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Medicine Block Year 3 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is the management for an oesophageal variceal bleed?

A

IV Terlipressin and IV Antibiotics ( Co-Amoxiclav )

Band ligation

If bleeding does not stop insert a Sengstaken-Blakemore tube or use TIPSS

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2
Q

What is the most common organism found on ascitic fluid culture in Spontaneous Bacterial Peritonitis?

A

E.Coli

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3
Q

What do IGA anti-endomysial antibodies indicate?

A

Coeliac’s disease

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4
Q

What blood test is used to detect Coeliac Disease?

A

Tissue Transglutaminase IgA antibody (tTG-IgA) test

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5
Q

What is Hepatic Encephalopathy caused by?

A

Accumulation of ammonia in the blood stream due to the livers’s decreased ability to detoxify ammonia

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6
Q

What is the treatment for Hepatic Encephalopathy?

A

Lactulose PO and Rifaximin

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7
Q

What autoantibody test is raised in Primary Sclerosing Cholangitis?

A

p-ANCA

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8
Q

What does dysphagia equally to solids and liquds suggest?

A

Achalasia

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9
Q

How do you confirm the diagnosis of Achalasia?

A

A barium swallow fleuroscopy showing a grossly expanded oesophagus that tapers at the lower oesophageal sphincter. - “ Bird’s Beak” appearance ( kinds looks like a slug more )

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10
Q

What is the pharmacological treatment for ascites secondary to liver cirrhosis?

A

Spironolactone

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11
Q

What vaccine is indicated as part of Coeliac disease management?

A

Pneumocccocal vaccine due to hyposplenism

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12
Q

What are the Red Flag symptoms for Gastric Cancer?

A

New-onset dyspepsia in those >55 ( burning pain/ indigestion )
Unexplained persistent vomiting
Unexplained weight loss
Progressively worsening dysphagia ( difficulty swallowing )
Odynophagia ( painful swallow )
Epigastric pain

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13
Q

What drug is first line to maintain remission in Crohn’s?

A

Azathioprine

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14
Q

What test helps to distinguish between IBD and IBS?

A

Faecal calprotectin

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15
Q

How is Hepatic Encephalopathy categorised?

A

Graded from I - IV

Grade IV is Coma

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16
Q

What electrolyte imbalance can PPIs cause?

A

Hyponatraemia

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17
Q

How long must a patient be sure to eat gluten for before Coeliac testing ?

A

6 weeks prior to testing

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18
Q

What is the first line treatment for Primary Biliary Cholangitis

A

Ursodeoxycholic Acid

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19
Q

What is the most common inheritable form of Colorectal Cancer?

A

Hereditary Nonpolyposis Colorectal Cancer ( HNPCC )

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20
Q

What is the most likely area to be affected by ishcaemic colitis?

A

The splenic fixture

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21
Q

What are the two types of IBD?

A

Crohns
Ulcerative Colitis

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22
Q

Where in the gut does Crohns affect?

A

Anywhere from mouth to the anus ( Whole GI Tract )

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23
Q

Where in the gut does UC affect?

A

Always effects the rectum and extends proximally varying distances

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24
Q

What is the pattern of inflammation in Crohns?

A

Skip Lesions

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25
Q

What is the pattern of inflammation in UC?

A

Continuous

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26
Q

What type of inflammation does Crohns cause?

A

Transmural

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27
Q

Wha type of inflammation does UC cause?

A

Mucosal and Submucosal only

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28
Q

What are the morphological effects of Crohns?

A

Fissuring ulcers

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29
Q

What are some microscopic features of Crohns?

A

Lymphoid and neutrophil aggregates
Non caseating Granulomas

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30
Q

What are some morphological features of UC?

A

Crypt abcesses

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31
Q

How does smoking affect Crohns and UC ?

A

Worsens Crohn’s
Shown to improve UC

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32
Q

What blood tests should be done for IBD and why?

A

FBC - check for anaemia or raised platelets
U&Es - may have deranged electrolytes due to GI losses
CRP - may be raised, normal CRP does not exclude IBD though

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33
Q

What stool tests should be done for IBD?

A

Stool cultures - to rules out infective colitis/parasites
Faecal calprotectin - raised in active IBD and not raised in IBS or IBD in remission

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34
Q

What investigation should be done in suspicion of Toxic Megacolon?

A

Abdo Xray

Immediately- very serious

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35
Q

What endoscopy tests should be done when investigating Crohn’s?

A

Flexible sigmoidoscopy – safest test in bloody diarrhoea
Colonoscopy – needed to look for more proximal disease Capsule endoscopy – useful to view the small bowel mucosa

Capsule Endoscopy involves swallowing a tiny capsule with a camera

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36
Q

What cross sectional imaging should be used when looking for Crohn’s?

A

CT abdomen - when looking for acute complications

MRI enterography - when looking for small bowel crohn’s, fistulas or to map the extent of small bowel crohn’s

MRI Pelvis - to image perianal crohn’s

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37
Q

What is the mainstay of treatment for Crohn’s?

A

Steroids

Can be topical ( suppositories or enemas )
Orally ( Prednisolone or Budesonide in small bowel disease )
IV ( Hydrocortisone )

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38
Q

What is the treatment for patients with a Crohns’s or UC flare up bad enough to be admitted to hospital?

A

IV Hydrocortisone 100mg qds for 3-5 days

If no improvement must be escalated

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39
Q

What is the escalation for in hospital UC patients?

A

Ciclosporin
Biologics
Or Surgery

Around half will require surgery

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40
Q

What is the escalation for admitted patients with Crohn’s?

A

Biologics
Or Surgery

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41
Q

What is the treatment to maintain remission in UC?

A

Mesalazine

If it doesn’t work - Azathioprine / Biologics

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42
Q

What is the treatment to maintain remission in Crohn’s?

A

Azathioprine and Biologics

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43
Q

What is the first choice in Crohn’s patients with perianal or fistulating disease to maintain remission?

A

Biologics

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44
Q

As all the medication for IBD remission causes immunosupression , what monitoring is required?

A

FBC
U&Es
LFTs

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45
Q

What do patient’s with Crohn’s usually present with?

A

Change in bowel habit, usually diarrhoea
Blood in stools
Fever
Fatigue
Abdominal Pain
Mouth Sores
Reduced appetite
Weight Loss

Usually younger patients

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46
Q

How do patients with Ulcerative Colitis present?

A

Diarrhoea
Waking up in the night to poo ( Urgency)
Tenesmus
Blood/ Mucus in poo

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47
Q

How does Coeliac’s Disease present?

A

Loose stools
Bloating
Flatulence
Abdominal Cramps
Weight Loss
Dermatitis Herpetiformis

Fx also

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48
Q

What type of anemia can Coeliac’s Disease cause?

A

Iron deficiency - due to malabsorbtion

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49
Q

What are some complications of untreated Coeliac’s disease?

A

Malignancy
Osteoporosis
Gluten ataxia
Neuropathy

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50
Q

What types of malignancies are associated with Coeliac Disease?

A

Enteropathy-associated T-cell lymphoma (EATL)
Non-Hodgkin’s lymphoma
Adenocarcinoma of the small intestine

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51
Q

What are the diagnostic tests for Coeliac’s disease?

A

OGD and duodenal biopsies

tTG (tissue transglutaminase) is usually raised , but not the diagnostic test in adults

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52
Q

What will you see histologically with Coeliac’s Disease?

A

Villous atrophy
Intra-epithelial Lymphocytosis

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53
Q

What is the treatment for Coeliac’s Disease?

A

Dieticians - gluten free diet

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54
Q

What foods contain gluten?

