Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine > GI > Flashcards

GI Flashcards

1
Q

Name 5 predisposing factors for Diverticular Disease

A

Age
Developed country
Low fibre diet
Constipation
Small faecal volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why dont diverticulae form in the rectum?

A

it has an outer longitudinal layer that completely surrounds the diameter of the rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How would you manage Diverticulosis?

A

Increased fibre
Bulk-forming laxatives (e.g. Ispaghula husk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How would you manage uncomplicated diverticulitis

A

Oral co-amoxiclav (5 days)

Analgesia

Clear fluids until symptoms improve

Follow up in 2 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name 6 complications of acute diverticulitis

A

Perforation
Peritonitis
Peridiverticular abscess
Harmorrhage
Fistula (colon to bladder or vagina)
Ileus / obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name 3 Abs related to coeliac disease

A

anti-TTG
anti-EMA
anti-DGP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the main histological features of coeliac disease?

A

Crypt hypertrophy of the small bowel

Villous atrophy

Intra-epithelial WBCs

Chronic inflammation of the lamina propria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which HLA genotypes are associated with Coeliac disease?

A

HLA-DQ2 (95%)
HLA-DQ8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which dermatological finding is associated with coeliac disease?

A

Dermatitis herpetiformis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What first line blood tests are indicated in coeliac disease?

A

FBC - anaemia
Irodn studies
B12 / folate
Total IgA levels
anti-TTG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do you manage coeliac disease?

A

gluten-free diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Who are most likely to be affected by IBS?

A

Younger women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the 3 main symptoms of IBS?

A

IBS

Intenstinal discomfort
Bowel havit abnormalities
Stool abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you diagnose IBS?

A

Exclude red flags

Rome III criteria (>6 months of abdo pain / discomfort + one of the following);

Pain relieved by opening bowels
Bowel habit abnormalities
Stool abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the subtypes of IBS?

A

IBS-D (diarrhoea)
IBS-C (constipation)
IBS-M (mixed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What dietary changes are suggested for those with IBS?

A

FODMAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How might you pharmacologically manage IBS?

A

Loperamide - diarrhoea

Ispaghula husk

Antispasmodics for cramps

Linaclotide - when 1st line laxatives fail

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the key features differentiating Crohn’s and UC?

A

Crohn’s - weight loss, RIF mass

UC - bloody diarrhoea, LLQ pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do you classify UC?

A

Mild - intermittent bleeding, mild diarrhoea (<4 stools/day)

Moderate - up to 10 bloody stools daily

Severe - >10 bloody stols a day, weight loss, anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the most common extra-intestinal manifestations specific to Crohn’s?

A

Gallstones
Oxalate renal stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the most common extra-intestinal manifestations specific to UC?

A

PSC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What extra-intestinal manifestations are common to both Crohn’s and UC?

A

Erythema nodosum
Pyoderma gangrenosum
Enteropathic arthritis
Red eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How does Crohn’s and UC affect the length of the bowel?

A

Crohn’s - skip lesions, mouth to anus

UC - rectum, never beyond ileocaecal valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the histological findings of Crohn’s?

A

Inflammation of all layers

Increased goblet cells

Non-caseating granuloma

Skip lesions, ulcerations, cobblestoning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the histological findings of UC?

A

No inflammation beyond submucosa

Neutrophilic infiltration of crypt abscesses

Depletion of goblet cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which types of enema would you use to image IBD?

A

Crohn’s - Small bowel enema

UC - barium enema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How would you manage Crohn’s?

A

Induce remission - steroids / enteral nutrition

(if steroids don’t work then azathrioprine, methotrexate…)

Maintain remission - azathioprine / mercaptopurine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How would you manage UC?

A

MIld-moderate
1) - aminosalicylate
2) - corticosteroids

Severe - IV hydrocortisone

Maintain remission - aminosalicylate, azathioprine, mercaptopurine

Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How would you manage an acute severe attack of UC?

A

IV hydrocortisone cyclosporin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How would you manage UC surgically?

