GI Flashcards
What is charcot’s triad
And what does it suggest?
RUQ pain
Fever
Jaundice
Suggests cholangitis
What are some common causes of decompensated liver disease?
Sepsis Bleeding (H and M) HCC Meds (EtOH, paracetamol) Non-compliance Portal vein thrombosis
which signs are caused by high oestrogen?
Palmar erythema
Gynaecomastia
Spider naevi
What does raised AST and ALT suggest?
Hepatocellular damage
What does presence of the HBVeAg imply?
Active HBV replication
What is a typical level of ALT in acute viral hepatitis?
1,000
What LFT profile is suggestive of chronic viral hepatitis?
AST and ALT raisedALT may be > AST
What does ALT>AST suggest?
Chronic or resolving liver injury
What LFT profile is suggestive of alcoholic liver disease?
AST>ALT
AST/ALT ratio typically 2:1 or more
GGT raised
Normal ALP
What is a typical level of ALT in ischaemic hepatitis?
100,000
If someone is HBsAb positive, how can you tell whether they have been previously infected or previously immunised?
HBcAg positive = previous infection
HBcAg negative = previous immunisation
What does presence of the HBsAb imply?
Previous immunisation or infection
What LFT profile is suggestive of acute viral hepatitis?
ALT and AST raised
AST may be raised ++
What does raised ALP and GGT suggest?
Cholestatic problem
If you see ALT = 10,000 in an alcoholic, what must you consider?
Paracetamol toxicity
What LFT profile is suggestive of cholestasis?
ALP and GGT increased
AST and ALT may also be mildly increased
What LFT profile is suggestive of ischaemic hepatitis?
ALT and AST raised
LDH is raised
What does AST>ALT suggest?
Acute liver injury
What does presence of the HBVsAg imply?
Active HBV infection
What is a typical level of ALT in alcoholic hepatitis?
500
What is a typical level of ALT in paracetamol poisoning?
10,000
What does ALT = 100,000 suggest?
Ischaemic hepatitis
What is Murphy’s sign and what does it suggest?
Pain/catch on inspiration in RUQ while palpating
Suggests cholecystitis
What are the 5 factors that determine Child-Pugh grading of cirrhosis?
Albumin, Bilirubin, Prothrombin time, Ascites, Encephalopathy
What does TIPS stand for?
Trans-jugular intra-hepatic porto-systemic shunt
Which protein is a marker for hepatocellular carcinoma?
Alpha foetal protein
What are the 3 features of decompensated cirrhosis?
Hepatic encephalopathy,
Ascites,
Jaundice
What is it called when ulcerative colitis affects part of the colon?
Left-sided colitis
What is the treatment for steroid-refratice ulcerative colitis?
Ciclosporin or infliximab
Colectomy
What is it called when ulcerative colitis is restricted to the rectum?
Proctitis
What are the extraintestinal manifestations of IBD?
Occular (iritis, scleritis)
Rheumatoid arthritis (large axial joints)
Dermatological (erythema nodosum and pyoderma gangranosum)
What is the treatment of mild Crohn’s disease?
Prednisolone PO
Which part of the GIT does ulcerative colitis affect?
From rectum to ascending colon
Which part of GIT is most often affected in Crohn’s disease?
Terminal ileum
What is the depth of lesion in ulcerative colitis?akaWhich layers of the GI wall are affected in ulcerative colitis?
Restricted to the mucosa
What is the treatment of severe Crohn’s disease?
Admit
Hydrocortisone IV
Metronidazole
IV fluids
What is the treatment of mild ulcerative colitis?
Sulfasalazine or mesalazine
PLUS
Prednisilone PO and PR
What is the treatment of moderate ulcerative colitis?
Prednisolone PO
Sulfasalazine or mesalazine
Steroid enema
What is it called when ulcerative colitis affects the whole colon?
Pancolitis
Which part of the GIT does Crohn’s affect?
Gum to bum
What is the depth of lesion in Crohn’s disease?akaWhich layers of the GI wall are affected in Crohn’s disease?
Transmural lesion
How many bowel motions per day are consistent with moderate ulcerative colitis?
4-6
what is the max volume of fluid the colon can absorb?
4.5L
which imaging technique is best at looking at the gallbladder?
