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AA Y4 Finals cards NE > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

name the 1st and 2nd line treatment for moderate - severe flares of UC?

A

1st line: oral aminosalicylates (mesalazine)

2nd line: oral corticosteroid (IV if severe and admitted)

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2
Q

what does Courvoisier’s law state?

A

a palpable gallbladder in a patient with painless obstructive jaundice is most likely due to pancreatic malignancy

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3
Q

describe the triad seen in ascending cholangitis?

A

jaundice

fever

RUQ tenderness

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4
Q

what is the difference between cholangitis and cholecystitis?

A

cholangitis - inflammation of the bile ducts

cholecystitis - inflammation of the gallbladder

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5
Q

which symptoms occurring for >6mths should warrant considering IBS as a diagnosis?

A
  1. Abdominal pain
  2. Bloating
  3. Change in bowel habit
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6
Q

in addition to anti-TTG, what other marker must be looked at?

A

IgA

there is an association between coeliac disease and selective IgA deficiency

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7
Q

what is the gold standard for diagnosis in coeliac disease?

A

endoscopic intestinal biopsy

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8
Q

what type of malignancy is associated with coeliac disease?

A

enteropathy-associated T cell lymphoma

Px would present with fever, night sweats and lymphadenopathy in addition to the coeliac s/sx

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9
Q

what is the investigation of choice in suspected perianal fistulae’s in patients with Crohn’s?

A

MRI pelvis

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10
Q

where is the most common place for UC to develop?

A

the rectum

inflammation always starts at the rectum and is continuous

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11
Q

where does the inflammation always stop in UC?

A

inflammation never spreads past the ileoceacal valve

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12
Q

when is the peak incidence of UC?

A

it has 2 peaks…

15-25 years

55-65 years

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13
Q

what symptoms do the bradykinin and serotonin secreted by carcinoid tumours typically cause ?

A

flushing

diarrhoea

bronchoconstriction

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14
Q

what can be measured to identify carcinoid tumours?

A

urinary 5-HIAA

carcinoid tumours secrete serotonin

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15
Q

when should PPIs be stopped prior to an upper GI endoscopy?

A

PPIs should be stopped 2 weeks before an upper GI endoscopy

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16
Q

what does fetor hepaticus describe?

what is it a sign of?

A

fetor hepaticus = a sweet and feral breath

it is a sign of liver failure and a late sign of hepatic encephalopathy

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17
Q

what class of drug is mesalazine?

A

an oral aminosalicylate

1st line in UC

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18
Q

how is life threatening C.Diff infection treated?

A

ORAL vancomycin + IV metronidazole

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19
Q

what should be used 2nd line in C.Diff if it is not a life threatening infection?

A

2nd line: oral fidaxomicin

oral vancomycin is 1st line

fidoximycin can also be given if course of oral vancomycin doesn’t clear the C.Diff

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20
Q

what is now the most common type of oesophageal cancer?

A

adenocarcinoma

more likely to develop in px’s with GORD or Barretts

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21
Q

compare the location of squamous and adenocarcinomas in the oesophagus?

A

adenocarcinomas: near the gastrooesophageal junction
squamous: upper 2/3 of oesophagus

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22
Q

name the 2 antibodies associated with PSC?

A

ANCA

anti-smooth muscle cell antibodies

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23
Q

name the 4 signs of cholestasis seen in PSC?

A

jaundice
pruritus
raised bilirubin
ALP

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24
Q

describe BGL in alcoholic ketoacidosis?

how is it treated?

A

BGL is in the normal range

Tx = infusion of saline and thiamine

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25
Q

what is the standard procedure to visualise PSC?

A

MRCP

M for Man

compared to ERCP, it is non-invasive so it is classed as 1st line

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26
Q

what medication is used 1st line to induce remission of Crohn’s?

A

glucocorticoids (steroids)

ie- prednisolone

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27
Q

what is the definition of pernicious?

A

“causing harm, especially in a gradual or subtle way”

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28
Q

what investigation is used 1st line to Ix biliary colic?

A

Ab US

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29
Q

what is the classic triad seen in Budd chiari syndrome?

A

ab pain

ascites

tender hepatomegaly

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30
Q

what is Budd chiari syndrome usually seen in association with?