A

Panproctocolectomy
Ileostomy / J-pouch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How would you classify haemorrhoids?

A

1) no prolapse

2) prolapse when straining, returns on relaxing

3) prolapse when straining, does not return on relaxing

4) prolapse permanently

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Name 4 topical treatments for haemorrhoids

A

Anusol (shrinks haemorrhoids)

Anusol HC (short term, has hydrocortisone)

Germoloids (LA)

Proctosedyl (short term, steroids)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Name 4 non-surgical treatments for haemorrhoids

A

Band ligation

Injection sclerotherapy

IR coagulation

Bipolar diathermy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Name 3 surgical options for haemorrhoids

A

Haemorrhoidal artery ligation

Haemorrhoidectomy

Stapled haemorrhoidectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How would you manage a patient with intractable rectal prolapse who is unfit for surgery?

A

Circumanal rubber ring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Who tends to have malabsorption due to bacterial overgrowth?

A

Elderly patients, those with structural problems

e.g. surgery, diverticula, crohn’s, SB dysmotility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What investigations would you perform on someone with suspected bacterial overgrowth?

A

Bloods (low B12)
Breath test
SB aspirate
Barium test radiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How would you treat bacterial overgrowth?

A

Abx 2 weeks
Abx free period

Repeat cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How is Giardia Lamblia transmitted?

A

faeco-orally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What will giardia lamblia show on bloods?

A

Low B12
Low iron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How would you treat Giardia Lamblia infection?

A

Metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What pathogen causes whipple’s disease?

A

Tropherym Whipplei

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How does Whipple’s disease present?

A

Fever
Arthralgia
Weight loss
Malabsorption
Neurological signs (foot drop)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What disease does Tropical Sprue mimic?

A

Giardia Lamblia infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How would you manage Tropical sprue?

A

Tetracycline
Folic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the main post-mucosal factor contributing to malabsorption?

What causes this?

A

Lymphangiectasia

May be primary (pt born without lymphatics)

Secondary - radiotherapy / cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

How would you confirm the diagnosis of lymphangiectasia?

A

Signs - oedema, steatorrhoea

Bloods - low albumin, lymphocytes, and gamma globuline

Duodenal biopsy (stranded fat)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the most common cause of SBO?

A

adhesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the most common cause of LBO?

A

malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What sort of vomiting is expected in someone with BO?

A

Green bilious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How do you manage BO?

A

DRIP and SUCK

(NBM, fluids)
Prepare for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is ‘third spacing’ in BO?

A

Bowel secretes fluid which is absorbed in the colon

In BO, this can’t be reabsorbed. The further up the obstruction, the more fluid accumulates, leading to hypovolaemia and shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

How would you differentiate SBO from LBO on AXR?

A

SBO - valvulae conniventes, central

LBO - haustra, peripheral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How would you differentiate peritonitis from ischaemia in bowel perforation?

A

Peritonitis - rigid abdomen

Ischaemia - soft abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What areas of the bowel are particularly susceptible to ischaemic colitis?

A

Watershed areas;
- splenic flexure
- rectosigmoid junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Name all of the causes of pancreatitis

A

I GET SMASHED

Idiopathic
Gallstones
Ethanol
Trauma
steroids
Mumps
AI
Scoprion sting
Hyperlipidaemia
ERCP
Drugs (furosemide, thiazide-diuretics, azathioprine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What are the 3 most common causes of pancreatitis?

A

Gallstones
Ethanol
ERCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

How would acute pancretitis affect serum amylase levels?

A

> 3x upper limit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

An increase in what enzyme is considered more sensitive and specific compared to amylase?

A

Lipase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Which scoring system is used to classify pancreatitis?

A

0-1 - mild
2 - moderate
3+ - severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

How would you manage chronic pancreatitis?

A

Abstinence from smoking / alcohol

Analgesia
Creon

SC insulin
ERCP with stenting

Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is the definition of acute gastritis?

