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Medicine - Finals > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Most common inheritable form of colorectal cancers

A

1 - HNPCC

2 - FAP

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2
Q

Features of ascending cholangitis

A

Reynolds Pentad (jaundice, right upper quadrant pain, fever/rigors, shock and altered mental status)

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3
Q

Ix for acute cholecystitis

A

Abdo USS

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4
Q

Diagnosing Pernicious Anaemia

A

Intrinsic factor antibodies are more useful than gastric parietal cell antibodies when investigating vitamin B12 deficiency, given low specificity of gastric parietal cell antibodies

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5
Q

Initial Ix for IBD

A

faecal calprotectin

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6
Q

How can response to colorectal cancer treatment be monitored?

A

CEA

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7
Q

Positive anti-HBc IgG,
Negative anti-HBc IgM
Negative anti-HBc
Positive HBsAg

A

chronic HBV infection

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8
Q

Define the symptom “waterbrush”

A

bitter taste in mouth commonly found in GORD

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9
Q

Dietry advice in GORD

A

avoid late night meals
avoid caffeine and alcohol
avoid spicy food
weight loss

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10
Q

Diagnosis of H.pylori

A

stool antigen test

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11
Q

Management of H.pylori

A

Amoxicillin
Clarithromycin/Metronidazole
PPI

Avoid NSAIDs

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12
Q

What increases the risk of oesophageal and gastric adenocarcinoma?

A

GORD -> Barrett’s

H.pylori -> Dyspepsia

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13
Q

Which cell releases intrinsic factor?

A

Parietal cells

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14
Q

Gene associated with Crohn’s

A

NOD2

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15
Q

Gene associated with UC

A

HLA-B27

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16
Q

Diagnosis of irritable bowel syndrome

A

Abdominal discomfort for ≥ 3 days per week + ≥2 of:

  • improvement on defaecation
  • change in bowel frequency
  • change in stool form
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17
Q

Biochemistry seen in acute pancreatitis

A

elevated serum amylase
high glucose
low calcium
high lipase

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18
Q

Drugs associated with pancreatitis

A 
Corticosteroids 
Alcohol 
Valproic Acid 
Azathiprine 
Diuretics

Remember: Drugs Causing A Violent Abdominal Distress

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19
Q

Signs of retroperitoneal bleeding

A

Cullen -> periumbilical bruising

Grey Turner -> flank bruising

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20
Q

Management of motion sickness

A

Cyclizine

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21
Q

Which condition is associated with pigmented gallstones?

A

Sickle Cell Anaemia

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22
Q

Risk factors for gallstones

A

The 4 F’s

Fertile 
Fourty 
Female 
Female
Fat
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23
Q

What is Primary Sclerosing Cholangitis associated with?

A

UC

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24
Q

Presentation of Ascending Cholangitis

A

Charcot’s Triad

  • RUQ pain
  • Fever
  • Jaundice
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25
Q

Gene associated with Coeliac Disease

A

HLADQ2/Q8 gene

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26
Q

Risk factors for squamous cell carcinoma of the oesophagus

A

Smoking

HPV

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27
Q

Duke’s staging for GI malignancy

A

A - confined by muscularis propria
B - invaded the muscularis propria
C - Metastatic

28
Q

Two main inherited colorectal cancer syndromes

A

HNPCC (<100 polyps) - most common, late onset, r-sided
FAP (>100 polyps) early onset adenocarcinoma

Both are autosomal dominant conditions

29
Q

What is Wilson’s disease?

A

Ceruloplasmin deficiency causing copper build-up

This can be detected by the increased copper in urine, reduced serum copper (as deposited in tissue) and reduced ceruloplasmin

30
Q

Features of Wilson’s disease

A

Parkinsonism
Dementia
Kayser-Fleischer rings
Cirrhosis

31
Q

Hep B serology. Distinguishing between acute and chronic disease

A

Acute - HBsAg +ve for 1-6 months

Chronic - HBsAg +ve for >6 months

32
Q

Management of C.difficile

A

Mild - PO Metronidazole
Severe - PO Vancomycin
Life-threatening - PO Vancomycin and IV Metronidazole

33
Q

Initial investigation for acute bowel obstruction

A

Supine AXR

  • small bowel -> valvulan convientes “coinstacked” appearance
  • large bowel -> haustra coli
34
Q

What is the “silk” sign associated with?

A

Inguinal hernia - specifically in paediatrics

35
Q

Raised CA 19-9

A

Pancreatic Cancer

36
Q

Raised CA 15-3

A

Breast Cancer

37
Q

Medications associated with hyponatraemia

A

PPI, ACEI, Thiazides, Sodium valproate, Loops, Ecstacy

38
Q

Management of IBS

A

First -line pharmacological treatment

  • pain: antispasmodic agents
  • constipation: laxatives but avoid lactulose
  • diarrhoea: loperamide is first-line

Second-line pharmacological treatment
- low-dose tricyclic antidepressants (e.g. amitriptyline 5-10 mg) are used in preference to selective serotonin reuptake inhibitors

39
Q

Management of Crohn’s

A

Inducing remission

  1. Steroid or Budesonide
  2. Consider enteral feeding with elemental diet (especially in children)
  3. 5-ASA drugs (e.g. mesalazine)

Add-on therapy: azathioprine or mercaptopurine

Metronidazole is often used for isolated peri-anal disease

Maintaining remission

  1. Lifestyle e.g. stopping smoking is a priority (remember: smoking makes Crohn’s worse, but may help ulcerative colitis)
  2. azathioprine or mercaptopurine is used first-line to maintain remission
  3. methotrexate is used second-line
  4. 5-ASA drugs (e.g. mesalazine) should be considered if a patient has had previous surgery

Surgery

40
Q

What should be tested before starting Azathioprine?

A

thiopurine methyltransferase (TPMT) activity before offering azathioprine or mercaptopurine

41
Q

Management of UC flare

A

Inducing remission: rectal aminosalicyclate add oral aminosalicyclate if no better in 4 weeks and if serious consider steroids at this point

42
Q

Management of UC - maintaining remission

A

Following a mild-to-moderate ulcerative colitis flare
proctitis and proctosigmoiditis
- topical (rectal) aminosalicylate alone (daily or intermittent)
- an oral aminosalicylate plus a topical (rectal)
aminosalicylate (daily or intermittent)
- an oral aminosalicylate by itself: this may not be effective as the other two options

left-sided and extensive ulcerative colitis
low maintenance dose of an oral aminosalicylate

Following a severe relapse or >=2 exacerbations in the past year
oral azathioprine or oral mercaptopurine

43
Q

Features and management of Zollinger-Ellison syndrome

A

Zollinger-Ellison syndrome typically presents with multiple gastroduodenal ulcers causing abdominal pain and diarrhoea. High-dose proton pump inhibitors are needed to control the symptoms.

44
Q

What tumour syndrome is associated with Zollinger-Ellison syndrome?

A

MEN1

45
Q

What can be used as a measure of pancreatitis severity?

A

Mainly: Hypocalcaemia - full list below

P - PaO2 (< 7.9 kPa).

A - age (>55).

N - neutrophils (white cell count > 15x 109/L).

C - calcium (calcium < 2 mmol/L).

R - renal function (urea > 16 mmol/L).

E - enzymes (lactate dehydrogenase > 600 IU/L).

A - albumin (albumin < 32 g/L).

S - sugar (blood glucose > 10 mmol/L).

3 points and above suggests a high risk for severe pancreatitis.

46
Q

What marker is used to assess exocrine function in chronic pancreatitis?

A

Faecal elastase

47
Q

Secondary prevention of hepatic encephalopathy

A

Lactulose and rifaximin

48
Q

What is the best measure of acute liver failure?

A

Prothrombin time

49
Q

Isolated rise in bilirubin in response to physiological stress

A

Gilbert’s Syndrome

50
Q

Sigmoid Volvulus associations

A

older patients
chronic constipation
Chagas disease
neurological conditions e.g. Parkinson’s disease, Duchenne muscular dystrophy
psychiatric conditions e.g. schizophrenia

51
Q

Abdominal X-ray. Coffee Bean Sign

A

Sigmoid volvulus

52
Q

Management of Campylobacter jejuni gastroenteritis

A

Watchful waiting

Clarithromycin if complicated or immunosuprressed

53
Q

When should urea breath test not be performed for H.pylori?

A

Within 4 weeks of antibacterial therapy or within 2 weeks of antisecretory medication (e.g. PPI)

54
Q

What is the only test recommended for testing H pylori eradication?

A

Urea breath test

55
Q

Vitamin A + Deficiency

A

Retinoids deficiency causes night-blindness

56
Q

Vitamine B1 + Deficiency

A

Thiamine deficiency causes:

  • dry beriberi –> peripheral neuropathy
  • wet beriberi –> dilated cardiomyopathy
  • Wernicke’s –> nystagmus, ophthalmoplegia and ataxia
  • Korsakoff –> amnesia and confabulation
57
Q

Vitamine B6 + Deficiency

A

Pyridoxine deficiency presents with anaemia, irritability and seizures

58
Q

Bitamin B3 + Deficiency

A

Niacin deficiency causes Pellagra (Remember: Vit B3 deficiency gives you the 3D’s)

Dermatitis
Diarrhoea
Dementia

59
Q

Vitamin B7 + Deficiency

A

Biotin –> dermatitis and seborrhoea

60
Q

Vitamin B9 + Deficiency

A

Folic Acid –> Megaloblastic Anaemia and Neural Tube defects in early pregnancy

61
Q

Vitamin B12 + Deficiency

A

Cyanocobalamin –> Megaloblastic Anaemia and Peripheral Neuropathy

62
Q

Vitamin C + Deficiency

A

Ascorbic Acid –> Scurvy (gingivitis and bleeding)

63
Q

Vitamin D + Deficiency

A

Cholecalciferol –> Rickets and Osteomalacia

64
Q

Vitamin E + Deficiency

A

Tocopherol –> Mild haemolytic anaemia in newborns, ataxia and peripheral neuropathy

65
Q

Vitamin K + Deficiency

A

Naphthoquinone –> Haemorrhagic Disease of the Newborn, bleeding diathesis

Medicine - Finals (21 decks)

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