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Nick's MD2 > GI > Flashcards

GI Flashcards

1
Q

What is charcot’s triad

And what does it suggest?

A

RUQ pain
Fever
Jaundice
Suggests cholangitis

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2
Q

What are some common causes of decompensated liver disease?

A 
Sepsis
Bleeding (H and M)
HCC
Meds (EtOH, paracetamol)
Non-compliance
Portal vein thrombosis
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3
Q

which signs are caused by high oestrogen?

A

Palmar erythema

Gynaecomastia

Spider naevi

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4
Q

What does raised AST and ALT suggest?

A

Hepatocellular damage

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5
Q

What does presence of the HBVeAg imply?

A

Active HBV replication

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6
Q

What is a typical level of ALT in acute viral hepatitis?

A

1,000

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7
Q

What LFT profile is suggestive of chronic viral hepatitis?

A

AST and ALT raisedALT may be > AST

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8
Q

What does ALT>AST suggest?

A

Chronic or resolving liver injury

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9
Q

What LFT profile is suggestive of alcoholic liver disease?

A

AST>ALT
AST/ALT ratio typically 2:1 or more
GGT raised
Normal ALP

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10
Q

What is a typical level of ALT in ischaemic hepatitis?

A

100,000

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11
Q

If someone is HBsAb positive, how can you tell whether they have been previously infected or previously immunised?

A

HBcAg positive = previous infection

HBcAg negative = previous immunisation

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12
Q

What does presence of the HBsAb imply?

A

Previous immunisation or infection

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13
Q

What LFT profile is suggestive of acute viral hepatitis?

A

ALT and AST raised

AST may be raised ++

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14
Q

What does raised ALP and GGT suggest?

A

Cholestatic problem

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15
Q

If you see ALT = 10,000 in an alcoholic, what must you consider?

A

Paracetamol toxicity

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16
Q

What LFT profile is suggestive of cholestasis?

A

ALP and GGT increased

AST and ALT may also be mildly increased

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17
Q

What LFT profile is suggestive of ischaemic hepatitis?

A

ALT and AST raised

LDH is raised

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18
Q

What does AST>ALT suggest?

A

Acute liver injury

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19
Q

What does presence of the HBVsAg imply?

A

Active HBV infection

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20
Q

What is a typical level of ALT in alcoholic hepatitis?

A

500

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21
Q

What is a typical level of ALT in paracetamol poisoning?

A

10,000

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22
Q

What does ALT = 100,000 suggest?

A

Ischaemic hepatitis

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23
Q

What is Murphy’s sign and what does it suggest?

A

Pain/catch on inspiration in RUQ while palpating

Suggests cholecystitis

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24
Q

What are the 5 factors that determine Child-Pugh grading of cirrhosis?

A 
Albumin, 
Bilirubin, 
Prothrombin time, 
Ascites, 
Encephalopathy
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25
Q

What does TIPS stand for?

A

Trans-jugular intra-hepatic porto-systemic shunt

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26
Q

Which protein is a marker for hepatocellular carcinoma?

A

Alpha foetal protein

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27
Q

What are the 3 features of decompensated cirrhosis?

A

Hepatic encephalopathy,
Ascites,
Jaundice

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28
Q

What is it called when ulcerative colitis affects part of the colon?

A

Left-sided colitis

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29
Q

What is the treatment for steroid-refratice ulcerative colitis?

A

Ciclosporin or infliximab

Colectomy

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30
Q

What is it called when ulcerative colitis is restricted to the rectum?

A

Proctitis

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31
Q

What are the extraintestinal manifestations of IBD?

A

Occular (iritis, scleritis)

Rheumatoid arthritis (large axial joints)

Dermatological (erythema nodosum and pyoderma gangranosum)

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32
Q

What is the treatment of mild Crohn’s disease?

A

Prednisolone PO

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33
Q

Which part of the GIT does ulcerative colitis affect?

A

From rectum to ascending colon

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34
Q

Which part of GIT is most often affected in Crohn’s disease?

A

Terminal ileum

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35
Q

What is the depth of lesion in ulcerative colitis?akaWhich layers of the GI wall are affected in ulcerative colitis?

A

Restricted to the mucosa

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36
Q

What is the treatment of severe Crohn’s disease?

A

Admit
Hydrocortisone IV
Metronidazole
IV fluids

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37
Q

What is the treatment of mild ulcerative colitis?

A

Sulfasalazine or mesalazine
PLUS
Prednisilone PO and PR

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38
Q

What is the treatment of moderate ulcerative colitis?

A

Prednisolone PO
Sulfasalazine or mesalazine
Steroid enema

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39
Q

What is it called when ulcerative colitis affects the whole colon?

A

Pancolitis

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40
Q

Which part of the GIT does Crohn’s affect?

A

Gum to bum

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41
Q

What is the depth of lesion in Crohn’s disease?akaWhich layers of the GI wall are affected in Crohn’s disease?

A

Transmural lesion

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42
Q

How many bowel motions per day are consistent with moderate ulcerative colitis?

A

4-6

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43
Q

what is the max volume of fluid the colon can absorb?

