GI Flashcards
(217 cards)
1
Q
What is the difference between cholangitis and cholecystitis?
A
There is usually jaundice in cholangitis, but not in cholecystitis.
2
Q
Give 4 sites where a hernia may be present.
A
Inguinal
Femoral
Incisional (at surgical incision site)
Umbilical
3
Q
What do tympanic bowel sounds indicate?
A
Air in the bowel
4
Q
What factors would you consider when deciding whether to resect a tumour?
A
Age of patient
Metastases/how the tumour has spread
Co-morbidities
Is the cancer resectable
5
Q
What antibody is associated with ulcerative colitis?
A
ANCA antibodies (p-ANCA)
6
Q
What antibody is associated with Crohn’s?
A
ASCA antibodies
7
Q
Which inflammatory bowel disease is granulomatous?
A
Crohn’s
8
Q
Give 5 side effects of steroids.
A
Weight gain Thinning hair Osteoporosis Hyperglycaemia Oedema
9
Q
Give 5 functions of the stomach.
A
Regulates empyting into the duodenum Digests food Secretes intrinsic factor Secretes acid Secretes and activates proteases
10
Q
What is Charcot’s triad?
A
RUQ pain
Fever
Jaundice
11
Q
What condition is Charcot’s triad seen in?
A
Ascending cholangitis
12
Q
What is Reynold’s pentad?
A
RUQ pain Fever Jaundice Confusion Hypotension
(Charcot’s triad + other symptoms)
13
Q
What type of inheritance does haemochromatosis show?
A
Autosomal recessive
14
Q
What does slate grey or bronze pigmented skin suggest?
A
Haemochromatosis
15
Q
Give 4 signs of haemochromatosis.
A
Stigmata of liver disease
Fatigue
Erectile dysfunction
Diabetes
16
Q
Which gene is affected in haemochromatosis?
A
Chromosome 6
17
Q
Describe the pain in patients suffering with appendicitis.
A
Diffuse pain around the umbilicus then concentrates to the right iliac fossa.
18
Q
Which HLA is haemochromatosis associated with?
A
HLA-A3
19
Q
What condition does painless jaundice suggest?
A
Pancreatic cancer
20
Q
What condition does clay coloured stools suggest?
A
Cholangiocarcinoma
21
Q
What causes prehepatic jaundice?
A
Haemolytic anaemia
Malaria
Reduced red blood cell lifespan
Gilbert’s syndrome
22
Q
What type of bilirubin is high in prehepatic jaundice?
A
Unconjugated bilirubin
23
Q
What are stools and urine like in prehepatic jaundice?
A
Normal urine and stools
24
Q
What causes hepatic jaundice?
A
Alcoholic liver disease
Viral hepatitis
Hepatocellular carcinoma
Haemochromatosis
25
What type of bilirubin is high in hepatic jaundice?
Can be mixed picture
26
What causes post hepatic jaundice?
Gallstones
Cholangiocarcinoma
Pancreatic cancer
27
What type of bilirubin is high in post hepatic jaundice?
Conjugated bilirubin
28
What are stools and urine like in post hepatic jaundice?
Dark urine and pale stools
29
What are stools and urine like in hepatic jaundice?
Dark urine and pale stools
30
Which two antibodies are associated with coeliac disease?
IgA tissue transglutaminase (anti-tTg)
| IgA anti-endomysial (EMA)
31
Which hepatitis viruses are associated with faeco-oral transmission?
A and E
32
Which hepatitis viruses are blood borne?
B, D and C
33
What features are suggestive of oesophageal cancer?
Progressive dysphagia and weight loss
34
Give 2 examples of a H2 receptor antagonist.
Cimetidine, ranitidine
35
What is the first line investigation for NAFLD?
LFTs
36
What is the gold standard investigation for NAFLD?
Liver biopsy
37
What LFT results would be seen in non-alcoholic fatty liver disease?
AST/ALT ratio close to 1
38
What LFT results would be seen in alcoholic liver disease?
AST:ALT ratio of more than 2:1
39
What condition is Murphy's sign associated with?
Acute cholecystitis
40
What is Murphy's sign?
Murphy's sign is positive if on inspiration (whilst the physician is palpating the gallbladder) there is pain as the gallbladder comes into contact with the clinicians hand
41
What is Charcot's triad?
