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40
Q

what does fibroscan measure?

A

liver stiffness measurement

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41
Q

late complications of pancreatitis

A

peri-pancreatic fluid collection
pseudocysts
abscess
pancreatic necrosis

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42
Q

investigations in chronic pancreatitis

A

USS
contrast enhanced CT

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43
Q

HR-CT finding in Pancreatic Ca

A

double duct sign
= simultaneous dilatation of CBD and pancreatic duct

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44
Q

indications for urgent 2ww OGD

A

dysphagia
upper GI mass
age >55yo + weight loss + dyspepsia/GORD/upper GI pain

45
Q

indications for non-urgent OGD

A
  • haematemesis
  • age >55yo + tx-resistant dyspepsia/ UGI pain with low Hb
46
Q

when is an anal fissure chronic? tx?

A

more than 6 weeks
treat with topical GTN, sphinceterotomy

47
Q

aspects of Child Pugh score

A

ABCDE
Albumin
BR
Clotting (PT)
Distention (ascites)
Encephalopathy

48
Q

how to treat alcoholic hepatitis

A

prednisolone (if high DF)

49
Q

what is Budd-Chiari and what are the S/S?

A

blockage of hepatic vein
S/S: abdo pain, ascites, tender hepatomegaly

50
Q

carcinoid syndrome investigations

A

urinary 5-HIAA

51
Q

Small bowel overgrowth treatment

A

rifaxicim

52
Q

Types of oesophageal cancer and RFs

A

Adenocarcinoma (GORD, lower 3rd)
SCC (smoking, upper/middle third)

53
Q

Management of oesophageal cancer

A

Most are palliative
Others: stenting, secretion, analgesia, radiotherapy

54
Q

When to do OGD in GORD

A

> 55
ALARMS
Anaemia
Loss of weight
Anorexia
Recent onset progressive ax
Malaena
Swallowing difficulties
Persistent despite treatment

55
Q

Complications of Nissan fundiplication

A

Gas bloat syndrome
Dysphagia

56
Q

Symptoms of duodenal vs gastric ulcer

A

DU: pain before meals and at night, relived by eating
GU: worse on eating

57
Q

Rockall score

A

Prediction of re bleeding and mortality

58
Q

Pre hepatic causes of portal HTN

A

Portal vein thrombosis

59
Q

Hepatic cause of portal HTN

A

Cirrhosis
Schisto
Sarcoidosis

60
Q

Post hepatic cause of portal HTN

A

Budd Chiari
RHF

61
Q

What is a TIPSS procedure?

A

Artificial channel between hepatic vein and portal vein
Dec portal pressure

62
Q

What scan to do in a perforated viscus ?

A

Erect CXR = air under diaphragm

63
Q

Zollinger Ellison syndrome causes

A

Gastrinoma = inc gastric
PUD and chronic diarrhoea

64
Q

Presentation and treatment of Zollinger Ellison

A

Abdo pain, dyspepsia, refractory PUD
Treatment: high dose PPI, sugars

65
Q

Criteria to meet for Bariatric Surgery

A

BMI >40 or >35 with surgical comorbidity
Failure of non surgical management of weight loss for 6 months
Fit for surgery
Integrated program for guidance on diet/exercise

66
Q

Complication of gallstones in gut

A

Gallstone ileus

67
Q

When doing an USS for gallstones, what to look for ?

A

Stones
Dilated ducts
Inflamed GB

68
Q

Mirizzi’s syndrome

A

Large stone in GB presses on common healthcare duct
= obstructive jaundice

69
Q

How does a gallstone ileus form?

A

Large stone erodes from GB to duodenum
May impact distal ileum = obstruction
Mx: remove stone via enterostomy

70
Q

Meaning of Glasgow score

A

1 = mild
2 = moderate
3 = severe

71
Q

Pancreatic pseudo cyst presentation

A

4-6 weeks after acute attack
Persisting abdominal pain
Epigastric mass = early satiety

72
Q

Causes of chronic pancreatitis

A

Alcohol
Genetic (CF, HH)
Immune (IgG4)

