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Medicine Year 2 5 > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What is gastro-oesophageal reflux disease?

A

Reflux of stomach contents (acid and bile) causes troublesome symptoms such as heartburn

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2
Q

What can prolonged GORD cause? (3)

A

1) Oesophagitis
2) Benign oesophageal strictures
3) Barrett’s oesophagus

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3
Q

Give 4 causes of GORD

A
  • ) Lower oesophageal sphincter hypotension
  • ) Hiatus hernia
  • ) Oesophageal dysmotility
  • ) Obesity
  • ) Gastric acid hypersecretion
  • ) Delayed gastric emptying
  • ) Smoking
  • ) Alcohol
  • ) Pregnancy
  • ) Drugs (nitrates)
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4
Q

Give 3 oesophageal symptoms of GORD

A
  • ) Heartburn
  • ) Belching
  • ) Acid brash (acid/bile regurgitation)
  • ) Waterbrash (increased salivation)
  • ) Odynophagic (painful swallowing)
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5
Q

Give 3 extra-oesophageal symptoms of GORD

A
  • ) Nocturnal asthma
  • ) Chronic cough
  • ) Laryngitis
  • ) Sinusitis
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6
Q

What can GORD lead to that could lead to cancer?

A

Barrett’s oesophagus

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7
Q

What is the histological change in Barrett’s oesophagus?

A

Distal oesophageal epithelium undergoes metaplasia from squamous to columnar

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8
Q

What tests can we do for GORD? (3)

A

1) Endoscopy
2) Barium swallow
3) 24 hours of oesophageal monitoring and manometry

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9
Q

When do we do an endoscopy in GORD? (2)

A

1) Symptoms >4 weeks

2) >55 with alarm symptoms

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10
Q

What is the treatment for GORD? (4)

A
  • ) Lifestyle changes
  • ) Drugs (antacids alginates, PPI)
  • ) Avoid nitrates, antcholinergics, calcium channel blockers, NSAIDs, bisphosphonates
  • ) Surgery to increase sphincter pressure
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11
Q

Give an example of a PPI

A

Lanzoprazole

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12
Q

Give the lifestyle changes for GORD

A
  • ) Weight loss
  • ) Smoking cessation
  • ) Small regular meals
  • ) Reduce hot drinks
  • ) Alcohol
  • ) Citrus fruits, tomatoes, onions
  • ) Fizzy drinks
  • ) Spicy foods
  • ) Caffeine, chocolate
  • ) Avoid eating <3hr before bed
  • ) Raised bed head
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13
Q

Give 3 symptoms of peptic ulcer disease

A
  • ) Epigastric pain often related to hunger, specific foods, time of day
  • ) Bloating
  • ) Fullness after meals
  • ) Heartburn
  • ) Tender epigastrium
  • ) ALARM symptoms
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14
Q

What are the ALARMS symptoms?

A 
Anaemia
Loss of weight
Anorexia
Recent onset
Melena (or haematemesis)
Swallowing problems
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15
Q

What do we test for if the patient is <55 with peptic ulcer disease?

A

H. pylori

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16
Q

How do we treat a H. pylori infection?

A

PAC
PPI
Amoxicillin
Clarithromycin

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17
Q

What should we do if a patient is >55 and has new dyspepsia or ALARM symptoms?

A

Urgent endoscopy

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18
Q

What drugs can cause peptic ulcer disease?

A

NSAIDs

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19
Q

How can a duodenal ulcer cause pancreatitis?

A

It erodes through to the pancreas

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20
Q

Where do ulcers erode into to cause haemorrhaging?

A

Arteries

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21
Q

Where do ulcers erode into to cause peritonitis

A

Layers of stomach/duodenal wall

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22
Q

Is H. pylori gram negative or positive?

A

Negative

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23
Q

Are duodenal or gastric ulcers more common?

A

Duodenal

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24
Q

Give 2 minor risk factors for duodenal ulcers

A
  • ) Increased gastric secretion
  • ) Increased gastric emptying (decreased duodenal pH)
  • ) Smoking
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25
Q

What test do we do in peptic ulcer disease to diagnose?

A

Upper GI endoscopy

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26
Q

On which curve of the stomach do gastric ulcers usually occur?

A

Lesser curve

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27
Q

Give 3 risk factors for gastric ulcers

A
  • ) H. pylori
  • ) Smoking
  • ) NSAIDs
  • ) Reflux
  • ) Delayed emptying
  • ) Stress
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28
Q

What are the 4 parts of peptic ulcer disease treatment?

A

1) Lifestyle (decrease alcohol and tobacco)
2) H. pylori eradication
3) Drugs to reduce acid
4) Drug induced ulcers (stop drug if possible)

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29
Q

What drugs can we give to reduce acid in peptic ulcer disease? (2)

A

1) PPIs - lansoprazole

2) H2 blockers - ranitidine

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30
Q

What is gastritis?

A

Inflammation of the lining of the stomach

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31
Q

What are the 3 pathophysiological causes of gastritis?

A

1) Mucosal ischaemia (less mucin made)
2) Increased acid
3) Helicobacter infection (live in mucus layer)

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32
Q

Give 4 causes of gastritis

A
  • ) Alcohol
  • ) NSAIDs
  • ) H. pylori
  • ) Reflux/hiatus hernia
  • ) Atrophic gastritis
  • ) Granulomas
  • ) CMV (cytomegalovirus)
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33
Q

What are the symptoms of gastritis? (2)

A

Epigastric pain

Vomiting

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34
Q

How do we diagnose gastritis?

A

Upper GI endoscopy

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35
Q

How do we prevent gastritis when taking NSAIDs?

A

PPI

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36
Q

What is malabsorption?

A

Where we do not absorb enough food/nutrients from our diet

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37
Q

What are the 3 most common causes of gastrointestinal malabsorption in the UK?

A

1) Coeliac disease
2) Chronic pancreatitis
3) Crohn’s disease

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38
Q

Give 4 more rare causes of malabsorption

A
  • ) Decreased bile
  • ) Pancreatic insufficiency
  • ) Small bowel mucosa
  • ) Bacterial overgrowth
  • ) Infection
  • ) Intestinal hurry
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39
Q

What 2 drugs can cause malabsorption?

A

Alcohol, metformin

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40
Q

Give 5 symptoms of malabsorption

A
  • ) Diarrhoea
  • ) Weight loss
  • ) Lethargy
  • ) Steatorrhoea
  • ) Bloating
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41
Q

Give 4 signs of malabsorption

A
  • ) Anaemia
  • ) Bleeding disorders
  • ) Oedema
  • ) Metabolic bone disease
  • ) Neurological features
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42
Q

What decreases in anaemia in malabsorption? (3)

A

Fe, B12, folate

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43
Q

What decreases in bleeding disorders in malabsorption?

A

Vitamin K

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44
Q

What decreases in oedema in malabsorption?

A

Protein

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45
Q

What decreases in metabolic bone disease in malabsorption?

A

Vitamin D

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46
Q

What are we looking for in a blood test for malabsorption? (8)

A
  • ) FBC (micro/macrocytic anaemia)
  • ) Low Ca2+
  • ) Low Fe
  • ) Low B12
  • ) Low folate
  • ) Lipid profile
  • ) High INR
  • ) Coeliac tests
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47
Q

What are we looking for in a stool test for malabsorption?

A

Fat globules, microscopy, elastase

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48
Q

What do we do for bacterial overgrowth testing in malabsorption?

A

Breath hydrogen analysis

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49
Q

What are the results of breath hydrogen analysis if there is bacterial overgrowth?

A

Increased exhaled hydrogen after giving glucose

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50
Q

Give an organism that can cause infectious malabsorption

A

Giardia lamblia

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51
Q

What physical test can we do for malabsorption?

A

Endoscopy and small bowel biopsy

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52
Q

What is coeliac disease?

A

T cell responses to gluten in the small bowel causing villous atrophy and malabsorption

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53
Q

What gene is associated with 95% of cases of coeliac disease?

A

HLA DQ2

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54
Q

What gene is associated with 5% of cases of coeliac disease?

A

HLA DQ8

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55
Q

What is coeliac disease associated with? (2)

A

1) Autoimmune disease

2) Dermatitis herpetiformis

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56
Q

What are the 2 peaks of prevalence of coeliac disease?

A

Childhood and 50-60 yrs

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57
Q

What should we suspect in patients with diarrhoea, weight loss and anaemia?

A

Coeliac disease

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58
Q

Give 6 presenting features of coeliac disease

A
  • ) Bad smelling stools/steatorrhoea
  • ) Diarrhoea
  • ) Abdominal pain
  • ) Bloating
  • ) Nausea and vomiting
  • ) Aphthous ulcers
  • ) Angular stomatitis
  • ) Weight loss
  • ) Fatigue
  • ) Weakness
  • ) Osteomalacia
  • ) Failure to thrive
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59
Q

What main antibodies are found in coeliac disease? (3)

A

1) Anti-transglutaminsae (IgA)
2) Anti-endomysial
3) Deamidated gliadin peptide

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60
Q

What do blood tests show in coeliac disease? (4)

A
  • ) Decreased Hb
  • ) Increased red cell distribution width
  • ) Low B12
  • ) Low ferritin
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61
Q

What is the treatment for coeliac disease?

A

Lifelong gluten free diet

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62
Q

Give 3 complications of coeliac disease

A
  • ) Anaemia
  • ) Dermatitis herpetiformis
  • ) Osteopenia/osteoporosis
  • ) Hyposplenism
  • ) GI T cell lymphoma
  • ) Increased risk of malignancy
  • ) Neuropathies
  • ) Secondary lactose intolerance
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63
Q

What is irritable bowel syndrome? (IBS)

A

A group of mixed abdominal symptoms for which no organic cause can be found

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64
Q

What are most IBSs though to be due to? (3)

A

Disorders of intestinal motility, enhanced visceral perception, microbial dysbiosis

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65
Q

How do we diagnose IBS?