A

seen in association with an underlying haematological disease or procoag condition

eg - polycythemia rubra vera

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31
Q

what is the Ix of choice for Budd chiari syndrome?

A

US w/ doppler flow studies

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32
Q

what actually is Budd chiari syndrome?

A

hepatic vein thrombosis

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33
Q

what electrolyte imbalance can long-term omeprazole use cause?

A

hypomagnesaemia

this can cause muscle weakness

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34
Q

what can help distinguish an upper GI bleed from a lower GI bleed?

A

urea levels

high urea levels suggest upper GI bleed

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35
Q

does the presence of blood in the stool point to a diagnosis of UC or Crohn’s?

A

UC!

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36
Q

what does a combination of liver and neurological disease point towards?

A

Wilson’s disease

children usually present with liver disease 1st but young adults tend to present with neurological disease 1st

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37
Q

where is most of the copper in the brain deposited in Wilson’s disease?

A

the basal ganglia

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38
Q

other than alcohol cessation, what is the other key intervention for patients with ascites?

A

reducing dietary sodium

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39
Q

in a patient with suspected alcoholic ascites, what would a fever, ab pain and distension suggest a diagnosis of?

A

spontaneous bacterial peritonitis

tx this with IV ceftriaxone

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40
Q

what 2 vessels are connected in a trans jugular intrahepatic portosystemic shunt (TIPS)?

A

hepatic vein and portal vein

it aims to treat portal HT by making a route for blood flow to bypass the liver

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41
Q

what class of antibiotic is usually used to reduce mortality in patients with liver cirrhosis?

A

quinolones

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42
Q

what is the main complication of a TIPS procedure?

A

exacerbation of hepatic encephalopathy

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43
Q

what is given to prevent vatical bleeding in oesophageal varices?

A

propranolol

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44
Q

compare the temperatures seen in patients with mesenteric adenitis or appendicitis?

A

mild fever = appendicitis

much higher fever = mesenteric adenitis

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45
Q

what is psoas sign indicative of?

A

acute appendicitis

pain on extending the hip

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46
Q

describe how many stools quantify mild, moderate and severe UC?

A

mild: <4, small amount of blood
moderate: 4-6
severe: >6 bloody stools/day +systemic upset

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47
Q

what is the 1st line tx of mild/moderate UC?

A

rectal mesalazine

rectal mesalazine has been shown to be superior to rectal steroids and oral mesalazine

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48
Q

how does the tx of extensive mild/moderate UC differ from that which is more confined to the lower colon?

A

add in an oral mesalazine as well as the topical one

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49
Q

what is used to maintain remission in UC?

A

rectal +/- oral mesalazine

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50
Q

which gastrointestinal condition presents commonly in young females with amennorrhoea and jaundice?

A

autoimmune hepatitis

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51
Q

name the 3 main antibodies seen in autoimmune hepatitis?

A
  • anti nuclear antibodies
  • anti smooth muscle antibodies
  • LKM1 antibodies (T2 AI hepatitis, seen in kids only)
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52
Q

compare how Wilson’s disease and haemachromatosis are managed?

A

Wilson’s disease: excess copper - tx = penicillamine

haemachromatosis: venesection (excess iron)

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53
Q

what is the major copper carrying protein in the blood called?
how are it’s levels affected by Wilson’s disease?

A

major copper carrier = caeruloplasmin

in Wilson’s disease, serum caeruloplasmin is decreased

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54
Q

what is key to determining the severity of a C.Diff infection?

A

the WCC

raised but < 15x10^9 = moderate infection

> 15x10^9 = severe infection

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55
Q

what is given to manage severe alcoholic hepatitis?

A

prednisolone

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56
Q

normally, what is the ratio of AST:ALT in alcoholic liver disease?

A

AST:ALT >2

a ratio >3 is very suggestive of acute alcoholic hepatitis

GGT is always characteristically raised

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57
Q

name the only 2 conditions whereby increased ferritin levels occur with an iron overload (increased transferrin saturation)?

A
  • Primary iron overload = hereditary haemachromatosis

- secondary iron overload = following repeated transfusions

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58
Q

what is the tx of choice for barrett’s oesophagus with high grade dysplasia?

A

endoscopic mucosal resection

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59
Q

describe the cellular change seen in Barretts oesophagus?

