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Things I don't know, but need to know, for fourth year > GI > Flashcards

GI Flashcards

1
Q

List some negative prognostic factors of pancreatitis.

A 
Over 55
hypocalcaemia
Hyperglycaemia
Hypoxia
Neutrophilia
increased LDH
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2
Q

How can a diagnosis of Pancreatitis be made?

A

Imaging USS or CT

Or clinical diagnosis + 3x increase in amylase or lipase

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3
Q

In Pancreatitis which is more specific Amylase or Lipase

A

Lipase - it also has a longer half life so can be used in delayed presentation.

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4
Q

How long must someone have been of PPI before having a urease breath test

A

2 weeks

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5
Q

How long must someone have not had antibiotics prior to a urease breath test?

A

4 weeks

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6
Q

What is used in the management of ascites?

A

Spironolactone

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7
Q

What is an indication for a Liver transplant in a paracetamol overdose?

A

pH <7.3 after 24 hours

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8
Q

HNPCC

A

Right sided colonic lesions

Less frequent polyps then found in FAP

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9
Q

What criteria must be met in order to be diagnosed with HNPCC?

A

3 relatives with HNPCC lesions
2 Succesive Generations
1 < 50 years old

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10
Q

Melanosis Coli

A

laxative abuse

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11
Q

Management of severe Campylobacter or someone who is immunosuppressed with mild symptoms

A

Clarithromycin

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12
Q

If someone is unable to tolerate a Colonoscopy in a suspected cancer what can be used?

A

CT

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13
Q

Once a diagnosis of Colon Cancer is given. What other investigations should be done?

A

CT Chest Abdo Pelvis - Staging

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14
Q

What is the imaging modality of choice in Rectal Carcinoma?

A

MRI or USS

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15
Q

In a perforated duodenal ulcer what artery is likely to have been affected?

A

Gastroduodenal artery

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16
Q

A serum Albumin Ascites Gradient of over 11 generally means what?

A 
Portal Hypertension
Cirrhoiss
Liver failure
Liver metastase
Budd Chiari
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17
Q

A serum albumin ascites gradient SAAG <11 means what?

A 
Nephrotic 
Malutrition
Pancreatitis
TB
Peritoneal Carcinoma
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18
Q

Management of Ascites

A

Fluid restriction if Na ,125
Spironolactone +/- loop
Drainage + albumin cover

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19
Q

In uncontrolled variceal bleeding that has failed to respond to endoscopic banding what is the next treatment?

A

Sengotaken Blakemore Tube

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20
Q

Anti Emetics - 1,2,3

A 
1 = H1 receptor antagonist Cyclizine -intracranial causes - brain tumours 
2 =  D2 receptor Antagonist Metaclopramide - Good for chemotherapy induced 
3 = 5HT-3 receptor antagonist Odansetron - good for chemically mediated nausea
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21
Q

C.Diff - management

A

Oral vancomycin -> Oral Findaxomicin -> Oral Vancomycin + IV Metronidazole

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22
Q

C. Diff reinfection - management

A

<12 weeks - Oral Findaxomycin

>12 weeks - Oral vancomycin or findaxomycin

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23
Q

Ischaemic Colitis vs Mesenteric ischaemia

A

IC - Large bowel, less severe, transient - managed conservatively, NBM, thrombolysis
MI - Small bowel, Severe acute pain - surgical emergency

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24
Q

Investigations for Ischaemic colitis

A

Serum Lactate
X ray - thumbprinting
CT scan - gold standard

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25
Q

When is Ischaemic colitis managed surgically?

A

Failure of conservative methods

Perforation

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26
Q

Commonest site of ischaemia in the bowel?

A

Splenic flexture

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27
Q

Grading C.Diff

A

Mild - normal WBC
Moderate - WBC <15 + 3-5 stools
Severe - WBC >15 or temp >38.5
Life threatening - Hypotension, Megacolon, Ileus

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28
Q

When are azathioprine or mercaptopurine used in UC?

A

For remission if >2 admissions for UC in a year.

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29
Q

What is used in the secondary prevention of hepatic encephalopathy?

