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GI Flashcards

1
Q

What is the difference between cholangitis and cholecystitis?

A

There is usually jaundice in cholangitis, but not in cholecystitis.

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2
Q

Give 4 sites where a hernia may be present.

A

Inguinal
Femoral
Incisional (at surgical incision site)
Umbilical

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3
Q

What do tympanic bowel sounds indicate?

A

Air in the bowel

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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

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5
Q

What antibody is associated with ulcerative colitis?

A

ANCA antibodies (p-ANCA)

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6
Q

What antibody is associated with Crohn’s?

A

ASCA antibodies

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7
Q

Which inflammatory bowel disease is granulomatous?

A

Crohn’s

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8
Q

Give 5 side effects of steroids.

A 
Weight gain 
Thinning hair 
Osteoporosis
Hyperglycaemia 
Oedema
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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
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10
Q

What is Charcot’s triad?

A

RUQ pain
Fever
Jaundice

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11
Q

What condition is Charcot’s triad seen in?

A

Ascending cholangitis

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12
Q

What is Reynold’s pentad?

A 
RUQ pain
Fever
Jaundice
Confusion 
Hypotension

(Charcot’s triad + other symptoms)

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13
Q

What type of inheritance does haemochromatosis show?

A

Autosomal recessive

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14
Q

What does slate grey or bronze pigmented skin suggest?

A

Haemochromatosis

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15
Q

Give 4 signs of haemochromatosis.

A

Stigmata of liver disease
Fatigue
Erectile dysfunction
Diabetes

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16
Q

Which gene is affected in haemochromatosis?

A

Chromosome 6

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17
Q

Describe the pain in patients suffering with appendicitis.

A

Diffuse pain around the umbilicus then concentrates to the right iliac fossa.

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18
Q

Which HLA is haemochromatosis associated with?

A

HLA-A3

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19
Q

What condition does painless jaundice suggest?

A

Pancreatic cancer

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20
Q

What condition does clay coloured stools suggest?

A

Cholangiocarcinoma

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21
Q

What causes prehepatic jaundice?

A

Haemolytic anaemia
Malaria
Reduced red blood cell lifespan
Gilbert’s syndrome

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22
Q

What type of bilirubin is high in prehepatic jaundice?

A

Unconjugated bilirubin

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23
Q

What are stools and urine like in prehepatic jaundice?

A

Normal urine and stools

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24
Q

What causes hepatic jaundice?

A

Alcoholic liver disease
Viral hepatitis
Hepatocellular carcinoma
Haemochromatosis

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25
Q

What type of bilirubin is high in hepatic jaundice?

A

Can be mixed picture

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26
Q

What causes post hepatic jaundice?

A

Gallstones
Cholangiocarcinoma
Pancreatic cancer

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27
Q

What type of bilirubin is high in post hepatic jaundice?

A

Conjugated bilirubin

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28
Q

What are stools and urine like in post hepatic jaundice?

A

Dark urine and pale stools

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29
Q

What are stools and urine like in hepatic jaundice?

A

Dark urine and pale stools

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30
Q

Which two antibodies are associated with coeliac disease?

A

IgA tissue transglutaminase (anti-tTg)

IgA anti-endomysial (EMA)

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31
Q

Which hepatitis viruses are associated with faeco-oral transmission?

A

A and E

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32
Q

Which hepatitis viruses are blood borne?

A

B, D and C

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33
Q

What features are suggestive of oesophageal cancer?

A

Progressive dysphagia and weight loss

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34
Q

Give 2 examples of a H2 receptor antagonist.

A

Cimetidine, ranitidine

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35
Q

What is the first line investigation for NAFLD?

A

LFTs

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36
Q

What is the gold standard investigation for NAFLD?

A

Liver biopsy

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37
Q

What LFT results would be seen in non-alcoholic fatty liver disease?

A

AST/ALT ratio close to 1

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38
Q

What LFT results would be seen in alcoholic liver disease?