A

Barley
Rye
Oats - can be reintroduced in some patients
Wheat

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55
Q

What are some differential symptoms for dyspepsia that must be clarified in a history?

A

Abdominal pain
Retrosternal burning
Waterbrash
Vomiting
Upper GI Wind

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56
Q

What treatment/ investigations are reasonable for Dyspepsia/ Reflux ?

A

PPI +/- test for H.Pylori

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57
Q

What are some Red Flag symptoms associated with GORD/ Reflux that should be further investigated?

A

Dysphagia ( Difficulty swallowing )
Odynophagia ( Painful Swallow )
Unintentional Weight Loss
New onset at older age
GI Bleeding
Recurrent vomiting
Anaemia
Palpable mass
Lymphadenopathy

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58
Q

What is key to distinguish when a patient presents with dysphagia?

A

Which swallowing phase the difficulty occurs in

Oropharyngeal Phase - patient struggles to get food to leave mouth

Oesophageal Phase - patient’s food can leave mouth but gets stuck after

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59
Q

What is the cause of oro-pharyngeal dysphagia?

A

Problems coordinating the muscles to move the food bolus - usually do to neurological problems

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60
Q

What can the causes of oesophageal dysphagia be ?

A

Physical obstruction - tumour, benign stricture, oesophagitis

Neuromuscular - achalasia, dysmotility, presbyoesophagus

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61
Q

What investigations can be done for oesophageal dysphagia?

A

OGD to exclude obstructive cause first
Barium swallow or Oesophageal manometry to look for neuromuscular causes

OGD = OesophagoGastroDuodenoscopy

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62
Q

What examinations/ investigations can be done for oro-pharyngeal dysphagia?

A

Cranial nerve examination
Speech Therapy assessment of swallow
Video-Fluoroscopy may be indicated

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63
Q

What is the treatment for benign oesophageal strictures ?

A

Dilation

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64
Q

What is the treatment for oesophageal cancer?

A

Surgery

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65
Q

What is the treatment for oro-pharyngeal dysphagia?

A

Altered food consistency

Enteral feeding tube may be needed if swallow remains unsafe ( NG / PEG tube )

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66
Q

What are the functions of the liver?

In terms of metabolic, production, detoxification and immune

A

Nutrition/ Metabolic
- Stores glycogen
- Releases glucose
- Absorbs fats/ ADEK Vitamins and iron
- Makes cholesterol
- Bile salt production ( emulsification of fats )

Production
- Clotting factors
- Albumin
- Other binding proteins

Detoxification
- Drug excretion
- Alcohol breakdown
- Haemoglobuin -> Billirubin

Immune
- Kupfer cells engulf antigens

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67
Q

What are important questions to ask in a Liver disease history?

A

Blood transfusions prior to 1990
IVDU
Operation/ Vaccinations
Sexual history
Medications
Hx
Obesity
Alcohol use
Foreign Travel

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68
Q

What is it important to distinguish in liver disease?

A

If its acute ( resolves in 6 months ) or chronic

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69
Q

What causes cirrhosis and chronic liver disease?

A

Alcohol abuse
Hepatitis C
Non-Alcoholic Steatohepatitis ( NASH )
Autoimmune ( PBC, PSC. AIH )

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70
Q

What are causes of acute liver disease?

A

Hepatitis A , Hepatitis E
Cytomegalovirus
Epstein-Barr Virus
Drug induced liver injury ( DILI )

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71
Q

What are stigmata of Chronic Liver Disease ?

A

Spider Naevi
Clubbing
Jaundice
Palmar Erythema
Ascites
Hepatic Flap
Dupuytren’s Contracture
Splenomegaly
Caput Medusa
Gynecomastia
Leuchonychia

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72
Q

How is Hepatic Encephalopathy categorised?

A

Graded 1-4

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73
Q

What is Grade 1 of Hepatic Encephalopathy?

A

Psychomotor slowing
Constructional apraxia ( inability to copy/ draw basic diagrams or figures )
Poor memory
Reversed sleeping pattern

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74
Q

What is Grade 2 Hepatic encephalopathy?

A

Lethargy
Disorientation
Agitation
Asterixis

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75
Q

What is Grade 3 Hepatic Encephalopathy ?

A

Drowsy

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76
Q

What is Grade 4 Hepatic Encephalopathy?

A

Coma

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77
Q

What are some investigations and expected results for Liver Disease?

A

FBC - Thrombocytopenia = sensitive marker of fibrosis
LFTS - Show location of damage

Hepatocytes = raised ALT / AST
Cholestatic = raised ALP , raised gamma GT ( GGT is found in both Hepatocytes and biliary epithelial cells so used with ALP to confirm it is cholestatic not bone disease )

Abdo USS (Fibroscan)- can be used to find cirrhosis ( coarse, nodular, splenomegaly, ascites ) or to find obstructive jaundice ( dilated biliary duct )

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78
Q

What are causes or Hepatitic Liver diease with an ALT > 500

A

Viral
Ischaemia
Toxicity ( e.g. Paracetamol )
Autoimmune

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79
Q

What are causes of Hepatitic Liver Disease with an ALT of 100-200 ?

A

NASH
Autoimmune
Chronic Viral Hepatits
DILI

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80
Q

What are causes of Cholestatic Liver Disease with dilated ducts on USS?

A

Gallstone
Malignancy

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81
Q

What are causes of Cholestatic Liver Disease with non-dilated ducts?

A

Alcoholic hepatitis
Cirrhosis ( PBC, PSC, Alcohol )
DILI ( Antibiotics )

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82
Q

Which investigations make up the liver screen?

A

-AST, ALT, ALP
- Hepatitis B&C Serology (in acute liver disease consider Hep A & E if marked ALT rise)
- Iron studies (Ferritin & transferrin saturation ) (Haemochromatosis)
- A-utoantibodies (AMA & SMA) and immunoglobulins
- Consider caeuruloplasmin if age under 30 years (Wilson’s)
- Alpha-a-antitrypsin
- Coeliac serology
- TFTs, lipids & glucose

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83
Q

Which less common aetiologies of Chronic Liver Disease have a higher incidence in women?

A

Autoimmune Hepatitis
Primary Biliary Cholangitis

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84
Q

Which less common aetiology of Chronic Liver Disease have a higher incidence in men?

A

Primary Sclerosing Cholangitis ( associated with UC )

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85
Q

Which less common aetiology of Chronic Liver Disease has a higher incidence in men at a young age?

A

Haemochromatosis

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86
Q

Which less common aetiologies of Chronic Liver Disease only occur in children and young adults?

A

Wilson’s Disease
Anti LKM Autoimmune Hepatitis

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87
Q

What is the treatment of Chronic Liver Disease?

A

Remove underlying aeteiology

E.g stop drinking alcohol, antivirals, venesection etc

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88
Q

What is the end pathology of any cause of Chronic Liver Disease?

A

Cirrhosis

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89
Q

What is the most specific imaging technique to diagnose cirrhosis? The presence of what other pathology is diagnostic of cirrhosis?

A

Fibroscan

Presence of varices also diagnostic

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90
Q

What is the management of Liver Disease/Cirrhosis?

A

Ascitis - Spironolactone or Paracentesis if tense
Itching- Antihistamine or Cholestyramine
Encephalopathy- Lactulose PO and Rifaxamin
Varices - bleeding prophylaxis ( Propanolol )

DEXA scan - cirrhotic patients at risk of Osteoporosis

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91
Q

What type of cancer can develop in patients with Cirrhosis?

A

Hepatocellular carcinoma

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92
Q

How should Hepatocellular Carcinoma be screened for in patients with Cirrhosis?