A

Lactulose

Rifaximin

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30
Q

Oesophageal cancer diagnoses

A

Endoscopic Biopsy
USS- localised staging
CT - staging

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31
Q

Oesophageal cancer diagnoses

A

Endoscopic Biopsy
USS- localised staging
CT - staging

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32
Q

Crohns Management

A

Flare up
Steroids -> 5ASA -> Azathioprine -> Infliximab
Maintain Remission
Stop smoking + Azathioprine or Mercaptopurine

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33
Q

What is used in spontaneous bacterial peritonitis prophylaxis management?

A

Co-Trimoxazole

Ciprofloxacin

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34
Q

Management of Dyspespia with no red flags

A

Medication review

Lifestyle changes

1 month PPI trial -> no improvement test for H.Pylori
or
Test for H.Pylori first -> if negative trial PPI

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35
Q

Hepatitis D

A

Co infects with Hepatitis B - same speed via bodily fluids

Superinfection - Chronic Hep B with a new acute Hep D = fulminant hepatitis cirrhosis

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36
Q

How is hepatitis D treated?

A

Interferron - not very successful

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37
Q

1-6 day incubation period
Headache malaise appendicitis like pain
Diarrhoea +/- blood

A

Campylobacter

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38
Q

Virchows node - left supraclavicular

Sister Mary Joseph nodule - periumbilical node

A

Gastric carcinoma

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39
Q

Gold standard imaging for Pancreatitis

A

CT with IV contrast

x- Ray will show some calcification

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40
Q

What can be used to work out exocrine function of the pancreas

A

Faecal elastase

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41
Q

How long does it take most people with chronic pancreatitis to develop diabetes?

A

20 years

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42
Q

H. Pylori - Management

A

1st line Amox + PPI + Metronidazole/Clarithromycin
- pen allergic - Clarithromycin + PPI + Metronidizaole
2nd line - PPI (BD) + Amoxicillin + Metronidazole/Clarithromycin ( one you didn’t use last time)

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43
Q

Perianal Fistula

A

Crohns
MRI is diagnostic investigation
Oral Metronidazole -> infliximab help close
Draining Seton for complex fistulae

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44
Q

Perianal Abscess

A

Incision and drainage is key management

Draining seton if tract is identified

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45
Q

Commonest cause of Hepatocellular carcinoma

A

Hep C in Europe

Hep B worldwide

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46
Q

What is the main risk factor for developing Hepatocellular carcinoma ?

A

Cirrhosis - hepatitis, alcohol, heamochromatosis

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47
Q

Signs and management of a hepatocellular carcinoma.

A

Late onset features - cirrhosis jaundice ascites RUQ pain
Raised AFP

Surgical excision if small -> radio frequency ablation -> embolisation -> liver transplant

48
Q

Sweet focal smelling breath can indicate what?

A

Liver failure

Fetor Hepaticus

49
Q

How can C.Diff appear on endoscopy?

A

Yellow plaques on wall

Pseudomembranous colitis

50
Q

How are thrombosed haemorrhoids managed?

A

<72 hours since start - consider surgery

>72 hours since started - analgesia stool softener and ice pack

50
Q

How are thrombosed haemorrhoids managed?

A

<72 hours since start - consider surgery

>72 hours since started - analgesia stool softener and ice pack

51
Q 
Middle aged woman 
AMA A2 +ve
Anti smooth muscle antibodies +ve
IgM increase
Jaundice Fatigue pruritic RUQ pain
A

Primary Biliary Cholangitis

52
Q

Management of PBC

A

Ursedeoxycholic acid - even in asymptomatic if LFTs show change use it
Cholestyramine - use for pruritis
Fat soluble vitamins supplements
Liver transplant - bilirubin > 100

53
Q

What are the two types of haemorrhoids?

A

External - Below dentate line - painful and thrombose

Internal - above dentate line - painless

54
Q

How do you classify haemorrhoids?

A

Type 1 - don’t prolapse
Type 2 - prolapse out but spontaneously reduce
Type 3 - prolapse out but need manually reducing
Type 4 - None reducible haemorrhoids

55
Q

Management of non thrombosed haemorrhoids.

A

Stool softener -> topical anaesthetic + steroid
Outpatient clinic - Band ligation is better that scleropathy
Surgical - large symptomatic that haven’t responded to treatment.