A

Recurrent abdominal pain/discomfort with at least 2 of:

  • ) Relief by defecation
  • ) Altered stool form
  • ) Altered bowel frequency
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66
Q

Give 3 other features of IBS

A
  • ) Urgency
  • ) Incomplete evacuation
  • ) Abdominal bloating/distension
  • ) Mucous PR
  • ) Worsening of symptoms after food
  • ) Nausea, bladder symptoms, backache
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67
Q

What the the chronic symptoms of IBS often exacerbated by? (3)

A
  • ) Stress
  • ) Menstruation
  • ) Gastroenteritis
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68
Q

What drug do we give for constipation?

A

Lactulose

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69
Q

What drug do we give for diarrhoea?

A

Loperamide

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70
Q

What drugs do we give for bloating/colic in IBS?

A

Antispamodics

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71
Q

What non medical treatment is given in IBS

A

CBT and hypnotherapy

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72
Q

What do we need to diagnose IBS if the history is classic? (4)

A

FBC, ESR, CRP, coeliac serology

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73
Q

What is ulcerative colitis?

A

A relapsing and remitting inflammatory disorder of the colonic mucosa

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74
Q

Where does UC not spread past?

A

Ileocaecal valve

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75
Q

What is UC in the rectum named?

A

Proctitis

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76
Q

What is UC in the left part of the colon named?

A

Left-sided colitis

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77
Q

What is US in the entire colon named?

A

Pancolitis

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78
Q

What is the cause of UC?

A

Inappropriate immune response against possibly abnormal colonic flora in genetically susceptible individuals

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79
Q

What is the difference in lesions between UC and Crohn’s?

A

UC has distinct cut off line, Crohn’s has skip lesions

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80
Q

Is UC or Crohn’s more common in non-smokers?

A

UC

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81
Q

What is the pathological appearance in UC? (2)

A

1) Hyperaemic/haemorrhagic colic mucosa +/- pseudo polyps formed by inflammation
2) Punctate ulcers may extend deep into lamina propria

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82
Q

Give 3 GI symptoms of UC

A
  • ) Episodic/chronic diarrhoea (+/- blood and mucus)
  • ) Crampy abdominal discomfort
  • ) Bowel frequency relates to severity
  • ) Urgency/tenesmus = proctitis
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83
Q

Give 3 systemic symptoms of a UC attack

A

Fever, malaise, anorexia, weight loss

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84
Q

Give 3 signs of acute severe UC

A

Fever, tachycardia, tender distended abdomen

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85
Q

Give 4 extra intestinal signs of UC

A
  • ) Clubbing
  • ) Aphthous oral ulcers
  • ) Erythema nodosum
  • ) Conjunctivitis
  • ) Episcleritis
  • ) Iritis
  • ) Large joint arthritis
  • ) Sacroilitis
  • ) Anklosing spondylitis
  • ) Primary sclerosing cholingitis
  • ) Nutritional deficits
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86
Q

What 5 tests do we do for UC?

A
  • ) Blood
  • ) Stool MC&S/CDT
  • ) Faecal calprotectin
  • ) AXR
  • ) Lower GI endoscopy
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87
Q

What does MC&S stand for?

A

Microbiology culture & sensitivity

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88
Q

What does CDT stand for?

A

Carbohydrate deficient transferrin test

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89
Q

What 3 things does an AXR show in UC?

A
  • ) No faecal shadows
  • ) Mucosal thickening/islands
  • ) Colonic dilatation
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90
Q

Give 2 acute complications of UC

A
  • ) Toxic dilatation of colon with risk of perforation
  • ) Venous thromboembolism
  • ) Decreased K+
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91
Q

Give a chronic complication of UC

A

Colonic cancer

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92
Q

What do we treat mild UC with?

A

5-amino salicylic acid (mesalazine)

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93
Q

What do we treat moderate UC with? (2)

A
  • ) Prednisolone

- ) Then maintain on 5-ASA (mesalazine)

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94
Q

What do we treat severe UC with?

A

Admit by nil by mouth with:

  • ) IV hydration
  • ) IV steroids (hydrocortisone)
  • ) Thromboembolism prophylaxis
  • ) Daily tests
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95
Q

What do we give if they improve on severe UC treatment?

A

Prednisolone

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96
Q

What do we give if they don’t improve on severe UC treatment?

A

Colectomy

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97
Q

What do we give in UC if there is no remission with steroids?

A

Immunomodulation (azathioprine)

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98
Q

What are UC and Crohn’s both types of?

A

Inflammatory bowel disease - IBD

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99
Q

What is Crohn’s disease?

A

A chronic inflammatory disease characterised by transmural granulomatouss inflammation affecting any part of the gut from the mouth to anus

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100
Q

Where does Crohn’s especially occur?

A

Terminal ileum and proximal colon

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101
Q

What causes Crohn’s disease?

A

Inappropriate immune response against possibly abnormal gut flora in genetically susceptible individuals

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102
Q

Does UC or Crohn’s have skip lesions?

A

Crohn’s

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103
Q

What drugs may exacerbate Crohn’s

A

NSAIDs

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104
Q

Give 3 GI symptoms of Crohn’s

A
  • ) Diarrhoea
  • ) Abdominal pain
  • ) Weight loss/failure to thrive
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105
Q

Give 3 systemic symptoms of Crohn’s

A
  • ) Fatigue
  • ) Fever
  • ) Malaise
  • ) Anorexia
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106
Q

Give 3 GI signs of Crohn’s

A
  • ) Bowel ulceration
  • ) Abdominal tenderness/mass
  • ) Perianal abscess/ fistulae/ skin tags
  • ) Anal strictures
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107
Q

Give 2 extra intestinal signs of Crohn’s

A
  • ) Clubbing

- ) Skin, joint and eye problems

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108
Q

Give 4 complications of Crohn’s

A
  • ) Small bowel obstruction
  • ) Toxic dilatation
  • ) Abscess formation
  • ) Fistulae
  • ) Perforation
  • ) Colon cancer
  • ) PSC
  • ) Malnutrition
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109
Q

What tests do we do in Crohn’s?

A
  • ) Blood
  • ) Stool
  • ) Colonscopy and biopsy
  • ) Barium enema
  • ) Small bowel MRI
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110
Q

What does a barium enema show in Crohn’s? (3)

A
  • ) Cobblestoning
  • ) Deep fissuring ulcers
  • ) Strictures
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111
Q

What lifestyle changes do we advise in Crohn’s?

A

Smoking cessation and optimisation of nutrition

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112
Q

What do we give to treat mild attacks of Crohn’s?

A

Prednisolone

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113
Q

What do we give to treat severe attacks of Crohn’s?

A
  • ) IV hydration/electrolytes
  • ) IV steroids (hydrocortisone)
  • ) Thromboembolism prophylaxis
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114
Q

What do we give if the patient is improving on severe Crohn’s treatment?

A

Prednisolone

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115
Q

What do we give if the patient is not improving on severe Crohn’s treatment?

A

Biologics - anti-TNFalpha, infliximab

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116
Q

What treatment is given in perianal disease of Crohn’s?

A
  • ) Oral antibiotics
  • ) Immunosuppressant therapy
  • ) +/- anti-TNFalpha
  • ) Local surgery
  • ) Metronidazole
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117
Q

What is bowel obstruction?

A

Blockage to the lumen of the gut

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118
Q

What are the 3 types of obstruction?

A

1) Intraluminal
2) Intramural
3) Extraluminal

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119
Q

What is Hirschsprung’s disease?

A

Developmental abnormality of an aganglionic segment - no rhythm cells, so impaired motility

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120
Q

Give 2 causes for a SBO

A
  • ) Adhesions

- ) Hernias

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121
Q

Give 4 causes for a LBO

A
  • ) Colon cancer
  • ) Constipation
  • ) Diverticular stricture
  • ) Volvulus
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122
Q

What are adhesions?

A

Parts of the bowel connected by thin white fibrous bands

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123
Q

What are adhesions usually secondary to?

A

Previous surgery

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124
Q

What are 4 rarer causes of a bowel obstruction?

A
  • ) Crohn’s
  • ) Gallstone ileus
  • ) Appendicitis
  • ) Intussusception
  • ) Foreign bodies
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125
Q

What are the 4 ways in which we classify bowel obstructions?

A
  • ) Site
  • ) Extent of luminal obstruction
  • ) Mechanism (true/paralytic)
  • ) Pathology
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126
Q

What are the 4 cardinal features of bowel obstruction?

A

1) Vomiting
2) Colicky pain
3) Constipation
4) Abdominal distension

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127
Q

What does fermentation of the intestinal contents in established obstruction cause?

A

Faeculent vomiting

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128
Q

What are the bowel sounds like in an obstruction?

A

Active, tinkling

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129
Q

What are the differences in presentation between a SBO and a LBO? (5)

A
  • ) Vomiting occurs earlier in SBO
  • ) Less distension in SBO
  • ) Pain higher in abdomen in SBO
  • ) Earlier constipation in LBO
  • ) More constant pain in LBO
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130
Q

What is absolute constipation?

A

Obstipation

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131
Q

What are the bowel sounds like in a paralytic ileus obstruction?

A

Absent

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132
Q

What is a paralytic ileus?

A

Functional obstruction from decreased bowel motility, less pain

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133
Q

What is a simple bowel obstruction?

A

One obstruction point and no vascular compromise

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134
Q

What is a closed loop bowel obstruction?

A

Obstruction at 2 points forming a loop of grossly distended bowel at risk of perforation

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135
Q

What is a strangulated bowel obstruction?

A

Blood supply is compromised, sharper and more localised pain, peritonitis, possible fever

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136
Q

Give an example of a closed loop obstruction

A

Colonic volvulus

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137
Q

What is a closed loop obstruction due to?

