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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 stool 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
irregular border of enlarged, tender liver deranged LFTs weight loss
hepatocellular carcinoma
26
Rovsing's sign positive
appendicitis pain on the right side when the left iliac fossa is palpated
27
rigid abdomen, rebound tenderness
peritonitis, infection due to perforation
28
Appendicitis pain
peri-umbilical pain spreading to the right iliac fossa
29
Trousseu's syndrome
migratory thrombophlebitis repeated venous thromboembolism in the peripheries associated with pancreatic/gastric cancers etc
30
common cause of sigmoid volvulus
chronic constipation in older patient. causes bowel to weight down and twist -> volvulus
31
sign of sigmoid volvulus
coffee bean sign on xray
32
signs of peritonitis
rebound tenderness percussion tenderness
33
positive urea breath test indicates:
H pylori
34
ulcer. better after eating, worse when hungry
duodenal ulcer
35
which hernia is more common in older people and trauma
direct
36
which hernia is more likely to be strangulated
indirect
37
Mx of suspected bowel obstruction
insert NG tube CT abdomen & erect chest x ray barium enema surgical exploration
38
imaging used for penumoperitoneum
use erect chest x ray
39
severe retching and vomiting, now presenting with chest pain and haemodynamic instability
boerhaave syndrome
40
definitive treatment of primary sclerosis cholangitis
liver transplant
41
anal fistula presentation
an abnormal tract that connects the anal canal to the perianal skin peri-anal discharge, itchiness, pain, swelling
42
Peutz-jeghers syndrome
autosomal dominant colonic polyps + mucocutaneous hyper pigmented macules
43
what drug is used to maintain IBD remission
azathioprine
44
Mx of relatively stable patient with suspected bowel obstruction
Ng tube, abdominal CT
45
what antibody is raised in PBC and PSC
PBC: anti mitochondrial PSC: anti smooth muscle and pANCA
46
what antibody is raised in celiac disease
anti-endomysial
47
cause of secondary achalasia
Chagas disease infection causing destruction of myenteric plexus
48
two types of oesophageal cancer, which is more common
squamous cell adenocarcinoma adenocarcinoma is more common
49
achalasia
failure of lower oesophageal sprinter to relax
50
where in the oesophagus are the two types of cancer found?
SCC: upper 2/3 adenocarcinoma: lower 1/3
51
cause of stress ulcers
ischemia, sepsis, shockl
52
cause of curlings ulcers
severe burns, trauma
53
cause of cushings ulcers
intracranial injury
54
where in the stomach are h pylori ulcers most commonly found
antrum
55
FAP
familial adenomatous polyposis development of hundreds of polyps in the colon 100% risk of colorectal cancer if untreated Require panprotolectomy
56
Garnder syndrome
FAP + bone cancer
57
Turcot syndrome
FAP + CNS cancer
58
Lynch syndrome
Hereditary Non Polyposis Colorectal Cancer
59
indications for liver transplant in primary sclerosing cholangitis
recurrent bacterial cholangitis intractable pruritus
60
what is plummer vinson syndrome and what does it increase the risk of
iron deficiency anaemia oesophageal web dysphagia increased risk of pharynx or oesophageal carcinoma
61
budd chiari syndrome
hepatic venous outflow obstruction
62
Mx of budd chiari
mild: anticoagulation, TIPSS severe: liver transplant
63
Px of budd chiari
RUQ pain, worsening young, no history, COCP gets bad quickly - ascites
64
where is zollinger ellison syndrome
duodenum
65
Mx of haemorrhoids
Injection sclerotherapy
66
pre existing malaria is caused by
plasmodium vivax
67
where is b12 absorbed from
terminal ileum
68
where is thiamine absorbed from
proximal small intestine (jejunum)
69
differences between crohns and UC: inflammation
crohns: transmural UC: mucosal
70
crypt abscesses are present in
UC
71
rose thorn ulcers are present in
crohns
72
causes of direct inguinal hernia
weakness in abdominal muscle, acquired
73
causes of indirect inguinal hernia
congenital
74
contents of the inguinal canal in men
spermatic cord ilioinguinal nerve
75
contents of inguinal canal in females
round ligament of the uterus genital branch of the genitofemoral nerve ilioinguinal nerve
76
grey turner sign
retroperitoneal haemorrhage flank ecchymosis
77
cullen sign
peri-umbilical ecchymosis ectopic pregnancy/acute pancreatitis
78
localised peritonitis can be caused by...
