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GI Flashcards

1
Q

What is raised in Post-hepatic jaundice?

A

ALP
GGT (Gamma-glutaml transferase)

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2
Q

What is the general term for rasied ALP AND GGT? What does this indicate?

A

Cholestatic picture
Obstruction of biliary tree: gallstones, external compression from other organs or scarring of bile ducts

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3
Q

Would un-conjugated be raised in post-hepatic jaundice?

A

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

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3
Q

Pre-hepatic jaundice could be indicative of what anaemia?

A

Pernicious anaemia caused commonly by Vitamin B12 deficiency

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4
Q

What promotes gastric acid secrtion?

A

G cell

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5
Q

Metaclopramide causes higher appetite because?

A

Dopamine antagonist

Increases gastric motility leading to increased gastric emptying

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6
Q
A
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7
Q

What helps in protein digestoin?

A

Enterokinase released by duodenal cells in SI

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8
Q

What would you suspect in a child with reduced colonic motility and constipation

A

Hirschsprungs disease (absent colonic innervation)

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9
Q

Cholecystokinin (CCK) responsible for what?

A

CCK for contraction of GB (Chole- bile) (cysto: sac) (kinin: move) = Move the bile sac

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10
Q

What lines the crypts of lieberkuhn?

A

Proliferating stem cells

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11
Q

Painless jaundice=?

A

Pancreatic cancer

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12
Q

Common symptoms of viral hep?

A

N/V
Anorexia
Myalgia
Lethargy
RUQ Pain

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13
Q

Biliary colic presentation?

A

Abrupt beginning and subsides gradually
After eating
Nausea

“Female, forties, fat, fair”

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14
Q

Acute cholecystitis pain?

A

Similar to biliary colic, may radiate to back or right shoulder, may be pyrexial

Murphy’s sign +ve

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15
Q

What is Murphy’s sign?

A

Arrest of inspiration on palpation of RUQ

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16
Q

Presentation of cholangiocarcinoma?

A

Biliary colic
Assoc anorexia, jaundice, wt loss

Palpable mass in RUQ
Perimbilical lymphadenopathy
Left supraclavicular adenopathy (virchow node)

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17
Q

Symptoms in amoebic liver disease?

A

Malaise
Anorexia
Wt loss

Assoc RUQ pain tends to be mild

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18
Q

Triad of symptoms in budd-Chiari syndrome?

A

Sudden onset abdo pain
Ascites
Tender hepatomegaly

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19
Q

Triad of symptoms for acute liver failure?

A

Triad of encephalopathy, jaundice and coagulopathy

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20
Q

What is reynold’s pentad? What does it indicate?

A

Charcot’s triad + hypotension + confusion

Indicates: suspected ascending cholangitis

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21
Q

What is Courvoisier’s law?

A

States that presence of painless obstructive jaundice + palpable Gallbladder is unlikely due to gallstones

(More likely pancreatic malignancy)

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22
Q

Double duct sign is significant of which disease?

A

Pancreatic cancer

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23
Q

What can serum amylase levels rise in? (2 conditions)

A

Acute pancreatitis
Small bowel obstruction

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24
Q

Classic features of carcinoid syndrome?

A

Abdominal pain
Diarrhoea
Flushing

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25
Q

Causes of pancreatitis?

A

Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion
Hypertriglyceridaemia, hypothermia, hyeprcalcaemia, hyperchylomicronaemia
EERCP
Drugs

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26
Q

Investigating late presentations of pancreatitis? What do you order?

A

Serum lipase

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27
Q

What can develop many years following the symptoms of chronic pancreatitis?

A

Diabetes Mellitus

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28
Q

Investigation of choice for suspected perianal fistulae in Crohn’s patients?

A

MRI Pelvis

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29
Q

What is Courvoisier’s sign?

A

Palpable Gallbladder

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30
Q

Features of pancreatic cancer?

A

Pale stools/dark urine
Pruritus
Cholestatic LFTs
Hepatomegaly
Palpable GB, no pain

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31
Q

Investigation for pancreatic cancer?

A

High res CT

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32
Q

Causes of metabolic akalosis?

A

Vomiting
Diuretics
Hypokalaemia
Primary hyperaldosteronism
Cushing’s
Bartter’s

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33
Q

Mechanism of Metabolic alkalosis?

A

-Activation of RAA system
Aldosterone causes reabsorption of Na+ in exchange fro H+
ECF Depletion

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34
Q

Patients with ascites secondary to liver cirrrhosis, what you give them?

A

Aldosterone antagonist

Spironolactone

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35
Q

What is this pattern typical of:
- RUQ Pain
-Pruritus
-Background of ulcerative cilitis?

A

Primary Sclerosing Cholangitis

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36
Q

Investigation for sus primary sclerosing cholangitis?

A

ERCP or MRCP

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37
Q

Treatment for mild/moderate flare of distal UC?

A

Topical (rectal) aminosalicylates

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38
Q

What drug out of these options could result in cholestatic jaundice?
- Methotrexate
-Paracetamol
-Morphine
-Simvastatin
-Co-amoxiclav

A

Co-Amoxiclav

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39
Q

Beaded appearance on ERCP?

