GI Flashcards

Question

What is a choledocholithiasis

Answer 1

Gallstone in the common bile duct

Answer 2

Increasing age Male Hepatitis B Cirrhosis

Answer 3

Choledocholithiasis Biliary stricture Tumours ERCP

Answer 4

Antibiotic | Remove cause

Answer 5

Fever, jaundice and abdominal pain | Associated with acute cholangitis

Answer 6

Bacterial infection in conjugation with obstruction of the biliary tree Commonly due to gallstones

Answer 7

``` Epigastric pain Right upper quadrant pain Vomiting Fever Peritonism ```

Answer 8

Raised unconjugated bilirubin More marked in fasting or illness Autosomal recessive No long-term sequelae

Answer 9

Entamoeba histoltica 90% Are solitary Commonly involves right liver lobe Treated by aspiration

Answer 10

``` 80% = adenocarcinoma Rest = adenosqamous And mucinous cystadenocarcinoma ``` 75% in head/neck of pancreas 15% in body 10% in tail

Answer 11

Anorexia Weight loss Malaise Later jaundice and epigastric pain

Answer 12

``` Severe epigastric pain radiating to the back Relieved by sitting forward Worse on movement Anorexia Nausea and vomiting ```

Answer 13

Discolouration around the umbilicus inpatients with acute pancreatitis

Answer 14

Bruising of the flanks | Can occur in a severe attack of acute pancreatitis

Answer 15

Pain Bloody diarrhoea. Flask-shaped ulcers on colon PAS +ve trophozites + ingested RBC

Answer 16

``` Jaundice Hepatomegally Hydrocephalus Choroidoretinitis necrosis of brain, liver, heart, lung, retina ```

Answer 17

Sub clinical infection | Mild lymphadenopathy

Answer 18

Colorectal carcinoma

Answer 19

Carcinoid syndrome

Answer 20

Primary resection of a lesion leaving a temporary colostomy and oversewing the rectum. For later re-anastomosis. Emergency procedure.

Answer 21

``` Fluid loss Odour Skin ulceration Leaking Stenosis Herniation Prolapse Ischaemia Psychosocial / sexual ```

Answer 22

Large bowel | Not full width

Answer 23

Small bowel | Complete width

Answer 24

Pain Vomiting Distension Absolute constipation - no flatus or faeces

Answer 25

``` Adhesions Hernias Tumours Gall stone ileus Sigmoid or caecal volvulus ```

Answer 26

``` Generalised abdominal pain Worsening ascites Vomiting Fever Rigor ```

Answer 27

E. coli | Klebsiella

Answer 28

Oesophagus Rectum Umbilical veins

Answer 29

Therapeutic endoscopy Banding or sclerosis of varices If unresponsive haemostasis is achieved with balloon tamponade = sengstaken-blakemore tube

Answer 30

Elective endoscopic variceal banding/sclerotherapy | Propranolol to reduce portal Venous pressure

Answer 31

``` Reversed sleep pattern Asterixis Constructional apraxia Agitation Reduced consciousness Coma Death ```

Answer 32

``` High protein diet Upper GI bleeding Hypokalaemia Alcohol Benzodiazepines Diuretics ```

Answer 33

Correct underlying cause Low protein diet nurse patient in light room Lactulose (osmotic laxative)

Answer 34

Acute renal failure despite normal kidneys in a patient with cirrhosis and portal hypertension

Answer 35

Pain on Swallowing

Answer 36

Heartburn regurgitation dysphagia (Atypical symptoms= Retrosternal chest pain, hoarseness, hiccups, ear pain, loss of dental enamel, night sweats, chronic wheeze, globus sensation, hypersalivation, halitosis)

Answer 37

``` Oesophageal inflammation Erosions Ulceration Stricture Metaplasia of lower oesophagus (Barrett's oesophagus) ```

Answer 38

Lifestyle - Weight loss, smoking cessation, avoid late night meals, avoid spicy food, elevate head of bed Medical - Ranitidine (H2 antagonist), omeprazole (PPI), metoclopramide (Prokinetic) Surgical - fundoplication

Answer 39

Post-op adhesions Incarcerated hernia Malignancy Less common (diverticulitis, gallstone ileus, IBD)

Answer 40

Autosomal dominant Hundreds of adenomatous polyps in early adulthood Malignant transformation by age 50

Answer 41

Overgrowth of clostridium difficile Most occurs following antibiotic use Treatment is oral Metronidazole

Answer 42

``` Diverticulitis Abscess formation Fistula Bleeding Perforation ```

Answer 43

Constant throbbing pain Discharge of pus per rectum Rectal lump/nodule

Answer 44

End colostomy is required after abdomino-perineal resection of a low rectal or anal canal tumour. It has a single opening. Usually found in the left iliac fossa - contents will be solid.

Answer 45

Hartman's procedure is done after emergency resection of rectosigmoid lesions When primary anastomosis is unfavourable. The diseased segment is resected, the proximal end of bowel is made into an end colostomy. The distal segment of bowel / rectal stump, is oversewn to remain closed. Secretions from the rectal stump still pass through the anus. Later once inflammation settled the two ends are rejoined.

Answer 46

Digital rectal examination - AP. procedure leave no rectum

Answer 47

End ileostomy is an end stoma using distal ileum. Often created after resection of the colon and rectum, e.g for IBD. Ileostomies usually found in RIF Contents will be liquid. Once outside abdominal wall - small bowel is everted to create a spout to protect the abdominal wall skin from the irritation.

Answer 48

Defunctioning ileostomy is a temporary stomas created to protect distal anastomosis at risk of leakage or breakdown. Allows bowel time to rest. Commonly used in difficult low rectal anastomoses and in emergency resections. Reversal of the temporary stoma at about 3-4 months.

Answer 49

Temporary stomas are usually loop stomas. E.g. Defunctioning stomas A loop of bowel is brought to the surface. The loop is supported by a 'bridge' beneath it (between bowel and skin) to prevent the loop slipping back in. The bridge is removed after a few days once wound healed. Bowel wall is partially cut to create two openings: an afferent limb and an efferent limb. The afferent limb leads to the functioning part of the bowel and allows stool and gas to pass out. The efferent limb leads into the non-functioning part of bowel and secretes mucus. This is the mucous stoma.

Answer 50

Urostomies are used for diversion of the urinary system. Used for bladder cancers, urinary incontinence not anemable to other treatments, and neuropathic bladders. Requires an ileal conduit = a segment of ileum open at 1 end + closed at the other. Ureters are implanted into this. The open end is used to create a spout similar to an ileostomy It allows urine collection in a stoma bag.

Answer 51

Epigastric pain Radiating to the back Hx of gallstones, alcohol

Answer 52

Acute pancreatitis Perforation Cholecystitis

Answer 53

Place hand on RUQ and ask patient to breathe in. Causes pain as gallbladder contacts hand. --> arrest of inspiration. Repeat on LUQ. +ve = pain on RUQ palpation and not on L. Indicates acute cholecystitis

Answer 54

Early onset vomiting - bilious not faceculant Late onset distension Abdominal pain - colicky

Answer 55

Early onset distension Late onset vomiting - faeculant Abdominal pain - colicky

Answer 56

Epigastic pain relieved by eating or milk | Worse at night

Answer 57

Epigastric pain worse on eating

Answer 58

H. Pylori | Chronic NSAID use

Answer 59

Central colicky abdominal pain Shifts to RIF once peritoneum inflamed Rebound tenderness

Answer 60

Terminal ileum

Answer 61

``` Persistent dyspepsia Mass above L clavicle Weight loss Fatigue (anaemia) Ascites if advanced ```

Answer 62

Weight loss Anaemia RIF mass

Answer 63

Change in bowel habit | PR bleeding

Answer 64

Caecal carcinoma

Answer 65

Abdominal discomfort Nausea Early satiety Usually due to acute or chronic pancreatitis

Answer 66

Liver metastasis Hepatocellular carcinoma Conditions causing macronodular cirrhosis (Viral hepatitis B or C. Wilson's disease. Alpha-1-antitrypsin deficiency)

Answer 67

``` Lethargy Arthralgia Features of chronic liver disease Bronze diabetes (Dilated cardiomyopathy) ```

Answer 68

Male | Middle aged

Answer 69

Type 1 = autosomal recessive Mutation of HFE gene Disorder of iron metabolism

Answer 70

``` Spider naevi Gynaecomastia Testicular atrophy Clubbing Leuconychia Dupuytrens contracture Palmar erythema Parotid enlargement ```

Answer 71

Kaiser-fleischer ring | Pathognomonic of Wilson's disease

Answer 72

Long term penicillamine | Copper-chelating agent

Answer 73

Biliary tract diseases

Answer 74

Hepatic and post hepatic disease

Answer 75

Hepatocellular disease

Answer 76

Biliary tract diseases

Answer 77

Hepatic and post hepatic disease

Answer 78

Hepatocellular disease

Answer 79

Congenital hyperbillirubinaemia Unconjugated jaundice Causes severe brain damage in early years

Answer 80

Biliary tract obstruction | Commonly due to gallstones

Answer 81

Ceruloplasmin level (low)

Answer 82

Raised ferritin | Reduced total iron binding capacity

Answer 83

Antimitochondrial antibody

Answer 84

+ve for anti-mitochondrial antibody Hepatic USS ERCP

Answer 85

Symptomatic relief Cholestyramine to treat pruritus ursodeoxycholic acid for ascites and jaundice Liver transplant (or death within 2 years of jaundice onset)

Answer 86

Stress Caffeine Alcohol

Answer 87

Steroid foam enema | Mesalazine suppositories

Answer 88

- Aminosalicylates: - Mesalazine (= 1st line for induction + maintenance of remission in mild cases - topical then oral), olsalazine, balsalazide, sulfasalazine (more SE) - Corticosteroids: induce remission in relapses. No role in maintenance. Topical - suppository, liquid, foam enema. Oral or iv. - Thiopurines: - Azathioprine (if intolerant of steroids). - Ciclosporin: salvage therapy - severe refractory colitis. - Infliximab: effective in inducing remission in refractory to conventional treatment - Stool bulking agents: - distal transit is rapid but proximal transit is slowed --> proximal constipation.