A

AST:ALT ratio of more than 2:1

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39
Q

What condition is Murphy’s sign associated with?

A

Acute cholecystitis

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40
Q

What is Murphy’s sign?

A

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

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41
Q

What is Charcot’s triad?

A

Jaundice, RUQ pain, pyrexia

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42
Q

What condition is Charcot’s triad seen in?

A

Ascending cholangitis

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43
Q

What antibodies are seen in autoimmune hepatitis?

A

Anti-smooth muscle Ab

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44
Q

What antibodies are seen in primary biliary cholangitis?

A

Anti-mitochondrial Ab

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45
Q

What antibodies are seen in coeliac disease?

A

IgA endomysial Ab

Anti-tTG Ab

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46
Q

What is the first line treatment of haemochromatosis?

A

Phlebotomy

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47
Q

What is the second line treatment of haemochromatosis?

A

Iron chelating drugs

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48
Q

What condition is primary sclerosing cholangitis associated with?

A

Ulcerative colitis (as well as Crohn’s and hepatocellular carcinoma)

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49
Q

What is the most common first presenting symptom of MS?

A

Optic neuritis

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50
Q

What condition is alpha feto-protein primarily associated with?

A

Hepatocellular carcinoma

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51
Q

Give 5 risk factors for hepatocellular carcinoma

A

Hepatitis B/C, alcohol, diabetes, obesity, family history of liver cancer

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52
Q

What kind of virus is hepatitis C?

A

Positive sense single stranded RNA

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53
Q

What kind of virus is hepatitis B?

A

Double stranded DNA

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54
Q

What kind of virus is hepatitis A?

A

Single stranded RNA

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55
Q

What antibody indicates an acute hepatitis B infection?

A

HBsAg

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56
Q

What antibody indicates a previous or current infection?

A

Anti-HBc

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57
Q

What pattern of inheritance does alpha-1 antitrypisin deficiency show?

A

Autosomal recessive

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58
Q

How do patients with alpha-1 antitrypsin deficiency present?

A

With emphysema at an early age

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59
Q

What pattern of inheritance does von willebrand syndrome show?

A

Autosomal dominant

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60
Q

What is the first line treatment of Wilson’s disease?

A

Penicillamine (chelating agent)

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61
Q

What is the management of paracetamol overdose?

A

N-acetyl cystine

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62
Q

What drug is given to reverse an opiate overdose?

A

Naloxone

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63
Q

How does N-acetyl cystine work?

A

It restores levels of glutathione, needed to metabolise paracetamol safely

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64
Q

What are dupuytren’s contractures?

A

Progressive shortening and thickening of the palmar fascia

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65
Q

What are dupuytren’s contractures associated with?

A

Liver disease/alcohol

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66
Q

What are leukonychia?

A

White nail beds

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67
Q

What is the pain like in pancreatitis?

A

Severe epigastric pain radiating to the back

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68
Q

What LFT is raised in primary biliary cholangitis?

A

ALP

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69
Q

What antibodies are associated with primary biliary cholangitis?

A

Anti-mitochondrial antibodies

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70
Q

Give 4 upper GI bleed symptoms.

A

Melaena
Coffee ground vomit
Tachycardia
Hypotension

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71
Q

What are the causes of pancreatitis?

A

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
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72
Q

What is Horner’s syndrome?

A

A problem with sympathetic nerve supply to one side of the face

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73
Q

What are the symptoms of Horner’s syndrome?

A

Loss of sweating, drooping eyelid, dilated pupil

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74
Q

What is the main acute complication of alcohol withdrawal?

A

Seizures

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75
Q

What is the first line medication for alcohol withdrawal seizures?

A

Chlordiazepoxide

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76
Q

What vitamin is often deficient in alcohol dependent patients?

A

Vitamin B1

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77
Q

What vitamin deficiency Wernicke’s encephalopathy caused by?