A

Alpha-Fetoprotein and USS

Every 6 months

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93
Q

What is the investigation for Spontaneous Bacterial Peritonitis?

A

A diagnostic ascitic tap to look at cell count and Microscopy, Culture and Sensitivity ( MCS )

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94
Q

What tool is used for a Nutrional Assessment?

A

MUST ( Malnutrition Universal Screening Tool )

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95
Q

What is food fortification?

A

A tool used to add calories to meals without increasing the volume consumed

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96
Q

What are some options if patients are unable to meet their nutrional requirements, have an unsafe swallow or a non-functioning GI tract?

A

Nutrional supplements
NG Tube
PEG/ RIG/ PEGJ/ RIGJ
Paraenteral nutrition

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97
Q

What is an NG Tube and what is the procedure before use?

A

Short term access feeding into stomach

Check pH prior to use to ensure it is in the stomach and not lungs ( pH can be affected by PPI use so a CXR may be needed to confirm position)

Patient can still aspirate on saliva , not on food though

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98
Q

What are PEG/ RIG/ PEGJ/ RIGJ tubes?

A

All provide long term enteral access

PEG - inserted into stomach endoscopically
RIG - inserted into small intestine radiologically
PEG-J - inserted into stomach endoscopically
RIG-J - inserted into small intestine radiologically

Do not prevent aspiration of saliva

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99
Q

What is the procedure of PEG/ RIG etc tubes?

A

Require puncture of the stomach with a trocar

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100
Q

What is Paraenteral nutrition?

A

IV feeding - only indicated if GI tract is not accessible (blocked) or not working (short, leaking or diseased)

Must be given via dedicated central line ( PICC or Hickman )

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101
Q

What are the types of GI bleed?

A

Haematemesis - fresh blood in vomit
Coffee Ground Vomit - altered blood or stomach contents
Malaena -black, tarry, sticky stool
Fresh PR Bleed - indicated lower GI bleed but could also be brisk upper GI bleed in haemodynamically unstable patient

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102
Q

What are risk factors for a GI bleed?

A

Varices
Chronic Liver Disease
NSAID use
Anticoagulants
Antiplatlets

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103
Q

What is the ROCKALL score?

A

Simple score based on bedside parameters that predicts risk of death and rebleeding from an Upper GI bleed

Split into pre and post endoscopy findings

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104
Q

What are the sections in the ROCKALL score?

A

Pre-endoscopy
-Age
-Comorbidity
-Shock
Post-endoscopy
-Source of bleeding
-Stigmata of recent bleeding

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105
Q

What is the Blatchford score?

A

Predicts the need for intervention in a GI Bleed, requires blood tests

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106
Q

What are the sections on the Glasgow-Blatchford score?

A

Blood Urea
Hb ( different for men and women)
Systolic BP
Other markers - Pulse> 100bpm, Malaena, Syncope, Hepatic Disease, Cardiac failure

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107
Q

What are the investigations required in an acute Upper GI Bleed?

A

FBC - check Hb and platelets
U&Es - raised urea
Clotting
Group and Save - transfusion may be needed
LFTs - check for liver disease
VBG - quick way to get Hb levels

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108
Q

What type of Upper GI Bleed is a medical emergency?

A

Variceal bleed

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109
Q

What is the management of a Variceal bleed?

A

Gain IV access
Fluid recuss if haemodynamically unstable
Blood transfusion if needed
IV Terlipressin and IV antibiotics
Refer to GI team for urgent upper GI endoscopy

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110
Q

What is the definitive treatment of variceal bleeding?

A

Mechanical obstruction to the flow of blood through the varices via

  • Oesophageal banding

If bleeding is not controlled then
- Linton tube
- Sengstaken tube
- TIPPS ( Trans-jugular intrahepatic porto-systemic shunt)

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111
Q

What are the causes of non variceal bleeding?

A

Peptic Ulcer disease
Angiodysplasia
Dieulofoys

These are more likely to stop bleeding on their own

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112
Q

What is the mangement of a non variceal Upper GI Bleed?

A

IV Access
Fluid Recuss if haemodynamically unstable followed by blood
Discuss with GI Team - various endoscopic treatments available . If not stopped by endoscopy then radiological embolisation or surgery are possible

PPIs after endoscopy

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113
Q

What type of ulcer is more characteristic of pain several hours after eating?

A

Duodenal as apposed to stomach

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114
Q

Which blood vessel is a duodenal ulcer most likely to affect?

A

Gastroduodenal artery ( posterior duodenal ulcers are more likely to cause serious upper GI haemorrhage

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115
Q

What should a recurrent episode of C.Diff within 12 weeks of symptom resolution be treated with?

A

Fidaxomicin PO

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116
Q

If a C.Diff infection doesn’t respond to either Vancomycin or Fidaxomicin then what should be tried next?

A

Oral vancomycin and IV metronidazole

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117
Q

What does a combination of liver and neurological disease in a young male point towards?

A

Wilson’s Disease

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118
Q

How do you investigate for a suspicion of Wilson’s disease?

A

Copper studies ( Serum copper, Serum caeruloplasmin, Urine copper )
LFTs ( raised ALT )

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119
Q

How does Pancreatic Cancer present ?

A

PAINLESS JAUNDICE

Weight loss
Pruritus
Older age
Smoker
Diabetes
Raised ALP and gGT ( Cholestic pattern on LTFs )

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120
Q

What is use of the oral contraceptive pill associated with?

A

Drug-induced cholestasis

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121
Q

What malignancy is associated with Coeliac’s Disease?

A

Enteropathy-associated T Lymphoma ( EATL )

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122
Q

What pharmological treatment would be suitable for an acute presentation of IBS-D ?

A

Loperamide ( anti-motility agent )

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123
Q

What test implies an active or chronic Hepatitis B infection

A

Positive HbsAg

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124
Q

What can help distinguish between an upper and lower GI bleed?

A

High urea levels ( >14mmol/L) indicate an upper GI bleed

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125
Q

How do you work out alcohol units?

A

Units = ABV% x Volume ( mls )

1 unit is 10 ml of pure ethanol, so a 25ml shot (ABV 40%) would be 25 x 0.4 = 10ml = one unit

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126
Q

What type of anemia does a Vitamin B12 deficiency imply ?

A

Pernicious anemia

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127
Q

What type of cancer does Pernicious Anaemia predispose to ?

A

Gastric Cancer

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128
Q

What is the triad of symptoms associated with Acute Liver Failure?

A

Encephalopathy
Jaundice
Coagulopathy

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129
Q

What is the main treatment for Wilson’s disease?

A

Penicillamine - a metal chelating agent

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130
Q

A SAAG ( Serum Ascitic Albumin ) gradient of what indicates portal hypertension?

A

> 11g/L

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131
Q

What vitamin in high doses can be teratogenic?

A

Vitamin A

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132
Q

What is the gold standard investigation for perianal fistulae in Crohn’s patients?

A

MRI Pelvis

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133
Q

What is the treatment for a life threatening C.Diff infection?

A

Oral vancomycin and IV Metronidazole

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134
Q

What is a important complication of Primary Sclerosing Cholangitis?

A

Cholangiocarcinoma

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135
Q

How is Alcoholic Ketoacidosis treated?

A

IV Thiamine and 0.9% Saline

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136
Q

What is the treatment for a liver abscess?

A

IV Antibiotics and Image-guided percutaneous drainage

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137
Q

What is the treatment for a Pharyngeal Pouch?

A

Surgical treatment

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138
Q

What is the most useful test for investigating Vitamin B12 deficiency?

