GI Flashcards
Name 2 causes of pre-hepatic jaundice?
Thalassaemia, Malaria, Sickle Cell Disease
Which 3 components make up charcot’s traid?
Fever, Right Upper Qudarant pain and jaundice
What is Leukonchyia?
White discolouration on nails due to hypoalbuminaemia
Name 4 clinical presentations of cirrhosis?
LACS - Leuconchyia, ascites, clubbing, spider naevi
Name the two most common intra-hepatic causes of portal hypertension?
Cirrhosis
Schistomiasis
Name 3 post-hepatic causes of portal hypertension?
IVC obstruction
Constrictive pericarditis
Right heart failure
Where are the most common sites for varices to form?
Gastro-oesaphgeal junction, rectum, left renal vein, diaphram, anterior abdominal wall via umbilical vein
At what pressure do varices tend to rupture?
About 12mmHg
What is the clinical presentation of a ruptures varicies?
Shock
Fresh Rectal bleeding
Vomitting fresh blood
What is given to treat G-O varices and how does this drug work?
Banding OR IV Terlipressin (causes splanchnic vasoconstriction)
Name a sign that can be seen in a patient with portal hypertension?
Splenomegaly
Name two methods to treat alcohol withdrawal ?
Lorazepam
Diazepam
IV thiamine prevent werknickes encephalopathy
Name 4 reasons why patients with chronic liver disease are vulnerable to infections?
- Impaired reticula-endothelial function
- Reduced opsonic activity
- Leucocyte function
- Permeable gut wall
Which drugs should you avoid in prescribing in liver damage?
ACE- Inhibitors
Aminoglycosides
Short acting benzodiazepines with care
Name a treatment method for encephalopathy caused by liver disease?
Lactulose
Name 5 causes of peritonitis?
- Spontaneous bacterial peritonitis
- Surgical
- Secondary to peritoneal dialysis
- TB
- Pelvic inflammatory disease
Name 3 organisms which cause peritonitis?
Staph aureus, E.coli and klebsiella
Name 3 complications of peritonitis?
Septicaemia
Toxaemia
Paralytic Ileus
What does serum amalayse -ve exclude?
Pancreatitis
What are the main causes of chronic liver disease?
Alcohol Non alcoholic steatohepatitis Metabolic (wilsons, alpha q , haemachromatosis) Vascular (budd-chiari) Immune (autoimune hepaitis, PBC, PSC)
Which drug do you used to prevent Wernicke- Korsakoff?
IV thiamine
Name an exudate cause of ascites?
Peritonitis, surgery, TB, neoplasia, sepsis
Name a transudate cause of ascites?
Hypoalbuminaemia, nephrotic syndrome and malnutrition
Name a cause of ascites associated with low flow due to obstruction?
Budd-Chiari
Name 3 management strategies in a patient with ascites?
Paracentesis
Spironalactone
Trans-jugular portosytemic shunts
Which serum antibody is found in almost all patients with PBC?
AMA
Name the three most common symptoms of PBC?
Pruritis, lethargy and fatigue, jaundice
How do you treat pruritits?
Cholestyramine
How do you treat fatigue?
Modafinil
How do you reduce rate of vatical development?
Ursodeoxycholic acid
Which auto-antibodies are present in autoimmune hepatitis?
ANA and ASMA
Where is the gene mutation in haemachromatosis?
Chromosome 6
Name the diagnosis and treatment of haemachromatosis?
Raised serum ferritin and transferrin saturation
Treated with regular removal of blood and desferoxamine
In Wilson’s Disease, what is the name of the rings that encircle the iris of the eye?
Kayser-Fleischer
What is the difference in presentation between adults and children in wilsons disease?
Children = hepatic problems eg cirrhosis
Adults present with CNS problems eg tremor and dysphasia
What is the difference in presentation between adults and children in alpha-1-antitrypsin deficiency?
Children present with liver disease eg jaundice
Adults present with respiratory problems eg dyspnoea
Which is the only DNA virus in viral hepatitis?
Hepatitis B
Name 2 organisms which cause chronic diarrhoea?
Giardiasis
Cryptosporidiosis
Which organism is the most common cause of bacterial diarrhoea?
Camplylobacter jejuni
What is the definition of travellers diarrhoea?
3 or more unformed stool per day and at least one of pain/cramps/nausea/vomiting/dysentry
Name 3 organism causes of bloody diarrhoea?
E.coli, salmonella, shigella
Name 3 protozoa that cause diarrhoea?
Giardia, cryptosporidium and microsporidiea and entamoeba histolytica
Name 2 helminths causes of diarrhoea?
Schistosomiasis
Strongyloides
Which 4 antibiotics commonly cause C. difficle?
Clindamycin, co-amoxiclav, cephalosporin, ciprofloxacin
What is the treatment of c. difficile?
Oral vancomycin and metronidazole
What is Hirschprungs disease?
Neonates born without complete innervation of colon to rectum
What are the 4 main symptoms of bowel obstruction?
