Gastroenterology Flashcards
1
Q
Dyspepsia (new):
Management
A
>55 OR Anaemia Loss of weight Anorexia Recent onset Melaena/haematemesis Swallowing problems --> refer for upper GI endoscopy
2
Q
H pylori regimes
A
PPI + 2 abx
PAC500
PMC250
Bd for 7 days
Review after 4w
3
Q
Melaena:
Causes
A
Peptic ulcers Mallory-Weiss Varices Drugs (NSAIDs) Dudodenitis Malignancy
4
Q
Appendicitis:
Presentation
A
Periumbilical pain moves to RIF (guarding, rebound) anorexia Vomiting Constipation Fever Tachycardia
5
Q
Leukoplakia
A
Oral musical white patch
Does NOT rub off
Refer - premalignant
6
Q
Oral hairy leukoplakia
A
Shaggy patch on sides of the tongue
In HIV
caused by EBV
7
Q
Sliding hiatus hernia
A
GOJ slides up into chest
Reflux as LES becomes less competent
Diagnose - barium swallow
Tx - lose weight, treat reflux, surgery last line
8
Q
Rolling hiatus hernia
A
GEJ remains in abdo, but stomach herniated into stomach alongside esophageal
Less common to have bad GORD
Diagnose - barium swallow
Tx - lose weight, GORD Tx, surgery last line
9
Q
Pancreatitis:
Symptoms and signs
A
Gradual or sudden severe central abdominal pain Radiates to back Alleviated sitting forward Vomiting Tachycardia Fever Jaundice Rigid tender abdo Cullen's sign Grey Turners sign
10
Q
Cullen’s sign
A
Peri umbilical bruising - sign of pancreatitis
11
Q
Grey turners sign
A
Flank bruising - in pancreatitis
12
Q
Pancreatitis:
Ix
A
Serum amylase >1000 (but can be normal) Serum lipase raised ABG - monitor O2 and acidosis AXR - no psoas shadow CXR - can exclude other causes eg perforation CT/MRI to assess severity ERCP is deteriorating LFTS
13
Q
Pancreatitis:
Management
A
Fluids Analgesia Monitor closely ERCP + gallstone removal if progressive jaundice Retreat imaging to monitor progress
14
Q
Pancreatitis:
Complications
A
Pancreatic necrosis +pseudocyst Access Bleeding/thrombosis Bowel fistulae Recurrent pancreatitis
15
Q
Glasgow Criteria for pancreatitis
A
To assess severity PANCREAS
PaO2 55 Neutrophilia Calcium Renal function Enzymes Age Sugar
16
Q
Ulcer pain relieved by eating
A
Duodenal
17
Q
Skip lesions
A
Crohn’s disease
18
Q
Painless jaundice+steatorrhea
A
Pancreatic cancer
19
Q
Post-splenectomy vaccines
A
Hib Pneumococcal Meningococcal Pen V (2 years to life) Medicard
20
Q
Peritonitis signs
A
T tenderness and tachycardia R reflex and rigidity A absent bowel sounds P pyrexia P percussion pain E extremely unwell R rovsing sign
21
Q
Gout:
Acute management
A
NSAIDS (colchicine if ulcer etc)
Intraarticular steroid injection
Oral steroids if above CI
If already taking allopurinol then continue
22
Q
Gout:
Allopurinol prophylaxis
A
Not until 2w after attack has settled
Initially 100mg then titration, aim for Uric acid
23
Q
Gout:
Allopurinol indications
A
Recurrent attacks Tophi Renal disease Uric acid stones Prophylaxis if on gout causing meds
24
Q
Ginigivitis:
Causes
A
Pregnancy
AML
Vit C deficiency
Phenytoin, cicoosporin, nifedipine
25
Gastric ulcer
Worse when eating, relieved by antacids
Weight loss
Need to biopsy if worried gastric ca
26
Duodenal ulcer
Same risk factors as gastric
| Relieved by eating or drinking milk
27
Portal hypertension:
| Causes
Prehepatic: thrombosis
Hepatic: cirrhosis, schistosomiasis
Post hepatic: buds chiari, right heart failure
28
Varicies:
| Prophylaxis
Primary: propanalol, band ligation
Secondary: TIPS, banding
29
Varicies:
| Acute bleed management
Fluid resus
Vit K if abnormal clotting, FFP, platelets
IVI terlipressin
Banding/ balloon compression
30
Hepatorenal syndrome
Cirrhosis+ascites+renal failure
Liver failure causes renal vasoconstriction even though all others are vasodilation
31
Spontaneous Bacterial Peritonitis
Sudden deterioration of patient with ascites
E. coli, klebsiella, strep
Broad spec ABx
32
Haemochromatosis:
| Signs and symptoms
```
Tiredness
Joint pain
Grey skin
Signs if liver disease
Diabetes
Hypogonadism
```
33
Haemochromatosis:
| Blood results
Raised LFTS
Raised serum ferritin
High glucose
34
Primary billiary Cirrhosis:
| Signs and features
```
Lethargy
Pruritis
⬆️ alk phos
AMA +ve
Jaundice
Pigmented skin
Hepatosplenomegaly
Hyperlipidaemia
```
35
Primary billiary cirrhosis:
| Blood results
```
⬆alk phos
️⬆GGT️
Mildly⬆ AST, ALT
⬇️albumin
️⬆Billirubin
⬆PT, immunoglobulins, cholesterol
```
36
Primary billiary cirrhosis:
| Management
Treat pruritis and diarrhea
Give vitamin DAK
Osteoporosis prophylaxis
Eventually liver transplant
37
PBC vs PSC
PSC affects intra and extra hepatic bile ducts
Only PBC has AMA
PSC 90% have IBD
PSC mainly men can also be children, PBC only adults
PSCcan cause various malignancies
38
Primary sclerosing cholangitis:
