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Medicine Finals: HARD STUFF ONLY > GI > Flashcards

GI Flashcards

(65 cards)

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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
Which part of the colon is most commonly affected by Ischaemic colitis?
Splenic flexure
26
How is a colorectal cancer in the caecal, ascending or proximal transverse colon managed? (including the hepatic flexure)
Right hemicolectomy
27
How is a colorectal cancer in the distal transverse or descending colon managed? (including the splenic flexure)
Left hemicolectomy
28
How is a colorectal cancer in the sigmoid colon managed?
High anterior resection
29
How is a colorectal cancer in the rectum managed?
Low anterior resection
30
How is a colorectal cancer in the anal verge managed?
Abdomino-perineal excision
31
What is Plummer-Vinson syndrome and how is it managed?
Condition where there is.. 1) Dysphagia 2) Glossitis 3) Iron-deficiency anaemia management: iron supplementation
32
External vs. internal haemorrhoids?
``` External = originate below the dentate line, can be painful Internal = originate above the dentate line, not usually painful ```
33
What are conservative measures for haemorrhoids?
Increase fluid intake Increase fibre intake Analgesia
34
What are surgical measures for haemorrhoids?
Band ligation | Haemorrhoidectomy
35
What are long term side effects of Crohn’s disease?
Perianal abscess SBO Colonic carcinoma Malnutrition
36
What is Zollinger-Ellison syndrome? | How is it diagnosed?
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
What are ENDOSCOPY findings for Crohn’s?
Skip lesions | Cobblestone appearance
38
What are ENDOSCOPY findings for UC?
Continuous inflammation | Pseudopolyps
39
What are HISTOLOGICAL findings for Crohn’s?
Transmural inflammation Increased goblet cells Granulomas
40
What are HISTOLOGICAL findings for UC?
Submucosal inflammation only Crypt abscesses Goblet cell depletion
41
What is seen on small bowel enema in Crohn’s disease?
Strictures - Kantor’s string sign Rose thorn ulcers Fistulae
42
What is seen on barium enema in UC?
Loss of haustrations Pseudopolyps Drainpipe colon
43
What are features of Lower GI bleeding?
Bright red/dark red blood per rectum | Lower GI bleeding rarely presents with melaena - not retained long enough for transformation to occur
44
What are features of upper GI bleeding?
Haematemesis Melaena Raised urea
45
What score is used to assess management of upper GI bleeding?
Glasgow-Blatchford score
46
What score is used after endoscopy for upper GI bleeding to provide risk of re-bleeding?
Rockall score
47
How soon should someone with upper GI bleeding get an endoscopy?
Within 24 hours
48
How does oesophageal cancer appear on barium swallow?
"apple core" sign --> part of oesophagus = strictured
49
Lower GI 2WW guidelines
>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
How is colorectal cancer staged?
``` Dukes Staging A - confined to mucosa B - invading bowel wall C - lymph node mets D - distant mets ```
51
What are options for short term and long term enteral feeding?
Short term = NG tube, NJ tube Long term = PEG, PEJ If stomach not able to function - TPN
52
What is the management of a sigmoid volvulus?
Rigid sigmoidoscopy with rectal tube insertion
53
What is the management of a caecal volvulus?
Management is usually operative - right hemicolectomy
54
How do you induce remission in UC?
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
How do you maintain remission in UC?
1. Topical mesalazine | 2. Topical mesalazine AND oral sulfasalazine
56
How to maintain remission in someone who has had a severe relapse or has had more than 1 exacerbation in the last year?
Go straight to oral azathioprine/mercaptopurine (check TPMT activity first)
57
How can you diagnose UC?
Colonoscopy + biopsy | If severe colitis —> flexible sigmoidoscopy instead. Colonoscopy can cause perforation.
58
How do you induce remission in Crohn's?
Steroids - topical/oral/IV 2nd line = Azathioprine/Mercatopurine
59
How do you maintain remission in Crohn's?
1) Azathioprine/Mercaptopurine | 2) Methotrexate
60
How do you monitor Barrett’s oesophagus?
Endoscopy every 3-5 years | If dysplasia is seen - resection/ablation
61
How is achalasia diagnosed?
Birds beak appearance on barium swallow | Increased lower oesophageal sphincter tone on oesophageal manometry
62
How does vitamin B3 (niacin) deficiency present?
Also known as Pellagra Dermatitis Diarrhoea Dementia
63
How does vitamin B6 deficiency present?
Peripheral neuropathy Sideroblastic anaemia Can be caused by isoniazid
64
Which cancer is associated with Achalasia?
Squamous cell carcinoma of the oesophagus
65
What electrolyte abnormalities can PPIs cause?
Hyponatraemia | Hypomagnasaemia

Medicine Finals: HARD STUFF ONLY (23 decks)

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