Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NME > GI > Flashcards

GI Flashcards

1
Q

Features and management of biliary colic

A

Colicky abdo pain, worst post prandially (esp after fatty foods) If imaging shows gallstones, the NBM, analgesia, laparoscopic cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is courvoisiers law?

A
  • …a patient with a painless, enlarged gallbladder and mild jaundice the cause is unlikely to be gallstones.
  • It is more likely to be a malignancy of the pancreas or biliary tree.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mesenteric ischaemia definition, risk factors and features

A

Arterial embolism resulting in colon infarction. Most commonly in areas like splenic flexure RF: Age AF Endocarditis CVD RF (e.g. Smoking, htn, diabetes Features… Abdo pain, rectal bleeding, diarrhoea, fever Elevated WBC and acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Bacteria that predisposes to gastritis

A

H pylori, gram negative urease secreting bacteria In %50 of people in developed countries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Behçet’s syndrome

A

Thought to be autoimmune… Most often found in Turkish, and men ~20-40 Classically oral / genital ulcers and anterior uveitis Can also get diarrhoea/abdo pain, thrombophlebitis, erythema nodosum, arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Mouth ulcer diagnosis causes and maanagement

A

Aphthous ulcer. Very common normally Could be Crohn’s, coeliac, Behçet’s, trauma, lichen planus, phemphigoid, pemphigus, herpes, syphilis, Avoid hard abrasive acidic foods Hydrocortisone lozenge Chlorhexidine BIOPSY IF NOT HEALED IN THREE WEEKS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pt PC lightheaded and lethargic, only treated with naproxen for arthritis. Bloods show MCV 77fL and Hb 73. What investigation next and why?

A

Do gastroscopy. Patient has iron deficient anaemia, probably from GU and bleed from naproxen (NSAIDs inhibit COX1 and 2, so inhibit prostaglandins… Do increase in gastric acid production and decrease in gastric mucous production. Predisposing to ulcers and bleeds)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Alcoholic comes to ward and started on Chlordiazepoxide and Pabrinex. What are these drugs????

A

Chlodiazepoxide is a benzodiazepine used for alcohol drug withdrawal Pabrinex is a yellow coloured fluid containing vit B and C. B1 (thiamine) is to prevent Wernicke’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Definition of severe UC and management

A

Severe is defined by the Truelove and Witt’s index…. ‘Severe’ if more than 6 stools per day OR blood in stool and one of… ➡️temp above 37.8 ➡️HR above 90 ➡️anaemia (Hb less than 105) ➡️ESR greater than 30mm/️Hr ADMIT TO HOSP AS EMERGENCY IV corticosteroids to induce remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Risk factors (4) and management of oral candida

A

Extremes of age DM Immunosuppression Abx Management➡️ is Nystatin or amphotericin (antifungals)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Causes of cheilitis

A

AKA Angular stomatitis Denture problems Candidiasis Iron or B2 (riboflavin) deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Peutz jeghers syndrome

A

Auto Dom condition with numerous hamartomatous polyps in GI tract. 59% die by 60 from gi cancer Pigmentation found on lips, face, palms, soles, May present with GI bleeding or intussusception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Diagnosis of infectious mononucleosis

A

Do a monospot / Paul bunnell test (heterophil antibodies develop in 90%) Atypical lymphocytes too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Old male Pt with dysphagia. Also suffers from regurge and aspiration

A

Pharyngeal pouch. This is a posteromedial diverticulum through Killians dehiscence - triangle between wall of pharynx, thyropharyngeus and cricopharyngeus muscles 5X more common in men Dysphagia, regurge, aspiration, chronic cough, neck swelling that gurgles on palpation occasionally halitosis Do endoscopic stapling, diverticulotomy, or diverticulotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Risk factors for oesophageal cancer

A

GORD, Male, smoking, drinking, barretts oesophagus, achalasia (if untreated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Description and management of Achalasia

A

➡️Lower oesophageal sphincter fails to relax ➡️Unknown cause but probably due to degeneration of myenteric plexus ➡️Dilated tapering on barium swallow Mx ➡️Endoscopic balloon dilation ➡️Then PPI ➡️Can give CCB ➡️Botulinum can help relax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Causes of dysphagia (organise into categories)

A

Basically urgent refer all ➡ Mechanical block …malignant (oesoph, gastric, pharyngeal) …benign (oesoph web, peptic stricture) …extrinsic (lung ca, mediastinal LN, goitre, AA) …pharyngeal pouch ➡️ Motility disorder (Achalasia, MG, systemic sclerosis) ➡️ Other …oesophagitis –>infection: candida, HSV; reflux disorder …globus hystericus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Types of hiatus hernia

