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Phase 2a Summaries > GI > Flashcards

GI Flashcards

1
Q

Name 2 causes of pre-hepatic jaundice?

A

Thalassaemia, Malaria, Sickle Cell Disease

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2
Q

Which 3 components make up charcot’s traid?

A

Fever, Right Upper Qudarant pain and jaundice

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3
Q

What is Leukonchyia?

A

White discolouration on nails due to hypoalbuminaemia

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4
Q

Name 4 clinical presentations of cirrhosis?

A

LACS - Leuconchyia, ascites, clubbing, spider naevi

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5
Q

Name the two most common intra-hepatic causes of portal hypertension?

A

Cirrhosis

Schistomiasis

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6
Q

Name 3 post-hepatic causes of portal hypertension?

A

IVC obstruction
Constrictive pericarditis
Right heart failure

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7
Q

Where are the most common sites for varices to form?

A

Gastro-oesaphgeal junction, rectum, left renal vein, diaphram, anterior abdominal wall via umbilical vein

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8
Q

At what pressure do varices tend to rupture?

A

About 12mmHg

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9
Q

What is the clinical presentation of a ruptures varicies?

A

Shock
Fresh Rectal bleeding
Vomitting fresh blood

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10
Q

What is given to treat G-O varices and how does this drug work?

A 
Banding OR 
IV Terlipressin (causes splanchnic vasoconstriction)
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11
Q

Name a sign that can be seen in a patient with portal hypertension?

A

Splenomegaly

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12
Q

Name two methods to treat alcohol withdrawal ?

A

Lorazepam
Diazepam
IV thiamine prevent werknickes encephalopathy

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13
Q

Name 4 reasons why patients with chronic liver disease are vulnerable to infections?

A
  1. Impaired reticula-endothelial function
  2. Reduced opsonic activity
  3. Leucocyte function
  4. Permeable gut wall
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14
Q

Which drugs should you avoid in prescribing in liver damage?

A

ACE- Inhibitors
Aminoglycosides
Short acting benzodiazepines with care

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15
Q

Name a treatment method for encephalopathy caused by liver disease?

A

Lactulose

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16
Q

Name 5 causes of peritonitis?

A
  1. Spontaneous bacterial peritonitis
  2. Surgical
  3. Secondary to peritoneal dialysis
  4. TB
  5. Pelvic inflammatory disease
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17
Q

Name 3 organisms which cause peritonitis?

A

Staph aureus, E.coli and klebsiella

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18
Q

Name 3 complications of peritonitis?

A

Septicaemia
Toxaemia
Paralytic Ileus

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19
Q

What does serum amalayse -ve exclude?

A

Pancreatitis

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20
Q

What are the main causes of chronic liver disease?

A 
Alcohol 
Non alcoholic steatohepatitis 
Metabolic (wilsons, alpha q , haemachromatosis) 
Vascular (budd-chiari) 
Immune (autoimune hepaitis, PBC, PSC)
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21
Q

Which drug do you used to prevent Wernicke- Korsakoff?

A

IV thiamine

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22
Q

Name an exudate cause of ascites?

A

Peritonitis, surgery, TB, neoplasia, sepsis

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23
Q

Name a transudate cause of ascites?

A

Hypoalbuminaemia, nephrotic syndrome and malnutrition

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24
Q

Name a cause of ascites associated with low flow due to obstruction?

A

Budd-Chiari

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25
Q

Name 3 management strategies in a patient with ascites?

A

Paracentesis
Spironalactone
Trans-jugular portosytemic shunts

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26
Q

Which serum antibody is found in almost all patients with PBC?

A

AMA

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27
Q

Name the three most common symptoms of PBC?

A

Pruritis, lethargy and fatigue, jaundice

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28
Q

How do you treat pruritits?

A

Cholestyramine

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29
Q

How do you treat fatigue?

A

Modafinil

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30
Q

How do you reduce rate of vatical development?

A

Ursodeoxycholic acid

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31
Q

Which auto-antibodies are present in autoimmune hepatitis?

A

ANA and ASMA

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32
Q

Where is the gene mutation in haemachromatosis?

A

Chromosome 6

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33
Q

Name the diagnosis and treatment of haemachromatosis?

A

Raised serum ferritin and transferrin saturation

Treated with regular removal of blood and desferoxamine

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34
Q

In Wilson’s Disease, what is the name of the rings that encircle the iris of the eye?

A

Kayser-Fleischer

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35
Q

What is the difference in presentation between adults and children in wilsons disease?

A

Children = hepatic problems eg cirrhosis

Adults present with CNS problems eg tremor and dysphasia

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36
Q

What is the difference in presentation between adults and children in alpha-1-antitrypsin deficiency?

A

Children present with liver disease eg jaundice

Adults present with respiratory problems eg dyspnoea

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37
Q

Which is the only DNA virus in viral hepatitis?

A

Hepatitis B

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38
Q

Name 2 organisms which cause chronic diarrhoea?

A

Giardiasis

Cryptosporidiosis

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39
Q

Which organism is the most common cause of bacterial diarrhoea?

A

Camplylobacter jejuni

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40
Q

What is the definition of travellers diarrhoea?

A

3 or more unformed stool per day and at least one of pain/cramps/nausea/vomiting/dysentry

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41
Q

Name 3 organism causes of bloody diarrhoea?

A

E.coli, salmonella, shigella

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42
Q

Name 3 protozoa that cause diarrhoea?

A

Giardia, cryptosporidium and microsporidiea and entamoeba histolytica

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43
Q

Name 2 helminths causes of diarrhoea?

A

Schistosomiasis

Strongyloides

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44
Q

Which 4 antibiotics commonly cause C. difficle?

A

Clindamycin, co-amoxiclav, cephalosporin, ciprofloxacin

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45
Q

What is the treatment of c. difficile?

A

Oral vancomycin and metronidazole

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46
Q

What is Hirschprungs disease?

A

Neonates born without complete innervation of colon to rectum

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47
Q

What are the 4 main symptoms of bowel obstruction?

A
  1. Pain -colicky -poorly localised
  2. Billous vomitting
  3. Constipation
  4. Abdominal distension
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48
Q

What are the main causes of small bowel obstruction in a) adults and b) children?

A

a) Adhesions, hernia, malignancy

b) Appendicitis, intersussuption, volvulus

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49
Q

Name 3 differences in presentation of small and large bowel obstruction?

A
  1. Early vomiting suggests SBO
  2. Constipation suggest LBO
  3. Less distension in SBO
50
Q

Where is the mutation in FAP?

A

Mutation in APC gene which is a tumour suppressor gene

51
Q

What are the 2 genetic predispositions that lead to colorectal cancer?

A

FAP

Hereditary Non-Polyposis colon cancer

52
Q

Where do most colon cancers arise?

A

Sigmoid colon

53
Q

What is GOLD standard diagnosis for colorectal cancer ?

A

Colonoscopy with biopsy

54
Q

In the elderly if you can’t perform a colonoscopy, what would you do?

A

CT colonoscopy

55
Q

Name the stages of Duke’s classification?

A 
A= limited to muscularis mucosae 
B = Extension through muscularis mucosae 
C = Involvement of regional lymph nodes (chemo useful) 
D= Distant metastases
56
Q

Which type of oesophageal cancer is more commonly found in patients with GORD?

A

Adenocarcinoma

57
Q

Where does squamous cell carcinoma of the oesaphagus occur?

A

Middle and upper third of the oesophagus

58
Q

What are the main causes of gastric cancer?

A

H. pylori infection (1st), pernicious anaemia, dietary factors eg high salt, lower social economic class, polyps and loss of P53

59
Q

Name 2 chronic liver diseases which increase chance of developing hepatocellular carcinoma?

A

Hepatitis B and C

Haemochromatosis

60
Q

What is the Rome III diagnostic criteria in IBS?

A

Recurrent abdominal pain or discomfort at least 3 days a month in the past 3 months, associated with 2 or more of the following:

  1. Improvement with defecation
  2. Onset with change in frequency of stool
  3. Onset with a change in form of stool
61
Q

Give an example of a laxititve which can be used in constipation for IBS?

A

Mavicol

62
Q

Which drug could you use for pain and bloating in IBS?

A

Meberverine

63
Q

What is often seen in IBD but not specific?

A

Faecal caprotectin

64
Q

What is the histology of ulcerative colitis?

A

Only affects colon, continuous ulceration with no skip lesions and not full thickness

65
Q

Where is pain often felt in patient with ulcerative colitis?

A

Pain in left lower quadrant

66
Q

Which drug acts on the colonic lumin in ulcerative colitis?

A

Aminosalicylate (5ASA) in mild/moderate UC and to maintain remission

67
Q

Name 5 extra-articular complications of Ulcerative colitis?

