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Medicine > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Left hypochondriac pain

A

PU

Pancreatitis
Gastric or DUODENAL Ulcer

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2
Q

Epigastric pain

A

PHUGE

Pancreatitis
HEART BURN
Gastric Ulcer
GALL STONES
EPIGASTRIC HERNIA
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3
Q

Right hypochondriac pain

A

PUBG

Pancreatitis
Gastric Ulcer
Biliary Colic
GALLSTONES

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4
Q

Left lumbar

A

CUKID

Constipation
UTI
Kidney stones
IBD
Diverticular disease
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5
Q

Umbilical

A

PIG EAR

Pancreatitis
IBD
Gastric Ulcer

EARLY STAGES of APPENDICITIS
AORTIC ANEURYSM
Ruptured AORTIC ANEURYSM

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6
Q

Right lumbar

A

CUK

Constipation
UTI
Kidney stones

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7
Q

Left Iliac

A

OI DIE

Ovarian torsion
IBD

Diverticular Disease
Inguinal/ Femoral Hernia
Ectopic Pregnancy

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8
Q

Hypogastric

A

A IUD

APPENDICITIS

IBD
UTI
Diverticular Disease

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9
Q

Right Iliac

A

AEIO

Appendicitis
Ectopic pregnancy
Inguinal/ femoral hernia
Ovarian torsion

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10
Q

Causes of UPPER GI bleeding

A

GP MOM

Gastritis
Peptic ulcer

Mallory Weiss Tear
Oesophageal VARICES
Malignancy

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11
Q

Causes of LOWER GI bleeding

A

I IUD CHAMP

INFECTIOUS DIARRHOEA

IBD
Ulcerative Colitis
Diverticulitis

Crohn's
HAEMMORRHOIDS
ANGIODYSPLASIA (breakdown of blood vessels in GI tract (red spots in GI tract))
Malignancy
POLYPS
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12
Q

Causes of GASTRITIS

A

BAN US

Burns: CURLING’s ULCER
Alcohol
NSAIDs

Uraemia
Stress

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13
Q

Two types of CHRONIC GASTRITIS

A

Type A-

  • Autoimmune to PARIETAL CELLS
  • Presents with PERNICIOUS ANAEMIA
  • FUNDUS or BODY of stomach

Type B-

  • Most COMMON
  • Associated with H. PYLORI
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14
Q

Investigations for H. Pylori

A

CUBES

Carbon isotope- urea breath test
Urinalysis
Bloods- ANAEMIA and H. PULORI
Endoscopy with biopsy of stomach lining
Stool sample for H. Pylori
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15
Q

Treatment for H. Pylori

A

TRIPLE THERAPY

PPI and CLARITHROMYCIN (and either AMOXICILLIN or METRONIDAZOLE)

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16
Q

Treatment for Gastritis

A

Mild- Antacids or H2 antagonists

Moderate/ Sever- PPI

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17
Q

Complications of Gastritis (4 things)

A

MAPS

Mucosa-associated lymphoid tissue lymphoma
Anaemia (from bleeding ulcers)
Peptic ulcers
Stricture formation

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18
Q

Signs and Symptoms of IBS

A

Recurrent abdominal pain which improves with defaecation

Change in bowel habit

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19
Q

Treatment of IBS

A

ANTIMUSCARINICs

Laxatives

Stool Softeners

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20
Q

Appendicitis investigations

A

FBC, U and E, CRP

Pregnancy test to rule out ECTOPIC PREGNANCY

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21
Q

Complication of Appendicitis

A

Peritonitis

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22
Q

Where is Ulcerative Colitis seen in the GI tract?

A

Colon- rarely terminal ileum

Always starts at rectum- never spreads beyond ileocaecal valve

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23
Q

5 P’s of Ulcerative Colitis

A 
Pyrexia
Pseudopolyps
Lead pipe radiological appearance
Poo (bloody diarrhoea)
Proctitis (lining of inner rectum is inflamed)- URGENCY and TENESMUS
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24
Q

Investigations of Ulcerative Colitis

A

ALBUMIN (low albumin)
ESR and CRP

Colonoscopy with biopsy

Radiology- small bowel follow through/ Abdominal X ray for toxic megacolon

AXR

  • No faecal shadowing
  • Mucosal thickening/ islands
  • Colonic dilatation
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25
Q

Treatment of Ulcerative Colitis

A

Mild (<4 motions a day)-

  • 5 ASA (mesalazine)
  • +topical steroid foam (hydrocortisone)/ prednisolone

Moderate (4-6 motions a day)-

  • Prednisolone
  • Then 5-ASA

Severe (>6 motions a day)

  • EXCLUDE INFECTIONS
  • IV hydration/ electrolyte replacement
  • IV hydrocortisone/ methylprednisolone
  • If CRP/ motions are still high- CICLOSPORIN/ INFLIXIMAB
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26
Q

What part of the GI tract does Crohn’s affect?

