GI Flashcards
Does achalsia present with haematemesis?
No
Define a Mallory Weiss tear:
tear in the mucosal lining of the junction between stomach and lower oesophagus. Due to increased pressure (eg, coughing, pregnancy)
What is the treatment of H.pylori infection?
CAP
- PPI
- amoxicillin
- clarithromycin
How do you test for H.pylori infection?
Urease breath test
What is the first line investigation for obstruction and the gold standard?
- 1st line: x-ray
- gold standard: CT
where is the most common site of colon cancer?
distal colon
When would an IgA Ttg serum test be done?
Queried coeliac disease
What condition does primary sclerosing cholangitis commonly exist alongside?
Ulcerative Colitis. 80% of people with UC have PSC
What bacteria commonly causes diarrhoea when taking antibiotics?
C. diff
What antibiotics commonly cause C.diff infection?
Clindamycin, quinolones, cephlasporin, aminopenicillins
what is the treatment for a C.diff infection?
Metronidazole
What is the gold standard dx for Coaelic disease, and what does it show?
Duodenal biopsy. shows villous atrophy and crypt hyperplasia
What is the Marsh scale used for?
Severity of coeliac disease
What is used as a screening tool for CRC?
Faecal immunochemical test (FIT). Form of faecal occult test.
What is the gold standard investigation for diverticulitis?
CT colonography. Can’t do anything internal (eg, colonoscopy) due to risk of perforation
Is malar flush a sign of liver disease?
NO. It is a sign of heart disease, and is flushing due to high CO2
What is dupuytren’s contracture and when might it be seen?
finger abnormality seen in liver disease
What disease should be suspected if presence of diarrhoea, weight loss and anaemia?
Coeliac disease
What is dermatitis herpeformis a sign of?
Coeliac disease
Histological changes in UC vs Crohn’s
UC: continuos mucosal inflammation with no skip lesions. Pseudo-polyps. Goblet cell depletion and crypt abscess
Crohns: skip lesions. Cobblestone appearance and granulomtous inflammation
p-ANCA results in UC vs Crohns
positive in UC and negative in Crohns
Does Crohn’s have bloody diarrhoea and tenesmus?
No
What is the gold standard dx for IBD?
colonoscopy
IBD treatment? Differences between UC and Crohn’s?
- 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)
What can mimic appendictis?
Crohns
RF: crohns
female. stronger genetic links
which IBD are mouth ulcers more common in?
Crohns
What IBS symptoms are red flags for CRC?
unexplained weightloss, bleeding on defacation, mass, increased inflammatory markers, anaemia, FHx
What type of bowel obstruction is more common?
Small
What is the most common aetiology for small and large bowel obstruction?
Small: adhesions
Large: malignancies
Differentiations for bowel obstruction?
- SBO: tinkling bowel sounds. Initially colicky then diffuse. Starts as vomiting
- LBO: starts as constipation. No bowel sounds. More constant pain
Tx of obstruction?
bowel decompression
Most common bacterial causes of diarrhoea?
campylobacter jejuni, E.coli, salmonella, shigella
Most common cause of diarrhoea in children vs adults?
Viral for both
- adults: norovirus
- children: rotavirus
What is AF and abdomen pain a reg flag for?
Acute mesenteric ischaemia
What is the triad for presentation of mesenteric ischaemia
acute sever abdo pain with no abdo signs, and hypovolaemia and shock
What is the rockall score?
Score used for upper GI bleeding
What is tx for mallory weis tear?
terlipression and endoscopy. then banding/clipping
what is an oesophageal varices?
dilated veins at site of portosystemic anastomoses
what is the aetiology of oesophageal varices?
pre-hepatic, hepatic and post hepatic. Anything that causes portal hypertension.
what is the cell changes in barrett’s oesophagus?
stratified squamous to columnar epithelium with goblet cells
what cancer can barretts oesophagus progress to?
adenocarcinoma
Stress and alcohol are each a risk factor for ulcers. which is a RF for peptic and which duodenal?
Stress: peptic
alcohol: duodenal
How can gastritis cause pernicious anaemia?
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
where are diverticula most commonly found?
Sigmoid.
Diverticuluitis presn:
LIF pain w/ tenderness, tachycardia, pyrexia, constipation
What cancer is Duke’s staging used with?
CRC
What are haemhorroids and what are the two types?
Enlarged vascular muscosal cushions in the anal canal. There is internal (above the dentate line) and external (below the dentate line)
What is a fissure in ano?
Tear in the mucosa of the anal canal
What is a pilonidal sinus?