A

Intrinsic Factor antibody titre

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139
Q

What is the most appropriate prophylaxis for the prevention of bleeding following a variceal bleed?

A

Propanolol

This is a Non-Cardiac selective B Blocker, they cause vasodilation in engorged variceal veins, this lowers the BP and therefore risk of rupture

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140
Q

What cancers is Hereditary Non-Polyposis Colorectal Cancer ( HNPCC ) associated with?

A

Colorectal Cancer
Endometrial Cancer

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141
Q

Whst id the management of severe alcoholic hepatitis?

A

Prednisolone PO

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142
Q

What constitutes a severe flare up of Crohn’s?

A

> 6 bowel movements a day with blood and fever

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143
Q

What is the most accurate marker for assessing the extent acute liver failure?

A

Prothrombin Time

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144
Q

What is Murphy’s Sign and what does is indicate?

A

Ask patient to take a deep breath and hold it
Press down on the RUQ and if the patient experiences pain then Murphy’s sign is positive

Gallbladder pathology

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145
Q

What is Rovsing Sign? What does it indicate?

A

Press down on LIF and there is pain on the RIF as the peritoneum is irritated

Acute appendicitis

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146
Q

What is the management for Acute Appendicitis?

A

NBM
IV Fluids
Analgesia ( e.g IV Morphine )

APPENDECTOMY

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147
Q

What on a blood test indicates severe Acute Pancreatitis?

A

Hypocalcaemia >2

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148
Q

How do you differentiate between Anaemia of Chronic Disease and Iron Deficiency Anaemia? ( The iron is low in both and both are microcytic )

A

In Iron Deficiency Anaemia , the Total Binding Capacity of Iron will be high on an iron study. It will be low in Anaemia of Chronic Disease

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149
Q

What are the causes of Acute Pancreatitis?

A

I - Idiopathic

G- Gallstones
E - Ethanol
T - Trauma

S - Steroids
M - Mumps
A - Autoimmune Disease
S - Scorpion Sting
H - Hypercalcaemia
E - Endoscopic Retrograde Cholangiopancreatography
D - Drugs

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150
Q

What are the electrolyte imbalances present in Refeeding Syndrome?

A

Hypophosphataemia
Hypokalaemia
Hypomagnesaemia

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151
Q

What diagnosis does the combination of cholestatic jaundice, raised IgM and postive anti-mitochondrial antibodies lead to?

A

Primary Biliary Cholangitis

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152
Q

What is the first line treatment for Primary Biliary Cholangitis?

A

Ursodeoxycholic Acid

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153
Q

What is the difference between the pain present in a Gastric Ulcer vs in a Duodenal Ulcer?

A

Gastric Ulcer - pain comes on when or shortly after eating

Duodenal Ulcer - pain comes on an hour or two after eating

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154
Q

What is the management for Barrett’s oesophagus?

A

High dose proton pump inhibitor therapy
Endoscopic monitoring - to check for dysplastic or malignant changes

155
Q

What is Proctitis?

A

Inflammation of the lining of the rectum

156
Q

What is the first line investigation for primary sclerosing cholangitis?

A

MRCP

157
Q

What is the management for patients with Crohn’s who develop perianal abcess?

A

Incision and drainage

158
Q

If patient has had a severe relapse with UC or >2 exacerbations in the past year what should they be treated with?

A

Azathioprine to maintain remission

159
Q

What is the most likely organism to be found on an ascitic fluid culture in Spontaneous Bacterial Peritonitis?

A

E.Coli

160
Q

What is Boerhaave Syndrome?

A

Spontaneous perforation of the esophagus due to a sudden increase in oesophageal intrathoracic pressure

161
Q

What is the Boerhaave Syndrome?

A

Vomiting
Thoracic Pain
Subcutaneous Emphysema

162
Q

What type of anaemia is associated with glossitis?

A

Pernicious Anaemia

163
Q

Which blood test is useful for detecting Pernicious Anaemia?

A

Instrinsic Factor antibodies

164
Q

What is Pernicious Anaemia?

A

An autoimmune disorder that causes diminishment in dietary Vitamin B12 absorption. Gastric parietal cells are detroyed , so intrinsic factor cannot be made. This is needed for absorbtion in the ileum

165
Q

Offer urgent direct access upper gastrointestinal endoscopy (to be performed within 2 weeks) to assess for oesophageal cancer in people with dysphagia, or aged 55 and over with weight loss and any of the following:

A

Upper abdominal pain
Reflux
Dyspepsia

166
Q

What is the treatment for a life-threatening C. Difficile infection?

A

I.V Metronidazole and Oral Vancoymcin

167
Q

What is Melanosis Coli?

A

Abnormal pigmentation of the colon due to the presence of pigment-laden macrophages, usually due to laxative abuse (Senna)

168
Q

What is Melanosis Coli most commonly caused by?

A

Prolonged Laxative Use

169
Q

If C.Difficile does not respond to first-line oral Vancomycin, what should be used next?

A

Oral fidaxomicin

170
Q

What is used first-line to induce remission in Crohn’s?

A

Glucocorticoids e.g Prednisolone

171
Q

What is the screening for haemochromatosis?

A

Transferrin saturation > Ferritin
Genetic testing - HFE testing

172
Q

Which serology result indicates an active Hepatitis B infection?

A

HBsAg positive

173
Q

What is Courvoisier’s Law ?

A

States the presence of a palpable mass in the RUQ is more likely to be a malignant obstruction ( Cholangiocarcinoma) than obstruction due to stones

174
Q

What malignancy develops in 10% of primary sclerosing cholangitis patients?

A

Cholangiocarcinoma

175
Q

What must be administered before endoscopy in suspected Variceal bleeds?

A

Terlipressin AND I.V Antibiotic

176
Q

What is the best first line management for NAFLD?

A

Weight Loss

177
Q

What pathology is characteristically more painful when hungry and relieved by eating?

A

Duodenal ulcer

178
Q

Which type of ulcer is more likely to be malignant, gastric or duodenal?

A

Duodenal

179
Q

What is the diagnostic investigation of choice for pancreatic cancer?

A

High Res CT

180
Q

What is a parecetemol overdose likely to show on LFTs?

A

High ALT
Normal ALP
ALT/ALP ratio high

181
Q

What is Peutz-Jegher’s Syndrome?

A

Autosommal Dominant condition associated with the growth of multiple benign polyps ( harmartomas ) within the GI system. Associated with blue to dark brown macules around the hands, face, feet, oral mucosa and anus

182
Q

What is a common presenting complaint in Peutz-Jegher’s Syndrome?

A

Intussusception causing small bowel obstruction

183
Q

What is intussusception?

A

When one part of the bowel slides into another part. ( think like a collapsable telescope )

184
Q

What indicates a severe flare up od UC?

A

Doesn’t respond to advanced treatment
Shock
Obstruction
Peritonitis
Cachexia

185
Q

What is the first line for treatment of diarrhoea in IBS?

A

Loperamide

186
Q

What malignancy does Pernicious Anaemia predispose you to?

A

Gastric Carcinoma

187
Q

What is the investigation for a suspected pharyngeal pouch?

A

Barium Swallow with fluoroscopy

188
Q

What is the most likely condition in a young male with an isolated unconjugated hyperbilirubinaemia?

A

Gilbert’s Sydrome

189
Q

What condition is Primary Sclerosing Cholangitis strongly associated with?

A

Ulcerative Colitis ( 80% of PSC patients have UC )

190
Q

What is the cause of hepatic encephalopathy?

A

Ammonia crossing the blood-brain barrier due to increased concentration

191
Q

What is the treatment of Haemochromatosis?

