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Gastrointestinal > GI 7 > Flashcards

GI 7 Flashcards

1
Q

What is achalasia?

A

A rare disorder of the food pipe (oesophagus), which can make it difficult to swallow food and drink.

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2
Q

What are the signs of scurvy?

A

1) Listlessness, anorexia, cachexia
2) Gingivitis, loose teeth, halitosis
3) Bleeding from gums, nose, hair follicles or into joints, bladder or gut
4) Muscle pain or weakness
5) Oedema

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3
Q

What is Beriberi?

A

Heart failure with general oedema (wet beriberi) or neuropathy (dry beriberi) due to lack of vitamin B1 (thiamine)

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4
Q

What is Pellagra and how does it present?

A

Lack of nicotinic acid/nicotinamide which presents as the classic triad - diarrhoea, dementia, dermatitis (Casal’s necklace) - and additionally: neuropathy, depression, insomnia, tremor, rigidity, ataxia and fits

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5
Q

What is Xerophthalmia?

A
  • Vitamin A deficiency syndrome which is a big cause of blindness in the tropics.
  • Conjunctivae - dry and develop oval/triangular spots
  • Corneas - cloudy and soft
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6
Q

What is Budd-Chiari syndrome?

A

A condition where there is obstruction to the venous outflow of the liver owing to occlusion of the hepatic vein

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7
Q

How does acute Budd-Chiari syndrome present?

A
  • Abdominal pain
  • Nausea and vomiting
  • Tender hepatomegaly
  • Ascites
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8
Q

How does chronic Budd-Chiari syndrome present?

A

Chronically: hepatomegaly, mild jaundice, ascites, negative hepatojugular reflex, splenomegaly with portal hypertension

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9
Q

What are the signs of chronic liver disease?

A
  • stigmata: spiders, fetor, encephalopathy
  • ‘synthetic dysfunction’
  • prolonged prothrombin time, hypoalbuminaemia
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10
Q

What are the signs of portal hypertension?

A
  • caput medusa
  • hypersplenism
  • Thrombocytopenia (pancytopenia)
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11
Q

What are the features of alcoholic hepatitis?

A
  • recent excess alcohol
  • Bilirubin > 80mol/l
  • exclusion of other liver disease
  • AST < 500 (AST: ALT ratio >1.5)
  • hepatomegaly / fever / leucocytosis / hepatic bruit
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12
Q

What are the benign liver tumours?

A
  • Haemangioma
  • Focal nodular hyperplasia
  • Adenoma
  • Liver cysts
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13
Q

What are the malignant liver tumours?

A
  • Primary liver cancers (HCC and cholangiocarcinomas)

- Secondary metastases

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14
Q

What is a liver haemangioma?

A
  • Commonest liver tumour
  • Hypervascular well demarcated capsule
  • Diagnosed by imaging, no need for treatment
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15
Q

What are the types of cystic lesions in the liver?

A
  • Simple
  • Hyatid
  • Atypical
  • Polycystic lesion
  • Pyogenic or amoebic abscess
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16
Q

What is a liver simple cyst?

A
  • Liquid collection lined by epithelium
  • No biliary tree communication
  • Solitary and uniloculated
  • Usually asymptomatic
  • Symptoms relating to: intracystic haemorrhage, infection, rupture, compression
17
Q

What is the management for a liver simple cyst?

A
  • No follow up necessary
  • If doubt, imaging in 3-6 mths
  • If symptomatic or uncertain diagnosis (complex cystic lesion), then consider surgical intervention
18
Q

What is a liver hyatid cyst?

A
  • Echinoccocus granulosus
  • Endemic regions
  • Patients may present with disseminated disease, or erosion of cysts into adjacent structures and vessels (IVC)
  • Clinical diagnosis based on history, appearance, and serologic testing-detection of anti-Echinococcus antibodies
19
Q

What is the management for a liver hyatid cyst?

A
  • Surgery (conservative or radical)
  • Medical: Albendazole
  • Percutaneous Drainage: PAIR
20
Q

What is polycystic liver disease?

