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FINALS- random flashcards per system > GI > Flashcards

GI Flashcards

1
Q

Acute pancreatitis- 2 main causes

A

gallstones

alcohol

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2
Q

Acute pancreatitis- diagnosis

A

raised serum amylase

raised Lipase (more sensitive and specific than lipase)

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3
Q

Acute pancreatitis- scoring system used

A

Glasgow score

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4
Q

what is primary sclerosing cholangitis?

A

intrahepatic and extrahepatic duct become strictured/ fibrotic, resulting in obstruction to bile flow out of the liver

causes backflow, inflammation and fibrosis/ cirrhosis

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5
Q

what is primary sclerosing cholangitis associated with?

A

ulcerative colitis

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6
Q

presentation of primary sclerosing cholangitis

A

jaundice
fatigue
pruritus
RUQ pain
hepatomegaly
some cirrhosis signs

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7
Q

primary sclerosing cholangitis- blood results

A

‘cholestatic picture’

significantly raised Alk Phos (ALP)
raised bilirubin

transaminases (ALT, AST) raised

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8
Q

diagnosis of primary sclerosing cholangitis

A

MRCP

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9
Q

management of primary sclerosing cholangitis

A

ERCP- to stent strictures

ursodeoxycholic acid

colestyramine

liver transplant

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10
Q

what does alpha-1-antitrypsin deficiency effect and cause?

A

liver- cirrhosis

lungs- bronchiectasis and emphysema

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11
Q

causes of hepatitis

A
  • alcoholic hepatitis
  • NAFLD
  • viral hepatitis
  • autoimmune
  • drug induced (paracetamol)
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12
Q

presentation of hepatitis

A

abdo pain, fatigue, pruritis, muscle/ joint aches, N&V, jaundice, fever

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13
Q

blood results in hepatitis

A

hepatic picture

raised AST/ ALT (transaminases)

ALP raised but to a less extent

raised bilirubin

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14
Q

transmission of each type of viral hepatitis

A

A- faeco-oral

B- blood/ bodily fluid

C- blood/bodily fluid

D- blood/ bodily fluid-but must have primary infection with hepatitis B

E- faeco-oral

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15
Q

Barrett’s oesophagus changes

A

replacement of stratified squamous epithelium with columnar epithelium

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16
Q

management of small bowel obstruction

A

drip and suck

iv fluids and an ng tube to decompress stomach

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17
Q

HNPCC- associated cancers

A

colorectal
endometrial
pancreatic

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18
Q

what is the psoas sign and what condition is it seen in

A

The test is performed by passively extending the thigh of a patient with knees extended. In other words, the patient is positioned on his/her left side, and the right leg is extended behind the patient. If abdominal pain results, it is a positive psoas sign.

appendicitis

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19
Q

liver failure triad

A

triad of encephalopathy, jaundice and coagulopathy

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20
Q

iron study profile in haemochromatosis

A

Raised transferrin saturation and ferritin, with low TIBC is the characteristic iron study profile in haemochromatosis

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21
Q

pancreatic cancer- blood marker

A

CA 19-9

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22
Q

initial management of haemochromatosis

A

Venesection

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23
Q

RF’s for IBD

A

Smoking (a risk factor in Crohn’s, but protective in ulcerative colitis)
Family history - NOD2 mutations, HLA-B27 positive have both been linked
White ethnicity - a risk factor for ulcerative colitis

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24
Q

if a patient is ascitic, what Abx should be used as prophylaxis against spontaneous bacterial peritonitis?

A

ciprofloxacin/ norfloxacin

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25
Q

what antibody can be present in PSC?

A

p-ANCA

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26
Q

Where does UC most commonly affect?

A

rectum

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27
Q

management of c.diff infection

A

ORAL vancomycin- even in severe disease, as better uptake into GI system compared to IV

If life threatening, add IV metronidazole

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28
Q

why does c diff infection occur?

A

Clostridium difficile is a Gram positive rod often encountered in hospital practice. It produces an exotoxin which causes intestinal damage leading to a syndrome called pseudomembranous colitis. Clostridium difficile develops when the normal gut flora are suppressed by broad-spectrum antibiotics.

