GI Flashcards
What is the difference between cholangitis and cholecystitis?
There is usually jaundice in cholangitis, but not in cholecystitis.
Give 4 sites where a hernia may be present.
Inguinal
Femoral
Incisional (at surgical incision site)
Umbilical
What do tympanic bowel sounds indicate?
Air in the bowel
What factors would you consider when deciding whether to resect a tumour?
Age of patient
Metastases/how the tumour has spread
Co-morbidities
Is the cancer resectable
What antibody is associated with ulcerative colitis?
ANCA antibodies (p-ANCA)
What antibody is associated with Crohn’s?
ASCA antibodies
Which inflammatory bowel disease is granulomatous?
Crohn’s
Give 5 side effects of steroids.
Weight gain Thinning hair Osteoporosis Hyperglycaemia Oedema
Give 5 functions of the stomach.
Regulates empyting into the duodenum Digests food Secretes intrinsic factor Secretes acid Secretes and activates proteases
What is Charcot’s triad?
RUQ pain
Fever
Jaundice
What condition is Charcot’s triad seen in?
Ascending cholangitis
What is Reynold’s pentad?
RUQ pain Fever Jaundice Confusion Hypotension
(Charcot’s triad + other symptoms)
What type of inheritance does haemochromatosis show?
Autosomal recessive
What does slate grey or bronze pigmented skin suggest?
Haemochromatosis
Give 4 signs of haemochromatosis.
Stigmata of liver disease
Fatigue
Erectile dysfunction
Diabetes
Which gene is affected in haemochromatosis?
Chromosome 6
Describe the pain in patients suffering with appendicitis.
Diffuse pain around the umbilicus then concentrates to the right iliac fossa.
Which HLA is haemochromatosis associated with?
HLA-A3
What condition does painless jaundice suggest?
Pancreatic cancer
What condition does clay coloured stools suggest?
Cholangiocarcinoma
What causes prehepatic jaundice?
Haemolytic anaemia
Malaria
Reduced red blood cell lifespan
Gilbert’s syndrome
What type of bilirubin is high in prehepatic jaundice?
Unconjugated bilirubin
What are stools and urine like in prehepatic jaundice?
Normal urine and stools
What causes hepatic jaundice?
Alcoholic liver disease
Viral hepatitis
Hepatocellular carcinoma
Haemochromatosis
What type of bilirubin is high in hepatic jaundice?
Can be mixed picture
What causes post hepatic jaundice?
Gallstones
Cholangiocarcinoma
Pancreatic cancer
What type of bilirubin is high in post hepatic jaundice?
Conjugated bilirubin
What are stools and urine like in post hepatic jaundice?
Dark urine and pale stools
What are stools and urine like in hepatic jaundice?
Dark urine and pale stools
Which two antibodies are associated with coeliac disease?
IgA tissue transglutaminase (anti-tTg)
IgA anti-endomysial (EMA)
Which hepatitis viruses are associated with faeco-oral transmission?
A and E
Which hepatitis viruses are blood borne?
B, D and C
What features are suggestive of oesophageal cancer?
Progressive dysphagia and weight loss
Give 2 examples of a H2 receptor antagonist.
Cimetidine, ranitidine
What is the first line investigation for NAFLD?
LFTs
What is the gold standard investigation for NAFLD?
Liver biopsy
What LFT results would be seen in non-alcoholic fatty liver disease?
AST/ALT ratio close to 1
What LFT results would be seen in alcoholic liver disease?
AST:ALT ratio of more than 2:1
What condition is Murphy’s sign associated with?
Acute cholecystitis
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
What is Charcot’s triad?
Jaundice, RUQ pain, pyrexia
What condition is Charcot’s triad seen in?
Ascending cholangitis
What antibodies are seen in autoimmune hepatitis?
Anti-smooth muscle Ab
What antibodies are seen in primary biliary cholangitis?
Anti-mitochondrial Ab
What antibodies are seen in coeliac disease?
IgA endomysial Ab
Anti-tTG Ab
What is the first line treatment of haemochromatosis?
Phlebotomy
What is the second line treatment of haemochromatosis?
Iron chelating drugs
What condition is primary sclerosing cholangitis associated with?
Ulcerative colitis (as well as Crohn’s and hepatocellular carcinoma)
What is the most common first presenting symptom of MS?
Optic neuritis
What condition is alpha feto-protein primarily associated with?
Hepatocellular carcinoma
Give 5 risk factors for hepatocellular carcinoma
Hepatitis B/C, alcohol, diabetes, obesity, family history of liver cancer
What kind of virus is hepatitis C?
Positive sense single stranded RNA
What kind of virus is hepatitis B?
