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AMK > Gastroenterology / GI surgery > Flashcards

Gastroenterology / GI surgery Flashcards

1
Q

Px of ulcerative colitis

A

chronic inflammation of the large bowel

abdominal discomfort,
bloody diarrhoea, tenesmus

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2
Q

what is seen on imaging and bloods in UC

A

loss of haustral markings = lead pipe
continuous inflammation

raised fecal calprotectin

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3
Q

Mx of acute UC

A
  1. IV hydrocortisone
  2. ciclosporin/inflixamab
  3. surgery
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4
Q

Mx of mild/moderate UC

A
  1. mesalazine
  2. prednisolone
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5
Q

what is seen on Ix in Crohns

A

high fecal calprotectin
skip lesions, cobblestone appearance
non-casaeated granulomas

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6
Q

IBS Px

A

abdominal pain, discomfort. worse after eating, relieved by defecation.

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7
Q

what infection causes pseudomembranous colitis?
what is seen on imaging
Mx

A

C diff infection!!!
Raised yellow plaques
ABs: vancomycin

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8
Q

Ix in celiac disease

A

Anti TTG IgA antibodies
B12, folate deficiencies, IDA

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9
Q

Zollinger Ellison Syndrome pathophis + assoc.

A

gastrinoma (neuroendocrine tumour in the duodenum)
results in hypersecretion of gastrin + gastric acid; and peptic ulcer disease
not relieved by PPI
associated with MEN1

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10
Q

gold standard diagnosis for ZES

A

secretin stimulation test

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11
Q

wilsons disease pathophys, symptoms, Ix

A

copper deposition in tissues
jaundice, akinesia, tremor
low ceruloplasmin and low serum copper

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12
Q

Hereditary Haemochromatosis
pathophys, symptoms, Ix

A

iron deposition in tissues
bronzed skin, joint pain, liver cirrhosis
high serum ferritin+transferrin

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13
Q

Haemochromatosis Mx

A

lifestyle changes (avoid iron supplements, vitamin C)
phlebotomy in later stages

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14
Q

Charcots triad

A

ascending cholangitis/Biliary obstruction:
1. RUQ pain
2. jaundice
3. fever

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15
Q

ascending cholangitis
px, ix, mx

A

infection of the biliary tree
Px: charcots triad
Ix: MRCP
Mx: antibiotics,drainage, ERCP to remove blockage, treat systemic illness

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16
Q

difference between primary biliary cholangitis and primary sclerosing cholangitis

A

PBC = more women, PSC = more men
PSC associated with IBD e.g. UC
PBS = chronic inflammation of the biliary tree
PSC = chronic fibrosis and scarring of the biliary tree

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17
Q

anti mitochondrial antibodies are raised in:

A

Primary biliary cholangitis

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18
Q

painless rectal bleeding

A

haemorrhoids

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19
Q

murphys sign positive

A

on inspiration the inflamed gallbladder moves up and can be palpated, causing pain
Acute cholecystitis

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20
Q

RUQ pain, radiates to the shoulder
Fever, raised CRP, WBC

A

Px of acute cholecystitis

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21
Q

Mx of acute cholecystitis

A

cholecystectomy

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22
Q

what do you see on US in acute cholecystitis

A

thickened gallbladder wall
Gallbladder distension

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23
Q

Causes and Px and Ix of acute pancreatitis

A

alcohol, gallstones
RUQ pain, relieved when sitting forwards, worse after a meal
High lipase & amylase, hypocalcemia

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24
Q

Mx of pancreatitis

A

fluid resus (crystalloid)
analgesia

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25
Q

irregular border of enlarged, tender liver
deranged LFTs
weight loss

A

hepatocellular carcinoma

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26
Q

Rovsing’s sign positive

A

appendicitis
pain on the right side when the left iliac fossa is palpated

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27
Q

rigid abdomen, rebound tenderness

A

peritonitis, infection due to perforation

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28
Q

Appendicitis pain

A

peri-umbilical pain spreading to the right iliac fossa

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29
Q

Trousseu’s syndrome

A

migratory thrombophlebitis
repeated venous thromboembolism in the peripheries
associated with pancreatic/gastric cancers etc

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30
Q

common cause of sigmoid volvulus

A

chronic constipation in older patient.
causes bowel to weight down and twist -> volvulus