A

Axial rotation at mesenteric attachments

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138
Q

What is the rule when looking at AXRs of bowel obstruction?

A

3-6-9 rule

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139
Q

What does a SBO look like on an AXR? (3)

A
  • ) Central gas shadows with valvular conniventes that completely cross lumen
  • ) No gas in large bowel
  • ) Normal diameter of SB <3cm
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140
Q

What does a LBO look like on an AXR? (4)

A
  • ) Peripheral gas shadows proximal to blockage
  • ) Large bowel haustria do not cross lumen width
  • ) Normal diameter of LB <6cm
  • ) Normal diameter of caecum and sigmoid <9cm
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141
Q

What does an intersusseption look like on a CT?

A

Doughnut

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142
Q

What does a volvulus look like on a CT?

A

Coffee bean

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143
Q

What is the treatment for an obstruction?

A

Surgery - strangulations, LBOs, volvulus, hernias, tumours

Medical - Ileus, incomplete SBOs

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144
Q

What is the medical treatment for an obstruction?

A
  • ) NGT
  • ) IV fluids
  • ) Analgesia
  • ) Catheter
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145
Q

What is a pseudo-obstruction?

A

Like a mechanical GI obstruction but with no cause found

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146
Q

How do we treat a pseudo-obstruction? (2)

A

Neostigmine or colonscopic decompression

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147
Q

What is a sigmoid volvulus?

A

Bowel twists on mesentery and proceeds severe strangulated obstruction

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148
Q

How do we manage a sigmoid vovulus? (2)

A

Sigmoidoscopy and insertion of flatus tube

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149
Q

What is intussusception?

A

Where the small bowel telescopes, and there is invagination of one part into the other

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150
Q

What are intussusceptum and intussuscipien?

A

Intussusceptum - invaginating portion

Intussuscipien - receiving portion

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151
Q

How do we treat an intussusception?

A

Air enema

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152
Q

How do we diagnose an intussusception?

A

US

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153
Q

Where does acute mesenteric ischaemia almost always involve?

A

Small bowel

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154
Q

What are the 3 things acute mesenteric ischaemia may follow?

A

1) Superior mesenteric artery thrombosis/embolism
2) Mesenteric vein thrombosis
3) Non-occlusive disease

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155
Q

What is the classic clinical triad of presentation for acute mesenteric ischaemia?

A

1) Acute severe abdominal pain
2) No/minimal abdominal signs
3) Rapid hypovolaemia leading to shock

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156
Q

What is the pain like in acute mesenteric ischaemia?

A

Contant and central/around right iliac fossa

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157
Q

How are most diagnoses of acute mesenteric ischaemia found?

A

Necrotic bowel at laparotomy

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158
Q

What does an AXR show in acute mesenteric ischaemia?

A

Gasless abdomen

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159
Q

What are 4 findings on tests with acute mesenteric ischaemia?

A

1) Increased Hb
2) Increased WCC
3) Raised plasma amylase
4) Persistent metabolic acidosis (high lactate)

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160
Q

What are the 2 main complications of acute mesenteric ischaemia?

A

1) Septic peritonitis

2) Progression of a systemic inflammatory response syndrome (SIRS) to muti-organ failure

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161
Q

How do we treat acute mesenteric ischaemia?

A

Resus with fluid, antibiotics (piperacillin), LMWH/heparin, dead bowel surgically removed

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162
Q

What is the presenting triad of chronic mesenteric ischaemia?

A

1) Severe, colicky post-prandial pain
2) Weight loss (eating hurts)
3) Upper abdominal bruit

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163
Q

What are some other symptoms of chronic mesenteric ischaemia?

A
  • ) PR bleeding
  • ) Malabsorption
  • ) Nausea and vomiting
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164
Q

What is chronic mesenteric ischaemia typically brought on by?

A

Combination of a low flow state with atheroma

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165
Q

What tests do we use to diagnose chronic mesenteric ischaemia? (2)

A

CT angiography and contrast enhanced MR angiography

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166
Q

How do we treat chronic mesenteric ischaemia?

A

Surgery is percutaneous transluminal angioplasty and stent insertion

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167
Q

What is ischaemic colitis also known as?

A

Chronic colonic ischaemia

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168
Q

What does chronic colonic ischaemic usually follow?

A

Low flow in the inferior mesenteric artery territory

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169
Q

What is the presentation of chronic colonic ischaemia?

A

Lower left sided abdominal pain +/- bloody diarrhoea

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170
Q

What is the gold standard for diagnosis of chronic colonic ischaemia?

A

Lower GI endoscopy

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171
Q

What is the treatment for chronic colonic ischaemia?

A

Fluids and antibiotics

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172
Q

What does gangrenous ischaemic colitis present with? (2)

A

Peritonitis and hypovolaemic shock

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173
Q

What is the treatment for gangrenous ischaemic colitis?

A

Resus and resection of affected bowel and stoma formation

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174
Q

What is a GI diverticulum?

A

An out pouching of the gut wall

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175
Q

Where does a GI diverticulum usually occur?

A

At the sites of entry of perforating arteries

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176
Q

What is diverticulosis?

A

Inflammation of a diverticulum

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177
Q

What is diverticular disease?

A

Symptomatic diverticula, when the pouch fills with material that becomes secondarily infected

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178
Q

Which are the most important type of diverticulum?

A

Acquired colonic diverticula

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179
Q

Where are most colonic diverticula?

A

Sigmoid colon

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180
Q

What is the pathology of a diverticula?

A

High intraluminal pressure possible to due lack of dietary fibre force the mucosa to herniate through the muscle layers of the gut at weak points adjacent to penetrating vessels

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181
Q

How is peritonitis caused in diverticular disease?

A

Pouches rupture

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182
Q

How are diverticula usually found?

A

Incidental finding at colonoscopy

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183
Q

What test confirms a diagnosis of acute diverticulitis?

A

Abdominal CT

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184
Q

What does diverticular disease present with? (2)

A
  • ) Altered bowel habit +/- left sided colic relieved be defecation
  • ) Nausea and flatulence
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185
Q

What is a treatment of diverticular disease?

A

Antispasmodics (mebeverine)

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186
Q

What does diverticulitis present with?

A

Diverticular disease features and:

  • ) Pyrexia
  • ) High WCC
  • ) High CRP/ESR
  • ) Tender colon
  • ) +/- localised/generalised peritonism
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187
Q

How do we treat mild attacks of diverticulitis?

A

Bowel rest (fluids only) +/- antibiotics

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188
Q

How do we treat less mild attacks of diverticulitis?

A

Admit for analgesia, NBM, IV fluids, IV antibiotics

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189
Q

Give 3 complications of diverticulitis

A

1) Abscess formation
2) Perforation
3) Haemorrhage
4) Fistulae
5) Post infective strictures

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190
Q

How does appendicitis occur?

A

Gut organisms invade the appendix wall after lumen obstruction by lymphoid hyperplasia, faecolith, or filarial worms

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191
Q

What does gut organisms invading the appendix wall lead to? (3)

A
  • ) Oedema
  • ) Ischaemic necrosis
  • ) Perforation
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192
Q

What is the classic presentation of appendicitis?

A

Periumbilical pain that moves to the right iliac fossa

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193
Q

Give 3 associated signs of appendicitis

A
  • ) Tachycardia
  • ) Fever
  • ) Peritonism with guarding and reboud/percussion tenderness in RIF
  • ) Anorexia
  • ) Constipation
  • ) Possibly vomiting, diarrhoea
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194
Q

What do we use to diagnose appendicitis?

A

CT

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195
Q

What does CRP stand for?

A

C-reactive protein

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196
Q

What does ESR stand for?

A

Erythrocyte sedimentation rate

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197
Q

What is the treatment for appendicitis? (2)

A
  • ) Appendicetomy

- ) Antibiotics (piperacillin, metronidazole, cefuroxime)

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198
Q

What is peritonitis?

A

Inflammation of the peritoneum

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199
Q

Give 4 causes of peritonitis

A

Perforation of:

  • ) Peptic/duodenal ulcer
  • ) Diverticulum
  • ) Appendix
  • ) Bowel
  • ) Gallbladder
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200
Q

What is the classification of peritonitis? (4)

A
  • ) Onset
  • ) Origin
  • ) Cause
  • ) Location
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201
Q

Give 3 symptoms of peritonitis

A
  • ) Pain
  • ) Tenderness
  • ) Systemic symptoms
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202
Q

Give 4 signs of peritonitis

A
  • ) Prostration
  • ) Lying still
  • ) Positive cough test
  • ) Tenderness (+/- rebound)
  • ) Abdominal righty
  • ) Guarding
  • ) No bowel sounds
  • ) Shock
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203
Q

How do we differentiate peritonitis from pancreatitis?

A

Serum amylase levels (raised in pancreatitis)

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204
Q

What may an erect CXR show in peritonitis?

A

Gas under the diaphragm

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205
Q

What colour is the fluid on peridyalisis?

A

Yellow (infection)

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206
Q

What ascites lactate level is 100% sensitive of an infection?

A

> 25mg/dL

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207
Q

What is the management of peritonitis?

A
  • ) Resus
  • ) Antibiotics
  • ) Treat cause
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208
Q

What is a hernia?

A

An abnormal protrusion of a viscus/part of a viscus through a defect of the wall of its containing cavity into an abnormal position

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209
Q

What is a irreducible hernia?

A

Contents cannot be pushed back into place

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210
Q

What is an obstructed hernia?

A

Bowel contents cannot pass

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211
Q

What is a strangulated hernia?

A

Ischaemia occurs

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212
Q

What is an incarceration hernia?

A

Contents of hernial sac are stuck inside by adhesions

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213
Q

Which is the most common hernia, and which gender is it more common in?

A

Inguinal, male

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214
Q

What are the 2 types of inguinal hernia?