A

Ulcerative Colitis

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40
Q

What is this syndrome? Dermatitis, diarrhoea, dementia/delusions, leading to death?

A

Pellegra

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41
Q

Management if flare of distal UC doesn’t respond to topical aminosalicylates?

A

Oral aminosalicyclates

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42
Q

Treatment of recurrent episodes of C. Difficile?

A

Oral fidaxomicin

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43
Q

Treatment of first episode of C. Diff infection?

A

Oral vancomycin for 10 days

2nd line: oral fidaxomicin

3rd line: Oral vancomycin +/- IV Metronidazole

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44
Q

What is used to monitor treatment in haemochromatosis?

A

Ferritin
Transferrin saturation

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45
Q

Medical management of severe alcoholic hepatitis?

A

Corticosteroids

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46
Q

Most common inheritable form of colorectal cancer?

A

Lynch syndrome (HNPSS)

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47
Q

What is the presentation of Zollinger-Ellison syndrome?

A

Multiple Gastroduodenal ulcers causing abdo pain and diarrhoea

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48
Q

Which vitamin in high doses is teratogenic?

A

Vitamin A

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49
Q

Test for small bowel overgrowth?

A

Hydrogen breath test

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50
Q

Intussusception + brown spots + fam history = ?

A

Peutz-Jegher’s syndrome

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51
Q

What medical treatment should you give in ongoing diarrhoea in Crohn’s patient post-resection with normal CRP?

A

Cholestyramine

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52
Q

Grading of hepatic encephalopathy?

A

Grade I: Irritability
Grade II: Confusion, inappropriate behaviour
Grade III: Incoherant, restless
Grade IV: Coma

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53
Q

What can omeprazole increase you risk of developing?

A

C. Difficile

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54
Q

What cancer does Barrett’s grow into?

A

Adenocarcinoma of oesophagus

55
Q

What do you think if a patient has liver failure following MI?

A

Ischaemic hepatitis

56
Q

What is used to maintain remission of UC?

A

Oral aminosalicylate

57
Q

What marker is most accurate for assessing the function of the liver in acute liver failure?

A

Prothrombin time

58
Q

Treatment of life threatening C. Diff?

A

Oral vancomycin
IV Metronidazole

59
Q

What is used for prophylaxis of oesophageal bleeding?

A

Non-cardioselective B-blocker (NSBB) (Propanolol)

60
Q

What can you use to stop an uncontrolled variceal haemorrhage?

A

Sengstakn Blakemore Tube

61
Q

Is this presentation CD or UC?
-Wt loss
-Mouth ulcers

A

Crohn’s disease
(Can affect GI tract anywhere from mouth to anus)

62
Q

Where is most affected in Crohn’s?

A

Ileum

63
Q

Medications for remission in Crohn’s?

A

Azathiprine
Mercaptopurine

64
Q

UC histology?

A

Crypt abscesses

65
Q

What are hypersegmented polymorphs an early sign of?

A

Megaloblastic anaemia

66
Q

What other cancer is associated with Lynch syndrome after colorectal cancer?

A

Endometrial

67
Q

When does hepatorenal syndrome come on for type 1 and 2?

A

1: Rapid onset, less than 2 weeks, following acute event like UGI bleed

2: Gradual decline in renal function

68
Q

Biochem of autoimmune hepatitis?

A

ALT & AST raised
ALP normal/slightly raised

69
Q

What drug do you give with isoniazid and why?

A

Pridoxine (Vitamin B6)
Prevents peripheral neuropathy

70
Q

Common side of metaclopramide?

A

Diarrhoea (metaSLOPramide)

71
Q

What would a the presence of ANA, Anti-SM and raised IgG levels be characteristic of?

A

Autoimmune hepatitis

72
Q
A
73
Q

InvGX for bacterial overgrowth?

A

H breath test

74
Q

Pulsatile liver edge?

A

RHF

75
Q

Which type of cancer is barrett’s oesophagus more associated with?

A

Adenicarcinoma

76
Q

Crypt abscesses indicate what?

A

UC

77
Q

What should be given before endoscopy in patients with suspected variceal haemorrhage?

A

Terlipressin
ABs

78
Q

Medical management of patients presenting with severe alcoholic hepatitis?

A

Prednisalone

78
Q

Dysphagia affecting both solids and liquids form the start makes you think what disease?

A

Achalasia

79
Q

When should you stop PPIs before an OGD?

A

2 weeks prior

80
Q

Characteristic Iron studies for haemochromatosis?

A

Raised transferrin saturation
Raised serum ferritin
Low Total Iron Binding Capacity

81
Q

Triad of presentation for budd-Chiari Syndrome?

A

Abdo pain sudden onset
Ascites
Tender hepatomegaly

82
Q

What would the VBG picture be of in vomiting?

A

Metabolic alkalosis

83
Q

What is Wilson’s disease and what is it characterised by?

A

Autosomal recessive disorder
Defective hepatic copper transport leading to copper accumulation

84
Q

Common finding in Wilson’s disease?

