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Medicine > GI > Flashcards

GI Flashcards

1
Q

Give 3 differentials for an upper GI bleed?

A 
Peptic ulcer
Mallory-Weiss tear
Gastroduodenal erosions
Oesophagitis
Oesophageal varices
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2
Q

What is the score used to assess risk in upper GI bleeds and what is the criteria used?

A

Rockall score-assess risk of rebleeds and mortality

Preendoscopy
Age
Shock: BP and pulse
Comorbidity

Post endoscopy
Diagnosis
Signs of recent haemorrhage

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3
Q

Give 5 steps in your management of an upper GI bleed?

A 
High flow oxygen
2 wide bore cannulae (FBC, U&E, LFT, clotting and x-match 6 units)
IV fluid resus + transfusion
Urinary catheter
Urgent endoscopy
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4
Q

Give 4 differentials of dysphagia in terms of mechanical and motility disorders?

A 
Mechanical
Benign stricture
Malignant stricture
Pharyngeal pouch
Extrinsic pressure

Motility
Achalasia
Diffuse oesophageal spasm
Systemic sclerosis

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5
Q

Give 2 diagnostic investigations you could do in a patient with dysphagia?

A

Endoscopy
Barium swallow
CXR
Bloods

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6
Q

What are the risk factors for dyspepsia?

A 
H.Pylori
NSAIDS
Smoking/Alcohol
Pregnancy
Obesity
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7
Q

How do you manage new onset dyspepsia?

A

Refer for urgent endoscopy
Or
Antigen stool test for h.pylori
Antacids, stop NSAIDS, PPIs, Lifestyle changes

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8
Q

When would you refer for endoscopy in a patient with dyspepsia?

A 
>55y/o
Anaemia
Loss of weight
Anorexia
Recent onset of symptoms
Melaena or Haematemesis
Swallowing difficulty
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9
Q

What are the possible complications of a peptic ulcer?

A

Bleeding
Perforation
Gastric ca

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10
Q

What is the treatment regime for h.pylori eradication and how long?

A

PPI
Amoxicillin
Clarithromycin

1 week

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11
Q

State 3 symptoms of GORD?

A 
Heartburn
Belching
Acid brash
Water brash
Odynophagia
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12
Q

Name 3 complications that could arise from GORD?

A

Oesophagitis
Benign stricture
Barrets oesophagus
Oesophageal ca

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13
Q

Give 5 lifestyle changes to aid in treatment of GORD?

A 
Weight loss
Smoking cessation
Raise bed head
Avoid alcohol
Avoid spicy foods
Avoid NSAIDs
Avoid hot drinks/coffee
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14
Q

When would you suspect coeliac disease?

A

Patients presenting with diarrhoea + weight loss or anaemia

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15
Q

Give 4 symptoms of coeliac disease?

A 
Steatorrhoea
Diarrhoea
Abdo pain
Bloating
N&V
Weight loss
Fatigue
Weakness
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16
Q

What are the antibodies present in coeliac disease?

A

Alpha gliadin
Transglutaminase
Anti-endomysial

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17
Q

What are the histological changes seen in coeliac disease?

A

Villous atrophy

Crypt hyperplasia

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18
Q

What is the treatment for coeliac disease?

A

Life long gluten free diet

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19
Q

Describe bilirubin metabolism?

A 
Bilirubin is formed from Hb breakdown
Conjugated by hepatocytes
Secreted into bile --> gut
Converted to urobillinogen
Reabsorbed and either taken up by liver or excreted by kidneys
Rest converted to stercobilin --> faeces
20
Q

How can you classify jaundice and name a cause for each?

A

Prehepatic-
Haemolytic anaemia
Congestive heart failure

Hepatic-
Hepatitis
Cirrhosis

Post hepatic-
Gall stone
Pancreatic ca
PBC

21
Q

What is Courvoisier’s law?

A

Palpable bladder + painless jaundice

Suggests a cause other than gallstones

22
Q

A patient presenting with jaundice. Give 3 things you would ask?

A 
Alcohol
Travel
IV drug use
Sexual activity
Medications
23
Q

Give 3 signs seen in the hands of a patient with chronic liver disease?

A

Leuconychia
Clubbing
Palmar erythema
Dupuytrens contracture

24
Q

Name 3 causes of liver cirrhosis?

A

Chronic alcohol abuse
Chronic HBV or HCV infection
Autoimmune disease eg. PBC

25
Q

How is the severity of cirrhosis graded?

A

Child-Pugh score

26
Q

Name 2 possible complications of cirrhosis?

A

Hepatic failure
Portal hypertension
Hepatocellular carcinoma

27
Q

What are the steps taken in management of cirrhosis?

A

Alcohol abstinence
Good nutrition
Regular US and alpha fetoprotein screening for HCC (carcinoma)
Ascites-low salt, fluid restriction, diuretics
Liver transplant is definitive treatment

28
Q

What is the questionnaire used to screen for alcoholism?

A 
CAGE
Cut down?
Annoyed by criticism?
Guilty about drinking?
Eye opener to steady nerves in the morning?
29
Q

What are the differences between UC and Crohns? 5 things

A 
UC vs. CROHNS
Rectum + colon vs. any part of tract
Continuous vs. skip lesions
Superficial vs. transmural
Pseudopolyps vs. cobblestone
Goblet cell depletion vs. granulomas
Cured with surgery vs. surgery not curative
30
Q

Name 4 extra intestinal signs seen in IBD?

A 
Clubbing
Oral ulcers
Erythema nodosum
Conjunctivitis
Iritis
Large joint arthritis
Ankylosing Spondylitis
31
Q

What investigations would you order in a suspect UC patient?

A 
Bloods-anaemia, inflammation, cultures
Stool culture-rule out infection 
AXR-no faecal shadows, mucosal thickening, colonic dilatation
CXR-perforation
Sigmoidoscopy-inflamed, friable mucosa
Rectal biopsy
32
Q

Name 3 complications of UC?

A 
Perforation
Bleeding
Toxic dilatation of colon
Venous thrombosis
Colonic cancer
33
Q

What are the indications for surgery in UC?

A

Perforation
Massive haemorrhage
Toxic mega colon
Failure to respond to medical therapy

34
Q

How can you induce remission and maintain in IBD?

A 
Course of steroids (prednisalone)
5 ASAs (sulfasalazine or mesalazine)
Azothioprine as steroid sparing
Methotrexate in Crohns
TNF alpha inhibitors (infliximab)
Surgery
35
Q

Broadly identify 5 causes of diarrhoea and give an example for each?

A

IBD-Crohns and UC
INFECTIVE bacterial-Staph, salmonella, e.coli
INFECTIVE viral-Rotavirus, CMV, HSV
MALIGNANCY-colon ca
MALABSORPTION-coeliac, lactose intolerance, pernicious anaemia
MEDICATION-antibiotics and antacids

36
Q

Give 3 things you could assess for severity in UC? What is this criteria called?

A 
Stool frequency
Rectal bleeding
Temperature
Pulse rate
Haemoglobin levels
ESR/CRP

Truelove and Witts

37
Q

What is the pathology that paracetamol causes liver damage?

A

Paracetamol > toxic metabolite >glutathione converts to inactive form
In overdose, glutathione runs out so toxic metabolite builds up causing hepatocyte necrosis

38
Q

Give 3 causes of; acute hepatitis and chronic hepatitis?

A

Acute
Viruses, alcohol, drugs, metabolic

Chronic
Viruses, autoimmune disease, alcohol, drugs

39
Q

What is the inheritance pattern of hereditary haemochromatosis?

A

Autosomal recessive

40
Q

Give 2 organs affected by haemochromatosis?

A

Heart
Pancreas
Pituitary gland

41
Q

AST:ALT >2 ?
AST:ALT <1 ?

A

Alcoholic liver disease

Nonalcoholic fatty liver disease or Hepatitis C

42
Q

Give 3 symptoms of large bowel obstruction?

A 
Abdominal pain
Abdominal distension
Vomiting
Fecal vomiting
Constipation
43
Q

Give 4 causes of large and small bowel obstruction?

A 
Large bowel:
Hernias
IBD
Diverticulitis
Neoplasm

Small bowel:
Adhesions
Hernias
Volvulus

44
Q

Patient with suspected bowel obstruction, name an investigation you would do?

A

AXR

45
Q

What is the immediate management of bowel obstruction?

A 
Drip and Suck
NGT and IV fluids
Analgesia
Catheterise to monitor fluid balance
Surgery

Medicine (17 decks)

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