GI Flashcards
What is raised in Post-hepatic jaundice?
ALP
GGT (Gamma-glutaml transferase)
What is the general term for rasied ALP AND GGT? What does this indicate?
Cholestatic picture
Obstruction of biliary tree: gallstones, external compression from other organs or scarring of bile ducts
Would un-conjugated be raised in post-hepatic jaundice?
No
Conjugated would be though
Liver is functioning normally so retains it’s abilityto conjugate bilirubin howevere conjugated bilirubin would be being blocked from passing through biliary tree to duodenum causing it to seep into circulation
Pre-hepatic jaundice could be indicative of what anaemia?
Pernicious anaemia caused commonly by Vitamin B12 deficiency
What promotes gastric acid secrtion?
G cell
Metaclopramide causes higher appetite because?
Dopamine antagonist
Increases gastric motility leading to increased gastric emptying
What helps in protein digestoin?
Enterokinase released by duodenal cells in SI
What would you suspect in a child with reduced colonic motility and constipation
Hirschsprungs disease (absent colonic innervation)
Cholecystokinin (CCK) responsible for what?
CCK for contraction of GB (Chole- bile) (cysto: sac) (kinin: move) = Move the bile sac
What lines the crypts of lieberkuhn?
Proliferating stem cells
Painless jaundice=?
Pancreatic cancer
Common symptoms of viral hep?
N/V
Anorexia
Myalgia
Lethargy
RUQ Pain
Biliary colic presentation?
Abrupt beginning and subsides gradually
After eating
Nausea
“Female, forties, fat, fair”
Acute cholecystitis pain?
Similar to biliary colic, may radiate to back or right shoulder, may be pyrexial
Murphy’s sign +ve
What is Murphy’s sign?
Arrest of inspiration on palpation of RUQ
Presentation of cholangiocarcinoma?
Biliary colic
Assoc anorexia, jaundice, wt loss
Palpable mass in RUQ
Perimbilical lymphadenopathy
Left supraclavicular adenopathy (virchow node)
Symptoms in amoebic liver disease?
Malaise
Anorexia
Wt loss
Assoc RUQ pain tends to be mild
Triad of symptoms in budd-Chiari syndrome?
Sudden onset abdo pain
Ascites
Tender hepatomegaly
Triad of symptoms for acute liver failure?
Triad of encephalopathy, jaundice and coagulopathy
What is reynold’s pentad? What does it indicate?
Charcot’s triad + hypotension + confusion
Indicates: suspected ascending cholangitis
What is Courvoisier’s law?
States that presence of painless obstructive jaundice + palpable Gallbladder is unlikely due to gallstones
(More likely pancreatic malignancy)
Double duct sign is significant of which disease?
Pancreatic cancer
What can serum amylase levels rise in? (2 conditions)
Acute pancreatitis
Small bowel obstruction
Classic features of carcinoid syndrome?
Abdominal pain
Diarrhoea
Flushing
Causes of pancreatitis?
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion
Hypertriglyceridaemia, hypothermia, hyeprcalcaemia, hyperchylomicronaemia
EERCP
Drugs
Investigating late presentations of pancreatitis? What do you order?
Serum lipase
What can develop many years following the symptoms of chronic pancreatitis?
Diabetes Mellitus
Investigation of choice for suspected perianal fistulae in Crohn’s patients?
MRI Pelvis
What is Courvoisier’s sign?
Palpable Gallbladder
Features of pancreatic cancer?
Pale stools/dark urine
Pruritus
Cholestatic LFTs
Hepatomegaly
Palpable GB, no pain
Investigation for pancreatic cancer?
High res CT
Causes of metabolic akalosis?
Vomiting
Diuretics
Hypokalaemia
Primary hyperaldosteronism
Cushing’s
Bartter’s
Mechanism of Metabolic alkalosis?
-Activation of RAA system
Aldosterone causes reabsorption of Na+ in exchange fro H+
ECF Depletion
Patients with ascites secondary to liver cirrrhosis, what you give them?
Aldosterone antagonist
Spironolactone
What is this pattern typical of:
- RUQ Pain
-Pruritus
-Background of ulcerative cilitis?
Primary Sclerosing Cholangitis
Investigation for sus primary sclerosing cholangitis?
ERCP or MRCP
Treatment for mild/moderate flare of distal UC?
Topical (rectal) aminosalicylates
What drug out of these options could result in cholestatic jaundice?
- Methotrexate
-Paracetamol
-Morphine
-Simvastatin
-Co-amoxiclav
Co-Amoxiclav
Beaded appearance on ERCP?