A

Any part of the GI tract but often targets TERMINAL ILEUM

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27
Q

Signs and Symptoms of CROHN’s (10 things)

A 
Weight loss
Abdominal pain with mass
Diarrhoea
FEVER
Skin lesions
Cobblestone mucosa
FISTULA FORMATION
FISSURE FORMATION
Clubbing
LINEAR ULCERATION
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28
Q

Investigations of Crohn’s

A

ALBUMIN (low albumin)
ESR and CRP

Colonoscopy with biopsy

Radiology- small bowel follow through/ Abdominal X ray for toxic megacolon

AXR

  • No faecal shadowing
  • Mucosal thickening/ islands
  • Colonic dilatation
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29
Q

Treatment of CROHN’s

A

Mild-moderate-

  • Prednisolone
  • Then MAINTENANCE THERAPY

Severe-

  • IV hydration/ electrolyte replacement
  • IV steroids (hydrocortisone)
  • If Hb<80, consider BLOOD TRANSFUSION
  • Switch to prednisolone if improving
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30
Q

Complications of Crohn’s (5 things)

A 
Stricture and Fistula formation
Obstruction
Pyoderma gangrenosum
ANAEMIA
Osteoporosis (from steroid use)
31
Q

Complications of Ulcerative Colitis (4 things)

A

Primary sclerosing cholangitis
Osteoporosis
Increasing incidence of colon cancer
Toxic megacolon

32
Q

4 side effects of 5-ASAs

A

Hepatitis
Pancreatitis
Haemolysis rash
Paradoxical worsening of Colitis

33
Q

50% of CROHN’s patients can get this condition

A

PERIANAL DISEASE-

  • MRI to check for this
  • Oral antibiotics- INFLIXIMAB
  • Immunosuppressants
  • Local surgery
34
Q

CROHN’s MAINTENANCE THERAPY

4 things

A

AZATHIOPRINE-

  • If steroids are contraindicated (DIABETES, OSTEOPOROSIS, TB, CHICKENPOX, HYPERTENSION)
  • If not, use other immunomodulators (METHOTREXATE/ 6-MERCAPTOPURINE)- which are contraindicated in females of reproducing age

BIOLOGICS-
- Anti TNF-alpha- contraindicated in SEPSIS, TB, high LFTs, MALIGNANCY

NUTRITION-

  • ENTERAL (polymeric) diet is preferred
  • Elemental- amino acids can give remission
  • Low residue- helps in those with active disease or strictures

SURGERY if-

  • Drug failure
  • FISTULA
  • PERFORATION
  • GI OBSTRUCTION from STRICTURE
  • ABSCESS
35
Q

Cause of COELIAC DISEASE

A

Autoantibodies to GLIADIN

Issue with GLUTEN

36
Q

Which part of the GI tract does COELIAC DISEASE affect?

A

Proximal part of small intestine

37
Q

Signs of COELIAC DISEASE

A

Low B12, Low FERRITIN, Low Hb

Steatorrhoea

Weight loss

38
Q

Signs and Symptoms of Gastrooesophageal reflex disorder

A

LAND WH

Laryngitis
Acidic taste in mouth
Nocturnal asthma/ chronic cough
Dysphagia (swallowing difficulties)

Water brash (excessive salivation)
Heart burn- worse AFTER LYING DOWN/ STOOPING/ HEAVY MEALS
39
Q

Causes of GORD

A

Oesophagitis
Genetic inheritance of angle of LOWER OESOPHAGEAL SPHINCTER
Rolling hiatus hernia
Sliding hiatus hernia

40
Q

Risk factors for GORD

A

SPEEDO

Smoking
Pregnancy
Excessive alcohol
Excessive coffee
Drugs (CCB, Antimuscarinics, Tricyclic antidepressants)
Obesity
41
Q

Investigations for GORD

A

If <55yo-

  • Proceed to treatment unless:
    1) Unintentional weight loss
    2) DYSPHAGIA
    3) Haematemesis
    4) Melaena
    5) ANOREXIA
  • Then do ENDOSCOPY if they have these symptoms

If >55yo-
- Endoscopy and biopsy

42
Q

Treatment for GORD

A

Weight loss
Raising of head of bed at night

1) ANTACIDS (like Al2O3)
2) PPI (like OMEPRAZOLE)
3) H2 antagonists (RANITIDINE)

SURGERY- Nissen’s Fundoplication

43
Q

Barret’s Oesophagus (complication of GORD). Investigation/ Treatment/ Complication

A
  • Metaplasia of normal SQUAMOUS epithelium of lower oesophagus into COLUMNAR epithelium
  • Investigate with endoscopy
  • Treat with radiofrequency ablation or mucosal resection
  • Complication- ADENOCARCINOMA of oesophagus
44
Q