A

4.5L

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44
Q

which imaging technique is best at looking at the gallbladder?

A

U/S

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45
Q

Severe abdominal pain that is worse with moving implies what?

A

Peritonitis

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46
Q

causes of chronic pancreatitis

A 
Alcohol
Obstruction
Autoimmune
Hereditary pancreatitis
Repeated episodes of acute pancreatitis
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47
Q

where is the pancreas anatomically (vertebra)

A

level of L2

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48
Q

the more proximal the visceral pain the more …….. the peristaltic pain wave

A

frequent

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49
Q

Pain with defecation associated with bleeding. Dx?

A

Anal fissures

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50
Q

what blood results do you expect in someone with CLD

A 
Low albumin
Raised bilirubin
Raised ALT
Increased INR
Low platelets
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51
Q

3 things you look for in a diagnostic ascitic tap

A

WCC

Albumin

Cytology

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52
Q

current treatment for HBV

A
  • oral nucleos(t)ide analogues

- peg interferon

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53
Q

What is the triad of Budd-Chiari syndrome and what causes it?

A

Abdominal pain, ascites, hepatomegally

Caused by portal vein thrombosis

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54
Q

what is the major complication of UC?

A

Toxic megacolon

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55
Q

which ABx are commonly associated with liver toxicity?

A

Augmentin (amox + clavulonic acid)

Flucloxacillin

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56
Q

where are spider naevi normally found

A

SVC distribution

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57
Q

What two conditions commonly cause rigid plank like abdomen?

A

Acute pancreatitis

Perforated peptic ulcer

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58
Q

2 most common causes of ascites

A

Portal hypertension from cirrhosis

Peritoneal malignancy

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59
Q

presentation of epididymitis

A

diffuse tenderness in the epididymis, marked redness and oedema

60
Q

Explain dukes staging for CRC

A

A - cancer up to/into muscularis propria
B - cancer through muscularis propria and into fat/serosa
C - lymph nodes involved
D - distant spread

61
Q

What 3 things does the MELD system base its scoring system on?

A

Creatinine
Bilirubin
INR

62
Q

Where is the pain of diverticulitis usually located?

A

LIF

63
Q

What are some perianal complications in Crohn’s disease?

A

fissures
skin tags
fistulae

64
Q

what causes leuconychia

A

hypoalbuminaemia

65
Q

What test on ascitic fluid suggests it is due to portal hypertension?

A

serum-ascites albumin gradient >11g/L

=serum albumin - ascites albumin

66
Q

definition of chronic diarrhoea

A

decrease in faecal consistency lasting for 4 or more weeks

67
Q

explain TNM staging for CRC

A 
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
68
Q

treatment of ascites

A

salt and fluid restriction

large volume paracentesis

diuretics - first line: spironolactone

69
Q

What is the triple therapy for H. pylori eradication?

A

CAP

Clarithromycin and amoxicillin for 1 week
PPI for 2 months

70
Q

At what vertebral levels are preganglionic sympathetic fibres for the hindgut derived from?

A

T12-L2

71
Q

Which organ is just below the celiac trunk?

A

Pancreas

72
Q

What is the surface landmark for the deep inguinal ring?

A

Exactly half way between ASIS (ant sup iliac spine) and the pubic tubercle and a fingers breadth above the inguinal ligament

73
Q

What does the proper hepatic artery divide into?

A

Right and left hepatic arteries

74
Q

Which arteries supply the greater curvature of the stomach?

A

Left and right gastro-epiploic arteries

75
Q

Where is pain from the hindgut referred to?

A

Suprapubic

76
Q

At what vertebral level is the transpyloric plane?

A

L1

77
Q

What does the common hepatic artery branch into?

A

Proper hepatic artery and gastroduodenal artery

78
Q

What does the gastroduodenal artery divide into?

A

Anterior superior pancreaticduodenal artery. Right gastroepiploic artery

79
Q

Under which ribs does the spleen lie?

A

9-11

80
Q

Where is the junction of the foregut and midgut?

A

Major duodenal papilla

81
Q

Where will irritation of the mid-sigmoid colon to rectum be referred?

A

Peri-anal

82
Q

What is behind the foramen of Winslow?

A

IVC

83
Q

What forms the superficial inguinal ring?

A

The triangular opening in external oblique between its attachment between the pubic tubercle and the pubic crest

84
Q

At what vertebral levels are preganglionic sympathetic fibres for the foregut derived from?

A

T6-T9

85
Q

Where is pain from the midgut referred to?

A

Periumbillical

86
Q

Where is McBurney’s point?

A

1/3 of the way from the right ASIS to the umbilicus

87
Q

What are the 3 branches off the celiac trunk?

A

Splenic artery. Left gastric artery. Common hepatic artery

88
Q

At what level does the esophagus pass through the diaphragm?

A

T10

89
Q

How long is the small intestine from the point of the D-J flexure?

A

4-6m

90
Q

What forms the common bile duct?

A

Common hepatic duct and cystic duct

91
Q

Where does the foregut begin?

A

Abdominal oesophagus

92
Q

What forms the common hepatic duct?

A

Left and right hepatic ducts

93
Q

What vertebral levels do the kidneys span?