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31
Q

sign of sigmoid volvulus

A

coffee bean sign on xray

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32
Q

signs of peritonitis

A

rebound tenderness
percussion tenderness

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33
Q

positive urea breath test indicates:

A

H pylori

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34
Q

ulcer. better after eating, worse when hungry

A

duodenal ulcer

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35
Q

which hernia is more common in older people and trauma

A

direct

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36
Q

which hernia is more likely to be strangulated

A

indirect

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37
Q

Mx of suspected bowel obstruction

A

insert NG tube
CT abdomen & erect chest x ray
barium enema
surgical exploration

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38
Q

imaging used for penumoperitoneum

A

use erect chest x ray

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39
Q

severe retching and vomiting, now presenting with chest pain and haemodynamic instability

A

boerhaave syndrome

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40
Q

definitive treatment of primary sclerosis cholangitis

A

liver transplant

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41
Q

anal fistula presentation

A

an abnormal tract that connects the anal canal to the perianal skin
peri-anal discharge, itchiness, pain, swelling

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42
Q

Peutz-jeghers syndrome

A

autosomal dominant
colonic polyps + mucocutaneous hyper pigmented macules

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43
Q

what drug is used to maintain IBD remission

A

azathioprine

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44
Q

Mx of relatively stable patient with suspected bowel obstruction

A

Ng tube, abdominal CT

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45
Q

what antibody is raised in PBC and PSC

A

PBC: anti mitochondrial
PSC: anti smooth muscle and pANCA

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46
Q

what antibody is raised in celiac disease

A

anti-endomysial

47
Q

cause of secondary achalasia

A

Chagas disease
infection causing destruction of myenteric plexus

48
Q

two types of oesophageal cancer, which is more common

A

squamous cell
adenocarcinoma

adenocarcinoma is more common

49
Q

achalasia

A

failure of lower oesophageal sprinter to relax

50
Q

where in the oesophagus are the two types of cancer found?

A

SCC: proximal 2/3
adenocarcinoma: distal 1/3

51
Q

cause of stress ulcers

A

ischemia, sepsis, shockl

52
Q

cause of curlings ulcers

A

severe burns, trauma

53
Q

cause of cushings ulcers

A

intracranial injury

54
Q

where in the stomach are h pylori ulcers most commonly found

A

antrum

55
Q

FAP

A

familial adenomatous polyposis
development of hundreds of polyps in the colon
100% risk of colorectal cancer if untreated
Require panprotolectomy

56
Q

Garnder syndrome

A

FAP + bone cancer

57
Q

Turcot syndrome

A

FAP + CNS cancer

58
Q

Lynch syndrome

A

Hereditary Non Polyposis Colorectal Cancer

59
Q

indications for liver transplant in primary sclerosing cholangitis

A

recurrent bacterial cholangitis
intractable pruritus

60
Q

what is plummer vinson syndrome and what does it increase the risk of

A

iron deficiency anaemia
oesophageal web
dysphagia

increased risk of pharynx or oesophageal carcinoma

61
Q

budd chiari syndrome

A

hepatic venous outflow obstruction

62
Q

Mx of budd chiari

A

mild: anticoagulation, TIPSS
severe: liver transplant

63
Q

Px of budd chiari

A

RUQ pain, worsening
young, no history, COCP
gets bad quickly - ascites

64
Q

where is zollinger ellison syndrome

A

duodenum

65
Q

Mx of haemorrhoids

A

Injection sclerotherapy

66
Q

pre existing malaria is caused by

A

plasmodium vivax

67
Q

where is b12 absorbed from

A

terminal ileum

68
Q

where is thiamine absorbed from

A

proximal small intestine (jejunum)

69
Q

differences between crohns and UC: inflammation

A

crohns: transmural
UC: mucosal

70
Q

crypt abscesses are present in

A

UC

71
Q

rose thorn ulcers are present in

A

crohns

72
Q

causes of direct inguinal hernia

A

weakness in abdominal muscle, acquired

73
Q

causes of indirect inguinal hernia

A

congenital

74
Q

contents of the inguinal canal in men

A

spermatic cord
ilioinguinal nerve

75
Q

contents of inguinal canal in females

A

round ligament of the uterus
genital branch of the genitofemoral nerve
ilioinguinal nerve