A

squamous cells replaced by columnar epithelium

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60
Q

what pulmonary condition may sulphasalazine cause?

A

pulmonary fibrosis

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61
Q

which drug used in UC may cause pancreatitis?

A

mesalazine

pancreatitis is x7 more common in patients taking mesalazine than sulphasalazine

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62
Q

which drug used in GI can cause extrapyramidal side effects?

A

metoclopramide

acute dystonia causing oculogyric crises is most common

can also cause tardive dyskinesia

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63
Q

what is the difference in presentation of acute dystonia and tardive dyskinesia?

A

acute dystonia: most commonly causes an oculogyric crises

tardive dyskinesia: smacking of lips and licking lips

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64
Q

what 2 electrolyte imbalances can PPIs cause?

A

hyponatremia

hypomagnesia

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65
Q

what is the 1st line investigation for acute mesenteric ischaemia?

A

venous blood gas

AMI causes a raised lactate

however, CT angiography is the investigation of choice

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66
Q

what triad is seen in Plummer-vinson syndrome?

A

dysphasia

glossitis

iron deficiency anaemia

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67
Q

how can oesophageal cancer be differentiated from alchalasia on barium swallow?

A

oesophageal cancer: looks like an apple core, area of narrowing occurs in proximal oesophagus, dysphagia for solids before liquids

achalasia: birds beak sign, area of narrowing occurs distally with dilation of upper oesophagus, can present with simultaneous dysphasia to liquids and solids

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68
Q

what is a typical feature of oesophageal candidiasis?

A

pain on swallowing

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69
Q

what measurement is the most accurate determinate of acute liver failure?

A

prothrombin time

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70
Q

what does it mean if a patient is anti-HBc IgG positive?

A

the patient has developed long term antibodies to the core antigen of the virus

ie- the hepatitis is a chronic condition

71
Q

what does it mean if the patient is HBsAg positive?

A

this is the 1st marker to become positive in hep B infection

its positivity means there is an acute or chronic infection

72
Q

what is the most common cause of abdominal pain in young guys?

A

testicular problems (torsion or infection)

73
Q

what should be assessed prior to starting azathioprine?

A

TPMT activity

this is the enzyme that breaks down azathioprine - some people have a deficiency of it due to genetic mutations

74
Q

what is the most serious condition that can occur 2ndary to pernicious anaemia?

A

gastric cancer

75
Q

what is gold standard Ix for oesophageal cancer?

A

endoscopy

76
Q

what is one main differentiating factor between haemachromatosis and Wilson’s disease?

A

the age of onset:

haemachromatosis: much older (>50y/o)

Wilson’s disease: young kids and teenagers

77
Q

what 2 tests are used to monitor tx of venesection in haemachromatosis?

A

transferrin saturation and serum ferritin

78
Q

compare where the inflammation extends to in crohns and UC?

A

crohns: inflammation involves all layers of the bowel

UC: inflammation limited to submucosa

79
Q

compare bisoprolol, propranolol and metoprolol in terms of selectivity?

A

bisoprolol and metoprolol: cardioselective

propranolol: non-selective BB

propranolol is used for prophylaxis of oesophageal bleeding

80
Q

which should be replaced 1st; vit B12 or folate?

A

vit B12 always

giving folate prior to B12 can precipitate combined degeneration of the cord

81
Q

what vitamin can be given to alcoholics to reduce risk of wenickes-korsakoff syndrome?

A

vit B1 (thiamine)

82
Q

what investigation can be used to differentiate irritable bowel syndrome from inflammatory bowel disease?

A

faecal calprotectin

it is released in the bowel in the presence of inflammation (IBD)

83
Q

what is the most appropriate hepatitis serology test to use to screen patients?

A

hepatitis surface antigen

HBsAg - if it is positive, it suggests ongoing infection, which can either be acute or chronic

84
Q

which TB drug causes peripheral neuropathy?

A

isoniazid

85
Q

which TB drug causes optic neuritis?

A

ethambutol

86
Q

which TB drug causes hepatitis and arthralgia?

A

pyrazinamide

87
Q

which TB drug causes all bodily fluids to turn orange?

A

rifampicin

88
Q

what is the most appropriate management for H.Pylori eradication?

A

lansoprazole + amoxicillin + clarithromycin

89
Q

name the 2 malignancies most commonly associated with HNPCC?

