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GI P2a > GI > Flashcards

GI Flashcards

1
Q

Does achalsia present with haematemesis?

A

No

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2
Q

Define a Mallory Weiss tear:

A

tear in the mucosal lining of the junction between stomach and lower oesophagus. Due to increased pressure (eg, coughing, pregnancy)

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3
Q

What is the treatment of H.pylori infection?

A

CAP

  • PPI
  • amoxicillin
  • clarithromycin
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4
Q

How do you test for H.pylori infection?

A

Urease breath test

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5
Q

What is the first line investigation for obstruction and the gold standard?

A
  • 1st line: x-ray

- gold standard: CT

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6
Q

where is the most common site of colon cancer?

A

distal colon

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7
Q

When would an IgA Ttg serum test be done?

A

Queried coeliac disease

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8
Q

What condition does primary sclerosing cholangitis commonly exist alongside?

A

Ulcerative Colitis. 80% of people with UC have PSC

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9
Q

What bacteria commonly causes diarrhoea when taking antibiotics?

A

C. diff

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10
Q

What antibiotics commonly cause C.diff infection?

A

Clindamycin, quinolones, cephlasporin, aminopenicillins

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11
Q

what is the treatment for a C.diff infection?

A

Metronidazole

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12
Q

What is the gold standard dx for Coaelic disease, and what does it show?

A

Duodenal biopsy. shows villous atrophy and crypt hyperplasia

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13
Q

What is the Marsh scale used for?

A

Severity of coeliac disease

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14
Q

What is used as a screening tool for CRC?

A

Faecal immunochemical test (FIT). Form of faecal occult test.

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15
Q

What is the gold standard investigation for diverticulitis?

A

CT colonography. Can’t do anything internal (eg, colonoscopy) due to risk of perforation

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16
Q

Is malar flush a sign of liver disease?

A

NO. It is a sign of heart disease, and is flushing due to high CO2

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17
Q

What is dupuytren’s contracture and when might it be seen?

A

finger abnormality seen in liver disease

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18
Q

What disease should be suspected if presence of diarrhoea, weight loss and anaemia?

A

Coeliac disease

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19
Q

What is dermatitis herpeformis a sign of?

A

Coeliac disease

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20
Q

Histological changes in UC vs Crohn’s

A

UC: continuos mucosal inflammation with no skip lesions. Pseudo-polyps. Goblet cell depletion and crypt abscess
Crohns: skip lesions. Cobblestone appearance and granulomtous inflammation

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21
Q

p-ANCA results in UC vs Crohns

A

positive in UC and negative in Crohns

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22
Q

Does Crohn’s have bloody diarrhoea and tenesmus?

A

No

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23
Q

What is the gold standard dx for IBD?

A

colonoscopy

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24
Q

IBD treatment? Differences between UC and Crohn’s?

A
  • UC: start of sulfasalazine (5-ASA). Then steroid. Aziothriprine for maintenance
  • Crohn’s: start on steroids (prednisolone), then 5-ASA. Can also use immunosuppressants (Eg infliximab if no steroid response)
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25
Q

What can mimic appendictis?

A

Crohns

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26
Q

RF: crohns

A

female. stronger genetic links

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27
Q

which IBD are mouth ulcers more common in?

A

Crohns

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28
Q

What IBS symptoms are red flags for CRC?

A

unexplained weightloss, bleeding on defacation, mass, increased inflammatory markers, anaemia, FHx

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29
Q

What type of bowel obstruction is more common?

A

Small

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30
Q

What is the most common aetiology for small and large bowel obstruction?

A

Small: adhesions
Large: malignancies

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31
Q

Differentiations for bowel obstruction?

A
  • SBO: tinkling bowel sounds. Initially colicky then diffuse. Starts as vomiting
  • LBO: starts as constipation. No bowel sounds. More constant pain
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32
Q

Tx of obstruction?

A

bowel decompression

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33
Q

Most common bacterial causes of diarrhoea?

A

campylobacter jejuni, E.coli, salmonella, shigella

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34
Q

Most common cause of diarrhoea in children vs adults?

