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medicine finals > GI > Flashcards

GI Flashcards

1
Q

RF for gastric cancer?

A 
H-pylori
atrophic gastritis 
Diet 
Smoking 
male 
>75
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2
Q

CF of gastric Ca?

A
  • dyspepsia / epigastric pain
  • Wt loss
  • N + V
  • Dysphagia
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3
Q

Ix / Dx of Gastric Ca?

A

endoscopy with biopsy
- Signet rings
CT for staging

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4
Q

gastric Ca Tx?

A
  • endoscopic mucosal resection
  • partial / total gastrectomy
  • chemo
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5
Q

Classic CF of gall stone ileus?

A

Acute, severe abdo pain
Vomiting
Not passed stool or flatus
Previous intermittent colicky RUQ pain

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6
Q

Classic X-ray findings in gallstone ileus?

A

small bowel obstruction (dilated loops of bowel) and air in biliary tree

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7
Q

plain abdo X-ray shows ‘coffee bean’ sign - likely Dx?

A

sigmoid volvulus

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8
Q

What CF would you expect to find in a Px with a pharyngeal pouch?

A
  • Dysphagia
  • Hx aspiration pneumonia
  • halitosis (bad breath)
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9
Q

How would you Dx pharyngeal pouch?

A

barium swallow combines with dynamic video fluoroscopy

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10
Q

How would you Mx pharyngeal pouch?

A

Surgery

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11
Q

How would you treat life-threatening C. Diff infection?

A

oral vancomycin and IV metronidazole

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12
Q

What can cause C. diff infection?

A
  • ABx - clindamycin, cephalosporins

- PPIs

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13
Q

CFs of C. Diff?

A
  • Diarrhoea
  • Abdo pain
  • Raised WCC (esp. if severe toxic megacolon develops)
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14
Q

Dx of C Diff?

A

C diff toxin in stool

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15
Q

C. Diff Tx?

A
  • Stop any causative ABx if poss.
  • 1st: oral vancomycin 10 days
  • 2nd: oral fidaxomicin (and in recurrent)
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16
Q

RF’s for bowel cancer?

A
  • FHx
  • Familial adenomatous polyposis (FAP)
  • Hereditary nonpolyposis colorectal cancer (HNPCC)
  • IBD
  • older age
  • diet (meat and low fibre\0
  • obesity and sedentary lifestyle
  • smoking and alcohol
17
Q

What is a panproctocolectomy?

A

Prophylactic resection of large bowel in Px with FAP

18
Q

What Ca does HNPCC increase risk of ?

A
  • colorectal

- endometrial

19
Q

CF of bowel cancer?

A
  • change in bowel habit - usually looser
  • wt loss
  • rectal bleeding
  • abdo pain
  • microcytic anaemia
  • abdo/rectal mass
20
Q

When to 2 week wait suspected bowel Ca?

A
  • > 40 with unexplained abdo pain and unexplained weight loss
  • > 50 with unexplained rectal bleeding
  • > 60 with change in bowel habit or Fe anaemia
21
Q

When would you FIT test?

A
  • Px who don’t meet TTW referral but suspected bowel ca
  • looks at amount of human haemoglobin in stool
  • used as screening in people 60-74 every 2 years
22
Q

Ix for bowel Ca?

A
  • colonoscopy and biopsy
  • CT for staging
  • CT colonography if unfit for colonoscopy
  • sigmoidoscopy in PX with rectal bleeding only
23
Q

Summarise the TMN classification for bowel Ca?

A

T for Tumour:

TX – unable to assess size
T1 – submucosa involvement
T2 – involvement of muscularis propria (muscle layer)
T3 – involvement of the subserosa and serosa (outer layer), but not through the serosa
T4 – spread through the serosa (4a) reaching other tissues or organs (4b)

N for Nodes:

NX – unable to assess nodes
N0 – no nodal spread
N1 – spread to 1-3 nodes
N2 – spread to more than 3 nodes

M for Metastasis:

M0 – no metastasis
M1 – metastasis

24
Q

Options for bowel ca :

A
  • Surgical resection
    Chemotherapy
    Radiotherapy
    Palliative care
25
Q

What symptoms may you experience in low anterior resection syndrome ?

A
  • urgency and frequency of bowel movements
  • faecal incontinence
  • difficulty controlling flatulence
26
Q

What follow-up is involved in bowel cancer?

A
  • Serum carcinoembryonic antigen (CEA)

- CT TAP

27
Q

a woman presenting with lethargy, arthralgia, easy bruising and bleeding gums, what is the likely Dx?

A

Scurvy - vitamin C deficiency

It is associated with severe malnutrition as well as drug and alcohol abuse, and those living in poverty with limited access to fruits and vegetables.

medicine finals (7 decks)

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