Reasons for Prehepatic Jaundice (6 things)

A 
Drugs (Rifampicin)
MALARIA
Haemolysis (THALASSAEMIA/ SICKLE CELL ANAEMIA)
Haemolytic uraemic syndrome
CRIGLER-NAJJAR SYNDROME
GILBERT's SYNDROME
45
Q

Reasons for Intra-hepatic Jaundice (6 things)

A 
Viral/ drug induced hepatitis
ALCOHOLIC liver disease
Primary biliary CIRRHOSIS
Hepatic CIRRHOSIS
LEPTOSPIROSIS
Physiological neonatal jaundice
46
Q

Reasons for Posthepatic Jaundice (6 things)

A 
Pancreatic cancer
Cholangiocarcinoma
GALLSTONES in COMMON BILE DUCT
BILIARY ATRESIA
SCHISTOSOMIASIS
Mirizzi's syndrome
47
Q

Investigations in Prehepatic Jaundice-

URINE-
STOOL-
Conjugated bilirubin-
Unconjugated bilirubin-
Total bilirubin-
Alkaline phosphatase-
A 
URINE- NORMAL
STOOL- NORMAL
Conjugated bilirubin- NORMAL
Unconjugated bilirubin- NORMAL or HIGH
Total bilirubin- NORMAL or HIGH
Alkaline phosphatase- NORMAL
48
Q

Investigations in Intrahepatic Jaundice-

URINE-
STOOL-
Conjugated bilirubin-
Unconjugated bilirubin-
Total bilirubin-
Alkaline phosphatase-
A 
URINE- DARK
STOOL- PALE
Conjugated bilirubin- HIGH
Unconjugated bilirubin- HIGH
Total bilirubin- HIGH
Alkaline phosphatase- HIGH
49
Q

Investigations in Post-hepatic Jaundice-

URINE-
STOOL-
Conjugated bilirubin-
Unconjugated bilirubin-
Total bilirubin-
Alkaline phosphatase-
A 
URINE- DARK
STOOL- PALE
Conjugated bilirubin- HIGH
Unconjugated bilirubin- NORMAL
Total bilirubin- HIGH
Alkaline phosphatase- HIGH
50
Q

Treatment of Jaundice

A

Treat UNDERLYING CAUSE

Adequate hydration
Broad spectrum ANTIBIOTICS if OBSTRUCTION

51
Q

Complications of Jaundice (6 things)

A
  • Liver/ Renal failure
  • Pancreatitis
  • Biliary CIRRHOSIS
  • SEPSIS
  • CHOLANGITIS
  • KERNICTERUS (serious complication in NEONATES)
52
Q

Hepatitis A

DNA/RNA-
Transmission-
Incubation period-
Investigations-
Treatment-
Complication-
A

DNA/RNA- RNA picornvirus

Transmission- Faecal-oral transmission, associated with contaminated shellfish- passes into bile after replication within liver cells. Leads to necrosis in ZONE 3 of hepatic lobule

Incubation period- 2-3 weeks

Investigations- Anti-HAV IgM in serum

Treatment- Supportive since often self-resolving

Complications- Rarely-acute liver disease

53
Q

Hepatitis B

DNA/RNA-
Transmission-
Incubation period-
Investigations-
Treatment- (6 things)
Complications- (3 things)
A

DNA/RNA- DNA

Transmission- Contaminated needles, Infected blood products, sexual intercourse, VERTICAL TRANSMISSION

Incubation period- 1-5 months

Investigations- HBV DNA in serum, and antigens etc. present in histology with GROUND GLASS appearance

Treatment- Antiviral medications-

  • Pegylated alpha 2a interferon
  • Telbivudine
  • Lamivudine
  • Adefovir
  • Tenofovir
  • Entecavir

Complications-

  • Hepatic cirrhosis
  • Hepatocellular carcinoma
  • Fulminant hepatitis B
54
Q

Hepatitis C

DNA/RNA-
Transmission-
Incubation period-
Investigations-
Treatment- (4 things)
Complications- (3 things)
A

DNA/RNA- RNA

Transmission- Contaminated needles, Infected blood products, VERTICAL TRANSMISSION

Incubation period- 6-9 weeks

Investigations- Antibody to HCV in serum

Treatment- Antiviral medications-

  • Pegylated alpha 2a interferon
  • Ribavirin
  • Taribavirin
  • Telaprevir

Complications-

  • Hepatic cirrhosis
  • Hepatocellular carcinoma
  • Liver Failure
55
Q

Hepatitis D

DNA/RNA-
Transmission-
Incubation period-
Investigations-
Treatment- (1 thing)
Complications- (2 things)
A

