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General Surgery > GI > Flashcards

GI Flashcards

1
Q

How does metoclopramide work?

A

D2 receptor anatagonist

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2
Q

Side effects of metoclopramide

A

Extra pyramidal movements (e.g. tardive dyskinesia, oculogyral crisis)
Hyperprolactinaemia
Parkinonism

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3
Q

Management of variceal bleeding

A

Terlipressin and prophylactic antibiotics at presentation (i.e. before endoscopy)

Then do band ligation

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4
Q

Treatment of gastric varices

A

Injections of N-butyl-2-cyanoacrylate

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5
Q

If initial management of varices does not work, what should you do?

A

Transjugular intrahepatic shunt

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6
Q

Hereditary haemochromatosis inheritance pattern

A

Autosomal recessive

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7
Q

Liver failure triad

JEC

A

Jaundice
Encephalopathy
Coagulopathy

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8
Q

First line test for coeliac disease

A

Tissue transglutaminase antibodies

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9
Q

What is coeliac disease

A

A sensitivity to gluten

-repeated exposure leads to villous strophy, which in turn causes malabsorption

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10
Q

What are patients with primary sclerosing cholangitis at risk of?

A

Around 10% of patients with primary sclerosing cholangitis will develop cholangiocarcinoma
Also have an increased risk of colorectal cancer

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11
Q

What is primary sclerosing cholangitis?

A

Inflammation of the intra- and extra hepatic bile ducts

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12
Q

Which other conditions are associated with primary sclerosing cholangitis?

A

Ulcerative colitis
Crohn’s
HIV

(10% of patients with PSC will develop cholangiocarcinoma)

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13
Q

What might you see on liver biopsy in primary sclerosing cholangitis?

A

Would see onion skin fibrosis

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14
Q

First line investigation for primary sclerosing cholangitis, and what will investigation show?

A

ERCP - will show beaded appearance (from multiple biliary strictures)

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15
Q

A young man with RIF pain, what must you do?

A

MUST always examine the testicles

In young men with RIF pain, could be appendicitis or testicular problems (infection/torsion)

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16
Q

Which type of peptic ulcers are more common? and clinical feature?

A

Duodenal ulcers more common, epigastric pain relieved by eating

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17
Q

Colicky pain, typically in the LLQ
Diarrhoea, sometimes bloody
Fever, raised inflammatory cells and white cells

A

Acute diverticulitis

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18
Q

Tinkling bowel sounds

A

Intestinal obstruction

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19
Q

How does mesenteric ischaemia present?

A

Central abdominal pain - patients typically have a history of AF or other cardiovascular disease
-Diarrhoea, rectal bleeding may be seen
A METABOLIC ACIDOSIS IS OFTEN SEEN (due to tissue ‘dying’)

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20
Q

What type of ABG would you see in mesenteric ischamia

A

Often see a metabolic acidosis

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21
Q

When is mesenteric ischaemia worse?

A

Worse after eating - as gut is having to work and digest food
- Do MR angiogram

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22
Q

Investigation for mesenteric ischaemia

A

MR angiogram

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23
Q

Thumb printing

A

Ischaemic colitis

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24
Q

Risk factors for mesenteric ischaemia?

A

Atrial fibrillation

Other causes of emboli include endocarditis, malignancy

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25
Q

What drug might predispose to bowel ischaemia?

A

Cocaine - ischaemic colitis is sometimes seen in young patients following cocaine use

26
Q

Management of ischaemic colitis

A

Usually supportive - surgery may be required in a minority of cases (e.g. if generalised peritonitis or perforation or on-going haemorrhage)

27
Q

Treatment of overflow diarrhoea?

A

Treat with high dose osmotic laxatives

28
Q

May cause confusion in old people

A

Constipation

29
Q

Characteristic presentation of feacal impaction?

A

Loose stools intermixed with solid or hard stools and abdominal pains

30
Q

Treatment for clostridium difficile infection?

A

Metronidazole

31
Q

Budd-chiari triad?