A
  1. colorectal cancer

2. endometrial carcinoma

90
Q

which cancers are patients with haemachromatosis and A1 antitrypsin deficiency both at risk of?

A

hepatocellular carcinoma

91
Q

what should patients with ascites secondary to liver cirrhosis be given?

A

spironolactone

92
Q

what should be given to patients with UC who have had a severe relapse or >2 exacerbations in the last year?

A

give them oral azathioprine or oral mercaptopurine

(both are oral thiopurines

93
Q

which GI problem is H.Pylori most associated with?

A

peptic ulcer disease

95% of duodenal ulcers
75% of gastric ulcers

94
Q

which test is used to check for H.Pylori eradication?

how long prior to the test must PPIs or antibiotics be stopped?

A

urea breath test

PPIs: stopped 2 weeks before

antibiotics: stopped 4 weeks prior

95
Q

how can duodenal and gastric ulcers be differentiated?

A

duodenal: epigastric pain when hungry, relieved by eating

gastric ulcers: epigastric pain is worse when eating

96
Q

name the 2 tests associated with H.Pylori?

A
  • stool antigen

- urea breath test

97
Q

what medication is used in the management of severe alcoholic hepatitis?

A

prednisolone

98
Q

compare the drugs used to induce remission and the drugs used to maintain remission in crohns?

A

induce remission: glucocorticoids 1st line

maintain remission: azathioprine or mercaptopurine

99
Q

which drug used in crohns management may cause haemolytic Heinz body anaemia?

A

sulphasalazine

100
Q

what GI side effect can SSRIs cause?

A

peptic ulcer disease

101
Q

name the 2 LFTs that indicate hepatocellular damage?

A

the transaminases

ALT
AST

102
Q

name the 2 LFTs that are released from the cells lining the bile ducts and suggest a cholestatic disease?

A

ALP

GGT

103
Q

what complication of PSC presents with jaundice, weight loss, pruritus and biliary symptoms?

A

chloangiocarcinoma

104
Q

what Ix best confirms C.Diff infection?

A

stool C.Diff toxin

don’t confuse this with stool C.Diff antigen - positive antigen only shows exposure to the bacteria rather than current infection

105
Q

name the 2 things in LFTs that would point towards alcoholic liver disease?

A
  1. AST:ALT ratio = 2:1

2. markedly raised GGT

106
Q

which condition causes a lump in the throat? often, it is more difficult to swallow saliva than food and drink.

A

globus pharyngis

the persistent sensation of having a lump in the throat when there is none

107
Q

how can anaemia of chronic disease be differentiated from iron deficiency anaemia?

A

iron deficiency anaemia: the total iron binding capacity is HIGH

anaemia of chronic disease: the total iron binding capacity is LOW

in IDA, total iron binding capacity and ferritin would both be low, as there is a deficiency in iron

108
Q

what condition causes right sided tenderness on PR exam?

A

acute appendicitis

109
Q

what is the 1st line treatment for irritable bowel syndrome?

A

loperamide

an anti diarrhoeal

110
Q

compare the most common cause of hepatocellular carcinoma in the UK vs rest of the world?

A

UK: Hep C

Rest of world: Hep B

111
Q

what is the investigation of choice to detect liver cirrhosis?

A

transient elastography

measures the stiffness of the liver, which is a proxy for fibrosis

112
Q

what is the 1st line tx for PBC?

A

ursodeoxycholic acid

all patients with PBC, even those that are asymptomatic, should be treated with ursod acid- it has been shown to slow disease progression

113
Q

when is biologic therapy (infliximab) considered in treatment of an acute flare of crohns?

A

when the symptoms dont improve after 5 days of IV hydrocortisone

114
Q

which antibodies are most useful with investigating a B12 deficiency?

A

intrinsic factor antibodies

115
Q

compare the types of anaemia seen in coeliac and pernicious anaemia?

A

coeliac: microcytic anaemia (iron deficiency due to malabsorption)

pernicious anaemia: macrocytic anaemia (due to B12 and thiamine deficiency)

116
Q

what is the most commonly used diagnostic marker for carcinoid syndrome?

A

5 HIAA

carcinoid tumours release serotonin, so 5 HIAA will be raised

117
Q

why does Wilson’s disease cause a reduced serum copper?

A

excess copper is deposited in the tissues, which causes a low serum copper

118
Q

what is synonymous with gastric adenocarcinoma on biopsy?

A

signet ring cells

119
Q

name the triad of symptoms seen in acute liver failure?

A

encephalopathy

jaundice

coagulopathy

120
Q

what is Zollinger-ellison syndrome characterised by?

A

excessive levels of gastrin

usually from a gastrin secreting tumour of the duodenum or pancreas

associated with MEN1 syndrome

121
Q

in UC flares, which patients should have oral aminosalicylate as well as a rectal one?

A

those where the UC occurs outside the reach of enemas

ie - extending past the left sided colon

122
Q

which condition is a risk factor for bacterial overgrowth syndrome?

A

diabetes

so is systemic sclerosis

123
Q

in patients with severe UC, why is flexible sigmoidoscopy preferred to colonoscopy?

A

there is a reduced risk of perforation in flexible sigmoidoscopy

124
Q

which medication is associated with a drug induced cholestasis?

A

COCP

125
Q

which causative is resistant to chlorination and therefore has a risk of transfer in swimming pools?

A

giardia lamblia

giardia causes fat malabsorption, so a greasy stool can occur

126
Q

compare how norovirus affects children and adults differently?

A

children: causes vomiting
adults: causes diarrhoea

127
Q

how is norovirus investigated?

A

stool PCR

128
Q

how can norovirus be differentiated from rotavirus?

A

both most common in kids

rotavirus causes diarrhoea

norovirus causes vomiting

129
Q

which parasitic causes of gastroenteritis have an incubation time of 12-28 hours?

A

salmonella (both enteritis and enteric fever form)

E.Coli

130
Q

what is the difference between salmonella enteritis and salmonella typhi?

A

salmonella typhi presents with a macular rash on chest, fever and rigors

salmonella enteritis just causes N&V and bloody diarrhoea

131
Q

name the 2 parasitic causes of gastroenteritis with the shortest incubation times?

A

Staph aureus

bacillus cereus

1-6 hour incubation time

132
Q

what is the average incubation time of campylobacter?

A

2-5 days

it is the most common cause of gastroenteritis

133
Q

the source of which parasitic causative of gastroenteritis is food or water contaminated with faecal matter?

A

shigella

incubation period of 1-4 days

134
Q

how are the effects of E.Coli 0157 mediated?

A

via the release of shigella like toxin (VTEC)

135
Q

name one possible complication of E.Coli 0157?

A

haemorrhagic colitis

136
Q

how may haemolytic uraemic syndrome present?

A

presents within 2 weeks of E.Coli 0157 infection

causes abdominal pain, fever, pallor and oliguria

137
Q

which vaccine should all patients with coeliac disease receive? why?

A

all patients with coeliac disease should get the pneumococcal vaccine every 5 years

due to hyposplenism - this can lead to more severe infections with pneumococcus

138
Q

which cause of hepatomegaly is characterised by a firm, smooth and tender to touch liver edge?

A

right heart failure

its one of the most common causes of hepatomegaly

the liver is also pulsatile due to the back up of blood as R heart cant pump effectively - this distinguishes it from other answers

139
Q

which side effect of mesalazine (used in UC tx) , causes fever, shivers, and a sore throat?

A

agranulocytosis

do a FBC to check for it

140
Q

what is the 1st line Tx for small intestine bacterial overgrowth syndrome?

A

rifaximin

it is poorly absorbed in the GIT which allows a large dose of the AB to reach it’s target in the small bowel without high systemic concentrations

141
Q

what is the most commonly associated site in UC?

A

the rectum

142
Q

what treatments are 1st and 2nd line for inducing remission of crohns?

A

1st line: prednisolone

2nd line: mesalazine

143
Q

in UC and crohns, compare when mesalazine is used?

A

UC: mesalazine is 1st line to induce remission

crohns: mesalazine is 2nd line to induce remission

144
Q

in anaemia of chronic disease, why are transferrin levels reduced?

A

anemia of chronic disease is the body’s physiological response to a danger

the body wants to reduce how much iron is available to the pathogen, so circulates less of it

therefore, transferrin levels are reduced

145
Q

compare transferrin levels in iron deficiency anaemia and anaemia of chronic disease?

A

look at the transferrin levels:

high in iron deficiency anaemia: body wants to make the most of the little iron it has

low in anaemia of chronic disease: body is trying to prevent pathogens access to iron

146
Q

which 2 portions of the bowel are most affected by coeliac disease?

A

duodenum and jejunum

147
Q

what is the gold standard Ix to diagnose coeliac disease?

A

duodenal or jejunal biopsy

148
Q

what is the 1st line screening method for haemachromatosis?

A

transferrin saturation

149
Q

what should a recurrent episode of C.Diff within 12 weeks of symptom resolution be treated with?

A

fidaxomicin

150
Q

what is the incubation period of hepatitis A?

A

2-4 weeks

a flu like prodrome initiates the illness

151
Q

what is the investigation of choice for suspected perianal fistulae in patients with crohns?

A

MRI pelvis

152
Q

what is the diagnostic gold standard investigation for pancreatic cancer?

A

abdominal CT

ERCP can perform biopsy in suspected malignancy but couldn’t give a def diagnosis

MRCP is non invasive and does not show the ampulla as clearly - it is used more in gallstone disease

153
Q

what is the most sensitive and specific lab finding for diagnosis of liver cirrhosis in those with chronic liver disease?

A

thromocytopenia

ie, a platelet count <90x10^9

154
Q

what does HBsAg normally imply about a patient’s hepatitis status?

A

HBsAg is the 1st marker to appear

normally implies acute disease

if it is present for >6 mths then indicates chronic disease

155
Q

which antigen is a marker of infectivity in hepatitis B?

A

HbeAg

it results from breakdown of core antigen from infected liver cells so is therefore a marker of infectivity

156
Q

what does presence of anti-HBs suggest about ones hepatitis status?

is it present in chronic disease?

A

anti-HBs implies immunity (from exposure or immunisation)

it is negative in chronic disease

157
Q

what antibiotic is given as prophylaxis against spontaneous bacterial peritonitis?

A

oral ciprofloxacin

158
Q

compare the antibiotics used to treat spontaneous bacterial peritonitis and those used as prophylaxis?

A

treat: IV cefotaxime
prophylaxis: oral ciprofloxacin

159
Q

what do manometry studies measure?

A

measures the pressures within the LOS and helps to confirm GORD

it is required prior to a fundoplication

160
Q

what derangement can the COCP cause on LFTs?

A

a cholestatic liver

ie- raised ALP and GGT

161
Q

what is the 1st line Tx for both inducing remission and maintaining it in UC?

A

topical (rectal) mesalazine

162
Q

what condition is most strongly associated with H.Pylori?

A

duodenal ulceration

163
Q

describe the relationship between duodenal and gastric ulcers with food?

A

gastric ulcers: pain worsened by eating

duodenal: pain relieved by eating

164
Q

name the triad typical of cholangitis?

A

jaundice
fever
systemic sepsis

165
Q

what are the 2 most common causes of acute pancreatitis?

A
  • gallstones

- alcohol

166
Q

how can acute pancreatitis be differentiated from acute cholecystitis?

A
  1. site of pain: AP is tender in epigastrium, AC is tender in RUQ
  2. fever in AC, no fever in AP
167
Q

which part of the colon is most likely to be affected by ischaemic colitis?

A

splenic flexure

168
Q

describe 1st, 2nd, and 3rd line Mx of ascites?

A

1st: fluid restriction and sodium restriction
2nd: alcohol cessation
3rd: spironolactone (aldosterone antagonist)

169
Q

where in the oesophagus are squamous cell tumours most likely to be found?

A

the upper 2/3rds

170
Q

which investigation must be done in a patient taking mesalazine who becomes unwell with a sore throat and fever?

A

FBC

there is a risk of agranulocytosis when taking mesalazine

171
Q

which side of the heart can carcinoid syndrome affect?

A

the right side

causes tricuspid insufficiency and pulmonary stenosis

172
Q

what must be prescribed when performing a large volume paracentesis for treatment of ascites to reduce mortality risk?

A

IV human albumin solution

evidence suggests this reduces paracentesis-induced circulatory dysfunction and mortality

173
Q

what is usually seen on AXR in gallstone ileus?

A

small bowel obstruction and air in the biliary tree

AA Y4 Finals cards NE (40 decks)

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