Brainscape's Knowledge GenomeTM

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


See full index

AKT > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Most common organisms for spontaneous peritonitis

A

Escherichia coli
Klebsiella pnuemoniae
Gram positive cocci (such as staphylococcus and enterococcus)

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

Treatment of portal varices

A

Propranolol reduces portal hypertension by acting as a non-selective beta blocker

Elastic band ligation of varices

Injection of sclerosant (less effective than band ligation)

Transjugular Intra-hepatic Portosystemic Shunt (TIPS) connection through the liver tissue between the hepatic vein and the portal vein and put a stent in place. This allows blood to flow directly from the portal vein to the hepatic vein and relieves the pressure in the portal system and varices.

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

Treatment of bleeding varices

A

Vasopressin analogues (i.e. terlipressin) cause vasoconstriction and slow bleeding in varices

Correct any coagulopathy with vitamin K and fresh frozen plasma (which is full of clotting factors)

Giving prophylactic broad spectrum antibiotics has been shown to reduce mortality

Consider intubation and intensive care as they can bleed very quickly and become life threateningly unwell

Injection of sclerosant into the varices can be used to cause “inflammatory obliteration” of the vessel

Elastic band ligation of varices

Sengstaken-Blakemore Tube is an inflatable tube inserted into the oesophagus to tamponade the bleeding varices. This is used when endoscopy fails.

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

Management of Ascites

A

Low sodium diet
Anti-aldosterone diuretics (spironolactone)
Paracentesis (ascitic tap or ascitic drain)
Prophylactic antibiotics against spontaneous bacterial peritonitis (ciprofloxacin or norfloxacin) in patients with less than 15g/litre of protein in the ascitic fluid
Consider TIPS procedure in refractory ascites
Consider transplantation in refractory ascites

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

How do laxatives/antibiotics reduce hepatic encephalopathy?

A

By giving laxatives we help clear the ammonia from the gut before it is absorbed and by giving antibiotics we reduce the number of bacteria in the gut producing ammonia.

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

Diagnosis of haemochromatosis

A

If serum ferritin and transferrin saturation is high and there is no other reason then genetic testing can be performed to confirm haemochromatosis.

Perl’s stain on liver tissue

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

The most common type of inherited colorectal cancer

A

Hereditary non-polyposis colorectal carcinoma

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

All patients with a suspected upper GI bleed need _____ unless _____

A

Any patient with a suspected upper gastrointestinal bleed requires endoscopy within 24 hours of admission unless they score less than 1 on the Glasgow-Blatchford score.

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

Contraindication of Metoclopramide

A

Metoclopramide has prokinetic properties, which can stimulate peristalsis within the bowel. This can exacerbate mechanical bowel obstruction and precipitate perforation.

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

Sign of appendicitis on bloods

A

Neutrophil predominant leucocytosis is present in 80–90% of people with appendicitis

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

What are carcinoid tumours

A

Usually occurs when metastases are present in the liver and release serotonin into the systemic circulation

May also occur with lung carcinoid as mediators are not ‘cleared’ by the liver

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

Signs of carcinoid tumours

A

Flushing, diarrhoea, bronchospasm, hypotension, and weight loss.

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

Investigation of carcinoid tumour

A

The investigation for this is urinary 5-HIAA, as the tumour will secrete serotonin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Dysphagia, aspiration pneumonia, halitosis →

A

?pharyngeal pouch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is achalasia

A

Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter (LOS) due to degenerative loss of ganglia from Auerbach’s plexus

Dysphagia affecting both liquids and solids

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

Trigger for liver decompensation in cirrhotic patients

A

Constipation

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

Anaemia and epigastric tenderness?

A

Upper GI bleed, OGD in 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Right heart failure liver

A

Right heart failure is associated with a firm, smooth, tender and pulsatile liver edge

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

What is the Rockall score?

A

Used after endoscopy and utilises information such as the patient’s age, observations, comorbidities and the endoscopy result to provide an estimation of rebleeding risk and mortality.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the Oakland score?

A

The Oakland score for safe discharge predicts readmission risk for patients admitted with lower GI bleeding.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the Glasgow-Blatchford score?

A

The Glasgow-Blatchford score is used before endoscopy. It helps assess patients with suspected upper GI bleeds who are deemed ‘lower risk’ and could be managed as outpatients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the most sensitive and specific lab finding for diagnosis of liver cirrhosis in those with chronic liver disease?

A

Thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Criteria for urgent 2ww upper GI endoscopy (suspected oesophageal or stomach cancer)

A

Applies to upper abdominal pain or dyspepsia with weight loss in adults 55 years and over, for suspicion of oesophageal or stomach cancer.

24
Q

Criteria for non urgent upper GI endoscopy (suspected oesophageal or stomach cancer)

A

Patients aged 55 or over who have dyspepsia with raised platelet count or nausea/vomiting.

25
Q

Positive antimitochondrial antibodies are commonly associated with

A

Primary biliary cirrhosis (PBC)

26
Q

What is Peutz-Jeghers syndrome?

