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Finals!!! > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Features of coeliac

A
  • Wheat intolerance –> villous atrophy and malabsorption
  • Sx: Weight loss, offensive stools, diarrhoea, fatigue
  • Ix: Anti-transglutaminase, biopsy
  • Tx: gluten free diet
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2
Q

Causes of pancreatitis

A
  • Gallstones
  • Ethanol
  • Trauma
  • Steroids
  • Mumps/ Malignancy
  • Autoimmune
  • Scorpion/ spider bite
  • Hypercalcaemia/thyroid/lipidaemia
  • ERCP
  • Drugs- azathioprine, oestrogens, thiazides, isoniazid, steroids, NSAIDs
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3
Q

Functional causes of bowel obstruction

A
  • Paralytic ileus- post abdo surgery, pancreatits, spinal injury. NO BOWEL SOUNDS.
  • Pseudo-obstruction- Ogilvies syndrome
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4
Q

Presentation of colorectal cancer

A
  • Left sided- PR bleed, diarrhoea/constipation, mass on PR, tenesmus, ++ obstruction
  • Right sided- Iron deficient anaemia, weight loss, abdo pain, fatigue
  • Rectal- PR bleed, tenesmus
  • General- Weight loss, loss of appetite, obstruction, perforation
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5
Q

What is Budd-Chiari syndrome?

A

Occlusion of hepatic vein Triad:

  1. Abdo pain
  2. Ascites
  3. Hepatomegaly
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6
Q

Jaundice- Post-hepatic causes

A

Conjugated

  • Gallstone/ cholangitis
  • External compression- PSC, pancreatic cancer, Mirrizi syndrome
  • Drugs- flucloxacillin, fusidic acid, nitrofurantoin, sulfonylureas
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7
Q

Features of large bowel obstruction

A
  • More gradual onset.
  • Continual pain.
  • Normal bowel sounds
  • Metabolic acidosis
  • AXR- Peripheral. Haustra partial width of bowel.
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8
Q

Psoas sign

A

Pain on extension of hip. (Appendicitis)

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9
Q

Pancreatic cancer 2 week wait criteria

A
  • >40y with jaundice
  • >60 years + weight loss and 1 of: diarrhoea, back pain, abdo pain, nausea, vomiting, constipation, new onset DM
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10
Q

Signs of chronic liver disease

A
  • Hepatosplenomegaly
  • Encephalopathy
  • Constructional apraxia
  • Jaundice
  • Ascited
  • Spider naevi (>5)
  • Caput medusae
  • Oesophageal
  • Varices
  • Palmar erythema/ Dupuytren’s
  • Bruising
  • Testicular atrophy
  • Gynaecomastia
  • Peripheral oedema
  • Asterixis
  • Clubbing
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11
Q

Definition of SBP

A

Neutrophils >250/mm3

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12
Q

Features and management of Wilson’s

A
  • Copper in liver and CNS
  • Sx: Liver failure, tremor, dysarthria, dyskinesias, parkinsonism, kayser-fleischer rings
  • Ix: Urine 24h copper excretion, serum caeruloplasmin
  • Tx: Penacillamine
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13
Q

Alcoholic liver disease bloods

A
  • AST:ALT 2:1
  • Normal Alk phos
  • Raised GGT
  • Macrocytic anaemia
  • Raised IgA
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14
Q

Bacterial infections that cause gastroenteritis

A
  • Campylobacter- milk, poultry, water
  • Salmonella- meat, eggs, poultry
  • E. Coli
  • Shigella- ++ blood
  • C. Diff- ABx, PPIs. Green watery stool. Risks: Perforation, toxic megacolon
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15
Q

Causes of small and large bowel obstruction

A
  • Small- adhesions, hernias
  • Large- Colon Ca, constipation, diverticular stricture, volvulus, caecal
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16
Q

Features of delirium tremens

A
  • 2-3d later
  • Hallucinations
  • Seizures
  • Confusion
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17
Q