A

1) Indirect

2) Direct

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215
Q

Where does an indirect inguinal hernia pass?

A

Through the internal inguinal ring, through the external ring if large

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216
Q

Where does a direct inguinal hernia go?

A

Pushes directly forward through the posterior wall of the inguinal cancel into a defect in the abdominal wall (Hesselbach’s triangle)

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217
Q

Is a direct or indirect inguinal hernia more common?

A

Indirect

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218
Q

Give 3 predisposing conditions for an inguinal hernia

A
  • ) Male
  • ) Chronic cough
  • ) Constipation
  • ) Urinary obstruction
  • ) Heavy lifting
  • ) Ascites
  • ) Past abdominal surgery
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219
Q

How do we distinguish a direct inguinal hernia from an indirect one?

A

Reduce the hernia and occludes deep (internal) ring with 2 fingers. Ask patient to cough/stand. If the hernia is restrained, it is indirect.

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220
Q

Which side of the inferior epigastric vessels does each inguinal hernia arise?

A

Direct - medial

Indirect - lateral

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221
Q

What surgery do we do to repair an inguinal hernia?

A

Polypropylene mesh reinforces posterior wall

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222
Q

What are the 2 types of hiatus hernia?

A

1) Sliding (80%)

2) Rolling (20%)

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223
Q

What occurs in a sliding hiatus hernia?

A

Gastro-oesophageal junction slides up into the chest, acid reflux often happens

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224
Q

What occurs in a rolling hiatus hernia?

A

Gastro-oesophageal junction remains in abdomen but bulge of stomach herniates into chest alongside oesophagus

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225
Q

How do we treat a hiatus hernia?

A
  • ) Weight loss
  • ) GORD treatment
  • ) Possibly surgery
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226
Q

What is a femoral hernia?

A

Where bowel enters the femoral canal

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227
Q

How does a femoral hernia present?

A

Mass in upper medial thigh or above inguinal ligament (points down leg)

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228
Q

What is the treatment of a femoral hernia?

A

Surgical repair (herniotomy/herniorrhaphy)

229
Q

Which gender is a femoral hernia more common in?

A

Female

230
Q

What is an incisional hernia?

A

Follows breakdown of muscle closure after surgery

231
Q

What is gastroenteritis?

A

Diarrhoea (+/- vomiting) due to enteric infection with viruses, bacteria, parasites

232
Q

What are 5 things diarrhoea can be defined as?

A
  • ) Acute diarrhoea
  • ) Dysentery
  • ) Persistent
  • ) Traveller’s
  • ) Food poisoning
233
Q

What is diarrhoea?

A

A decreased stool consistency from water, fat, or inflammatory discharge

234
Q

What is the rule of C with C. diff infections?

A

C. diff is linked to clindamycin, ciprofloxacin, co-amoxiclav, cephalosporins - we should give additional antibiotics

235
Q

How can we prevent C. diff infections?

A

Thorough handwashing with soap and water

236
Q

Give 2 viral causes of infective diarrhoea

A

Norovirus, rotavisus

237
Q

Give 4 bacterial causes of infective diarrhoea

A

Salmonella, campylobacter, E. coli, shigella

238
Q

Give 1 parasitic cause of infective diarrhoea

A

Giardia

239
Q

What does C. diff stand for?

A

Clostridium difficile

240
Q

Give 4 signs of infective diarrhoea

A
  • ) Dehydration
  • ) Dry mucous membranes
  • ) Decreased skin tugor
  • ) Slow capillary refill
  • ) Weight loss
  • ) Anaemia
  • ) Oral ulcers
  • ) Fever
241
Q

What tests can we do for infective diarrhoea? (5)

A
  • ) Rectal exam
  • ) Bloods
  • ) Stool MC&S, faecal fat
  • ) Sigmoidoscopy with biopsy
  • ) Colonoscopy/barium enema
242
Q

How do we treat infective diarrhoea? (2)

A
  • ) Treat cause

- ) Oral rehydration unless severe (IV)

243
Q

Which 2 drugs will decrease the frequency of the diarrhoea?

A

1) Codeine phosphate

2) Loperamide

244
Q

What is acute pancreatitis characterised by?

A

Self perpetuating pancreatic enzyme mediated auto digestion

245
Q

What are the causes of acute pancreatitis? (10)

A 
GET SMASHED
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune (PAN)
Scorpion venom
Hyperlipidaemia, hypothermia, hypercalcaemia
ERCP and emboli
Drugs
246
Q

Give the 2 main symptoms of acute pancreatitis

A
  • ) Gradual/sudden severe epigastric or central abdominal pain
  • ) Vomiting prominent
247
Q

How is the pain relieved in acute pancreatitis?

A

Sitting forward

248
Q

Give 4 signs of acute pancreatitis

A
  • ) Increased HR
  • ) Fever
  • ) Jaundice
  • ) Shock
  • ) Ileus
  • ) Rigid abdomen
  • ) +/- local/general tenderness
  • ) Periumbilical bruising (Cullen’s sign)
  • ) Flanks bruising (Grey Turner’s sign)
249
Q

What do we test for in pancreatitis? (2)

A
  • ) Raised serum amylase

- ) Serum lipase

250
Q

What does an AXR show in pancreatitis?

A
  • ) No psoas shadow

- ) Sentinel loop of proximal jejunum from ileus

251
Q

What is the modified Glasgow criteria for predicting severity of pancreatitis? (8)

A 
PANCREAS
PaO2, <8kPa
Age, >55
Neutrophilia, high WCC 
Calcium, low
Renal function, urea high
Enzymes, LDH and AST high
Albumin, low
Suger, high
252
Q

What are the causes of pancreatitis when using the modified Glasgow criteria? (2)

A
  • ) Gallstones

- ) Alcohol

253
Q

What is the treatment of acute pancreatitis?

A
  • ) NBM
  • ) Catheter
  • ) IV fluids
  • ) Analgesia
  • ) Monitor
  • ) If worsening, oxygen, antibiotics, debridement
  • ) ERCP and gallstone removal if progressive jaundice
254
Q

Give 3 complications of acute pancreatitis

A
  • ) Shock
  • ) ARDs
  • ) Renal failure
  • ) Increased glucose and decreased calcium
  • ) Sepsis
  • ) Necrosis
  • ) Fluid in lesser sac
  • ) Abscesses
  • ) Bleeding
  • ) Thrombosis
  • ) Fistulae
255
Q

What does chronic pancreatitis present with?

A

Epigastric pain that ‘bores’ through to the back

256
Q

Give 3 signs of chronic pancreatitis

A
  • ) Erythema ab igneous mottled dusky geyness
  • ) Bloating
  • ) Steatorrhoea
  • ) Weight loss
  • ) Brille diabetes (up and down)
257
Q

What do symptoms do in chronic pancreatitis?

A

Relapse and worsen

258
Q

Give 3 causes of chronic pancreatitis

A
  • ) Alcohol
  • ) Smoking
  • ) Autoimmune
  • ) Familial, CF, haemochromatosis, pancreatic duct obstruction, congenital
259
Q

How do we diagnose chronic pancreatitis?

A

Pancreatic calcifications on US

260
Q

What is the treatment for chronic pancreatitis?

A
  • ) Analgesia
  • ) Lipase
  • ) Insulin
  • ) No alcohol and low fat
  • ) Surgery for unremitting pain, weight loss, narcotic abuse
261
Q

What is the surgery in chronic pancreatitis?

A

Pancreatectomy

262
Q

Give 3 complications of chronic pancreatitis

A
  • ) Pseudocyst
  • ) Diabetes
  • ) Biliary obstruction
  • ) Local arterial aneurysm
  • ) Splenic vein thrombosis
  • ) Gastric varices
  • ) Pancreatic carcinoma
263
Q

What occurs in primary biliary cholangitis? (PBC)

A

Interlobular bile ducts damaged by chronic autoimmune granulomatous inflammation causing cholestasis

264
Q

What may cholestasis in PBC lead to? (3)

A
  • ) Fibrosis
  • ) Cirrhosis
  • ) Portal hypertension
265
Q

What is PBC caused by?

A

Unknown environmental triggers and genetic predisposition leading to loss of immune tolerance to self-mitochondrial proteins

266
Q

What gender is PBC more common in?

A

Women

267
Q

Give 2 risk factors for PBC

A
  • ) Family history
  • ) Many UTIs
  • ) Smoking
  • ) Past pregnancy
  • ) Other autoimmune diseases
  • ) Nail polish/hair dye use
268
Q

What (found in blood) are the hallmark of PBC?

A

Antimitochondrial antibodies (AMA)

269
Q

How is a patient with PBC usually diagnosed?

A

Asymptomatic, incidental finding of increased ALP

270
Q

What does ALP stand for?

A

Alkaline phosphate

271
Q

Give 3 symptoms of PBC

A
  • ) Lethargy
  • ) Sleepiness
  • ) Pruritus preceding jaundice
272
Q

Give 3 signs of PBC

A
  • ) Jaundice
  • ) Skin pigmentation
  • ) Xanthelasma (lipid laden yellow plaques around eyes)
  • ) Hepatosplenomegaly
273
Q

Give a complication of PBC

A

Osteomalacia/osteoporosis

274
Q

What type of AMA subtype are 98% of PBC patients?

A

M2 subtype positive

275
Q

What is the treatment for symptomatic PBC? (3)

A
  • ) Colestyramine for pruritus
  • ) Codeine phosphate for diarrhoea
  • ) Bisphosphonates for osteoporosis prevention
276
Q

What is a specific treatment for PBC? (2)

A
  • ) Fat soluble vitamin prophylaxis - A, D, K

- ) High dose ursodeoxycholic acid

277
Q

What is primary sclerosis cholangitis? (PSC)

A

Progressive cholestasis with bile duct inflammation and strictures

278
Q

Give 2 symptoms of PSC

A
  • ) Pruritus

- ) Fatigue

279
Q

Give 3 genetic associations with PSC

A
  • ) HLA-A1
  • ) HLA B8
  • ) HLA DR3
280
Q

What does advanced PSC present with?

