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Its the final countdown > GI > Flashcards

GI Flashcards

1
Q

what GI condition is PSC commonly found in

A

Ulcerative colitis

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2
Q

give 5 managements in PSC

A
  1. Lifestyle (e.g. avoid alcohol)
  2. Sx e.g. cholestyramine for pruritus
  3. Supplementation of fat soluble vitamins (A,D,E,K)
  4. ERCP dilation of strictures
  5. Liver transplantation (in cases complicated by chronic liver disease and/or hepatobiliary malignancies).
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3
Q

Tx for H.pylori infection

A

triple therapy:
2xAbx + 1 PPI

Metronidazole/amoxicillin, clarithromycin & PPI (omeprazole/lansoprazole etc)

think 2 Abx are needed to tackle the bacteria

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4
Q

What 3 psych conditions are associated with EDs?

A

personality disorders
OCD
anxiety

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5
Q

give 5 features of anorexia

A

Amenorrhoea
* Lanugo hair is fine, soft hair across most of the body
* Hypokalaemia
* Hypotension
* Hypothermia
* Changes in mood, anxiety and depression
* Solitude
* Cardiac complications (arrhythmia, cardiac atrophy and sudden cardiac death).

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6
Q

what blood findings are indicative of bulimia

A

Alkalosis (vomiting `HCL from stomach)

Hypokalaemia

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7
Q

what are the GI findings of bulimia

A

mouth:
* Erosion of teeth
* Swollen salivary glands (swelling of face & under the jaw)
* Mouth ulcers
* reflux and irritation

non-GI
* Russell’s sign

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8
Q

apart from slef=-help resources & coun6sellin6g, n6ame 2x psych Mx for eatin6g disorders

A

CBT
SSRI- in CAMHS

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9
Q

what characteristics put people at risk of refeeding syndrome

A

1 BMI<20
2 little intake >/= 5 days

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10
Q

what are the biochemical findings in refeeding syndrome (MG, K, PO43-)

A

hypomagnesaemia
hypokalaemia
hypophosphataemia

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11
Q

Mx in refeeding Syndrome ( x5)

A
  • Slowly reintroducing food with restricted calories
  • Mg, K, phosphate and glucose monitoring along with other routine bloods
  • Fluid balance monitoring
  • ECG monitoring (in severe cases)
  • Supplementation with electrolytes and vitamins,
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12
Q

what are the features of Crohns disease which differentiate it from UC (X5)

A

Crows NESTS

No blood/mucus
Entire GI tract (mouth to anus - inc. mouth ulcers)
Skip lesions on endoscopy ( alternate areas of disease w/ no disease)
Terminal ileum most affected & Transmural (full thickness inflammation)
Smoking is a risk factor

strictures & fistulas also present

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13
Q

what are the features of UC which differentiate it from Crohns (x7)

A

You see (UC) CLOSE UP

Continuous inflammation
Limited to colon&rectum
Only superficial mucosa affected
Smoking protective
Excrete blood & mucous

Use aminosalicylates
Primary sclerosing cholangitis

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14
Q

what 5 non-GI conditions can occur in IBD

A
  • Erythema nodosum (tender, red nodules -inflammation of the subcut fat)
  • Pyoderma gangrenosum (rapidly enlarging, painful skin ulcers)
  • Enteropathic arthritis
  • Primary sclerosing cholangitis (esp in UC)
  • Red eye conditions (e.g., episcleritis, scleritis and anterior uveitis)
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15
Q

IBD Mx is split into mx acute exacerbation, and maintaining remission

what is the management in an acute UC exacerbation

A

Acute
mild-mod
1st line - aminosalicylate (Mesalazine)
2nd line - corticosteroid (prednisolone)

sev
IV steroid (hydrocortisone)

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16
Q

IBD Mx is split into mx acute exacerbation, and maintaining remission

what is the management in maintaining remission in UC

A

1st line aminosalicylate - Masalazine

Azathioprine
Mercaptopurine

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17
Q

IBD Mx is split into mx acute exacerbation, and maintaining remission

what is the management in an acute exacerbation in Crohns

A

1st line Steroid (oral pred / IV hydrocortisone
Enteral nutrition

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18
Q

IBD Mx is split into mx acute exacerbation, and maintaining remission

what is the management in maintaining remission in Crohns

A

1st line either Aathiprine/ Mercaptopurine

2nd Methotrexate

(1st line similar to UC, but remember you see closeUp - Use of aminosalicylate (mesalazine) is only in UC)

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19
Q

In what age groups isUC common

A

The peak incidence of ulcerative colitis is in people aged 15-25 years and in those aged 55-65 years.