A

Reduced serum caeruloplasmin

-this is a copper-carrying protein and it’s synthesis is impaired in Wilson’s due to copper overload intracellularly

85
Q

Early signs of haemochromatosis?

A

Fatigue
ED
Arthralgia

86
Q

Diagnostic method for pancreatic cancer?

A

High resolution Abdo CT

87
Q

What alarm bells are ringing if an elderly person is diagnosed with new onset diabetes? + they have jaundice and raised serum lipase?

A

Pancreatic cancer

88
Q

Patient with UC has severe relapse or >=2 exacerbations in past year what should you trial with them?

A

Oral azathioprine
Oral mercaptopurine

89
Q

What can a high urea indicate bleed wise?

A

UGI Bleed

90
Q

Firs line management for NAFLD?

A

Weight loss

91
Q

What management does dysplasia on biopsy warrant in barrett’s?

A

Endoscopic intervention

92
Q

Heart defects of carcinoid syndrome?

A

Pulmonary stenosis
Tricuspid insufficiency

93
Q
A
94
Q

What artery is at risk with duodenal ulcers?

A

Gastroduodenal

95
Q

Gold standard for confirming a coeliac diagnosis?

A

Endoscopy
Biopsy

96
Q

What GI related condition can cause hypogonadoptrophic and hypogonadism?

A

Haemochromatosis

97
Q

What GI condition often is associated with polycythaemia rubra vera?

A

Budd-Chiari Syndrome

98
Q

1st and 2nd line treatments for herediatary haemochromatosis?

A

Venesection

Desferrioxamine

99
Q

What is likely if a patient has new yellow plaques on sigmoidoscopy following a course of Cephalosporins?

A

Pseudomembranous colitis

100
Q

Differentiating between IBD and IBS?

A

Faecal calprotectin

101
Q

How long is isolation if a patient has C.Diff?

A

48 hours

102
Q

Alcohol units equation?

A

Alcohol units = volume (ml) * ABV/1000

103
Q

What electrolyte imbalance can omeprazole cause?

A

Hyponatraemia

104
Q

Pre-endoscopic score for identifying patients risk levels and if they can discharged?

A

Glasgow Batchford score

105
Q

Grey skin, sore hand joints diagnosis and monitoring requirements?

A

Haemochromatosis
Ferritin and Tranferrin saturation

106
Q

Treatment of severe alcoholic hepatitis?

A

Prednisalone

107
Q

What medication helps with bile acid malabsorption?

A

Cholestyramine

108
Q

What is low in iron deficiency anaemia but high/normal in anaemia of chronic disease?

A

Ferritin

109
Q

Metabolic ketoacidosis with normal or low glucose…What ya think is the cause?

A

ALCOHOL

110
Q

What should be prescribed for treatment of large volume ascites with large volume paracentesis?

A

IV Human albumin solution

111
Q

How does loperamide work?

A

Reduction in gastric motility through stimulation of opioid receptors

112
Q

Pre-op tests required before a Nissen fundoplication?

A

Oesophageal manometry

113
Q

Treatment of perianal fistula

A

Oral metronidazole

114
Q

1st line during endoscopy to stop variceal bleeding?

A

Band ligation

115
Q

What deficiency causes angular chelitis?

A

Riboflavin

116
Q

Surgical treatment of achalasia?

A

Heller Cardiomyotomy

117
Q

Gene in Lynch syndrome?

A

MSH2/MLH1

118
Q

What might occur in association with Iron deficiency anaemia and cause dysphagia?

A

Plummer-Vinson Syndrome (VERY RARE THOUGH)

119
Q

How would you treat a patient with a folate and B12 deficiency?

A

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)

120
Q

Raised platelet count + nausea invgX?

A

Non-urgent referral for dyspepsia

121
Q

Anaemia of chronic disease blood results?

A

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

122
Q

What type of anaemia is haemolytic?

A

Normocytic

You would expect
-Increased reticulocyte count
-Increased lactate dehydrogenase
-High bilirubin

123
Q

What type of anaemia is iron deficient? What is the TIBC like?

A

Microcytic anaemia

-High (as there is no iron bound and the ferritin would be decreased as low iron to store)

124
Q

What type of anaemia does B12 deficiency cause?

A

Macrocytic

125
Q

Medicine for dodgy bowels after cholecytsectomy?

A

Cholestyramine

126
Q

What is fetor hepaticus? what does it indicate?

A

Sweet and fecal breath

Sign of liver failure

127
Q

Criteria components for Truelove and Witt’s score and what it assesses?

A

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

128
Q

What drug is contraindicated in parkinsonism?

A

Metaclopramide

129
Q

What cancer develops in 10% of Primary sclerosing Cholangitis cases?

A

Cholangiocarcinoma

130
Q

Treatment of alcoholic ketoacidosis?

A

IV Thiamine and 0.9% saline

131
Q

Most common organism found in ascitic fluid?

A

E Coli

132
Q

How long must patients eat gluten before being coeliac tested?

A

6 weeks

133
Q

T2DM with deranged LFTs?

A

NAFLD

134
Q
A

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