Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3 FoCP > Gastrointestinal Week 3 > Flashcards

Gastrointestinal Week 3 Flashcards

1
Q

What’s is charcots triad and its significance?

A

Jaundice, fever, rigors. Suggests cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what kind of organ typically cause colicky pain

A

hollow, tube muscular type organs like bowel, or gall bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how what a peritonitis pain present

A

patient would say that pain is worse on movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what kind of pain will start at the front at go to the back and to the right shoulder?

A

gallbladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

where does pancreas pain often radiate to

A

to the back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

an abdominal pain that comes and stays at around the same intensity in the epigastric region - what is the first ddx?

A

peptic ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what kind of pain is acute cholescytistis

A

constant pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what foods often aggravate cholescystitis

A

fatty foods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what kind of foods will aggravate a peptic ulcer

A

citrus, spicy food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

where in the GI would melena suggest its origin from?

A

upper GI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what pathology is tenesmus associated with

A

cancer
colitis
IBS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is GET SMASHED

A

risk factors for pancreatitis

gall stones
ethanol
trauma

steroids
mumps
autoimmune
scorpion venom
hyperlipidaemia/hypercalcaemia/hyperparathyroidism
ERCP
Drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

why do you get swollen ankles with hepatitis

A

reduced albumin synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what GI diseases are related to clubbing

A

IBD (crohns, UC), primary biliary cirrhosis, malabsorption (celiac), cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

difference between telangiectasia and spider naevi

A

telangiectasia fill from outside in. spider naevi from inside out. can differentiate by pressing on it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are kayser fleischer rings indicative of

A

wilsons disease, copper retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what does angle stomatitis indicate

A

iron deficiency anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what does glossitis indicate

A

iron/b12/folate deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is rovsing’s sign

A

push left side, if right side pain then positive rovsing sign, may be appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

complications with GORD

A

esfgitis
peptic ulcer
benign strictures
barrett’s esfgs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

difference between duodenal ulcer and peptic ulcer in regards to pain relief

A

duodenal ulcers are usually relieved by eating, vs peptic ulcers which are often relieved by lying down or vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

complications in peptic ulcer

A

erosion, perforation, peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

difference between crohn’s and UC

A

UC assoc w cancer
crohns have skip lesions, UC is continuous
Uc affects large colon, crohn’s anywhere in GI
crohn’s affect transmurally, while UC is just surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

bloody stool is common in UC or CD?

A

UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

how does CF affect the pancreas

A

thickened secretions block ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are the SSS CCC TTT F to describe a lump

A

size
shape
site

color
consistency
contour

transilluminance
tethering
tenderness

fluctuance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

contents of the spermatic cord

A

piles dont contribute to a good sex life

pimpiniform plexus
ductus deference
cremasteric artery
testicular artery
artery of ductus deferens
genital branch of the genito femoral nerve
sympathetic nerves
lymphatics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what forms the inguinal canal? (ant/post/floor/roof)

A

anterior wall - external oblique
posterior - fascoa transversalis
roof - conjoint tendon
floor - inguinal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

difference between a direct and indirect hernia

A

direct hernia goes through the abdominal wall away from the inguinal canal

indirect hernia goes through the deep ring of the inguinal canal and out through the superficial ring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

where does a femoral hernia happen

A

below inguinal canal, lateral to pubic tubercle, through femoral ring and into femoral canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

how to conduct a hernia exam

A

patient standing, expose testicles if male
inspect patient, cough
palpate lump
lie down, fingers on lump and cough, if hernia reappears is direct hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

3 things that can happen to a hernia

A

reducible - can be pushed back in
incarcerated - stuck between structures
strangulated - stuck with blood flow cut off

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what does a bag of worms in the testicles mean

A

varicocele (enlargement of pampiniform plexus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

who gets femoral hernias more often

A

women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what position should a patient be in when doing a DRE

A

lying on side with knees tucked in

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is hematochezia

A

fresh red blood from rectum with stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what is the most common cause of UGI bleeding

A

Peptic ulcer disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what kind of bleed arises from a PUD bleed

A

fresh red blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what is a mallory weiss tear

A

tear in esfgs at junction between stomach and esfgs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what bloods are important in massive GI bleed cases

A

HB, ABG, cross match, LFTs, coagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what is “fluid challenge”?

A

give 500ml crystalloid then assess condition again after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

noteworthy history to take in GI bleed case

A 
previous episode
previous endoscopy
drug history
chronic liver dz state
family history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what drugs can exacerbate GI bleeds

A

antiplatelets

anticoagulatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

options for treating GI bleed after initial stabilisation

A

endoscopic therapy including adrenaline injection in situ, heat energy therapy, clips

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what drugs should be prescribed after PUD bleed?