Dyspepsia management

A
  1. lifestyle and stop high risk drugs
  2. PPI eg lansoprazole (risk C. Diff)
  3. H2 receptor antagonist eg ranitidine (X with CYP450)
  4. Antacids eg aluminium hydroxide
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18
Q

Appendicitis ABx

A

Metronidazole + cefuroxime

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19
Q

Conditions associated with IBD

A

APICES

  • Apthos ulcers
  • Pyoderma gangrenosum
  • Iritis
  • Clubbing
  • Erythema nodosum
  • Sclerosing cholangitis
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20
Q

Causes of acute liver failure

A
  • Infection
  • Metabolic eg Wilson’s, haemachromatosis
  • Alcohol
  • AI
  • Fatty liver
  • Pre-eclampsia/ HELLP
  • Drugs
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21
Q

Features of duodenal ulcer

A
  • 4x more common
  • 50% ASx
  • Sx- Epigastric pain RELIEVED by eating
  • Ix- upper GI endoscopy
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22
Q

Features of Korsikoff’s

A
  • Often after Wernicke’s
  • Confabulation
  • Amnesia
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23
Q

Features of chronic colonic ischaemia

A
  • ‘Ischaemic colitis’
  • Left lower abdominal pain +/- bloody diarrhoea
  • Ix= Lower GI endoscopy
  • Tx: IVT, ABx, surgical resection
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24
Q

Indications for stool sample in gastroenteritis

A
  • Travel
  • Institutional care
  • ??Outbreak
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25
Q

Genetic RF for colorectal cancer

A
  • Lynch syndrome (HNPCC)- small no. adenomas with rapid malignancy. Aspirin prophylaxis
  • FAP- 1000s adenomas
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26
Q

Gastritis RF

A
  • H. Pylori
  • Alcohol
  • NSAIDs
  • Hiatus hernia
  • CMV
  • Crohn’s
  • Sarcoidosis
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27
Q

Indication for upper GI endoscopy

A
  • Dysphagia or >55y with persistent alarms symptoms
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28
Q

H. Pylori triple therapy

A
  • PPI + 2x ABx
  • Lansoprazole
  • Amoxicillin (metronidazole if pen allergic)
  • Clarithromicin
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29
Q

Treatment of ascities

A
  • Bed rest
  • Fluid and salt restriction
  • Spironolactone
  • Daily weights and U+Es
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30
Q

Presentation of pancreatic cancer

A
  • Painless jaundice
  • Weight loss + anorexia
  • Steatorrhoea
  • Epigastric pain –> back. Relieved by sitting forward
  • ?Acute pancreatitis
  • Epigastric mass
  • Hepatosplenomegaly
  • Lymphadenopathy
  • Portal hypertension
  • Hypercalcaemia
  • Coirvoisier’s law- jaundice, palpable GB
  • Thrombophlebitis migrans
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31
Q

What is GORD? Symptoms and RF.

A
  • Gatroesophageal Ruflux Disease Reflux of stomach contents –> 2 or more heart burn episodes/ week.
  • Sx- heartburn, belching, water brash, chronic cough
  • RF- Hiatus hernia, pregnancy, obesity, alcohol, smoking, overeating, H. Pylori
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32
Q

Murphy’s sign

A

Hand on RUQ –> breath in –> sharp pain

Only +ve if -ve on left

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33
Q

Key features of UC

A
  • Colon and rectum
  • Diffuse.
  • Mucous
  • RF: non-smokers, 15-30y or >50y
  • Sx- diarrhoea **BLOOD**, weight loss, tenesmus
  • Complications- ++ Colorectal cancer, toxic megacolon, VTE, hypokalaemia
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34
Q