Double stranded DNA
What kind of virus is hepatitis A?
Single stranded RNA
What antibody indicates an acute hepatitis B infection?
HBsAg
What antibody indicates a previous or current infection?
Anti-HBc
What pattern of inheritance does alpha-1 antitrypisin deficiency show?
Autosomal recessive
How do patients with alpha-1 antitrypsin deficiency present?
With emphysema at an early age
What pattern of inheritance does von willebrand syndrome show?
Autosomal dominant
What is the first line treatment of Wilson’s disease?
Penicillamine (chelating agent)
What is the management of paracetamol overdose?
N-acetyl cystine
What drug is given to reverse an opiate overdose?
Naloxone
How does N-acetyl cystine work?
It restores levels of glutathione, needed to metabolise paracetamol safely
What are dupuytren’s contractures?
Progressive shortening and thickening of the palmar fascia
What are dupuytren’s contractures associated with?
Liver disease/alcohol
What are leukonychia?
White nail beds
What is the pain like in pancreatitis?
Severe epigastric pain radiating to the back
What LFT is raised in primary biliary cholangitis?
ALP
What antibodies are associated with primary biliary cholangitis?
Anti-mitochondrial antibodies
Give 4 upper GI bleed symptoms.
Melaena
Coffee ground vomit
Tachycardia
Hypotension
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
What is Horner’s syndrome?
A problem with sympathetic nerve supply to one side of the face
What are the symptoms of Horner’s syndrome?
Loss of sweating, drooping eyelid, dilated pupil
What is the main acute complication of alcohol withdrawal?
Seizures
What is the first line medication for alcohol withdrawal seizures?
Chlordiazepoxide
What vitamin is often deficient in alcohol dependent patients?
Vitamin B1
What vitamin deficiency Wernicke’s encephalopathy caused by?
Vitamin B1
What does a low serum-ascites albumin ratio indicate?
Ascites is not due to portal hypertension
What does a high serum-ascites albumin ratio indicate?
Ascites is due to portal hypertension
Give 4 causes of peritonitis.
Ectopic pregnancy, bowel obstruction, gastritis from h. pylori, peptic ulcer formation
Give 3 signs of alcoholic liver damage.
Raised GGT
High AST to ALT ratio
Mallory bodies on biopsy
What is the presentation of posthepatic jaundice?
Dark urine, pale stools
What is the presentation of hepatic jaundice?
Dark urine, normal stools
What is the presentation of prehepatic jaundice?
Normal urine, normal stools
What non-pathological factor can cause ALP to be high?
Being postmenopausal
Why can postmenopausal women have high ALP?
Bones are a source of ALP
- Osteoporosis in menopause can cause an increase in ALP
What is the classic picture of alpha-1 antitrypsin deficiency?
Dyspnoea, obstructive lung picture, liver disease, cholestatic jaundice
What is the mechanism of N-acetyl cysteine?
Increaseses glutathione that conjugates paracetamol into non-toxic compounds
What do both primary sclerosing cholangitis and ulcerative colitis increase the risk of?
Colorectal and biliary system cancers
What complication of primary sclerosing cholangitis and ulcerative colitis is screened for annually?
Colorectal cancer
What is the first line investigation for haemochromatosis?
Serum ferritin levels
What disease is loss of haustrations on barium enema associated with?
Ulcerative colitis
What condition are kayser-fleischer rings associated with?
Wilson’s disease
What is the most appropriate step to investigate a long history of dyspepsia?
Upper GI endoscopy within 2 weeks
What does a long history of dyspepsia indicate?
Oesophageal cancer
What is the classic presentation of coeliac disease in a child?
Failure to thrive, tired all the time, family history of autoimmune conditions
What is the gold standard investigation of coeliac disease?
Endoscopic intestinal biopsy
What would an intestinal biopsy in coeliac disease show?
Villous atrophy, crypt hyperplasia, lymphocytes
What is the most appropriate first line management of IBS?
Give dietary advice and a mild laxative (if constipated), or loperamide (for diarrhoea)
What dietary advice is given for IBS?
Limit coffee and alcohol, and increase fibre intake
What is the second line treatment of IBS?
Amitryptyline (tricyclic antidepressant)
Where is an ulcer likely to be if pain improves upon eating?
Duodenum
What is the most common cause of a small bowel obstruction?
Surgical adhesions
What is the presentation of achalasia?
Dysphagia of both liquids and solids
Regurgitation (as opposed to reflux)
What type of anaemia do colorectal cancer patients typically show?
Iron deficiency anaemia
What is the most common cause of oesophageal varices?
Portal hypertension due to liver cirrhosis
What is the first line mangement of h pylori?