| Features
```
Pruritis
Fatigue
Often IBD
Liver disease
Male
Ascending cholangitis
```
39
Primary sclerosing cholangitis:
| Blood results
⬆️alk phos
⬆️bilirubin
Hypergammaglobuminaemia
40
Primary sclerosing cholangitis:
| Management
Management pruritis
Liver transplant for end stage
ABX for bacterial cholangitis
41
NAFLD:
| Presentation
```
Middle aged
Obese
Women
DM, dislipidaemia
Amiodarone, methotrexate, tetracycline
Raised LFTs with fatty liver on USS
```
42
Never proximal to ileocaecal valve
UC
43
Inflammation of entire colon
UC
44
UC:
| Presentation
Diarrhoea +- blood, mucus
Cramps
Frequency/urgency/tenesmus
Attacks: fever, malaise, anorexia, weight loss
Aphthous ulcers
Conjunctivitis/episcleritis/arthritis/ank spond
45
```
Goblet cell depletion
Mucosal ulcers
Crypt abscesses
Inflammatory infiltrate
Mucosal thickening/islands
```
UC
46
AXR findings for UC
No face cal shadows
Mucosal thickening/islands
Colonic dilatation
47
Colonoscopy findings for UC
```
Inflammatory infiltrate
Goblet feel depletion
Glandular distortion
Mucosal ulcers
Crypt abscesses
```
48
Complications of UC
Toxic dilation
Venous thrombosis when inpatient
Malignancy - needs regular colonoscopy
49
UC:
| Treatment
5ASAs - sufalazine
Steroids - pred (oral/suppositories for mild, enema mod)
IV hydrocortisone for severe (or rectal)
Ciclosporin or infliximab
Immunomodulation last line - azothiaprine, methotrexate
50
GI inflammation anywhere from mouth to anus
Crohns
51
Not continuous - areas of unaffected in between bowel inflammation - skip lesions
Crohns
52
Crohns:
| Symptoms
```
Diarrhea
Urgency
Weight loss
Fever malaise anorexia
Aphthous ulcers
Abdo tenderness
Perianal abscess or fistula
```
53
Crohns:
| Complication
```
Toxic dilatation
Small bowel obstruction
Access
Fistulae
Peroration
Rectal haemorrhage
Cancer
```
54
Barium enema findings for Crohns
Cobblestone
Rose thorn ulcers
Colon strictures
55
Crohns:
| Treatment
```
Pred
Or hydrocortisone if severe
Metronidazole
Infliximab
Azothiaprine/sufalazine
```
56
Painless obstructive jaundice
Carcinoma of pancrea
57
No inflammation beyond submucosa
UC
58
Acute cholecysitis:
| Presentation
```
Continuous epigastric or RUQ pain
Vomiting
Fever
Local peritonitis
GB mass
```
59
Acute cholecysitis vs billiary colic
AC is inflammatory - so raised WCC, fever, local peritonism
60
Murphys sign
Fingers over RUQ ask patient to breathe in, they stop breathing due to pain as inflamed gallbladder hits your fingers
Only positive if same in LUQ doesn't hurt
+ve shows acute cholecysitis
61
Acute cholecysitis:
| Ix
Bloods show raised WCC
| USS shows thick walled shrunken GB, pericholecystic fluid, stones,
62
Acute cholecysitis:
| Treatment
NBM
Pain relief
Broad spec eg cefuroxime
63
Chronic cholecysitis:
| Presentation
```
Chronic inflammation
Colic
Flattening dyspepsia
Abdo distention
Fat intolerance
```
64
Billiary colic:
| Presentation
RUQ pain radiating to back +-jaundice
65
Cholangitis:
| Presentation
RUQ pain, jaundice, rigors
66
Billiary colic vs acute cholecysitis vs cholangitis
Billiary colic: RUQ pain
Acute cholecysitis: RUQ pain + fever⬆️WCC
Cholangitis: RUQ pain + fever⬆️WCC + jaundice
67
Boerhaave syndrome
HSevere vomiting --> esophageal rupture
68
Plummer-Vinson syndrome
Triad of
| Dysphasia (from esophageal webs) + glossitis + IDA
69
Mesenteric ischemia:
| Presentation
Elderly patient
Vascular history/risk factors
Abdo pain, rectal bleeding, diarrhea, fever
Metabolic acidosis
70
Rovsing sign
Pressing left lower quadrant causes pain in right lower quadrant
Appendicitis
71
Hirschprungs disease
failure of mesenteric plexus to develop
Neonate so fail/delay to pass meconium or older children constipated
More common in males and downs
72
Budd-Chiari syndrome
Hepatic vein thrombosis
Usually from haematological or coagulation disorder
E.g polycythaemia, pregnancy, COCP
Sudden severe abdo pain, ascites, tender hepatomegaly
73
Cholangiocarcinoma
Persistent biliary colic symptoms
Jaundice, anorexia, weight
Palpable gallbladder (Courvosier)
74
Kantors string sign
Crohns
75
Gallstones ileus
Small bowel obstruction secondary to impacted gallstone
Abdo pain, distention, vomiting +- hx of gallstones
76
Most common travelers diarrhea
Watery stools
Cramps and nausea
E. coli
77
Infective diarrhea, prolonged non bloody
Giardia
78
Infective diarrhea
| Bloody diarrhea, vomiting and Abdo pain
Shigella
79
Infective diarrhoea
Flu symptoms then cramps Abdo pains, fever, diarrhoea
Can cause GBS
Campylobacter
80
C diff treatment
Metronidazole
81
Barium enema with loss of hays teal markings creating lead pipe colon
Ulcerative colitis
