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YEAR 3 CORRECTIONS > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What stool test gets done before deciding to refer for the colorectal cancer 2 week wait?

A

Faecal occult blood test/ FIT test

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2
Q

Which one causes pain between mesenteric ischaemia and colorectal cancer causing obstruction?

A

Mesenteric ischaemia

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3
Q

Give three scoring systems to aid with acute pancreatitis severity.

A
  1. Glasgow score
  2. Ranson score
  3. Apache II (for ICU patients)
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4
Q

Which viral hepatitis is the number one cause of HCC worldwide?

A

Hepatitis B

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5
Q

Which viral hepatitis is the number one cause of HCC in the UK?

A

Hepatitis C

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6
Q

What is the most common type of liver tumour and how is it found?

A

Liver haemangioma is benign, asymptomatic and usually found incidentally

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7
Q

Which rare liver tumour usually grows in young people with healthy livers?

A

Fibrolamellar carcinoma

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8
Q

What is the most appropriate treatment to give to a patient with an acute abdomen caused by a perforated peptic ulcer?

A

ABCDE approach. give IV fluids as they are dehydrated (made NBM) and in shock and then give IV Abx to prevent sepsis.

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9
Q

A patient has abdo pain straight to the back that is tender, with a low grade fever. What do they have?

A

Acute pancreatitis

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10
Q

A patient presents with abdo pain, ascites, tender hepatomegaly, a raised JVP, with no signs of peripheral oedema or stigmata of chronic liver disease. What do they have?

A

Budd Chiari syndrome

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11
Q

What gene is mutated in haemochromatosis?

A

HFE

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12
Q

What gene is mutated in HNPCC/ Lynch syndrome?

A

MMR (MCH1)

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13
Q

Where in the GI tract does melaena suggest bleeding in and hence what is the order of investigations the patient should have?

A

Bleed in the UPPER GI tract or right sided colon.
1. OGD
2. Colonoscopy
3. CT angiography

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14
Q

If a patient is haemodynamically unstable with a profuse lower GI bleed, which imaging investigation should they have?

A

CT angiography

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15
Q

When do you refer a patient to a 2 week wait colorectal cancer pathway without doing a FIT test?

A

A rectal/ anal mass or anal ulcer is felt/ seen on DRE

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16
Q

What is the first imaging investigation for acute cholecystitis?

A

Abdo USS

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17
Q

What is the first imaging investigation for a patient with painless rectal bleeding after DRE ?

A

Proctoscopy for haemorrhoids

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18
Q

A young man has constipation and anorectal pain that is relieved by sitting on the toilet. What is the first investigation?

A

Anal manometry

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19
Q

What is the first line imaging for pancreatic cancer?

A

2 week wait for a CT abdomen

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20
Q

A patient with low BP and acute cholangitis- what is the most appropriate management?

A

ABCDE
IV ABx and fluids
then ERCP

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21
Q

A patient has high ALP and Sjorgens syndrome. What antibodies are you looking for?

A

Antimitochondrial Ab- PBC

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22
Q

What is the stepwise investigations for acute pancreatitis?

A
  1. bloods
  2. imaging
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23
Q

What kind of SAAG picture does liver metastasis give?

A

the same SAAG picture as liver cirrhosis

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24
Q

What kind of SAAG picture does peritoneal carcinoma give?

A

SAAG <1.1g/dL - exudative picture

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25
Q

A young patient has a refractory and severe peptic ulcer disease, back pain with no NSAID use and negative H.pylori. What is the first investigation?

A

Fasting serum gastrin for Zollinger Ellison syndrome. MEN1.

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26
Q

What screening is done in patients with haemochromatosis and why?

A

Abdo USS for HCC

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27
Q

What is the next step for a patient who has taken paracetamol tablets 2 hours ago and is asymptomatic?

A

Check in 4 hours and measure serum paracetamol

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28
Q

A patient with a history of anxiety/ depression feels a lump in her throat but all investigations come back normal. What does she have?

A

Global hystericus

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29
Q

What is the first line imaging to confirm aetiology in acute pancreatitis?

A

Abdo USS to confirm diagnosis of e.g. gallstones

30
Q

For Wilson’s disease comment on:
- serum caeruloplasmin levels
- total serum copper
- urinary copper excretion
- LFTs

A
  • low serum caeruloplasmin levels
  • low total serum copper
  • high urinary copper excretion
  • raised LFTs
31
Q

What gene is mutated in Wilson’s disease?

A

ATP7B

32
Q

What is the most common cause of duodenal ulcers?