A

Gastric mucosal infiltration by neutrophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the definition of chronic gastritis?

A

Gastric mucosal infiltration by lymphocytes and plasma cells (+ maybe neutrophils)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What are the causes of chronic gastritis?

A

H. pylori
AI
Reactive (chronic bile reflux, NSAIDs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What other condition is AI gastritis associated with?

A

Pernicious anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What are the 4 consequences of gastritis?

A

Acute peptic ulceration

Peptic ulcer disease

Intestinal metaplasia

Gastric cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What are the causes of acute peptid ulceration?

A

NSAIDs
Stress ulcers (sepsis/shock/trauma)
Curling ulcers (severe burns)
Cushing ulcers (intracranial disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What are the 3 main causes of peptic ulcer disease?

A

H.pylori infection
NSAIDs
Zollinger-Elison syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is Zollinger-Ellison syndrome?

A

Uncontrolled gastrin production by tumour cells -> hyperacidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is the greatest RF for development of gastric cancer?

What is the most common type of gastric cancer?

A

H.pylori

Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

How might you differentiate Appendicitis and Mesenteric Adenitis?

A

MA - maintains appetite, high grade fever (>39), normal WCC + CRP, improves after 24 hours

A - No appetite, low grade fever, ^ WCC+CRP, pt deteriorates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Where is McBurney’s point?

A

1/3 distance from ASIS to umbilicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What is Robsing’s sign?

A

Appendicitis

Palpation of LIF -> RIF pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is the Cope sign?

A

Retrocaecal appendix, slides over obturator internus

Pain on flexion and internal rotation of R hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What are the 2 types of oesophageal cancer?

Which infections are RF for these cancers?

Where in the oesophagus do they occur?

A

SCC - HPV, upper

Adenocarcinoma - H.pylori, lower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is the main mode of diagnosis of oesophageal cancer?

A

Endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

How would you manage a superficial oesophageal or gastric cancer?

A

Endoscopic mucosal resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

In pancreatic cancer, what is the most common type and where do they occur?

A

Adenocarcinoma

Head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What is the average survival of pancreatic cancer from diagnosis?

A

6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What is the key presenting feature of pancreatic cancer?

A

Painless obstructive jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What metabolic sign might be an indication of pancreatic cancer?

A

New onset DM
Rapid worsening of glycaemic control of T2DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Who gets a 2WW for suspected pancreatic cancer?

Who gets a direct access CT abdomen?

A

> 40 jaundice

> 60 weight loss + additional symptom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What is Courvoisier’s law?

A

A palpable gallbladder along with jaundice is unlikely to be gallstones.

The cause is usualy cholangiocarcinoma or pancreatic cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What is Trousseau’s sign?

A

Migratory thrombophlebitis as a sign of malignancy, particularly pancreatic adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Which tumour marker is raised in pancreatic cancer?

A

CA 19-9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What is the technical name for the Whipple procedure?

How is a modified Whipple procedure different?

A

pancreaticoduodenectomy

Leaves the pylorus in place (PPPD, pylorus-preserving pancreaticoduodenectomy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What common drug reduces the incidence and mortality of colorectal cancer?

A

Aspirin 75mg ODN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

When should you refer to a specialist for investigation of genetic colorectal cancer?

A

2x 1st degree relatives w/ colorectal cancer at average <60years

Criteria for AD colorectal cancer syndrome met

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Name 3 AD colorectal cancer syndromes

A

Lynch syndrome (HNPCC)

Familial adenomatous polyposis (FAP)

Peutz-Jegher’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What are the 3 most common cancers in Lynch syndrome?

A

Colorectal cancer
Endometrial cancer
Ovarian cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What criteria is used to diagnose Lynch syndrome?

A

Amsterdam criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Which mutations are associated with Lynch syndrome?

A

MLH1
MSH2
MSH6
PMS2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

How are those with Lynch syndrome screened for colorectal cancer?

A

2 yearly colonoscopy from 25-75 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What mutation is associated with FAP?

