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Medicine Finals: HARD STUFF ONLY > GI > Flashcards

GI Flashcards

1
Q

What is the treatment for H.pylori?

A

triple therapy

PPI + Amox + Cipro/Metronidazole

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2
Q

How is H.pylori diagnosed?

A

Urea breath test

C13 stool test

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3
Q

How are peptic ulcers managed?

A

Test for H.pylori

H.pylori positive + NSAID use= PPI for 8 weeks!!! and then triple therapy

H.pylori positive + no NSAID use= triple therapy

H.pylori negative + NSAID use = PPI for 8 weeks

H.pylori negative + no NSAID use = PPI for 4 weeks

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4
Q

Which artery is associated with significant gastrointestinal disease in the context of peptic ulcer disease?

A

Gastroduodenal artery

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5
Q

How long to stop PPI prior to testing for H.pylori?

A

2 weeks

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6
Q

What to check prior to starting Azathioprine?

A

TPMT activity

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7
Q

What vaccine is needed in coeliac disease?

A

Pneumococcal every 5 years

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8
Q

What electrolytes are seen in refeeding syndrome?

A

Hypokalaemia
Hypomagnasaemia
Hypophosphataemia

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9
Q

What are risk factors for diverticular disease?

A

obesity, older age, low fibre diet, NSAID use

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10
Q

What is mesenteric ischaemia and how is it diagnosed? How is it managed?

A

Ischaemia due to the small bowel due to an embolus - main RF is AF!!!

Presents with acute abdomen
Blood gas = raised lactate
Diagnosis = CT angiogram

Management = immediate laporotomy - HIGH MORTALITY

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11
Q

What is ischaemic colitis and how is it managed?

A

Ischaemia to the large bowel
Less severe abdominal pain, bloody diarrhoea

thumbprinting on XR

Conservative management

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12
Q

What is toxic megacolon? How is it managed?

A

Complication of severe UC
Leadpipe bowel , loss of haustrations, dilated loops of bowel
Acute abdomen, severe bloody diarrhoea, fever
Tachycardia, raised WCC

Management =
Resus + Broad spectrum abx

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13
Q

How are internal haemorrhoids graded?

A

Grade 1 – do not prolapse
Grade 2 – prolapse but reduce spontaneously
Grade 3 – can be manually reduced
Grade 4 – cannot be reduced

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14
Q

What is small bowel bacterial overgrowth syndrome? How is it diagnosed? How is it managed?

A

Excessive bacteria in the small bowel –> diarrhoea, bloating, flatulence, abdominal pain

Diagnosis = hydrogen breath test

Management = Rifaximin

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15
Q

What is Whipple’s disease?

A

A rare systemic condition caused by Trophenyma Whipplei

Causes diarrhoea, abdominal pain and joint pain

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16
Q

What is seen on small bowel biopsy in Whipple’s disease?

A

Acid-Schiff-positive macrophages

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17
Q

How is Whipple’s disease managed?

A

Co-trimoxazole

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18
Q

What is the most common hereditary condition associated with colorectal cancer? What other cancers are associated with this condition?

A

HNPCC (Lynch syndrome)

Endometrial cancer and gastric cancer

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19
Q

What is the familial condition with the highest risk of developing colorectal cancer? How is it monitored?

A

Familial adenomatous polyposis

Annual flexible sigmoidoscopy from 15 years old

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20
Q

What is Kantor’s string sign and what is it seen in?

A

Seen in Crohn’s

Narrowing of the terminal ileum due to stricturing

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21
Q

What is the Glasgow-Blatchford score?

A

Used to determine whether patients with an upper GI bleed can be discharged home

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22
Q

How to manage abdominal wound dehiscence?

A

Cover wound with saline soaked gauze + give IV abx

Return to theatre

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23
Q

What is the main risk factor of aminosalicylates?

A

Agranulocytosis

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24
Q

What complication of diverticular disease can present with bubbles or faecal matter in the urine?

A

Colovesical fistula

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25
Q

Which part of the colon is most commonly affected by Ischaemic colitis?

A

Splenic flexure

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26
Q

How is a colorectal cancer in the caecal, ascending or proximal transverse colon managed? (including the hepatic flexure)

A

Right hemicolectomy

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27
Q

How is a colorectal cancer in the distal transverse or descending colon managed? (including the splenic flexure)

A

Left hemicolectomy

28
Q

How is a colorectal cancer in the sigmoid colon managed?

A

High anterior resection

29
Q

How is a colorectal cancer in the rectum managed?

A

Low anterior resection

30
Q

How is a colorectal cancer in the anal verge managed?

A

Abdomino-perineal excision

31
Q

What is Plummer-Vinson syndrome and how is it managed?

A

Condition where there is..

1) Dysphagia
2) Glossitis
3) Iron-deficiency anaemia

management: iron supplementation

32
Q

External vs. internal haemorrhoids?

