GI Flashcards
Where does the Oesophagus Begin?
C6
Where does Oesophagus Terminate
T11-T12
Oesophagus is a mixture of which two muscle
Striated and Smooth
Oesophagus Epithelium
Stratified Squamous
Contraction in Oesophagus and Relaxation mediated via
Vagus Nerve
Lower Oesophageal Sphincter s made up of
Striated Muscles
What has corkscrew appearance on Barium swallow
Hypermotility
Hypomotility in Oesophageal causes failure of
LOS Mechanism
What is Achalasia
Functional loss of Myenteric Plexus
Cardiac Feature of Achalasia
Failure of LOS to relax
Hypomotility of oesophageal associated with
Connective Tissue Disease
Diabetes
Neuropathy
Barret’s Oesophagus is precursor to
Dysplasia/Adenocarcinoma
Oesophageal Cancer what type of cancers common
Squamous Cell or Adenocarcinoma
Squamous Cell Carcinoma in Oesophageal Cancer often occurs in
Prox and mid third of oesophagus
Adenocarcinoma in Oesophageal Cancer often occurs in
Distal Oesophagus
Which type of oesophageal cancer associated with Barret’s Oesophagus
Adenocarcinoma
What is Eosinophilic Oesophagitis
Chronic Immune/Allergen Mediated
Eosinophilic Oesophagitis is classified by how many eosinophils per high power microscopy
> 15
Where are pain receptors for somatic and referred pain in GI
parietal peritoneum or abdo wall
An Upper GI Bleed comes from which three locations
Oesophagus
Stomach
Duodenum
An upper GI bleed is proximal to
Ligament of Trietz
A lower GI bleed comes from
distal to duodenum
A lower GI bleed is distal to ligament of
trite
Signs of Upper GI Bleed
Haematemesis
Elevated Urea
Melena
Most common cause of Upper GI bleed
Peptic Ulcer
Risk factors for peptic ulcer
H pylori
Nsaids/Aspirin
What type of peptic ulcer most common
duodenal than gastric
Gastric ulcers may sit over a
gastric carcinoma
What is Zollinger Ellison syndrome
gastrin secreting pancreatic tumour
what does Zollinger Ellison syndrome cause
recurrent poor healing duodenal ulcers
Varices in GI are secondary to
Portal Hypertension
Varices are most common in GI where
Oesophagus
A mallory weiss tear occurs where
OG Junction
Lower GI bleed signs
Fresh Blood/Clots
Magenta Stools
Normal Urea
painless
Lower GI bleeding accounts for 25% of
Acute GI bleed
Colitis mucosa looks like what in Ischaemic Colitis
Dusky Blue
Swollen
Radiation Procitis occurs in previous history of radiotherapy for
Cervical or Prostate Cancer
When to blood transfuse in Management of GI bleed
hb <7g/dl or ongoing active bleed
What does shock lead to
Global Hypoperfusion and Tissue Hypoxia
Risk Stratification Score for Shock
Rockall or Blatchford
Low risk criteria for blatchford shock score - Urea
Urea <6.5
What does Terlipressin do in GI Bleed Varices Management
Vasoconstricts Splanchic Blood Supply
If bleeding keeps going in GI Bleed Varices management
Sengstaken Blakemore Tube
TIPSS
What is Steatosis
Fatty Liver
Which cell infiltrates in Steatohepatitis
Neutrophil Infiltration
Signs of Chronic Liver Disease
Spider Naevi Palmar Erythema Gynaecomastia Loss of Axillary and Pubic Hair Ascites Encephalopathy
what is thrombocytopenia
low platelets
what is hepatic encephalopathy
Liver failure
In spontaneous bacterial peritonitis what does neutrophil count come back as
> 0.25 x 10.9
In spontaneous bacterial peritonitis what does protein count come back as
<25g
How does decompensated hepatic function present
low albumin
raised INR
what things does Glasgow alcoholic hepatitis score consider
Age WCC Urea INR Bilirubin
Steatohepatitis can turn into
Cirrhosis
what is steatosis
fatty liver non alcoholic fatty liver
what is steatohepatitis
non alcohol steatohepatitis
fatty liver who does it affect in particular