A

APC gene mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

At what age are those with FAP initiated in colorectal cancer screening?

A

12 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What oral clinical sign is associated with Peutz-Jeghers syndrome?

A

hyper-pigmented macules on the tongue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

what gene mutation is associated with Peutz-Jeghers syndrome?

A

STK11

(TSG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

How is colorectal cancer staged?

A

TNM

Duke’s still commonly used but technically outdated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

How would you differentiate HSV and CMV oesophagitis?

A

HSV - fewer ulcers, 2mm shallow, volcano-like

CMV - deeper and wider

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What must you test for in someone with oesophagitis?

A

HIV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

How would you treat oesophagitis?

A

Ganciclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What pathogen causes gastritis?

A

H.pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

How would you diagnose gastritis?

A

Urea breath test
Rapid urease test (CLO test)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What can untreated H.pylori gastritis lead to?

A

Stomach cancer
Gastric MALT lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

How do you treat H.pylori gastritis?

A

1 week triple therapy

PPI
Clarithromycin
Amoxicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What area of the bowel is affected by watery and bloody diarrhoea?

A

Watery - small bowel
Bloody - large bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What is the main diarrhoeal illness requiring treatment?

A

C.Diff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Name 5 causes of watery diarrhoea

A

Staph aureus

C.perfringens

C.Diff

Bacillus cereus

Vibrio cholera

109
Q

How does staph aureus look down the microscope?

A

Gram + cocci

110
Q

How might you differentiate C.perfringens and staph aureus infection?

A

C. perfringens no vomiting as it produces it’s toxin once ingested

111
Q

What are the main complications associated with C.Diff?

A

Toxic megacolon
Bowel perforation

112
Q

How would you treat C.Diff infection?

A

1st episode - PO vanc 10 days

Life-threatening - PO vanc + IV metronidazole

Recurrent - PO fidaxomicin

Consider FMT

113
Q

What 2 types of toxins are produced by bacillus cereus?

A

Emetic - vomiting within 1-5 hours
Diarroheal - diarrhoea within 8-16 hours

114
Q

What sign sugests vibrio cholera infection?

A

Rice-water stool

115
Q

How would you manage vibrio cholera?

A

Ciprofloxacin
Rehydration

116
Q

How would C.perfringens look down the microscope?

A

Gram + bacilli

117
Q

What sort of bacteria cause bloody diarrhoea?

A

Gram - bacilli

118
Q

Name 4 bacterial causes of bloody diarrhoea

A

Salmonella enteritidis
Salmonella typhi
Shigella
Campylobacter jejuni
E.coli

119
Q

How long can diarrhoea last for in with salmonella enteritidis?

A

7 days

120
Q

What is the pathophysiology of salmonella typhi?

A

travel shits

enteric fevers, invade peyer’s patches, disseminates

121
Q

How do you manage salmonella typhi?

A

Azithromycin
Ceftriaxone
Meropenem

122
Q

What complications are associated with Shigella infection?

A

RA
conjunctivitis
HUS

123
Q

What is the most common serotype of E.coli?

How do you treat them? why?

A

0157:H7

DON’T GIVE ABX - ^toxin release, making it worse

124
Q

Name 3 parasitis causes of bloody diarrhoea

A

Giardia
Worms
Schistosomiasis

125
Q

Where might you catch schistosomiasis?

A

Lake MalawiW

126
Q

What is Cirrhosis?

A

Liver insult over many years causing fibrosis and vascular remodelling

127
Q

What is liver Fibrosis?

A

Damage to hepatocytes stimulating Kupffer cells to produce chemical mediators activating perisinusoidal stellate cells

128
Q

What is involved in vascular remodelling of the liver?

A

Capillarisation of sinusoidal endothelium due to loss of fenestrations and perisinusoidal fibrosis

129
Q

What are the 3 main clinical consequences of Cirrhosis?

A

Hepatocellular failure
Portal HTN
Hepatocellular carcinoma

130
Q

How would you define chronic hepatitis?

