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IK6 - Exams > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Is PSC or PBC associated with IBD?

A

Primary sclerosing cholangitis (PSC)

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2
Q

What disease is associated with IBD?

A

Primary sclerosing cholangitis

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3
Q

Is PSC associated with IBD?

A

yes

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4
Q

Is PBC associated with IBD?

A

no

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5
Q

what is the typical PBC patient?

A

middle aged woman presenting with: pruritus + jaundice + pigmentation

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6
Q

What is the typical PSC patient?

A

usually the middle-aged man presenting with: pruritus + jaundice + abdominal pain

raised ALP, negative AMA
associated with IBD

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7
Q

features of Crohn’s disease

A

mouth - anus can be affected
weight loss, diarrhoea, abdo pain, strictures, fistulae

cobble-stoning (barium), rose-thorn ulcers, granulomas

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8
Q

features of UC

A

colon only
diarrhoea + blood/mucus
fever, tachycardia, toxic megacolon in severe acute UC

barium: loss of haustra, sigmoid - oedematous, friable mucosa

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9
Q

what does elevated AST and ALT with AST > ALT suggest?

A

alcoholic hepatitis/liver dysfunction

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10
Q

what does elevated AST and ALT with ALT > AST suggest?

A

viral hepatitis

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11
Q

What would a raised GGT and ALP suggest?

A

bile obstruction

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12
Q

what is the pathophysiology of achalasia?

A

ganglion cell degeneration in the mesenteric plexus. this leads to loss of inhibitory cells causing over stimulation of the LOS and failure to relax -> dysphagia

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13
Q

what are the most common causes of ascending cholangitis?

A

gallstones or strictures (benign or malignant in the bile duct)

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14
Q

what are the forms of alcohol liver disease?

A

alcoholic fatty liver
alcoholic hepatitis
chronic cirrhosis

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15
Q

what are the presentations of decompensated liver failure?

A

jaundice
ascites
hepatic encephalopathy
variceal haemorrhage

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16
Q

what 2 antibiotics are generally used to cover GI organisms?

A

cefuroxime and metronidazole

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17
Q

what are the major types of autoimmune hepatitis?

A

TYPE 1 - 80%, classic
all ages, mainly young women. ANA, ASMA, AAA, anti-SLA

TYPE 2 - young girls w/ other autoimmune disease (e.g. thyroid). ALKM-1 antibodies and ALC-1 antibodies

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18
Q

what are the changes that occur in Barret’s oesophagus?

A

the normal squamous epithelium is replaced by columnar epithelium

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19
Q

what are the symptoms of GORD?

A

heartburn
nausea
water-brush
bloating, belching
burning pain on swallowing
dry cough at night

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20
Q

what is a cholangiocarcinoma?

A

it is a primary adenocarcinoma of the biliary tree

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21
Q

what is the association with cholangiocarcinoma?

A

generally a rare condition but related to parasite infections

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22
Q

whats the most common type of gallstone?
what are the other types?

A

most common = mixed stone

pure cholesterol stone, pigment stones

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23
Q

what might cause cholecystitis in the absence of a gallstone?

A

starvation
TPN
narcotic analgesia
immobility

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24
Q

what kind of gallstones are haemolytic anaemias such as sickle cell a risk factor for?

A

pigment stones

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25
Q

how would you manage cholecystitis?

A

if just biliary colic advise low fat diet

acute cholecystitis -> analgesia, anti-emetics, NMB, IV fluids, antibiotics if signs of infection

cholecystectomy (open or laparoscopic), either elective or urgent

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26
Q

what is the difference between compensated and decompensated cirrhosis?

A

in compensated the patient has clinical and histological findings of cirrhosis but synthetic function of liver is intact

in decompensated cirrhosis the synthetic function of the liver is impaired with complications

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27
Q

what are the most common causes of cirrhosis?

A

alcoholic liver disease (2nd to alcoholism)
chronic hepatitis C or B infections

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28
Q

causes of cirrhosis?

A

alcohol
autoimmune - AI hepatitis, PBC, PBC
viral - hepatitis B + C
drugs - amiodarone, methotrexate
genetic - haemochromatosis, wilson’s, alpha-1 anti def
Budd-chiari syndrome
NASH

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29
Q

what clotting factors are made by the liver?