76
Q

grey turner sign

A

retroperitoneal haemorrhage
flank ecchymosis

77
Q

cullen sign

A

peri-umbilical ecchymosis
ectopic pregnancy/acute pancreatitis

78
Q

localised peritonitis can be caused by…

A

inflammation of an abdominal organ

79
Q

global peritonitis can be caused by…

A

result of a viscus perforation

80
Q

gold standard diagnosis for achalasia

A

oesophageal manometry

81
Q

bacterial overgrowth syndrome
pathophis and Px

A

overgrowth of colonic bacteria
- steatorrhoea (bacteria break down conjugated bile salts, fat can’t be absorbed)
- microcytic anaemia (bacteria use too much b12)
diarrhoea

82
Q

difficulty swallowing liquids before solids caused by?

A

neuromuscular issue
e.g. oesophageal dysmotility, achalasia

83
Q

difficulty swallowing solids before liquids caused by?

A

mechanical obstruction
oesophageal stricture

84
Q

mcburneys point

A

1/3 of the way from ASIS to umbilicus

85
Q

what requires a 5 yearly colonoscopy

A

low risk
1/2 adenomas <10mm

86
Q

what requires a 3 year colonoscopy

A

intermediate risk
3/4 <10mm
1/2 >10mm

87
Q

what requires a 1 yearly colonoscopy

A

high risk
5/6 <10mm
3/4 >10mm

88
Q

where does diverticulitis commonly occur

A

sigmoid and descending colon
left side

89
Q

what drug is used for secondary prevention of bleeding oesophageal varices

A

propanolol

90
Q

Mx of neuroendocrine tumour (gastronome)

A

octeotride (somatostatin)

91
Q

Autoimmune hepatitis first line Mx

A

Azathioprine
Prednisolone

92
Q

colostomies usually have….faeces

A

solid

93
Q

ileostomies usually have …. faeces

A

liquid

94
Q

how much alcohol is one unit

A

10ml of pure alcohol

95
Q

how many units is 1 pint of 5% beer

A

3 units

96
Q

moa of cyclizine

A

H2 receptor anatagonist

97
Q

moa of metaclopramide

A

D2 receptor antagonist

98
Q

moa of haloperidol

A

d2 antagonist

99
Q

moa of hyoscine

A

MAChr antagonist

100
Q

moa of odansetron

A

5-HT3 receptor antagonist

101
Q

what structures are cut through during a midline incision

A

Skin, Camper’s fascia, Scarpa’s fascia, linea alba, transversalis fascia, extraperitoneal fat, peritoneum

102
Q

PSC is associated with what antibody rise

A

Anti smooth muscle antibody

103
Q

Abx for sbp

A

Pip taz

104
Q

hemochrombtosis Mx

A

venesection
chelation (desferroxamine)

105
Q

small bowel bacterial overgrowth syndrome Ix

A

hydrogen breath test (fasted pt given glucose drink, bacteria in bowel will metabolised this and produce Hydrogen, can be measured during exhalation)

small bowel aspiration and culture

106
Q

3 risk factors for small bowel overgrowth syndrome

A

diabetes
scleroderma
neonates with congenital GI abnormlaities

107
Q

Mx of small bowel overgrowth syndrome

A

rifampicin

108
Q

bloody stool and abdominal pain after travelling from abroad

A

campylobacter jejuni

109
Q

non bloody diarrhoea and nausea and abdominal pain after travelling

A

e coli

110
Q

how to tell the difference between femoral and inguinal hernias

A

femoral hernia: inferolateral to the pubic tubercle

inguinal hernia: superomedial to the pubic tubercle

111
Q

Courvoisiers law

A

in the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones . it is probably a malignant obstruction of the bile duct

112
Q

whipples procedure..what is it, indication, complications

A

pancreaticoduodenectomy
used to treat pancreatic cancer (resectable head of pancreas tumours)

Complications: dumping syndrome (food moves too fast into stomach: abdominal pain and cramps)
marginal ulcer (ulcer that forms at the site of anastamosis)

113
Q

how to classify ascites

A

SAAG (serum ascites albumin gradient) >11 = portal hypertension, so likely to be cirrhosis as the cause

114
Q

management of inguinal hernia (2)

A

mesh repair

hernia truss if not fit for surgery

AMK (29 decks)

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