A
  • ) Ascending cholangitis
  • ) Cirrhosis
  • ) Hepatic failure (jaundice)
281
Q

Is IBD associated with PSC, and what does it raise the risk of?

A

IBD, colorectal malignancy

282
Q

What are the positive antibodies in PSC? (and the one negative one?)

A

Positive
-) ANA, SMA, ANCA
Negative
-) AMA

283
Q

What does ANA stand for?

A

Antinuclear antibody

284
Q

What does SMA stand for?

A

Smooth muscle antibody

285
Q

What does ANCA stand for?

A

Antineutrophil cytoplasmic antibody

286
Q

What is the mainstay treatment for PSC?

A

Liver transplant

287
Q

What is hereditary haemochromatosis? (HH)

A

An inherited disorder of iron metabolism in which increased intestinal iron absorption leads to iron deposition

288
Q

Where does iron deposition occur in hereditary haemochromatosis?

A
  • ) Joints
  • ) Liver
  • ) Heart
  • ) Pancreas
  • ) Pituitary
  • ) Adrenals
  • ) Skin
289
Q

Why are women affected less severely & present later in hereditary haemochromatosis?

A

Menstrual blood loss is protective

290
Q

What is the gene responsible for most HH?

A

HFE, recessive

291
Q

What are the 2 most common mutations in HH?

A

C282Y

H63D

292
Q

Give 2 early symptoms of HH

A
  • ) Tiredness
  • ) Arthralgia
  • ) Decreased libido
293
Q

Give 2 later symptoms/signs of HH

A
  • ) Slate grey skin pigmentation
  • ) Signs of chronic liver disease
  • ) Hepatomegaly
  • ) Cirrhosis
  • )Dilated cardiomyopathy
294
Q

What 3 things can deposition cause in organs in HH?

A
  • ) Pancreas - DM
  • ) Pituitary - hypogonadism
  • ) Adrenals - hypoaldosteronism
295
Q

What stain on a liver biopsy quantifies iron loading? (HH)

A

Perl’s

296
Q

What do liver and cardiac MRIs show in HH?

A

Iron overload

297
Q

What is the treatment for HH?

A

Venesect until ferritin decreased, then maintenance for life

298
Q

What is the treatment if the patient is intolerant of HH?

A

Desferrioxamine

299
Q

What other management is there for HH?

A
  • ) No iron in other drugs
  • ) Screening
  • ) Diet - alcohol, seafood
300
Q

What does bile contain?

A

Cholesterol, bile pigments (from broken down Hb), phospholipids

301
Q

What are pigment gallstones and what are they caused by?

A
  • ) Small, friable, irregular

- ) Haemolysis

302
Q

What are cholesterol gallstones and what are they caused by?

A
  • ) Large, often solitary

- ) Age, obesity, female

303
Q

What are mixed gallstones?

A

-) Faceted (calcium salts, pigment, cholesterol)

304
Q

What are 2 risk factors for gallstones becoming symptomatic?

A

Smoking, parity

305
Q

How do we treat gallbladder stones? (2)

A
  • ) Laparoscopic cholecystectomy

- ) Bile acid dissolution therapy

306
Q

How do we treat bile duct stones? (3)

A
  • ) ERCP with sphincterotomy and removal
  • ) Crushing (mechanical/laser)
  • ) Stent placement
307
Q

What is ascending cholangitis?

A

Infection of the bile duct

308
Q

What is ascending cholangitis caused by?

A

Bacteria ascending from duodenum, occurs more often with stones

309
Q

What are the 3 main symptoms of ascending cholangitis?

A

Charcot’s triad

  • ) Jaundice
  • ) Fever
  • ) Abdominal pain
310
Q

What is Reynold’s triad of symptoms?

A

Charcot’s triad plus low BP and confusion

311
Q

What are the most common causative organisms of ascending cholangitis? (2)

A
  • ) E. coli

- ) Klebsiella

312
Q

How do we treat ascending cholangitis? (3)

A
  • ) Fluid
  • ) Antibiotics
  • ) Treat obstruction
313
Q

What is acute cholecystitis?

A

Inflammation of the gallbladder

314
Q

What can recurrent episodes of acute cholecystitis cause?

A

Pancreatitis

315
Q

What is the pain in acute cholecystitis like?

A

Continuous epigastric or right upper quadrant pain referred to right shoulder

316
Q

What symptoms of acute cholecystitis are there?

A
  • ) Pain
  • ) Vomiting
  • ) Fever
  • ) Local peritonism
  • ) GB mass
317
Q

What is Murphy’s sign? (acute cholecystitis)

A

Lay 2 fingers over the RUQ, when the patient breaths in there is pain and arrest of inspiration

318
Q

What does an US show in acute cholecystitis?

A

Thick walled shrunken GB, pericholecystitc fluid, stones, dilated common bile duct

319
Q

What is the treatment of acute cholecystitis? (4)

A
  • ) NBM
  • ) Pain relief
  • ) Antibiotics (cefuroxime)
  • ) Surgery
320
Q

What is jaundice?

A

Yellowing of skin, sclerae, mucosa from increase plasma bilirubin

321
Q

What on an AXR of a GB shows an increased risk of cancer?

A

Porcelain GB

322
Q

What is jaundice classified by? (2)

A
  • ) Site of problem

- ) Type of circulating bilirubin

323
Q

What are the sites of jaundice? (3)

A
  • ) Pre-hepatic
  • ) Hepatocellular
  • ) Post-hepatic (cholestatic/obstructive)
324
Q

What are the types of circulating bilirubin in jaundice? (2)

A
  • ) Conjugated

- ) Unconjugated

325
Q

What is unconjugated hyperbilirubinaemia caused by? (4)

A
  • ) Overproduction (haemolysis)
  • ) Impaired hepatic uptake (drugs)
  • ) Impaired conjugation (Gilbert’s)
  • ) Physiological neonatal jaundice
326
Q

Why does unconjugated bilirubin not go into the urine?

A

Insoluble

327
Q

What is conjugated hyperbilirubinaemia caused by? (2)

A
  • ) Hepatocellular dysfunction

- ) Impaired hepatic excretion (cholestasis)

328
Q

What do the urine and faeces look like in conjugated hyperbilirubinaemia?

A

Urine - dark

Faeces - pale

329
Q

Give 3 causes of hepatocelluar dysfunction in jaundice

A
  • ) Viruses (hepatitis)
  • ) Drugs
  • ) Alcohol
  • ) Cirrhosis
  • ) Liver mets/abscess
  • ) Budd-Chiari
  • ) Wilson’s
330
Q

Give 3 causes of impaired hepatic excretion in jaundice

A
  • ) Primary biliary cholangitits
  • ) Primary sclerosis cholangitis
  • ) Drugs
  • ) Common bile duct gallstones
  • ) Pancreatic cancer
  • ) Compression of bile duct
331
Q

How is bilirubin formed in the breakdown of haemoglobin? (7)

A

1) Hepatic uptake
2) In liver, bilirubin conjugated with glucuronic acid by hepatocytes to conjugated bilirubin
3) Secreted in bile and passes into gut
4) Some reuptaken in liver
5) Rest converted to urobilinogen by gut bacteria
6) Urobilinogen reabsorbed and excreted by kidney
7) Or urobilinogen converted to stercobilin for faeces

332
Q

What is absent in the urine in each stage of jaundice?

A
  • ) Pre-hepatic - no bilirubin
  • ) Obstructed - no urobilinogen
  • ) Post-hepatic - N/A
333
Q

What are the 3 mainstays of tests in jaundice?

A
  • ) Liver enzymes (high AST/ALT)
  • ) Biliary obstruction on US
  • ) Urine
334
Q

How do we treat jaundice?

A
  • ) Treat cause
  • ) Antibiotics if obstruction
  • ) Hydration
335
Q

What is cirrhosis?

A

Irreversible liver damage

336
Q

What does cirrhosis look like histologically?

A

Loss of normal hepatic architecture with bridging fibrosis and nodular regeneration

337
Q

What are the 3 most common causes of cirrhosis?

A
  • ) Chronic alcohol abuse
  • ) HBV
  • ) HCV
338
Q

Give 4 signs of cirrhosis/chronic liver disease

A
  • ) Leuconychia (white nails)
  • ) Terry’s nails (proximally white, distal red)
  • ) Clubbing
  • ) Palmar erythema
  • ) Hyperdynamic circulation
  • ) Spider nave
  • ) Xanthelasma (yellow deposit of cholesterol under skin)
  • ) Gynaecomastia (swelling o breast tissue in males)
  • ) Loss of body hair
  • ) Parotid enlargement
  • ) Hepatomegaly
  • ) Ascites
  • ) Splenomegaly
339
Q

Give 3 complications of cirrhosis

A
  • ) Hepatic failure
  • ) Portal hypertension
  • ) HCC
340
Q

What is the most common serious infection in cirrhosis?

A

Spontaneous bacterial peritonitis

341
Q

What are increased (bloods) in cirrhosis? (6)

A
  • ) Bilirubin
  • ) AST
  • ) ALT
  • ) Gamma GT
  • ) ALP
  • ) PT/INR later
342
Q

What are decreased (bloods) in cirrhosis? (3)

A

-) Albumin
-) WCC
-) Platelets
Last 2 indicate hypersplenism

343
Q

How do we diagnose a spontaneous bacterial peritonitis?

A

Ascitic tap - neutrophils high presence

344
Q

What is the treatment for cirrhosis?

A
  • ) Good nutrition
  • ) Avoid alcohol, NSAIDs, sedatives, opiates
  • ) Colestyramine for pruritis
  • ) US screen for cancer
  • ) High dose ursodeoxycholic acid in PBC
  • ) Penicillamine in Wilson’s disease
345
Q

What is the treatment for ascites?

