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Year 3 Semester 2 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Which biomarkers can be used to diagnose and monitor IBD?

A

Faecal calprotectin and lactoferrin

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2
Q

What is cholelithiasis?

A

Gallstones

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3
Q

What is cholecystitis?

A

Inflammation of the gallbladder

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4
Q

What is cholangitis?

A

Infection of the biliary tree

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5
Q

What are the risk factors for cholelithiasis?

A

Fat, Female, Fertile (multiple children or pregnant), Forty (or older), Fair-skinned, Family history

6 F’s

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6
Q

What is charcot’s triad for cholangitis?

A
  1. Abdominal pain
  2. High fever
  3. Jaundice
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7
Q

What is the most common cause of Budd-Chiari syndrome?

A

Polycythemia vera

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8
Q

What is the pathophysiology of Budd-Chiari syndrome?

A

Obstruction of hepatic blood outflow → hepatic venous congestion → increased sinusoidal pressure and cellular hypoxia → liver cell damage

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9
Q

What is Murphy’s sign?

A

Ask the patient to take a deep breath while palpating the right subcostal area

If pain occurs when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive

Acute cholecystitis

https://www.youtube.com/watch?v=2T0XUQ1M-x0

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10
Q

What is the most important risk factor for AAAs?

A

Smoking

Also advancing age, atherosclerosis, hypercholesterolaemia, hypertension

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11
Q

Where is splenic pain referred to?

A

Left shoulder

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12
Q

What are five clinical signs which suggest appendicitis?

A
  1. Blumberg’s sign (rebound tenderness)
  2. McBurney point tenderness
  3. Rovsing’s sign
  4. Psoas sign
  5. Obturator sign
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13
Q

What is McBurney’s sign?

A

Point tenderness in the area one-third of the distance from the right anterior superior iliac spine to the umbilicus

Suggests appendicitis

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14
Q

What is Rovsing’s sign

A

Deep palpation of the LLQ causes RLQ pain

Appendicitis

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15
Q

What is the psoas sign?

A

RLQ pain with extension of the right leg against resistance

Appendicitis

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16
Q

What is the obturator sign?

A

RLQ pain with flexion and internal rotation of the right leg

Appendicitis

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17
Q

Which 3 organisms are most commonly responsible for cholecystitis?

A
  1. E. coli
  2. Klebsiella
  3. Enterococcus
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18
Q

Name 3 of the most common organisms found in abdominal sepsis from the stomach or duodenum

A

1. Streptococcus

  1. Candida
  2. Lactobacilli
  3. Fungi
    * Aerobic species predominate*
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19
Q

Name 3 of the most common organisms found in abdominal sepsis from the bowel and appendix

A

1. E. coli

2. Bacteroides fragilis

  1. Clostridium
  2. Peptostreptococcus
  3. E. faecalis

Anaerobes predominate

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20
Q

Bowel ischaemia dramatically increases the risk of sepsis from which organism?

A

Clostridium

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21
Q

What is the empirical treatment for intra-abdominal infections of the lower GI tract e.g. diverticulitis, appendicitis

A

Gentamicin PLUS amoxicillin/ampicillin PLUS metronidazole

  • Metronidazole provides anaerobe cover*
  • G + A provide Gram -ve cover*
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22
Q

What is the empirical treatment for intra-abdominal infections originating from the biliary system?

A

Gentamicin PLUS amoxicillin/ampicillin

G + A provide Gram -ve cover

Anaerobe cover not needed

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23
Q

An increased proportion of immature neutrophils in the blood is known as a right or left shift?

A

Left shift

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24
Q

What are 4 causes of elevated LFTs in a febrile patient?

A
  1. Ascending cholangitis
  2. Bacteraemia
  3. Drug reaction
  4. Viral hepatitis (rare)
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25
Q

What type of nociceptors are most commonly involved in visceral pain and what stimulates them?

A

Mechanoreceptors

Stimulated by stretch

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26
Q

What type of nociceptors are most commonly involved in somatic pain and what stimulates them?

A

Chemoreceptors

Stimulated by blood or inflammatory cytokines

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27
Q

List 3 places in the abdomen with somatic chemoreceptors

A
  1. Skin
  2. Muscle (abdominal wall)
  3. Parietal peritoneum
  4. Mesenteric attachment
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28
Q

List 2 places in the abdomen with visceral chemoreceptors

A
  1. Muscular lumen
  2. Organ capsules
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29
Q

How do signals from abdominal visceral nociceptors enter the dorsal horn?

A

Sympathetic and parasympathetic efferent nerves

Via splanchnic nerve

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30
Q

What do Cullen’s and Grey Turner’s signs suggest?

