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Finals Revision - Last Min > GI > Flashcards

GI Flashcards

1
Q

Wilson’s Ix?

A

Low caeruloplasmin
Low total serum copper
Increased free copper

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2
Q

Epigastric pain, non-bilious vomiting, inability to pass NG tube?

A

Gastric volvolus

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3
Q

Link between Crohn’s and Gall Stones?

A

Crohn’s commonly causes inflammation in terminal ileum, where bile salts are reabsorbed

Less bile salts being reabsorbed causes pigment gall stones

(Crohn’s = Stones; UC = PSC)

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4
Q

Richter hernia?

A

Hernia where only one side of the bowel wall herniates through - can strangulate without causing obstruction

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5
Q

Budd-Chiari triad?
Risk factors?
Ix?

A

Triad:

  • sudden onset, severe abdo pain
  • ascites (high saag - transudate)
  • tender hepatomegaly

COCP, polycythaemia, pregnancy, thrombiphilia

USS with doppler

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6
Q

Foul smelling, greasy stools in an alcoholic?

1st line Ix?

A

Chronic pancreatitis

CT pancreas - look for calcifications

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7
Q

Approach to treating dyspepsia with no red flags and no meds/food?

A

Full dose PPI for 1 month
If response then low dose treatment PRN

If no recovery - take 2 weeks off then test for H Pylori using urea breath test or stool antigen

If negative then double dose PPI may be trialled for 1 month

Then can try other drugs like Ranitidine (H2 antagonist) or Metoclopramide (pro-kinetic)

No need to test for cure but if done then urea breath test

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8
Q

Dyspepsia:

  • what warrants urgent referral?
  • non-urgent?
A

URGENT:
Dysphagia + dyspepsia
Palpable abdo mass

> 55 with weight loss AND dyspepsia, reflux or upper abdomen pain

NON-URGENT:
Haematemesis
Treatment resistant dyspepsia
Upper abdo pain + low Hb

Raised platelet count or nausea and vom with weight loss/reflux/pain

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9
Q

Dysphagia:

  • weight loss, vomiting with eating, GORD?
  • Heartburn, odynophagia, no systemic?
  • HIV or steroid inhalers?
  • solids+liquids, heartburn, regurgitate food, aspiration pneumonia?
  • older man, midline lump in neck, regurgitates food, aspiration pneumonia, bad breath?
  • Raynaud’s, talengiectasia, stiff fingers, difficulty breathing?
  • Ptosis, muscle weakness at end of day, difficulty swallowing solids+liquids?
  • anxiety, intermittent symptoms, painless?
A

Cancer

Oesophagitis

Oesophageal candidiasis

Achalasia

Pharyngeal pouch

Systemic sclerosis

Myasthenia gravis

Globus hystericus

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10
Q 
Symptoms of carcinoid syndrome?
What does the tumour secrete?
Ix?
Rx?
Where are they commonly found?
A

Flushing
Diarrhoea
Bronchospasm
Hypotension

Can release ACTH - cushingoid symptoms and hypokalaemia

Can release GHRH - acromegaly

Secretes serotonin into bloodstream - can develop pellagra as dietary tryptophan is diverted to make serotonin by tumour (common precursor with Niacin)

Ix: urinary 5-HIAA
Plasma chromogranin A

Management: Octreotide
Cryoheptadine may help diarrhoea

Liver and lung

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11
Q

When fever, constant RUQ pain, raised inflammatory markers, what points towards cholangitis rather than cholecystitis?

A

Jaundice or raised bili

Absence of Murphy’s sign

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12
Q

Management peptic ulcer?

Drugs that can cause ulcer?

A

Test for H pylori
If neg, PPI until healed

NSAIDs
SSRIs
Corticosteroids
Bisphosphonates

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13
Q

Why can TPN result in deranged LFT’s?

A

Cholestasis as nothing passing though bowel - causes slight raise in bili, AST and moderately raised ALP, gGT

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14
Q

What gastroenteritis pathogens have an incubation of:

  • 1-6 hrs?
  • 12-48 hrs?
  • 48-72 hrs?
  • > 7 days?
A

1-6: Staph Aureus, Bacillus Cereus

12-48: Salmonella, E Coli

48-72: Shigella, Campylobacter

> 7 days: Giardiasis, Amoebiasis

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15
Q

Shigella pattern and what Gram stain?

A

Gm -ve bacilli

Occurs in outbreaks, especially in schools and nurseries - abdominal pain, bloody diarrhoea, vomiting

Never invades further than gut wall - pus and blood in stools

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16
Q

Cryptosporidium - what is it, gastroenteritis pattern, test, treatment?

A

Protozoal infection (commonest protozoal infection in UK)

Cysts are ingested from animal sources or contaminated water or swimming pools (resistant to chlorine)

Diarrhoea - esp severe in HIV

Red spores seen on Ziehl-Neelson stain of stool

Symptomatic

17
Q

Giardiasis - what is it, gastroenteritis pattern, test, treatment?

A

Single parasite - protozoa

Often asymptomatic
Abdo pain, flatulence, non-bloody CHRONIC diarrhoea, malabsorption and lactose intolerance can occur. Also resistant to chlorine so can get in pools.

