GI Flashcards
How do you calculate Anion gap?
(Sodium + Potassium) – (Bicarbonate + Chloride)
What is the most common cause of abnormal LFTs in T2DM pt?
Non-alcohol fatty liver disease
What are the causes of transient non-visible haematuria? (4 things)
- UTI
- Exercise (settles after 3 days)
- Menstruation
- Sexual intercourse
What procedure can be used to treat Portal Hypertension?
TIPS (transjugular intrahepatic portosystemic shunt)
What 2 vessels does TIPS (transjugular intrahepatic portosystemic shunt) connect?
- Hepatic vein
- Portal vein
What blood results will make you sus macrocytic anaemia (aka low B12 aka pernicious anaemia)?
- Low Hb
- High MCV
What investigation should you do when you sus Macrocytic anaemia?
Intrinsic factor antibodies
In UC, what is better, oral or rectal mesalazine?
Rectal
If you have LOA and WL, is it still unexplained WL?
Yes
How can Nephrotic syndrome lead to DVT? (3 steps)
- Nephrotic syndrome
- Increased LOSS of antithrombin III from kidneys
- Antithrombin III deficiency –> DVT
What is the M rule for Primary Biliary Cholangitis (PBC)? (3 things)
- igM
- anti-Mitochondrial antibodies (M2 subtype)
- Middle aged females
What are the side fx of Erythropoetin aka EPO (given for CKD anaemia)? (3 things)
- Flu-like sympoms
- Skin rashes
- Bone aches
What are Elderly ppl at risk of after critical illness / major surgery?
Refeeding syndrome
What are the CF of Refeeding syndrome? (5 things)
Arthymias n Electrolye dysf:
1. Arrhythmias (AF)
2. Low K
3. High Na
4. Low Mg
5. Low P
We said renal dialysis is indicated when 4 aki complications are not treated by meds, so what is the one you should look out for in bloods / UnEs?
High urea, suggests uraemia (encephalopathy / pericarditis)
What urea levels suggest UPPER GI bleed more likely than lower?
High Urea
(high like upper innit)
What is the GOLD standard investigation for Primary Sclerosing Cholangitis (PSC) (assoc w UC)?
MRCP/ERCP
What will a MRCP / ERCP show you in PSC?
Inflamm / fibrosis / stricture of intra and extra-hepatic bile ducts
What is a complication of PSC?
Cholangiocarcinoma
How do you differentiate between Alcohol cause and Drug induced Cholestasis cause of deranged LFTs?
- GGT raised by itself = Alcohol
- GGT + ALP both raised = Drug induced Cholestasis
Apart from GGT how can you check if abnormal LFTs are caused by Alcohol? (2 things)
- Calculate AST / ALT ratio
- Normal = 0.8, but if 2+ then its Alcohol nigga
What causes Liver failure following MI?
Ischaemic hepatitis
(ischaemia coz like they had an infarction innit)
What are you at increased risk of with Nephrotic syndrome?
VTE (so give LMWH)
What works to remove Potassium from body?
Calcium RESONIUM
How do you differentiate between Achalasia and Oesophageal cancer? (3 things)
Achalasia:
1. Both solids AND liquids affected
2. NOT progressive
3. Bird beak appearance in barium swallow
What will you see in Barium swallow of Oesophageal cancer?
Apple core sign
How do you differentiate between PSGN and igA nephropathy?
- PSGN: Develops 1-2 weeks after URTI
- igA nephropathy: Develops 1-2 days after URTI
What should make you sus PSGN? (2 things)
- Nephritic syndrome
- Recent lung / skin infection (e.g cellulitis)
How do you confirm PSGN dx?
Raised anti-streptolysin O titres
(confirm dx of recent strep inf)
When prescribing fluids, what is the glucose requirement per day?
50-100g / day (regardless of pt weight)
What is the Triad you will see in Mesenteric ischaemia? (3 things)
- CVD
- High lactate (obv bc ischaemia)
- Soft but tender abdomen
What type of anion gap and acidosis / alkalosis do you get in DKA?