A

Viral for both

  • adults: norovirus
  • children: rotavirus
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35
Q

What is AF and abdomen pain a reg flag for?

A

Acute mesenteric ischaemia

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36
Q

What is the triad for presentation of mesenteric ischaemia

A

acute sever abdo pain with no abdo signs, and hypovolaemia and shock

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37
Q

What is the rockall score?

A

Score used for upper GI bleeding

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38
Q

What is tx for mallory weis tear?

A

terlipression and endoscopy. then banding/clipping

39
Q

what is an oesophageal varices?

A

dilated veins at site of portosystemic anastomoses

40
Q

what is the aetiology of oesophageal varices?

A

pre-hepatic, hepatic and post hepatic. Anything that causes portal hypertension.

41
Q

what is the cell changes in barrett’s oesophagus?

A

stratified squamous to columnar epithelium with goblet cells

42
Q

what cancer can barretts oesophagus progress to?

A

adenocarcinoma

43
Q

Stress and alcohol are each a risk factor for ulcers. which is a RF for peptic and which duodenal?

A

Stress: peptic
alcohol: duodenal

44
Q

How can gastritis cause pernicious anaemia?

A

Autoimmune gastritis can cause destruciton of the gastric mucosa. This can destroy the parietal cells. This stops IF production, needed for absorption of vitamin B12. deficiency means megaloblastic macrocytic anaemia

45
Q

where are diverticula most commonly found?

A

Sigmoid.

46
Q

Diverticuluitis presn:

A

LIF pain w/ tenderness, tachycardia, pyrexia, constipation

47
Q

What cancer is Duke’s staging used with?

A

CRC

48
Q

What are haemhorroids and what are the two types?

A

Enlarged vascular muscosal cushions in the anal canal. There is internal (above the dentate line) and external (below the dentate line)

49
Q

What is a fissure in ano?

A

Tear in the mucosa of the anal canal

50
Q

What is a pilonidal sinus?

A

Obstruction of natural hair follicles above anus

51
Q

What is Troisier’s sign, and what condition does it link to, and what is the thing it causes called?

A

Enlarged left supraclavicular node (Virchow’s node). Sign of gastric cancer

52
Q

What is the difference between direct and indirect inguinal hernias?

A

Indirect: medial to inferior episgastric vessels
Direct: lateral to inferior epigastric vessels

53
Q

How do you diagnose hernias?

A

Ultrasound

54
Q

What do parietal cells produce?

A

IF and HCl

55
Q

What do chief cells produce?

A

pepsinogen. Inactive form of pepsin that HCl activates

56
Q

What do entereoendocrine cells produce?

A

gastrin from g cells

57
Q

What is achalsia and it’s risk factors?

A

failure of LOS to close. Can be due to nerve issues or failure of smooth muscle relaxation

58
Q

What is the dx of achalsia and the classic findings?

A

barium swallow and xray. See aperistalsis and a beak deformity (Where the oesophagus tapers down to a point)

59
Q

what is systemic sclerosis? How is it diagnose?

A

multisystem AID. Increased fibroblast activity leads to abnormal growth of connective tissue and internal organ fibrosis. Dx: ANA Ab.

60
Q

What is the symptoms for limited cutaneous scleroderma, and the mnemonic?

A

CREST:

  • C: calcinosis (calcium deposits in soft tissue)
  • R: raynauds
  • E: eosphageal immotility
  • S: sclerodactyl (hardening of skin on hands)
  • T: telangiectasia (spider veins)
61
Q

If there is an IBD patient that has different symptoms between flare ups, what is the likely diagnosis?

A

Crohns. symptoms vary with region affected.

62
Q

What are classic risk factors for non alcoholic fatty liver disease?

A

middle aged, overweight and t2DM.

63
Q

what is MELD? and what does it calculate

A

Model for End stage Liver Disease. Stratifies severity of end stage liver disease and can be used for transplant planning. Looks at creatinine, bilirubin, INR (relates to blood clotting( and sodium, and where a patient has had dialysis at least twice in the last week

64
Q

What is mesenteric adenitis and who does it typically affect?