A

Retroperitoneal bleeding

Non-specific and sensitive sign of haemorrhagic pancreatitis, but associated with a poor prognosis

Also ruptured or leaking AAA

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31
Q

What electrolyte abnormality is found in pancreatitis?

A

Hypocalcaemia

Lipase breaks down peripancreatic and mesenteric fat → release of free fatty acids that bind calcium →hypocalcaemia

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32
Q

What is the most common cause of acute pancreatitis?

A

Gallstone

Distal to the ampulla of Vater, impeding the flow of pancreatic secretions

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33
Q

Which organs are retroperitoneal?

A

SAD PUCKER

S: suprarenal (adrenal) gland

A: aorta/IVC

D: duodenum (second and third part)

P: pancreas (except tail)

U: ureters

C: colon (ascending and descending)

K: kidneys

E: (o)esophagus

R: rectum

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34
Q

What are the pancreatic enzymes?

A

Lipase

Amylase

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35
Q

What is the most common cause of small bowel obstruction?

A

Adhesions

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36
Q

What is the most common cause of large bowel obstruction?

A

Colorectal cancer

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37
Q

Where does pain from nephrolithiasis radiate?

A

Upper ureteral or renal pelvic obstruction: flank pain or tenderness

Lower ureteral obstruction: pain that may radiate to the ipsilateral testicle or labium

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38
Q

What is the most common type of renal calculi?

A

Calcium oxalate

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39
Q

Which type of renal calculi is radiolucent?

40
Q

What are the risk factors for uric acid stones?

A

Gout and hyperuricemia

High purine diet

41
Q

What causes struvite renal calculi?

A

Upper urinary tract infections with urease-producing bacteria

(Proteus mirabilis, Klebsiella, Pseudomonas, Providencia, Enterobacter)

Staghorn stones

42
Q

What are gallstones characteristically made of?

A

Cholesterol

43
Q

What causes black gallstones?

44
Q

What type of inguinal hernia herniates lateral to the inferior epigastric vessels?

45
Q

Which type of inguinal hernia involves protrustion of tissue through the internal inguinal ring, external inguinal ring and into the scrotum

A

Indirect inguinal hernia

46
Q

What are the boundaries of Hesselbach’s triangle?

A

Superior: inferior epigastric vessels

Lateral: inguinal ligament

Medial: rectus abdominis

47
Q

What is the most common cause of lower GI bleeding in adults?

A

Diverticulosis

48
Q

What is diverticulosis?

A

Asymptomatic diverticula

49
Q

When is the peak incidence of testicular torsion?

A

First 30 days of life or during puberty

50
Q

What is Prehn’s sign?

A

Relief of pain during elevation of the testes and suggests epididymitis rather than torsion

51
Q

What is the definition of overwhelming post-splenectomy infection?

A

A bacterial infection that rapidly progresses to fulminant, overwhelming sepsis in the setting of anatomic or functional asplenia

52
Q

When is the peak incidence of appendicitis?

A

10-19 years of age

53
Q

What precipitates appendicitis?

A

Obstruction of the appendiceal lumen e.g. faecal material, undigested food, enlarged lymphoid follicle

54
Q

Why do patients with appendicitis initially have diffuse periumbilical pain?

A

Obstruction of the appendiceal lumen stimulates mechanoreceptors (visceral)

55
Q

How does an obstruction of the appendiceal lumen cause bacterial overgrowth?

A

Obstruction → breakdown of mucosal barrier → bacterial invasion

56
Q

What is the characteristic US sign of appendicitis?

A

Target sign

Inflammation and oedema of the appendiceal wall causes hyperechoic and hypoechoic layers

57
Q

What finding on a FBC is classical of appendicitis?

A

Mild leukocytosis with left shift

(not required for diagnosis)

58
Q

Which antibody is most strongly associated with coeliac disease?

A

IgA anti-tissue transglutaminase

59
Q

What are the x-ray features of a SBO?

A
  1. Dilated loops of small or large bowel
  2. Air-fluid levels proximal to the obstruction
  3. Distal bowel collapse
  4. Minimal or no gas in colon
60
Q

What are the x-ray features of a LBO?

A
  1. Air-fluid levels in the colon
  2. Bowel distention before obstruction
  3. Kidney bean/coffee-bean appearance of bowel e.g. volvulus
61
Q

What are the xray features of a paralytic ileus?

A
  1. Uniform distribution of gas in the small bowel, colon and rectum
  2. Obliteration of the psoas muscle outline
62
Q
A

Large: haustra

Small: valvulae conniventes/plicae circulares

63
Q

Why might a urinalysis be performed when investigating appendicitis? What are the expected findings

A

Evaluate DDx e.g. acute UTI, nephrolithiasis

Mild pyuria may be present because of the close proximity between the right ureter and appendix

64
Q

Draw the 9 regions of the abdomen

65
Q

Where does subdiaphragmatic abdominal pain radiate?

66
Q

What can cause hyperoxaluria?

A

Dietary: beets, beans, dark green vegetables

Vitamin C supplements

Bile malabsorption and/or chronic diarrhoea

Low calcium (calcium is required for oxalate absorption, and a decrease in absorption increases renal excretion)

67
Q

When do people with an ectopic pregnancy present?

A

4-6 weeks after last period

68
Q

What is more common, gastric or duodenal ulcers?

A

Duodenal (3:1)

69
Q

What is the most common cause of peptic/duodenal ulcers?

A

H. pylori (80-90% of all ulcers)

70
Q

What is the history of pain in patients with a perforated peptic ulcer?

A

Sudden onset, intense, stabbing pain followed by diffuse abdominal pain and distention

71
Q

Which type of peptic ulcer is associated with weight gain?

A

Duodenal - pain is worst on an empty stomach

72
Q

Which type of peptic ulcer is associated with weight loss?

A

Gastric ulcer

Pain is worst post-prandial

73
Q

Which bacteria commonly causes mesenteric adenitis, mimicking appendicitis (pseudoappendicitis)?

A

Yersinia enterocoliticia

74
Q

How long following the onset of appendicitis does perforation tend to occur?

A

After 72 hours of symptom onset

75
Q

What is the most common cause of appendicitis in children?

A

Lymphoid hyperplasia

76
Q

What is the most common cause of appendicitis in adults?

A

Faecalith

Other: fibrosis, neoplasia

77
Q

What is the classic x-ray finding of gastrointestinal perforation?

A

Free intraperitoneal air

Image: pneumoperitoneum secondary to PUD

78
Q

What is Fitzhugh-Curtis syndrome?

A

Perihepatitis (extension of inflammation to the liver capsule and adjacent peritoneal surfaces)

Seen in PID

Right upper quadrant pain or pleuritic pain, no liver enzyme abnormalities

79
Q

What findings are found on auscultation of a bowel obstruction?

A

Hyperactive “tinkling” bowel sounds early in the obstruction

Later bowel sounds are reduced or absent, often in combination with a markedly distended abdomen

80
Q

Why is serum lactic acid measured in the acute abdomen?

A

Elevated in mesenteric ischaemia

81
Q

Which cause of an acute abdomen classically has increased polymorphonucleocytes? (>75%, normal (50-65%)

A

Appendicitis

82
Q

Which is a more useful clinical sign of appendicitis, migrating pain or RLQ tenderness/pain?

A

RLQ pain

Very unlikely if RLQ pain is not present

83
Q

What is the “pointing sign”?

A

Patients will point to the spot of pain in peptic ulcer disease

84
Q

What are the 4 Ds of endometriosis?

A
  1. Dysmenorrhoea (unrelieved by NSAIDs)
  2. Dysuria
  3. Dyschezia
  4. Dyspareunia
85
Q

When does pain from endometriosis occur?

A

2 days before the onset of menses

Can last for several days

86
Q

What activities are associated with rupture of an ovarian cyst?

A

Strenuous physical activities e.g. exercise or intercourse

87
Q

What is the most common cause of intestinal obstruction in patients without a history of abdominal surgery?

A

Incarcerated hernia

88
Q

A patient in pain and moving around unable to find a comfortable position is characteristic of which condition?

A

Renal colic

89
Q

What imaging is used for diverticular disease?

A

Contrast enema and colonoscopy

90
Q

What imaging is used for acute diverticulitis?

91
Q

What are some complications of diverticular disease?

A

Haemorrhage

Abscess

Perforation

Peritonitis

Fistula

Stricture

Obstruction

92
Q

Through which nerve do somatic pain signals travel from the liver capsule/falciform ligament/biliary system/central diaphragmatic peritoneum?

A

Phrenic nerve

93
Q

Through which nerve do somatic pain signals travel from the peripheral diaphragmatic peritoneum?

A

Lower 6 thoracic nerves

94
Q

Through which nerve do somatic pain signals travel from the parietal peritoneum lining the anterior abdominal wall?

A

Lower six thoracic and first lumbar nerves

95
Q

Through which nerve do somatic pain signals travel from the parietal peritoneum?

A

Obturator nerve (branch of the lumbar plexus)

Year 3 Semester 2 (7 decks)

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