GI Flashcards
Atypical lymphocytes, Intraepithelial involvement, endoscopic appearance of thickened folds and ulceration
Lymphomatous
Purple, plaque like lesion in fundus, slit like vascular spaces with spindle fibres. HIV positive
Kaposi’s sarcoma
hypopigmented patches over dorsum, weight loss, loose stools, ogliomenorrhoea, tachycardiac and fine tremor
Thyrotoxicosis
Weight loss and polydipsia
Type 1 diabetes
Carcinoid Syndrome
Flush
Urinary frequency and dysparenuria complications
IBS
Postive Murphy’s sign
cholecystitis
severe epigastric pain radiating to back, alcohol and gallstones involved
Acute pancreatitis
Sharp left loin and LUQ pain radiating to the groin
Renal colic
colicky central abdomen pain and bile stained vomit
Small bowel obstruction
Epigastric pain worse at night, relived by eating and or drinking milk
Duodenal ulcer
Epigastric pain worse when eating
Gastric ulcer
air under diaphragm on chest radiograph
Perforated Duodenal ulcer
Aphtmous ulcers in mouth, mass in RIF, vitamin B12 deficiency
Crohn’s Disease
On treatment for TB, abdominal pain, malaise and jaundice
Hepatitis
Expansive and pulsatile mass
AAA
Right sided carcinoma of caecum
Weight loss and anaemia
Left sided carcinoma of sigmoid/colon
Change in bowel habit and bleeding PR
Patient over 40 presenting with acute appendicitis
Caecal carcinoma
Middle aged woman, increased menstrual bleeding, mass in lower middle quadrant which is not palpable.
Fibroids
Thick walled, rounded, fluid filled mass adjacent to the pancreas
Pancreatic Pseudocysts
Swelling of left supraclavicular node (Virchow’s node)
suggestive of intra abdominal mass malignancy. Gastric carcinoma.
Dysphagia for solids and liquids with tapering and weight loss
Oesophageal achalasia
“lump in throat” but no abnormality found
Globus Hystericus
Flaccid fasciculating tongue
Nerve XII involvement
signet ring
Adenocarcinoma
Recurrent orogenital ulceration, ocular disease with joint pain
Behcet’s disease
How to treat hyperventilation
Rebreathing or sedation with benzodiazepine
1st step management in diabetic ketoacidosis
IV rehydration with normal saline
Aged 30-40, gradually progressive dysphagia over the years, regurgitation of partially digested food, halitosis (bad breath) and coughing
Achalasia of the oesophagus
What are the 3 classic phases of gastric acid secretion?
Cephalic: triggered by smell, site, thought and taste before it enters the mouth
Gastric:initiated by presence of food in the stomach
Intestinal: presence of amino acid and food in the stomach
The 3 factors which inhibit gastric acid
Somatostatin
Secretin
Cholestysokinin
Gingival Hypertrophy–> Gingivectomy/biting on own gums
Side effect of Ca Channel Blockers or phenytoin
Bird beak appearance (and distended oesophagus)
Achalasia; if in lower GI imagining is a sign of bowel obstruction
Grey Turner’s (lumbar redness) and Cullen’s sign (umbilical redness) positive
acute pancreatitis
Mneumonic for causes of acute pancreatitis
GET SMASHED Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion stings/bites Hyperlipideaemia/hyperthermia/hypercalaemia ERCP Drugs
Murphy’s sign positive
Cholecystitis
Pale stools, jaundice, abdominal pain
biliary obstruction
Abdominal disension, caput medusae, shifting dullness
Portal hypertension and ascites
Pyoderma gangrenosum, erythema nodosum
Crohn’s/UC
Tickling bowel sounds
bowel obstruction
Vesicular rash and weight loss
Coeliac disease
Virchow’s node (lefts supraclavicular)
gastric cancer
Urea breath test
H pylori
C breath test
bacterial overgrowth
“Rice water” like stools
Vibrio Cholera
Primary Biliary Cirrhosis
Presence of anti mitochondrial antibodies
Autoimmune hepatitis
Presence of Anti Smooth Muscle antibodies
Alpha Feto protein assay
hepatocellular carcinoma (or terratoma)
Cobblestone mucosa–> indicating deep fissuring ulceration of mucosa
Crohn’s disease
Diuretic for ascites (due to cirrhosis)
Spironolcatone
Corkscrew oesophagus on barium swallow
Diffuse oesphageal spasm
Severe Abdominal pain and Disention after raw milk
Campylobacter
Russel’s sign
self induced vomiting
Mallory’s hyaline bodies
Alcoholic liver disease (acute hepatitis) and chronic active hepatitis
Crypt abscess/cryptitis
IB Crohn’s
Onion skinning fibrosis, beading of bile ducts
Primary Sclerosing Cholangitis
Signet ring cells seen on biopsy
Linitis Plastica- diffuse stomach cancer
Thumb printing on X-ray commonly at splenic flexure
Ischaemic colitis
Charcot’s Triad
Acute cholangitis ie fever, jaundice and abdominal pain secondary to cholelithiasis
Causes for abdominal mass
A: Chemical AAA
Crohn’s, hernia, enlarged organ, malignancy, intersusception, cyst or abscess, appendicitis, lymphadenopathy
Causes for bowel obstruction
BATH VIPS Bolus Adhesions Tumour Hernia Volvolus Intersussception Pseudo-obstruction Stricture
An important medical emergency in cancer patients
Hypercalaemia
Extra intestinal clinical features associated with IBD?