A

H.pylori

33
Q

What is the most sensitive test in detecting a hiatus hernia?

A

Barium swallow

34
Q

Name two drugs that cause deranged LFTs.

A

Amiodarone
methotrexate

35
Q

What nail changes is seen in chronic liver disease?

A

Leukonychia
due to hypoalbuminaemia

36
Q

Give an example of an osmotic laxative

A

Lactulose

37
Q

How is autoimmune hepatitis managed?

A

Steroids
Azathioprine/ cyclosporin

38
Q
A
39
Q

Name a benign liver tumour

A

Adenoma liver tumour

40
Q

Give an example of a stimulant laxative

A

Senna

41
Q

Which GI ulcers bleed more and what are they caused by?

A

Gastric ulcers > duodenal ulcers
due to NSAID use

42
Q

At what bilirubin level is jaundice clinically visible?

A

> 35

43
Q

What kind of bilirubin is absent and raised in gallstones obstructing the CBD?

A

No unconjugated bilirubin
raised conjugated bilirubin
Post hepatic obstruction

44
Q

What artery is occluded in intestinal angina/ chronic mesenteric ischaemia?

A

Superior mesenteric artery

45
Q

What artery is occluded in ischaemic colitis?

A

Inferior mesenteric artery

46
Q

What drug class is Cimetidin?

A

H2 receptor antagonist.
Inhibits stomach acid production

47
Q

What drug class is hycosine and what is it used to treat?

A

Anticholinergic
Abdo pain in IBS

48
Q

What is the earliest serological marker for acute hepatitis A?

A

IgM antibody

49
Q

What medication is avoided in reflux disorders?

A

CCBs can relax the oesophageal sphincter

50
Q

What is given to a patient with SBP with a rising creatinine?

A

Human albumin solution

51
Q

What haematological condition can predispose to Budd Chiari syndrome?

A

Polycythaemia rubra vera can lead to hepatic vein obstruction

52
Q

What can be given to treat pruritis affecting sleep?

A

Chlorphenamine (anti histamine)

53
Q

How can cirrhosis affect the kidneys?

A

Can lead to hepatorenal syndrome
Release of vasoactive mediators leads to splanchnic vasodilation, reducing blood flow to kidneys causing AKI

54
Q

Does early or late liver damage cause hepatomegaly?

A

Early -> fatty liver-> hepatomegaly
Late-> fibrosis-> small and scarred liver

55
Q

Is Crohn’s associated with HLA-B27?

A

Yes

56
Q

What is recommended for patients with Barretts with metaplasia not dysplasia seen?

A

endoscopy is recommended every 3-5 years

57
Q

What symptoms does Whipple disease produce?

A

Fat malabsorption
Steatorrhoea

58
Q

What is seen on jejunal biopsy for Whipple disease?

A

Vacuolated macrophages
Purple on periodic acid schiff stain

59
Q

What cancer gives an obstructive cancer picture with a palpable liver and abdominal discomfort?

A

Cholangiocarcinoma
HCC does not give as much of an obstructive picture

60
Q

How do you manage a high output stoma?

A

Fluid restrict
Loperamide (anti-diarrhoeal)
PPIs (reduce acid generation)

61
Q

What is an important investigation to do in a patient with acute pancreatitis progressing to ARDS?

A

ABG

62
Q

What can be inserted to treat recurrent ascites refractory to diuretics?

A

TIPS
transjugular intrahepatic portosystemic shunt

63
Q

What investigation should be done first for someone with profuse rectal bleeding and abdo pain who is unstable?

A

VBG
gives lactate level and Hb levels

64
Q

In endoscopically negative reflux disease for GORD what should be done if PPI fails?

A

Trial histamine antagonist e.g. Nizatidine

65
Q

Is odynophagia likely to be associated with cancer?

A

No

66
Q

Is there usually weight loss in IBS?

A

No

67
Q

What protein is useful in assessing severity if pancreatitis?

A

Serum albumin

68
Q

What medication can be used to treat bloating in IBS?

A

Berbeberine hydrochloride
antispasmodic effects

69
Q

What laxative can be used to treat constipation in IBS?

A

Isphaghula husk
Bulk forming laxative

70
Q

What investigation can be used to monitor the progression of non alcholic fatty liver disease before it gets to liver fibrosis?

A

Enhanced liver fibrosis blood test

71
Q

What is screened for when there is decompensation in cirrhosis without an obvious trigger?

A

HCC
using alpha fetoprotein

72
Q

What does NICE suggest should be done in primary care as part of diagnosis of IBD?

A

Stool culture

YEAR 3 CORRECTIONS (16 decks)

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