A
  • ) Fluid restriction
  • ) Low salt diet
  • ) Spironolactone
346
Q

How do we treat spontaneous bacterial peritonitis?

A

Piperacillin with tazobactam until sensitivities known

347
Q

What is the only definite treatment/cure for cirrhosis?

A

Liver transplant

348
Q

What is portal hypertension?

A

High blood pressure in the hepatic portal vein

349
Q

What can portal hypertension lead to? (2)

A

Varices and haemorrhages

350
Q

What are the 3 types of causes of portal hypertension?

A
  • ) Pre-hepatic
  • ) Intra-hepatic
  • ) Post-hepatic
351
Q

Give 4 causes of portal hypertension

A
  • ) Thrombosis
  • ) Cirrhosis
  • ) Schistosomiasis
  • ) Budd-Chiari syndrome
  • ) Right HF
352
Q

What are gastro-oesophageal varices?

A

Submucosal venous dilatation secondary to increased portal pressures

353
Q

What is the management of gastro-oesophageal varices?

A

Endoscopic banding or sclerotherapy

354
Q

What is the prophylaxis for gastro-oesophageal varices?

A

Non-selective beta-blocker, propranolol or repeat endscopic banding

355
Q

What is the management for resistant gastro-oesophageal varices?

A

Transjugular intrahepatic porto-systemic shunt

356
Q

What is a liver abscess?

A

Pus filled mass inside liver

357
Q

What is a liver abscess commonly caused by? (2)

A

Appendicities or diverticulititis due to haematogenous spread

358
Q

Give 3 symptoms of a liver abscess

A
  • ) Fever
  • ) Lethargy
  • ) RUQ discomfort
  • ) Anorexia
  • ) Enlarged liver if chronic
359
Q

What are common causative bacteria of liver abscesses?

A
  • ) Strep. milleri
  • ) E. coli
  • ) Klebsiella
  • ) Opportunistic staphs
360
Q

How do we treat a liver abscess?

A

Antibiotics, percutaneous drainage, possible laparotomy

361
Q

What is an amoebic liver abscess?

A

Pus is like ‘anchovy sauce’

362
Q

What is an amoebic liver abscess due to?

A

Entamoeba histolytica

363
Q

What are 3 symptoms of amoebic liver abscesses?

A
  • ) High swinging fever
  • ) Sweats
  • ) RUQ pain and tenderness
  • ) Pallor
  • ) Weight loss
364
Q

How do we treat an amoebic liver abscess? (2)

A

Aspiration and metronidazole

365
Q

What does alcoholic liver disease include? (3)

A
  • ) Fatty liver
  • ) Alcoholic hepatitis
  • ) Cirrhosis
366
Q

What drug do we give for alcohol withdrawal symptoms?

A

Chlordiazepoxide

367
Q

What drug do we give for cravings or anxiety?

A

Acamprosate

368
Q

What drug can we give for chronic alcohol dependence?

A

Disulfiram

369
Q

What is ascites?

A

Accumulation of fluid in the peritoneal cavity

370
Q

What is exudate?

A

High protein fluid

371
Q

What is transudate?

A

Low protein fluid

372
Q

What does ascites present with? (2)

A

Swelling of abdomen and SOB

373
Q

Give 3 signs of ascites

A
  • ) Medusa veins
  • ) Possible umbilical hernia
  • ) Visible bulging of flanks
  • ) Shifting dullness on examination
374
Q

What is transudate due to in ascites? (3)

A
  • ) Decreased oncotic pressure
  • ) High serum to ascites albumin gradient
  • ) Outflow problem
375
Q

What is exudate due to in ascites? (2)

A
  • ) Low serum to ascites albumin gradient

- ) Membrane more porous

376
Q

Is exudate or transudate worse?

A

Exudate

377
Q

Give 2 causes of transudate ascites

A

Cirrhosis, cardiac failure, Budd-Chiari syndrome

378
Q

Give 2 causes of exudate ascites

A

Cancer (ovarian), sepsis, TB, nephrotic syndrome

379
Q

What can the stasis of fluid in an ascites cause?

A

Infection - spontaneous bacterial peritonitis

380
Q

How do we diagnose an ascites?

A

Paracentesis

381
Q

Do transudates or exudates have increased pressure on the hepatic portal vein?

A

Transudates

382
Q

Are transudates or exudates actively excreted?

A

Exudates

383
Q

What occurs in non-alcoholic fatty liver disease? (NAFLD)

A

Increased fat in hepatocytes with inflammation

384
Q

Give 4 risk factors for NAFLD

A
  • ) Obesity
  • ) Female
  • ) DM
  • ) Dyslipiaemia
  • ) Parenteral feeding
  • ) Hyperlipidaemia
  • ) Wilson’s disease
385
Q

How do we distinguish NAFLD from NASH?

A

Biopsy

386
Q

What is NASH?

A

Non-alcoholic steatohepatitis

387
Q

How do we treat NAFLD?

A

Control risk factors

388
Q

What is alpha 1 antitrypsin deficiency?

A

Inherited conformational disease that commonly affects lungs and liver

389
Q

What is A1AT?

A

Glycoprotein (serine protease inhibitor) made in the liver that controls inflammatory cascades

390
Q

What is Wilson’s disease?

A

Inherited disorder copper excretion with excess deposition in liver and CNS

391
Q

What is the genetic component of Wilson’s disease?

A

Autosomal recessive disorder of a copper transporting ATPase, ATP78

392
Q

What is impaired in the liver in Wilson’s disease?

A

Copper incorporation into caeruloplasmin

393
Q

What do children present with in Wilson’s disease?

A

Liver disease (hepatitis, cirrhosis)

394
Q

What do adults present with in Wilson’s disease?

A

CNS signs (tremor, dysarthria, dysphagia, dementia, ataxia etc)

395
Q

What is the mood like in Wilson’s disease? (3)

A
  • ) Depression/mania
  • ) Changed libido
  • ) Personality change
396
Q

What is cognition like in Wilson’s disease?

A

Decreased memory, slow to solve problems, decreased IQ, delusions

397
Q

What are Kayser-Fleischer rings, and in which disease are they found?

A

Rings of copper in iris, Wilson’s

398
Q

What 3 other symptoms does Wilson’s present with?

A

Haemolysis, blue lunulae, arthritis, hyper mobile joints, grey skin

399
Q

Give 3 tests for Wilson’s

A
  • ) Copper high in urine
  • ) Serum caeruloplasmin low
  • ) Hepatic copper increased
  • ) Genetic testing
400
Q

What is the management for Wilson’s? (3)

A
  • ) Avoid foods with high copper content
  • ) Lifelong penicillamine
  • ) Possible liver transplantation
401
Q

What is acute liver failure?

A

Suddenly occuring, 8-21 days

402
Q

What is chronic liver failure?

A

Occurs with a background of cirrhosis

403
Q

What is fulminant hepatic failure?

A

Clinical syndrome resulting from massive necrosis of liver cells, leading to a severe impairment of function

404
Q

Give 4 causes of liver failure

A
  • ) Viral hepatitis (B, C)
  • ) Yellow fever
  • ) Paracetamol overdose
  • ) Toxins
  • ) Budd-Chiari syndrome
  • ) Alcohol
  • ) Fatty liver disease
  • ) PBC
  • ) PSC
  • ) Autoimmune hepatitis
  • ) A1AT deficiency
  • ) Wilson’s
  • ) Malignancy
405
Q

Give 3 signs of liver failure

A
  • ) Jaundice
  • ) Hepatic encephalopathy
  • ) Fector hepaticas (pear drop smell)
  • ) Asterixis/flap
  • ) Apraxia
406
Q

Give 4 tests for liver failure

A
  • ) Blood
  • ) Microbiology
  • ) Radiology, Doppler flow
  • ) Neurophysiology
407
Q

What is the treatment for liver failure?

A
  • ) Intubate, NGT, catheter
  • ) Monitor
  • ) Glucose 10% to avoid hypoglycaemia
  • ) Treat cause
  • ) Treat complications
408
Q

What drug is given for seizures?

A

Phenytoin/lorazepam

409
Q

What do we do if there is renal failure?

A

Haemofiltration/haemodialysis

410
Q

Give 3 complications of liver failure

A
  • ) Cerebral oedema
  • ) Ascites
  • ) Bleeding
  • ) Infection
  • ) Hypoglycaemia
  • ) Encephalopathy
411
Q

What is the drug treatment for paracetamol poisoning?

A

N acetyl cysteine

412
Q

What is the drug given for cerebral oedema?

A

Mannitol

413
Q

What type of virus is hepatitis A?

A

RNA virus

414
Q

How is hepatitis A spread?

A

Faecal-oral or shellfish

415
Q

Give 3 symptoms of hepatitis A

A
  • ) Fever
  • ) Malasie
  • ) Anorexia
  • ) Nausea
  • ) Arthralgia
  • ) Then jaundice, hepatosplenomegaly, adenopathy
416
Q

What Ig shows that it is a recent infection?

A

IgM

417
Q

What 2 things are raised in hepatitis A?

A

ALT and AST

418
Q

What is ALT?

A

Alanine aminotransferase

419
Q

What is AST?

A

Aspartate aminotransferase

420
Q

What is the treatment for hepatitis A?

A

Supportive, avoid alcohol

421
Q

Which hepatitis types are chronic? (or can be)

A

B, C, D

422
Q

What do we give for fulminant hepatitis?

A

Interferon alfa

423
Q

What type of virus is hepatitis B?

A

DNA virus

424
Q

How is hepatitis B spread?

A

Blood/sexual

425
Q

Give 3 risk groups for hepatitis B

A
  • ) IVDU
  • ) Sexual partners/carers
  • ) Health workers
  • ) Haemophiliacs
  • ) MSM
  • ) Haemodialysis
  • ) etc
426
Q

How does hepatitis B present?