A

Inflammation of the liver continuing without improvement for at least 6 months

131
Q

How is the morphology of acute hepatitis different to portal hepatitis?

A

Acute - lobular inflammation
Portal - portal inflammation

132
Q

What are the 3 AI liver diseases?

A

AIH
PSC
PBC

133
Q

What are the 2 types of AIH?

A

1 - women, 40-50s, after menopause, more acute

2 - children, girls, jaundice

134
Q

Which antibodies are associated with AIH?

A

1 - ANA, anti-SM, anti-SLA/LP

2 - anti-LKM1, anti-LC1

135
Q

How would you confirm a diagnosis of AIH?

A

LIver biopsy

136
Q

How would you manage AIH?

A

Steroids
Azathioprine
Liver transplant

137
Q

Who is at higher risk of PBC?

A

Females

138
Q

What is the most common AI liver disease?

A

PBC

139
Q

How do you treat PBC and PSC?

A

Ursodeoxycholic acid (UDCA)

140
Q

Who is at higher risk of PSC?

A

Males

141
Q

How do you investigate PSC?

A

MRCP

142
Q

What are the 3 extra-hepatic manifestations of PSC?

A

Pyoderma gangrenosum
Erythema nodosum
Episcleritis

143
Q

What proportion of adults are estimated to have NAFLD?

A

25%

144
Q

What are the 4 stages of NAFLD?

A

NAFLD
NASH
Fibrosis
Cirrhosis

145
Q

What score is used to assess liver fibrosis in NAFLD?

A

Fibrosis 4

146
Q

What are the management options for NAFLD?

A

Lots of lifestyle stuff

Lose 10% of bosy weight
Control DM

147
Q

What is the stepwise progression of ALD?

A

Alcoholic fatty liver
Alcoholic hepatitis
Cirrhosis

148
Q

What is the definition of binge-drinking?

A

6 units for women and 8 for men in a single session

149
Q

How would you manage ALD?

A

Stop drinking
Nutritional support (thiamine)

150
Q

When should you suspect Portal HTN?

A

Chronic liver disease
Thrombocytopenia
Splenomegaly

151
Q

What is the main cause of pre-hepatic Portal HTN?

A

Portal vein thrombosis

152
Q

Name 2 causes of intra-hepatic Portal HTN

A

Cirrhosis (developed world)

Schistosomiasis (developing world)

153
Q

Name 3 causes of post-hepatic Portal HTN

A

Budd Chiari syndrome
IVC obstruction
HF

154
Q

What is Budd-Chiari syndrome?

A

Hepatic vein obstruction

155
Q

What are the 3 main consequences of Portal HTN to be aware of?

A

Ascites
Variceal Haemorrhage
Hepatic Encephalopathy

156
Q

How would you manage Portal HTN?

A

NSBBs (propranolol or nadolol)

Carvedilol

Endoscopy

Variceal band ligation

157
Q

How would you know if ascites is caused by Portal HTN?

A

SAAD >1.1 g/dL

158
Q

How would you manage Ascites?

A

Spironolactone

Consider paracentesis, liver transplant, or TIPSS if resistance to diuretics

159
Q

What is TIPSS?

A

Trans-jugular intra-hepatic, porto systemic shunt

Way of reducing portal pressure quickly, shunting blood fro the portal vein directly to the hepatic vein

160
Q

How might you reduce the risk of SBP in those with ascites?

A

Ciprofloxacin

161
Q

What are the key features of hepatorenal syndrome?

A

Ascites
Hyponatraemia
Hepatorenal syndrome

162
Q

What are the 2 types of hepato renal syndrome?

A

Acute - sepsis
Chronic - end stage liver disease

163
Q

How would you manage hepatorenal syndrome?

A

AKI stuff
Sepsis screen
Terlipressin

164
Q

What are the 4 key sources of upper GI bleeds?

A

Peptic ulcers
Mallory-Weiss tears
Oesophageal varices
Stomach ulcers

165
Q

What is used to estimate the risk of a patient having an upper GI bleed?