A

2, 7, 9, 10

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30
Q

what is the worst Child-Pugh grading for cirrhosis?

A

stage C

(A is the mildest), scores > 8 mean high risk for bleeds

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31
Q

what procedure might help reduce portal HTN?

A

TIPS procedure

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32
Q

what is the definitive treatment for cirrhosis?

A

liver transplant

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33
Q

what are the common causative organisms of SBP?

A

E. coli and kleibsella

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34
Q

what is coeliac disease?

A

when T cells respond to gluten causing an intolerance reaction which over time leads to villous atrophy, crypt hyperplasia and malabsorption

lose immune tolerance to gliadin peptide antigens

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35
Q

what skin condition is a sign of coeliac disease?

A

dermatitis herpetiformis

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36
Q

what is the most common type of colon cancer?

A

adenocarcinoma

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37
Q

what is the typical presentation of a left sided malignancy?

A

PR bleeding + mucus
altered bowel habit
tenesmus/ PR mass
less common - obstruction

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38
Q

what is the typical presentation of a right sided malignancy?

A 
constitutional symptoms (FLAWS) 
iron deficiency anaemia 
weight loss 
abdominal pain/discomfort in the lower abdo (rare)
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39
Q

what is the tumour marker for colon cancer?

A

CEA

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40
Q

what might be seen on barium enema in patients with colon cancer?

A

apple core lesions

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41
Q

where does colon cancer often metastasis to?

A

liver
lung
bone

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42
Q

what is a sister mary joseph nodule a sign of?

A

metastatic abdominal cancer

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43
Q

what are common triggers for GORD?

A

hot drinks
alcohol
citrus fruits
tomatoes
fizzy drinks
spicy foods
coffee
chocolate

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44
Q

what pharmacological therapy can be given to GORD patients?

A

antacids and alginates (gaviscon) from OTC

PPI (lansoprazole 30mg) up to twice a day 
H2 antagonist (ranitidine) if incomplete response to PPI
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45
Q

what are the causes of a bloody infectious diarrhea?

A

CHESS

Campylo
entamoeba Histolytica
E. coli
Shigella
Salmonella

46
Q

what might cause large bowel perforation?

A

diverticulitis
colon cancer
appendicitis
volvulus
toxic megacolon (UC)

47
Q

what might cause gastric or duodenal perforation?

A

duodenal or gastric ulcer perforation
gastric cancer

48
Q

what might cause small bowel perforation?

A

in general very rare
trauma
infection (TB)
crohns

49
Q

what investigation is performed if you suspect oesophageal rupture?

A

gastrograffin swallow

50
Q

what blood results would one expect in haemochromatosis?

A

raised serum iron
raised ferritin
low transferrin
low total iron binding capacity

51
Q

what are the grades of haemorrhoids?

A

1 - protrude into anal canal
2 - protrude beyond anal canal, spontaneously reduce
3 - protrudes and required manual reduction
4 - protrudes and irreducible

52
Q

what is the management of haemorrhoids?

A

reduce straining and time on low, increase fibre + fluids, stool softeners

1 - topical corticosteroids
2 + 3 - band ligation
4 - surgical haemorrhoidectomy

53
Q

what is the leading cause of HCC?

A

chronic hepatitis infection

54
Q

what is acute mesenteric ischaemia?

A

acute thrombo-embolic occlusion of the SMA

55
Q

what is ischaemic colitis?

A

inflammation of the colon due to reduced blood supply

56
Q

what is the stool test for IBD?

A

faecal calprotectin

57
Q

what is the most common liver disease in the developed world?

A

non-alcoholic steatohepatitis

58
Q

what is the difference between NAFLD and NASH?

A

NASH has hepatocyte degeneration as well as lobular infiltrates with steatosis

biopsy of liver may be required to confirm diagnosis between the 2

59
Q

what are the causes of acute pancreatitis?

A

GET SMASHED

Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion bite
Hyperlipidaemia, hypercalcaemia, hypothermia
ERCP and emboli
Drugs

60
Q

what are pre hepatic causes of portal HTN?