Features of inguinal and femoral hernias

A
  • Indirect- through deep and superficial ring. Doesn’t come out if deep ring occluded. More common. Commonly into scrotum
  • Direct- though superficial ring. Comes out when deep ring occluded. Rarely into scrotum.
  • Femoral hernias- more in women. Most likely to strangulate.
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35
Q

Signs of peritonitis

A
  • Fever +/- rigors
  • Severe generalised abdo pain –> back/ shoulders.
  • Worse with movement/ coughing
  • Guarding and rigidity
  • Septic
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36
Q

Jaundice- Pre-hepatic causes

A
  • Unconjucated hyperbilirubinaemia
  • Haemolysis- haemolytic anaemia, DIC, antimalarials
  • Impaired hepatic uptake- contrast, RHF Impaired conjugation- Gilbert’s Physiological neonatal jaundice (combo of above)
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37
Q

Colorectal cancer 2 week wait referral

A
  • >40y with unexplained weight loss and abdo pain
  • >50y with unexplained rectal bleeding
  • >60 with one of: Fe deficient anaemia, change in bowel habit, tenesmus, FOB
  • ?Rectal/abdominal mass
  • ?<50y with rectal bleeding and 1 of: abdo pain, change in bowel habit, weight loss, iron deficient anaemia
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38
Q

Features of gastric ulcer

A
  • RF- H.Pylori, smoking, NSAIDs
  • Sx- Epigastric pain made WORSE by meals and relieved by antacids
  • Ix- upper GI endoscopy + biopsies. Repeat 6-8w to rule out malignancy
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39
Q

What is Barrett’s oesophagus?

A

Distal oesophagus epithelium from squamous –> collumnar. Metaplasia –> dysplasia –> neoplasia

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40
Q

Key features of Crohn’s

A
  • Mouth to anus. Esp terminal ileum
  • Patchy. Transmural.
  • RF: smoking, esp 20-40y
  • Sx: diarrhoea, abdo pain, weight loss, fever, lethargy, anorexia, mouth ulcer, perianal skin tags, arthritis
  • Complications- SBO, fistulae
41
Q

Pancreatic cancer Ix and Tx

A
  • Ix: Bm, Ca19-9, USS, CT, ERCP
  • Tx: Palliative, Whipples, CBD stent
42
Q

2 week wait criteria for upper GI endoscopy

A
  • Dysphagia
  • >55y with weight loss and 1 of: upper abdo pain, reflux, dyspepsia
43
Q

Antibiotics in gastroenteritis + their indication

A

Ciprofloxacin

Indications- unwell ++, elderly, immunosuppressed

44
Q

Rovsing’s Sign

A

Pain in RIF when LIF pressed. Seen in appendicitis.

45
Q

Features of IBS

A
  • Recurrent abdo pain associated with at least 2 of:
    • Relief by defecation
    • Altered stool form
    • Altered bowel frequency
  • FLUCTUATING
  • Doesn’t wake from sleep
46
Q

Charcot’s triangle

A

= Cholangitis RUQ, fever, obstructive jaundice

47
Q

Features of norovirus

A
  • Fever
  • Abdominal pain
  • Diarrhoea
  • Projectile vomiting- “winter vomiting illness”
48
Q

Dyspepsia ALARMS symptoms

A
  • Anaemia (iron deficient)
  • Loss of weight
  • Anorexia
  • Recent/ progressive change
  • Melaena/ haematemesis
  • Swallowing difficulty
49
Q

Presentation of acute liver failure

A
  • Jaundice
  • Hepatic encephalopathy- confusion, flap
  • Fetor hepaticus
  • Constructional apraxia
50
Q

Liver cancer presentation

A
  • Jaundice (late)
  • Weight loss
  • Anorexia
  • Malaise
  • Fever
  • RUQ liver capsule pain
  • Abdo mass Bruit
51
Q

Grading and management of hepatic encephalopathy

A
  1. altered mood, sleep disturbance, dyspraxia
  2. drowsiness, confusion, inappropriate behaviour +/- flap
  3. Incoherent, stupor, liver flap
  4. coma. GCS<8
  • Ix= ammonia
  • Tx= lactulose +/- rifaxamin
52
Q