73
Q

UC complications

A

Toxic mega colon
Bleeding
Malignancy
Cholangiocarcinoma

74
Q

Chron’s complications

A

Fistulae
Strictures
Abscesses
Malabsorption

75
Q

UC pathology

A

Lead pipe
Thumb printing (mucosal thickening)
Pseudopolyps

76
Q

Additional therapies in UC

A

Azathioprine
Infliximab

77
Q

Chron’s pathology

A

Skip lesions
Rose thorn ulcers
Cobblestoning (ulceration and mural oedema)
String sign of Kantor (narrow terminal ileum)

78
Q

Maintaining remission in Chron’s

A
  1. Azathioprine / mercatopurine
  2. Methotrexate
  3. Infliximab
79
Q

Complications of diverticulitis

A

Perforation
Haemorrhage
Abscess
Fistulae
Strictures

80
Q

Paralytic ileus

A

Adynamic bowel secondary to absence of normal peristalsis
Usually SBO

81
Q

Causes of paralytic ileus

A

Post op
Peritonitis
Pancreatitis
Metabolic (dec K, Na, Mg)

82
Q

BS in Ileus vs Mechanical Obstruction

A

Ileus = dec BS
Mechanical obstruction = inc BS

83
Q

SBO AXR

A

> 3cm
Central
Valvulae coniventes (completely across)
Many loops of bowel

84
Q

LBO AXR

A

> 6cm
Peripheral
Haustra (partially across)
Few loops of bowel

85
Q

Colorectal Ca RFs

A

Diet (inc fibre)
IBD
Familial (FAP, HNPCC)
Smoking

86
Q

Rectal Ca: anterior resection indication

A

Tumour 4-5cm from anal verge
Defunct in with loop ileostomy

87
Q

Rectal Ca: AP resection

A

<4cm from anal verge
Permanent colostomy

88
Q

Sigmoid Ca operation

A

High anterior resection or sigmoid Colectomy

89
Q

Transverse Ca operation

A

Extended R hemicolectomy

90
Q

FAP defect

A

APC gene

91
Q

HNPCC defect

A

Mismatch repair genes

92
Q

Anal cancer HPV mutations

A

16, 18, 31, 33

93
Q

Definition of hernia

A

Protrusion of a viscus or part of a viscus through the walls of its containing cavity into an abnormal position

94
Q

Inguinal hernia RFs

A

Cough
Constipation
Obesity
Heavy lifting

95
Q

Questions to ask about inguinal hernia

A

Reducible
Every had episode of obstruction/strangulation

96
Q

Complications of inguinal hernia repair

A

Early: haematoma, infection, intra-abdo injury
Late: recurrence, chronic groin pain

97
Q

H. pylori eradication

A

PAC 500
PPI: Lansoprazole 30mg BD
Amoxicillin: 1g BD
Clarithromycin 500mg BD

98
Q

pathophysiology of GORD

A

LOS dysfunction

99
Q

GI bleeding (not varices) endoscopic treatment of vessel/ulcer problem

A
  • adrenaline injection
  • thermal/laser coag
  • fibrin glue
  • endoclips
100
Q

what is hepatorenal syndrome?

A

renal failure in patients with advances CLF
due to underfilling of renal circulation

101
Q

management of hepatorenal syndrome

A

IV albumin and terlipressin

102
Q

criteria for liver transplant in paracetamol induced LF

A

pH < 7.3 after 24 hrs
or all of:
- PT >100 s
- Cr > 300
- Grade 3/4 encephalopathy

103
Q

what are the complications of cirrhosis?

A
  1. decompensation (jaundice, encep, dec albumin, coag, dec glucose)
  2. SBP
  3. Portal HTN
  4. inc risk of HCC
104
Q

what does Child Pugh score do?

A

predicts risk of bleeding and mortality and need for treatment

105
Q

SAAG and causes

A

> 1.1g/dL = portal HTN (cirrhosis)
<1.1g/dL = other causes

106
Q

score used to determine treatment in Alcoholic Hep?

A

Maddrey score

107
Q

which ducts affected in PBC vs PSC?

A

PBC = intra-hepatic
PSC = intra and extra hepatic

108
Q

extra-articular of IBD

A
  • skin (clubbing, erythema nodosum)
  • eyes (iritis, conjunctivitis)
  • joints (arthritis, AS)
  • HPB (PSC, gallstones, fatty liver)
109
Q

what does lead pipe mean?

A

no haustra

110
Q

what does cobblestoning mean?

A

ulceration and mural oedema

Year 6 Cross Section (23 decks)

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