A

thrombosis
congenital stenosis or atresia
extrinsic compression

61
Q

what are hepatic causes of portal HTN?

A

cirrhosis
schistosomiasis
sarcoidosis
myeloproliferative disease
congenital hepatic fibrosis

62
Q

what are post hepatic causes of portal HTN?

A

Budd-Chiari syndrome
right heart failure
constrictive pericarditis
veno-occlusive disease

63
Q

what infection may occur with hepatitis B?

A

hepatitis D

64
Q

which hepatitis does hepatitis D occur with?

A

hep B

65
Q

what hepatitis is most likely to cause:

a) acute infection
b) chronic infection

A

a) hepatitis A
b) hepatitis C

hep B can be either

66
Q

what is the treatment for chronic hepatitis?

A

interferon alpha

67
Q

which hepatitis do traveller usually get?

A

hep A

68
Q

what hepatitis is associated with shellfish?

A

hep A

69
Q

what is hepatitis E similar to?

A

hep A

70
Q

which vitamins are fat soluble?

A

A D E K

71
Q

what are the signs of chronic liver disease?

A

ABCDEFGHIJ+S

asterixis
bruising
clubbing
dupuytren’s contracture
palmar erythema
fetor hepaticus

gynaecomastia
hair loss
icterus/jaundice

spider naevi
leukonychia (due to hypoalbuminaemia)

72
Q

causes of hepatomegaly

A

3 C’s and 1 I

cancer - primary or mets
cirrhosis - early on
cardiac - CCF, constrictive pericarditis

Infiltrative: fatty infiltrate, haemochromatosis, amyloidosis, sarcoidosis, lymphoproliferative diseases

73
Q

causes of jaundice

A

AADVM

alcohol
autoimmune
drugs
viral
biliary disease

74
Q

causes of splenomegaly

A

HI HI

H- portal HTN
Haematological - lymphoproliferative diseases, myeloproliferative diseases or haemolytic anaemia

Infection: TB, brucellosis
infiltration: chronic inflammatory conditions (sarcoidosis)

75
Q

differentials of epigastric pain:

A

stomach - peptic ulcer, GORD, gastritis, malignancy

acute pancreatitis
MI
ruptured aortic aneurysm
cholecystitis
hepatitis

76
Q

differentials for RUQ pain

A

cholecystitis, cholangitis, gallstones (biliary colic)

hepatitis, abscess

basal pneumonia
appendicitis (retro-caecal or pregnancy more likely)

peptic ulcer
pancreatitis
pyelonephritis

77
Q

differentials for right iliac fossa pain

A

appendicitis
mesenteric adenitis
colitis (IBD)
malignancy

ovarian cyst rupture
ovarian cyst twist
ovarian cyst bleed
Ectopic Pregnancy

testicular torsion
hernia

78
Q

differentials of suprapubic pain

A

cystitis
urinary retention

testicular torsion/referred pain from epidiymis-orchitis

79
Q

differentials for left iliac fossa pain

A

diverticulitis
colitis (IBD)
malignancy

ovarian cysts rupture/twist/bleed
Ectopic Pregnancy

testicular torsion
hernia

80
Q

diffuse abdominal pain

A

Bowel obstruction
peritonitis
gastroenteritis
IBD
mesenteric ischaemia

DKA, Addison’s, hypercalcaemia

porphyria, lead poisoning

81
Q

causes of an ascitic transudate?

A

low protein level

cirrhosis
cardiac failure

82
Q

causes of an ascitic exudate

A

high protein level

malignancy in the abdomen, pelvis or peritoneum
infection = TB, pyogenic (cause formation of pus)

nephrotic syndrome (this is only because overall albumin is low)

budd-chiari syndrome
portal vein thrombosis

83
Q

What does the celiac artery supply?

A

stomach
spleen
liver
gallbladder
part of the duodenum

84
Q

what does the superior mesenteric artery supply?

A

small intestine
right colon

85
Q

what does the inferior mesenteric artery supply?

A

left colon

rectum is supplied by a branch of the iliac artery

86
Q

differentials for abdominal distention

A

THE 5 F’S

fluid (ascites)
flatus
fat
faeces
foetus

87
Q

causes of bloody diarrhoea

A

infective colitis (campylobacter, E.coli, entaemoeba histolytica, salmonella, shigella)

inflammatory colitis (young)
ischaemic colitis (older)
diverticulitis
malignancy

88
Q

What might cause a pre-hepatic jaundice?