A

Resembles hepatitis A but arthralgia and urticaria are more common

427
Q

Give 2 antigens present in stages of hepatitis B

A

HBsAg - 1-6 months after exposure, >6 months means carrier, alone means vaccination
HBeAg - 1.5-3 months after illness, high infectivity
HBcAg - past infection

428
Q

Is hepatitis B highly infective?

A

Yes

429
Q

Give 3 complications of hepatitis B

A
  • ) Fulminant hepatic failure
  • ) Cirrhosis
  • ) HCC
430
Q

What is the treatment for hepatitis B?

A
  • ) Avoid alcohol
  • ) Immunise sexual contacts
  • ) Antivirals for chronic liver inflammation (tenofovir, entecavr)
431
Q

What type of virus is hepatitis C?

A

RNA flavivirus

432
Q

How is hepatitis C spread?

A

Blood/sexual

433
Q

Give 2 risk factors for progression of hepatitis C?

A
  • ) Male
  • ) Older
  • ) Higher viral load
  • ) Alcohol
  • ) HIV, HBV
434
Q

Is hepatitis C more acute or chronic?

A

Chronic (C for chronic!)

435
Q

The presence of what confirms exposure to hepatitis C

A

Anti-HCV antibodies

436
Q

What is the treatment for hepatitis C?

A

Avoid alcohol, pegylated interferon with ribavirin and protease inhibitor

437
Q

Give 2 complications of hepatitis C

A
  • ) Glomerulonephritis
  • ) Autoimmune hepatitis
  • ) Thyroiditis
  • ) Cryoglobulinaemia
  • ) PAN
438
Q

What is higher in a LFT in hepatitis C?

A

ALT

439
Q

What type of virus is hepatitis D?

A

Incomplete RNA virus

440
Q

What does hepatitis D need for its assembly?

A

HBV

441
Q

What can hepatitis D cause?

A

Acute liver failure/cirrhosis

442
Q

What can prevent hepatitis D?

A

HBV vaccination

443
Q

What type of virus is hepatitis E?

A

RNA virus

444
Q

Is HAV or HEV more common in the UK?

A

HEV

445
Q

How does hepatitis D spread?

A

Blood/seuxal

446
Q

How does hepatitis E spread?

A

Faeco-oral

447
Q

What is non alcoholic steatohepatitis?

A

NAFLD with inflammation

448
Q

What is autoimmune hepatitis?

A

An inflammatory liver disease of unknown cause characterised by abnormal T cell function and autoantibodies directed against hepatocyte surface antigens

449
Q

What does (some) autoimmune hepatitis present with?

A
  • ) Acute hepatitis
  • ) Signs of autoimmune disease (fever, malaise, rash, poly arthritis, glomerulonephritis)
  • ) Jaundice
  • ) Asypmtomatic
450
Q

What antibodies are usually positive in autoimmune hepatitis? (2)

A

ANA and ASMA

451
Q

What does a liver biopsy show in autoimmune hepatitis?

A

Mononuclear infiltrate of portal and periportal areas and piecemeal necrosis +/- fibrosis

452
Q

How do we diagnose autoimmune hepatitis?

A

Exclude other diseases, look at IgG, autoantibodies, histology

453
Q

What is the management of autoimmune hepatitis?

A

Immunosuppression with prednisolone +/- azathioprine

454
Q

Give 3 risk factors for oesophageal cancer

A
  • ) Diet
  • ) Alcohol excess
  • ) Smoking
  • ) Achalasia
  • ) Reflux oesophagitis +/- Barrett’s oesophagus
  • ) Obesity
  • ) Hot drinks
  • ) etc
455
Q

What is Barrett’s oesophagus also known as?

A

CELLO - columnar lined lower oesophagus

456
Q

Where does oesophageal cancer occur most?

A

In the middle (50%)

457
Q

Give 3 symptoms/signs of oesophageal cancer

A
  • ) Dysphagia
  • ) Weight loss
  • ) Retrosternal chest pain
  • ) Upper 1/3rd of oesophagus - hoarseness, cough
458
Q

What is the main investigation for oesophageal cancer?

A

Oesophagoscopy with biopsy

459
Q

What are the 5 T stages of oesophageal cancer?

A 
Tis - carcinoma in situ
T1 - invading lamina propria/submucosa
T2 - muscularis propria
T3 - adventitia
T4 - adjacent structures
460
Q

What are the survival rates of oesophageal cancer like?

A

Poor with/without treatment :(

461
Q

What are some options for treatment of oesophageal cancer?

A
  • ) Radical curative oesophagectomy
  • ) Pre-op chemo
  • ) Chemoradiotherapy
  • ) Palliation with chemo/radio, stenting to restore swallowing
462
Q

What type of cancer can oesophageal be? (2)

A
  • ) Squamous cell (proximal)

- ) Adenocarcinomas (distal)

463
Q

Give 3 risk factors for gastric cancer

A
  • ) Pernicious anaemia
  • ) Blood group A
  • ) H. pylori
  • ) Atrophic gastritis
  • ) Smoking, diet (pickled food), lower social class)
464
Q

What are the symptoms of gastric cancer?

A
  • ) Often non-specific
  • ) Dyspepsia
  • ) Weight loss
  • ) Vomiting
  • ) Dysphagia
  • ) Anaemia
465
Q

Give 2 signs of gastric cancer

A
  • ) Epigastric mass
  • ) Hepatomegaly
  • ) Jaundice
  • ) Ascites
466
Q

What is the spread of gastric cancer?

A

Local, lymphatic, blood bourne, transcoelomic (eg to ovaries)

467
Q

What are the tests for gastric cancer?

A

Gastroscopy and multiple ulcer edge biopsies

468
Q

What are the treatments for gastric cancer?

A
  • ) Gastrectomy - total/partial
  • ) Combination chemotherapy
  • ) Surgical palliation
469
Q

What may be given as a target therapy for HER-2 positive tumours?

A

Trastuzumab

470
Q

What is the commonest predisposing factor for bile duct and gallbladder cancers?

A

Primary sclerosis cholangitis

471
Q

Give 3 presenting features of bile duct and gallbladder cancer

A
  • ) Obstructive jaundice
  • ) Pruritus
  • ) Abdominal pain
  • ) Weight loss
  • ) Anorexia
472
Q

How do we treat bile duct and gallbladder cancer?

A

Surgical resection if operable

473
Q

Give 3 predisposing factors to colorectal cancer

A
  • ) Neoplastic polyps
  • ) IBD
  • ) Genetic predisposition
  • ) Diet (low fibre, high red meat)
  • ) Alcohol
  • ) Smoking
  • ) Previous cancer
474
Q

What drug reduces the incidence and mortality of colorectal cancer?

A

Daily aspirin

475
Q

What is familial adenomatous polyposis (FAP) due to?

A

Germline mutations in the APC tumour suppressor gene

476
Q

What are the 2 genetic predispositions to colorectal cancer?

A

FAP and HNPCC

477
Q

What prevents cancer in those with FAP?

A

Total colectomy

478
Q

What is HNPCC?

A

Hereditary non-polyposis colorectal cancer entails familial aggregation of colorectal cancer

479
Q

Where are the mutations in HNPCC 1?

A

1/5 DNA mismatch repair genes

480
Q

Is HNPCC autosomal dominant or recessive?

A

Dominant

481
Q

What do virtually all colorectal cancers develop from?

A

Adenomatous polyps

482
Q

Give 3 symptoms of left sided colorectal cancer

A
  • ) Bleeding/mucus PR
  • ) Altered bowel habit/obstruction
  • ) Tenesmus
  • ) Mass PR
483
Q

Give 2 symptoms of right sided colorectal cancer

A
  • ) Weight loss
  • ) Low haemoglobin
  • ) Abdominal pain
484
Q

Give 3 symptoms of either sided colorectal cancer

A
  • ) Abdominal mass
  • ) Perforation
  • ) Haemorrhage
  • ) Fistula
485
Q

Give 3 tests for colorectal cancer

A
  • ) PR
  • ) Sigmoidoscopy/colonscopy
  • ) Faecal occult blood
  • ) FBC
486
Q

What is the NHS screening programme for colorectal (bowel) cancer?

A

Faecal occult blood (FOB) every 2 years if 60-75yrs

487
Q

What is the spread of colorectal cancer?

A

Local, lymphatic, by blood (liver, lung, bone), transcoelomic

488
Q

What is the Duke’s classification of colorectal cancer?

A

A - limited to muscular mucosae
B - extension through muscular mucosae
C - involvement of regional lymph nodes
D - distant mets

489
Q

What is the TNM staging in colorectal cancer? (T)

A 
Tx - primary tumour cannot be assessed
Tis - carcinoma in situ 
T1 - invading submucosa
T2 - muscular propria
T3 - subserosa and beyond (not other organs)
T4 - adjacent structures
490
Q

What is the TNM staging in colorectal cancer? (N)

A

Nx - nodes cannot be assessed
N0 - no node spread
N1 - mets in 1-3 regional nodes
N2 - mets in >3 regional nodes

491
Q

What is the TNM staging in colorectal cancer? (M)

A

M0 - no distant spread

M1 - distant mets

492
Q

What does a positive CRM (circumferential resection margin) have a large risk of?

A

Local recurrence and lower survival

493
Q

What is the treatment for colorectal cancer? (5)

A
  • ) Right hemicolectomy - caecal, ascending, proximal transverse
  • ) Left hemicolectomy - distal transverse, descending
  • ) Sigmoid colectomy - sigmoid
  • ) Anterior resection - low sigmoid, high rectal
  • ) Abdomino-perianal - low in rectum
494
Q

What procedure do we do in emergency bowel obstruction, perforation or palliation?