A

Small bowel obstruction can commonly be the presenting complaint as polyps can cause intusussception

Hyperpigmented mucosal macules (most commonly seen on the vermillion border of the lips).

27
Q

Which drugs increase risk of C.difficile?

A

Antibiotics

Omeprazole PPIs

28
Q

Side effect of sulphasalazine.

A

This drug, used in the treatment of ulcerative colitis and rheumatoid arthritis, can cause haemolytic anaemia with Heinz bodies.

29
Q

Sign of upper GI bleed in bloods

A

Urea increase

An upper gastrointestinal bleed can act as a ‘protein meal’ and cause a temporary, disproportionate rise in the blood urea.

30
Q

How to treat life threatening C.diff

A

In life-threatening C. difficile infection treatment is with ORAL vancomycin and IV metronidazole

31
Q

Sister Mary Josephs node

A

Sister Mary Joseph node is a palpable nodule in the umbilicus due to metastasis of malignant cancer within the pelvis or abdomen

32
Q

First line treatment for PBC

A

The first-line treatment is ursodeoxycholic acid

This is a secondary bile acid and its precise mechanism of action is not well understood but it may protect the liver by increasing bile flow through the liver.

33
Q

Anal fistula treatment for patients with Crohns vs normal patients

A

Normal - close surgically

Crohns - manage with antibiotics (oral metronidazole)

34
Q

If C. difficile does not respond to first-line vancomycin ,______ should be used next, except in life-threatening infections

A

Oral fidaxomicin

35
Q

Treatment of alcoholic hepatitis

A

Prednisolone

36
Q

What assesses patients for malnutrition?

A

MUST

MUST takes into account three main parameters: BMI, unplanned weight loss in the previous 3-6 months and whether the patient is acutely unwell with likely no nutritional intake for 5 or more days.

37
Q

What is procitis?

A

Proctitis is the most common disease pattern in UC and is seen in 40-50% of the cases.

Bloody diarrhoea, tenesmus, and mucoid discharge are the presenting features of proctitis.

Inflammation in UC starts as proctitis and does not usually spread beyond the ileocaecal valve.

38
Q

What extra intestinal symptom is more common in UC than Crohns?

A

Primary sclerosing cholangitis more common

39
Q

Investigation for suspected pharyngeal pouch

A

Barium swallow with fluoroscopy which shows protrusion of the pharynx posteriorly.

40
Q

Vaccine for coeliac disease and why?

A

Hyposplenism is common, which can lead to more severe infections with pneumococcus.

Administration of the pneumococcal vaccine every 5 years.

41
Q

Patients with UC are more likely to develop which HPB disease?

A

PSC

42
Q

p-ANCA antibodies are associated with

A

p-ANCA can be found in broad range of conditions including primary sclerosing cholangitis, autoimmune hepatitis and ulcerative colitis.

43
Q

What is TBIC in the context of iron deficiency?

A

TIBC measures the number of binding sites on transferrin available for iron. It therefore also increases in ID and decreases in ACD.

44
Q

Budd-Chiari syndrome presents with the triad of

A

Sudden onset abdominal pain, ascites, and tender hepatomegaly

45
Q

Causes of Budd-Chiari syndrome

A

Causes
polycythaemia rubra vera
thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies
pregnancy
combined oral contraceptive pill: accounts for around 20% of cases

46
Q

What is Budd-Chiari syndrome?

A

Budd-Chiari syndrome, or hepatic vein thrombosis, is usually seen in the context of underlying haematological disease or another procoagulant condition.

47
Q

Management of B12 deficiency

A

Vitamin B12 deficiency is typically managed intramuscular B12 replacement, a loading regime followed by 2-3 monthly injections

48
Q

Use of the Blatchford score

A

The Blatchford score is used to determine the severity of a suspected GI bleed and whether or not the patient needs admitting +/- the requirement for urgent upper GI endoscopy.

49
Q

Second most common association of HNPCC after colorectal cancer

A

Endometrial cancer

50
Q

A short history of progressive dysphagia in a middle aged man who has a background history of reflux is strongly suggestive of

A

Malignancy

51
Q

The AST/ALT ratio in alcoholic hepatitis is

A

2:1

52
Q

Why does AST rise more than ALT in alcoholic hepatitis

A

The disproportionate rise in AST relative to ALT is due to alcohol-induced deficiency of the cofactor pyridoxine-phosphate, the active form of vitamin B6, which limits the rise in ALT.

53
Q

Antibiotic which can cause cholestasis

A

Co-amoxiclav

54
Q

Diagnostic investigation of choice for pancreatic cancer

A

High-resolution CT scan

55
Q

Acute cholecystitis vs ascending cholangitis presentation

A

BOTH
Constant right upper quadrant pain. History of gallstones. She is pyrexial and has raised inflammatory markers

Ascending cholangitis only
Pt likely will be jaundiced

56
Q

Steroids can cause ____

A

Pancreatitis

57
Q

Investigation of choice for pharyngeal pouch

A

Barium swallow combined with dynamic video fluoroscopy

AKT (16 decks)

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