Gastroenterology/ Surgery Flashcards
What is the Ix of Carcinoid tumour?
Urinary 5-Hydroxyindoleacetic acid (5-HIAA)
What age and risk factor for NAFLD?
Middle aged, obese woman
What 4 risk factors for oesophageal candidiasis?
What is a main symptom
HIV, hep C and immunocompromised patients
Complication of inhaled steroid therapy
Pain on swallowing (odynophagia)
Symptoms of achalasia
Dysphagia to both liquids and solids
What is Zollinger-Ellison syndrome?
Which MEN?
Dx?
Gastroduodenal ulcers, epigastric pain, diarrhoea
Occurs as part of MEN type I
(hyperparathyroidism)
Dx: fasting gastrin levels, secretin stimulation test
What is the triad for Plummer-Vinson syndrome?
+ Rx
- Dysphagia (secondary to oesophageal webs)
- Glossitis
- Iron deficiency anaemia
Rx: Iron supplementation and dilation of webs
Triad for Budd-Chiari Syndrome
1) Sudden abdominal pain
2) Ascites
3) Tender hepatomegaly
Triad for mesenteric ischaemia
1) CVD (esp AF)
2) High lactate (due to the acute infarction of tissue)
3) Soft but tender abdomen
What medication would you give for H.pylori eradication?
PPI + amoxicillin + clarithromycin
OR
PPI + metronidazole + clarithromycin
Standard diagnostic procedure for Primary sclerosing cholangitis
MRCP or ERCP
Patient with painless obstructive jaundice
Pancreatic cancer
ALP - indicates bile or liver issue?
Bile duct
Which blood test is a useful diagnostic marker of HCC?
AFP (alpha-fetoprotein)
What is Peutz-Jeghers syndrome?
- hamartomatous polyps in GI tract (mainly small bowel)
- pigmented lesions on lips, oral mucosa, face, palms and soles
- Autosomal dominant condition
What is Sister Mary Joseph node?
A palpable nodule in the umbilicus due to metastasis of malignant cancer within the pelvis or abdomen
What will U&Es show in upper GI bleed?
High Urea
What is first line treatment for mild/moderate UC?
Topical (rectal) aminosalicylates
What is the 1st line investigation for mesenteric ischaemia?
Lactate
What is the first-line for treatment of diarrhoea in IBS?
Loperamide
What is Globus pharyngis/ globus hystericus?
The persistent sensation of having a ‘lump in the throat’, when there is none. Symptoms are often intermittent and relieved by swallowing food or drink. Swallowing of saliva is often more difficult.
What will Serum Copper and Serum Caeruloplasmin be in Wilson’s disease?
Urine?
Serum Copper - decreased
Serum Caeruloplasmin - decreased
(serum is lower as the copper is taken into cells)
Urine Copper excretion increased
How many weeks should you stop taking PPT before endoscopy?
stopped at least 2 weeks prior to the endoscopy as it could mask serious underlying pathology such as gastric cancer.
Can PPI’s cause hypo or hypernatraemia
hypo or hyper magnesaemia?
PPIs can cause hyponatraemia
hypomagnesaemia
Treatment for severe alcoholic hepatitis
Corticosteroids (Prednisolone)
What is gallstones associated with?
Pick one: crohns, UC, Sudden weight gain…
CROHNS
Crohn’s disease can result in terminal ileitis, this is the section of the bowel where bile salts are reabsorbed. When this area is inflamed and the bile salts are not absorbed and people are prone to development of gallstones.
Ischaemic colitis presentation and predisposing factors
Ischaemic colitis is the most likely diagnosis given this man’s classic presentation (after a meal, intermittent and severe pain, pain out of proportion to clinical findings) and given his predisposing factors (prev. myocardial infarction, atrial fibrillation, hypertension).
What is a prophylaxis of oesophageal bleeding?
Propranolol- non-cardioselective B-blocker (NSBB)
What type of dysphagia cause has an increased risk of adenocarcinom of the oesphagous?
Squamous cell carcinoma?
Barrett’s oesophagus increases the risk of oesophageal adenocarcinoma AND GORD
Achalasia increases the risk of squamous cell carcinoma of the oesophagus.
What vitamin deficiency can Isoniazid cause?
vitamin B6 deficiency causing peripheral neuropathy
What is the treatment for hepatorenal syndrome?
Terlipressin and Albumin
Liver cirrhosis investigation of choice
Transient elastography
What abdo condition should metoclopramide be avoided in?
Bowel obstruction
How many weeks before do you have to stop antibiotic and PPI use before doing a urea breath test?
Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks
What is the triad for Boerhaave syndrome
And who is it more common in?
Vomiting, thoracic pain, subcutaneous emphysema
Alcohol abusers
Pernicious anaemia
Vit B12 deficiency
ethargy, weakness
dyspnoea
paraesthesia
also: mild jaundice, diarrhoea, sore tongue
possible signs: retinal haemorrhages, mild splenomegaly, retrobulbar neuritis
The loss of vibration sense occurs due to low B12 levels, they can also cause reflex loss or weakness.