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29
Q

risk factors for c diff

A

Clindamycin is historically associated with causing Clostridium difficile but the aetiology has evolved significantly over the past 10 years. Second and third generation cephalosporins are now the leading cause of Clostridium difficile. (cefuroxime, ceftriaxone etc)

PPI’s

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30
Q

what is carcinoid syndrome?

A

Carcinoid syndrome is a neuroendocrine tumour. There are many locations that they can occur in such as in the GI tract, in the respiratory tract and many other places. They can secrete serotonin which leads to many of the symptoms this patient suffers

31
Q

features of carcinoid syndrome

A

flushing (often earliest symptom)
diarrhoea
bronchospasm
hypotension
right heart valvular stenosis (left heart can be affected in bronchial carcinoid)
other molecules such as ACTH and GHRH may also be secreted resulting in, for example, Cushing’s syndrome
pellagra can rarely develop as dietary tryptophan is diverted to serotonin by the tumour

32
Q

what is elevated in carcinoid syndrome?

A

urinary 5-HIAA

33
Q

management of carcinoid syndrome

A

octreotide (somatostatin analogue)

surgery

34
Q

features of a pharyngeal pouch

A

dysphagia
regurgitation
aspiration
neck swelling which gurgles on palpation
halitosis (bad breath)

35
Q

how would a suspected pharnygeal pounch be investigated?

A

barium swallow

36
Q

PBC- antibody?

A

AMA (anti-mitochondrial antibody)

37
Q

what is Peutz-Jegher’s syndrome?

A

Peutz-Jegher’s syndrome is an autosomal dominant condition causing GI tract polyp formation and hyperpigmented lesions of the face, palms, lips and soles

38
Q

spontaneous bacterial peritonitis- most common causative organism?

A

e.coli

39
Q

what is pernicious anaemia?

A

Pernicious anaemia is an autoimmune disorder affecting the gastric mucosa that results in vitamin B12 deficiency

leads to macrocytic anaemia

40
Q

antibody test in pernicious anaemia

A

anti-intrinsic factor antibodies

41
Q

causes of bile acid malabsorption

A

primary- excess bile acid

Secondary causes are often seen in patients with ileal disease, such as with Crohn’s. Other secondary causes include:
cholecystectomy
coeliac disease
small intestinal bacterial overgrowth

42
Q

management of bile acid malabsorption

A

bile acid sequestrants e.g. cholestyramine

43
Q

potential complication of pernicious anaemia

A

Pernicious anaemia predisposes to gastric carcinoma

44
Q

mesenteric ischaemia triad

A

Mesenteric ischaemia: triad of CVD, high lactate and soft but tender abdomen

45
Q

what is Cheilitis?

A

inflammation of the lips

46
Q

In Gilberts syndrome, when is jaundice usually seen?

A

jaundice may only be seen during an intercurrent illness, exercise or fasting

47
Q

what should be prescribed to maintain remission in patients with UC?

A

A topical (rectal) aminosalicylate +/- an oral aminosalicylate is used first-line in maintain remission in ulcerative colitis patients with proctitis and proctosigmoiditis

48
Q

what deficiencies does coeliac disease present with?

A

Coeliac disease is associated with iron, folate and vitamin B12 deficiency

49
Q

barrett’s oesophagus management

A

endoscopic surveillance with biopsies
high-dose proton pump inhibitor

if dysplasia noted- endoscopic resection/ ablation

50
Q

inhertiance of haemochromatosis

A

autosomal recessive disorder of iron absorption and metabolism resulting in iron accumulation. It is caused by inheritance of mutations in the HFE gene on both copies of chromosome 6*

51
Q

symptoms of haemochromatosis

A

early symptoms include fatigue, erectile dysfunction and arthralgia (often of the hands)
‘bronze’ skin pigmentation
diabetes mellitus
liver: stigmata of chronic liver disease, hepatomegaly, cirrhosis, hepatocellular deposition)
cardiac failure (2nd to dilated cardiomyopathy)
hypogonadism (2nd to cirrhosis and pituitary dysfunction - hypogonadotrophic hypogonadism)
arthritis (especially of the hands)

52
Q

most common organisms found in pyogenic liver abscesses in adults and children

A

Staphylococcus aureus in children and Escherichia coli in adults.