A

IV PPI for 3 days

antibiotics if H pylori +ve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

how large dilatations in small and big bowel to be considered obstruction

A

> 6cm for colon, >9cm for caecum

>3cm in small bowel in at least 3 places

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what level is the transpyloric plane (rib and spinal level)

A

L1 // 9th rib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

which vein supply the portal vein

A

sup and inferior mesenteric veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

why do you get dark urine and pale stools in biliary obstruction?

A

bilirubin is usually excreted through the faeces through a process done by the liver, however in biliary obstruction, the bilirubin is unable to reach the intestine and hence high amounts of soluble conjugated bilirubin enter the circulation which are then excreted by the kidneys.

pale stools because the bilirubin is unable to reach the stools

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

genetic mutation that causes decreased activity of protein which helps conjugate bilirubin in the liver, leading to impaired excretion and build up

A

what is gilbert’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

route of transmissions of hepatitis viruses A B C E

A

A and E, oral faecal, shellfish and pork

B blood born/sex IVDU

C IVDU, blood, sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

how does sphincter of oddi dysfunction cause issues

A

failure to relax causes build up of bile in the CBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what is courvoisier’s law

A

painless jaundice + palpable GB = malignancy of pancreas or biliary tree, until proven otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

which cells in the pancreas are responsible for its exocrine and endocrine functions

A

islets of langerhans - endocrine

acinar cells - exocrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

loss of pancreatic function leads to what kind of stool?

A

steatorrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what imaging can be used for pancreatic investigations

A

CT/MRCP

EUS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what levels are tested for in LFTs (5)

A 
GGT
ALT
Alk phos
albumin
bilirubin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what is the most reliable marker of liver function

A

PT/INR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what is the healthy range for INR in a normal person and someone on warfarin

A

<1.1 for normal

2-3.0 for warfarin therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

albumin goes down in malnutrition - T or false

A

False, except in kwashiokor which is protein malnutrition

61
Q

what is ALT a marker of?

A

marker of liver cell death.

62
Q

if ALT is raised, what else can cause it other than liver cell death

A

muscle/heart

63
Q

what is alk phos a marker of in relation to liver function

A

goes up if damage is in bile duct, gives an obstructive picture of liver function

64
Q

what else can a raised alk phos mean if not liver related?

A

raised in high bone resorption also

65
Q

what is GGT typically used in conjunction with and what do they suggest?

A

a raised ALT or alk phos should be seen with raised GGT to suggest any liver issues.

if ALT/alk phos is raised without GGT rise, then likely to be non-liver related

66
Q

whats the right investigation for suspected obstruction?

A

Ultrasound

CT/MCRP

67
Q

what is the LFT picture for fulminant liver failure?

A

ALT very raised
alk phos may or may not be raised
PT raised

68
Q

if PT is raised, other than liver failure, what can be the cause?

A

vitamin K deficiency

69
Q

case 1 on LFTs

39M, prev well
3 days lethargy, achy
pale stool and dark urine

LFTs
GGT 546
ALT 2554
Alk phos 228
bili 78
albumin 46

PT normal

what investigations to do? and why?

A

serology test - viral hepatitis?

70
Q

case 2 on LFTs

77M, hx of renal cell cancer surgery

PC with sudden onset abdo pain

GGT 215
ALT 25
alk phos 173
bili 30
albumin 45

what picture is this? what investigations should you do?

A

obstructive - do ultrasound

71
Q

ERCPs are a diagnostic procedure - T or F

A

false, risky, only do for treatment

72
Q

Case 3 LFTs

65M hx of colon cancy and colectomy

GGT 233
alt 25
alp 154
bili 11
albumin 46

what picture is this? what investigation?

A

slight obstructive picture w normal bilirubin

US

73
Q

case 4

unwell, abdo pain, swelling, leg edema

GGT 249
ALT 99
alk phos 270
bili 42
albumin 18

what picture is this? what further investigations?

A

mixed picture, PT, platelets

=> cirrhosis?

74
Q

what LFT picture does alcoholic cirrhosis give?

A

obstructive picture

75
Q

case 5 LFT

77M recently treated for UTI w co-amoxiclav

jaundice and itch

GGT 52
ALT 690
alk phos 148
bili 291
albumin 31

what picture is this? what causes are we thinking about? what further investigations?

A

hepatitic picture, could be drug induced? do acute liver screen for other causes, autoimmune?