Types of obstruction

A
  • Simple
  • Closed loops (2 points of obstruction) –> grossly distended with risk of perforation.
  • Strangulated- blood supply compromised. ++pain, localised peritonism, Fever, high WCC.
53
Q

Causes of acute lower GI bleed

A
  • Anal fissure
  • Haemorrhoids
  • Polyps
  • Diverticular disease
  • IBD
  • Colon cancer
  • Ischaemic colitis
  • Radiation proctitis
  • Upper GI bleed
  • Angiodysplasia
54
Q

IBD investigations

A
  • Bedside- NEWS, stool culture and faecal calprotectin
  • Bloods- FBC, U+Es, LFTs, ESR, CRP, culture, coags, B12, folate
  • Imaging- AXR, colonoscopy, MRI, USS
55
Q

Features of Auto-immune hepatitis

A
  • Markers: ANA/ASMA, IgG, raised ALT
  • Any age any sex
  • Ix: Biopsy
  • Tx: immunosuppression- azathioprine, prednisolone
56
Q

RF for acute mesenteric ischaemia

A
  • !!! AF !!!
  • Hypercoaguable state
  • Poor cardiac output
  • Renal failure
  • Trauma
  • Vasculitis
  • Radiation
57
Q

What is dysentry?

A

Diarrhoea with blood

58
Q

Treatment of oesophageal varices

A
  • ABCDE +/- IVT/ transfusion
  • Tx based on Child-Pugh score- risk of variceal bleeding in cirrhossis
  • Blachford score- guides acute management
  • Rockall score= post-endoscopy prognosis
  • Terlipressin + ABx Endoscopic banding
59
Q

Causes of acute upper GI bleed

A
  • Peptic ulcer
  • Oesophageal varices
  • Mallory-Weiss tear
  • Oesophagitis
  • Swallowed blood- epistaxis
  • Upper GI cancer
  • AVM
  • Underlying coagulopathy
  • High risk meds- NSAIDs, blood thinners, aspirin, steroids
60
Q

Features and treatment of hepatorenal syndrome

A
  • Cirrhosis + ascites + renal failure
  • Tx: type 1= terlipressin, haemodialysis type 2= transjugular intrahepatic portosystemic shunt
61
Q

Features of haemachromatosis

A
  • Iron deposition in joints, liver, heart, pancreas, pituitary, adrenals, skin
  • Sx: Tired, arthralgia, slate-grey pigmentation, cirrhosis, cardiomyopathy
  • Tx: venesection
62
Q

Features of Wernicke’s encephalopathy

A

Low thiamine Triad:

  1. Ophthalmoplegia
  2. Altered GCS
  3. Ataxia
63
Q

Phlegmon

A

RUQ mass of inflamed omentum/ bowel

64
Q

UC management

A
  • ABCDE
  • Mild- mesalazine, topical steroids
  • Mod- PO prednisolone
  • Severe- IVT, IV hydrocortisone, VTE prophylaxis
  • Day 3-5 decline –> rescue therapy: ciclosporin, infliximab
  • Immunomodulation- azathioprine if >2 steroids/ year. CHECK TPMT LEVELS
  • All fail –> colectomy
65
Q

Antibiotic treatment for peritonitis

A

Metronidazole + Cefuroxime

66
Q

Features of primary sclerosis cholangitis

A
  • Markers: ANCA, raised ALP
  • Men>women. Esp IBD (UC)!!
  • Sx: ASx, jaundice, RUQ pain, cholangitis?
  • Ix: MRCP- beeding in large duct, Biopsy- onion skin in small duct
  • Tx: Sx control, ERCP
67
Q

Presentation of bowel obstruction

A
  • Vomiting
  • Nausea
  • Anorexia
  • Abdominal distention
  • Constipation
  • No flatus
68
Q