Raised anion gap metabolic acidosis
(excess ketones causes raised anion gap)
If C difficile doesn’t respond to vancomycin or fidaxomicin, what should you try?
Oral vancomycin + IV metronidazole
What medication should you avoid in bowel obstruction?
Metoclopramide
(pro-kinetic)
How Hyperparathyroidism, what do you give to correct vit D deficiency?
Alfacalcidol
How Hyperparathyroidism, what do you give to correct hyperphosophataemia?
Calcium carbonate (Phosphate binder)
How Hyperparathyroidism, what do you give to correct hyperphosophataemia?
Calcium carbonate (Phosphate binder)
What is the first line Mx of Barrets oesophagus becoming high grade dysplasia?
Endoscopic intervention
(preffered over oesophagectomy)
What do you assess if you sus Diabetic nephropathy?
Albumin : Creatinine ratio (ACR) early morning specimen
What is an early sign of Diabetic nephropathy?
Enlarged kidneys
What serology shows someone has been immunised against Hep B but hasn’t had an infection before?
- HBsAg: Negative
- IgG anti-HBc: Negative
- anti-HBs: Positive
(HBsAg and igG being negative show no active / chronic infection
Anti-HB positive means been immunised)
What are the guidelines for investigating AKI when cause is unclear?
Renal US within 24 hours of diagnosing AKI if cause unclear
(checking for intrinsic or post-renal aka obstructive causes)
When preparing for dialysis, how long does it take for AV fistula to be ready?
2 months
What investigations do you need to do before doing Fundoplication surgery on GORD pt?
- Oesophageal pH
- Manometry
Where are the cysts in Autosomal Dominant Polcystic Kidney Disease (ADPKD)?
- Cysts in kidney
- Cysts in liver
- Cysts in brain
(quite literally “polycystic” kidney disease)
How do you prevent against contrast-induced nephropathy? (lets say you need to do a CT on a pt w CKD)
1L 0.9% saline
How do you stage eGFR / AKI?
- Stage 1: all the 1s (1.5-1.99x increase in creatinine)
- Stage 2: al the 2s (2-2.99x increase in creatinine)
- Stage 3: all the 3s (3x or more increase in creatinine)
When should you start meds in CKD and what meds?
ACEi if ACR (albumin:creatinine ratio) is more than 30
How should you change Levothyroxine dose in pregnancy for Hypothyroid pt?
Increase dose by upto 50%
What can happen to thyroid levels in sickness?
Free t4 can drop, called Sick Euthyroid
NEEDS NO MX
What is a CF of Graves disease that needs urgent referral?
Losing colour vision –> urgent referral to eye ppl
What can give falsely low HbA1c results?
Haemodialysis
What should you give a post menopausal woman with hip fracture?
Bisphosphonates + calcium supplements
NO NEED FOR DEXA SCAN
What gynae conditions are Hyper / Hypothyroidism assco w?
HYPER = Oligomenorrhea / Amenorrhoea
HYPO = Menorrhagia (HMB)
(hyperActive so they don’t have periods)
Why is Pioglitazone CI in HF?
Causes fluid retention –> worsens HF
What is the difference in Tx for Addisons and Addisonian crisis?
Addisons = Hydrocortisone + Fludrocortisone
Addisonian crisis = IV Hydrocortisone
If Low dose Dexamethasone suppression test gives low (aka suppressed) cortisol, what is the Dx?
Normal
If Low dose Dexamethasone suppression test gives high (aka not suppressed) cortisol, what is the Dx?
Cushings syndrome –> dose high dose to find cause
If High dose Dexamethasone suppression test gives low (aka suppressed) cortisol, what is the Dx?
Cuhsings disease
If High dose Dexamethasone suppression test gives high (aka not suppressed) cortisol, what is the Dx?
- High ACTH = Pituitary (higher up in body) (aka Ectopic ACTH)
- Low ACTH = Adrenal (lower down in body)