A

Vitamin B1

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78
Q

What does a low serum-ascites albumin ratio indicate?

A

Ascites is not due to portal hypertension

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79
Q

What does a high serum-ascites albumin ratio indicate?

A

Ascites is due to portal hypertension

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80
Q

Give 4 causes of peritonitis.

A

Ectopic pregnancy, bowel obstruction, gastritis from h. pylori, peptic ulcer formation

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81
Q

Give 3 signs of alcoholic liver damage.

A

Raised GGT
High AST to ALT ratio
Mallory bodies on biopsy

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82
Q

What is the presentation of posthepatic jaundice?

A

Dark urine, pale stools

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83
Q

What is the presentation of hepatic jaundice?

A

Dark urine, normal stools

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84
Q

What is the presentation of prehepatic jaundice?

A

Normal urine, normal stools

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85
Q

What non-pathological factor can cause ALP to be high?

A

Being postmenopausal

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86
Q

Why can postmenopausal women have high ALP?

A

Bones are a source of ALP

- Osteoporosis in menopause can cause an increase in ALP

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87
Q

What is the classic picture of alpha-1 antitrypsin deficiency?

A

Dyspnoea, obstructive lung picture, liver disease, cholestatic jaundice

88
Q

What is the mechanism of N-acetyl cysteine?

A

Increaseses glutathione that conjugates paracetamol into non-toxic compounds

89
Q

What do both primary sclerosing cholangitis and ulcerative colitis increase the risk of?

A

Colorectal and biliary system cancers

90
Q

What complication of primary sclerosing cholangitis and ulcerative colitis is screened for annually?

A

Colorectal cancer

91
Q

What is the first line investigation for haemochromatosis?

A

Serum ferritin levels

92
Q

What disease is loss of haustrations on barium enema associated with?

A

Ulcerative colitis

93
Q

What condition are kayser-fleischer rings associated with?

A

Wilson’s disease

94
Q

What is the most appropriate step to investigate a long history of dyspepsia?

A

Upper GI endoscopy within 2 weeks

95
Q

What does a long history of dyspepsia indicate?

A

Oesophageal cancer

96
Q

What is the classic presentation of coeliac disease in a child?

A

Failure to thrive, tired all the time, family history of autoimmune conditions

97
Q

What is the gold standard investigation of coeliac disease?

A

Endoscopic intestinal biopsy

98
Q

What would an intestinal biopsy in coeliac disease show?

A

Villous atrophy, crypt hyperplasia, lymphocytes

99
Q

What is the most appropriate first line management of IBS?

A

Give dietary advice and a mild laxative (if constipated), or loperamide (for diarrhoea)

100
Q

What dietary advice is given for IBS?

A

Limit coffee and alcohol, and increase fibre intake

101
Q

What is the second line treatment of IBS?

A

Amitryptyline (tricyclic antidepressant)

102
Q

Where is an ulcer likely to be if pain improves upon eating?

A

Duodenum

103
Q

What is the most common cause of a small bowel obstruction?

A

Surgical adhesions

104
Q

What is the presentation of achalasia?

A

Dysphagia of both liquids and solids

Regurgitation (as opposed to reflux)

105
Q

What type of anaemia do colorectal cancer patients typically show?

A

Iron deficiency anaemia

106
Q

What is the most common cause of oesophageal varices?

A

Portal hypertension due to liver cirrhosis

107
Q

What is the first line mangement of h pylori?

A

Triple therapy

  • Amoxicillin
  • Clarithromycin
  • Omeprazole
108
Q

What is the second line treatment of h pylori?

A

PPI, amoxicillin and tetracycline for 7 days

109
Q

How may pancreatic pain be relieved?

A

By leaning forwards

110
Q

What features likely describe intususception?

A

Red currant jelly stools and a palpable sausage like lump in the RUQ

111
Q

Where does pain in diverticulitis most commonly occur?