Jaundice- Hepatic causes

A
  • Mixed conjugated and unconjugated
  • Infection- Hep A/B/C, CMV, EBV
  • Drugs- paracetamol OD, isoniazid, rifampicin, MAOi, statins, sodium valproate
  • Alcohol
  • Cirrhosis
  • Genetic- haemachromatosis, Wilson’s, alpha1 antitryptase AI hepatitis Budd-Chiari
69
Q

Crohn’s management

A
  • ABCDE
  • Mild- Prednisolone PO
  • Severe- IV hydrocortisone Immune modulation- azathioprine/ methotrexate
70
Q

Causes of liver decompensation

A
  • Sepsis
  • Bleed
  • Medication - new/ OD, paracetamol
  • Constipation
  • AKI
71
Q

Presentation of gastric cancer

A
  • Non-specific
  • Early satiety
  • Dyspepsia
  • Weight loss
  • Vomiting
  • Dysphagia
  • Anaemia
72
Q

Liver screen bloods

A
  • LFTs
  • Coags/ PT
  • Hep A/B/C serology
  • EBV
  • CMV
  • AMA, ASMA, Anti-LKM, ANA, pANCA
  • Immunoglobulins- IgM, IgG
  • Alpha-1 antitrypsin
  • Serum copper
  • Ceruloplasmin
  • Ferratin
  • Paracetamol level
73
Q

Management of acute upper GI bleed

A
  • Ix: UO, ABG, bloods including X-match, OGD
  • Tx: ABCDE + fluid/ transfusion. ??SHOCK
  • NBM
  • analgesia
  • X anti-coags/ NSAIDs
  • Endoscopy
  • PPI post endoscopy
74
Q

Symptoms and complications of diverticular disease

A
  • Altered bowel habit
  • L abdo pain relieved by defecation
  • Nausea
  • Flatulance
  • PR bleed
  • Complications- haemorrhage, perforation, fistulae, abscess
75
Q

Colorectal cancer Ix

A
  • FOB
  • CEA
  • Colonoscopy
  • CT
76
Q

Different presentations of gallstones

A
  • Biliary cholic
  • Cholecystitis
  • Obstructive jaundice
  • Cholangitis
  • Pancreatitis
  • Mucocoele/empyema
  • Coirvoisier’s law- GB small, shrunken, not palpable
  • Gallstone Ileus
77
Q

Features of alpha1-antitrypsin

A
  • Affects lungs and liver
  • Sx: SOB, cirrhosis, cholestatis jaundice
  • Ix: liver biopsy
  • Tx: transplant?
78
Q

Acute liver failure diagnostic criteria

A
  • Raised PT by 4-6s
  • Encephalopathy In a patient with no pre-existing disease
79
Q

Features of Primary biliary cholangitis

A
  • Markers: AMA, raised ALP, raised IGM
  • Middle aged women
  • Sx: liver disease, jaundice, cholestatis LFTs
  • Tx: Ursodeoxycholic acid, fibrates, obeticholic acid, transplant?
80
Q

Features of chronic mesenteric ischaemia

A
  • ‘Abdominal angina’
  • Sx: weight loss, abdo pain (esp post-prandial), upper abdominal bruit
  • Ix: CT, MR angiography
  • Tx: revascularisation and stent
81
Q

Presentation of oesophageal cancer

A
  • Dysphagia
  • Weight loss
  • Anaemia
  • Chest pain
  • Mass
  • Horse voice/ mass
  • Vomiting
82
Q

Management of obesity

A
  1. lifestyle
  2. Orlistat + lifestyle. BMI>28 + complications or BMI>30
  3. Bariatric surgery- banding/ bypass. BMI35-40 + complications or BMI >40
83
Q

Indications that gastroenteritis is bacterial

A
  • More unwell
  • Higher fever
  • Blood/ mucus in stool
  • Abdominal pain
84
Q

Assessing UC severity

A

Truelove and Witts Severe:

  • >6 motions/ day
  • Large rectal bleeding
  • Temp >37.8
  • >90bpm
  • Hb <105g/L
  • ESR >30
85
Q

Signs of liver decompensation

A
  • Jaundice
  • Ascites
  • Encephalopathy
  • Renal impairment
  • Sepsis
86
Q

Presentation of pancreatitis

A
  • Epigastric pain –> back
  • Fever
  • Guarding/ rigidity
  • Vomiting ++
  • Dehydration
  • Ecchymosis: Cullen’s (umbilical), Grey Turner’s
87
Q

Symptoms of Cholecystitis

A
  • Epigastric/RUQ pain –> R shoulder
  • Phlegmon
  • Murphy’s
  • Anorexia, vomiting
  • Local peritonism
  • Fever
88
Q

Features of small bowel obstruction

A
  • Presents quicker
  • Pain higher in abdomen
  • Tingling bowel sounds
  • Metabolic alkalosis
  • AXR- central. valvulae coniventes across whole width.
89
Q

HCC screening

A

6 monthly USS and AFP in those at risk: Cirrhosis (esp HBV), FHx, African, Asian

90
Q

Types of laxatives and examples

A
  • Bulk forming- ispaghula husk
  • Osmotic- Macrogol, lactulose
  • Stimulant- senna, bisacodyl
  • Stool softeners- docusate, liquid paraffin
91
Q

Investigations and management of diverticular disease

A
  • Ix: Obs, bloods, CT
  • Tx: High fibre diet, IVT, NBM, analgesia, ?ABx, antispasmodics- mebevarine
92
Q

Causes of constipation

A
  • General- diet, elderly, IBS, environmental
  • Anorectal disease eg fissures
  • Bowel obstruction
  • **colorectal cancer**
  • Metabolic- hypercalcaemia, hypothyroidism, hypokalaemia
  • Drugs- Iron, opiates, diuretics, CCB, TCAs Neuromuscular eg spinal injury
93
Q

Acute mesenteric ischaemia Ix and Tx

A
  • Bedside- NEWS
  • Bloods- FBC, amylase, ABG/lactate
  • Imaging- AXR, CT, MR angiography
  • Tx: Piptaz, LMWH, surgical resection
94
Q

Presentation of acute mesenteric ischaemia

A

Triad:

  1. No/minimal abdo signs
  2. Acute, severe abdominal pain
  3. Rapid hypovolaemia/ shock
95
Q

What is achalasia and its symptoms, Ix and Tx?

A
  • Lower oesophageal sphincter fails to relax due to degeneration of myenteric plexus
  • Sx: Dysphagia or solids and fluids, regurgitation, weight loss, heart burn
  • Ix- CXR fluid level, barium swallow
  • Tx- Balloon dilatation
96
Q

Markers of synthetic liver function

A
  • Albumin
  • Bilirubin
  • PTT
  • Glucose
97
Q

Obturator/ Cope’s sign

A
  • Pain on flexion and internal rotation of hip. (Appendicitis)
98
Q

What is Mirizzi’s Syndrome?

A

Obstructive Jaundice from CBD compression by gallstone impacted on cystic duct. Associated with cholangitis.

99
Q

Presentation, Ix and Tx of testicular torsion

A
  • = Spermatic cord twists –> ischaemia. RF= undescended testes.
  • Presentation-
    • Sudden onset, severe, unilateral abdominal/groin/testicular pain –> always examine testes!
    • N+V
    • Fever
    • Swollen testicle - rapid
    • No cremasteric reflex
    • Preh’s -ve (lifting testis doesn’t relieve pain)
  • Ix- Doppler USS, urgent senior r/v
  • Tx- Emergency surgical exploration with bilateral fixation within 6h

Finals!!! (19 decks)

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