Jaundice, RUQ pain, pyrexia
42
What condition is Charcot's triad seen in?
Ascending cholangitis
43
What antibodies are seen in autoimmune hepatitis?
Anti-smooth muscle Ab
44
What antibodies are seen in primary biliary cholangitis?
Anti-mitochondrial Ab
45
What antibodies are seen in coeliac disease?
IgA endomysial Ab
| Anti-tTG Ab
46
What is the first line treatment of haemochromatosis?
Phlebotomy
47
What is the second line treatment of haemochromatosis?
Iron chelating drugs
48
What condition is primary sclerosing cholangitis associated with?
Ulcerative colitis (as well as Crohn's and hepatocellular carcinoma)
49
What is the most common first presenting symptom of MS?
Optic neuritis
50
What condition is alpha feto-protein primarily associated with?
Hepatocellular carcinoma
51
Give 5 risk factors for hepatocellular carcinoma
Hepatitis B/C, alcohol, diabetes, obesity, family history of liver cancer
52
What kind of virus is hepatitis C?
Positive sense single stranded RNA
53
What kind of virus is hepatitis B?
Double stranded DNA
54
What kind of virus is hepatitis A?
Single stranded RNA
55
What antibody indicates an acute hepatitis B infection?
HBsAg
56
What antibody indicates a previous or current infection?
Anti-HBc
57
What pattern of inheritance does alpha-1 antitrypisin deficiency show?
Autosomal recessive
58
How do patients with alpha-1 antitrypsin deficiency present?
With emphysema at an early age
59
What pattern of inheritance does von willebrand syndrome show?
Autosomal dominant
60
What is the first line treatment of Wilson's disease?
Penicillamine (chelating agent)
61
What is the management of paracetamol overdose?
N-acetyl cystine
62
What drug is given to reverse an opiate overdose?
Naloxone
63
How does N-acetyl cystine work?
It restores levels of glutathione, needed to metabolise paracetamol safely
64
What are dupuytren's contractures?
Progressive shortening and thickening of the palmar fascia
65
What are dupuytren's contractures associated with?
Liver disease/alcohol
66
What are leukonychia?
White nail beds
67
What is the pain like in pancreatitis?
Severe epigastric pain radiating to the back
68
What LFT is raised in primary biliary cholangitis?
ALP
69
What antibodies are associated with primary biliary cholangitis?
Anti-mitochondrial antibodies
70
Give 4 upper GI bleed symptoms.
Melaena
Coffee ground vomit
Tachycardia
Hypotension
71
What are the causes of pancreatitis?
Mnemonic - GET SMASHED
```
G - gallstones
E - ethanol
T - trauma
S - steroids
M - mumps
A - autoimmune
S - scorpion venom
H - hyperlipidaemia
E - ERCP/emboli
D - drugs
```
72
What is Horner's syndrome?
A problem with sympathetic nerve supply to one side of the face
73
What are the symptoms of Horner's syndrome?
Loss of sweating, drooping eyelid, dilated pupil
74
What is the main acute complication of alcohol withdrawal?
Seizures
75
What is the first line medication for alcohol withdrawal seizures?
Chlordiazepoxide
76
What vitamin is often deficient in alcohol dependent patients?
Vitamin B1
77
What vitamin deficiency Wernicke's encephalopathy caused by?
Vitamin B1
78
What does a low serum-ascites albumin ratio indicate?
Ascites is not due to portal hypertension
79
What does a high serum-ascites albumin ratio indicate?
Ascites is due to portal hypertension
80
Give 4 causes of peritonitis.
Ectopic pregnancy, bowel obstruction, gastritis from h. pylori, peptic ulcer formation
81
Give 3 signs of alcoholic liver damage.
Raised GGT
High AST to ALT ratio
Mallory bodies on biopsy
82
What is the presentation of posthepatic jaundice?
Dark urine, pale stools
83
What is the presentation of hepatic jaundice?
Dark urine, normal stools
84
What is the presentation of prehepatic jaundice?
Normal urine, normal stools
85
What non-pathological factor can cause ALP to be high?
Being postmenopausal
86
Why can postmenopausal women have high ALP?