- Pain -colicky -poorly localised
- Billous vomitting
- Constipation
- Abdominal distension
What are the main causes of small bowel obstruction in a) adults and b) children?
a) Adhesions, hernia, malignancy
b) Appendicitis, intersussuption, volvulus
Name 3 differences in presentation of small and large bowel obstruction?
- Early vomiting suggests SBO
- Constipation suggest LBO
- Less distension in SBO
Where is the mutation in FAP?
Mutation in APC gene which is a tumour suppressor gene
What are the 2 genetic predispositions that lead to colorectal cancer?
FAP
Hereditary Non-Polyposis colon cancer
Where do most colon cancers arise?
Sigmoid colon
What is GOLD standard diagnosis for colorectal cancer ?
Colonoscopy with biopsy
In the elderly if you can’t perform a colonoscopy, what would you do?
CT colonoscopy
Name the stages of Duke’s classification?
A= limited to muscularis mucosae B = Extension through muscularis mucosae C = Involvement of regional lymph nodes (chemo useful) D= Distant metastases
Which type of oesophageal cancer is more commonly found in patients with GORD?
Adenocarcinoma
Where does squamous cell carcinoma of the oesaphagus occur?
Middle and upper third of the oesophagus
What are the main causes of gastric cancer?
H. pylori infection (1st), pernicious anaemia, dietary factors eg high salt, lower social economic class, polyps and loss of P53
Name 2 chronic liver diseases which increase chance of developing hepatocellular carcinoma?
Hepatitis B and C
Haemochromatosis
What is the Rome III diagnostic criteria in IBS?
Recurrent abdominal pain or discomfort at least 3 days a month in the past 3 months, associated with 2 or more of the following:
- Improvement with defecation
- Onset with change in frequency of stool
- Onset with a change in form of stool
Give an example of a laxititve which can be used in constipation for IBS?
Mavicol
Which drug could you use for pain and bloating in IBS?
Meberverine
What is often seen in IBD but not specific?
Faecal caprotectin
What is the histology of ulcerative colitis?
Only affects colon, continuous ulceration with no skip lesions and not full thickness
Where is pain often felt in patient with ulcerative colitis?
Pain in left lower quadrant
Which drug acts on the colonic lumin in ulcerative colitis?
Aminosalicylate (5ASA) in mild/moderate UC and to maintain remission
Name 5 extra-articular complications of Ulcerative colitis?
- Skin erythema nodosum and pyoderma gangrenosum
- Liver- primary sclerosing cholangitis
- Joints ankylosing spondylitis
- eyes uveitis
- Colon - colorectal cancer
- Clubbing
What is the histology of Chron’s?
Skip lesions affecting anywhere from mouth to anus, goes through full thickness of the bowel wall
Organises into granulomas- cobblestone appearance
Which genetic mutation is associated with Chron’s?
NOD2 gene mutation
Name 4 diagnostic methods for ulcerative colitis?
a) FBC = pANCA, ESR, CRP
b) Pr = blood, c) Stool sample (exclude), d) sigmoidoscopy + biopsy, barium swallow
What drug is used to treat chron’s?
Glucocorticoids, in severe attacks IV hydrocortisone
What is used to maintain remission in chrons?
Anti-TNF antibodies Infliximab
What would you see on a biopsy in a patient with coeliac?
Villous atrophy and crypts hyperplasia
What part of the GI tract is affected in coeliac?
Proximal small bowel
Why is anaemia a common sign of coeliac?
Mucosal damage means B12, folate and iron cannot be absorbed - resulting in anaemia
Name three markers seen in the blood which would lead to a diagnosis of coeliac?
EMA - endomysial antibody
tTG - Tissue transglutaminase antibody
Alpha Gliadin
Is IBD or IBS associated with nocturnal diarrhoea?
IBD
Name three common presentations of dyspepsia?
- Postprandial (after eating) fullness
- Early satiation
- Epigastric pain
- Reflux when lying flat
Name the 6 red alarm signs for GI cancer?
- unexplained weight loss
- Anaemia
- evidence of GI bleeding
- Dysphagia
- Upper abdominal mass
- Persistant vomitting
How is H.pyroli pathogenic?
Produces ureas which converts urea to ammonia and Co2 which is toxic, since ammonia and H+ form ammonium which is toxic to gastric mucosa
What are 3 treatment methods for H.pylori?
- Omeprazole
Amoxicllin
Clarithromycin
How do you detect H.pylori?
Urea breath test
Stool antigen test
Name 5 causes of gastritis?
- H.pylori infection
- Autoimmune gastritis
- Herpes simplex virus
- Duodenogastric reflux
- NSAIDS
- Mucosal Ischameia
What is the clinical presentation of peptic ulcer disease?
Recurrent burning epigastric pain - radiating to shoulder
Nausea, anorexia and weight loss, fulness after meal
Name 5 causes of GORD?
- Lower oesophageal sphincter hypotension
- Hiatus hernia
- Loss of oesophageal peristaltic function
- Gastric Acid hyper-secretion
- Abdominal obesity
Which peptic ulcer is worse when hungry and which is worse on eating?
Duodenal worse on hungry and at night
Gastric is worse on eating
Patient presents with RUQ pain, jaundice, night sweats and travel history?
Enateomaba histolytica
causing amoebic liver abscess
How do you treat amoebic liver abcess?
Metronidazole
What is a treatment used in chronic viral hepatitis?
Pegylated interferon
What are the criteria of the child-pugh classification?
Prothrombin time Ascites Bilirubin Albumin Encephalopathy Each given score of 1-3
Give 3 risk factors of GORD?
- Pregnancy
- Smoking
- Abdominal Obesity
Give 4 complications of GORD?
- Barrets oesopahgus - adenocarcinoma of oesophagus
- Oesopahgitis
- Ulcers
- Benign strictures
Name 2 investigations you could perform in GORD?
Endoscopy if red flag symptoms
Barium swallow to show hiatus hernia
What are the red flag symptoms for GI cancer?
Unexplained weight loss, anaemia, evidence of GI bleeding, upper abdominal mass, dysphagia, persistent vomitting
In peptic ulcer disease and GORD, when would you perform an endoscopy?
> 55, symptoms despite treatment, weight loss, GI bleeding, vomiting, iron deficiency, palpable mass, symptoms for 4 weeks
Give a) 3 non-pharmacological and b) pharmacological treatments of GORD?
a) weight loss, smoking cessation, a void alcohol/cholcolate, small regular meals
b) Antacids, alginates and PPI
What is a Mallory Weiss tear?
Persistent vomiting leads to hanemtemesus via oesophageal mucosal tear
Give 3 symptoms of GORD other than heartburn?
Belching, painful swallowing, increased salivation, nocturnal asthma
What are the 3 most common causes of peptic ulcer disease?
H. pyrlori infection, Drugs eg NSAIDS, and increased gastric acid secretion, smoking
Name 4 investigations you would perform in peptic ulcer disease?
Stool antigen, urea breath test, endoscopy (>55), serum IgG antibodies and FBC = anaemia
Give a) 2 non-pharmacological and b) pharmacological treatments of Peptic ulcer disease?
a) Stress, alcohol and aggravating foods
b) PPI (triple therapy) and H2 blockers (ranitidine)
What is often given alongside NSAIDS to prevent gastritis?
PPI eg omeprazole
Name 3 diseases which cause malabsorption?
Coeliac, Chrons, chronic pancreatitis
Give 3 signs of malabsorption?
Anaemia, bleeding disorders and oedema, metabolic bone disease
Name 4 investigations you would carry out to diagnose malabsorption?
- FBC - anaemia, low ferritin, low B12/folate
- Stool for fat globules and stool microscopy
- Barium - may show Chrons
- Endoscopy and small bowel biopsy
Name 4 complications of diverticular disease?
Perforations, fistula formations, haemorrhage, ileum, peritonitis
What are the common causes of large bowel obstruction?
Colorectal cancer, volulus, diverticular stricture, constipation
What is the most common cause of mesenteric ischaemia?
Superior mesenteric artery thrombosis
Name 3 investigations and what you’d see on a patient with mesenteric ischaemia?
AXR= Gas-less Laparotomy = necrotic bowel FBC = increased HB
In severe relapse of UC what drug would you use?
IV hydrocortisone
What is it called in UC when proximal to ileocaecal valve is affected?
Backwash ileitus
Give 4 complications of chrons?
Obstruction due to fibrosis, adenocarcinoma, osteoporosis and fistulas
What is the most common extra-intestinal feature of chrons?
Mouth Ulcers
Give 4 non-pharmacological management steps for IBS?
Ensure water and fibre intake, avoid caffeine, alcohol, FODMAP, behavioural therapy, increase physical exercise
Give 4 management steps for a patient with coeliac?
- Gluten free diet
- manage anaemia
- Pneumococcal vaccine
- Vitamin supplementation
What are the risk factors for colorectal cancer?
Red meat diet, overweight, alcoholic, ulcerative colitis, decreased fibre in diet, FAP and lynch syndrome
Name 2 symptoms of a)right sided colon cancer and b) left sided colon cancer?
a) Abdominal mass, iron deficient anaemia and perforation
b) Change of bowel habit, mucus stools and bloody stools
At what age and how does the NHS bowel cancer screening programme work?
Screening every 2 years if 60-75 by focal occult blood test
What are the main risk factors for oesophageal cancer?
diet, alcohol excess, smoking, achalasia, obesity, Barret’s oesophagus
How do you diagnose oesophageal cancer?
Oesopahgostomy with biopsy
Name 5 questions you would ask when taking a history for diarrhoea?
- Travel history
- Drinking water/food
- Pets/animal contact
- Immunocompromised
- Malaria
Give 4 risk factors of C.difficle?
Age and co-morbidities, long hospital admissions, NG tube feeing, immunocompromised eg HIV, anti-cancer drugs
