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PACES > GI > Flashcards

GI Flashcards

1
Q

GI causes of clubbing

A 
Chronic liver disease
IBD
Coeliac 
GI lymphoma
Tropical sprue
Whipple's disease
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2
Q

Leuconychia

A

Associated with hypoalbuminaemia, heart failure, renal disease, Hodkin’s lymphoma and DM

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3
Q

Causes of palmar erythema

A

Vasodilated state - chronic liver disease, hypercapnoea, RA, thyrotoxicosis, pregnancy, fever, exercise

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4
Q

Gynaecomastia in chronic liver disease

A

Related to altered sex hormone metabolism oestradiol:freetestosterone ratio. Palpabe behind nipple

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5
Q

Hepatic bruit

A

?TIPPS

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6
Q

Hep C on examination

A

Tattoos, porphyria cutanea tarda + livedo reticularis from type iii cryoglobulinaemia

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7
Q

PBC signs

A

Hyperpigmentation, xanthelasma, tendon xanthomata, excoriation marks

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8
Q

Haemochromatois

A

Bronze pigmentation, arthropathy, finger pinprick (diabetes testing)

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9
Q

Drugs and cirrshosis

A

Methotrexate, isoniazid, amiodarone, phenytoin

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10
Q

Grading Encephalopathy

A 
West Haven Criteria 1-4
1 - insomnia / reversal of day-night sleep pattern
2 - lethargy / disorientation
3 - confusion / somnolence
4 - coma
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11
Q

Caput Medusae vs IVC obstruction

A

Occlude vessel and observe refilling. If towards legs = caput medusae, if cephalic = IVC obstruction

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12
Q

Causes of ascites

A 
Cirrhosis
Malignancy
Heart Failure
TB
Pancreatitis
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13
Q

Tender Hepatomegaly

A 
Infectious (e.g. viral) 
Alcoholi hepatitis
Malignancy 
Hepatic congestion 
Vascular liver disease
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14
Q

Which tumours metastasise to the liver

Which liver tumours are benign

A

CRC, oesophageal, lung, gastric, breast, lymph, renal, endometrial, neuroendocrine, sarcomatous, bone
Benign - cavernous haemangioma, hepatic adenoma, FNH, NRH

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15
Q

Causes and clinical manifestations of Budd-Chiari syndrome

A

Obstruction to hepatic venous outflow, thrombosis may occur at hepatic venules, hepatic vein or IVC
Myeloproliferative disease, protein C and S deficiency, fVL, APS, PNH
Acute presentation with jaundice and encephalopathy / subacute with abdominal pain and hepatomegaly
Doppler USS.
Anticoagulation but in severe cases thrombolysis, anigoplasty or liver Tx may be indicated.

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16
Q

What are the hepatic manifestations of SSD

A

Gall stone disease - chronic haemolysis causing pigment stones
Crisis - sickle thrombosis causeing sinusoidal obstruction
Intrahepatic cholestasis
Iron overload if recurrent transfusions

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17
Q

Splenomegaly (with or without anaemia)

A

Haematological malignancy
Portal HTN
Haemolytic anaemia
Felty’s syndrome

18
Q

Jaundice + Splenomegaly

A

Haemolysis

?Haematological malignancy with cold AIHA with CLL

19
Q

Splenomegaly with RA hands

A

Felty’s - neutropenia to confirm

20
Q

Splenomegaly without lymphadenopathy

Splenomegaly without lymphadenopathy

A

Myeloproliferative like CML

Lymphoproliferative

21
Q

Characeristics of spleen on palpation

A 
Enlarges towards RIF
Medial notch
Dull to percussion
Cannot palpate above it 
Not ballotable
22
Q

Causes of splenomegaly

A 
Portal HTN
Haematological malignancy 
Infection 
Congestion
Primary splenic disease (e.g. splenic vein thrombosis)

Massive - CML, myelofibrosis, Kala-azar (visceral leishmaniasis), Malaria
Moderate - Portal HTN, lymphoma, leukaemia, thalassaemia
Mild - haemolysis, EBV, IE, AI (SLE, RA), infiltrative (amyloid/sarcoid)

23
Q

What is the significance of B-symptoms in NHL

A

Fever >38
Weight loss >10% BW / 6 months
Drenching night sweats
If one is present, then patients clinical staging is altered accordingly

24
Q

Cytogenetics of CML

A

Philadelphia chromosome 90-95%
Translocation 9:22, increased oncogene activity through thyrosine kinase
Detection used for diagnosis and monoclonal Ab treatements

25
Q

Blast Crisis

A

Phase of disease similar to acute leukamia with survival 3-6 months, blast cells in BM and peripheral blood. Skin and soft tissue infiltration