Bones are a source of ALP
| - Osteoporosis in menopause can cause an increase in ALP
87
What is the classic picture of alpha-1 antitrypsin deficiency?
Dyspnoea, obstructive lung picture, liver disease, cholestatic jaundice
88
What is the mechanism of N-acetyl cysteine?
Increaseses glutathione that conjugates paracetamol into non-toxic compounds
89
What do both primary sclerosing cholangitis and ulcerative colitis increase the risk of?
Colorectal and biliary system cancers
90
What complication of primary sclerosing cholangitis and ulcerative colitis is screened for annually?
Colorectal cancer
91
What is the first line investigation for haemochromatosis?
Serum ferritin levels
92
What disease is loss of haustrations on barium enema associated with?
Ulcerative colitis
93
What condition are kayser-fleischer rings associated with?
Wilson's disease
94
What is the most appropriate step to investigate a long history of dyspepsia?
Upper GI endoscopy within 2 weeks
95
What does a long history of dyspepsia indicate?
Oesophageal cancer
96
What is the classic presentation of coeliac disease in a child?
Failure to thrive, tired all the time, family history of autoimmune conditions
97
What is the gold standard investigation of coeliac disease?
Endoscopic intestinal biopsy
98
What would an intestinal biopsy in coeliac disease show?
Villous atrophy, crypt hyperplasia, lymphocytes
99
What is the most appropriate first line management of IBS?
Give dietary advice and a mild laxative (if constipated), or loperamide (for diarrhoea)
100
What dietary advice is given for IBS?
Limit coffee and alcohol, and increase fibre intake
101
What is the second line treatment of IBS?
Amitryptyline (tricyclic antidepressant)
102
Where is an ulcer likely to be if pain improves upon eating?
Duodenum
103
What is the most common cause of a small bowel obstruction?
Surgical adhesions
104
What is the presentation of achalasia?
Dysphagia of both liquids and solids
| Regurgitation (as opposed to reflux)
105
What type of anaemia do colorectal cancer patients typically show?
Iron deficiency anaemia
106
What is the most common cause of oesophageal varices?
Portal hypertension due to liver cirrhosis
107
What is the first line mangement of h pylori?
Triple therapy
- Amoxicillin
- Clarithromycin
- Omeprazole
108
What is the second line treatment of h pylori?
PPI, amoxicillin and tetracycline for 7 days
109
How may pancreatic pain be relieved?
By leaning forwards
110
What features likely describe intususception?
Red currant jelly stools and a palpable sausage like lump in the RUQ
111
Where does pain in diverticulitis most commonly occur?
Left lower quadrant (because the sigmoid colon is most commonly affected)
112
Which IBD is granulomatous?
Crohn's
113
What is diverticular disease?
When diverticula cause symptoms?
114
What is diverticulosis?
The presence of asymptomatic diverticula
115
What is diverticulitis?
Inflammation of the diverticulum
116
What does blood in the stools in haemorrhoids look like?
Not mixed in with the stools
117
Where is Virchow's node located?
Left supraclavicular area
118
Which lymph nodes can be enlarged in breast cancer?
Axillary nodes
119
Which lymph nodes can be enlarged in testicular or ovarian cancer?
Inguinal nodes
120
Which cancers can cause enlarged mediastinal lymph nodes?
Lung cancer, Hodgkin's lymphoma, NHL
121
Where is iron absorbed?
Duodenum
122
Where is folate absorbed?
Duodenum and jejenum
123
Where it vitamin B12 absorbed?
Terminal ileum
124
Is autoimmune gastritis a cause of peptic ulcers?
No
125
Give 4 causes of peptic ulcers.
Mucosal ischaemia
Excessive NSAID use
H. pylori
Bile reflux
126
What enzyme is needed for prostaglandin synthesis?
COX-1
127
Where is the most common location for colorectal cancers?
Rectum
128
What system is used to classify coeliac disease?
Marsh classification
129
What is the Marsh classification?
```
1 - no crypt hyperplasia
2 - crypt hyperplasia
3a - partial/mild villous atrophy
3b - subtotal/moderate villous atrophy
3c - total villous atrophy
```
130
What gene causes inevitable familial colon cancer?
FAP gene (familial adenomatous polyposis)
131
What is the inheritance pattern of FAP?