sacrolitis, conjunctivitis, erythema nodosum, finger clubbing, primary sclerosing cholangitis
Colicky central abdominal pain, rapidly followed by production of copious bile-stained vomitus. Later on, can’t open bowels.
Small bowel obstruction
Colicky central abdominal pain with faeculent vomiting later on. First sign is can’t open bowels.
Large bowel obstruction
Helicopter pylori postive
Duodenal ulcer
Air under diaphragm
Perforated viscus
Low iron, vitamin B12 and folate
Small bowel disease leading to malabsorption
Weight loss, diarrhoea, vomiting, aphthous ulcers in the mouth and a mass is palpable in the right iliac fossa. Blood tests reveal low serum vitamin B12 and folate
Crohn’s disease
Positive Troisier’s sign
Same as Virchow’s node therefore gastric carcinoma
Over 40 and presenting with acute appendicitis. Severe microcytic anaemia, the mass is firm, irregular and 4 cm in diameter. Lower edge is palpable
Caecal carcinoma
Tender upper abdominal mass. CT shows a thick-walled, rounded, fluid-filled mass adjacent to the pancreas.
Pancreatic pseudocyst
Causes of CLUBBING
Cyanotic heart disease Lung disease (ABCDEF) - Abscess - Bronchiectasis - Cystic Fibrosis - Don’t say COPD - Empyema - Fibrosis Ulcerative Collitis + Crohn's disease Biliary cirrhosis Birth Defects Infective endocarditis Neoplasms (e.g. lung cancer or mesothelioma) Gastrointestinal malabsorption (Coeliac disease)
weight loss, fever and right upper quadrant pain. On examination, a hard, irregular liver can be felt on palpation. Serum AFP is grossly elevated!!
Hepatocellular carcinoma
Middle aged male, “Bronze diabetes” with raised serum iron and ferritin
Haemochromatosis
Spider naevi, gynaeco- mastia, testicular atrophy, Dupuytren’s contracture, palmar erythema, parotid enlargement, clubbing and leukonychia.
Chronic Liver disease
Slit-lamp examination reveals a greenish-brown ring at the corneoscleral junction
Wilson’s disease
Signs of chronic liver disease with a history of early onset pulmonary emphysema, predominantly affecting lung bases. Can be non smoker.
alpha-Antitrypsin deficiency
Diarrhoea with palpitations and a regular pulse
Thyroxitcosis
Abdominal pain, weight loss, fatty stools, extremely uncomfortable itchy blisters on her knees and elbows.
Coeliac disease
weight loss, Lanugo hair, mild hypokalaemia
Anorexia nervosa
Treatment for achalasia
First-line treatment involves endoscopic balloon dilatation of the sphincter.
Surgical treatment involves dividing the muscle at the lower end of the oesophagus – known as a Heller’s cardiomyotomy.
Constipation, bleeding PR, Buccal pigmentation
Peutz-Jeghers syndrome (benign hamartomatous polyps- autosomal dominant)
Squamous to columnar epithelium intestinal metaplasia
Barrett’s oesophagus
Risk factor for Pernicious anaemia
A condition characterised by atrophy of gastric mucosa and lack of intrinsic factor. Is a risk factor for gastric carcinoma
Treatment for Pseudomembranous colitis
Metronidazole
Presence of Anti-endomysial antibodies (serum IgA)
Coeliac disease
Recurrent cholangitis and UC
Primary sclerosing cholangitis