U/S
Severe abdominal pain that is worse with moving implies what?
Peritonitis
causes of chronic pancreatitis
Alcohol Obstruction Autoimmune Hereditary pancreatitis Repeated episodes of acute pancreatitis
where is the pancreas anatomically (vertebra)
level of L2
the more proximal the visceral pain the more …….. the peristaltic pain wave
frequent
Pain with defecation associated with bleeding. Dx?
Anal fissures
what blood results do you expect in someone with CLD
Low albumin Raised bilirubin Raised ALT Increased INR Low platelets
3 things you look for in a diagnostic ascitic tap
WCC
Albumin
Cytology
current treatment for HBV
- oral nucleos(t)ide analogues
- peg interferon
What is the triad of Budd-Chiari syndrome and what causes it?
Abdominal pain, ascites, hepatomegally
Caused by portal vein thrombosis
what is the major complication of UC?
Toxic megacolon
which ABx are commonly associated with liver toxicity?
Augmentin (amox + clavulonic acid)
Flucloxacillin
where are spider naevi normally found
SVC distribution
What two conditions commonly cause rigid plank like abdomen?
Acute pancreatitis
Perforated peptic ulcer
2 most common causes of ascites
Portal hypertension from cirrhosis
Peritoneal malignancy
presentation of epididymitis
diffuse tenderness in the epididymis, marked redness and oedema
Explain dukes staging for CRC
A - cancer up to/into muscularis propria
B - cancer through muscularis propria and into fat/serosa
C - lymph nodes involved
D - distant spread
What 3 things does the MELD system base its scoring system on?
Creatinine
Bilirubin
INR
Where is the pain of diverticulitis usually located?
LIF
What are some perianal complications in Crohn’s disease?
fissures
skin tags
fistulae
what causes leuconychia
hypoalbuminaemia
What test on ascitic fluid suggests it is due to portal hypertension?
serum-ascites albumin gradient >11g/L
=serum albumin - ascites albumin
definition of chronic diarrhoea
decrease in faecal consistency lasting for 4 or more weeks
explain TNM staging for CRC
T1 - cancer in submucosa T2 - cancer in muscularis propria but not through T3 - cancer through muscularis propria T4 - invasion of adjacent organs N1/2 - lymph node involvement M1 - distant spread
treatment of ascites
salt and fluid restriction
large volume paracentesis
diuretics - first line: spironolactone
What is the triple therapy for H. pylori eradication?
CAP
Clarithromycin and amoxicillin for 1 week
PPI for 2 months
At what vertebral levels are preganglionic sympathetic fibres for the hindgut derived from?
T12-L2
Which organ is just below the celiac trunk?
Pancreas
What is the surface landmark for the deep inguinal ring?
Exactly half way between ASIS (ant sup iliac spine) and the pubic tubercle and a fingers breadth above the inguinal ligament
What does the proper hepatic artery divide into?
Right and left hepatic arteries
Which arteries supply the greater curvature of the stomach?
Left and right gastro-epiploic arteries
Where is pain from the hindgut referred to?
Suprapubic
At what vertebral level is the transpyloric plane?
L1
What does the common hepatic artery branch into?
Proper hepatic artery and gastroduodenal artery
What does the gastroduodenal artery divide into?
Anterior superior pancreaticduodenal artery. Right gastroepiploic artery
Under which ribs does the spleen lie?
9-11
Where is the junction of the foregut and midgut?
Major duodenal papilla
Where will irritation of the mid-sigmoid colon to rectum be referred?
Peri-anal
What is behind the foramen of Winslow?
IVC
What forms the superficial inguinal ring?
The triangular opening in external oblique between its attachment between the pubic tubercle and the pubic crest
At what vertebral levels are preganglionic sympathetic fibres for the foregut derived from?
T6-T9
Where is pain from the midgut referred to?
Periumbillical
Where is McBurney’s point?
1/3 of the way from the right ASIS to the umbilicus
What are the 3 branches off the celiac trunk?
Splenic artery. Left gastric artery. Common hepatic artery
At what level does the esophagus pass through the diaphragm?
T10
How long is the small intestine from the point of the D-J flexure?
4-6m
What forms the common bile duct?
Common hepatic duct and cystic duct
Where does the foregut begin?