A

Swollen lymph glands in the abdomen. Typically in children alongside other viral symptoms

65
Q

What should be administered in a paracetamol OD?

A

N-acetylcysteine. Activated charcoal is only effective within 1 hr of OD.

66
Q

What is Gilbert’s syndrome?

A

Autosomal recessive disorder. Characterised by unconjugated hyperbilirubinaemia, but no other evidence of liver issues. Eg, just jaundice, no RUQ pain

67
Q

what anaemia would a GI bleed present with?

A

microcytic hypochromic anaemia

68
Q

What is Mirizzi’s syndrome? and how does it present?

A

acute charcot’s triad. Unlikely asecnding cholangitis, this is due to common hepatic duct obstruction, not CBD.

69
Q

What are the following symptoms a red flag for:painful rectal bleeding, young female patient, spasmodic anal sphincter and pain on DRE

A

anal fissue.

70
Q

What are the symptoms of severe B12 deficiency?

A

Subacute degeneration of the spinal cord: mixture of UMN and LMN signs. Spinothalamic tract: unaffected, so pain and temperature sensations remain.

71
Q

When is Beck’s triad seen?

A

Cardiac tamponade.

72
Q

Why do internal haemorrhoids have no related pain?

A

Above the dentate line, thus no pain reception

73
Q

What symptoms confirm a Giardia infection?

A

cysts with well defined walls.

74
Q

What Abx should be used for giardia infection? what should you warn patients of when taking this antibiotic?

A

Metronidazole. Don’t drink alcohol as it can lead to bad reactions

75
Q

What interleukin is responsible for stimulating production of eosinophils?

A

IL-5

76
Q

What deficiency is Crohn’s often associated with?

A

B12

77
Q

How do you assess severity of pancreatitis?

A

Modified Glasgow Criteria. mnemonic PANCREAS:

  • P: PaO2 low
  • A; age >55
  • N: neutrophilia (WCC>15)
  • C: calcium <2mmol/l
  • R: renal function (High urea
  • E: enzymes (high LDH, AST or ALT)
  • Albumin: <32g/L
  • Sugar

Amylase useful in dx but not assessment

78
Q

What LFTs would be expected for severe alcholism?

A

Raised ALT, AST and GGT (this is specific!)

79
Q

What is the typical presentation of pancreatic cancer?

A

Painless jaundice and a palpable non tender gallbladder

80
Q

What is the best marker of synthetic liver funciton?

A

Prothrombin

81
Q

What blood marker classically rises with a upper GI bleed?

A

Urea

82
Q

When does hepatic encephalopathy occur?

A

In liver failure when ammonia levels rise and cross the blood brain barrier.

83
Q

What is the treatment fro hepatic encephalopathy?

A

Lactulose. promotes explusion of ammonia from the body and decreases toxin absorption

84
Q

What is a common side effect of azathioprine?

A

Commonly causes thrombocytopenia –> low platelets would be seen

85
Q

What antibody would be positive in primary biliary cirrhosis?

A

anti mictochondrial antibodies

86
Q

Where is most affected in crohns?

A

terminal ileum

87
Q

What is the appeance of C.diff

A

gram positive bacillus

88
Q

Where does pain begin in appendicitis?

A

peri umbilical region

89
Q

What is the most common dermatological manifestation of IBD?

A

erythema nodosum

90
Q

How does NSAIDs lead to peptic ulcers?

A

via reducing bicarb and mucus secretion

91
Q

What is drip and suck treatment?

A
  • drip: correct fluid levels and electrolytes

- suck: nasogastric tube to decompress

92
Q

What is the surgical and non surgical hemorrhoid treatments?

A
  • non surgical: stool softeners, laxatives, high fibre diet, adequate water intake
  • surgery: haemorrhoidectomy
93
Q

What condition does LIF pain alert to?

A

diverticulitis

94
Q

What does infliximab target?

A

TNF

GI P2a (12 decks)

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