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Finals - Systems Paper > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Coeliac gene

A

HLA-DQ2

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2
Q

Coeliac diagnose

A 
Tissue transglutaminase (TTG) antibody and IgA
Endoscopic biopsy
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3
Q

Coeliac biopsy

A

Crypt hypertrophy

Villous atrophy

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4
Q

Treatment constipation

A

1) Lifestyle
2) Bulk forming - ispaghula
3) Osmotic - macrogol or lactulose
4) Stimulant - senna

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5
Q

Diagnose GORD

A

Clinical, endoscopy if red flag or failure treatment

If endoscopy -ve then 24h pH monitoring

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6
Q

Treatment GORD

A

1) Lifestyle
2) PPI one month
3) Lower dose if response, double if not
4) Surgery

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7
Q

Diagnose H Pylori

A

Urea breath test - 4w after antibiotic and 2w after PPI

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8
Q

Treatment H Pylori

A

7 days triple therapy:

- PPI + amoxicillin + (metronidazole or clarithromycin)

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9
Q

Upper GI bleeding scoring systems

A

Glasgow Blatchford - risk of having

Rochall - risk after endoscopy

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10
Q

Treatment oesophageal varices

A

1) Terlipressin and broad antibiotics

2) Vessel ligation

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11
Q

Identify IBS

A

6m:

  • Abdominal pain
  • Bloating
  • Change bowel habit
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12
Q

Treatment IBS

A

Pain - hyoscine butylbromide
Constipation - laxative but avoid lactulose
Diarrhoea - lopameride

CBT if failure

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13
Q

Identify crohns

A

No blood
Entire tract
Skip lesions
Full thickness

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14
Q

Identify UC

A

Blood
Continues inflammation
Superficial mucosa

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15
Q

Crohns histology

A

Goblet cells

Granuloma

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16
Q

Crohns induce remission

A

1) Glucocorticoid

2) Consider adding immunosuppresant

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17
Q

Crohns maintain remission

A

1) Azithrioprine or mercaptopurine

2) Methotrexate

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18
Q

Diagnose crohns fistula

A

MRI

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19
Q

Treat crohns fistula

A

Metronodazole

Draining seaton if complex

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20
Q

UC flares classification

A

Mild - <4 stools
Moderate - 4 to 6 stools or mimimal systemic
Severe - >6 or systemic disturbance

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21
Q

Diagnosis UC

A

Colonoscopy and biopsy

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22
Q

IC endoscopy findings

A

Pseudopolyps

Crypt abscesses

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23
Q

UC induce remission in proctatitis

A

1) Topical aminosalicylate (eg mesalazine)

2) Oral mesolazine

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24
Q

UC induce remission in left sided

A

1) Topical mesalazine

2) Oral mesolazine or corticosteroid

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25
Q

UC induce remission in extensive disease

A

1) Topical mesalazine and oral

2) Stop topical and add oral corticosteroid

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26
Q

Induce remission in severe UC

A

1) IV steroids

2) IV ciclosporin

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27
Q

Maintain remission up to moderate UC

A

Proctatitis - topical mesalazine or oral

Left sided and extensive - oral mesalazine

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28
Q

Maintain remission in severe or 2 exacerbations a year UC

A

1) Oral azathioprine or mercaptopurine

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29
Q

Treatment peptic ulcer disease

A

Pylori -ve - PPI until healed

Pylori +ve - eradicaction

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30
Q

Diagnose peptic ulcer perforation

A

Clinical, but get CXR

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31
Q

Treatment peptic ulcer active bleeding

A

IV PPI

Endoscopic intervention, surgery if fails

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32
Q

Artery for peptic ulcer bleeding

A

Gastroduodenal artery

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33
Q

Identify refeeding syndrome

A

Low everything - phosphate, K, Mg

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34
Q

Screening malnutrition

A

MUST

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35
Q

Definition malnutrition

A

> 10% weight loss in 3-6m

or BMI <18.5

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36
Q

Identify plummer vinson syndrome

A

Tirad:

  • Dysphagia secondary to webs
  • Glossitis
  • Iron deficiency anemia
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37
Q