A

Hartmann’s

495
Q

When is radiotherapy used in colorectal cancer? (3)

A
  • ) Palliation
  • ) Pre-op rectal cancer
  • ) Post-op rectal cancer with high risk of local recurrance
496
Q

When is chemotherapy used in colorectal cancer? (2)

A
  • ) Palliative

- ) Adjuvant for stage 3 disease (FOLFOX)

497
Q

What improves survival when added to combination therapy in advanced colorectal cancer?

A

Bevacizumab, anti VEGF antibody

498
Q

What improves response and survival in KRAS wild type metastatic colorectal cancer?

A

Cetuximab and panotumumab

499
Q

Where are adenocarcinomas of the SB usually found? (2)

A

Duodenum and jejunum

500
Q

Where are lymphomas (non-Hodgkin’s) usually found?

A

Ileum

501
Q

Give 2 predisposing factors to small bowel cancer

A

Coeliac disease, Crohn’s

502
Q

Give 3 risk factors for pancreatic cancer

A
  • ) Smoking
  • ) Alcohol
  • ) Carcinogen
  • ) DM
  • ) Chronic pancreatitis
  • ) Obesity
503
Q

What are most types of pancreatic cancer?

A

Ductal adenocarcinomas

504
Q

Where do pancreatic cancers present?

A
  • ) 60% head
  • ) 25% body
  • ) 15% tail
505
Q

Mutations in which gene is present in 95% of pancreatic cancer cases?

A

KRAS2

506
Q

What do tumours of the pancreatic head present with?

A

Painless obstructive jaundice

507
Q

What do tumours of the body and tail present with?

A

Epigastric pain radiating to back, relieved by sitting forwards

508
Q

What can any pancreatic cancer present with?

A
  • ) Anorexia
  • ) Weight loss
  • ) DM
  • ) Acute pancreatitis
509
Q

Give 3 signs of pancreatic cancer

A
  • ) Jaundice
  • ) Palpable gallbladder
  • ) Epigastric mass
  • ) Hepatomegaly
  • ) Splenomegaly
  • ) Lymphadenopathy
  • ) Ascites
510
Q

What tests do we do to diagnose pancreatic cancer?

A

US/CT

511
Q

What is the treatment for pancreatic cancer?

A
  • ) Resection surgery - pancreaticoduodenectomy (Whipple’s) only when curative
  • ) Tail lesions easiest
  • ) <20% suitable for surgery
  • ) Stent insertion for palliation
  • ) Opiates
512
Q

The commonest (90%) of liver tumours are from where? (3)

A

Breast, bronchus, GI tract

513
Q

What is primary HCC caused by? (3)

A
  • ) HBV
  • ) HCV
  • ) Cirrhosis
514
Q

Give 4 symptoms of liver tumours

A
  • ) Fever
  • ) Malaise
  • ) Anorexia
  • ) Weight loss
  • ) RUQ pain
  • ) Late jaundice (except with HCC)
515
Q

What are the signs of a liver tumour?

A

Hepatomegaly, chronic liver disease signs, decompensation, abdominal mass, bruit over liver

516
Q

What (bloods) is found in 50-80% of HCC?

A

Alpha-fetoprotein

517
Q

What tests can we do to diagnose liver cancer?

A
  • ) Bloods
  • ) US/CT
  • ) MRI
  • ) Biopsy
518
Q

What does HCC stand for?

A

Hepatocellular carcinoma

519
Q

How do we treat liver tumour mets?

A
  • ) Chemo maybe
  • ) Resection maybe
  • ) Palliation
520
Q

How do we treat primary HCC?

A
  • ) Resect small solitary tumours
  • ) Liver transplant
  • ) Percutaneous ablation
  • ) Sorafenib
521
Q

How do we treat cholangiocarcinoma?

A

Surgery, usually not suitable and recur, stenting possible

522
Q

What is a cholangiocarcinoma?

A

Biliary tree cancer

523
Q

Give 4 causes of infection

A
  • ) Norovirus
  • ) E. coli
  • ) Giardia
  • ) Salmonella
  • ) C. diff
524
Q

What is a Mallory Weiss tear?

A

Persistent vomiting/retching causes haematemesis via and oesophageal mucosal tear

525
Q

Where does the tear occur most often? (MW tear)

A

Lower oesophagus close to junction with stomach

526
Q

Give 2 causes of a Mallory Weiss tear

A
  • ) Alcohol
  • ) Bulimia
  • ) Pregnancy
527
Q

What is achalasia?

A

Coordinated peristalsis is lost and the lower oesophageal sphincter fails to relax (due to degeneration of the myenteric plexus)

528
Q

Give 3 things achalasia causes

A
  • ) Dysphagia
  • ) Regurgitation
  • ) Weight loss
529
Q

What does a barium swallow/manometry in achalasia show?

A

Dilated tapering oesophagus

530
Q

What is the treatment for achalasia?

A
  • ) Endoscopic balloon dilatation
  • ) Heller’s cardiomyotomy
  • ) PPIs
531
Q

What occurs in tropical sprue? (3)

A
  • ) Villous atrophy
  • ) Inflammation of small interstine
  • ) Malabsorption
532
Q

Give 3 symptoms of tropical sprue

A
  • ) Diarrhoea
  • ) Fever
  • ) Malaise
  • ) Later weight loss, anorexia, nutritional deficiencies
533
Q

What is the only cure of tropical sprue?

A

To leave the infected area

534
Q

What are haemorrhoids?

A

Disrupted and dilated anal cushions

535
Q

What are anal cushions?

A

The anus is lined mainly by discontinuous masses of spongy vascular tissue (anal cushions), which contribute to anal closure

536
Q

Give 2 causes of haemorrhoids

A
  • ) Increased anal tone (stress)
  • ) Straining due to constipation
  • ) Other congestion (tumour, pregnancy)
537
Q

Give 2 symptoms of haemorrhoids

A
  • ) Bright red rectal bleeding
  • ) Mucus discharge
  • ) Pruritus
  • ) Severe anaemia
538
Q

How do we diagnose haemorrhoids?

A

PR exam, abdominal exam, colonoscopy/flexible sigmoidoscopy

539
Q

What is the pathogenic circle of haemorrhoids?

A

1) Vascular cushions protrude through a high anus
2) Become more congested
3) Hypertrophy to protrude again more readily
4) Protrusions may strangulate

540
Q

What is the medical treatment for haemorrhoids?

A

Medical - fluid and fibre, stool softener, topical analgesics

541
Q

What is the non medical treatment for haemorrhoids?

A
  • ) Rubber band ligation
  • ) Sclerosant injections
  • ) Infra red coagulation
  • ) Bipolar diathermy and direct current electroptherapy
542
Q

What is the surgical treatment for haemorrhoids?

A

Excisional haemorrhoidectomy

543
Q

What is a fistula-in-ano?

A

A track communicated between the skin and the anal canal/rectum

544
Q

What is the pathogenesis of a fistula-in-ano?

A

Blockage of deep intramuscular gland ducks thought to predispose to formation of abscesses. which discharge to form the fistula

545
Q

Give 3 causes of a fistula-in-ano

A
  • ) Perianal sepsis
  • ) Abscesses
  • ) Crohn’s
  • ) TB
  • ) Diverticular disease
  • ) Rectal carcinoma
  • ) Immunocompromise
546
Q

What are the tests for a fistula-in-ano?

A

MRI and endoanal US

547
Q

What is the treatment for a fistula-in-ano?

A

Fistulotomy and excision

548
Q

What is a fissure-in-ano?

A

A painful tear in the squamous lining of the lower anal canal

549
Q

Are fissures-in-ano most anterior or posterior?

A

Posterior (90%)

550
Q

What is the main cause of fissures-in-ano?

A

Hard faeces

551
Q

What is the treatment for fissures-in-ano?

A
  • ) 5% lidocaine ointment and GTN ointment
  • ) Increase fibre and fluids
  • ) Stool softener
  • ) Topical botulinum and diltiazem
552
Q

What is a perianal abscess?

A

Anorectal abscesses

553
Q

What are perianal abscesses usually caused by?

A

Gut organisms

554
Q

What are perianal abscesses associated with?

A

DM, Crohn’s, malignancies, fistulaes

555
Q

What is the treatment for a perianal abscess?

A

Incision and drainage

556
Q

What is a pilonidal sinus?

A

Obstruction of the natal cleft hair follicles around 6cm above the anus

557
Q

What does the ingrowing of hair in a pilonidal sinus do?

A

Excites a foreign body reaction and may cause secondary tracts to open laterally +/- abscesses with foul smelling discharge

558
Q

Give 2 risk factors for a pilonidal sinus

A

Male, obese

559
Q

What is the treatment of a pilonidal sinus?

A

Excision of the sinus tract +/- primary closure

560
Q

What is biliary colic?

A

Pain from symptomatic gallstones if there is cystic duct obstruction or if the gallstones have passed into the common bile duct

561
Q

What does biliary colic present with?

A

RUQ pain which radiates to back, possible jaundice

562
Q

What is the treatment for biliary colic?

A

Analgesia, rehydration, NBM

563
Q

What symptom would indicate IBD not IBS?

A

Nocturnal diarrhoea

564
Q

What is the cystic artery a branch of?

A

Right hepatic artery

565
Q

What is the treatment for peptic ulcers?

A

PAC MAN
PPI
Amoxicillin
Clarithromycin

566
Q

Give the urine, stools, itching and liver tests in pre-hepatic jaundice

A

Urine - normal
Stools - dark/normal
Itching - none
Liver tests - normal

567
Q

Give the urine, stools, itching and liver tests in hepatic jaundice

A

Urine - dark
Stools - pale
Itching - maybe
Liver tests - abnormal

568
Q

Give the urine, stools, itching and liver tests in post-hepatic jaundice

A

Urine - dark
Stools - clay
Itching - yes
Liver tests - abnormal

Medicine Year 2 5 (17 decks)

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