56
Q

Pain in duodenal ulcers

A

Worse on hunger

Relieved by eating

57
Q

Globus + no red flags + occasional hoarse voice + Posterior pharynx erythema + cough + heartburn

A

Laryngopharyngeal reflux - silent reflux

Lifestyle advice + PPI + gaviscon

58
Q 
Younger woman
Amenorrhoea 
Hepatitis picture - chronic or acute 
Raised IgG
Piecemeal necrosis on biopsy
A

Autoimmune hepatits

59
Q

Management of autoimmune hepatitis

A

Steroid + immunosuppression

Liver transplant

60
Q

What antibodies may be positive in autoimmune hepatitis

A

ANA

Anti smooth muscle antibody

61
Q

Hamartomatous Polyps in small Bowel - obstruction, intususseption, bleeding
Pigmented lesions on lips hands and feet

A

Peutz Jeghers syndrome
Conservative management only
Polyps don’t have malignant potential once formed, but increase cell turn over increases risk of cancer developing.

62
Q

A positive psoas sign (pain on hip extension) in a query appendicitis may indicate what?

A

Retrocaecel appendix

63
Q

Management of acute cholecystitis

A

IV antibiotics + analgesia +fluids + anti emetic

Laparoscopic cholecystectomy within a week

64
Q

Ground glass cytoplasm in hepatocytes indicates what?

A

Chronic Hepatitis B

65
Q

If someone has not eaten anything in over five days how should there nutrition be managed?

A

Start off with less than 50% of calories and protein.

66
Q

What is first line for constipation in IBS?

A

Isphagula Husk

67
Q

History of farming
Middle East
Increased eosinophils
USS shows daughter cysts

A

Hydatid cyst

Surgery to remove capsule whole

68
Q

Why is a CT important if you aren’t certain on the diagnosis in liver cysts?

A

As rupturing the cyst, during USS guided biopsy, in a hydatid cyst can result in anaphylaxis.

69
Q

What is the most commonly used indicator that an NG tube is placed correctly?

A

Aspirate pH is below 5.3

70
Q

Obstructive defecation with a normal PR and barium enema.

History of childbirth

A

Rectal Intussusception

Defecating proctogram is imaging of choice

71
Q

What is the most sensitive indicator of liver failure seen on bloods?

A

Thrombocytopenia

72
Q

What management is sometimes used in children with a crohns flair up?

A

Enteral feeding with an elemental diet - avoid the side effects of steroids

73
Q

Primary Sclerosing Cholangitits

A

Raised ALP and Bilirubin, RUQ pain, Fatigue

USS-> MRCP or if unable to tolerate MRCP i.e metal plates ERCP is diagnostic
Looking for a beaded appearance

74
Q

Reasons for an urgent 2 week cancer referral.

A

> 40 + unexplained weight loss and abdominal pain
50 + unexplained rectal bleeding
60 + iron deficiency anaemia or change in bowel habits

75
Q

FIT test

A

Screening 50-74 years every two years. Can be requested over 75
FIT test should be used if you are suspicious but they don’t meet the criteria for the 2 week cancer referral.

76
Q

Diagnosis in acute IBD

A

Due to increased risk of perforation CT or flexible sigmoidoscopy is used ( no bowel prep)
Abdo and chest X ray needed swell

77
Q

Acute Pancreatitis management

A 
Aggressive fluid resuscitation 
Analgesia is opiods
Nutrition - not Nil By Mouth 
               - enteral nutrition if moderate or severe -> parenteral if needed
Antibiotics - no prophylaxis is given
78
Q

Budd Chiari - diagnosis

A

Sudden Abdominal pain + Ascites + Tender hepatosplenomegaly

USS doppler is first line

79
Q

Investigation of choice in Boerhaaves

A

CT contrast swallow

80
Q

Where is folate absorbed?

A

Duodenum and proximal jejunum

81
Q

Where is B12 absorbed?

A

Distal Ileum

82
Q

What is used to monitor someone at risk of developing Type 2 DM?

A

Yearly Hb1AC

83
Q

Management of pancreatic pseudocyst

A

Conservative is first line

Endoscopic or open surgery if - infected, mass effect, >12 week duration

84
Q

Management of sterile pancreatic necrosis

A

Conservative

85
Q

Drug Induced Pancreatitis

FATSHEEP

A 
Furosemide
Azathioprine 
Thiazide/Tetracyline
Statins Sulphonamides Sodium Valproate
Hydrochlorothian
Estrogen
Ethanol
Protease inhibitors
86
Q

Why should B12 be given before folate in someone who is deficient?