A

Left lower quadrant (because the sigmoid colon is most commonly affected)

112
Q

Which IBD is granulomatous?

A

Crohn’s

113
Q

What is diverticular disease?

A

When diverticula cause symptoms?

114
Q

What is diverticulosis?

A

The presence of asymptomatic diverticula

115
Q

What is diverticulitis?

A

Inflammation of the diverticulum

116
Q

What does blood in the stools in haemorrhoids look like?

A

Not mixed in with the stools

117
Q

Where is Virchow’s node located?

A

Left supraclavicular area

118
Q

Which lymph nodes can be enlarged in breast cancer?

A

Axillary nodes

119
Q

Which lymph nodes can be enlarged in testicular or ovarian cancer?

A

Inguinal nodes

120
Q

Which cancers can cause enlarged mediastinal lymph nodes?

A

Lung cancer, Hodgkin’s lymphoma, NHL

121
Q

Where is iron absorbed?

A

Duodenum

122
Q

Where is folate absorbed?

A

Duodenum and jejenum

123
Q

Where it vitamin B12 absorbed?

A

Terminal ileum

124
Q

Is autoimmune gastritis a cause of peptic ulcers?

A

No

125
Q

Give 4 causes of peptic ulcers.

A

Mucosal ischaemia
Excessive NSAID use
H. pylori
Bile reflux

126
Q

What enzyme is needed for prostaglandin synthesis?

A

COX-1

127
Q

Where is the most common location for colorectal cancers?

A

Rectum

128
Q

What system is used to classify coeliac disease?

A

Marsh classification

129
Q

What is the Marsh classification?

A 
1 - no crypt hyperplasia
2 - crypt hyperplasia
3a - partial/mild villous atrophy
3b - subtotal/moderate villous atrophy
3c - total villous atrophy
130
Q

What gene causes inevitable familial colon cancer?

A

FAP gene (familial adenomatous polyposis)

131
Q

What is the inheritance pattern of FAP?

A

Autosomal dominant

132
Q

What is the most common dermal manifestation of IBD?

A

Erythema nodosum

133
Q

What is the gold standard test for acute pancreatitis?

A

Serum amylase

134
Q

Give 3 risk factors for haemorrhoids.

A

Obesity
Chronic constipation
Coughing

135
Q

Give 4 symptoms of haemorrhoids.

A

Fresh red blood and mucus in the stool
Itching around the anus
Soreness around the anus (external haemorrhoids)

136
Q

Give 4 red flag GI symptoms.

A

Rectal bleeding, unintentional weight loss, anaemia, age>60

137
Q

Give 5 symptoms of small bowel obstruction.

A

Vomiting, nausea, constipation, abdominal distention, abdominal pain

138
Q

What investigation is used for a h. pylori infection?

A

Urea breath test

139
Q

Give 3 differentials of gastritis.

A

Peptic ulcer disease, GORD, gastric carcinoma

140
Q

What is the pathophysiology of haemorrhoids?

A

Swelling and inflammation of veins in the rectum and anus

141
Q

Which type of haemorrhoids are painful?

A

External haemorrhoids

142
Q

What are the non-surgical managements of haemorrhoids?

A

Topical anusol, topical hydrocortisone, bulk-forming laxatives

143
Q

What are the surgical managements of haemorrhoids?

A

Band ligation, haemorrhoidectomy

144
Q

Give 3 risk factors for Crohn’s disease?

A

Family history
HLAB27
NSAIDs

145
Q

What is the gold standard investigation for IBD?

A

Endoscopy and biopsy

146
Q

What is the histological appearance of Crohn’s?

A

Increased goblet cells
Skip lesions
Transmural inflammation

147
Q

What is the histological appearance of Ulcerative colitis?

A

Decreased goblet cells
Continuous inflammation
Mucosal and submucosal inflammation only

148
Q

What drug is used in Crohn’s to induce remission?