A
  1. Skin erythema nodosum and pyoderma gangrenosum
  2. Liver- primary sclerosing cholangitis
  3. Joints ankylosing spondylitis
  4. eyes uveitis
  5. Colon - colorectal cancer
  6. Clubbing
68
Q

What is the histology of Chron’s?

A

Skip lesions affecting anywhere from mouth to anus, goes through full thickness of the bowel wall
Organises into granulomas- cobblestone appearance

69
Q

Which genetic mutation is associated with Chron’s?

A

NOD2 gene mutation

70
Q

Name 4 diagnostic methods for ulcerative colitis?

A

a) FBC = pANCA, ESR, CRP

b) Pr = blood, c) Stool sample (exclude), d) sigmoidoscopy + biopsy, barium swallow

71
Q

What drug is used to treat chron’s?

A

Glucocorticoids, in severe attacks IV hydrocortisone

72
Q

What is used to maintain remission in chrons?

A

Anti-TNF antibodies Infliximab

73
Q

What would you see on a biopsy in a patient with coeliac?

A

Villous atrophy and crypts hyperplasia

74
Q

What part of the GI tract is affected in coeliac?

A

Proximal small bowel

75
Q

Why is anaemia a common sign of coeliac?

A

Mucosal damage means B12, folate and iron cannot be absorbed - resulting in anaemia

76
Q

Name three markers seen in the blood which would lead to a diagnosis of coeliac?

A

EMA - endomysial antibody
tTG - Tissue transglutaminase antibody
Alpha Gliadin

77
Q

Is IBD or IBS associated with nocturnal diarrhoea?

A

IBD

78
Q

Name three common presentations of dyspepsia?

A
  1. Postprandial (after eating) fullness
  2. Early satiation
  3. Epigastric pain
  4. Reflux when lying flat
79
Q

Name the 6 red alarm signs for GI cancer?

A
  1. unexplained weight loss
  2. Anaemia
  3. evidence of GI bleeding
  4. Dysphagia
  5. Upper abdominal mass
  6. Persistant vomitting
80
Q

How is H.pyroli pathogenic?

A

Produces ureas which converts urea to ammonia and Co2 which is toxic, since ammonia and H+ form ammonium which is toxic to gastric mucosa

81
Q

What are 3 treatment methods for H.pylori?

A
  1. Omeprazole
    Amoxicllin
    Clarithromycin
82
Q

How do you detect H.pylori?

A

Urea breath test

Stool antigen test

83
Q

Name 5 causes of gastritis?

A
  1. H.pylori infection
  2. Autoimmune gastritis
  3. Herpes simplex virus
  4. Duodenogastric reflux
  5. NSAIDS
  6. Mucosal Ischameia
84
Q

What is the clinical presentation of peptic ulcer disease?

A

Recurrent burning epigastric pain - radiating to shoulder

Nausea, anorexia and weight loss, fulness after meal

85
Q

Name 5 causes of GORD?

A
  1. Lower oesophageal sphincter hypotension
  2. Hiatus hernia
  3. Loss of oesophageal peristaltic function
  4. Gastric Acid hyper-secretion
  5. Abdominal obesity
86
Q

Which peptic ulcer is worse when hungry and which is worse on eating?

A

Duodenal worse on hungry and at night

Gastric is worse on eating

87
Q

Patient presents with RUQ pain, jaundice, night sweats and travel history?

A

Enateomaba histolytica

causing amoebic liver abscess

88
Q

How do you treat amoebic liver abcess?

A

Metronidazole

89
Q

What is a treatment used in chronic viral hepatitis?

A

Pegylated interferon

90
Q

What are the criteria of the child-pugh classification?

A 
Prothrombin time 
Ascites 
Bilirubin 
Albumin 
Encephalopathy 
Each given score of 1-3
91
Q

Give 3 risk factors of GORD?

A
  1. Pregnancy
  2. Smoking
  3. Abdominal Obesity
92
Q

Give 4 complications of GORD?

A
  1. Barrets oesopahgus - adenocarcinoma of oesophagus
  2. Oesopahgitis
  3. Ulcers
  4. Benign strictures
93
Q

Name 2 investigations you could perform in GORD?

A

Endoscopy if red flag symptoms

Barium swallow to show hiatus hernia

94
Q

What are the red flag symptoms for GI cancer?

A

Unexplained weight loss, anaemia, evidence of GI bleeding, upper abdominal mass, dysphagia, persistent vomitting

95
Q

In peptic ulcer disease and GORD, when would you perform an endoscopy?

