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Year 3 Drugs + Core Conditions > GI > Flashcards

GI Flashcards

1
Q

Extra-oesophageal manifestations of GORD

A

nocturnal asthma, chronic cough, laryngitis, sinusitis

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2
Q

common triggers of GORD

A

smoking
alcohol, coffee, fatty food
big meals - raised IAP

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3
Q

presentation of GORD

A 
heartburn - burning retrosternal pain
Belching, nausea, vomiting
related to meal time
regurgitation of food into mouth
acid brash, excess saliva
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4
Q

What are the ALARMS symptoms that warrant urgent endoscopy in PUD

A 
Anaemia
Losing weight
Anorexia
Recent onset of symptoms
Melena/Haematemesis
Swallowing difficulty
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5
Q

Investigating and managing GORD?

A

endoscopy if serious, or in over 55s not responding to treatment after 4 weeks + red flags
PPIs, H2 blockers, antacids, lifestyle changes

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6
Q

Causes of peptic ulcer disease? (PUD)

A

H. pylori infection (80%)

NSAID use

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7
Q

Presentation of PUD

A

epigastric, burning pain
associated with meals
haematemesis
melena

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8
Q

How is H. pylori diagnosed?

A

Urea breath test

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9
Q

Which is more common, upper or lower GI bleed?

A

Upper

4x more common

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10
Q

Causes and RF for GI bleed

A

oesophageal varices - alcohol abuse

previous GI problems, NSAIDs

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11
Q

How to manage a GI bleed

A

IV PPI started to reduce chance of re-bleeding
Offer Terlipressin to suspected variceal bleed - dilates splenic artery
not all treatment surgical - resolve acid

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12
Q

What is Mallory-Weiss syndrome?

A

haematemesis from a tear in the mucosa of the oesophagus, brought on by prolonged vomiting

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13
Q

Typical causes of a lower GI bleed?

A

Big bleeds - diverticular disease, ischaemic colitis

Small bleeds - haemorrhoids or anal fissures

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14
Q

Which part of the bowel is affected by UC?

A

Rectum (50%)
Left side of colon (30%)
Whole colon (20%)
it is continuous

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15
Q

Cobblestone appearance, granulomas, fistulae and deep ulcers/fissures more characteristic of which IBD?

A

Crohn’s disease

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16
Q

Typical characteristics of UC?

A

inflammatory polyps
reddened mucosa
superficial inflammation
crypt abscesses

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17
Q

differential diagnoses for IBD

A

infective colitis
IBS
coeliac disease
diverticulitis

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18
Q

Main diagnostic tool for IBD

A

Colonoscopy

mostly exclusion of other potential causes - stool microscopy

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19
Q

Treatment plan for CD

A

Glucocorticoids - prednisolone
Infliximab - anti-TNF-alpha monoclonal antibody
DMARDS - azathioprine
Surgery - 80% pts will require

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20
Q

Treatment plan for UC

A

Aminosalicylates - Mesalazine

surgery - can be curative, eliminates cancer risk

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21
Q

Complications of IBD

A

strictures, fistulae, perforation, colorectal cancer

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22
Q

what is tenesmus?

A

the sensation of needing to pass stool, despite an empty colon

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23
Q

what type of organism is C. diff

A

gram positive bacillus

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24
Q

Management of infective gastroenteritis

A

Oral rehydration solutions
Antibiotics if necessary - systemically unwell
antiemetics/ anti-diarrhoeals if necessary

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25
Q

antibiotic of choice to treat infection with Shigella / Campylobacter / salmonella

A

Ciprofloxacin PO

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26
Q

Common viral causes of gastroenteritis

A

Rotavirus - children

Norovirus - adults

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27
Q

How does gastroenteritis cause its symptoms?

A

inflammation of the lining of the stomach and small intestine
affects absorption of salts and water in the intestine - D+V

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28
Q

What relieves pancreatic pain?

A

sitting forward

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29
Q

what is the effect of inflammation of the pancreas

A

release of exocrine enzymes, causing autodigestion of the organ, and maybe local tissues

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30
Q

Main causes of pancreatitis

A

alcohol - chronic

gallstones - acute

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31
Q

what signs can be expected with acute pancreatitis?

A

systemic infection
jaundice - gallstone obstruction
Periumbilical bruising - Cullen’s sign
Flank bruising - Grey Turner’s sign

32
Q

what blood findings suggest acute pancreatitis?

A

serum amylase more than 3x the upper limit within 24hrs of pain onset

33
Q

what can cause raised serum amylase?

A 
acute pancreatitis
cholecystitis
mesenteric infarction
GI perforation
renal failure
34
Q

what investigations would you order if suspected pancreatitis

A

serum amylase
CXR - to exclude perforation
abdo USS - gallstones
Contrast spiral CT - assess pancreatic necrosis

35
Q

how is acute pancreatitis treated?

A

gallstones removed if cause

supportive if not - analgesia, H2 antagonist, nasogastric tube, nutrition

36
Q

management for chronic pancreatitis

A

abstinence from alcohol
low fat diet, enzyme supplements, fat-soluble vitamins
analgesia
surgery if severe

37
Q

How does alcohol cause chronic pancreatitis?

A

alcohol causes proteins to precipitate in the ducts&raquo_space; dilatation and fibrosis

38
Q

who is affected by gallstones

A 
5 F's
Fat
Female
Fertile
Fair
Forty
39
Q

what are the types of gallstone?

A 
Cholesterol stones (80%)
Bile pigment stones
40
Q

What are the presentations of gallstones?

A

Biliary colic
Acute cholecystitis
Cholangitis

41
Q

Symptoms of biliary colic

A

Epigastric/RUQ pain, radiating to the back
in waves
obstructive jaundice

42
Q

presentation of acute cholecystitis

A

Epigastric/RUQ pain referred to tip of scapula
systemically unwell
obstructive jaundice

43
Q

what is the difference between cholecystitis and cholangitis

A

Cholecystitis - inflammation of the gallbladder

Cholangitis - inflammation of the bile duct

44
Q

What is Murphy’s sign?

A

place 2 fingers on RUQ
ask pt to breathe in
pt cannot due to pain from inflamed GB

45
Q

most sensitive investigation for gallstones?

A

abdo USS

46
Q

Name of the scoring system to determine if endoscopy necessary in GI bleed

A

Blatchford score

47
Q

treatment of Hep A, D and E

A

supportive

avoid alcohol

48
Q

Treatment of Hep B

A

supportive
avoid alcohol
avoid sexual intercourse

49
Q

Treatment of Hep C

A

Weekly peginterferon-alpha SC

daily ribavirin

50
Q

Prognosis of Hep B

A

Majority will recover completely
some go on to develop chronic hepatitis, cirrhosis or HCC
complete eradication of Hep B is rare

51
Q

Prognosis of Hep C

A

90% develop chronic liver disease

15% develop HCC

52
Q

what is the prognosis of Hep A

A

usually acute, passes within 3 months

53
Q

typical symptoms of chronic hepatitis

A

muscle/joint pain, fever, jaundice, abdominal pain, dark urine, grey faeces

54
Q

What is McBurney’s sign

A

Appendicitis

Pain, guarding, rebound tenderness 2/3rd of the way between umbilicus and ASIS

55
Q

In what cases is surgical treatment of appendicitis contra-indicated

A

If pt has IBD, as it impairs healing

treat with DMARDs instead

56
Q

most common cause of bowel obstruction?

A

Small bowel - adhesions from previous surgery

Large bowel - colorectal cancer

57
Q

how is obstruction treated

A

full blockages will require surgery

blockage removal, or colon resected

58
Q

complications of hernias

A

strangulation, incarceration, irreducible hernia

59
Q

characteristics of oesophageal carcinoma

A

Squamous cell carcinoma

Barrett’s oesophagus leads to adenocarcinoma

60
Q

presentation of oesophageal carcinoma

A

swallowing problems, persistent heartburn, retrosternal pain, cough/hoarseness + red flags

61
Q

Characteristics of gastric carcinoma

A

90% are adenocarcinomas

often asymptomatic/ non-specific

62
Q

Signs associated with gastric carcinoma

A

Acanthosis nigricans in axilla

Dermatitis herpatiformis

63
Q

presentation of pancreatic adenocarcinoma

A

epigastric/back pain, painless obstructive jaundice, pale stools, dark urine, palpable mass

64
Q

What is Courvoisier’s sign?

A

Painless gall bladder mass

indicates not gallstones - pancreatic cancer

65
Q

characteristics of colorectal cancer

A

adenocarcinoma
60% are in the rectum
common with familial adenomatous polyposis

66
Q

classic red flags for colorectal cancer

A

persistent bloody stools + change in bowel habit (increased frequency and looseness), worsening obstruction

67
Q

What are the types of liver failure

A

Toxic - drugs, alcohol, paracetamol
Metabolic - NASH, PBC
Viral - hepatitis, CMV

68
Q

Presentation of liver failure

A

clubbing, palmar erythema, spider naevi, testicular atrophy, jaundice, encephalopathy, ascites

69
Q

LFT findings in liver failure

A

raised bilirubin, ALT and AST

70
Q

causes of ascites

A 
excessive alcohol + cirrhosis
metastatic cancer
portal hypertension
right heart failure
Nephrotic syndrome
71
Q

common causes of a perforated viscus

A

Perforated peptic ulcer
tumour, abdominal trauma
ruptured diverticulum

72
Q

presentation of coeliac disease

A

diarrhoea, abdo pain, bloating, flatulence, indigestion, constipation when eating gluten - leading to villous atrophy and malabsorption

73
Q

What mediates coeliac disease

A

T cells

74
Q

Malabsorption issues with coeliac disease

A

Steatorrhoea - fats
apthous ulcers
iron deficiency anaemia
delayed growth and puberty

75
Q

complications of a perforated viscus?

A

Upper GI - usually sterile but can cause chemical peritonitis
Lower GI - normally causes severe sepsis

76
Q

Difference between left and right sided colorectal cancer?

A

Left - bleeding/mucous PR, obstruction, tenesmus, PR mass

Right - weight loss, anaemia, abdo pain, obstruction less likely

Year 3 Drugs + Core Conditions (23 decks)

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