A

Corticosteroids (with azathioprine)

149
Q

What drug is used in Crohn’s to maintain remission?

A

Azathioprine

150
Q

What is the gold standard investigation for a Mallory-Weiss tear?

A

Upper GI endoscopy

151
Q

What is the Glasgow-Blatchford score used for?

A

Determines the risk of an upper GI bleed

152
Q

What factors are considered as part of the Glasgow-Blatchford score?

A
  • Melena
  • Haemoglobin
  • Gender
  • Blood pressure
  • Tachycardia
  • History of syncope
  • History of hepatic disease
153
Q

What is the treatment of a persistently bleeding Mallory-Weiss tear?

A

Upper GI endoscopy and clipping

154
Q

What specific LFT is most raised in alcoholic fatty liver disease?

A

Raised GGT - gamma glutamyl transferase

155
Q

Which benzodiazepine is used to manage alcohol withdrawal seizures?

A

Chlordiazepoxide

156
Q

List four presentations of delirium tremens.

A

Acute confusion
Tachycardia
Hypertension
Ataxia

157
Q

What is delirium tremens?

A

A complication of alcohol withdrawal

158
Q

What is Ca 19-9 a marker for?

A

Pancreatic cancer

159
Q

What is the most appropriate initial management of a small bowel obstruction?

A

‘Drip and suck’ - nil by mouth, IV fluids, and NG tube aspiration

160
Q

What is the most appropriate initial treatment of intusussception?

A

Air enema

161
Q

What IBD is blood in the stool more likely to be seen in?

A

Ulcerative colitis

162
Q

What is the gold standard investigation of portal hypertension?

A

Hepatic venous pressure gradient

163
Q

Which part of the pancreas do most pancreatic cancers originate from?

A

Head of the pancreas

164
Q

What kind of hypersensitivity reaction is coeliac disease?

A

Type 4 hypersensitivity

165
Q

What is the pathophysiology of hepatitis?

A

Inflammation of the liver:

  • Infiltration of inflammatory cells
  • Liver necrosis
  • Chronic inflammation can lead to progressive fibrosis and necrosis
166
Q

What is the management of appendicitis?

A

Appendicectomy

  • IV antibiotics for a few days after surgery
  • Oral antibiotics for 2-4 weeks
167
Q

What is the most common presenting complaint of primary biliary cholangitis?

A

Pruritis, with or without jaundice

168
Q

What is the treatment of paracetamol overdose if the patient presents within one hour?

A

N-acetyl cysteine and activated charcoal

169
Q

Give 4 differentials of haemoptysis.

A 
Mallory-Weiss tear
Oesophageal cancer
Stomach cancer
Ruptured oesophageal varices
Peptic ulcer
170
Q

What does signs of chronic liver disease and haemoptysis suggest?

A

Oesophageal varices

171
Q

What two conditions can cause a bronze pigment to the skin?

A

Haemochromatosis

Addison’s disease

172
Q

What is Cullen’s sign?

A

Superficial oedema and bruising around the umbilicus

173
Q

What is Grey-Turner’s sign?

A

Bruising of the flank

174
Q

What condition are Cullen’s sign and Grey-Turner’s sign seen in?

A

Acute pancreatitis

175
Q

What IBD are pseudopolyps characteristic of?

A

Ulcerative colitis

176
Q

What is the gold standard investigation for a large bowel obstruction?

A

CT abdomen

177
Q

What type of pain is classic in acute diverticulitis?

A

Left iliac fossa pain

178
Q

What is a major risk factor for diverticulitis?

A

Low fibre diet

179
Q

What is the gold standard test for liver cirrhosis?

A

Liver biopsy

180
Q

What is the most specific marker for acute liver damage?

A

ALT

181
Q

Why is ALT the most specific marker for liver damage?

A

AST is also found in the heart, muscle and kidneys

182
Q

Which antibody can be present in someone who either had Hep B, or who has been vaccinated?