Drugs that can cause cholestasis
COCP
antibiotics: flucloxacillin, co-amoxiclav, erythromycin
Sulphonylureas
Cholestatic jaundice, evidenced by her liver function tests (LFTs), dark urine and pruritis.
Oestrogens in the combined oral contraceptive pills (COCP) reduce the excretion of bile acids and conjugated bilirubin from the hepatocytes into the canaliculi, resulting in a build-up within the hepatocytes and diffusion into the bloodstream and what is known as intra-hepatic jaundice.
What medications increases the risk of C.diff infection?
Clindamycin, cephlosporins (cef), PPIs
Mechanism of how loperamide works
Stimulation of μ-opioid receptors in the submucosal neural plexus of the intestinal wall. This, in turn, reduces peristalsis of the intestines decreasing gastric motility.
What would you see in histology for gastric cancer?
Signet ring cells
In autoimmune hepatitis type 1, what antibodies will be present?
What is the management?
Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA)
Steroids
Fetor hepaticus, sweet and fecal breat - is a sign of?
Liver failure
Treatment for hepatic encephalopathy
Lactulose [1st line] + with rifaximin for the secondary prophylaxis of hepatic encephalopathy
lactulose is thought to work by promoting the excretion of ammonia and increasing the metabolism of ammonia by gut bacteria
antibiotics such as rifaximin are thought to modulate the gut flora resulting in decreased ammonia production
Mild UC with a colonoscopy showing inflammatory changes in the ascending, transverse and descending colon - what is the management
In a mild-moderate flare of ulcerative colitis extending past the left-sided colon, oral aminosalicylates should be added to rectal aminosalicylates, as enemas only reach so far
Pigment laden macrophages suggestive of melanosis coli
on histology is indicative of?
Laxative abuse
Patients who are elderly, have neurological conditions, or chronic constipation are at higher risk of recurrent …
sigmoid volvulus
Ix for acute pancreatitis
Serum Lipase
Treatment of Gastric MALT lymphoma
Eradicate H. pylori
What is Charcot’s cholangitis triad?
fever, jaundice and right upper quadrant pain
How does biliary colic present?
colicky right upper quadrant abdominal pain
worse postprandially, worse after fatty foods
the pain may radiate to the right shoulder/interscapular region
nausea and vomiting are common
Scoring system for pancreatitis prognostic factor
P - PaO2 <8kPa
A - Age >55-years-old
N - Neutrophilia: WCC >15x10(9)/L
C - Calcium <2 mmol/L
R - Renal function: Urea >16 mmol/L
E - Enzymes: LDH >600iu/L; AST >200iu/L
A - Albumin <32g/L (serum)
S - Sugar: blood glucose >10 mmol/L
What is the intervention of choice in patients with malignant distal obstructive jaundice due to unresectable pancreatic carcinoma?
Biliary stenting
What is Acute cholecystitis treatment?
Intravenous antibiotics + early laparoscopic cholecystectomy within 1 week of diagnosis
What biliary condition is Crohn’s associated with?
Gallstones
What is the most common causative agent of ascending cholangitis?
E.coli
What is Pigmented gallstones most associated?
Pigmented gallstones are primarily made of bilirubin and are associated with hemolytic anemia (e.g. sickle cell anaemia) and liver cirrhosis
What is the preferred diagnostic test for chronic pancreatitis?
CT pancreas - looking for pancreatic calcification
Acute cholecystitis vs Acute cholangitis
Right upper quadrant (RUQ) pain, fever and raised inflammatory markers suggests acute cholecystitis or ascending cholangitis. The abnormal liver function tests (LFTs) suggest ascending cholangitis rather than cholecystitis (according to Charcot’s triad of RUQ pain, fever and jaundice for cholangitis).
Are ileostomy sprouted or not?
An ileostomy is spouted to prevent the surrounding skin from coming into contact with the alkaline enzymes in the small intestine, whilst colostomies are flat
painful, bright red, rectal bleeding
anal fissure
Anal verge cancer
Abdomino-perineal excision of rectum
How to treat sigmoid volvulus
rigid sigmoidoscopy with rectal tube insertion
Diverticular disease symptoms
Altered bowel habit
Bleeding
Abdominal pain
cancer in the rectum: what type of surgery
Anterior resection
Cancer of Sigmoid colon: what type of surgery
High anterior resection
Distal transverse, descending colon cancer: what type of surgery
Left hemicolectomy
Caecal, ascending or proximal transverse colon cancer: what type of surgery
Right hemicolectomy
What are most colorectal cancers?
adenocarcinoma
What is loop ileostomy?
Loop ileostomy is a method to divert bowel contents away from a distal anastomosis. It is often indicated in rectal cancers. Reversal of the ileostomy restores bowel continuity and improves the patient’s overall quality of life.