A

> 55, symptoms despite treatment, weight loss, GI bleeding, vomiting, iron deficiency, palpable mass, symptoms for 4 weeks

96
Q

Give a) 3 non-pharmacological and b) pharmacological treatments of GORD?

A

a) weight loss, smoking cessation, a void alcohol/cholcolate, small regular meals
b) Antacids, alginates and PPI

97
Q

What is a Mallory Weiss tear?

A

Persistent vomiting leads to hanemtemesus via oesophageal mucosal tear

98
Q

Give 3 symptoms of GORD other than heartburn?

A

Belching, painful swallowing, increased salivation, nocturnal asthma

99
Q

What are the 3 most common causes of peptic ulcer disease?

A

H. pyrlori infection, Drugs eg NSAIDS, and increased gastric acid secretion, smoking

100
Q

Name 4 investigations you would perform in peptic ulcer disease?

A

Stool antigen, urea breath test, endoscopy (>55), serum IgG antibodies and FBC = anaemia

101
Q

Give a) 2 non-pharmacological and b) pharmacological treatments of Peptic ulcer disease?

A

a) Stress, alcohol and aggravating foods

b) PPI (triple therapy) and H2 blockers (ranitidine)

102
Q

What is often given alongside NSAIDS to prevent gastritis?

A

PPI eg omeprazole

103
Q

Name 3 diseases which cause malabsorption?

A

Coeliac, Chrons, chronic pancreatitis

104
Q

Give 3 signs of malabsorption?

A

Anaemia, bleeding disorders and oedema, metabolic bone disease

105
Q

Name 4 investigations you would carry out to diagnose malabsorption?

A
  1. FBC - anaemia, low ferritin, low B12/folate
  2. Stool for fat globules and stool microscopy
  3. Barium - may show Chrons
  4. Endoscopy and small bowel biopsy
106
Q

Name 4 complications of diverticular disease?

A

Perforations, fistula formations, haemorrhage, ileum, peritonitis

107
Q

What are the common causes of large bowel obstruction?

A

Colorectal cancer, volulus, diverticular stricture, constipation

108
Q

What is the most common cause of mesenteric ischaemia?

A

Superior mesenteric artery thrombosis

109
Q

Name 3 investigations and what you’d see on a patient with mesenteric ischaemia?

A 
AXR= Gas-less 
Laparotomy = necrotic bowel 
FBC = increased HB
110
Q

In severe relapse of UC what drug would you use?

A

IV hydrocortisone

111
Q

What is it called in UC when proximal to ileocaecal valve is affected?

A

Backwash ileitus

112
Q

Give 4 complications of chrons?

A

Obstruction due to fibrosis, adenocarcinoma, osteoporosis and fistulas

113
Q

What is the most common extra-intestinal feature of chrons?

A

Mouth Ulcers

114
Q

Give 4 non-pharmacological management steps for IBS?

A

Ensure water and fibre intake, avoid caffeine, alcohol, FODMAP, behavioural therapy, increase physical exercise

115
Q

Give 4 management steps for a patient with coeliac?

A
  1. Gluten free diet
  2. manage anaemia
  3. Pneumococcal vaccine
  4. Vitamin supplementation
116
Q

What are the risk factors for colorectal cancer?

A

Red meat diet, overweight, alcoholic, ulcerative colitis, decreased fibre in diet, FAP and lynch syndrome

117
Q

Name 2 symptoms of a)right sided colon cancer and b) left sided colon cancer?

A

a) Abdominal mass, iron deficient anaemia and perforation

b) Change of bowel habit, mucus stools and bloody stools

118
Q

At what age and how does the NHS bowel cancer screening programme work?

A

Screening every 2 years if 60-75 by focal occult blood test

119
Q

What are the main risk factors for oesophageal cancer?

A

diet, alcohol excess, smoking, achalasia, obesity, Barret’s oesophagus

120
Q

How do you diagnose oesophageal cancer?

A

Oesopahgostomy with biopsy

121
Q

Name 5 questions you would ask when taking a history for diarrhoea?

A
  1. Travel history
  2. Drinking water/food
  3. Pets/animal contact
  4. Immunocompromised
  5. Malaria
122
Q

Give 4 risk factors of C.difficle?

A

Age and co-morbidities, long hospital admissions, NG tube feeing, immunocompromised eg HIV, anti-cancer drugs

Phase 2a Summaries (12 decks)

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