A

Regular venesection

192
Q

What interventions are options when dysplasia is seen in Barrett’s oesophagus?

A

Endoscopic mucosal resection
Surgical removal of pre-cancerous cells
Radiofrequency ablation

193
Q

What is radiofrequency ablation?

A

Heat is used to destroy pre-cancerous cells

194
Q

What malignancies are associations of the HNPCC gene?

A

Colorectal cancer
Endometrial cancer

195
Q

How long do patients with C.Difficile need to be isolated for?

A

48 hours in a side room

196
Q

A 40-year-old man presents with dysphagia. He reports being reasonably well in himself other than an occasional cough. The dysphagia occurs with both liquids and solids. Clinical examination is normal.

What is the likely diagnosis?

A

Achalasia

Typically presents between 25-40 years

197
Q

A 55-year-old woman presents with swallowing difficulties for the past 5 weeks. She has also noticed some double vision

What is the likely diagnosis?

A

Myasthenia Gravis

198
Q

A 42-year-old haemophiliac who is known to be HIV positive presents with pain on swallowing for the past week. He has been generally unwell for the past 3 months with diarrhoea and weight loss

What is the likely diagnosis?

A

Oesophageal candidiasis

199
Q

What side effect are aminosalicylates ( e.g Mesalazine ) associated with?

A

Agranulocytosis , therefore FBC is required is user has sudden onset rigors, fever and sore throat

200
Q

What is seen on a VBG after profuse vomiting?

A

Metabolic Alkalosis with hypokalaemia

201
Q

How does vomiting cause metabolic alkalosis?

A

Vomiting leads to loss of H+ ions through gastric secretions, which are acidic.
When vomiting, the pancreas also stops releasing bicarbonate ions, so they are added to the ECF rather than secreted into the small bowel lumen

202
Q

What is used for the prophylaxis of oesophageal bleeding?

A

Propanolol

203
Q

What treatment do patients who have had an episode of sponatenous bacterial peritonitis require on discharge?

A

Antibiotic Prophylaxis e.g Ciprofloxacin

204
Q

A cachectic 32-year-old man with severe perineal Crohns disease is receiving treatment with intravenous antibiotics. Over the past 72 hours he has complained of intermittent dysphagia and odynophagia.

What is the most likely diagnosis?

A

Oesophageal Candidiasis

Treatment with systemic antibiotics may result in candidiasis

205
Q

A 78-year-old lady presents 6 years following a successfully treated squamous cell carcinoma of the oesophagus. She has a long history of dysphagia but it is not progressive

What is the most likely diagnosis?

A

Post radiotherapy fibrosis

SCC of the oesophagus is commonly treated with chemoradiotherapy. Fibrosis and dysphagia may occur in survivors.

206
Q

A 32-year-old lady presents with dysphagia. She has a 10 year history of anaemia secondary to menorrhagia and has been strongly resistant to treatment

What is the most likely cause?

A

Plummer Vinson syndrome

Triad of dysphagia, iron-deficiency anaemia and oesophageal webs

207
Q

What is the triad for Budd-Chiari syndrome?

A

Sudden onset abdominal pain
Ascitis
Tender hepatomegaly

208
Q

What is gallstone ileus?

A

A gallstone enters the small intestine and lodges in the ileocaecal valve

Symptoms - Episodes of RUQ colicky pain, severe abdoinal pain and vomiting, not passing stool or flatulence for > 48 hours

209
Q

Why do coeliac patients require regular immunisations?

A

Functional hyposplenism

210
Q

What should anyone diagnosed with Type 1 diabetes or an autoimmune thyroid disease also be screened for?

A

Coeliac disease - its associated with both of them

211
Q

How do you differentiate between type one and type type hepatorenal disease?

A

Speed of onset

Type 1 - rapid onset , typically occurs following an acute event

Type 2 - more gradual , associated with refractory ascites

212
Q

What does refractory ascites mean?

A

Its ascites that cannot be resolves by high dose diuretics and low sodium diet

213
Q

How do you distinguish between natural immunity and vaccination for Hepatitis B?

A

Vaccination only provides anti-HBs antigen
Natural immunity due to prior infection will also show Anti-HBc antigen is positive on blood test

214
Q

What is the pattern of overflow diarrhoea?

A

Long periods of constipation relieved by watery foul smelling diarrhoea

215
Q

What is the treatment for Overflow diarrhoea?

A

Faecal disimpaction

216
Q

What is the ‘double duct’ sign?

A

Dilation of both the common bile duct and pancreatic duct. Present in both Pancreatic Cancer and Cholangiocarcinoma

217
Q

What are some risk factors for developing oesophageal cancer ( Adenocarcinoma )

A

GORD
Overweight
Smoking history

218
Q

What is the cell type change seen in Barret’s Oesophagus? ( metaplasia )

A

Squamous epithelium changes to simple columnar epithelium

219
Q

In which IBD are crypt abscesses seen?

A

UC

220
Q

What is the most important lifestyle management to prevent the progression of NAFLD?

A

Weight loss

221
Q

What is the management for a liver abscess?

A

Drainage and antibiotics

222
Q

What is the expected iron profile study with Haemochromatosis?

A

Raised Trasferrin saturation
Raised Ferritin
Low Total Iron Binding Capacity ( TIBC )

223
Q

Which test shows a current infection with C. Difficile?

A

Stool C.Difficile toxin

224
Q

What is the Primary Biliary Cholangitis M rule to suspect it?

A

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

225
Q

What site is most commonly affected by Crohn’s?

A

Ileum

226
Q

What test is recommended to see H.Pylori eradication therapy was effective?

A

Urea breath test

227
Q

What is the first line treatment for primary biliary cholangitis?

A

Ursodeoxycholic acid

228
Q

Which antibiotic is most closely associated with a C. Diff infection?

A

Clindamycin

229
Q

What is Carcinoid Syndrome?

A

A type of neuroendocrine tumour that produces vasoactive amines ( 5-HT, NA, Dopamine ) , peptides ( bradykinin ) and prostaglandins

230
Q

What symptom/signs does Carcinoid syndrome present with?

A

Abdo pain
Diarrhoea
Facial flushing
Bronchospasm
Tachycardia

231
Q

A 78-year-old lady presents with episodic dysphagia and halitosis, occasionally she complains of regurgitation. A recent attempted upper GI endoscopy was poorly tolerated and abandoned.

What is the likely diagnosis?

A

Pharyngeal pouch

232
Q

An overweight 56-year-old man with longstanding Barrett’s oesophagus complains of worsening dysphagia to solids over the past 6 weeks.

What is the likely diagnosis?

A

Adenocarcinoma of the oesophagus

233
Q

A 24-year-old man complains of occasional retrosternal chest pain and dysphagia that occurs to both liquids and solids. He is otherwise well.

A

Achalasia

234
Q

What must be assessed in patients before stating azathioprine?

A

Thiopurine Methyltransferase (TPMT) activity

This is the enzyme that metabolises azathioprine. People with a deficiency are at greater risk of side effects so should be avoided in them.

235
Q

What are the two most common causes of lower abdominal pain in young men?

A

Appendicitis
Testicular problem ( Infection and Torsion )

ALWAYS important to to scrotal exam in male with lower abdo pain

236
Q

What is the AST/ALT ratio in Alcoholic Hepatitis ?

A

2:1

237
Q

What type of anaemia can Sulphasalazine cause?

A

Haemolytic Anaemia ( Heinz bodies on smear )

238
Q

What is the treatment for Wilson’s Disease?

