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June Exam Revision > GI > Flashcards

GI Flashcards

1
Q

Where does the Oesophagus Begin?

A

C6

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2
Q

Where does Oesophagus Terminate

A

T11-T12

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3
Q

Oesophagus is a mixture of which two muscle

A

Striated and Smooth

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4
Q

Oesophagus Epithelium

A

Stratified Squamous

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5
Q

Contraction in Oesophagus and Relaxation mediated via

A

Vagus Nerve

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6
Q

Lower Oesophageal Sphincter s made up of

A

Striated Muscles

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7
Q

What has corkscrew appearance on Barium swallow

A

Hypermotility

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8
Q

Hypomotility in Oesophageal causes failure of

A

LOS Mechanism

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9
Q

What is Achalasia

A

Functional loss of Myenteric Plexus

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10
Q

Cardiac Feature of Achalasia

A

Failure of LOS to relax

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11
Q

Hypomotility of oesophageal associated with

A

Connective Tissue Disease
Diabetes
Neuropathy

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12
Q

Barret’s Oesophagus is precursor to

A

Dysplasia/Adenocarcinoma

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13
Q

Oesophageal Cancer what type of cancers common

A

Squamous Cell or Adenocarcinoma

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14
Q

Squamous Cell Carcinoma in Oesophageal Cancer often occurs in

A

Prox and mid third of oesophagus

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15
Q

Adenocarcinoma in Oesophageal Cancer often occurs in

A

Distal Oesophagus

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16
Q

Which type of oesophageal cancer associated with Barret’s Oesophagus

A

Adenocarcinoma

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17
Q

What is Eosinophilic Oesophagitis

A

Chronic Immune/Allergen Mediated

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18
Q

Eosinophilic Oesophagitis is classified by how many eosinophils per high power microscopy

A

> 15

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19
Q

Where are pain receptors for somatic and referred pain in GI

A

parietal peritoneum or abdo wall

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20
Q

An Upper GI Bleed comes from which three locations

A

Oesophagus
Stomach
Duodenum

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21
Q

An upper GI bleed is proximal to

A

Ligament of Trietz

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22
Q

A lower GI bleed comes from

A

distal to duodenum

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23
Q

A lower GI bleed is distal to ligament of

A

trite

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24
Q

Signs of Upper GI Bleed

A

Haematemesis
Elevated Urea
Melena

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25
Q

Most common cause of Upper GI bleed

A

Peptic Ulcer

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26
Q

Risk factors for peptic ulcer

A

H pylori

Nsaids/Aspirin

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27
Q

What type of peptic ulcer most common

A

duodenal than gastric

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28
Q

Gastric ulcers may sit over a

A

gastric carcinoma

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29
Q

What is Zollinger Ellison syndrome

A

gastrin secreting pancreatic tumour

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30
Q

what does Zollinger Ellison syndrome cause

A

recurrent poor healing duodenal ulcers

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31
Q

Varices in GI are secondary to

A

Portal Hypertension

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32
Q

Varices are most common in GI where

A

Oesophagus

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33
Q

A mallory weiss tear occurs where

A

OG Junction

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34
Q

Lower GI bleed signs

A

Fresh Blood/Clots
Magenta Stools
Normal Urea
painless

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35
Q

Lower GI bleeding accounts for 25% of

A

Acute GI bleed

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36
Q

Colitis mucosa looks like what in Ischaemic Colitis

A

Dusky Blue

Swollen

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37
Q

Radiation Procitis occurs in previous history of radiotherapy for

A

Cervical or Prostate Cancer

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38
Q

When to blood transfuse in Management of GI bleed

A

hb <7g/dl or ongoing active bleed

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39
Q

What does shock lead to

A

Global Hypoperfusion and Tissue Hypoxia

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40
Q

Risk Stratification Score for Shock

A

Rockall or Blatchford

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41
Q

Low risk criteria for blatchford shock score - Urea

A

Urea <6.5

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42
Q

What does Terlipressin do in GI Bleed Varices Management

A

Vasoconstricts Splanchic Blood Supply

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43
Q

If bleeding keeps going in GI Bleed Varices management

A

Sengstaken Blakemore Tube

TIPSS

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44
Q

What is Steatosis

A

Fatty Liver

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45
Q

Which cell infiltrates in Steatohepatitis

A

Neutrophil Infiltration

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46
Q

Signs of Chronic Liver Disease

A 
Spider Naevi
Palmar Erythema
Gynaecomastia
Loss of Axillary and Pubic Hair
Ascites
Encephalopathy
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47
Q

what is thrombocytopenia

A

low platelets

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48
Q

what is hepatic encephalopathy

A

Liver failure

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49
Q

In spontaneous bacterial peritonitis what does neutrophil count come back as

A

> 0.25 x 10.9

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50
Q

In spontaneous bacterial peritonitis what does protein count come back as

A

<25g

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51
Q

How does decompensated hepatic function present

A

low albumin

raised INR

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52
Q

what things does Glasgow alcoholic hepatitis score consider

A 
Age
WCC
Urea
INR 
Bilirubin
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53
Q