A

Glasglow-Blatchford Bleeding Score

166
Q

What is the association between urea and upper GI bleeding?

A

High urea

Acids + enzymes break down blood from bleed -> urea absorbed in intestines

167
Q

What is used to estimate the risk of bleeding and mortality after endoscopy for upper GI bleed?

A

Rochall score

168
Q

What primary prevention is there for variceal bleeding?

A

Small - carvedilol
Medium-large - band ligation + NSBBs

If oesophageal varices - terlipressin, Abx

169
Q

How would you manage acute variceal bleed?

A

Terlipressin -> supportive -> endoscopy (ligation) -> 5 days -> 2nd endoscopy if indicated -> TIPSS if indicated

170
Q

What secondary prevention is available for variceal bleeding?

A

Terlipressin (wean off)
Abx 7 days
Lactulose
Sucralfate

171
Q

Why is lactulose offered to those with oesophageal varices?

A

Encephalopathy risk

172
Q

Why is Sucralfate offered to those with oesophageal varices?

A

May reduce rate of banding induced oesophageal ulceration

173
Q

How would you differentiate cholecystitis from cholangitis?

A

Cholecystitis - no jaundice

Cholangitis - jaundice

174
Q

What are most gallstones made of?

A

Cholesterol

175
Q

What would you call a biliary stone in the common hepatic duct?

A

Hepatolithiasis

176
Q

What would you call a biliary stone in the CBD?

A

Choledocolithiasis

177
Q

What are the 4 RF’s for developing gallstones?

A

4F’s
Fat
Fair
Female
Fourty

178
Q

Why are patients with gallstones encouraged to reduce their fat intake?

A

reduces CCK secretion and hence gallbladder contraction

179
Q

What sign is suggestive of acute cholecystitis?

A

Murphy’s sign

180
Q

What is the first line imaging for acute cholecystitis?

A

Abdo US

181
Q

What is gallbladder empyema?

A

infected tissue and pus in the gallbladder

182
Q

How would you manage gallbladder empyema?

A

IV Abx

One of;
Cholecystectomy
Cholecystostomy

183
Q

What are the 2 main causes of Acute Cholangitis?

A

Obstruction in bile ducts (gallstones)
Infection from ERCP

184
Q

What is the most common pathogen causing acute cholangitis?

A

E.coli

185
Q

What is the presentation of acute cholangitis?

A

Charcot’s Triad
RUQ pain
Fever
Jaundice

186
Q

What is the most common type of primary liver cancer?

A

Hepatocellular carcinoma

187
Q

Name 4 established RFs for HCC

A

ALD
NAFLD
Hep B
Hep C

188
Q

Who is screened for HCC and how is this done?

A

Liver cirrhosis

Every 6 months - US, AFP

189
Q

What interventional radiology procedure may be used to treat HCC?

A

Transarterial chemoembolisation

190
Q

What is the most common type of cholangiocarcioma?

A

Adenocarcinoma

191
Q

What is the most commo site for cholangiocarcinoma?

A

Perihilar region

192
Q

What form of AI liver disease is associated with cholangiocarcinoma?

A

PSC

193
Q

What tumour marker is associated with cholangiocarcinoma?

A

CA19-9

194
Q

Name 2 benign liver tumours

A

Haemangioma
Focal Nodular Hyperplasia

195
Q

Who is more at risk of Focal Nodular Hyperplasia?

A

women, those on OCP

(related to oestrogen)

196
Q

Which 2 LFTs are associated with hepatic pathology?

A

ALT
AST

197
Q

Which 2 LFTs are associated with biliary pathology?

A

ALP
GGT

198
Q

What other 2 tests are essential alongside LFTs?

A

Coagulation screen
BGL

199
Q

What would an isolated rise in ALP suggest?

A

Bone pathology

200
Q

What would an isolated rise in GGT suggest?

A

Alcohol XS

201
Q

What would a rise in both ALP and GGT suggest?

A

Cholestasis

202
Q

What might cause an isolated ^Bilirubin?