inflammation of an abdominal organ
79
global peritonitis can be caused by...
result of a viscus perforation
80
gold standard diagnosis for achalasia
oesophageal manometry
81
bacterial overgrowth syndrome pathophis and Px
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
difficulty swallowing liquids before solids caused by?
neuromuscular issue e.g. oesophageal dysmotility, achalasia
83
difficulty swallowing solids before liquids caused by?
mechanical obstruction oesophageal stricture
84
mcburneys point
1/3 of the way from ASIS to umbilicus
85
what requires a 5 yearly colonoscopy
low risk 1/2 adenomas <10mm
86
what requires a 3 year colonoscopy
intermediate risk 3/4 <10mm 1/2 >10mm
87
what requires a 1 yearly colonoscopy
high risk 5/6 <10mm 3/4 >10mm
88
where does diverticulitis commonly occur
sigmoid and descending colon left side
89
what drug is used for secondary prevention of bleeding oesophageal varices
propanolol
90
Mx of neuroendocrine tumour (gastronome)
octeotride (somatostatin)
91
Autoimmune hepatitis first line Mx
Azathioprine Prednisolone
92
colostomies usually have....faeces
solid
93
ileostomies usually have .... faeces
liquid
94
how much alcohol is one unit
10ml of pure alcohol
95
how many units is 1 pint of 5% beer
3 units
96
moa of cyclizine
H2 receptor anatagonist
97
moa of metaclopramide
D2 receptor antagonist
98
moa of haloperidol
d2 antagonist
99
moa of hyoscine
MAChr antagonist
100
moa of odansetron
5-HT3 receptor antagonist
101
what structures are cut through during a midline incision
Skin, Camper’s fascia, Scarpa’s fascia, linea alba, transversalis fascia, extraperitoneal fat, peritoneum
102
PSC is associated with what antibody rise
Anti smooth muscle antibody
103
Abx for sbp
Pip taz
104
hemochrombtosis Mx
venesection chelation (desferroxamine)
105
small bowel bacterial overgrowth syndrome Ix
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
3 risk factors for small bowel overgrowth syndrome
diabetes scleroderma neonates with congenital GI abnormlaities
107
Mx of small bowel overgrowth syndrome
rifampicin
108
bloody stool and abdominal pain after travelling from abroad
campylobacter jejuni
109
non bloody diarrhoea and nausea and abdominal pain after travelling
e coli
110
how to tell the difference between femoral and inguinal hernias
femoral hernia: inferolateral to the pubic tubercle inguinal hernia: superomedial to the pubic tubercle
111
Courvoisiers law
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
whipples procedure..what is it, indication, complications
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
how to classify ascites
SAAG (serum ascites albumin gradient) >11 = portal hypertension, so likely to be cirrhosis as the cause
114
management of inguinal hernia (2)
mesh repair hernia truss if not fit for surgery
115
1st and 2nd line for C diff
1. oral vancomycin 2. oral fidaxomicin
116
mx of severe c diff with systemic illness
iv metronidazole and iv vancomycin
117
hypocalcemia despite calcium supplementation. which ion is deficient?
Mg
118
triple therapy for H pylori
omeprazole + amoxicillin + clarithromycin or metronidazole
119
what serious complication is assoc with clarithromycin
long QT -> tornadoes des pointes
120
Indications for oral vanc and iv metro
If they have c diff and systemic illness. Shock, intestinal obstruction, hypotension
121
prophylaxis after getting SBP
ciprofloxacin
122
Drug to manage ascites
Spironolactone
123
omeprazole rules before endoscopy
stop 2 weeks before
124
young patient with personality changes, tremors and liver disease....
wilson's disease
125
older patient with recently diagnosed diabetes, bronzed skin and liver disease
hereditary haemachormatosis
126
criteria for mild, moderate and severe UC flares
mild = <4 moderate = 4-6 severe = >6
127
Mx of severe UC flare 3 steps
1. IV steorids 2. IV ciclosporin 3. surgery
128
Most common site of inflammation for Crohn’s disease
Terminal ileum
129
Young patient with tremors, personality changes and liver disease
Wilson’s disease
130
Middle aged person with diabetes, darkened skin and liver problems
Hereditary haemochromatosis
131
gi bleed, what blood test can be used to differentiate upper vs lower
upper gi bleed has high urea
132
which nerve controls taste in posterior 1/3rd of tongue
glossopharyngeal

AMK (30 decks)

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