Steatohepatitis can turn into

A

Cirrhosis

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54
Q

what is steatosis

A

fatty liver non alcoholic fatty liver

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55
Q

what is steatohepatitis

A

non alcohol steatohepatitis

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56
Q

fatty liver who does it affect in particular

A

obese
diabetes
hypercholesterolaemia
alcohol

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57
Q

How does steatohepatitis present

A

Asymptomatic

Fatty Liver on USS

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58
Q

Risk Factors of Perianal Abscess

A

Diabetes
BMI
Immunosuppression
Trauma

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59
Q

What is Fistula in Ano

A

Peri Anal Sepsis

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60
Q

Anal and Rectal Cancer how to test

A

Fit Test

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61
Q

Chronic Constipation causes in order of commonest to least

A

Diet
Evacuation Related
Slow Transit

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62
Q

Passive Faecal incontinence associated with

A

Internal Sphincter Defect

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63
Q

Overflow Faecal Incontinence associated with

A

Constipation

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64
Q

Name three congenital ano-rectal abnormalities

A

Imperforate Anus
Uro-Genital Fistulae
Hirschprung Myenteric Plexus Deficiency

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65
Q

Most common colo rectal cancer site

A

Left Colon

66
Q

Colorectal Cancer Dukes Stage A Percentage and Where best

A

> 90% Submucosa

67
Q

which drug can cause anal ulcers

A

nicorandil

68
Q

Which protein does Liver synthesis

A

Albumin

69
Q

Which lipid does liver synthesise

A

cholesterol
lipoprotein
TG Synthesis

70
Q

Liver procedures urea from

A

ammonia

71
Q

what is metabolised in liver

A

Bilirubin

72
Q

Which organ stores glycogen

A

Liver

73
Q

Which vitamins does liver store

A

Vitamin A, D, B12 and K

74
Q

Bilirubin is bound to what when unconjugated

A

Albumin

75
Q

which organ conjugates bilirubin

A

liver

76
Q

Aminotransferases are present in

A

Hepatocytes

77
Q

Aminotransferases suggests what involvement

A

parenchymal involvement

78
Q

Alkaline Phosphatase present in

A

Bile duct

79
Q

Alkaline Phosphatase is elevated with

A

Obstruction or liver Infiltration

80
Q

which liver enzyme is also present in bone

A

alkaline phosphatase

81
Q

Gamma GT is elevated with

A

alcohol use

82
Q

what is an important test for synthetic function of liver

A

Albumin

83
Q

Low levels of what suggests chronic liver disease

A

Albumin

84
Q

What is an extremely important test for Liver Function

A

Prothrombin Time

85
Q

Which test used to calculate liver transplant

A

prothrombin time

86
Q

liver is an important source of

A

thrombopoeitin

87
Q

Cirrhosis results in

A

Splenomegaly

88
Q

Platelet count is an indirect marker of

A

portal hypertension

89
Q

Jaundice is caused by

A

excess circulating bilirubin

90
Q

when is jaundice detectable

A

when total plasma bilirubin exceed 34

91
Q

Pre Hepatic Jaundice is said to be

A

Unconjugated

92
Q

What happens in Hepatic causes of Jaundice

A

Defective uptake of Bilirubin, Defective Conjugation, Defective Excretion

93
Q

What does haemolysis do to bilirubin

A

increased quantity of bilirubin

94
Q

How does Cholestasis present

A

Pruritius
Pale Stool
High Coloured Urine

95
Q

What is Courvoiser Sign

A

Palpable Gall Bladder

96
Q

Most important test for Jaundice

A

Ultrasound

97
Q

Which out of MRCP and ERCP has radiation

A

ERCP

98
Q

Which test can only image ducts in GI

A

ERCP

99
Q

Hepatitis A and E are

A

Enteric Viruses

100
Q

Hepatitis B, C and D are

A

Parenteral viruses

101
Q

Hepatitis A and E are

A

self limiting acute

102
Q

Hepatitis B, C and D

A

chronic disease

103
Q

Hep A Transmission

A

Fecal Oral
Sexual
Blood

104
Q

When there is surface antigen in Hepatitis what does this mean

A

Presence of Virus

105
Q

The there is core antigen what does this mean

A

Active replication not detected in blood

106
Q

IgM in Hepatitis means

A

Acute Infection

107
Q

IgG in Hepatitis means

A

Chronic infection/exposure

108
Q

Hepatitis E is commonest cause of

A

acute Hepatitis

109
Q

If Albumin is below 34 what does this mean in NAFLD

A

High Risk

110
Q

Autoimmune Hepatitis associated with elevated what

A

IgG

111
Q

Primary Biliary Cholangitis Features

A

IgM elevated
Anti-mitochondrial antibody positive
Intrahepatic bile duct involved