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20
Q

what antibacterial med is associated with causing C.diff

A

clindamycin (typically ass.w/ diabetic foot)

also 2nd & 3rd gen cephalosporins
and PPIs

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21
Q

features of C.diff infection (x4)

A

diarrhoea
abdo pain
raised WCC ***characteristic
severe toxic megacolon may develop

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22
Q

Mx in c.diff 1st line

  • first epsode
  • life threatening
A

1st episode
Oral vancomycin 10days

life-threatening
oral vancomycin & IV metronidazole

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23
Q

Give 5 exam findings suggestive of excess Alcohol

A
  • Smelling of alcohol
  • Slurred speech
  • Bloodshot eyes
  • facial telangiectasia
  • Tremor
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24
Q

which of the liver enzymes are cholestatic

A

ALP, GGT

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25
Q

which of the liver enzymes are hepatocellular

A

AST, ALT

(SALT = liver enzymes )

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26
Q

Raised ALT & AST levels indicate hepatocellular damage/injury/inflammation. Which of these hepatocellular enzymes are more specific to the liver>

A

ALT

think aLt - Lfor liver

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27
Q

when AST> ALT, what kind of damage to the liver is this indicative of?

A

> 1.5:1 AST:ALT - alcoholic liver disease

AST > ALT = cirrhosis & acute alcoholic hepatitis
AST < ALT = chronic Liver disease

28
Q

raised ALP levels indicate can be caused by… (x2)

A

cholestasis

Bone disease

(ALP derived from biliary epithelium & bones)

if both raised but ALT > ALP = hepatocellular damage

if both raised but ALT < ALP = cholestasis

29
Q

interpreting a rise in the biliary enzymes

ALP: high
GGT: normal

A

Bone disease ( pagets disease, Vit D deficiency, bony mets)

ALP = biliary and bone
ALP on its own is bone

30
Q

interpreting a rise in the biliary enzymes

ALP: high
GGT: high

A

cholestasis, in biliray tree

31
Q

interpreting a rise in the biliary enzymes

ALP: normal
GGT: high

A

excess alcohol

32
Q

rise in bilirubin can be further investigated by requesting conjugated vs unconjugated bilirubin

causes of predominantly unconjugated hyperbilirubinaemia

A

Causes of predominantly
 Pre-hepatic jaundice (e.g. haemolysis
 Gilbert syndrome

Isolated bilirubin rise = pre-hepatic jaundice or Gilbert’s disease

33
Q

Causes of predominantly conjugated hyperbilirubinaemia

A

 Cholestasis
 Hepatocellular jaundice*

34
Q

what protein is used as a marker for liver function

A

albumin

Low albumin = Decreased synthetic function of the liver indicating severe liver disease.

35
Q

give 2 questionnaires used to assess alcohol dependence

A

CAGE
C- CUT DOWN?
A – ANNOYED?
G – GUILTY?
E – EYE OPENER?

AUDIT
Alcohol Use Disorders Identification Test (AUDIT)

36
Q

give the 4 stages of NAFLD

A
  1. Non-alcoholic fatty liver disease
  2. Non-alcoholic steatohepatitis (NASH)
  3. Fibrosis
  4. Cirrhosis
37
Q

what liver enzyme will be raised in NAFLD & AFLD

A

ALT - the liver enzyme

in NAFLD, AST:ALT ratio >0.8 suggests advanced fibrosis

AST1.5 x greater that ALT (cirhoSiS and alcoholic hepatitiS) - alcohol-related liver disease

38
Q

what scan diagnoses the presence of a fatty lilver

A

US

39
Q

what is the Gold standard test to diagnose hepatic steatosis

A

liver biopsy

40
Q

what are the 4 most common causes of liver cirhosis

A
  • Alcohol-related liver disease
  • Non-alcoholic fatty liver disease (NAFLD)
  • Hepatitis B
  • Hepatitis C
41
Q

why is splenomegaly a finding in liver cirrhosis

A

splenomegaly occurs in liver cirrhosis due to portal hypertension

42
Q

liver cirrhosis causes endocrine dysfunction, particularly raised oestrogens. what are the 2 findings in males

A

gynaecomasgtia
testicular atrophy

43
Q

what causes leukonychia

A

leukonychia - white nails

liver cirrhosis –> reduced albumin production –> hypoalbunaemia –> leukonychia

44
Q

what is the 1st line Ix for asessing fibrosis in NAFLD

A

ELF - enhanced liver fibrosis

  • 10.51 or above – advanced fibrosis
  • Under 10.51 – unlikely advanced fibrosis (NICE recommend rechecking every 3 years in NAFLD)
45
Q