Ulcerative Colitis
What is this syndrome? Dermatitis, diarrhoea, dementia/delusions, leading to death?
Pellegra
Management if flare of distal UC doesn’t respond to topical aminosalicylates?
Oral aminosalicyclates
Treatment of recurrent episodes of C. Difficile?
Oral fidaxomicin
Treatment of first episode of C. Diff infection?
Oral vancomycin for 10 days
2nd line: oral fidaxomicin
3rd line: Oral vancomycin +/- IV Metronidazole
What is used to monitor treatment in haemochromatosis?
Ferritin
Transferrin saturation
Medical management of severe alcoholic hepatitis?
Corticosteroids
Most common inheritable form of colorectal cancer?
Lynch syndrome (HNPSS)
What is the presentation of Zollinger-Ellison syndrome?
Multiple Gastroduodenal ulcers causing abdo pain and diarrhoea
Which vitamin in high doses is teratogenic?
Vitamin A
Test for small bowel overgrowth?
Hydrogen breath test
Intussusception + brown spots + fam history = ?
Peutz-Jegher’s syndrome
What medical treatment should you give in ongoing diarrhoea in Crohn’s patient post-resection with normal CRP?
Cholestyramine
Grading of hepatic encephalopathy?
Grade I: Irritability
Grade II: Confusion, inappropriate behaviour
Grade III: Incoherant, restless
Grade IV: Coma
What can omeprazole increase you risk of developing?
C. Difficile
What cancer does Barrett’s grow into?
Adenocarcinoma of oesophagus
What do you think if a patient has liver failure following MI?
Ischaemic hepatitis
What is used to maintain remission of UC?
Oral aminosalicylate
What marker is most accurate for assessing the function of the liver in acute liver failure?
Prothrombin time
Treatment of life threatening C. Diff?
Oral vancomycin
IV Metronidazole
What is used for prophylaxis of oesophageal bleeding?
Non-cardioselective B-blocker (NSBB) (Propanolol)
What can you use to stop an uncontrolled variceal haemorrhage?
Sengstakn Blakemore Tube
Is this presentation CD or UC?
-Wt loss
-Mouth ulcers
Crohn’s disease
(Can affect GI tract anywhere from mouth to anus)
Where is most affected in Crohn’s?
Ileum
Medications for remission in Crohn’s?
Azathiprine
Mercaptopurine
UC histology?
Crypt abscesses
What are hypersegmented polymorphs an early sign of?
Megaloblastic anaemia
What other cancer is associated with Lynch syndrome after colorectal cancer?
Endometrial
When does hepatorenal syndrome come on for type 1 and 2?
1: Rapid onset, less than 2 weeks, following acute event like UGI bleed
2: Gradual decline in renal function
Biochem of autoimmune hepatitis?
ALT & AST raised
ALP normal/slightly raised
What drug do you give with isoniazid and why?
Pridoxine (Vitamin B6)
Prevents peripheral neuropathy
Common side of metaclopramide?
Diarrhoea (metaSLOPramide)
What would a the presence of ANA, Anti-SM and raised IgG levels be characteristic of?
Autoimmune hepatitis
InvGX for bacterial overgrowth?
H breath test
Pulsatile liver edge?
RHF
Which type of cancer is barrett’s oesophagus more associated with?
Adenicarcinoma
Crypt abscesses indicate what?
UC
What should be given before endoscopy in patients with suspected variceal haemorrhage?
Terlipressin
ABs
Medical management of patients presenting with severe alcoholic hepatitis?
Prednisalone
Dysphagia affecting both solids and liquids form the start makes you think what disease?
Achalasia
When should you stop PPIs before an OGD?
2 weeks prior
Characteristic Iron studies for haemochromatosis?
Raised transferrin saturation
Raised serum ferritin
Low Total Iron Binding Capacity
Triad of presentation for budd-Chiari Syndrome?
Abdo pain sudden onset
Ascites
Tender hepatomegaly
What would the VBG picture be of in vomiting?
Metabolic alkalosis
What is Wilson’s disease and what is it characterised by?
Autosomal recessive disorder
Defective hepatic copper transport leading to copper accumulation
Common finding in Wilson’s disease?
Reduced serum caeruloplasmin
-this is a copper-carrying protein and it’s synthesis is impaired in Wilson’s due to copper overload intracellularly
Early signs of haemochromatosis?
Fatigue
ED
Arthralgia
Diagnostic method for pancreatic cancer?