112
Q

Primar Sclerosing Cholangitis features

A

Male
PANCA Pos
Intra and Extrahepatic

113
Q

What is the Meld Score made up of in cirrhosis

A

Bilirubin
Creatinine
INR

114
Q

What is the UKELD Score made up of in cirrhosis

A

Bilirubin
Sodium
Creatinine
INR

115
Q

Scoring System for Cirrhosis

A

Meld
UKELD
Child Pugh

116
Q

Cirrhosis Causes

A

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

117
Q

How does Cirrhosis present

A

Chronic Liver Disease

Hepatocellular Carcinoma

118
Q

How does Decompensated Chronic Liver Disease present

A

Ascites
Hepatorenal Syndrome
Variceal Syndrome
Hepatic Encephalopathy

119
Q

What happens to kidneys in ascites

A

Renal Vasoconstriction

120
Q

Ascitic Fluid Analysis

A

Cell count
Protein
Albumin

121
Q

Hepatorenal Syndrome pathogenesis

A

volume expansion with albumin

122
Q

What does Varices occur

A

Portal Hypertension

123
Q

what is hepatic encephalopathy

A

confusion due to liver disease

124
Q

how does hepatic encephalopathy present

A

Flap Astrexis

Foetor Hepaticus

125
Q

Commonest cause of liver cancer

A

Hepatocellular Carcinoma

126
Q

Hepatocellular Carcinoma associated with which hepatitis

A

b and c chronic

127
Q

Second largest cause of death worldwide

A

Colorectal Cancer

128
Q

Most common Colorectal cancer

A

Adenocarcinoma

129
Q

What can increase risk of Colorectal Cancer

A

Diabetes

130
Q

Colorectal Adenoma Polyps Features

A

Benign
Epithelial
Tubular More Common
High Risk

131
Q

Which oncogene activated in colorectal cancer

A

Krs and c-myc

132
Q

which tumour suppression genes lost in colorectal cancer

A

APC, p53, DDC

133
Q

Which stage of Dukes Stage for Colorectal Cancer best

A

Stage D

134
Q

What age colorectal cancer screen

A

50-74

135
Q

FAP in Colorectal cancer is what type of condition

A

Autosomal DOminant

136
Q

How to screen for FAP in colorectal cancer

A

annual colonoscopy

137
Q

how to prophylactic for FAP in colorectal cancer

A

Proctocolecotmy

138
Q

MAP in colorectal cancer is

A

Autosomal Recessive

139
Q

Adenocarcinomas most common in GI

A

Distal Oesophagus

140
Q

Squamous Cell Carcinoma most common in GI

A

Prox and mid Third Oesophagus
Smoking
Alcohol

141
Q

Adenocarcinomas causes in GI

A

Obesity

Gord

142
Q

When does Jaundice manifest clinically

A

Serum Bilirubin >3mg

143
Q

Unconjugated Bilirubin is produced from

A

Catabolism of Haemoglobin

144
Q

What happens to Unconjugated Bilirubin

A 
Water insoluble
Bound to albumin in blood
Not excreted by kidney into urine
Unconjugated in Liver
Secreted in Small Bowel
145
Q

What is unconjugated Bilirubin taken up by where it is conjugated

A

Hepatocytes

146
Q

What happens to Conjugated bilirubin

A

Excreted into Bile
Passes into Bowel
Metabolised by Intestine to Stercolin = Brown Poo

147
Q

What does Haemyloysis lead to

A

Increased Unconjugated Bilirubin in Blood

148
Q

Reduction in Conjugated Bilirubin leads to

A

Pale Stools

149
Q

When there is blockage what happens to Bilirubin

A

Conjugated Bilirubin excreted by Urine producing dark urine instead of normal brown poo

150
Q

What can cause hepatocellular jaundice

A

Viral Hepatitis

151
Q

Calcular Obstructive Jaundice is more common in

A

Females

152
Q

What does Charot’s Triad consist of

A

RUQ Pain
Fever
Jaundice

153
Q

In ascending cholangitis is there is a positive courvoiser sign

A

no

154
Q

In the presence of palpable bladder what is true about jaundice

A

Jaundice unlikely to be caused by gallstones

155
Q

Palpable bladder can lead to

A

Malignant Obstructive

156
Q

Why can patients with obstructive jaundice have increased INR

A

Lack of Vit K absorption from gut

157
Q

Vitamin K is what type of vitamin and dependent on what

A

Fat Soluble

Absorption from Gut

158
Q

Why is there vitamin K deficiency in obstructive jaundice

A

lack of vitamin k absorption due to lack of bile

159
Q

What is the first radiological examination performed in patients with abnormal liver functions suggestive of obstructive jaundice

A

ultrasound

160
Q

What could MRCP detect

A 
Biliary Stones
Tumours
Liver Mets
Dilated Biliary Tree
Biliary Stones
161
Q

What could ERCP detect

A

Stones

Dilated Biliary Tree

162
Q

Complications of ERCP

A

Cholanigits
Pancreatitis
Bleed
Perforation

June Exam Revision (2 decks)

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