76
Q

why do acutely very raised LFTs sometimes go down very quickly after a few days?

A

liver cells have died to the point where there is nothing left to give a bad reading

77
Q

what are the steps for a MUST assessment?

A

M - BMI
U - unexplained weight loss
S - acute disease
T - add up the scores to obtain overall risk

78
Q

what MUST score warrants referral to dietitian?

A

2 or more

79
Q

how much unplanned weight loss in the last 3-6 months gives a score of 2? on the MUST assessment tool

A

more than 10% of weight

80
Q

what investigations are done for suspected GI cancer?

A

CT, PET, EUS, Laproscopy

81
Q

who should always have gastroscopy for dyspepsia?

A

> 55 with indigestion

82
Q

older >50M with severe abdomen and back pain, what are we thinking of?

A

AAA or renal colic

83
Q

in abdo pain what systems are we thinking about

A

Gi, gynae, urinary

84
Q

what kind of pain can testicular torsion present with

A

abdo pain

85
Q

how is suspected appendicitis investigated

A

USS or CT

86
Q

what kind of pain is characteristic of biliary conditions

A

colicky, comes in waves, pain.

worse after eating fatty foods

87
Q

where is PUD pain usually located

A

epigastric

88
Q

in small bowel obstruction why is surgical hx important?

A

surgical adhesions

89
Q

how to differentiate pneumoperitnoeum from gastric bubble?

A

gastric bubble is dark but hazy and blends into stomach opacity

90
Q

what can a large pneumoperitoneum indicate?

A

bowel perforation

91
Q

what kind a small amount of gas under the diaphragm be caused by?

A

recent laproscopic surgery, Co2

92
Q

if suspected bowel perf, what kind of xray to get?

A

erect CXR

93
Q

what is the systematic way to interpret an AXR

A

projection + patient deets + adequacy

obvious abnormalities

systematic observation from rectum and up noting any dilatations, wall thickening.

others like foreign bodies and bones

94
Q

what is the normal limits of bowel dilatations SB, LB

A

LB - 6cm, or 9 for caecum

SB - 3cm

95
Q

how to tell if dilatation is small bowel or large bowel

A

look at valvulae conniventes if present, then SBO

look for haustra, if present then LBO

96
Q

presentation of SBO

A

abdo pain, abdo distension, vomitting, absolute constipation, lack of bowel sounds or tinkling sounds

97
Q

why is a patent ileocaecal valve good in bowel obstruction

A

then backlog of gas can fill up the small bowel as well to reduce pressure and perforation risk

98
Q

how to tell if sigmoid or caecal volvulus?

A

left side is sigmoid, coffee been shape

right side is caecal, kidney bean shape

99
Q

how to see inflamed bowel wall?

A

“thumb printing” sign, bowel wall thickening

100
Q

how to differentiate between IBS and IBD

A

IBS has no bloody stool
IBS has bloating, IBD doesn’t
IBS abdominal pain is relieved by passing stool
IBD has more systemic symptoms like fever, fatigue, weight loss, change in appetite

101
Q

Is IBS usually associated with change in appetite?

A

no

102
Q

what environmental factor is commonly associated with IBS

A

stress

103
Q

How to tell if someone has UC gastroenteritis

A

Stool cultures

104
Q

If someone has symptoms suggesting UC flare, what should be done to rule out what ?

A

Rule out gastroneteritis by doing a stool culture

105
Q

Why can gastroenteritis look like uc?

A

pain, diarrhea; sometimes fever

106
Q

what skin conditions can you get with IBD

A

pyoderma gangrenosum

107
Q

what is koilonychia and what does it present

A

curved nails - irond deficiency anaemia

108
Q

what is leukonychia and what does it typically present

A

white nails - chronic liver disease

109
Q

what is koilonychia and what does it present

A

curved nails - irond deficiency anaemia

110
Q

what is leukonychia and what does it typically present

A

white nails - chronic liver disease

111
Q

what is painless jaundice suggestive of?

A

malignancy

112
Q

5 F’s that can cause distended abdomen

A

Fluid fat fetus fletus faeces

113
Q

What signs will u get on abdomen palpation if someone has peritonitis

A

Rebound tenderness, guarding, percussion tenderness

114
Q

what is the criteria used to diagnose IBS?

A

ROME IV criteria

abdo pain at least once a week for 3 months, related to change in stool frequency, change in stool form and pain related to defecation

115
Q

what is important to rule out before diagnosing IBS?