A

Ascites
Abdominal pain
Enlarged liver

32
Q

Who is Budd Chiari most likely to occur in?

A

More likely to occur in a patient with hypercoagulative state e.g. anti-phospholipid syndrome

(can also occur as a result of physical obstruction e.g. tumour)

33
Q

What is Barrett’s osesophagus?

A

When squamous epithelium is replaced by columnar epithelium

34
Q

Risk factors for Barrett’s

A

GORD (biggest risk factor)
Male (7:1)
Smoking
Central obesity

35
Q

Management of Barrett’s

A

endoscopic surveillance with biopsies

high-dose proton pump inhibitor

36
Q

How often should you scope someone with Barrett’s?

A

Scope every 3-5 years

-if they develop dysplasia then will need endoscopic mucosal resection or radiofrequency ablation

37
Q

Features of achalasia

A

Dysphagia of both solids and liquids

Regurgitation of food - may lead to cough, aspiration pneumonia etc

38
Q

CREST

A 
Calcinosis
Raynauds
Esophageal dysmotility
Sclerodactyly
Telangiectasia
39
Q

Lower oesophageal sphincter pressure in achalasia/systemic sclerosis

A

Increased pressure in achalasia

Decreased pressure in systemic sclerosis

40
Q

When is myasthenia gravis better?

A

Better in the morning

41
Q

Villous atrophy
Raised intraepithelial lymphocytes
Crypt hyperplasia

A

Coeliac disease

42
Q

Treatment for giardia lamblia

A

Metronidazole

43
Q

Biopsy findings of a gastric adenocarcinoma

A

Signet ring cells

44
Q

Signet ring cells

A

Gastric adenocarcinoma

45
Q

Side effects of 5-ASAs e.g. mesalazine

A 
Diarrhoea, nausea, vomiting, exacerbation of colitis
ACUTE PANCREATITIS (7 times more common inpatients taking mesalazine rather than sulfasalazine)
46
Q

“severe epigastric pain which radiates through to the back”

A

Acute pancreatitis

47
Q

Side effects of sulphasalazine

A 
Rashes
Oligospermia
Headache
Heinz body anaemia
Megaloblastic anaemia
Lung fibrosis
48
Q

What should you give patients with ascites and protein <15g/dl

A

Give them oral ciprofloxacin or nofloxacin as prophylaxis against spontaneous bacterial peritonitis

49
Q

Management of spontaneous bacterial peritonitis

A

IV cefotaxime

50
Q

Antibiotics for pyogenic liver abscess

A

MAC
Metronidazole
Amoxicillin
Ciprofloxacin

51
Q

What is Peutz Jeghers syndrome

A

Autosomal dominant
Polyps in the GI tract (may lead to intussusception)
Pigmented lesions on lips, oral mucosa, face, palms and soles
GI bleeding

52
Q

You want to screen someone for hep B infection what should you look for?

A

HBsAg

53
Q

What is Mirizzi syndrome?

A

When the common hepatic ducts become obstructed because of extrinsic compression e.g. impacted stone in cystic duct/hartmann’s pouch of gallbladder

54
Q

What is gallstone ileus?

A

Obstruction of the bowel due to impaction of gallstones

55
Q

Treatment with clindamycin is associated with high risk of what

A

C. diff

56
Q

diarrhoea
abdominal pain
a raised white blood cell count is characteristic
if severe toxic megacolon may develop

A

C diff.

57
Q

Diagnosis of C diff.

A

C. diff toxin in stool

58
Q

Endoscopy when someone has a pharyngeal pouch

A

Will probably be poorly tolerate - also quite hazardous and may result in iatrogenic perforation

59
Q

Increased goblet cells

A

Crohn’s

60
Q

How long should you reintroduce gluten for, before testing for coeliac?

A

Reintroduce for 6 weeks

61
Q

Test for H. pylori

A

Carbon-13 urea breath test or stool antigen

62
Q

Test of h. pylori cure

A

Carbon-13 urea breath test

General Surgery (25 decks)

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