Triple therapy
- Amoxicillin
- Clarithromycin
- Omeprazole
What is the second line treatment of h pylori?
PPI, amoxicillin and tetracycline for 7 days
How may pancreatic pain be relieved?
By leaning forwards
What features likely describe intususception?
Red currant jelly stools and a palpable sausage like lump in the RUQ
Where does pain in diverticulitis most commonly occur?
Left lower quadrant (because the sigmoid colon is most commonly affected)
Which IBD is granulomatous?
Crohn’s
What is diverticular disease?
When diverticula cause symptoms?
What is diverticulosis?
The presence of asymptomatic diverticula
What is diverticulitis?
Inflammation of the diverticulum
What does blood in the stools in haemorrhoids look like?
Not mixed in with the stools
Where is Virchow’s node located?
Left supraclavicular area
Which lymph nodes can be enlarged in breast cancer?
Axillary nodes
Which lymph nodes can be enlarged in testicular or ovarian cancer?
Inguinal nodes
Which cancers can cause enlarged mediastinal lymph nodes?
Lung cancer, Hodgkin’s lymphoma, NHL
Where is iron absorbed?
Duodenum
Where is folate absorbed?
Duodenum and jejenum
Where it vitamin B12 absorbed?
Terminal ileum
Is autoimmune gastritis a cause of peptic ulcers?
No
Give 4 causes of peptic ulcers.
Mucosal ischaemia
Excessive NSAID use
H. pylori
Bile reflux
What enzyme is needed for prostaglandin synthesis?
COX-1
Where is the most common location for colorectal cancers?
Rectum
What system is used to classify coeliac disease?
Marsh classification
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
What gene causes inevitable familial colon cancer?
FAP gene (familial adenomatous polyposis)
What is the inheritance pattern of FAP?
Autosomal dominant
What is the most common dermal manifestation of IBD?
Erythema nodosum
What is the gold standard test for acute pancreatitis?
Serum amylase
Give 3 risk factors for haemorrhoids.
Obesity
Chronic constipation
Coughing
Give 4 symptoms of haemorrhoids.
Fresh red blood and mucus in the stool
Itching around the anus
Soreness around the anus (external haemorrhoids)
Give 4 red flag GI symptoms.
Rectal bleeding, unintentional weight loss, anaemia, age>60
Give 5 symptoms of small bowel obstruction.
Vomiting, nausea, constipation, abdominal distention, abdominal pain
What investigation is used for a h. pylori infection?
Urea breath test
Give 3 differentials of gastritis.
Peptic ulcer disease, GORD, gastric carcinoma
What is the pathophysiology of haemorrhoids?
Swelling and inflammation of veins in the rectum and anus
Which type of haemorrhoids are painful?
External haemorrhoids
What are the non-surgical managements of haemorrhoids?
Topical anusol, topical hydrocortisone, bulk-forming laxatives
What are the surgical managements of haemorrhoids?
Band ligation, haemorrhoidectomy
Give 3 risk factors for Crohn’s disease?
Family history
HLAB27
NSAIDs
What is the gold standard investigation for IBD?
Endoscopy and biopsy
What is the histological appearance of Crohn’s?
Increased goblet cells
Skip lesions
Transmural inflammation
What is the histological appearance of Ulcerative colitis?
Decreased goblet cells
Continuous inflammation
Mucosal and submucosal inflammation only
What drug is used in Crohn’s to induce remission?
Corticosteroids (with azathioprine)
What drug is used in Crohn’s to maintain remission?
Azathioprine
What is the gold standard investigation for a Mallory-Weiss tear?
Upper GI endoscopy
What is the Glasgow-Blatchford score used for?
Determines the risk of an upper GI bleed
What factors are considered as part of the Glasgow-Blatchford score?
- Melena
- Haemoglobin
- Gender
- Blood pressure
- Tachycardia
- History of syncope
- History of hepatic disease
What is the treatment of a persistently bleeding Mallory-Weiss tear?
Upper GI endoscopy and clipping
What specific LFT is most raised in alcoholic fatty liver disease?
Raised GGT - gamma glutamyl transferase
Which benzodiazepine is used to manage alcohol withdrawal seizures?
Chlordiazepoxide
List four presentations of delirium tremens.
Acute confusion
Tachycardia
Hypertension
Ataxia
What is delirium tremens?
A complication of alcohol withdrawal
What is Ca 19-9 a marker for?
Pancreatic cancer
What is the most appropriate initial management of a small bowel obstruction?
‘Drip and suck’ - nil by mouth, IV fluids, and NG tube aspiration
What is the most appropriate initial treatment of intusussception?
Air enema
What IBD is blood in the stool more likely to be seen in?
Ulcerative colitis
What is the gold standard investigation of portal hypertension?
Hepatic venous pressure gradient
Which part of the pancreas do most pancreatic cancers originate from?
Head of the pancreas
What kind of hypersensitivity reaction is coeliac disease?
Type 4 hypersensitivity
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
What is the management of appendicitis?
Appendicectomy
- IV antibiotics for a few days after surgery
- Oral antibiotics for 2-4 weeks
What is the most common presenting complaint of primary biliary cholangitis?
Pruritis, with or without jaundice
What is the treatment of paracetamol overdose if the patient presents within one hour?
N-acetyl cysteine and activated charcoal
Give 4 differentials of haemoptysis.
Mallory-Weiss tear Oesophageal cancer Stomach cancer Ruptured oesophageal varices Peptic ulcer
What does signs of chronic liver disease and haemoptysis suggest?
Oesophageal varices
What two conditions can cause a bronze pigment to the skin?
Haemochromatosis
Addison’s disease
What is Cullen’s sign?
Superficial oedema and bruising around the umbilicus
What is Grey-Turner’s sign?
Bruising of the flank
What condition are Cullen’s sign and Grey-Turner’s sign seen in?
Acute pancreatitis
What IBD are pseudopolyps characteristic of?
Ulcerative colitis
What is the gold standard investigation for a large bowel obstruction?
CT abdomen
What type of pain is classic in acute diverticulitis?
Left iliac fossa pain
What is a major risk factor for diverticulitis?
Low fibre diet
What is the gold standard test for liver cirrhosis?
Liver biopsy
What is the most specific marker for acute liver damage?
ALT
Why is ALT the most specific marker for liver damage?
AST is also found in the heart, muscle and kidneys
Which antibody can be present in someone who either had Hep B, or who has been vaccinated?
HBsAb
Which antibody can only be present in someone who has previously had Hep B?
HBcAb
Which antigens circulate in acute hepatitis?
HBsAg and HBeAg
Which antigens circulate in chronic hepatitis?
HBsAg only
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
What type of drug is aziathropine?
Immunosuppressant
What complication of an upper GI obstruction would lead to emergency surgery?
Bowel ischaemia or strangulation
Give 4 complications of diverticulitis.
Large bowel obstruction
Large bowel perforation
Fistula formation
Bleeding
What drug can be used to control variceal bleeding?
IV terlipressin
What is the gold standard investigation for acute appendicitis?
CT abdomen
Which hepatitis cannot be vaccinated against?
Hepatitis C
What is Rovsing’s sign?
Palpating the left iliac fossa will cause pain in the right iliac fossa
What condition is Rovsing’s sign seen in?
Appendicitis
What condition is Murphy’s sign seen in?
Acute cholecystitis
Which IBD is the risk of colorectal cancer higher in?
Ulcerative colitis
Give 4 complications of Crohn’s disease.
Obstruction
Gallstones
Fistula
Colorectal cancer
What mutation is seen in Wilson’s disease?
ATP7B mutation on chromosome 13
Give 6 physical manifestations of liver disease.
Ascites Caput medusae Hepatomegaly Splenomegaly Peripheral oedema Spider naevi
Give 4 causes of acute liver injury.
Alcohol
Viral hepatitis
Drugs
Obstruction - stones
What is the first line imaging for gallstone?
Ultrasound
What procedure is used for gallstone retrieval?
ERCP - endoscopic retrograde cholangiopancreatography
What must be ruled out in patients with ascited?
Peritonitis
What are the three groups of intestinal obstruction?
Intraluminal
Intramural
Extraluminal
What is the most common histological type of colorectal cancer?
Adenocarcinoma
Give 5 non-infective causes of diarrhoea.
Inflammatory Cancer Irritable bowel syndrome Chemical Hormonal
What does untreated h. pylori increase the risk of?
Oesophageal cancer
Which IBD is weight loss more likely in?
Crohn’s
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
What is the gold standard investigation for a parasitic infection?
Small intestine biopsy
What home test is used to screen for bowel cancer?
Faecal immunochemistry testing
What is faecal calprotectin?
A marker of gastrointestinal inflammation, such as in IBD
What is the first line treatment in autoimmune hepatitis?
Prednisolone
What is the gold standard treatment in autoimmune hepatitis?
Prednisolone and aziathropine
What is the pathogenesis of primary sclerosing cholangitis?
Fibrosis destroys the intrahepatic and extrahepatic ducts
What is the presentation of primary biliary cirrhosis?
Pruritis, jaundice, fatigue and irritable bowel symptoms
What is the most common cause of liver cirrhosis?
Alcohol abuse