A

As giving it the other way around can trigger subacute combined degeneration of the spinal chord

87
Q

Progressive renal failure in those with liver cirrhosis - generally triggered by an acute event i.e variceal bleed.

A

Hepatorenal syndrome
Type 1 = rapidly progressive <2 weeks - very poor prognosis
Type 2 = Slowly progressive >2 weeks - poor prognosis

88
Q 
Ascites
Jaundice
AKI
No proteinuria or haematuria
Hx of liver cirrhosis
A

Hepatorenal syndrome

89
Q

Management of hepatorenal syndrome

A

Management - terlipressin and volume expansion with 20% albumin
Liver transplant - usually to ill to undergo the surgery

90
Q

Small Bowel Overgrowth Syndrome - managment

A

Rifaximin

91
Q

What is the characteristic sign of a pancreatic cancer on CT or USS

A

Double Duct sign

Both ducts are dilated

92
Q

What criteria make it a severe UC flair up?

A

> 37.8 degrees
90bpm
anaemia <105
ESR >30

93
Q

Long term management of pernicious anaemia

A

life long replacement with Cobalamin (B12)

94
Q

Prophylaxis in ascites

A

Oral Ciprofloxacin or Norfloxacin
SAAG <15
1 episode of SBP
Hepatorenal syndrome

95
Q

Chronic ascites

A

Restrict dietary sodium

Repeat therapeutic ascitic drains

96
Q

Pigmented gallstones could indicate what?

A

Increased haemolysis i.e sickle cell G6PD etc

97
Q

Indications for dialysis in a patient with a high urea

A

Encephalitis - signs of confusion reduced consciousness etc

Uraemic pericarditis

98
Q

Genes associated with FAP and HNPCC

A

FAP - APC

HNPCC - MSH2 MLH1

99
Q

Sigmoid Volvulus Management

A

Flexible sigmoidoscopy + rectal tube insertion

Laparoscopy if peritonitis or failure of sigmoidoscopy

100
Q

Caecal Volvulus

A

Any age - link to adhesions and pregnancy
Presents with small bowel obstruction
Surgical management - right hemicolectomy

101
Q

Autoimmune hepatitis

A

Type 1 - IgG increased

Type 2 - IgG increased IgA decreased + children only

102
Q

Salmonella incubation time

A

12-48 hours

103
Q

Shigella incubation time

A

48-72 hours

104
Q

Campylobacter incubation time

A

48-72 hours

105
Q

Amoebesis incubation time

A

Long incubation time
Profuse bloody diarrhoea
Trophozotes

106
Q

Modified Glasgow Score - negative prognosis for pancreatitis

A 
Pa02 < 8
Age >55
Neutrophilia >15 WCC
Calcium <2
Renal urea >16
Elevated liver enzyme - AST >200 LDH >600
Albumin <32
Sugar >10

PANCREAS

107
Q

When testing someones Anti TTG if they are deficient in IgA what is the next test that should be used?

A

IgG Anti TTG

108
Q

Management of barrets oesophagus

A

PPI

Plus endoscopic monitoring every 3-5 years

109
Q

2 week referral to oral surgery

A

Unexplained oral ulceration >3 weeks
Unexplained one sided pain within head + ear ache + > 4weeks + normal otoscopy
Unexplained persistent or sore throat.

110
Q

Management of diverticulitis

A

Home with oral antibiotics -> A and E if no improvement in 3 days

IV ceftriaxone + metronidazole in hospital

111
Q

Management of UC - proctitis and proctosigmoiditis

A

Topical ASA -> oral prednisolone -> Tacrolimus after 2 weeks if no improvement

112
Q

Management of UC - left sided or extensive

A

High dose oral ASA -> prednisolone -> tacrolimus if no improvement after 2 weeks

113
Q

Management of UC - Severe

A

IV corticosteroid -> 72 hours no change = IV ciclosporin or surgery or infliximab

114
Q

In a GI bleed due to a peptic ulcer what is required once treatment has been started?

A

6-8 week endoscopy to ensure healing is occurring

115
Q

Indications for an inpatient alcohol withdrawal.

A 
>30 units a day
Previous seizures, epilepsy, DT
Medical or psych co morbidities 
Vulnerable
<18

Things I don't know, but need to know, for fourth year (31 decks)

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