GI Flashcards
1
Q
Where does the Oesophagus Begin?
A
C6
2
Q
Where does Oesophagus Terminate
A
T11-T12
3
Q
Oesophagus is a mixture of which two muscle
A
Striated and Smooth
4
Q
Oesophagus Epithelium
A
Stratified Squamous
5
Q
Contraction in Oesophagus and Relaxation mediated via
A
Vagus Nerve
6
Q
Lower Oesophageal Sphincter s made up of
A
Striated Muscles
7
Q
What has corkscrew appearance on Barium swallow
A
Hypermotility
8
Q
Hypomotility in Oesophageal causes failure of
A
LOS Mechanism
9
Q
What is Achalasia
A
Functional loss of Myenteric Plexus
10
Q
Cardiac Feature of Achalasia
A
Failure of LOS to relax
11
Q
Hypomotility of oesophageal associated with
A
Connective Tissue Disease
Diabetes
Neuropathy
12
Q
Barret’s Oesophagus is precursor to
A
Dysplasia/Adenocarcinoma
13
Q
Oesophageal Cancer what type of cancers common
A
Squamous Cell or Adenocarcinoma
14
Q
Squamous Cell Carcinoma in Oesophageal Cancer often occurs in
A
Prox and mid third of oesophagus
15
Q
Adenocarcinoma in Oesophageal Cancer often occurs in
A
Distal Oesophagus
16
Q
Which type of oesophageal cancer associated with Barret’s Oesophagus
A
Adenocarcinoma
17
Q
What is Eosinophilic Oesophagitis
A
Chronic Immune/Allergen Mediated
18
Q
Eosinophilic Oesophagitis is classified by how many eosinophils per high power microscopy
A
> 15
19
Q
Where are pain receptors for somatic and referred pain in GI
A
parietal peritoneum or abdo wall
20
Q
An Upper GI Bleed comes from which three locations
A
Oesophagus
Stomach
Duodenum
21
Q
An upper GI bleed is proximal to
A
Ligament of Trietz
22
Q
A lower GI bleed comes from
A
distal to duodenum
23
Q
A lower GI bleed is distal to ligament of
A
trite
24
Q
Signs of Upper GI Bleed
A
Haematemesis
Elevated Urea
Melena
25
Most common cause of Upper GI bleed
Peptic Ulcer
26
Risk factors for peptic ulcer
H pylori
| Nsaids/Aspirin
27
What type of peptic ulcer most common
duodenal than gastric
28
Gastric ulcers may sit over a
gastric carcinoma
29
What is Zollinger Ellison syndrome
gastrin secreting pancreatic tumour
30
what does Zollinger Ellison syndrome cause
recurrent poor healing duodenal ulcers
31
Varices in GI are secondary to
Portal Hypertension
32
Varices are most common in GI where
Oesophagus
33
A mallory weiss tear occurs where
OG Junction
34
Lower GI bleed signs
Fresh Blood/Clots
Magenta Stools
Normal Urea
painless
35
Lower GI bleeding accounts for 25% of
Acute GI bleed
36
Colitis mucosa looks like what in Ischaemic Colitis
Dusky Blue
| Swollen
37
Radiation Procitis occurs in previous history of radiotherapy for
Cervical or Prostate Cancer
38
When to blood transfuse in Management of GI bleed
hb <7g/dl or ongoing active bleed
39
What does shock lead to
Global Hypoperfusion and Tissue Hypoxia
40
Risk Stratification Score for Shock
Rockall or Blatchford
41
Low risk criteria for blatchford shock score - Urea
Urea <6.5
42
What does Terlipressin do in GI Bleed Varices Management
Vasoconstricts Splanchic Blood Supply
43
If bleeding keeps going in GI Bleed Varices management
Sengstaken Blakemore Tube
| TIPSS
44
What is Steatosis
Fatty Liver
45
Which cell infiltrates in Steatohepatitis
Neutrophil Infiltration
46
Signs of Chronic Liver Disease
```
Spider Naevi
Palmar Erythema
Gynaecomastia
Loss of Axillary and Pubic Hair
Ascites
Encephalopathy
```
47
what is thrombocytopenia
low platelets
48
what is hepatic encephalopathy
Liver failure
49
In spontaneous bacterial peritonitis what does neutrophil count come back as
>0.25 x 10.9
50
In spontaneous bacterial peritonitis what does protein count come back as
<25g
51
How does decompensated hepatic function present
low albumin
| raised INR
52
what things does Glasgow alcoholic hepatitis score consider
```
Age
WCC
Urea
INR
Bilirubin