A 
IBD
gastric cancer
gastric ulcers
diverticulitis
appendicitis
GB problems
medications
gastroenteritis
coeliac disease
gynaecological conditions
116
Q

what 2 specific blood tests are important in diagnosing IBS

A

CRP and fecal calprotectin - rule out IBD

117
Q

red flag symptoms in GI presentations

A 
onset after 50 y/o
rectal bleeding/bloody stool
nocturnal diarrhea
progressive abdo pain
weight loss
family hx of colorectal cancer or IBD
blood markers - anaemia, raised CRP, raised fecal calprotectin
118
Q

3 types of laxatives

A

bulk forming e.g. husk
stimulating e.g. senna
osmotic e.g. macrogol

119
Q

red flags in someone with constipation

A

tenesmus
rectal bleeding
anaemia
weight loss

120
Q

what is important in managing someone with constipation?

A

find out what out the cause is

121
Q

difference in microscopic pathology between crohn’s and UC

A

crohns commonly have granulomas

UC has crypt cell abscess, goblet cell depletion and no granulomata

122
Q

difference between macroscopic pathology between crohn’s and UC

A

crohns - skip lesions, mouth to anus, transmural involvement

UC - continuous, only in colon, red mucosa, easily bleeding,

123
Q

what will bloods look like in IBD?

A

commonly anaemic - of chronic disease or iron def, or b12/folate def.

raised inflammatory markers,

124
Q

what is the diagnostic procedure for IBD

A

colonscopy + biopsy

125
Q

what other organs are commonly affected in IBD

A

eyes, skin, joints, hepatobiliary, kidney

126
Q

what eye conditions are associated with IBD

A

episcleritis, uveitis, conjunctivitis

127
Q

what skin conditions are associated with IBD

A

erythema nodosum, pyoderma grangrenosum

128
Q

describe erythema nodosum

A

macula patches, often on shin, often painful

129
Q

what joint conditions are associated with IBD?

A

ankylosing spondylitis

small joint arthritis

130
Q

investigations done in suspected IBD

A

bloods - CRP, ESR, FBC
rule out colon cancer - imaging (AXR, CT, scopes)
stool cultures
PR exam

131
Q

someone presenting with a palpable epigastric mass with a palpable lymph node at the supraclavicular fossa - what is the diagnosis to think about?

A

gastric cancer

132
Q

what medication is known to cause peptic ulcerations

A

NSAIDs

133
Q

4 common causes of haematemesis

A

gastric/duodenal ulcer
mallory weiss tear
esfgeal varicies
reflex esophagitis

134
Q

what blood tests can be done to detect excess alcohol drinking?

A

elevated gamma-GT and raised MCV or blood/urine alcohol level

135
Q

signs of wernicke’s encaphalopathy

A

ecephalopathy, delirium, ataxia, nystagmus

136
Q

mediciation used in alcohol withdrawal

A

chlordiazepoxide

137
Q

what is the most common reason for an LFT reading of ALT > 1000 ?

A

paracetamol overdose

138
Q

what causes primary biliary cirrhosis?

A

autoimmune

139
Q

symptoms of primary biliary cirrhosis?

A

puritis
+/- jaundice
hepatosplenomegaly
xanthelasma

140
Q

describe the pain of biliary colic

A

severe pain in upper abdomen - comes and goes, and gets better after hours

can radiate to right shoulder

can be assoc with vomiting

141
Q

investigations for suspected biliary colic?

A

history
US
LFTs -> increased ALP
absence of inflammatory markers

142
Q

when to suspect cholecystitis over biliary colic?

A

when pain progresses over hours
systemic signs of inflammation (fever, fatigue etc)
murphy’s sign +ve

abnormal WCC, LFTs

US showing gallstone with distended GB

143
Q

investigation in suspected pancreatitis

A

bloods - raised amylase, FBC, CRP, urea, LFTS, U&Es,

US

144
Q

what does ecchymoses around the umbilicus and flank suggest?

A

cullen’s sign and Grey Turners - pancreatitis

145
Q

why do LFTs often show obstructive pattern in alcoholic liver cirrhosis?

A

inra-hepatic obstruction

146
Q

difference in symptoms of viral gastroenteritis and bacterial gastroenteritis?

A

bacterial GES is more severe, sometimes with bloody diarrhea, lasts longer

147
Q

what is achlorhydria?

A

absence of hydrochloric acid in gastric secretions

148
Q

why are PPIs a risk factor for gastroenteritis

A

reduced acidity in the stomach can allow bacteria/viruses to proliferate and cause disease

149
Q

what MUST score should you refer to dietician?

A

2 or more

3 FoCP (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions