GI Flashcards
How do you differentiate between gallstones and cholecystitis using murphy’s sign?
Negative murphy’s sign with gallstones
What does ARDS look like in severe acute pancreatitis on a chest x-ray?
Bilateral ground-glass opacities
What are swinging fevers a characteristic of?
Abscess/Empyema
What HPV strain is most associated with anal cancer?
HPV 16
What is Peutz-Jegher’s syndrome and how does it present?
Autosomal dominant condition where theres a mutation in the STK11 gene
-About 40% of SBO cases are due to this syndrome
-pigmented lesions(macules) on mucosal surfaces, palms and plantar surface is BIG CLUE!
What is Lynch syndrome also known as and what side of the bowel does it tend to appear on more?
Hereditary nonpolyposis colorectal cancer
-Appear on right side more often
What do you do if patient is presenting with new abdominal pain in the absence of red flag symptoms such as weight loss, change in bowel habit, iron deficiency anaemia or unexplained rectal bleeding according to NICE Guidelines? What do you do if positive?
FIT test
-If positive then should refer patient to urgent 2 week wait cancer pathway
What other cancer are people with lynch syndrome more likely to develop?
Endometrial
When is Carcinoembryonic antigen(CEA) used in colorectal cancer?
Used as a tumour marker to see response to therapy
What gene is likely to be mutated in a patient presenting with the Gardner’s variant of familial adenomatous polyposis (FAP): lipomas, supernumerary teeth, osteomas, and epidermoid cysts?
Mutation in APC gene A tumour suppressor gene)
What anti emetic is used in bowel obstruction and what is contraindicated and why?
Antiemetic used is IM cyclizine
Contraindicated is metoclopramide due to its pro-kinetic nature
What are the most common causes of small and large bowel obstruction?
Small bowel-Adhesions
Large bowel-Bowel cancer
What is the kings college hospital liver transplant criteria in paracetamol induced hepatic failure?
Paracetamol induced:
-Arterial pH < 7.3 after 24 hours
or the follwing 3:
-The prothrombin time (PT) is >100 seconds.
-The creatinine is >300 µmol/L.
-The patient has grade III encephalopathy.
Which tumour marker is likely to be raised in pancreatic cancer?
CA 19-9
What are liver function markers like in ischaemic hepatitis?
transaminase will always be in the 1000s but normal ALP and bilirubin
What is the investigation for a Colo vesical fistula?
Cystoscopy
How is spontaneous bacterial peritonitis confirmed? What is a major risk factor?
Ascitic tap where the neutrophil count is >250
-Major risk factor is decompensated liver
What is hereditary haemochromatosis and what is a good line of investigation?
HH is a genetic condition which can cause liver failure,
What is recommended by NICE to prevent recurrence of hepatic encepalopathy?
Rifaxamin
What is the kings college criteria for liver transplant in non paracetamol induced hepatic failure?
Prothrombin time >100s
What is Budd-Chiari syndrome? First line investifation?
Obstruction of hepatic vein leading to liver obstruction and ischaemia. Due to thrombosis. Pts can develop hepatic failure.
-First line Ix is ultrasound liver with doppler flows
What is the ratio of AST and ALT levels in alcoholic liver disease and GGT as well as albumin?
An AST and ALT ratio >2:1
High GGT
Low albumin
What presents on blood tests in 70% of cases in autoimmune induced hepatitis?
Elevated levels of anti smooth muscle antibododies
What should every patient with hep b and liver cirrhosis get done every 6 months?
Liver US and AFP testing
What is the most critical factor in determining prognosis in non alcoholic fatty liver disease?
Presence of hepatic fibrosis
What is likely to be raised in type 2 autoimmune hepatitis
Anti liver/kidney antibodies
What is the greatest risk factor for non alcoholic fatty liver disease?
Metabolic syndrome i.e. obesity
What are you at high risk of after a TIPSS procedure?
Hepatic encephalophathy
Tx for Chronic Hep C
DAA
like sofosbuvir
What are the Indications for transjugular intrahepatic portosystemic shunt (TIPSS)?
-Refractory ascites
-Secondary prophylaxis of variceal haemorrahge
What laxative should be used in a case of constipation in an IBS patients?
Ispaghula husk-bulking agent
Why can azathioprine cause pancytopenia?
Because of Thiopurine methyltransferase (TPMT) deficiency leads to accumulation of toxic metabolites of azathioprine, increasing the risk of bone marrow suppression.
What is the most common type of gastric cancer
Adenocarcinoma
In a patient with ulcerative colitis, what positive result would suggest primary sclerosing cholangitis?
positive ANA and P-ANCA
What cancer can arise from ulcerative colitis?
Biliary tract carcinoma
-Cholangiocarcinoma
What must we do to patient with severe UC if they do not respond to therapy after 3 days?
Rescue therapy with IV ciclosporin until surgical review
What is boerhaave syndrome?
Boerhaave syndrome is a life-threatening oesophageal rupture caused by severe vomiting, which may present with pleural effusion due to the leakage of gastric contents into the mediastinum and pleural space.
-can present after binge drinking
What type of fistula can develop in an individual with crohns who has pneumaturia?
Colovesical fistula
What medications are associated with GI bleeds?
SSRI’s
-Citalopram, fluxoteine
What is the laxative used in patients with IBS and constipation?
Ispaghula husk
How can we treat dermatitis herpetiformis in coeliacs?
Dapsone, an ABx
How does Vitamin B3 deficiency present itself as?
Diarrhea
Dementia
Dermatitis
Death
-Can get hyperpigmented skin around neck due to lack of nicacin(B3)
In what newly diagnosed conditions should coeliacs be tested for according to NICE guidelines?
Any autoimmune thyroid condition and T1DM
What drug in triple therapy for H pylori can cause metallic taste in mouth?
Metronidazole
-(Met)al and (Met)ronidazole
if patient has a macrocytic anaemia and a blood film with Howell-jolly bodies, what is that indicative of?
Howell Jolly body suggest hyposplenism and this alongside the aneamia strongly suggests coeliac disease
What is a serious complication of TPN and what should you look out for?
Serious complication is refeeding syndrome which can cause congestive HF, seizures, diziness
-Look out for hypophosphatemia
What is MALToma usually a consequence of and how can we treat it?
The majority of tumours are caused by infection with Helicobacter pylori, and can be treated successfully using proton pump inhibitors and antibiotics
What does prolonged use of TPN increase the risk of?
Thrombophlebitis
Before an OGD, what must patients stop taking and when?
Stopping medications before OGD (1-4):
1 day = gaviscon
2 weeks = PPIs
3 days = ranitidine
4 weeks = antibiotics
What scoring system is used to assess bleeding risk and mortality after an endoscopy for upper GI bleeds?
Rockall
What scoring system is used before an endoscopy to assess bleeding?
Glasgow blatchford
Mx for Toxic megacolon
Oral Vancomycin to reach the gut
IV Metronidazole if it were to spead
Mx for esophageal varices before endoscopy
-Terlipressin and antibiotic prophylactic as it reduces mortality before endoscopy
What is the presentation of primary biliary cholangitis? and Mx
Fatigue, pruritus, Jaundice, hepatomegaly, Raised anti mitochondrial antibodies and raised serum IgM
-Ursodeoxycholic acid
What is the Mx for severe UC?
IV ciclosporin if corticosteroids do not work
What scoring system is used in cirrhosis for transplantation?
The Model for End-Stage Liver Disease (MELD) score is commonly used to assess liver disease severity and prioritise transplant candidacy. It incorporates bilirubin, INR, and creatinine.
What is plummer-vinson syndrome?