26
Q

Managing hyposplenism

A

Vaccinations - pneumococcal, HiB, Men C with repeat vaccinations
Prophylactic Abx - oral penoxymethylpenicillin / erythromycin
Advice re: presentations to hospital
Malaria prophylaxis and travel advice
Information card / medi-alert bracelet

27
Q

Felty’s syndrome

A

Seropositive RA + splenomegaly + neutropenia

(however splenomegaly no longer absolute diagnostic requirement

28
Q

Presentation of haemochromatosis

A

Bronze diabetes (cirrhosis / DM and slate-grey pigmentation (classical, rare)
Cutaneous pigmentation >90% (sun-exposed areas most evident) bronze/grey
Koilonychia, chronic liver disease signs are late
Gynaecomastia and loss of bofy hair due to iron deposition in pituitary gland
Hepatomegaly
Restrictive / dilated cardiomyopathy

29
Q

Diagnosing and managing haemochromatosis

A

Iron overload - serum studies, transferrin saturation, liver biopsy
Genetics - HFE gene testing (C282Y and H63D) >90%
Phlebotomy to target ferritin and transferring saturation <50% initially 1-2 weekly then maintenence 3 months. HCC monitoring
Can cause restrictive or dilated cardiomyopathy
Desferrioxamine (iron chelating agents)

30
Q

DDx Splenomegaly

A

Infiltrative - lymphoma, leukaemia, amyloidosis
Infective - visceral leishmaniasis, malaria, subacute bacterial endocarditis, EBV, brucellosis
Gain of function - thalassaemia, spherocytosis, early sickle cell, Gaucher’s type 1 (Ashkenazi jews)
Disordered AI regulation - RA (felty’s), SLE,
Disordered flow - hepatic / portal vein thrombosis

30
Q

DDx Splenomegaly

A

Infiltrative - lymphoma, leukaemia, amyloidosis
Infective - visceral leishmaniasis, malaria, subacute bacterial endocarditis, EBV, brucellosis
Gain of function - thalassaemia, spherocytosis, early sickle cell, Gaucher’s type 1 (Ashkenazi jews)
Disordered AI regulation - RA (felty’s), SLE,
Disordered flow - hepatic / portal vein thrombosis

31
Q

DDx massive splenomegaly

A

CML
Kala-Azar (visceral leishmaniasis)
Myelofibrosis
Gaucher’s lipid storage disease

32
Q

Hereditary spherocytosis

A

Autosomal dominant
Osmotic fragility test / flow cytometry
Increased reticulocytes with blood film of small dark cels with loss of central pallor
Splenomegaly for mod/severe disease

33
Q

DDx Hepatomegaly

A 
Cirrhosis
Carcinoma
CCF
Infectious (HBV, HCV)
Immune (PBC, PSC, AIH)
Infiltrative (amyloid, myeloproliferative
34
Q

AI in liver disease

A

AIH - ANA, ASMA, Anti LKM ab
PBC - AMA (M2 in 98%)
PSC - ANA, ASMA may be +ve

35
Q

DDx gynaecomastia

A 
Physiological 
Klinfelter's
Cirrhosis
Drugs - sprironolactone, digoxin 
Testicular tumour / orchidectomy
Endocrinopathy - thyroid / addison's
36
Q

Genetics of HH

A

AR chr 6
HFE gene - regulator of gut iron absorption
Homozygous 1:300, carrier 1:10
Females have menstual blood losses so present later

37
Q

DDx splenomegaly by size

A

Massive - >8cm Kala-azar, malaria CML, myelofibrosis
Moderate - myelo/lymph proliferative disease, infiltration amyloidosis
Tip - myelo/lympho proliferative, portal HTN, IE, viral hep, EBV, haemolytic anaemia

38
Q

Indication for splenectomy

A

Rupture (trauma)

Haematological - ITP, hereditary spherocytosis

39
Q

Splenectomy workup

A

Vaccinations at least 2/52 prior - encapsulated bacteria
Meningitis, pneumococcus, haemophilus
Lifelong prophylactic penicillin
Medic calert bracelet

40
Q

APCKD

A

Progressive replacement of renal tissue by cysts leading to renal enlargement and failure (5% ESRF in UK)
1:1000
85% APKD1 on chr 16
15% APKD2 chr 4
HTN, recurrent UTIs, abdo pain (cyst bleeding, cyst infection), haematuria
ESRFc by40-60s earlier in pdk1
Heptatic cysts, berri aneurysms and MV prolapse
Genetic coucelling, 10% de novo mutations
Nephrectomy / RRF

PACES (6 decks)

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