Give 5 investigations (non-bloods ) for diagnosing liver disease

A

US (fatty liver, screening tool for hepatocellular carcinoma)
Transient elastography ( fibroscan) - assess stiffness of liver using high frequency waves
CT, MRI
Liver biopsy

46
Q

what are the 2 classifications for the severity of liver cirrhosis

A

Child-pugh ( graded A,B,C - c being the worst)

MELD - model for end stage liver disease
predicts mortality ( the higher score, the higher percentage mortality) - use MELD every 6 months

47
Q

what are the 5 factors of the Child Pugh- score

A

Albumin
bilirubin
clotting (INR)
dilation
Encephalopathy

48
Q

what is the management in liver cirrhosis for
- NAFLD
- hepatitis C
- autoimmune hepatitis

A

NAFLD - lifestyle
Hep C - Antiviral drugs
Autoimmune hpatitis - immunosuppressants

49
Q

what 4 features suggest the need for a liver transplant

A

liver transplant - in decompensated liver disease

“AHOY” mnemonic:
* A – Ascites
* H – Hepatic encephalopathy
* O – Oesophageal varices bleeding
* Y – Yellow (jaundice)

50
Q

give the 1st and 2nd line Mx in preventing bleeding of oesophageal varices

A

1st Propanolol (non-selective B-blockers)

2nd variceal band ligation

51
Q

what type of ascites is found in cirrhosis

A

transudative ( w protein content) ascites

52
Q

what are the 2 most common causes of spontaneous bacterial peritonitis

A

E.Coli

klebsiella pneumoniae

10-20% of ascites pts develop this infection of ascitic fluid

53
Q

what is the Mx in hepatorenal syndrome

A

hepatorenal syndrome: portal HTN – impaired –> impaired bloodflow to kidneys –> kidney function affected

Liver Transplant (otherwise poor prognosis)

54
Q

Hepatic encephalopathy Mx (x3 )

A

Lactulose (2-3 soft stools/day) - ammonia & other toxin buildup –> neurotoxicity

Abx (e.g. rifaximin ) –> reduce intestinal bacteria prodcuing ammonia

Nutritional support ( NG feeding)

55
Q

most common histological form of pancreatic cancer

A

adenocarcinoma

*most common location: head of pancreas)

56
Q

complication of enlargement of head of pancreas in pancreatic cancer

A

bile duct compression –> block flow of bile from liver –> obstructive jaundice

57
Q

4 common features of pancreatic cancer

A

obstructive jaundice (yellow skin & sclera, pale stools, dark urine, generalised itching)

non-specific upper abdo/back pain

palpable epigastric mass

change in bowel habit

nausea/vomiting

new onset/worsening of T2DM

58
Q

criteria for referrel in suspecgted pancreas

A

> 40 with jaundice: (2ww)

> 60 weight loss +GI Sx (as pancreas sx unspecific) –> CT abdo

59
Q

what 2 signs are associated with pancreatic cancer

A

courvoisier’s law - palpable gall bladder + jaundice = cholangiocarcinoma or pacreatic cancer ( less likely to be gallstones )

Trousseau’s sign - migratory thrombophlebitis is signs of malignancy (inflammation and thrombus in vessels, which recurrs in different locations over time) = malignancy (esp. pancreatic adenocarcinoma)

60
Q

what is sed in the diagnosis for pancreatic cancer

A

CT thorax, abdo & pelvis + biopsy

61
Q

aside from pancreatic cancer, CA 19-9 is also raised in …

A

cholangiocarcinoma
other non-malignant conditions

62
Q

what scan is used to assess biliary obstruction

A

MRCP ( magnetic resonance cholangio-pancreatography)

63
Q

what mxs are available in pancreatic cancer

A

surgical removal:
* Total pancreatectomy
* Distal pancreatectomy
* Pylorus-preserving pancreaticoduodenectomy (PPPD) (modified Whipple procedure)
* Radical pancreaticoduodenectomy (Whipple procedure)

curative surgery not an options for most, so palliative used

stents (biliary obstruction), surgery for Sx ( bypassing biliary obstruction)

palliative chemo/radio

64
Q

what is the whipple proceducre

A

pancreaticodupdenectomy

used in head of pancreas where tumour has not spread

removes: head of pancreas, pylorus, duodenum, gallblader, bile duct, lymph nodes

65
Q

what structure is left in place in the modified whipple procedure

A

pylorus

modified whipple procedure = pylorus-preserving pancreaticoduodenectomy (PPPD).

whipple procedure otherwise removes removes: head of pancreas, pylorus, duodenum, gallblader, bile duct, lymph nodes

66
Q
A

Its the final countdown (23 decks)

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