53
Q

in acute liver failure, which blood markers are most accurate to assess for liver function?

A

coagulation (PT, APTT) and albumin

liver enzymes are a poor way to look at liver function as they remain normal for a long time, whilst coagulation and albumin are better measures.

54
Q

crohns- histology

A

inflammation in all layers from mucosa to serosa
goblet cells
granulomas

55
Q

complication of ERCP

A

pancreatitis

56
Q

prior to being investigated for coeliac, what must the patient do and why?

A

must eat a gluten containing diet for 6 weeks

If gluten is not consistently consumed the biopsy findings may be normal or less convincing and the patient may have to undergo the endoscopy again unnecessarily to confirm the diagnosis. Therefore all patients will be given the advice to consume gluten 6 weeks prior to endoscopy. Note that this is also the case for assessing coeliac antibodies (usually anti-tissue transglutaminase antibodies). To avoid a false negative result, patients must also consume gluten prior to testing. Thereafter, the antibody test may be used for monitoring adherence to the diet.

57
Q

coeliac- histology

A

villous atrophy, raised intra-epithelial lymphocytes, and crypt hyperplasia

58
Q

side effect of aminosalicylate’s

A

Aminosalicylates are associated with a variety of haematological adverse effects, including agranulocytosis - FBC is a key investigation

59
Q

what does the double duct sign on MRCP indicate?

A

pancreatic cancer

60
Q

surgical management of an upper rectal tumour

A

anterior resection

61
Q

management of an overactive bladder

A

antimuscarinics (oxybutynin, tolteridone)

62
Q

h.pylori urea breath test- what medication criteria should be met before starting?

A

Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks

63
Q

h.pylori urea breath test- what medication criteria should be met before starting?

A

Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks

64
Q

GI bleed- what do high urea levels indicate?

A

High urea levels can indicate an upper GI bleed versus lower GI bleed

65
Q

ascites- what does a high serum ascitic albumin gradient indicate?

A

Ascites: a high SAAG gradient (> 11g/L) indicates portal hypertension:
Liver disorders are the most common cause
cirrhosis/alcoholic liver disease
acute liver failure
liver metastases

Cardiac
right heart failure
constrictive pericarditis

Other causes
Budd-Chiari syndrome
portal vein thrombosis
veno-occlusive disease
myxoedema

66
Q

what monoclonal antibody is specific to C.diff toxin b?

A

Bezlotoxumab

67
Q

crohns- management of a perianal fistula

A

Oral metronidazole is useful in the management of Crohn’s patients who develop a perianal fistula

68
Q

where does ischaemic colitis most likely affect?

A

The splenic flexure is the most likely area to be affected by ischaemic colitis

69
Q

what blood result can indicate severe pancreatitis?

A

hypocalcaemia

70
Q

c.diff management

A

1st- oral vancomycin
2nd- oral findaxomicin
3rd (or if severe)= oral vancomycin and IV metronidazole

71
Q

other than antibiotics, what other medication class is a risk factor for c.diff?

A

PPI’s

72
Q

management of alcoholic ketoacidosis

A

Alcoholic ketoacidosis is managed with an infusion of saline and thiamine

73
Q

what is the double duct sign and what is it seen in?

A

‘double duct’ sign - the presence of simultaneous dilatation of the common bile and pancreatic ducts

74
Q

what can coeliac disease increase the risk of development of?

A

Coeliac disease increases the risk of developing enteropathy-associated T cell lymphoma. This is due to the neoplastic transformation of intraepithelial T lymphocytes in coeliac patients. Risk factors include poor adherence to a gluten-free diet and late diagnosis of coeliac disease.

FINALS- random flashcards per system (16 decks)

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