A

Penicillamine

239
Q

What pharmocological therapy is used in the management of severe Alcoholic hepatitis?

A

Corticosteroids

240
Q

What is Murphy’s Sign?

A

Arrest of inspiration on palpation of RUQ + in Acute Cholycystitis

241
Q

What deficiencies is Coeliac Disease associated with?

A

Iron
Folate
B12

242
Q

What are the risk factors for Scurvy ( Vit C deficiency )

A

Low income background
Elderly
Alcoholics
Poor diet

243
Q

What are the symptoms of Scurvy?

A

Lethargy
Arthralgia
Easy bruising
Bleeding Gums

244
Q

What is the first line treatment for Haemochromatosis?

A

Venesection

245
Q

What is the second line treatment for Haemochromatosis?

A

Desferrioxamine ( Iron chelating agent )

246
Q

A 24-year-old smoker presents with intermittent diarrhoea for the past 6 months. She feels bloated, especially around her periods. Bloods tests are normal.

What is the most likely diagnosis?

A

IBS

247
Q

A 23-year-old student is admitted due to a two-week history of bloody diarrhoea. He is normally fit and well and has not been abroad recently. His CRP is raised at 56 on admission.

What is the most likely diagnosis?

A

Ulcerative Colitis

248
Q

A 72-year-old woman presents with a two day history of diarrhoea and pain in the left iliac fossa. Her temperature is 37.8ºC. She has a past history of constipation.

What is the most likely diagnosis >

A

Diverticulitis

249
Q

What is Fetor Hepaticus?

A

A sweet, fecal smell to the breath

It is a late sign of liver failure

250
Q

If a pregnant lady presents with abdo pain and pruritis what diagnosis should you consider?

A

Acute fatty liver of pregnancy

251
Q

What causes the pruritus seen in liver diseases?

A

Hyperbilirubinaemia

252
Q

Are the levels of bilirubin correlated to the severity of the pruritus ?

A

No , they just cause it

253
Q

What are important gastro symptoms to ask about?

A

Malignancy ( Weight loss, Night sweats, Unexplained fever, Lethargy )
Mouth ulcers
Tenesmus
Hematochezia
Pain when passing stool
Waking up to go to toilet
N+V
Urinary symptoms

254
Q

How is nutritional status assessed?

A

MUST Score

-BMI
-Measure % of unplanned weight loss in past 3-6 months
-Add 2 points if patient is acutely ill/ no nutrional intake for 5 days

255
Q

What dietary measures can be used to manage malnutrition?

A

Food chart
Oral supplements
NG Feeding
Parenteral feeding ( only if there is complete obstruction in GI tract )

256
Q

What investigations should be done to investigate IBD?

A

Bloods ( FBC, U&Es, CRP )
Stool sample ( Parasites, Calprotectin )
Flexible sigmoidoscopy if neg stool culture
Anti-TTG ( Coeliac Screen )
TFTs
MRI Enterography for Small Bowel Crohn’s
AXR if Toxic Megacolon suspected

257
Q

What features can help differentiate Crohn’s and Ulcerative Colitis?

A

Crohn’s
-Can affect whole GI Tract
-Skip lesions
-Transmural inflammation
-Worse prognosis for smokers
-Fistulae/perforation

Ulcerative Colitis
-Always affects rectum and only colon
-Continuous inflammation
-Mucosal and Submucosal inflammation only
-Better prognosis for smokers
-

258
Q

What are some differentials for someone presenting with PR bleed?

A

Malignancy
Infection ( C.Difficile, E.Coli, Shigella, Campylobacter )
IBD
Diverticulitis
Haemorrhoids
Peptic Ulcer Disease/ Oesophageal Varices ( severe)

259
Q

What should be asked in the history of a patient with suspected liver disease?

A

Symptoms
-Vomiting blood
-Pruritus
-Loss of appetite
-Confusion
-Swelling ( Ascites)

Alcohol use
Sexual history
IVDU
Blood transfusions prior to 1990
FHx

260
Q

What clinical findings would you look for on examination of a liver disease patient?

A

Palmar Erythema
Dupytren’s Contracture
Clubbing
Hepatic Flap
Jaundice
Ascites
Caput Medusa
Spider Naevi
Positive Fluid Thrill
Easy bruising

261
Q

What important investigations should be done for suspected Liver disease?

A

Liver Screen ( Hep B&C, Iron studies, AMA, SMA, Immunoglobulins)
FBC ( Reticulocyte count)
Bilirubin ( Conjugated and unconjugated )
Alpha-a-antitrypsin
Coeliac Screen
TFTs
Lipids/Glucose
LFTs ( ALT,ASP,AST )
DEXA scan
Alpha Fetoprotein
Fibroscan
Endoscopy ( Varices )
Abso USS

262
Q

What are common differentials for a patient presenting with jaundice?

A

Pre-hepatic - Haemolytic anemia
Intra-hepatic - Cirrhosis, Hepatitis, Drugs, Pregnancy, Congenital
Post-hepatic - Cholestatic ( Gallstones, Biliary Colic, Acute Cholecystitis, Ascending Cholangitis), Acute Pancreatitis, Pancreatic Cancer

263
Q

What are key investigations for a patient presenting with jaundice?

A

USS of biliary tree
Bloods - FBC, LFTS, U&Es, Clotting
Haemolysis Screen

264
Q

Why might a patient with chronic liver disease be malnourished?

A

Decreased oral intake ( early satiety due to ascitic compression)
Fat malabsorption ( decreased bile salt production)
Hepatic shift from glycogenolysis to gluconeogenesis ( due to decreased hepatocyte mass, caused lipopenia and sarcopenia)

265
Q

How do you manage malnourishment in a chronic liver disease patient?

A

-Referral to dietician
-Increase caloric intake to prevent muscle tissue being used for energy

266
Q

How should alcohol withdrawal be managed in patients being admitted to hospital?

A

High risk - medically assisted withdrawal
Offer Benzodiazepine/ Carbamezapine to prevent siezures

267
Q

What can be offered as an alternative to Benzodiazepine/ Carbamezapine with alcohol withdrawal if its not tolerated well?

A

Clomethiazole

268
Q

What services/ treatments are available to help patients with alcohol addiction?

A

Disulfram
Local Alcoholic Support Services ( e.g AA )
Benzodiazepenes

269
Q

What scoring system is used to determine the likelihood of someone in withdrawal having seizures?

A

GWAMS score

270
Q

What long-term complications of cirrhosis should a patient be monitored for?

A

Oesophageal Varices
Hepatic Encephalopathy
Hepatocellular Carcinoma
Ascites
Osteoporosis

271
Q

What is NASH?

A

Non-Alcoholic Steatohepatitis

Liver inflammation and hepatocyte damage caused by build up of fat on liver, leads to CLD

272
Q

What symptoms are associated with Paracetamol poisoning?

A

Abdo pain
Nausea
Vomiting
Jaundice
Encephalopathy

273
Q

What investigations should be arranged for a Paracetamol overdose?

A

Blood Paracetamol concentration
Patient’s Weight
FBC, INR, U&Es, LFTs
VBG

274
Q

How long should you wait to test a person’s blood paracetamol concentration after last ingestion?

A

4 hours

275
Q

What clinical tools should be used to determine specific treatment for Paracetamol overdose?

A

TOXBASE

NPIS ( severe)

276
Q

What is the treatment for Paracetamol overdose?

A

Acetylcysteine

If patient consumed more than 12g give activated charcoal

277
Q

What is the mechanism of action of Acetylcysteine?