Obstruction of natural hair follicles above anus
What is Troisier’s sign, and what condition does it link to, and what is the thing it causes called?
Enlarged left supraclavicular node (Virchow’s node). Sign of gastric cancer
What is the difference between direct and indirect inguinal hernias?
Indirect: medial to inferior episgastric vessels
Direct: lateral to inferior epigastric vessels
How do you diagnose hernias?
Ultrasound
What do parietal cells produce?
IF and HCl
What do chief cells produce?
pepsinogen. Inactive form of pepsin that HCl activates
What do entereoendocrine cells produce?
gastrin from g cells
What is achalsia and it’s risk factors?
failure of LOS to close. Can be due to nerve issues or failure of smooth muscle relaxation
What is the dx of achalsia and the classic findings?
barium swallow and xray. See aperistalsis and a beak deformity (Where the oesophagus tapers down to a point)
what is systemic sclerosis? How is it diagnose?
multisystem AID. Increased fibroblast activity leads to abnormal growth of connective tissue and internal organ fibrosis. Dx: ANA Ab.
What is the symptoms for limited cutaneous scleroderma, and the mnemonic?
CREST:
- C: calcinosis (calcium deposits in soft tissue)
- R: raynauds
- E: eosphageal immotility
- S: sclerodactyl (hardening of skin on hands)
- T: telangiectasia (spider veins)
If there is an IBD patient that has different symptoms between flare ups, what is the likely diagnosis?
Crohns. symptoms vary with region affected.
What are classic risk factors for non alcoholic fatty liver disease?
middle aged, overweight and t2DM.
what is MELD? and what does it calculate
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
What is mesenteric adenitis and who does it typically affect?
Swollen lymph glands in the abdomen. Typically in children alongside other viral symptoms
What should be administered in a paracetamol OD?
N-acetylcysteine. Activated charcoal is only effective within 1 hr of OD.
What is Gilbert’s syndrome?
Autosomal recessive disorder. Characterised by unconjugated hyperbilirubinaemia, but no other evidence of liver issues. Eg, just jaundice, no RUQ pain
what anaemia would a GI bleed present with?
microcytic hypochromic anaemia
What is Mirizzi’s syndrome? and how does it present?
acute charcot’s triad. Unlikely asecnding cholangitis, this is due to common hepatic duct obstruction, not CBD.
What are the following symptoms a red flag for:painful rectal bleeding, young female patient, spasmodic anal sphincter and pain on DRE
anal fissue.
What are the symptoms of severe B12 deficiency?
Subacute degeneration of the spinal cord: mixture of UMN and LMN signs. Spinothalamic tract: unaffected, so pain and temperature sensations remain.
When is Beck’s triad seen?
Cardiac tamponade.
Why do internal haemorrhoids have no related pain?
Above the dentate line, thus no pain reception
What symptoms confirm a Giardia infection?
cysts with well defined walls.
What Abx should be used for giardia infection? what should you warn patients of when taking this antibiotic?
Metronidazole. Don’t drink alcohol as it can lead to bad reactions
What interleukin is responsible for stimulating production of eosinophils?
IL-5
What deficiency is Crohn’s often associated with?
B12
How do you assess severity of pancreatitis?
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
What LFTs would be expected for severe alcholism?
Raised ALT, AST and GGT (this is specific!)
What is the typical presentation of pancreatic cancer?
Painless jaundice and a palpable non tender gallbladder
What is the best marker of synthetic liver funciton?
Prothrombin
What blood marker classically rises with a upper GI bleed?
Urea
When does hepatic encephalopathy occur?
In liver failure when ammonia levels rise and cross the blood brain barrier.
What is the treatment fro hepatic encephalopathy?
Lactulose. promotes explusion of ammonia from the body and decreases toxin absorption
What is a common side effect of azathioprine?
Commonly causes thrombocytopenia –> low platelets would be seen
What antibody would be positive in primary biliary cirrhosis?
anti mictochondrial antibodies
Where is most affected in crohns?
terminal ileum
What is the appeance of C.diff
gram positive bacillus
Where does pain begin in appendicitis?
peri umbilical region
What is the most common dermatological manifestation of IBD?
erythema nodosum
How does NSAIDs lead to peptic ulcers?
via reducing bicarb and mucus secretion
What is drip and suck treatment?
- drip: correct fluid levels and electrolytes
- suck: nasogastric tube to decompress
What is the surgical and non surgical hemorrhoid treatments?
- non surgical: stool softeners, laxatives, high fibre diet, adequate water intake
- surgery: haemorrhoidectomy
What condition does LIF pain alert to?
diverticulitis
What does infliximab target?
TNF