```
53
Steatohepatitis can turn into
Cirrhosis
54
what is steatosis
fatty liver non alcoholic fatty liver
55
what is steatohepatitis
non alcohol steatohepatitis
56
fatty liver who does it affect in particular
obese
diabetes
hypercholesterolaemia
alcohol
57
How does steatohepatitis present
Asymptomatic
| Fatty Liver on USS
58
Risk Factors of Perianal Abscess
Diabetes
BMI
Immunosuppression
Trauma
59
What is Fistula in Ano
Peri Anal Sepsis
60
Anal and Rectal Cancer how to test
Fit Test
61
Chronic Constipation causes in order of commonest to least
Diet
Evacuation Related
Slow Transit
62
Passive Faecal incontinence associated with
Internal Sphincter Defect
63
Overflow Faecal Incontinence associated with
Constipation
64
Name three congenital ano-rectal abnormalities
Imperforate Anus
Uro-Genital Fistulae
Hirschprung Myenteric Plexus Deficiency
65
Most common colo rectal cancer site
Left Colon
66
Colorectal Cancer Dukes Stage A Percentage and Where best
>90% Submucosa
67
which drug can cause anal ulcers
nicorandil
68
Which protein does Liver synthesis
Albumin
69
Which lipid does liver synthesise
cholesterol
lipoprotein
TG Synthesis
70
Liver procedures urea from
ammonia
71
what is metabolised in liver
Bilirubin
72
Which organ stores glycogen
Liver
73
Which vitamins does liver store
Vitamin A, D, B12 and K
74
Bilirubin is bound to what when unconjugated
Albumin
75
which organ conjugates bilirubin
liver
76
Aminotransferases are present in
Hepatocytes
77
Aminotransferases suggests what involvement
parenchymal involvement
78
Alkaline Phosphatase present in
Bile duct
79
Alkaline Phosphatase is elevated with
Obstruction or liver Infiltration
80
which liver enzyme is also present in bone
alkaline phosphatase
81
Gamma GT is elevated with
alcohol use
82
what is an important test for synthetic function of liver
Albumin
83
Low levels of what suggests chronic liver disease
Albumin
84
What is an extremely important test for Liver Function
Prothrombin Time
85
Which test used to calculate liver transplant
prothrombin time
86
liver is an important source of
thrombopoeitin
87
Cirrhosis results in
Splenomegaly
88
Platelet count is an indirect marker of
portal hypertension
89
Jaundice is caused by
excess circulating bilirubin
90
when is jaundice detectable
when total plasma bilirubin exceed 34
91
Pre Hepatic Jaundice is said to be
Unconjugated
92
What happens in Hepatic causes of Jaundice
Defective uptake of Bilirubin, Defective Conjugation, Defective Excretion
93
What does haemolysis do to bilirubin
increased quantity of bilirubin
94
How does Cholestasis present
Pruritius
Pale Stool
High Coloured Urine
95
What is Courvoiser Sign
Palpable Gall Bladder
96
Most important test for Jaundice
Ultrasound
97
Which out of MRCP and ERCP has radiation
ERCP
98
Which test can only image ducts in GI
ERCP
99
Hepatitis A and E are
Enteric Viruses
100
Hepatitis B, C and D are
Parenteral viruses
101
Hepatitis A and E are
self limiting acute
102
Hepatitis B, C and D
chronic disease
103
Hep A Transmission
Fecal Oral
Sexual
Blood
104
When there is surface antigen in Hepatitis what does this mean
Presence of Virus
105
The there is core antigen what does this mean
Active replication not detected in blood
106
IgM in Hepatitis means
Acute Infection
107
IgG in Hepatitis means
Chronic infection/exposure
108
Hepatitis E is commonest cause of
acute Hepatitis
109
If Albumin is below 34 what does this mean in NAFLD
High Risk
110
Autoimmune Hepatitis associated with elevated what
IgG
111
Primary Biliary Cholangitis Features
IgM elevated
Anti-mitochondrial antibody positive
Intrahepatic bile duct involved
112
Primar Sclerosing Cholangitis features
Male
PANCA Pos
Intra and Extrahepatic
113