Autosomal dominant
132
What is the most common dermal manifestation of IBD?
Erythema nodosum
133
What is the gold standard test for acute pancreatitis?
Serum amylase
134
Give 3 risk factors for haemorrhoids.
Obesity
Chronic constipation
Coughing
135
Give 4 symptoms of haemorrhoids.
Fresh red blood and mucus in the stool
Itching around the anus
Soreness around the anus (external haemorrhoids)
136
Give 4 red flag GI symptoms.
Rectal bleeding, unintentional weight loss, anaemia, age>60
137
Give 5 symptoms of small bowel obstruction.
Vomiting, nausea, constipation, abdominal distention, abdominal pain
138
What investigation is used for a h. pylori infection?
Urea breath test
139
Give 3 differentials of gastritis.
Peptic ulcer disease, GORD, gastric carcinoma
140
What is the pathophysiology of haemorrhoids?
Swelling and inflammation of veins in the rectum and anus
141
Which type of haemorrhoids are painful?
External haemorrhoids
142
What are the non-surgical managements of haemorrhoids?
Topical anusol, topical hydrocortisone, bulk-forming laxatives
143
What are the surgical managements of haemorrhoids?
Band ligation, haemorrhoidectomy
144
Give 3 risk factors for Crohn's disease?
Family history
HLAB27
NSAIDs
145
What is the gold standard investigation for IBD?
Endoscopy and biopsy
146
What is the histological appearance of Crohn's?
Increased goblet cells
Skip lesions
Transmural inflammation
147
What is the histological appearance of Ulcerative colitis?
Decreased goblet cells
Continuous inflammation
Mucosal and submucosal inflammation only
148
What drug is used in Crohn's to induce remission?
Corticosteroids (with azathioprine)
149
What drug is used in Crohn's to maintain remission?
Azathioprine
150
What is the gold standard investigation for a Mallory-Weiss tear?
Upper GI endoscopy
151
What is the Glasgow-Blatchford score used for?
Determines the risk of an upper GI bleed
152
What factors are considered as part of the Glasgow-Blatchford score?
- Melena
- Haemoglobin
- Gender
- Blood pressure
- Tachycardia
- History of syncope
- History of hepatic disease
153
What is the treatment of a persistently bleeding Mallory-Weiss tear?
Upper GI endoscopy and clipping
154
What specific LFT is most raised in alcoholic fatty liver disease?
Raised GGT - gamma glutamyl transferase
155
Which benzodiazepine is used to manage alcohol withdrawal seizures?
Chlordiazepoxide
156
List four presentations of delirium tremens.
Acute confusion
Tachycardia
Hypertension
Ataxia
157
What is delirium tremens?
A complication of alcohol withdrawal
158
What is Ca 19-9 a marker for?
Pancreatic cancer
159
What is the most appropriate initial management of a small bowel obstruction?
'Drip and suck' - nil by mouth, IV fluids, and NG tube aspiration
160
What is the most appropriate initial treatment of intusussception?
Air enema
161
What IBD is blood in the stool more likely to be seen in?
Ulcerative colitis
162
What is the gold standard investigation of portal hypertension?
Hepatic venous pressure gradient
163
Which part of the pancreas do most pancreatic cancers originate from?
Head of the pancreas
164
What kind of hypersensitivity reaction is coeliac disease?
Type 4 hypersensitivity
165
What is the pathophysiology of hepatitis?
Inflammation of the liver:
- Infiltration of inflammatory cells
- Liver necrosis
- Chronic inflammation can lead to progressive fibrosis and necrosis
166
What is the management of appendicitis?
Appendicectomy
- IV antibiotics for a few days after surgery
- Oral antibiotics for 2-4 weeks
167
What is the most common presenting complaint of primary biliary cholangitis?
Pruritis, with or without jaundice
168
What is the treatment of paracetamol overdose if the patient presents within one hour?
N-acetyl cysteine and activated charcoal
169
Give 4 differentials of haemoptysis.
```
Mallory-Weiss tear
Oesophageal cancer
Stomach cancer
Ruptured oesophageal varices
Peptic ulcer
```
170
What does signs of chronic liver disease and haemoptysis suggest?
Oesophageal varices
171
What two conditions can cause a bronze pigment to the skin?
Haemochromatosis
| Addison's disease
172
What is Cullen's sign?
Superficial oedema and bruising around the umbilicus
173
What is Grey-Turner's sign?
Bruising of the flank
174
What condition are Cullen's sign and Grey-Turner's sign seen in?
Acute pancreatitis
175
What IBD are pseudopolyps characteristic of?
Ulcerative colitis
176
What is the gold standard investigation for a large bowel obstruction?
CT abdomen
177
What type of pain is classic in acute diverticulitis?
Left iliac fossa pain
178
What is a major risk factor for diverticulitis?
Low fibre diet
179
What is the gold standard test for liver cirrhosis?
Liver biopsy
180
What is the most specific marker for acute liver damage?
ALT
181
Why is ALT the most specific marker for liver damage?
AST is also found in the heart, muscle and kidneys
182
Which antibody can be present in someone who either had Hep B, or who has been vaccinated?
HBsAb
183
Which antibody can only be present in someone who has previously had Hep B?
HBcAb
184
Which antigens circulate in acute hepatitis?
HBsAg and HBeAg
185
Which antigens circulate in chronic hepatitis?
HBsAg only
186
What tests other than endoscopy and biopsy can be performed for IBD?
Faecal calprotectin - will be raised
CRP/ESR
Full blood count to look for anaemia
187
What type of drug is aziathropine?
Immunosuppressant
188
What complication of an upper GI obstruction would lead to emergency surgery?
Bowel ischaemia or strangulation
189
Give 4 complications of diverticulitis.
Large bowel obstruction
Large bowel perforation
Fistula formation
Bleeding
190
What drug can be used to control variceal bleeding?
IV terlipressin
191
What is the gold standard investigation for acute appendicitis?
CT abdomen
192
Which hepatitis cannot be vaccinated against?
Hepatitis C
193
What is Rovsing's sign?
Palpating the left iliac fossa will cause pain in the right iliac fossa
194
What condition is Rovsing's sign seen in?
Appendicitis
195
What condition is Murphy's sign seen in?
Acute cholecystitis
196
Which IBD is the risk of colorectal cancer higher in?
Ulcerative colitis
197
Give 4 complications of Crohn's disease.
Obstruction
Gallstones
Fistula
Colorectal cancer
198
What mutation is seen in Wilson's disease?
ATP7B mutation on chromosome 13
199
Give 6 physical manifestations of liver disease.
```
Ascites
Caput medusae
Hepatomegaly
Splenomegaly
Peripheral oedema
Spider naevi
```
200
Give 4 causes of acute liver injury.
Alcohol
Viral hepatitis
Drugs
Obstruction - stones
201
What is the first line imaging for gallstone?
Ultrasound
202
What procedure is used for gallstone retrieval?
ERCP - endoscopic retrograde cholangiopancreatography
203
What must be ruled out in patients with ascited?
Peritonitis
204
What are the three groups of intestinal obstruction?
Intraluminal
Intramural
Extraluminal
205
What is the most common histological type of colorectal cancer?
Adenocarcinoma
206
Give 5 non-infective causes of diarrhoea.
```
Inflammatory
Cancer
Irritable bowel syndrome
Chemical
Hormonal
```
207
What does untreated h. pylori increase the risk of?
Oesophageal cancer
208
Which IBD is weight loss more likely in?
Crohn's
209
Who should be screened for coeliac disease?
```
First degree relative with coeliac
Children failing to thrive
Unexpected weight loss
Type 1 diabetics
Unexplained iron, folate or b12 deficiency
```
210
What is the gold standard investigation for a parasitic infection?
Small intestine biopsy
211
What home test is used to screen for bowel cancer?
Faecal immunochemistry testing
212
What is faecal calprotectin?
A marker of gastrointestinal inflammation, such as in IBD
213
What is the first line treatment in autoimmune hepatitis?
Prednisolone
214
What is the gold standard treatment in autoimmune hepatitis?
Prednisolone and aziathropine
215
What is the pathogenesis of primary sclerosing cholangitis?
Fibrosis destroys the intrahepatic and extrahepatic ducts
216
What is the presentation of primary biliary cirrhosis?
Pruritis, jaundice, fatigue and irritable bowel symptoms
217
What is the most common cause of liver cirrhosis?
Alcohol abuse