A 
increased haemolysis (e.g. haemolytic anaemia) 
Gilbert's syndrome (reduced glucuronidation)
89
Q

what might cause a hepatic jaundice?

A

hepatitis (autoimmune, alcohol, drugs, viruses)

90
Q

what might cause a post-hepatic jaundice?

A

gallstones in the common bile duct
stricture
cancer of pancreas head

91
Q

What does thumb-printing on an AXR suggest?

A

mucosal oedema

92
Q

What does featureless colon on an AXR suggest?

A

IBD

93
Q

What medications should be given to patients presenting with variceal bleeding due to portal HTN?

A

terlipressin - induces splanchnic vasoconstriction reducing pressure in the portal system

Antibiotics -> taxosin

94
Q

How would you manage a patient with an acute abdomen?

A

INVESTIGATIONS
bloods: FBC, U&Es, LFTs, CRP, G&S, clotting, x-match
erect CXR
may need CT

MANAGEMENT PLAN

  1. monitor vitals and urine output
  2. NBM and fluids
  3. analgesia
  4. anti-emetics
  5. Abx - cephalosporins, metronidazole
95
Q

how would you manage a patient with ascites?

A

diuretics (spironolactone +/- furosemide)
dietary sodium restrictioni
fluid restrict if hyponatraemic
monitor weight daily

therapeutic paracentesis (drainage) with IV human albumin

96
Q

How would you manage a patient present with hepatic encephalopathy?

A

lactulose (reduce gut transit time)
phosphate enemas
avoid sedation

treat any infection and exclude a GI bleed

97
Q

what is the presenting complaint for an anal fissure/

A

severe pain on defecating
stool coated with small amount of bright red blood

98
Q

What would you tell a patient with anal fissure and what might you prescribe?

A

increase fibre and fluid in their diet
GTN cream to vasodilate vessels improving blood flow to promote healing

99
Q

what cancer is pernicious anaemia a RF for?

A

gastric cancer

100
Q

what are the characteristic features of haemolytic uraemic syndrome?

A

microangiopathic haemolytic anaemia (MAHA)
acute renal failure (AKI)
thrombocytopenia

101
Q

hernia superior and medial to pubic tubercle

A

inguinal hernia

102
Q

location of superficial ring

A

half way between ASIS and pubic tubercle

103
Q

differentiating direct and indirect inguinal hernia

A

direct

  • medial to interior epigastric vessels
  • not controlled by cough impulse

indirect

  • lateral to inferior epigastric vessels
  • controlled by pressure over the superficial ring
104
Q

describe the serum ascites albumin gradient

A
105
Q

what primary care test must be done prior to ?IBD diagnosis?

A

stool culture

exclude infective reason

106
Q

ddx day 1 post-op acute abdomen

A

bleeding, iatrogenic perforation

107
Q

ddx day 3-4 post-op acute abdomen

A

anastomotic leak, collection, paralytic ileus

108
Q

treatment of pancreatitis due to hyperlipidaemia?

A

insulin infusion

109
Q

complications of pancreatitis

A
  • ARDS
  • Dehydration - fluid third spaced, hypovolaemia, AKI etc
  • Retroperitoneal haemorrhage
  • Necrosis of pancreas
  • Fluid collections - can become infected
  • Pseudocyst - develops after 6 weeks
    • Large collections, no real epithelial lining to the cyst hence known as pseudo
  • Chronic pancreatitis
  • Pancreatic insufficiency
110
Q

triad of AAA (rupture)

A

diffuse mid-abdominal pain + shock + pulsatile abdominal mass

111
Q

what is the management of C. DIff.

A
  • 1st episode
    • 2st line oral vancomycin for 10/7
    • 2nd line is fidaxomicin
    • 3rd line - oral vancomycin + IV metronidazole
  • life-threatening - hypotension, partial/complete ileus, toxic megacolon, CT severe
    • oral vancomycin + IV metronidazole
    • specialist surgical consult

IK6 - Exams (24 decks)

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