obese
diabetes
hypercholesterolaemia
alcohol
How does steatohepatitis present
Asymptomatic
Fatty Liver on USS
Risk Factors of Perianal Abscess
Diabetes
BMI
Immunosuppression
Trauma
What is Fistula in Ano
Peri Anal Sepsis
Anal and Rectal Cancer how to test
Fit Test
Chronic Constipation causes in order of commonest to least
Diet
Evacuation Related
Slow Transit
Passive Faecal incontinence associated with
Internal Sphincter Defect
Overflow Faecal Incontinence associated with
Constipation
Name three congenital ano-rectal abnormalities
Imperforate Anus
Uro-Genital Fistulae
Hirschprung Myenteric Plexus Deficiency
Most common colo rectal cancer site
Left Colon
Colorectal Cancer Dukes Stage A Percentage and Where best
> 90% Submucosa
which drug can cause anal ulcers
nicorandil
Which protein does Liver synthesis
Albumin
Which lipid does liver synthesise
cholesterol
lipoprotein
TG Synthesis
Liver procedures urea from
ammonia
what is metabolised in liver
Bilirubin
Which organ stores glycogen
Liver
Which vitamins does liver store
Vitamin A, D, B12 and K
Bilirubin is bound to what when unconjugated
Albumin
which organ conjugates bilirubin
liver
Aminotransferases are present in
Hepatocytes
Aminotransferases suggests what involvement
parenchymal involvement
Alkaline Phosphatase present in
Bile duct
Alkaline Phosphatase is elevated with
Obstruction or liver Infiltration
which liver enzyme is also present in bone
alkaline phosphatase
Gamma GT is elevated with
alcohol use
what is an important test for synthetic function of liver
Albumin
Low levels of what suggests chronic liver disease
Albumin
What is an extremely important test for Liver Function
Prothrombin Time
Which test used to calculate liver transplant
prothrombin time
liver is an important source of
thrombopoeitin
Cirrhosis results in
Splenomegaly
Platelet count is an indirect marker of
portal hypertension
Jaundice is caused by
excess circulating bilirubin
when is jaundice detectable
when total plasma bilirubin exceed 34
Pre Hepatic Jaundice is said to be
Unconjugated
What happens in Hepatic causes of Jaundice
Defective uptake of Bilirubin, Defective Conjugation, Defective Excretion
What does haemolysis do to bilirubin
increased quantity of bilirubin
How does Cholestasis present
Pruritius
Pale Stool
High Coloured Urine
What is Courvoiser Sign
Palpable Gall Bladder
Most important test for Jaundice
Ultrasound
Which out of MRCP and ERCP has radiation
ERCP
Which test can only image ducts in GI
ERCP
Hepatitis A and E are
Enteric Viruses
Hepatitis B, C and D are
Parenteral viruses
Hepatitis A and E are
self limiting acute
Hepatitis B, C and D
chronic disease
Hep A Transmission
Fecal Oral
Sexual
Blood
When there is surface antigen in Hepatitis what does this mean
Presence of Virus
The there is core antigen what does this mean
Active replication not detected in blood
IgM in Hepatitis means
Acute Infection
IgG in Hepatitis means
Chronic infection/exposure
Hepatitis E is commonest cause of
acute Hepatitis
If Albumin is below 34 what does this mean in NAFLD
High Risk
Autoimmune Hepatitis associated with elevated what
IgG
Primary Biliary Cholangitis Features
IgM elevated
Anti-mitochondrial antibody positive
Intrahepatic bile duct involved
Primar Sclerosing Cholangitis features
Male
PANCA Pos
Intra and Extrahepatic
What is the Meld Score made up of in cirrhosis
Bilirubin
Creatinine
INR
What is the UKELD Score made up of in cirrhosis
Bilirubin
Sodium
Creatinine
INR
Scoring System for Cirrhosis
Meld
UKELD
Child Pugh
Cirrhosis Causes
Alcohol
Autoimmune – autoimmmune hepatitis, PBC (Primary Biliary cholangitis), PSC (Primary Sclerosing Cholangitis)