Answer 89

Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion / snake Hyperlipidaemia / hypercalcaemia / hypothyroidism ERCP / embolism Drugs (azathioprine, steroids, Thiazide diuretic, COCP) Pregnancy

Answer 90

Autodigestion of the pancreas by trypsin. | Fat necrosis by lipases

Answer 91

``` Acute onset epigastric pain Radiates to the back Severe and constant Relieved by sitting forwards Nausea and vomiting Fever +/- Shock +/- Peritionitis ```

Answer 92

Biliary tract obstruction | Commonly due to gallstones

Answer 93

Sentinel loop of small bowel on a-Xr Due to localised ileus

Answer 94

Abdominal pain - relieved by defection Bloating Change in bowel habit (Diagnosis of exclusion)

Answer 95

<10%-pure pigment (Bilirubin breakdown products) 75% - Cholesterol 15% - Mixed

Answer 96

``` Female obesity Haemolytic anaemia Hyperlipidaemia Crohn's (Lithogenic bike - innate tendency to form stones) ```

Answer 97

``` Chronic cholecystitis Biliary colic Acute cholecystitis (empyema/biliary peritonitis/abscess) Mucocele Gallbladder carcinoma Obstruction of the common bile duct --> jaundice Cholangitis Pancreatitis Gallstone ileus ```

Answer 98

Severe central abdominal pain that occurs soon after eating

Answer 99

Increased bile production- Haemolysis - hereditary spherocytosis - haemolytic transfusion reactions - thalassaemia - pernicious anaemia Gilbert's syndrome (underactive conjugating enzyme) Crigler-Najjar syndrome (rare autosomal recessive disorder of bilirubin metabolism)

Answer 100

Multiple blue-black Freckles around the lips nose oral mucosa and fingers. GI hamartomatous polyps (benign) Polyps predispose to GI bleeding and intussusception

Answer 101

``` Central domino pain, localises to LIF Vomiting Diarrhoea Fever Local guarding Leucocytosis Risk of perforation or fistula formation ```

Answer 102

- Viral hepatitis - A / B / leptospirosis / brucellosis / Coxiella burnetii/ glandular fever - Alcoholic hepatitis. - Autoimmune hepatitis - Drug-induced hepatitis: paracetamol, rifampicin, isoniazid, allopurinol, amitryptilline, amiodarone, phenytoin - Hepatotoxic chemicals: phosphorous, carbon tetrachloride, phenol. - Decompensated cirrhosis.

Answer 103

Impaired bile conjugation and excretion

Answer 104

Gilbert's syndrome

Answer 105

Progressive failure of relaxation of the lower oesophagus. Degeneration of the ganglia. Dilated, tortuous, hypertrophy of the oesophagus. Barium swallow shows a dilated tapering oesophagus

Answer 106

Peptic ulceration secondary to gastric secreting adenoma (gastrinoma) in pancreas, stomach or small bowel.

Answer 107

Smooth, red, swollen, painful tongue Iron deficiency Folate deficiency B12 deficiency

Answer 108

Embryological remnant Variable length Usually ~5cm from the ileo-caecal valve

Answer 109

``` Asymptomatic Haemorrhage Intestinal obstruction Diverticulitis Perforation ```

Answer 110

Presence of diverticulae | Without symptoms

Answer 111

diverticula with symptoms | E.g. Haemorrhage / infection / fistulae

Answer 112

Evidence of diverticular inflammation Lower quadrant pain h - fever, tachycardia

Answer 113

``` If partial - excise redundant prolapsed mucosa If complete (involves muscle) - surgical lifting of prolapse. E.g. De lormes procedure ```

Answer 114

Anterior anal fistulae track directly into the anal track - straight line. Posterior anal fistulae track around and open in the posterior midline = curved line

Answer 115

If not through the puborectalis muscle - lay open the fistula track. If it goes through the puborectalis muscle you shouldn't lay it open as this damages the muscle + causes incontinence - insert a seton (non absorbable) and tie - gradually cuts through the muscle and allows it to heal by scarring

Answer 116

Parasitic disease from S America. Skin nodule @ site of inoculation Fever, anorexia, lymphadenopathy Long time later - dysphagia + cardiomyopathy

Answer 117

Descending and sigmoid colon Elderly. Rare before 40

Answer 118

Gastrectomy syndrome - rapid gastric emptying B12 deficiency Iron deficiency Osteoporosis (reduced calcium absorption)

Answer 119

``` digital rectal examination Proctoscopy / sigmoidoscopy FBC Clotting studies LFTs if liver disease is suspected Colonoscopy ```

Answer 120

2 week wait for: - Rectal bleeding plus change of bowel habit for six weeks and are aged 40 years or older. - Palpable rectal or right-sided lower abdominal mass. - Iron-deficiency anaemia without any obvious cause Refer patients aged over 60 under 2 week rule if: - Rectal bleeding without anal symptoms for six weeks. - Change in bowel habit for six weeks without rectal bleeding.