-It is a rare condition associated with dysphagia, iron deficiency and oesophageal webs
What med is used for cytotoxic induced vomiting?
5-HT antagonist, ondansetron
What is a krukenberg tumour?
Metastases to the ovaries
What is a strong risk factor of gastric cancers?
H.pylori
What node is enlarged in gastric cancer that suggests early malignancy?
Supraclavicular(virchows)
Multiple duodenal and gastric ulcers, wont respond to treatment, what may it be?
Zollinger Ellison syndrome
-excess gastrin production, excess gastric acid, recurring peptic ulcer disease
Mx for alcohol withdrawal
- First line management is chlordiazepoxide
- 48-72 hours later patient may have seizures or hallucinations due to delirium tremens. For this you give lorazepam
What diuretic do you give if patient has ascites?
Spironolactone
-aldosterone antagonist
Differentiating between IBS vs IBD
PR bleeding is symptom of IBD not IBS
Patient had ERCP for gallstones and presents to A and e with epigrastric pain and vomiting. why
Post ERCP. acute pancreatitis can occur due to instruments damaging tissue
What is seen on an. x-ray film for. small bowel obstruction?
Valvular conniventes
What post cholecystectomy syndrome?
This is a typical description of what is known as post-cholecystectomy syndrome- colicky abdominal pain, diarrhoea and new jaundice. It is thought to be due to the lost of the gall bladder as a reservoir for bile moving through the biliary system. It is a common complication of the procedure and is often transient.
A patient with crohn’s comes in with gallstones. Whats the most likely risk factor
Ileal resection
What is an indication of poor prognosis in acute pancretitis?
PaO2<8kPa
When can a pseudocyst develop and associated symptoms?
Pseudocysts (collections of pancreatic juice) can develop 4 weeks after acute pancreatitis. These can cause bloating, indigestion and dull tummy pain. They often disappear on their own but can sometimes get infected and may need to be drained.
type of resection for tumours >8cm from the anus
Anterior resection
Type of resection for tumours<8cm from the anus
AP resection
What must you do to investigate post bowel resection and what may indicate it?
If pt appears septic, then it may be an anastomotic leak and AF increases the likelihood of it
-CT abdo and pelvis
What is appropriate mx for pt with rectal adenocarcinoma?
Surgical resection
What would a SAAG from ascites >11g/L suggest?
Cirrhosis
Heart failure
Budd Chiari syndrome
Constrictive pericarditis
Hepatic failure
How does haemachromatosis present and tx?
-Bronze tinge to skin
-High iron, ferritin, low total iron binding capacity
-Fatigue, joint pain
-Tx is venesection
What would increase your chances of diagnosing UC over crohns?
Perianal involvement
-usually spared in crohns
What white cell count is indicative of SBP?
An ascitic tap showing a neutrophil count/polymorphonuclear leukocyte count > 250/ul is diagnostic of SBP
What is the most specific test for haemochromatosis?
Serum ferritin saturation >45%
What is associated with increased oestrogen in the context of liver cirrhosis?
Palmer ertythema, gynocomastia and spider naevi
What is the mode of inheritance for haemochromatosis?
autosomal recessive with mutation in the HFE gene
What can happen to bowel movements after a cholecystectomy and what can be given to sort it out?
This bile acid sequestrant binds excess bile acids in the gastrointestinal tract, reducing their diarrhoeal effect. Bile acid malabsorption is a common cause of chronic diarrhoea after cholecystectomy due to unregulated bile acid release into the intestine, irritating the colon. The greenish diarrhoea and lack of systemic symptoms support this diagnosis.
What warrants an urgent referral for upper GI endoscopy to rule out gastric adenocarcinoma?
weight loss, abdo pain >55
What is MoA for imatinib?
Tyrosine kinase inhibitor
What should people with SBP be prescribed. with alongside tazocin?
Human albumin solution
What drug needs to be stopped before initiating azathioprine?
Allopurinol