A

Sliding (80%) and rolling. ➡️Sliding is where the gastro-oesophageal junction slides up into chest - reflux is common ➡️Rolling is where the GOJ is still in abdomen but a bulge of stomach rolls up - reflux is uncommon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Red flag symptoms with dyspepsia And referral

A

️Anaemia Loss of weight Anorexia Recent onset of progressive symp Melaena or haematemesis Swallowing difficulties Urgent investigation if weight loss Non urgent ix if over 55 with ⬆️️platelets/N/V and dyspepsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Referral for oesoph and stomach cancer

A

Urgent referral for patients ….with dysphagia ….with upper abdo mass(?stomach ca) ….over 55 with weight loss AND upper abdo pain, reflux, dyspepsia Non urgent ….with haematemesis Or over 55 with… ….treatment-resistant dyspepsia ….upper abdo pain with low Hb ….raised platelet count and n/v/weight loss/reflux/dyspepsia/upper abdo pain ….n or v with weight loss/reflux/dyspepsia/upper abdo pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When is pain classically worse with gallstones, and why??

A

Pain is classically colicky RUQ, post prandially. Especially after fatty meals, when CHOLECYSTOKININ levels are highest and gallbladder contraction is maximal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Patient with fatigue, RUQ pain, jaundice and itchiness and Hx of ulcerative colitis

A

Primary sclerosing cholangitis 4% of UC patients have PSC 80% of PSC patients have UC unknown aetiology, inflam and fibrosis of ️intra and extra hepatic bile ducts ERCP to diagnose, with ‘beaded’ appearance ANCA may be positive Cholangiocarcinoma is a complication in 10% + risk of CRC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pt with dyspepsia management

A

If over 55 or ALARM Symps then endo If none ➡️ stop any drugs ……..mucosa damage:NSAIDs, bisphosphonates ……..oesoph motility:TCA, antichol, ……..CCB relax LOS ➡️ lifestyle changes ……..weight loss, smoking cessation, raise head of bed avoid hot drinks, avoid citric, avoid spice, tomatoes onions ➡️ OTC antacids ➡️ review in 4wk …if not improved do carbon13 urea breath test or stool antigen test for H pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which is more common, DU or GU?

A

DU is four times more common DU pain often occurs several hours after eating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Patient presents with pain on swallowing. Their meditations are salbutamol, becotide, amlodipine. Most likely cause of presentation?

A

Oesophageal candidiasis secondary to inhaled steroid Also consider if Hx of HIV

26
Q

Features of primary biliary cirrhosis

A

9:1 f:m ratio, typically middle aged Raised ALP on routine LFTs, fatigue, Cholestatic jaundice Hyper pigmentation over pressure points Clubbing Distension Xanthelasmas Portal hypertension AMA M2 subtype in 98% sMooth Muscle antibodies in 30% Raised serum IgM

27
Q

Associations with primary biliary cirrhosis

A

Other autoimmune… Sjörgens, RA, systemic sclerosis, thyroid 20X risk of hepatocellular carcinoma

28
Q

Fat soluble vitamins

A

A, D, E, K Night bindness, bony pain, easy bruising So deficient if poor biliary secretion, eg any cause of cholestasis, etc

29
Q

Zollinger-Ellison syndrome

A

Excessive levels of gastrin, usually from gastrin secreting tumour of duo or pancreas Features: multiple DU Diarrhoea Malabsorption Dx with fasting gastrin levels

30
Q

Example of stimulant laxative and osmotic laxative

A

Senna and lactulose - bulking agent (can cause bloating so not less useful in constipation than hepatic encephalopathy)

31
Q

Scoring of constipation

A

Rome criteria. Needs more than two of ➡️ Straining in more than 1/4 ➡️ Hard lumpy in … ➡️ incomplete evacuation in… ➡️ obstructive sensation in ,,, ➡️ manual manoeuvres in ,,, ➡️ 3 or less a week

32
Q

Female pt presents with fatigue, signs of pigmentation over pressure points, clubbing, mild distension, jaundice. ALP found to be raised. Diagnosis and investigations to confirm

A

Could be Primary biliary cirrhosis ➡️AMA M2 subtype in 98% ➡️sMooth Muscle antibodies in 30% ➡️raised serum IgM

33
Q

End colostomy vs loop colostomy on examination

A

Two lumen on loop End colostomy one lumen

34
Q

Complication of ileostomy

A

Content is rich in proteolytic and digestive intestinal content, so harmful to skin. That’s why there is a spout. Fluid electrolyte depletion Terminal ileal loss may have vit B12 deficiency General stoma complications: Retraction, prolapse, herniation, psychosexual (Retraction and prolapse most common in end colostomy)