Haemochromatosis
Chronic Viral hepatitis: B & C
Non-alcoholic fatty liver disease (NAFLD)
Drugs (MTX, amiodarone)
Cystic fibrosis, a1antitryptin deficiency, Wilsons disease,
Vascular problems (Portal hypertension + liver disease)
Cryptogenic
Others: sarcoidosis, amyloid, schistosomiasis
How does Cirrhosis present
Chronic Liver Disease
Hepatocellular Carcinoma
How does Decompensated Chronic Liver Disease present
Ascites
Hepatorenal Syndrome
Variceal Syndrome
Hepatic Encephalopathy
What happens to kidneys in ascites
Renal Vasoconstriction
Ascitic Fluid Analysis
Cell count
Protein
Albumin
Hepatorenal Syndrome pathogenesis
volume expansion with albumin
What does Varices occur
Portal Hypertension
what is hepatic encephalopathy
confusion due to liver disease
how does hepatic encephalopathy present
Flap Astrexis
Foetor Hepaticus
Commonest cause of liver cancer
Hepatocellular Carcinoma
Hepatocellular Carcinoma associated with which hepatitis
b and c chronic
Second largest cause of death worldwide
Colorectal Cancer
Most common Colorectal cancer
Adenocarcinoma
What can increase risk of Colorectal Cancer
Diabetes
Colorectal Adenoma Polyps Features
Benign
Epithelial
Tubular More Common
High Risk
Which oncogene activated in colorectal cancer
Krs and c-myc
which tumour suppression genes lost in colorectal cancer
APC, p53, DDC
Which stage of Dukes Stage for Colorectal Cancer best
Stage D
What age colorectal cancer screen
50-74
FAP in Colorectal cancer is what type of condition
Autosomal DOminant
How to screen for FAP in colorectal cancer
annual colonoscopy
how to prophylactic for FAP in colorectal cancer
Proctocolecotmy
MAP in colorectal cancer is
Autosomal Recessive
Adenocarcinomas most common in GI
Distal Oesophagus
Squamous Cell Carcinoma most common in GI
Prox and mid Third Oesophagus
Smoking
Alcohol
Adenocarcinomas causes in GI
Obesity
Gord
When does Jaundice manifest clinically
Serum Bilirubin >3mg
Unconjugated Bilirubin is produced from
Catabolism of Haemoglobin
What happens to Unconjugated Bilirubin
Water insoluble Bound to albumin in blood Not excreted by kidney into urine Unconjugated in Liver Secreted in Small Bowel
What is unconjugated Bilirubin taken up by where it is conjugated
Hepatocytes
What happens to Conjugated bilirubin
Excreted into Bile
Passes into Bowel
Metabolised by Intestine to Stercolin = Brown Poo
What does Haemyloysis lead to
Increased Unconjugated Bilirubin in Blood
Reduction in Conjugated Bilirubin leads to
Pale Stools
When there is blockage what happens to Bilirubin
Conjugated Bilirubin excreted by Urine producing dark urine instead of normal brown poo
What can cause hepatocellular jaundice
Viral Hepatitis
Calcular Obstructive Jaundice is more common in
Females
What does Charot’s Triad consist of
RUQ Pain
Fever
Jaundice
In ascending cholangitis is there is a positive courvoiser sign
no
In the presence of palpable bladder what is true about jaundice
Jaundice unlikely to be caused by gallstones
Palpable bladder can lead to
Malignant Obstructive
Why can patients with obstructive jaundice have increased INR
Lack of Vit K absorption from gut
Vitamin K is what type of vitamin and dependent on what
Fat Soluble
Absorption from Gut
Why is there vitamin K deficiency in obstructive jaundice
lack of vitamin k absorption due to lack of bile
What is the first radiological examination performed in patients with abnormal liver functions suggestive of obstructive jaundice
ultrasound
What could MRCP detect
Biliary Stones Tumours Liver Mets Dilated Biliary Tree Biliary Stones
What could ERCP detect
Stones
Dilated Biliary Tree
Complications of ERCP
Cholanigits
Pancreatitis
Bleed
Perforation