A

It replaces Glutathione levels, preventing oxidative damage to liver. Overdose leads to the production of the toxic metabolite NAPQI. This causes direct oxidative damage to hepatocytes ( Lipid peroxidation, protein damage, DNA damage)

278
Q

What scoring system is particular for Paracetamol overdose?

A

King’s College Criteria

279
Q

What is the criteria for safe discharge of this patient?

A

-Paracetamol concentration below the treatment line
-Normal INR and ALT
-Asymptomatic
-Normal Creatinine

280
Q

What are the possible differentials of malnutrition?

A

IBD
Eating Disorder
Malignancy
Coeliac’s
Low Income
Depression
Alcohol Abuse
Dentition Issue

281
Q

How is malnutrition best managed?

A

-Gradual reintroduction of food back into diet
-Can be oral, enteral or paraenteral
-Monitoring

282
Q

What is refeeding syndrome?

A

A rapid increase in blood sugar and insulin leading glycogen, fat and protein synthesis.
These processes utilise phosphate, magnesium and potassium from already depleted body stores, resulting in electrolyte abnormalities

283
Q

What are the risk factors for Refeeding Syndrome?

A

-BMI < 16
-Unintentional weight loss >15% in 3-6 months
-10 or more days with little or no nutritional intake

284
Q

What is the first line treatment for C.Diff?

A

Oral vancomycin 10 days

285
Q

What is the criteria for the severity of a UC flare up?

A

Truelove & Witts

286
Q

What is Gallstone Ileus?

A

A small bowel obstruction secondary to an impacted gallstone

287
Q

What markers are used to monitor treatment in Haemochromatosis?

A

Ferritin
Transferrin Saturation

288
Q

What are some side effects of aminosalicylates?

A

Diarrhoea
Nausea
Vomiting
Exacerbation of colitis
In occasional cases, it can cause acute pancreatitis

289
Q

Which medication helps prevent an oesophageal varices bleed taking place ? ( Prophylaxis )

A

Propanolol ( Non-Cardioselective B-Blocker)

290
Q

What type of cancer does Barrett’s Metaplasia predispose a patient to?

A

Adenocarcinoma of the oesophagus

291
Q

What can some complications of a life-threatening C. Difficile infection?

A

Sepsis
Toxic Megacolon
Ileus

292
Q

What are the ALARMS symptoms where someone should be referred for Upper GI Endoscopy?

A

Anaemia
Loss of weight
Anorexia
Recent onset of progressive sx
Mass/malaena/haematemesis
Swallowing difficulties

Or if above 55

293
Q

What is the advice for Alcohol consumption in a NON pregnant person?

A

Maximum 14 units spread over 3 or more days

294
Q

How much alcohol is 14 units?

A

6 Pints
6 Medium glasses of wine

295
Q

What is Courvoisier’s Law ?

A

If gallbladder is palpable in a painlessly jaundiced patient, it is unlikely to be due to gallstones.

This is because stones would have given rise to chronic inflammation and subsequently fibrosis of gallbladder therefore, rendering it incapable of dilatation.

Gallbladder is palpable due to build up of bile ( obstruction) so presume pancreatic cancer or biliary neoplasm

296
Q

Why can Oesophageal Cancer present with hoarseness of voice?

A

Compression of the Recurrent Layngeal Nerve

297
Q

What is the treatment for B12 and folate deficiency?

A

IM B12 replacement
A loading regime followed by 2-3 monthly injections

Then later give Folate

298
Q

Why must you give Vitamin B12 replacement before folate replacement?

A

If given the other way round it can precipitate subacute combined degeneration of the cord

299
Q

How does bile acid malabsorption present?

A

Watery green diarrhoea

300
Q

How do you treat bile acid malabsorbtion?

A

Cholestyramine

301
Q

What are risk factors for developing gallstones?

A

Increasing age
Family history
Sudden weight loss
Loss of bile salts - eg, ileal resection, terminal ileitis ( Crohn’s Disease)
Diabetes - as part of the metabolic syndrome.
Oral contraception

302
Q

IBD and the billiary tree:
Crohns gives stones
UC gives PSC (Primary sclerosing cholangitis)

A

Useful ;)

303
Q

What abnormalities are associated with Carcinoid Syndrome?

A

Right side of heart is affected

TIPS
Tricuspid Insufficiency
Pulmonary Stenosis

304
Q

What medication is contraindicated in absolute constipation?

A

Metoclopramide - stimulates peristalsis in the bowel so could lead to a perforation
Can be useful in subacute obstruction

305
Q

What is the management for Alcoholic Ketoacidosis?

A

IV Saline 0.9%
Thiamine

306
Q

If a patient’s UC flare up extends past the left-sided colon ( e.g Ascending Colon) then what should be used to induce remission?

A

Oral AND Rectal Aminosalicylate

307
Q

What is a good way to remember Truelove & Witt UC Criteria?

A

Mild >4 stools a day
Moderate 4-6 stools a day
Severe >6 stools a day + Systemic Features ( Pyrexia, Tachycardia, Anaemia, Raised Inflammatory Markers)

MILD = 4 Letters
SEVERE = 6 Letters

308
Q

What is the first line imaging for the investigation of perianal fistula in Crohn’s?

A

MRI Pelvis

309
Q

Which antibiotics are strongly linked to C.DIfficile infections?

A

4 Cs

Clindamycin
Cephalosporins ( Ceftriaxone)
Co-Amoxiclav
Ciprofloxacin

310
Q

What does coffee-ground vomit suggest?

A

Perforated Gastric Ulcer

311
Q

What is the key investigation for suspected perforated Peptic Ulcer?

A

Erect Chest X-Ray

Can detect free air under diaphragm ( pneumoperitoneum). This is indicative of GI Tract perforation

312
Q

What is the treatment for a Pharyngeal Pouch?

A

Surgical repair and resection

313
Q

What is Sister Mary Joseph nodule?

A

Protrusion of the umbilicus with a small hard swelling palpable lateral to it

314
Q

What does Sister Mary Joseph nodule indicate?

A

A sign of metastasis to periumbilical lymph nodes, classically from a Gastric Carcinoma

315
Q

What is the most commonly affected area in UC?

A

Rectum

316
Q

What is a common side effect of Metoclopramide?

A

Diarrhoea

317
Q

Why does metoclopramide cause Diarrhoea?

A

It’s a prokinetic antiemetic , meaning it promotes peristalsis

318
Q

What is the surgical treatment for Achalasia?

A

Heller Cardiomyotomy

319
Q

In Refeeding Syndrome, which electrolyte disturbance can cause Torsades de Pointes?

A

Hypomagnesaemia

320
Q

Which deficiencies causes Angular Stomatitis?

A

Iron
Zinc
B Vitamins (B2,B3,B6,B9,B12)

321
Q

What malignancy does Achalasia increase the likelihood of?

A

Squamous Cell Carcinoma of the oesophagus

322
Q

What is Zollinger-Ellison Syndrome?

A

Multiple gastro-duodenal ulcers causing abdo pain and diarrhoea

323
Q

Why can PPIs cause muscle aches?

A

They can cause hypomagnesaemia, which can cause muscle weakness. Usually after long term use

324
Q

What is the first line treatment for IBS?

A

According to prominent symptom

Pain- Antispasmodic agents
Constipation - Laxative ( Avoid Lactulose)
Diarrhoea ( Loperamide)

325
Q

What is the gold standard for diagnosis of Coeliac’s ( Imaging) ?

A

Crosby Capsule biopsy, done in the Jejunum or Duodenum ( Where villous atrophy would be seen)

326
Q

What conditions are associated with H.Pylori?