A

Gilbert’s syndrome (glucosyltransferase deficiency)

203
Q

What might cause decreased production of albumin?

A

Malnutrition
Severe liver disease

204
Q

What might cause increased loss of Albumin?

A

Protein-losing enteropathies
Nephrotic syndrome

205
Q

Why is albumin not the best marker of liver function?

A

It has a 1/2 life of 20 days so takes some time to decrease

206
Q

How would severe liver disease affect a coagulation screen?

A

Decreased clotting factors
^PT / INR

207
Q

How would you manage a Crohn’s patient with a perianal fistula?

A

Oral metronidazole

208
Q

What do patients with coeliac disease require regular immunisations?

A

Functional hyposplenism

209
Q

What are the blood results stuff finding things for PBC?

A

^AMA
^IgM

210
Q

What blood test might differentiate an upper GI bleed from a lower GI bleed?

A

High urea levels can indicate an upper GI bleed

211
Q

What type of duodenal ulcer is more likely to cause major upper GI bleed?

Which artery is affected?

A

Posterior wall duodenal ulcer

Gastroduodenal artery

212
Q

What is the Rockall score used for?

A

Upper GI bleed

Provides a percentage risk of rebleeding and mortality after endoscopy

213
Q

When might you see ‘Kantor’s string sign’ on AXR?

A

Crohn’s disease

214
Q

What sign is indicative of PSC on ERCP?

A

beaded strictures

215
Q

How might you manage bile-acid malabsorption?

A

Cholestyramine

216
Q

What is the diagnostic investigaiton of choice for pancreatic cancer?

A

CT pancreas

217
Q

What is the most sensitive and specific lab finding for diagnosis of liver cirrhosis in those with chronic liver disease?

A

Thrombocytopenia

218
Q

Which antibiotic is a well known cause of cholestasis?

A

Co-amoxiclav

219
Q

How might you differentiate type 1 and type 2 hepatorenal syndrome?

What sign is type 2 associated with?

A

1 - rapid onset (<2/52)
2 - gradual onset (associated with refractory ascites)

220
Q

What is the investigation of choice for suspected perianal fistulae in patients with Crohn’s?

A

MRI

221
Q

Which drug would you administer to reduce the risk of isoniazid induced peripheral neuropathy?

A

Pyridoxine (vitamin B6)

222
Q

How would you calculate alcohol units?

A

Alcohol units = volume (ml) * ABV / 1,000

223
Q

When does carcinoid syndrome occer?

A

Usually when metastases are prevent in the liver and release serotonin into the systemic circulation

May also occur with lung carcinoid as mediators are not ‘cleared’ by the liver

224
Q

What investigations would you offer for carcinoid syndrome?

A

Urinary 5-HIAA
Plasma chromogranin A y

225
Q

What are the management options for carcinoid syndrome?

A

somatostatin analogues e.g. octreotide

Diarrhoea: cyproheptadine may help

226
Q

What is the most common organism found on ascitic fluid culture in SBP?

A

E. coli

227
Q

Which Abx is most likely to cause pseudomembranous colitis?

A

Clindamycin

(also cephalosporins)

228
Q

Which two iron study results are most useful in monitoring response to treatment in haemochromatosis?

A

Ferritin
Transferrin saturation

229
Q

Which vaccine are coeliac patients offered annually?

A

Pneumococcal vaccine

230
Q

What is a Sister Mary Joseph nodule?

A

Sign of metastasis to periumbilical lymph nodes, classically from a gastric cancer primary

231
Q

What is used for the secondary prophylaxis of hepatic encephalopathy?

A

Lactulose and Rifaximin

232
Q

What 2 agents are administered to patients in cirrhotic patients with GI bleeds?

A

Terlipressin
Broad-spectrum Abx (ceftriaxone)

233
Q

What electrolyte abnormalities are characteristic of refeeding syndrome?

A

Hypophosphataemia
Hypokalaemia
Hypomagnasaemia

234
Q

What finding on biopsy is indicative of gastric adenocarcinoma?