High resolution Abdo CT
What alarm bells are ringing if an elderly person is diagnosed with new onset diabetes? + they have jaundice and raised serum lipase?
Pancreatic cancer
Patient with UC has severe relapse or >=2 exacerbations in past year what should you trial with them?
Oral azathioprine
Oral mercaptopurine
What can a high urea indicate bleed wise?
UGI Bleed
Firs line management for NAFLD?
Weight loss
What management does dysplasia on biopsy warrant in barrett’s?
Endoscopic intervention
Heart defects of carcinoid syndrome?
Pulmonary stenosis
Tricuspid insufficiency
What artery is at risk with duodenal ulcers?
Gastroduodenal
Gold standard for confirming a coeliac diagnosis?
Endoscopy
Biopsy
What GI related condition can cause hypogonadoptrophic and hypogonadism?
Haemochromatosis
What GI condition often is associated with polycythaemia rubra vera?
Budd-Chiari Syndrome
1st and 2nd line treatments for herediatary haemochromatosis?
Venesection
Desferrioxamine
What is likely if a patient has new yellow plaques on sigmoidoscopy following a course of Cephalosporins?
Pseudomembranous colitis
Differentiating between IBD and IBS?
Faecal calprotectin
How long is isolation if a patient has C.Diff?
48 hours
Alcohol units equation?
Alcohol units = volume (ml) * ABV/1000
What electrolyte imbalance can omeprazole cause?
Hyponatraemia
Pre-endoscopic score for identifying patients risk levels and if they can discharged?
Glasgow Batchford score
Grey skin, sore hand joints diagnosis and monitoring requirements?
Haemochromatosis
Ferritin and Tranferrin saturation
Treatment of severe alcoholic hepatitis?
Prednisalone
What medication helps with bile acid malabsorption?
Cholestyramine
What is low in iron deficiency anaemia but high/normal in anaemia of chronic disease?
Ferritin
Metabolic ketoacidosis with normal or low glucose…What ya think is the cause?
ALCOHOL
What should be prescribed for treatment of large volume ascites with large volume paracentesis?
IV Human albumin solution
How does loperamide work?
Reduction in gastric motility through stimulation of opioid receptors
Pre-op tests required before a Nissen fundoplication?
Oesophageal manometry
Treatment of perianal fistula
Oral metronidazole
1st line during endoscopy to stop variceal bleeding?
Band ligation
What deficiency causes angular chelitis?
Riboflavin
Surgical treatment of achalasia?
Heller Cardiomyotomy
Gene in Lynch syndrome?
MSH2/MLH1
What might occur in association with Iron deficiency anaemia and cause dysphagia?
Plummer-Vinson Syndrome (VERY RARE THOUGH)
How would you treat a patient with a folate and B12 deficiency?
First give b12 IM replacement, loading regime followed by 2-3 monthly injections
THEN
Folate
Because if you give folate before Vit B12 there is a risk of precipitating subacute combined degeneration of the cord
BeFore (B before F)
Raised platelet count + nausea invgX?
Non-urgent referral for dyspepsia
Anaemia of chronic disease blood results?
Hb: Down
MCV: Down
Ferritin: Up (protein that stores iron outside and releases it)
TIBC: Down
If TIBC is low it indicates that all the iron in the body is already bound to avoid being dispersed
What type of anaemia is haemolytic?
Normocytic
You would expect
-Increased reticulocyte count
-Increased lactate dehydrogenase
-High bilirubin
What type of anaemia is iron deficient? What is the TIBC like?
Microcytic anaemia
-High (as there is no iron bound and the ferritin would be decreased as low iron to store)
What type of anaemia does B12 deficiency cause?
Macrocytic
Medicine for dodgy bowels after cholecytsectomy?
Cholestyramine
What is fetor hepaticus? what does it indicate?
Sweet and fecal breath
Sign of liver failure
Criteria components for Truelove and Witt’s score and what it assesses?
Severity of UC
UC is severe when patient has blood in their stool or is passing more than 6 per day plus at least one of
-Temp >37.8
-HR >90/min
-Anaemia (Less than 105g/L)
-ESR >30mm/hr
What drug is contraindicated in parkinsonism?
Metaclopramide
What cancer develops in 10% of Primary sclerosing Cholangitis cases?
Cholangiocarcinoma
Treatment of alcoholic ketoacidosis?
IV Thiamine and 0.9% saline
Most common organism found in ascitic fluid?
E Coli
How long must patients eat gluten before being coeliac tested?
6 weeks
T2DM with deranged LFTs?
NAFLD