(returned from holiday 3 weeks ago, has been opening bowels 5 times a day, crampy, bloating - stools float and are greasy (fat malabsorption))

  • Stool microscopy for trophozoite and cysts usually negative
  • duodenal fluid aspirate or ‘string tests’ sometimes needed

Metronidazole

18
Q

Amoebiasis - what is it, gastroenteritis pattern, liver pattern, tests, treatments?

A

Protozoal infection - estimated 10% of world chronically infected. Can cause severe dysentry or colonic/liver abscesses

Dysentry:

  • profuse, bloody diarrhoea,
  • Stool may show trophozoites if examined within 15 mins (hot stool)
  • Rx - metronidazole

Liver abscess:

  • Single mass in right lobe usually (may be multiple). ‘anchovy sauce’
  • Fever, RUQ pain
  • Serology +ve 90%

Cystic stage: luminal amoebicide
Invasive stage: metronidazole and tinidazole

19
Q

4 main causes of liver cirrhosis?
Diagnosis?
Monitoring?

A
  • Alcohol, Hep B, Hep C, NAFLD
  • Transient elastography (Fibroscan) 1st line, biopsy if not

Monitoring:

  • OGD to check for varices on diagnosis
  • Liver USS every 6 months + AFP to check for hepatocellular carcinoma
20
Q

RF for SIBO?
Features?
Ix?
Rx?

A
  • Neonates with GI problems
  • Scleroderma (dysmotility)
  • Diabetes (gastroparesis)

Similar to IBS - chronic diarrhoea, flatulence, bloating, abdo pain

H breath test

Rifaximin

21
Q

Management of thromboses haemorrhoid?

A

If <72 hrs - refer for excision

If >72 hrs - stool softeners, analgesia, ice packs
Symptoms normally settle in 10 days

22
Q

Levels of AA branches:

  • Coeliac?
  • SMA?
  • Renal?
  • Gonadal?
  • IMA?
  • Bifurcation?
A

Coeliac - T12

SMA - L1

Renal - L1/L2 (leave laterally - right renal artery goes behind IVC)

Gonadal - L2 - leave laterally

IMA - L3

Bifurcation to common iliacs - L4

23
Q

Spectrum of alcoholic liver disease?

A
  • alcoholic fatty liver disease
  • alcoholic hepatitis
  • cirrhosis

Ix:

  • gGT elevated
  • AST:ALT ratio >2, if >3 suggestive of alcoholic hepatitis

Rx:

  • prednisone in acute alcoholic hepatitis
  • pentoxyphylline also used sometimes
24
Q

MUST score?

A

Step 1:

  • BMI <20 = 0
  • 18.5-20 = 1
  • <18.5 = 2
Step 2:
unplanned weight loss in 3-6 months
<5% = 0
5-10% = 1
>10% = 2

Step 3:
if patient is acutely ill and there has been/is likely to be no nutritional intake for >5 days = 2

0 = low risk
1 = med risk - observe
2 = high risk - treat
25
Q

Management of Barrett’s?

A

Endoscopic surveillance every 3-5 years with biopsies
High dose PPI (prevents progression but no regression)

If dysplasia of any grade found:

  • endoscopic mucosal resection
  • radiofrequency ablation
26
Q

Management of alcoholic ketoacidosis?

A

IV saline and thiamine

27
Q

NAFLD spectrum?

What is NASH?

A

Steatosis - fat in liver
Steatohepatitis - fat with inflammation
Fibrosis and cirrhosis

NASH:
Similar to the changes in alcoholic hepatitis but absence of alcohol abuse

Assoc: obesity, T2DM, hyperlipidaemia, jejunal bypass, sudden weight loss/starvation

Features:

  • usually asymptomatic
  • hepatomegaly
  • ALT>AST
  • ALP may be raised as well with increased bile and decreased albumin
  • increased echogenicity on USS
28
Q

Ix NAFLD?

A

USS - can often be an incidental finding

If changes seen:
Enhanced liver fibrosis blood test
- pro collagen II
- tissue inhibitor metalloproteinase 1

If ELF not available:

  • Fibroscan for fibrosis
  • FIB4 score

Management:

  • Lifestyle change and weight loss
  • potentially metformin/TZD
  • monitor
29
Q

Cancers assoc w coeliac, pernicious anaemia and H Pylori?

A

Coeliac - T cell lymphoma

Pernicious - gastric

H Pylori - MALToma - 80% regress after treatment of H Pylori

30
Q

Dielofeau lesion?

A

Upper GI bleed, prominent vessels on lesser curvature

31
Q

intestinal angina/chronic mesenteric ischaemia?

A

Classically a triad of:

  • colicky post-prandial abdo pain
  • weight loss
  • abdominal bruit

Most common cause is atherosclerosis of arteries supplying GI tract

32
Q

Management of abdominal wound dehiscence?

A
  • Cover with sterile saline-soaked gauze
  • IV broad-spec abx
  • Analgesia
  • IV fluids
  • Arrange return to theatre
33
Q

Pt on immunosuppressants gets campylobacter, what is treatment?

A

Clarithromycin

Also used in severe infection (bloody stool, fever etc)

Finals Revision - Last Min (12 decks)

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