Abdominal oesophagus
What forms the common hepatic duct?
Left and right hepatic ducts
What vertebral levels do the kidneys span?
T12-L3
Which muscles from the roof of the inguinal canal?
Internal oblique and transversus abdominis
At what level does the inferior mesenteric artery branch off the aorta?
L3
At what level does the aorta end?
L4
At what vertebral levels are preganglionic sympathetic fibres for the midgut derived from?
T8-T12
Which arteries supply the lesser curvature of the stomach?
Left and right gastric arteries
What is formed by an opening in the transversalis fascia?
Deep inguinal ring
At what level does the superior mesenteric artery branch off the aorta?
L1
Where is visceral pain from the foregut referred to?
Epigastric
Where is visceral pain from the midgut referred to?
Peri-umbillical
At what vertebral level does the esophagus begin?
C6
At what vertebral level is the celiac trunk?
T12
What artery supplies the head of the pancreas?
Anterior superior pancreaticduodenal artery
From which artery does the splenic artery arise?
Celiac trunk
At what vertebral levels are preganglionic sympathetic fibres derived from?
T6-L2
What is an approximate radiological landmark for the descent of the ureters?
Tips of lumbar transverse processes
Which artery does the left gastroepiploic artery branch from?
Splenic artery
The rami of which spinal nerves contribute to the lumbar plexus?
L1-4
Which arteries supply derivatives of the fore-, mid- and hind-gut?
Celiac trunk, superior mesenteric artery, inferior mesenteric artery
How long is the large intestine?
1.5 m
Which receptors should be targetted for treatment of nausea associated with motion sickness?
Muscarinic and H1
What percentage of regular IVDUs are HCV positive?
50-60%
What do parietal cells of the stomach produce?
HCl and intrinsic factor
Name two D2 antagonists used to treat nausea
Metoclopramide (maxolon)
Prochlorperazine (stemetil)
Which zone of the acinar model is most vulnerbale to paracetemol toxicity?
Zone 3
What liver pathology is seen in alcoholic hepatitis?
Mallory bodies and hepatocyte swelling
Which enzyme conjugates bilirubin?
Glucuronyl transferase
What do chief cells of the stomach produce?
Proteases eg pepsinogen
Broad spectrum antibiotics can cause overgrowth of what in the gut?
Clostridium difficile
What % of gastric ulcers are due to Helicobacter pylori?
70%
Define cirrhosis
Diffuse nodules of regenerating hepatocytes surrounded by bands of fibrosis
What is the average incubation period for HBV?
60-90 days
Which zone of the acinar model is most vulnerable to ischaemia?
Zone 3
When does colon cancer become invasive?
When it breaches muscularis mucosae
Which receptors should be targetted for treatment of nausea associated with exposure to toxins?
D2 and 5HT3
Which bacteria typically causes traveller’s diarrhoea?
ETEC
What type of drug is ranitidine?
H2 antagonist
Which nerve mediates peristalsis along the esophagus?
Vagus
What % of gastric ulcers are due to NSAIDs?
25%
What are the important receptors for the chemoreceptor trigger zone?
D2 and 5HT3
Familial adenomatous polyposis is due to a mutation in which gene?
APC
What % of people infected with HCV will clear the virus?
30%
Oral rehydration mixtures typically contain what?
NaCl, KCl, NaHCO3, glucose
What % of duodenal ulcers are due to Helicobacter pylori?
92%
What are the American (more stringent) criteria for Barrett’s esophagus?
Evidence of columnar epithelial lining in esophagus; AND
Evidence of goblet cells in esophagus
What is the average incubation period for HCV?
6-7 weeks
What is the pathological hallmark feature of steatohepatitis?
Hepatocellular ballooning degeneration
Pharmacologically, what are the two most important inputs to the vomit centre?
Chemoreceptor trigger zone (CTZ)
Vestibular input
Pain from an ulcer in the duodenum is made _______ with eating
Better
Pain from an ulcer in the stomach is made _______ with eating
Worse
What causes pellagra?
Insufficient VitB3 (niacin)
If a patient presents with haematemesis, where must the source of blood be from?
Proximal to the ligament of Treitz (junction of D3/D4)
If a patient presents with melaena, where must the source of blood be from?
Proximal to the ileocaecal valve