What is the Meld Score made up of in cirrhosis
Bilirubin
Creatinine
INR
114
What is the UKELD Score made up of in cirrhosis
Bilirubin
Sodium
Creatinine
INR
115
Scoring System for Cirrhosis
Meld
UKELD
Child Pugh
116
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
117
How does Cirrhosis present
Chronic Liver Disease
| Hepatocellular Carcinoma
118
How does Decompensated Chronic Liver Disease present
Ascites
Hepatorenal Syndrome
Variceal Syndrome
Hepatic Encephalopathy
119
What happens to kidneys in ascites
Renal Vasoconstriction
120
Ascitic Fluid Analysis
Cell count
Protein
Albumin
121
Hepatorenal Syndrome pathogenesis
volume expansion with albumin
122
What does Varices occur
Portal Hypertension
123
what is hepatic encephalopathy
confusion due to liver disease
124
how does hepatic encephalopathy present
Flap Astrexis
| Foetor Hepaticus
125
Commonest cause of liver cancer
Hepatocellular Carcinoma
126
Hepatocellular Carcinoma associated with which hepatitis
b and c chronic
127
Second largest cause of death worldwide
Colorectal Cancer
128
Most common Colorectal cancer
Adenocarcinoma
129
What can increase risk of Colorectal Cancer
Diabetes
130
Colorectal Adenoma Polyps Features
Benign
Epithelial
Tubular More Common
High Risk
131
Which oncogene activated in colorectal cancer
Krs and c-myc
132
which tumour suppression genes lost in colorectal cancer
APC, p53, DDC
133
Which stage of Dukes Stage for Colorectal Cancer best
Stage D
134
What age colorectal cancer screen
50-74
135
FAP in Colorectal cancer is what type of condition
Autosomal DOminant
136
How to screen for FAP in colorectal cancer
annual colonoscopy
137
how to prophylactic for FAP in colorectal cancer
Proctocolecotmy
138
MAP in colorectal cancer is
Autosomal Recessive
139
Adenocarcinomas most common in GI
Distal Oesophagus
140
Squamous Cell Carcinoma most common in GI
Prox and mid Third Oesophagus
Smoking
Alcohol
141
Adenocarcinomas causes in GI
Obesity
| Gord
142
When does Jaundice manifest clinically
Serum Bilirubin >3mg
143
Unconjugated Bilirubin is produced from
Catabolism of Haemoglobin
144
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
```
145
What is unconjugated Bilirubin taken up by where it is conjugated
Hepatocytes
146
What happens to Conjugated bilirubin
Excreted into Bile
Passes into Bowel
Metabolised by Intestine to Stercolin = Brown Poo
147
What does Haemyloysis lead to
Increased Unconjugated Bilirubin in Blood
148
Reduction in Conjugated Bilirubin leads to
Pale Stools
149
When there is blockage what happens to Bilirubin
Conjugated Bilirubin excreted by Urine producing dark urine instead of normal brown poo
150
What can cause hepatocellular jaundice
Viral Hepatitis
151
Calcular Obstructive Jaundice is more common in
Females
152
What does Charot's Triad consist of
RUQ Pain
Fever
Jaundice
153
In ascending cholangitis is there is a positive courvoiser sign
no
154
In the presence of palpable bladder what is true about jaundice
Jaundice unlikely to be caused by gallstones
155
Palpable bladder can lead to
Malignant Obstructive
156
Why can patients with obstructive jaundice have increased INR
Lack of Vit K absorption from gut
157
Vitamin K is what type of vitamin and dependent on what
Fat Soluble
Absorption from Gut
158
Why is there vitamin K deficiency in obstructive jaundice
lack of vitamin k absorption due to lack of bile
159
What is the first radiological examination performed in patients with abnormal liver functions suggestive of obstructive jaundice
ultrasound
160
What could MRCP detect
```
Biliary Stones
Tumours
Liver Mets
Dilated Biliary Tree
Biliary Stones
```
161
What could ERCP detect
Stones
| Dilated Biliary Tree
162
Complications of ERCP
Cholanigits
Pancreatitis
Bleed
Perforation