A

Peptic Ulcer Disease
Gastric Adenocarcinoma
B Cell Lymphoma of MALT tissue
Chronic Gastritis

327
Q

How does Loperamide work to slow down bowel movements?

A

u-opioid receptor agonist

328
Q

Why is ferritin not necessarily a reliable marker for Iron Deficiency Anaemia?

A

Ferritin is an acute phase protein so it is raised in inflammatory conditions as well, TIBC is more reliable

329
Q

A WCC higher than what indicates a severe C . Difficile infection?

A

15

330
Q

A transjugular intrahepatic portosystemic shunt procedure connects which two vessels?

A

A transjugular intrahepatic portosystemic shunt (TIPS) procedure connects the hepatic vein to the portal vein

331
Q

What can Magnesium replacement tablets cause?

A

Diarrhoea

332
Q

What should be done for dysplasia in Barrett’s Oesophagus?

A

Endoscopic radiofrequency ablation
Mucosal Resection

333
Q

Why is high urea indicative of an Upper GI Bleed?

A

High urea is indicative of a ‘protein meal’, as urea is a major nitrogenous waste product of protein metabolism within the liver. It is a result of gut bacteria breaking down blood proteins as they move through the GI tract.

334
Q

What is the criteria for Acute Liver Failure?

A

Kings College Criteria

335
Q

What is a gastrointestinal complication of Diabetes?

A

Autonomic neuropathy -> Gastroparesis

336
Q

What are the symptoms of Gastroparesis?

A

Nausea
Vomiting
Early satiety
Diabetes

337
Q

Which tumour marker monitors response to treatment forColorectal Cancer?

A

CEA

338
Q

When PT is prolonged ( >14) what should be given in haematemesis?

A

I.V Vitamin K

339
Q

What is the treatment for Shigella?

A

Ciprofloxacin and IV fluids

340
Q

What infection most commonly predisposes Guillain-Barré syndrome?

A

Campylobacter jejuni

341
Q

What is the treatment for Carcinoid tumours?

A

Octreotide

342
Q

What is the treatment for SBP?

A

Tazocin (Piperacillin/Tazobactam) and Human Albumin Solution

343
Q

What is the treatment for Gastroparesis?

A

Domperidone

344
Q

Which GI Infection causes rose coloured macules on the chest and abdomen?

A

Salmonella Typhi

The rose-coloured macules are bacterial emboli to the skin

345
Q

What is Zollinger-Ellison caused by?

A

Excess gastrin secretion from gastrinoma -> multiple stomach and duodenal ulcers

346
Q

What is the test for Carcinoid Syndrome?

A

Raised urinary 5-HIAA level

This is a breakdown product of 5-HT, that is initially produced by the carcinoid tumour in excess

347
Q

What is the incubation period from exposure of Hepatitis A?

A

2-6 weeks

348
Q

What is the triple eradication therapy recommended for H.Pylori infection?

A

Amoxicillin, clarithromycin and omeprazole for 7 days

349
Q

What is the triple eradication therapy recommended for H.Pylori infection if the patient is Penicillin allergic?

A

Metronidazole, clarithromycin and omeprazole for 7 days

350
Q

In what cancers is CA 19-9 a tumour marker for?

A

Cholangiocarcinoma
Pancreatic cancer
Gastric cancer

351
Q

What is the triad of Pellagra?

A

Dermatitis
Dementia
Diarrhoea

352
Q

What is the management of rectal Crohn’s Disease?

A

Perianal Metronidazole

353
Q

What is the symptoms of Vitamin A Deficiency called?

A

Xerophthalmia

354
Q

What are the symptoms of Xerophthalmia?

A

Dry eyes ( conjunctiva and cornea)
Corneal Ulcers

355
Q

What is Vitamin B1 deficiency called? ( Thiamine )

A

Beriberi

356
Q

What are the symptoms of Beriberi?

A

Inflammation of nerves -> difficulty walking
Heart failure
Associated with alcholics

357
Q

What is Vitamin D deficiency called?

A

Rickets

358
Q

What is PBC?

A

PBC is due to chronic inflammation and scarring of the bile ducts leading to progressive and irreversible damage

359
Q

What are the clinical features of a carcinoid tumour?

A

Flushing
Diarrhoea
Hypotension
Wheezing

360
Q

What do carcinoid tumours release?

A

5-HT
Prostaglandins
Kinins
Substance P
Gastrin

361
Q

What are on the King’s College Criteria of paracetamol od? ( Require urgent liver transplant)

A

pH < 7.3

or ALL of these

Creatinine > 300
Prothrombin Time > 100 secs
Grade III or IV encephalopathy

362
Q

What rash is associated with Coeliac’s ?

A

Dermatitis Herpetiformis

Itchy vesicular rash on elbows

363
Q

What is Vitamin C deficiency called?

A

Scurvy

‘sCurvy’

364
Q

What are the investigation findings of Wilson’s Disease?

A

Low serum ceruloplasmin
Low copper levels

This is because copper is deposited preferentially in the tissues ( liver, eyes, CNS )

365
Q

What are the investigation findings of PBC?

A

Raised ALP
Raised AMA

366
Q

What is the treatment for peptic ulcer disease?

A

PPI for 4-8 weeks

367
Q

What are the symptoms of Vitamin A deficiency?

A

Night blindness
Bitot’s spots ( white spots on the conjunctiva)
Dry skin

368
Q

How does Staphylococcus Enteritis (Staph Aureus) present?

A

Following consumption of unpasteurized milk
Within 1-6 hours on ingestion due to preformed toxin

369
Q

What is the management of high grade dysplasia of the oesophagus? ( Barrett’s Oesophagus)

A

Endoscopic ablation

370
Q

What is a high SAAG ( Serum-Ascites Albumin Gradient)?

A

> 1.1g/dL

indicates portal hypertension

371
Q

How does Octeotride work?

A

Somatostatin analogue ( GnRH ) . This blocks the release of serotonin and counters its peripheral effects

372
Q

What is a Creon supplement used for?

A

Pancreatic Insufficiency

e.g Chronic Pancreatitis, Pancreatic Cancer, Cystic Fibrosis

373
Q

What are the differences between the Viral Hepatitis types?

A

Hepatitis A and E - acute liver failure
Hepatitis B and C - chronic liver failure
Hepatitis D - only occurs in individuals with Hep B

374
Q

What autoantibodies are raised in Autoimmune Hepatitis?

A

Anti-Smooth muscle antibodies
ANA

375
Q

What type of laxative is Macrogrol?

A

Osmotic

376
Q

What are the reversible complications of Haemochromatosis if treated with venepuncture?

A

Skin discolouration
Cardiomyopathy

377
Q

What should be co prescribed with opioids?

A

Senna ( stimulative laxative )
As constipation is such a common side effect

378
Q

When a patient is on Warfarin and has a major bleed, what should be done?

A

If INR is raised (>1.2)

5mg of vitamin K IV as well as prothrombin complex concentrate (PCC) to reverse the anticoagulation

379
Q

What HBV serology indicates you have either an acute or chronic infection?

A

HBsAg

380
Q

Which HBV Serology indicated you have either had the vaccine or the infection and are now immune?

A

Anti-HBsAg

381
Q

Which HBV Serology indicates you have an acute infection?

A

Anti-HBcAg IgM

382
Q

Which HBV Serology indicates you have either the chronic or previous infection and is now immune ? This one appears last

A

Anti-HBcAg IgG

383
Q

What is the best marker of acute liver failure?

A

Prothrombin time - short hlaf life

384
Q

What test confirms H.Pylori eradication?

A

Urea breath Test , only needed if symptoms are still present

Medicine Block Year 3 (12 decks)

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