A 
External = originate below the dentate line, can be painful
Internal = originate above the dentate line, not usually painful
33
Q

What are conservative measures for haemorrhoids?

A

Increase fluid intake
Increase fibre intake
Analgesia

34
Q

What are surgical measures for haemorrhoids?

A

Band ligation

Haemorrhoidectomy

35
Q

What are long term side effects of Crohn’s disease?

A

Perianal abscess
SBO
Colonic carcinoma
Malnutrition

36
Q

What is Zollinger-Ellison syndrome?

How is it diagnosed?

A

Condition characterised by excessive levels of gastrin
Usually from gastrin secreting tumour
Often part of MEN type I

Features = multiple peptic ulcers, diarrhoea, malabsorption

Diagnosis = fasting gastrin levels

37
Q

What are ENDOSCOPY findings for Crohn’s?

A

Skip lesions

Cobblestone appearance

38
Q

What are ENDOSCOPY findings for UC?

A

Continuous inflammation

Pseudopolyps

39
Q

What are HISTOLOGICAL findings for Crohn’s?

A

Transmural inflammation
Increased goblet cells
Granulomas

40
Q

What are HISTOLOGICAL findings for UC?

A

Submucosal inflammation only
Crypt abscesses
Goblet cell depletion

41
Q

What is seen on small bowel enema in Crohn’s disease?

A

Strictures - Kantor’s string sign
Rose thorn ulcers
Fistulae

42
Q

What is seen on barium enema in UC?

A

Loss of haustrations
Pseudopolyps
Drainpipe colon

43
Q

What are features of Lower GI bleeding?

A

Bright red/dark red blood per rectum

Lower GI bleeding rarely presents with melaena - not retained long enough for transformation to occur

44
Q

What are features of upper GI bleeding?

A

Haematemesis
Melaena
Raised urea

45
Q

What score is used to assess management of upper GI bleeding?

A

Glasgow-Blatchford score

46
Q

What score is used after endoscopy for upper GI bleeding to provide risk of re-bleeding?

A

Rockall score

47
Q

How soon should someone with upper GI bleeding get an endoscopy?

A

Within 24 hours

48
Q

How does oesophageal cancer appear on barium swallow?

A

“apple core” sign –> part of oesophagus = strictured

49
Q

Lower GI 2WW guidelines

A

> 40 with unexplained weight loss+abdo pain
50 + unexplained rectal bleeding
60 +iron deficiency anaemia

If 2WW guidelines not met - FIT (faecal occult blood)

50
Q

How is colorectal cancer staged?

A 
Dukes Staging
A - confined to mucosa
B - invading bowel wall
C - lymph node mets
D - distant mets
51
Q

What are options for short term and long term enteral feeding?

A

Short term = NG tube, NJ tube
Long term = PEG, PEJ

If stomach not able to function - TPN

52
Q

What is the management of a sigmoid volvulus?

A

Rigid sigmoidoscopy with rectal tube insertion

53
Q

What is the management of a caecal volvulus?

A

Management is usually operative - right hemicolectomy

54
Q

How do you induce remission in UC?

A
  1. Topical mesalazine
  2. Oral sulfasalazine
  3. Oral corticosteroid

If extensive - go straight to topical mesalazine + oral sulfasalazine

If severe (>6 bloody stools, fever, raised WCC) - treated in hospital with IV steroids

55
Q

How do you maintain remission in UC?

A
  1. Topical mesalazine

2. Topical mesalazine AND oral sulfasalazine

56
Q

How to maintain remission in someone who has had a severe relapse or has had more than 1 exacerbation in the last year?

A

Go straight to oral azathioprine/mercaptopurine (check TPMT activity first)

57
Q

How can you diagnose UC?

A

Colonoscopy + biopsy

If severe colitis —> flexible sigmoidoscopy instead. Colonoscopy can cause perforation.

58
Q

How do you induce remission in Crohn’s?

A

Steroids - topical/oral/IV

2nd line = Azathioprine/Mercatopurine

59
Q

How do you maintain remission in Crohn’s?

A

1) Azathioprine/Mercaptopurine

2) Methotrexate

60
Q

How do you monitor Barrett’s oesophagus?

A

Endoscopy every 3-5 years

If dysplasia is seen - resection/ablation

61
Q

How is achalasia diagnosed?

A

Birds beak appearance on barium swallow

Increased lower oesophageal sphincter tone on oesophageal manometry

62
Q

How does vitamin B3 (niacin) deficiency present?

A

Also known as Pellagra
Dermatitis
Diarrhoea
Dementia

63
Q

How does vitamin B6 deficiency present?

A

Peripheral neuropathy
Sideroblastic anaemia
Can be caused by isoniazid

64
Q

Which cancer is associated with Achalasia?

A

Squamous cell carcinoma of the oesophagus

65
Q

What electrolyte abnormalities can PPIs cause?

A

Hyponatraemia

Hypomagnasaemia

Medicine Finals: HARD STUFF ONLY (23 decks)

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