A

Signet ring cells

235
Q

Which medication may cause Heinz body anaemia?

What is it used for in gastroenterology?

A

Sulphasalazine

UC

236
Q

What is the gold standard investigation to confirm a coeliac disease diagnosis?

A

Small bowel biopsy

237
Q

What is the AST / ALT ratio in alcoholic hepatitis?

A

2;1

238
Q

What is the most common type of cancer in achalasia, and Barrett’s oesophagus?

A

Achalasia - squamous cell carcinoma

Barrett’s - adenocarcinoma

239
Q

An isolated rise in bilirubin in response to physiological stress in typical of what disease?

A

Gilbert’s syndrome

240
Q

What type of cancer is associated with pernicious anaemia?

A

Gastric carcinoma

241
Q

What is Zollinger-Ellison syndrome?

A

Multiple gastroduodenal ulcers causing abdominal pain and diarrhoea

1/3 will have MEN-1

242
Q

How is Zollinger-Ellison syndrome managed?

A

PPI

243
Q

How might you alter PPI regimen in anticipation of an upper GI endoscopy?

A

Stop 2 weeks prior

244
Q

Which vitamin in high doses is teratogenic?

A

Vitamin A

245
Q

Which feature of refeeding syndrome may cause torsades de pointes?

A

Hypomagnasaemia

246
Q

Which acute abdomen presentation might you consider in someone with AF?

A

Ischaemic colitis

247
Q

How might you confirm the diagnosis of fibrosis in NAFLD?

A

Enhanced liver fibrosis blood test

248
Q

What is Melanosis coli?

What is it associated with?

A

Pigment-laden macrophage in the lamina propria of the colon

Chronic use or abuse of anthraquinone-containing laxatives

249
Q

Which anatomical landmark is used to differentiate an upper GI bleed from a lower GI bleed?

A

Ligament of Treitz

250
Q

How would you differentiate IBS and IBD in primary care?

A

Faecal calprotectin

251
Q

What is the surgical management of Achalasia?

A

Heller cardiomyotomy

252
Q

How should patients referred for endoscopy to investigate upper GI malignancy alter their medications?

A

Stop taking PPI or H2 receptor blocker at least 2 weeks prior

253
Q

How would you investigate disease acitivyt in someone with a severe flare of UC?

A

Flexible sigmoidoscopy

(colonoscopy may cause a perforation)

254
Q

How is SBBOS diagnosed?

A

Hydrogen breath test

255
Q

What is Courvoisier’s law?

A

In the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones

256
Q

What would an apple core sign on CXR (barium swallow) indicate?

A

Oesophageal cancer

257
Q

What would a bird’s beak sign on CXR (barium swallow) indicate?

A

Achalasia

258
Q

How would you treat a Crohn’s patient with complex perianal fistulae

A

Draining seton

259
Q

How is C.diff infection severity determines?

A

WCC

Mild - normal
Moderate - raised but <15
Severe - >15

260
Q

How long must patients consume gluten for before being tested for coeliac disease?

A

6 weeks

261
Q

What are the best measures of liver function?

A

coagulation (PT) and albumin

prothrombin is best in acute situations as it has an even shorter half life than albumin

liver enzymes are a poor measure of liver function

262
Q

What is the 1st indication that someone may have NAFLD?

A

^ALT

263
Q

When treating ascites with large-volume paracentesis, what must you prescribe to reduce mortality risk?

A

IV human albumin solution

This reduces paracentesis-induced circulatory dysfunction and mortality

264
Q

What is the pain characteristic of duodenal ulcer?

A

pain when hungry

Relieved by eating

265
Q

What is the 1st line treatment for SBOS?

A

Rifaximin

266
Q

What is the treatment for Wilson’s disease?

A

Penicillamine

267
Q

Name 2 aminosalicylates

A

Mesalazine
Sulphasalazine

268
Q

Name a SE of mesalazine

A

agranulocytosis

269
Q
A

Medicine (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions