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Phase 2A HT > GI 1 > Flashcards

GI 1 Flashcards

1
Q

Clinical features of SBO?

A 
VITAL SIGNS
- tachycardia
- hypotension
- pyrexia
TENDERNESS
--> If localised = impending perforation
--> If diffuse = perforation
SWELLING
- discrete lump/diffuse (=more common)
RESONANCE
--> tympanic if gas filled, dull if fluid filled.
BOWEL SOUNDS
--> Increased in early stage and absent at late stage.
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2
Q

What does ‘thumb-printing’ of bowel indicate? (seen on XR)

A

Ischaemia

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3
Q

Why would you not do CT in pt with peritonitis and SBO?

A

Pt will be v unwell and will hurt to move and regardless of CT result will require surgery, therefore CT unnecessary.

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4
Q

In what pt group is intussusception most common and why?

A

Infants/toddlers - mesentery less formed and more easily inverted. (more supple)

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5
Q

When would you operate IMMEDIATELY in a pt with SBO?

A
  • signs of strangulation (radiologically/clinically)

- perforation (clinical peritonitis &/or free air on radiological imaging)

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6
Q

Why would you find low Hb levels in LBO?

A

Anaemia due to chronic occult blood loss.

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7
Q

What is the most commonly used investigation to diagnose LBO and what would it show?

A

CT - shows underlying cause, dilation of colon and risk of perforation –> allows staging of disease

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8
Q

Mx of non-perforated sigmoid volvulus?

A

Flexible/rigid sigmoidoscopy

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9
Q

Mx of perforated sigmoid volvulus?

A

Surgical resection and wash out

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10
Q

Pathophysiology of familial adenomatous polyposis?

A

BETA CATENIN not broken down ∴ levels increase –> Beta-catenin entering nucleus & binding to DNA which triggers epi. proliferation –> polyps formation –> adenoma formation.

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11
Q

Pathophysiology of hereditary nonpolyposis colorectal cancer (HNPCC)?

A

Loss of DNA repair proteins ∴ no DNA repair occurs. This –> to cancer as damaged DNA not recognised, apoptosis not triggered and ∴ cancer cells persist.

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12
Q

Define adenoma

A

A benign epithelial tumour in which the cells are derived from glandular epi.

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13
Q

What investigation is most commonly used to detect volvulus and what would it show?

A

Abdominal XR - shows characteristic INVERTED “U-LOOP” (looks like a coffee bean)

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14
Q

Who is most likely to develop sigmoid volvulus?

A

Elderly
Constipated
Comorbid pts

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15
Q

Complications of volvulus

A

Perforation and FATAL peritonitis

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16
Q

Presentation of gastro-oesophageal obstruction?

A 
Classic triad of:
- vomiting (then retching)
- pain
- failed attempts to pass a NG tube
(Also see regurgitation of saliva)
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17
Q

3 possible (broad) locations/mechanisms of intestinal obstruction

A
  • Intraluminal obstruction
    • -> tumour/diaphragm disease/ meconium ileus/ gallstone ileus
  • Intramural obstruction
    • -> inflam. (eg. Crohn’s)/tumours/neural (eg. Hirschsprung’s disease)
  • Extraluminal obstruction
    • -> adhesions/volvulus/tumour
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18
Q

What must be present in order for volvulus to occur?

A

Mesentery

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19
Q

How do you eradicate H. pylori

A

Triple therapy

  • amoxicillin
  • clarithromycin
  • PPI eg. omeprazole
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20
Q

define atresia

A

= Absence of opening/failure of development of hollow structure.

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21
Q

What is a feature of LBO not seen in SBO?

A

Weight loss

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22
Q

What is paralytic ileus

A

Abnormal peristalsis causing an a-dynamic bowel –> function bowel obstruction

  • -> decrease bowel sounds
  • -> absence of pain
23
Q

where do you find Pseudo-obstruction of bowel

A

Only in large bowel causing pain and obstruction

24
Q

What is the clinical presentation of acute mesenteric ischaemia?

A

triad:
abdo pain
no abdo signs
hypovolaemia –> shock

25
Q

What are the 2 life-threatening complications of acute mesenteric ischaemia?