A

HBsAb

183
Q

Which antibody can only be present in someone who has previously had Hep B?

A

HBcAb

184
Q

Which antigens circulate in acute hepatitis?

A

HBsAg and HBeAg

185
Q

Which antigens circulate in chronic hepatitis?

A

HBsAg only

186
Q

What tests other than endoscopy and biopsy can be performed for IBD?

A

Faecal calprotectin - will be raised
CRP/ESR
Full blood count to look for anaemia

187
Q

What type of drug is aziathropine?

A

Immunosuppressant

188
Q

What complication of an upper GI obstruction would lead to emergency surgery?

A

Bowel ischaemia or strangulation

189
Q

Give 4 complications of diverticulitis.

A

Large bowel obstruction
Large bowel perforation
Fistula formation
Bleeding

190
Q

What drug can be used to control variceal bleeding?

A

IV terlipressin

191
Q

What is the gold standard investigation for acute appendicitis?

A

CT abdomen

192
Q

Which hepatitis cannot be vaccinated against?

A

Hepatitis C

193
Q

What is Rovsing’s sign?

A

Palpating the left iliac fossa will cause pain in the right iliac fossa

194
Q

What condition is Rovsing’s sign seen in?

A

Appendicitis

195
Q

What condition is Murphy’s sign seen in?

A

Acute cholecystitis

196
Q

Which IBD is the risk of colorectal cancer higher in?

A

Ulcerative colitis

197
Q

Give 4 complications of Crohn’s disease.

A

Obstruction
Gallstones
Fistula
Colorectal cancer

198
Q

What mutation is seen in Wilson’s disease?

A

ATP7B mutation on chromosome 13

199
Q

Give 6 physical manifestations of liver disease.

A 
Ascites
Caput medusae
Hepatomegaly
Splenomegaly 
Peripheral oedema 
Spider naevi
200
Q

Give 4 causes of acute liver injury.

A

Alcohol
Viral hepatitis
Drugs
Obstruction - stones

201
Q

What is the first line imaging for gallstone?

A

Ultrasound

202
Q

What procedure is used for gallstone retrieval?

A

ERCP - endoscopic retrograde cholangiopancreatography

203
Q

What must be ruled out in patients with ascited?

A

Peritonitis

204
Q

What are the three groups of intestinal obstruction?

A

Intraluminal
Intramural
Extraluminal

205
Q

What is the most common histological type of colorectal cancer?

A

Adenocarcinoma

206
Q

Give 5 non-infective causes of diarrhoea.

A 
Inflammatory
Cancer
Irritable bowel syndrome
Chemical
Hormonal
207
Q

What does untreated h. pylori increase the risk of?

A

Oesophageal cancer

208
Q

Which IBD is weight loss more likely in?

A

Crohn’s

209
Q

Who should be screened for coeliac disease?

A 
First degree relative with coeliac
Children failing to thrive
Unexpected weight loss
Type 1 diabetics
Unexplained iron, folate or b12 deficiency
210
Q

What is the gold standard investigation for a parasitic infection?

A

Small intestine biopsy

211
Q

What home test is used to screen for bowel cancer?

A

Faecal immunochemistry testing

212
Q

What is faecal calprotectin?

A

A marker of gastrointestinal inflammation, such as in IBD

213
Q

What is the first line treatment in autoimmune hepatitis?

A

Prednisolone

214
Q

What is the gold standard treatment in autoimmune hepatitis?

A

Prednisolone and aziathropine

215
Q

What is the pathogenesis of primary sclerosing cholangitis?

A

Fibrosis destroys the intrahepatic and extrahepatic ducts

216
Q

What is the presentation of primary biliary cirrhosis?

A

Pruritis, jaundice, fatigue and irritable bowel symptoms

217
Q

What is the most common cause of liver cirrhosis?

A

Alcohol abuse

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