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