Treatment plummer vinson syndrome

A

Iron and dilation webs

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38
Q

Identify mallory-weiss syndrome

A

Severe vomiting in alcoholics cause painful laceration

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39
Q

Identify Boerheave syndrome

A

Severe vomiting causing oesophageal rupture

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40
Q

Identify peptic stricture

A

Longer history dysphagia not progressive

Symptoms GORD

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41
Q

Identify achalasia

A

Dyphagia both solids and liquids

Regurgitation food

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42
Q

Treatment achalasia

A

1) Pneumatic balloon dilation

2) Surgery

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43
Q

Diagnose pharangeal pouch

A

Barium swallow

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44
Q

Vit A deficiency

A

Night blindness

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45
Q

Vit B1 deficiency

A

Wernicke-Karottkoff syndrome

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46
Q

Vit C deficiency

A

Scurvy - bleeding and poor wound healing

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47
Q

Vit B3 deficiency

A

Pallagra - dermatitis and dementia

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48
Q

Vit B6 deficiency

A

Peripheral neuropathy and sideroblastic anaemia

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49
Q

Vit B12 deficiency

A

Degermation cord

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50
Q

Treatment hep B

A

1) Pegylated interferon alpha

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51
Q

Hepatitis vaccines

A

A and B

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52
Q

Hepatitis foecal oral

A

A and E

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53
Q

Hepatitis needs B

A

D

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54
Q

Hepatitis greatest risk cancer

A

Hep C

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55
Q

Hepatitis worse in pregnancy

A

Hep E

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56
Q

Treatment autoimmune hepatitis

A

1) Steroids

2) Liver transplant

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57
Q

Identify autoimmune hepatitis

A

Anti-nuclear antibody

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58
Q

Identify alcoholic liver disease

A

AST:AKT 2:1
Increased gamma GT
U and E derranged in hepatorenal syndrome

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59
Q

Diagnose alcoholic liver disease

A

US - increased echogenicity

CT and MRI

60
Q

Treatment alcoholic liver disease acute

A

1) Glucocorticoids

61
Q

Alcohol screening

A

CAGE

AUDIT

62
Q

Calculate units

A

(ml x ABV) / 1000

63
Q

Ascites cause if SAAG > 11

A

Portal hypertension:

  • liver
  • cardiac
  • Budd Chari
64
Q

Ascites cause if SAAG < 11

A

Hypoalbuminaemia - nephrotic syndrome
Malignancy
Infection

65
Q

Treatment ascites

A

1) Spironolactone and consider drainage

66
Q

Prophylactic antibiotics in ascites

A

Oral ciprofloxacin

67
Q

Measure severity liver cirrhosis

A

Child-Pugh score

68
Q

Treatment liver cirrhosis

A

1) Lifestyle and US every 6m

2) Consider transplant

69
Q

Liver cirrhosis US

A

Nodularity

Corkscrew appearance arteries

70
Q

Treatment hepatic encephaltis

A

1) Lactulose and rifaximin

71
Q

Identify non-alcoholic fatty liver disease

A

ALT>AST

72
Q

Identify acute liver failure

A

Decreased albumin and prolonged prothrombin time

73
Q

Diagnose lower GI bleeding

A

Unstable - CT angiogram

Stable - colonscopy

74
Q

Diagnose intestinal ischaemia

A

CT scan

75
Q

Diagnosis SBP

A

Paracentesis - neutrophil count >250

76
Q

Most common cause SBP

A

E coli

77
Q

Treatment SBP

A

IV cefotaxime

78
Q

Identify primary biliary colangitis (AKA cirrhosis)

A

Anti-mitochondrial antibody (AMA) positive

Increased IgM

79
Q

Diagnose primayr biliary colangitis

A

MRCP and immunology

80
Q

Treatment primary biliary colangitis

A

1) Ursodeoxycholic acid

2) Liver transplant

81
Q

Identify primary sclerosing colangitis

A

Associated UC
Cholestasis
Maybe pANCA positive

82
Q

Diagnose primary sclerosing cholanigits

A

ERCP or MRCP

83
Q

Diagnose acute cholecystitis

A

1) US

84
Q

Treatment acute cholecystitis

A

IV antibiotics and laparoscopic cholecystectomy

85
Q

Identify ascending cholangitis

A

Charcots triad:

  • RUQ pain
  • fever
  • jaundice

Renolds pentad:

  • hypotension
  • confusion
86
Q

Diagnose ascending cholanigtis

A

US

87
Q

Treatment ascending cholanitis

A

IV antibiotics and ERCP to relive obstruction

88
Q

Identify biliary colic

A

Colicky abdominal pain worse after fatty food

No fever

89
Q

Diagnose biliary colic

A

US

90
Q

Treatment biliary colic

A

Elective laparoscopic cholecystectomy

91
Q

Diagnose hiatus hernia

A

bariums swallow

92
Q

Treatment hiatus hernia

A

1) Conservative
2) PPI
3) Surgery

93
Q

Acute pancreatitis signs

A

Cullens - periumbilical discolourisation

Grey turner - flank discolourisation

94
Q

Diagnose acute pancreatitis

A

Amylase/lipase and symptoms, or imaging with CT

95
Q

Scoring systems acute pancreattiis

A

Randon
Glasgow
APACHE II

96
Q

Treatment acute pancreatitis

A

IV opiods and aggressive fluid

Surgery to rleieve obstruction or necrosis

97
Q

Oestophageal cancer histology

A

Upper 2/3 - SCC

Lower 1/3 - adenocarcinoma

98
Q

Oesophageal cancer smoking

A

SCC

99
Q

Treatment Barrets

A

Endoscopic surveillance and biopsy every 3-5y

PPI

100
Q

Pancreatic cancer histology

A

Adenocarcinoma

101
Q

Identify pancreatic cancer

A

Painless jaundice
Cholestatic LFTs
Pale stools

102
Q

Diagnose pancreatic cancer

A

CT scan - double duct sign

103
Q

Most common cause small bowel obstruction

A

Adhesions

104
Q

Diagnose small bowel obstruction

A

1) Xray first

2) CT definitive

105
Q

Diagnose chronic pancreatitis

A

CT - calcifications

106
Q

Diagnose gastric cancer

A

Endoscopy and biopsy - signet ring cells

CT for staging

107
Q

Diagnose appendicitis

A

Men - clinical

Female - US

108
Q

Treatment appendicitis

A

Appendicectomy and IV antibiotics

109
Q

Colorectal cancer screning

A

Every 2y to people aged 50-74y:
- Foecal immunochemical test

Colonoscopy if abnormal

110
Q

Diagnose colorectal cancer

A

Colonoscopy and biopsy, sigmoidoscopy if bleeding

CT CAP staging

111
Q

What is diverticular disease

A

Herniation colonic mucosa through muscle wall

112
Q

Diverticular disease diagnosis

A

Clinic - colonoscopy

Acute - identified on xray for perforation

113
Q

Diverticular classification

A

Hickley

114
Q

Diverticular treatment

A

Increase fibre
Mild - antibiotics
Abscess - drainage
Recurrent - consider surgery

115
Q

What is diverticulitis

A

Infection of diverticulum

116
Q

Treatment diverticulitis

A

Mild - antibiotics

Severe - IV antibiotics

117
Q

Identify haemorrhoids

A

Painless bleeding

Pruritis

118
Q

Treatment haemorrhoids

A

1) Increase fibre and fluid
2) Rubber band ligation
3) Surgery

119
Q

Sigmoid volvulus identify

A

Most common

Coffee bean sign

120
Q

Coecal volvulus identify

A

Looks like foetus

121
Q

Volvulus diagnosis

A

Xray

122
Q

Volvulus treatment

A

Sigmoid - right sigmoidoscopy with rectal tube

Caecal - right hemicolectomy

123
Q

Anal cancer histology

A

SCC

124
Q

Anal fissure treatment

A

1) bulk forming laxative and lubricants
2) Topical GTN
3) Surgery

125
Q

Diagnose necrotising enterocolitis

A

Neonate

AXR - dilated bowel loops, intramural gas

126
Q

Inguinal hernia location and treatment

A

Superior and medial to pubic tubercle

Surgery

127
Q

Femoral hernia location and treatment

A

Inferior and lateral to pubic tubercle

Surgery

128
Q

Identify alcoholic ketoacidosis

A

Metabolic acidosis increase anion gap
Increased ketones
Normal glucose

129
Q

Treatment alcoholic ketoacidosis

A

Saline infusion and thiamine

130
Q

Identify Budd Chairi syndrome

A

AKA hepatic vein thrombosis

Triad:

  • abdominal pain sudden and severe
  • ascites
  • tender hepatomegaly
131
Q

Diagnose Budd chari

A

US

132
Q

Blood film pernicious anaemia

A

Hypersegmented polymorph

133
Q

Treatment perncious anaemia

A

B12 replacement then folic acid

134
Q

Variceal haemorrhage treatment

A

1) Endoscopy and band ligation
2) Sengstakan blackmore tube
3) TIPS

135
Q

Prevention variceal haemorrhage

A

Propranolol

136
Q

Treatment Wilsons

A

Penicillamine

137
Q

Diagnose Wilsons

A

Decreased copper

138
Q

Diagnosis Borheaves syndrome

A

CT contrast swallow

139
Q

Oesophageal cancer barium sign

A

“Apple core”

140
Q

Carcinoid syndrome treatment

A

Octreotide

141
Q

Cause of pigmented gallstones

A

Sickle cell disease

142
Q

Colorectal cancer histology

A

Adenocarcinoma

143
Q

Incercerated hernia

A

Unable to be reduced

144
Q

Body area for burns

A

Wallace rules of 9

Lund and Browder chart

145
Q

Classification burns

A

Superficial - red and painful
Partial thickness (superficial dermal) - painful and blisters
Partial thickness (deep dermal) - white, reduced sensation
Full thickness - white/brown/black, no blisters no pain

146
Q

Burn when to refer

A

All deep dermal and full thicken
Superficial if >3% body
Inhalation injnury

147
Q

Parkland formula for IV fluid

A

4 x surface area x body weight

50% first 8h

Finals - Systems Paper (20 decks)

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