DNA/RNA- Defective RNA (COINFECTS with HBV)

Transmission- Contaminated needles, Infected blood products, sexual intercourse

Incubation period- 1-5 months

Investigations- Serum IgM anti-D

Treatment-
- Pegylated alpha 2a interferon

Complications-

  • Hepatic cirrhosis
  • Hepatocellular carcinoma
56
Q

Hepatitis E

DNA/RNA-
Transmission-
Incubation period-
Investigations-
Treatment- 
Complications-
A

DNA/RNA- Single stranded RNA

Transmission- Faecal-oral transmission, associated with contaminated WATER

Incubation period- 2-3 weeks

Investigations- IgG and IgM anti-HEV

Treatment-
- Usually self-liniting

Complications-

-High mortality of pregnant women (20%)

57
Q

Signs and Symptoms of Colorectal Cancer (6 things)

A

2F 3A U

Fatigue
FAECAL OCCULT BLOOD
Anaemia
Altered bowel habit
ABDOMINAL PAIN
Unintentional weight loss
58
Q

Risk factors for Colorectal Cancer (7 things)

A

Smoking

Increased age

Family history of CRC

INFLAMMATORY BOWEL DISEASE

Strep bovis bacteraemia

CONGENITAL POLYPOSIS SYNDROMES:

  • Juvenile polyposis syndrome
  • Peutz-Jeghers Syndrome

Genetic predisposition:

  • Familial Adenomatous Polyposis (FAP)- all lead to CRC
  • Hereditary nonpolyposis CRC
59
Q

Investigations for COLORECTAL CANCER (4 things)

A
  • Faecal Occult blood test
  • Bloods- IRON DEFICIENCY ANAEMIA/ CARCINOEMBRYONIC ANTIGEN
  • Endoscopy= colonoscopy/ sigmoidoscopy
  • Double contrast BARIUM ENEMA study ‘APPLE CORE’ sign
60
Q

Two types of staging systems for COLORECTAL CANCER

A

Duke’s and TMN

61
Q

Treatment for Colorectal Cancer

A

Chemotherapy-

  • Oxaliplatin
  • Folinic Acid
  • 5-Fluorouracil

Radiotherapy

Surgical resection

62
Q

Signs and Symptoms of Acute Pancreatitis

A

CG PAN

  • Cullen’s sign- PERIUMBILICAL BRUISIING
  • Grey Turner’s sign- FLANK BRUISING
  • Pain in EPIGASTRIC region which radiates to the back
  • ANOREXIA
  • Nausea/ vomiting
63
Q

Causes of Acute Pancreatitis

A

GET SMASHED

Gallstones
Ethanol
Trauma

Scorpion sting
Mumps
Autoimmune disease
STEROIDs
HYPERLIPIDAEMIA/ HYPERCALCAEMIA
ERCP
Drugs (AZATHIOPRINE)
64
Q

Investigations for Acute Pancreatitis

A

Bloods- RAISED serum AMYLASE and LIPASE

US to scan for gallstones

CT to rule out complications

65
Q

Treatment for Acute Pancreatitis

A

KEEP NIL BY MOUTH

Treatment usually symptomatic relief (ANALGESICS like TRAMADOL)

Treat underlying cause (ERCP for gallstones)

66
Q

Complications of Acute Pancreatitis

A

HDAMN

Haemorrhage
Disseminated intravascular coagulation
Acute respiratory distress syndrome
Multi organ failure
Necrosis
67
Q

Signs and Symptoms of Chronic Pancreatitis

A

A epigastric pain which radiates to the back and is also-

  • recurrent
  • worse when eating/ drinking heavily
  • relieved by sitting forward
68
Q

Causes of Chronic Pancreatitis

A

CAMP

Cystic Fibrosis
Alcohol
Malnourishment
Pancreatic duct obstruction

69
Q

Investigations for Chronic Pancreatitis

A

Decreased Faecal Elastase

CT SCAN- shows calcification

Perform MRCP

70
Q

Treatment of Chronic Pancreatitis

A

Alcohol cessation/ low fat diet

Analgesia (TRAMADOL)

Pancreatic enzyme replacement therapy

Start insulin therapy if diabetes has developed

71
Q

Complications of Chronic Pancreatitis

A

PODS

Pseudocysts
Obstruction (pancreatic)
Diabetes Mellitus
Steatorrhoea

72
Q

5 microbes involved in food poisoning

A 
Vibrio vulnificus
Bacillus cereus
Staphylococcus aureus
Clostrididium botulinium
E. coli
73
Q

5 microbes involved in bloody diarrhoea

A 
Campylobacter jejuni
Salmonella
E. coli
Shigella
Yersinia enterocolitica
74
Q

Intestinal tapeworm microbe

A

Taenia solium

Medicine (15 decks)

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