A
  • septic peritonitis

- SIRS –> MODS (due to bacterial translocation)

26
Q

Clinical presentation of chronic mesenteric ischaemia?

A
  • colicky post prandial pain
  • weight loss
  • abdominal bruit
27
Q

clinical presentation of ischaemic colitis

A

lower left sided abdo pain w. or w/o bloody diarrhoea

28
Q

What organism causes diarrhoea without blood?

A

Staph aureus

29
Q

What is the main cause of unconjugated bilirubin jaundice?

A

(unconjugated = pre-hepatic)
Most common = GILBERT’S syndrome
(also haemolysis)

30
Q

Risk factors for gallstones

A

Female
Fat
Fertile
(and liver disease)

31
Q

What medication is the most likely cause of DILI?

A

Antibiotics (augmentin, flucloxacillin, erythromycin, septrin, TB drugs)

32
Q

list 4 poor prognostic factors in paracetamol induced liver injury?

A
  • late presentation (NAC less effective >24h)
  • acidosis
  • prothrombin time > 70 secs
  • serum creatinine >/= 300mmol/L
33
Q

What is Mallory’s hyalin and when do you see it?

A

In ALCOHOL-related liver injury - ballooned injured hepatocyte may accumulate cytoskeletal proteins that appear irregular and red on H&E stain
(not specific to alcoholic liver disease)

34
Q

3 causes of portal hypertension?

A

cirrhosis, fibrosis and portal vein thrombosis

35
Q

What is the most common infection in chronic liver disease?

A

Infection of the ascitic fluid

36
Q

Why do you get coagulopathy with liver dysfunction

A
  • impaired synth of coag. factors
  • vitamin k deficiency
  • thrombocytopenia
37
Q

drugs to avoid in liver disease?

A

NSAIDs (cause renal failure), aminoglycasides and ACE inhibitors
take care with diuretics and sedation

38
Q

when would you see a rosette of hepatocytes at the interface with portal tracts?

A

autoimmune hepatitis

39
Q

How would you stage Primary biliary cirrhosis?

A

Ludwig system

40
Q

List 5 conditions you might see granulomas in?

A

Sarcoidosis/ Crohn’s/ TB/ GCA/ PBC

41
Q

What is seen in histology of PSC?

A

characterised in early stages by periductal oedema giving concentric ‘onion ring appearance’

42
Q

What might put you at high rick of developing hepatocellular carcinoma?

A

Risk highest for Hep B and C and haemochromatosis

lower risk for cirrhosis from alcohol/autoimmune

43
Q

Management of variceal haemorrhage?

A 
Endoscopic therapy (band ligation/sclerotherapy) = tx of choice
(can us pharmacological - telipressin/somatostatin - to reduce bleeding while waiting for endoscopy)
44
Q

how does H pylori increase risk of peptic ulcers

A

increases gastrin secretion
increases parietal cell mass
decreases mucus and bicarb

45
Q

what does dyspepsia mean

A

indigestion

46
Q

3 main causes of malabsorption

A

crohns
coeliac
chronic pancreatitis

47
Q

what is tropical sprue

A

progressive small intestine disorder with diarrhoea, steatorrhoea and megaloblastic anaemia
MALABSORPTION - esp fat and vit b12 - similar bx features coeliac (VILLOUS ATROPHY)
tx - folic acid and tetracycline (3-6m) plus nutritional supplements

48
Q

what is characteristic of steatorrhoea faeces

A

hard to flush

49
Q

what 2 conditions is coeliac specifically linked with

A

diabetes and thyroid disease

50
Q

why test for coeliacs

A

increased risk of malig
QoL/persistent symptoms
sub fertility
osteoporosis

51
Q

3 conditions associated with IBS

A

fibromyalgia, chronic fatigue, temporo-mandibular joint dysfunction

52
Q

anti diarrhoeal drug used in IBS

A

loperamide

53
Q

what organs is iron deposited in in haemochromatosis

A

liver pancreas joints skin heart pituitary

54
Q

triad in haemachomatosis

A

skin pigmentation, DM and micronodular cirrhosis

Phase 2A HT (11 decks)

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