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General med > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

1st line tx for mild-moderate flare of ulcerative colitis

A

Topical (rectal) aminosalicylates

oral possible if rectal declined

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2
Q

fts of moderate flare of ulcerative colitis

A
  • 4-6 bowel movements/day
  • b/w mild - severe blood in stools
  • no pyrexia (<37.8C)
  • pulse <90
  • no anaemia
  • ESR <30
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3
Q

Management of acute severe flare/first presentation of ulcerative colitis

A

IV prednisolone

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4
Q

2nd line tx for moderate flare ulcerative colitis

A

oral prednisolone/any corticosteroid

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5
Q

indication for surgery for ulcerative colitis

A

acute severe UC admitted to hospital

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6
Q

mild ulcerative colitis flare fts

A
  • < 4 stoold/day

- small amount of PR blood

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7
Q

severe falure of ulcerative colitis fts

A
  • > 6 blood stools per day

- systemic upset (purexia, tachy, anaemia, raised inflam markers)

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8
Q

Inducing remission of Crohn’s first line

A
  • glucocorticoids
  • +/- azathioprine
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9
Q

2nd line tx - inducing remission in Crohn’s

A

5-ASA drugs (mesalazine)

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10
Q

When is infliximab used to tx Crohn’s

A
  • refractory disease
  • fistulating Crohn’s
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11
Q

Drug tx for isolated peri-anal disease in Crohn’s

A

Metronidazole

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12
Q

Maintaining remission in Crohn’s

A
  • quit smoking
  • azathioprine/mercaptopurine (1st line)
  • methotrexate (2ndline)
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13
Q

What test should be done before starting azathioprine/mercaptopurine

A

thiopurine methyltransferase (TPMT)

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14
Q

Classic diverticulitis fts

A
  • LLQ pain
  • diarrhoea
  • fever
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15
Q

Classic presentation of UC

A
  • chronic ( +/-bloody) diarrhoea
  • crampy abdo pain
  • weight loss
  • faecal urgency
  • tenesmus
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16
Q

Classic fts Crohn’s disease

A
  • chronic diarrhoea
  • crampy abdo pain
  • malabsorption
  • mouth ulcers
  • perianal disease
  • intestinal obstruction
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17
Q

Classic presentation coeliac children

A
  • failure to thrive
  • chronic diarrhoea
  • abdominal distension
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18
Q

Classic presentation coeliac adults

A
  • lethargy
  • anaemia
  • weight loss
  • chronic diarrhoea
  • co-existing auto-immune conditions
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19
Q

Basic pathophys of haemochromatosis

A

disorder of iron aborption and metabolism = iron accumulation

20
Q

Fts of haemochromatosis
1- early
2- reversible complications
3- irreversible complications

A

1- asymptomatic; fatigue, erectile dysfunction, arthralgia (hands)
2- bronze skin pigmentation; cardiomyopathy (but progress to cardiac failure - 3); chronic liver disease with hepatomegally (but progress to cirrhosis or hepatocellular deposition - 3)
3- DM; hypogonadotrphic hypogonadism (cirrhosis + pituitary dysfunction); arthritis

21
Q

Genetic/ other Ca a/w pancreatic cancers

A
  • hereditary non-polyposis colorectal carcinoma
  • multiple endocrine neoplasia
  • BRCA2 gene
  • KRAS gene mutation
22
Q

Main type of pancreatic tumour

A

> 80% adenocarcinomas

23
Q

Endoscopy findings Crohn’s

A

deep ulcers
skip lesions
‘cobble-stone’

24
Q

Endoscopy findings UC

A

widespread ulceration
preservation of adjacent mucosa (appearance of polyps - ‘pseudopolyps’)

25
Q

Radiology Crohn’s
1. type used
2. findings

A
  1. Small bowel enema (specifically looking at terminal ileum)
  2. Kantor’s string sign = strictures; prox bowel dilatation; ‘rose thorn’ ulcers; fistulae
26
Q

Radiology UC
1. type used
2. findings

A
  1. barium enema
  2. loss of haustrations; sup ulcerations ‘pseudopolyps’; long standing disease = narrow and short colon (‘drainpipe colon’)
27
Q

Histology Crohn’s

A

inflammation in all layers of mucosa

  • incr goblet cells
  • granulomas
28
Q

Histology UC

A

No inflammation beyond submucosa (excl fulminant disease)
- inflam cell infiltrate in lamina propria
- neut migrate through walls of glands - form crypt abscesses
- depletion of goblet cells and mucin from gland epithelium
- granulomas are infrequent

29
Q

Lesion pattern in Crohn’s

A

anywhere from mouth to anus

+/- skip lesions

30
Q

Lesion pattern in UC

A

start at rectum and spreads proximal, nevery beyond ileocaecal valve

continuous disease

31
Q

Complications Crohn’s

A
  • obstruction
  • fistula
  • colorectal cancer
32
Q

Complications UC

A

colorectal cancer (higher than Crohn’s)
toxic megacolon

33
Q

Classic fts of Crohn’s

A
  • diarrhoea (non bloody)
  • weight loss (> than UC)
  • upper GI sx - mouth ulcers
  • perianal disease
  • abdo mass palpable in RIF
34
Q

Classic fts of UC

A
  • bloody diarrhoea more common
  • abdo pain in LLQ
  • tenesmus
35
Q

Fts of mesenteric ischaemic (acute)

A
  • sudden onset severe abdo pain out of keeping with physical exam
  • rectal bledeing
  • diarrhoea
    fever
  • bloods= elevated WCC; lactic acidosis
  • commonly BG of AF (thrombus of artery, i.e SMA)
36
Q

Mx of acute mesenteric ischaemia

A

Urgent surgery

37
Q

Pathophys of ischaemic colitis

A

acute but transient compromise in blood flow to large bowel
can lead to inflammation, ulceration and haemorrhage
> likely in ‘watershed’ areas (splenic flexure)

38
Q

viral hepatitis presentation

A
  • N&V, anorexia
  • myalgia
  • lethargy
  • RUQ pain

foreign travel or IVDU

39
Q

Presentation of congestive hepatomegaly

A

only painful if stretched (commonly due to congestive heart failure)

if severe - cirrhosis

40
Q

Biliary colic presentation

A
  • pain: RUQ, intermittent, aburpt onset, subsides gradually
  • attacks occur after eating
  • commonly: nausea

risk factors: female, forties, fat, fair, fertile

41
Q

Acue cholecystitis

A
  • biliary pain (RUQ, intermittent, acute onset after food) but > severe and persistent
  • +/- radiation to R shoulder
  • +/- fever
  • Murphy’s positive
42
Q

Ascending cholangitis presentation

A
  • fever (rigors)
  • RUQ pain
  • jaundice
43
Q

gallstone ileus presentation

A

abdominal pain
abdominal distension
vomiting

(SBO 2ry impacted galstone)

44
Q

cholangiocarcinoma presentation

A
  • persistent bilicary colic
  • anorexia
  • jaundice
  • weight loss
  • palpable mass in RUQ (Courvoisier)
  • periumbilical lymphadenopathy (sister May Joseph nodes)
  • left supraclavicular adenopathy (Virchow node)
45
Q

Acute pancreatitis presentation

A
  • severe epigastric pain
  • vomiting common
  • +/- ileus, tenderness, low grade fever
    +/- Periumbilical discolouration (Cullen’s sign) /flank (Grey-Turner’s sign) – rare
46
Q
A

General med (14 decks)

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