A
  • Embryonic ductal plate malformation of the intrahepatic biliary tree
  • Numerous cysts throughout liver parenchyma
21
Q

What are the 3 types of polycystic liver disease?

A

1) Von Meyenburg complexes (VMC)
2) Autosomal dominant Polycystic Kidney disease
3) Isolated polycystic liver disease

22
Q

What are the clinical features of a liver abscess?

A
  • High fever
  • Leukocytosis
  • Abdominal Pain
  • Complex liver lesion
  • History: dental procedure or abdominal/biliary infection
23
Q

What is the management for a liver abscess?

A

1) Initial empiric broad spectrum antibiotics
2) Aspiration/drainage percutaneously
3) Echocardiogram
4) Operation if no clinical improvement: Open drainage or Resection
5) 4 weeks antibiotic therapy with repeat imaging

24
Q

What are Von Meyenburg complexes (VMC)?

A
  • Benign cystic nodules throughout the liver + bile duct originating from the peripheral biliary tree
  • Remnants develop into small hepatic cysts and usually remain silent during life
25
Q

What is isolated polycystic liver disease (PCLD)?

A
  • Liver function preserved renal failure rare
  • Symptoms depend on size of cysts
  • PCLD gene – PRKCSH and SEC63
26
Q

What is autosomal dominant polycystic kidney disease (ADPKD)?

A
  • Renal failure due to polycystic kidneys and non-renal extra-hepatic features are common in ADPKD
  • Potential massive hepatic enlargement
  • ADPKD genes – PKD1 and PKD2
27
Q

What are the clinical observation in polycystic liver disease?

A
  • Abdominal pain
  • Abdominal distension
  • Atypical symptoms due to voluminous cysts resulting in compression of adjacent tissue or failure of the affected organ
28
Q

What is the treatment for polycystic liver disease?

A

1) Conservative treatment is recommended to halt cyst growth
2) Invasive procedures if symptomatic/advances (defenestration, aspiration, liver transplantation)
3) Pharmacological therapy - somatostatin analogues

29
Q

What are the differentials for solid liver lesions in young patients?

A

1) Adenoma

2) Focal nodular hyperplasia

30
Q

What is focal nodular hyperplasia?

A
  • Hypervascular response to abnormal arterial flow
  • Contains all liver ultrastructure, central scar
  • Most common in young and middle aged women
  • Usually asymptomatic but may cause pain
  • No malignant risk, minimal bleeding risk
31
Q

What is the diagnosis and management for focal nodular hyperplasia?

A
  • Tests: USS, CT, MRI, FNA

- No treatment required

32
Q

What is a hepatic adenoma?

A
  • Benign neoplasm composed of normal hepatocytes no portal tract, central veins or bile ducts
  • Most common in women 10:1
  • Associated with contraceptive hormones and anabolic steroids
  • Usually asymptomatic but may cause pain
  • Risk: rupture, hemorrhage, or malignant transformation
33
Q

What is the diagnosis and management for a hepatic adenoma?

A
  • Tests: USS, CT, MRI, FNA
  • Management: stop hormones, weight loss
  • Males - surgical excision
  • Females - imaging after 6 months
34
Q

What is dyspepsia?

A

Group of 3 symptoms seen in peptic ulcers consisting of: epigastric pain, burping and bloating

35
Q

What is the main symptom of gastroporesis?

A

Regurgitation of food/liquid

36
Q

What is the treatment for H pylori?

A

Omeprazole + Amoxicillin + metronidazole

37
Q

What is the first investigation for suspected GORD?

A

Trial lowest-dose PPI for 8/52 (omeprazole?)

38
Q

What are the three hallmarks of IBS, for which 2 are needed for a definitive diagnosis?

A

1) Relief on defaecation/bowel movements
2) Change in stool consistency
3) Change in stool frequency

39
Q

What is the tumour marker in pancreatic cancer?

A

CA-19.

Gastrointestinal (8 decks)

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