A

T12-L3

94
Q

Which muscles from the roof of the inguinal canal?

A

Internal oblique and transversus abdominis

95
Q

At what level does the inferior mesenteric artery branch off the aorta?

A

L3

96
Q

At what level does the aorta end?

A

L4

97
Q

At what vertebral levels are preganglionic sympathetic fibres for the midgut derived from?

A

T8-T12

98
Q

Which arteries supply the lesser curvature of the stomach?

A

Left and right gastric arteries

99
Q

What is formed by an opening in the transversalis fascia?

A

Deep inguinal ring

100
Q

At what level does the superior mesenteric artery branch off the aorta?

A

L1

101
Q

Where is visceral pain from the foregut referred to?

A

Epigastric

102
Q

Where is visceral pain from the midgut referred to?

A

Peri-umbillical

103
Q

At what vertebral level does the esophagus begin?

A

C6

104
Q

At what vertebral level is the celiac trunk?

A

T12

105
Q

What artery supplies the head of the pancreas?

A

Anterior superior pancreaticduodenal artery

106
Q

From which artery does the splenic artery arise?

A

Celiac trunk

107
Q

At what vertebral levels are preganglionic sympathetic fibres derived from?

A

T6-L2

108
Q

What is an approximate radiological landmark for the descent of the ureters?

A

Tips of lumbar transverse processes

109
Q

Which artery does the left gastroepiploic artery branch from?

A

Splenic artery

110
Q

The rami of which spinal nerves contribute to the lumbar plexus?

A

L1-4

111
Q

Which arteries supply derivatives of the fore-, mid- and hind-gut?

A

Celiac trunk, superior mesenteric artery, inferior mesenteric artery

112
Q

How long is the large intestine?

A

1.5 m

113
Q

Which receptors should be targetted for treatment of nausea associated with motion sickness?

A

Muscarinic and H1

114
Q

What percentage of regular IVDUs are HCV positive?

A

50-60%

115
Q

What do parietal cells of the stomach produce?

A

HCl and intrinsic factor

116
Q

Name two D2 antagonists used to treat nausea

A

Metoclopramide (maxolon)

Prochlorperazine (stemetil)

117
Q

Which zone of the acinar model is most vulnerbale to paracetemol toxicity?

A

Zone 3

118
Q

What liver pathology is seen in alcoholic hepatitis?

A

Mallory bodies and hepatocyte swelling

119
Q

Which enzyme conjugates bilirubin?

A

Glucuronyl transferase

120
Q

What do chief cells of the stomach produce?

A

Proteases eg pepsinogen

121
Q

Broad spectrum antibiotics can cause overgrowth of what in the gut?

A

Clostridium difficile

122
Q

What % of gastric ulcers are due to Helicobacter pylori?

A

70%

123
Q

Define cirrhosis

A

Diffuse nodules of regenerating hepatocytes surrounded by bands of fibrosis

124
Q

What is the average incubation period for HBV?

A

60-90 days

125
Q

Which zone of the acinar model is most vulnerable to ischaemia?

A

Zone 3

126
Q

When does colon cancer become invasive?

A

When it breaches muscularis mucosae

127
Q

Which receptors should be targetted for treatment of nausea associated with exposure to toxins?

A

D2 and 5HT3

128
Q

Which bacteria typically causes traveller’s diarrhoea?

A

ETEC

129
Q

What type of drug is ranitidine?

A

H2 antagonist

130
Q

Which nerve mediates peristalsis along the esophagus?

A

Vagus

131
Q

What % of gastric ulcers are due to NSAIDs?

A

25%

132
Q

What are the important receptors for the chemoreceptor trigger zone?

A

D2 and 5HT3

133
Q

Familial adenomatous polyposis is due to a mutation in which gene?

A

APC

134
Q

What % of people infected with HCV will clear the virus?

A

30%

135
Q

Oral rehydration mixtures typically contain what?

A

NaCl, KCl, NaHCO3, glucose

136
Q

What % of duodenal ulcers are due to Helicobacter pylori?

A

92%

137
Q

What are the American (more stringent) criteria for Barrett’s esophagus?

A

Evidence of columnar epithelial lining in esophagus; AND

Evidence of goblet cells in esophagus

138
Q

What is the average incubation period for HCV?

A

6-7 weeks

139
Q

What is the pathological hallmark feature of steatohepatitis?

A

Hepatocellular ballooning degeneration

140
Q

Pharmacologically, what are the two most important inputs to the vomit centre?

A

Chemoreceptor trigger zone (CTZ)

Vestibular input

141
Q

Pain from an ulcer in the duodenum is made _______ with eating

A

Better

142
Q

Pain from an ulcer in the stomach is made _______ with eating

A

Worse

143
Q

What causes pellagra?

A

Insufficient VitB3 (niacin)

144
Q

If a patient presents with haematemesis, where must the source of blood be from?

A

Proximal to the ligament of Treitz (junction of D3/D4)

145
Q

If a patient presents with melaena, where must the source of blood be from?

A

Proximal to the ileocaecal valve

Nick's MD2 (21 decks)

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