35
Q

Toxic megacolon

A

Acute toxic colitis with dilatation of the colon. The dilatation can be either total or segmental. Axr shows markedly dilated transverse colon and may show thumb printing on descending Abdo distension, fever, severe pain Usually UC or c diff

36
Q

Symptoms of ascending cholangitis and management

A

Fever (90%) RUQ pain (70%) Jaundice (60%) = Charcots triad And hypotension confusion Look for Inflam markers, LFT FBC, u e, USS looking for dilatation of CBD (90%) Needs IV abx And maybe endoscopic retrograde cholangiopancreatography (ERCP) after 24-48hr to relieve obstruction

37
Q

Volvulus sigmoid vs caecal

A

80% are sigmoid (large bowel ob) More common in older pt Associated with chronic constipation Neuro conditions like Parkinsons duchennes Caecal is all ages usually assx with adhesions or preg

38
Q

Man admitted with cramps abdo pain and diarrhoea. Attended wedding earlier that day and several other guests also ill…likely cause?

A

Clostridium perfringens

  • Relatively resistant to cooking
  • Typically evolves over several hours (Staph aureus typically occurs 1-6hr) (Bacillus ceraus (vomiting subtype) also 1-6)
39
Q

Scoring system for upper GI bleeds and prediction of mortality / rebleeding

A

Rockall score (there’s an initial one pre endo and a final one) ➡️ Age ➡️ BP / pulse ➡️ comorbidities Post endo ➡️ diagnosis ➡️ signs of recent bleed on endo Score under 3 excellent prog, over 8 high risk of death

40
Q

Causes of upper gi bleeding

A

PU (35-50) DU 8-15 Oesophagitis 5-15 Malory Weiss tear 15 Varices 5-10 Other: malig, facial trauma etc

41
Q

Management of h pylori

A

PAC-500 PMC-250 PPI amoxicillin clarithromycin 500mg bd for 7 days PPI metronidazole clarithromycin 250mg bd for 7 days

42
Q

Ibd smoking association

A

Improves UC Risk factor for CD

43
Q

Axr signs of cd

A
  • Focal narrowing (kantors string sign)
  • Thickened wall
  • “Comb sign”
44
Q

Most common cancer assx with h pylori

A

MALT Mucosa Associated Lymphoid Tissue

45
Q

Mneumonic for Crohn’s complications

A
  • Clubbing & Cobblestone mucosa
  • Aphthous ulcers
  • Mass in RIF & Malabsorption
  • Perianal disease (skin tags, abscess, fistula)
  • Erythema nodosum
  • Rose thorn ulcers
  • Skip lesions
46
Q

Causes of bowel obstruction (three common, three rare)

A
  • Hernias
  • Adhesions
  • Tumours
  • gall stones, diverticulitis, crohn’s, intussusception, volvulus
47
Q

symptoms of intestinal obstruction

A
  • pain
  • vomiting
  • distension
  • absolute constipation
48
Q

Late Complications of stoma

A
  • Parastomal Hernia
  • Prolapse
  • Fistulae
  • Psychological complications
  • Skin dermatitis
49
Q

What is a Cushing ulcer

A

A gastric ulcer produced by elevated intracranial pressure.

50
Q

What is a Curling’s ulcer

A

an acute peptic ulcer of the duodenum resulting as a complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa.

51
Q

pathogen that causes foul smelling flatus from eastern europe….malabsorption and diarrhoea

A

giardia lamblia (treat with metronidazole)

52
Q

Cause of toxic megacolon with pt with HIV

A

cryptosporidium

53
Q

Succussion splash

A

Gastric outlet obstruction.

Causes include both benign causes (such as peptic ulcer disease affecting the area around the pylorus, pyloric stnosis), as well as malignant causes, such as gastric cancer.

54
Q

What type of colitis does C Diff cause?

A

Pseudomembraneous colitis.

55
Q

Large obstruction causes

A
  • Cancer
  • Constipation
  • diverticular disease
  • strictures
56
Q

What microbiology is salmonella

A

Gram Negative MOBILE bacilli

treat with ciprofloxacin

57
Q

Spiral shaped organisms

A
  • Campylobacter jejuni
  • H pylori

both gram negative

58
Q

Causes of bloody diarrhoea

A
  • Shigella
    • ​with vom
    • abdo pain
    • 2-3d
  • Amoebiasis
    • ​gradual onset
    • lasting abdo pain
    • 7d
  • Campylobacter can be bloody
    • flu-like prodrome
    • 2-3d
59
Q

Ddx of short onset vomiting (within 6 hours)

A
  • Staph aureus
  • Bacillus Cereus (RICE)

both gram positive

60
Q

Ddx of watery stool

A
  • Cholera (profuse)
  • E. Coli (traveller)

negative gram

NME (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions