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Finals > GI > Flashcards

GI Flashcards

1
Q

Cephalosporins and clindamycin strong linked to?

A

C diff

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2
Q

Kantor’s string sign?

A

Crohns

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3
Q

Cancer developing in 10% of primary sclerosing cholangitis?

A

Cholangiocarcinoma

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4
Q

Obese, T2Dm abnormal LFts?

A

NAFLD

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5
Q

Sulphasalazine may cause what? (resp)

A

Pulmonary fibrosis

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6
Q

Rose thorn ulcers?

A

Crohns

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7
Q

Blue nails associated with?

A

Wilsons

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8
Q

Heinz body anaemia which GI drug?

A

Sulphasalazine

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9
Q

Coeliac disease linked to which other dietary problem?

A

Lactose intolerance

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10
Q

What is asterixis?

A

Flapping tremor

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11
Q

Lower vs upper Gi bleed blood tests?

A

Upper ↑urea

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12
Q

Hypothermia may cause which Gi problem?

A

pancreatitis

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13
Q

Osteoporosis may be caused by which intolerance?

A

Coeliac

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14
Q

Thiamine also know as?

A

Vitamin B1

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15
Q

Thiamine deficiency known as?

A

BeriBeri

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16
Q

What should be given in large volume paracentesis of ascites?

A

HAS 100ml/2.5l drained

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17
Q

A woman complains of lethargy, diplopia and dysphagia. She is noted to have a ptosis on examination?

A

Myasthenia gravis

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18
Q

Loss of haustrations on barium enema?

A

UC

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19
Q

Lead pipe colon ?

A

UC

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20
Q

UC or crohns more likely to cause obstruction?

A

Crohns

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21
Q

Most common form of inheritable colorectal cancer?

A

HNPCC

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22
Q

Type of liver failure in paracetamol overdose?

A

Hepatocellular

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23
Q

Which blood test is most sensitive and specific for liver failure?

A

Platelets ↓ <150,000 mm^3

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24
Q

Ulcerative colitis, extend of disease in wall of intestine?

A

No inflammation beyond submucosa

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25
Q

Blood Diarrhoea more common in which IBD?

A

UC

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26
Q

Neuropsychiatric symptoms such as depression and tremor in young person with signs of liver disease?

A

Wilson’s

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27
Q

Weight losss more common in which IBD?

A

Crohns

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28
Q

First line investigation suspected mesenteric ischaemia?

A

ABG/Lactate acidosis ↑WCC

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29
Q

Classically a history of what in mesenteric ischaemia?

A

AF

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30
Q

Thumbprinting on AXR?

A

Ischaemic colitis

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31
Q

Ischaemic colitis

A

More transient pain, oftne in splenic flexure area

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32
Q

SpontBP Neutrophils?

A

>250 per ml

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33
Q

When do you treat sbp with HAS?

A

if ↑creatinine

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34
Q

Imaging of choice in mesenteric ischaemia?

A

CT Abdo/Angio

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35
Q

Treatment of SBP?

A

Life long cipro prophylaxis

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36
Q

Abdo pain severe and not in keeping with physical signs?

A

Acute mesenteric ischaemia

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37
Q

Serum copper in wilsons?

A

Low

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38
Q

Ceruloplasmin low?

A

Wilsons

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39
Q

Primary biliary cholangitis - the M rule

A

IgM anti-Mitochondrial antibodies, M2 subtype Middle aged females

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40
Q

Isoniazid may cause?

A

Peripheral neuropathy

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41
Q

Villous atrophy, raised intra-epithelial lymphocytes, and crypt hyperplasia

A

Coeliac

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42
Q

Primary sclerosing cholangitis very common amongst who?

A

80% of UC sufferers

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43
Q

Single strongest risk factor for barrets?

A

GORD

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44
Q

H.pylori eradiction?

A

Always PPI and clarithro +/- metro or amox

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45
Q

Inflammation in all layers of bowel?

A

Crohns

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46
Q

Nystagmus, Ophthalmoplegia and Ataxia

A

Wernickes- B1 deficiency

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47
Q

Mesalazine> risk of what vs sulfasal?

A

7 x greater risk of pancreatitis

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48
Q

Metabolic acidosis elderly abdo pain?

A

Think ischaemia especially if lactate ↑

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49
Q

ABX for hepatic enceph?

A

rifaxamin

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50
Q

Colorectal cancer ↑ in which ibd?

A

UC

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51
Q

PPI role in acute endoscopy of bleeds?

A

PPIs should not be administered as part of the acute management of upper GI bleeding prior to endoscopy

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52
Q

Liver failure triad?

A

encephalopathy, jaundice and coagulopathy

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53
Q

Most common sites for each IBD?

A

Rectum- UC Terminal Ileum Crohns

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54
Q

AST:ALT ration >2 likely cause?

A

Alcoholic

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55
Q

AST:ALT ration <1 likely cause?

A

NAFLD or Hepatitis

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56
Q

Glasgow alcoholic score?

A

Scoring for

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57
Q

Blatchford score before or after endo?

A

Before

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58
Q

Rockall score ?

A

After endo risk of rebleeding

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59
Q

Prophylaxis of variceal bleeding?

A

Propranolol ↓portal venous pressure

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60
Q

Raised transferrin saturation and ferritin, with low TIBC?

A

Haemochromatosis

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61
Q

Serum albumin ascitic gradient numbers?

A

>11 Transudate = liver <11 exudate

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62
Q

Gallstones ↑ in which ibd?

A

Crohns

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63
Q

Right upper quadrant pain, fever and yellowing of the sclera

A

Ascending cholangitis

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64
Q

Investigation of choice for lover cirrhosis?

A

Transient elastography

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65
Q

New diagnosis cirrhosis other imaging/investigate?

A

Upper endo for variceals

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66
Q

Monitoring of cirrhosis imaging and bloods?

A

6/12 USS +/- AFP

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67
Q

Continuous disease ibd?

A

UC

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68
Q

Cobble-stone appearance on endoscopy

A

Crohns

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69
Q

Unintentional weight loss greater than ? within the last 3-6 months is diagnostic of malnutrition

A

10%

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70
Q

Prophylactic ABX for ascites if albumin in ascites is?

A

Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less until the ascites has resolved’

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71
Q

Acute SBP what is used?

A

Cefotaxime IV

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72
Q

Epigastric pain and diarrhoea

A

Zollinger ellison

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73
Q

Vomiting → severe chest pain, shock - ?

A

Boerhaave syndrome

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74
Q

Severe vomiting → ?

A

Mallory-Weiss tear

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75
Q

Hepatorenal syndrome treatment?

A

Terlipressin and HAS?

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76
Q

What is Hepatorenal syndrome?

A

>133 creat with ascites and liver failure

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77
Q

HBsAg normally implies ?

A

Acute infection 1-6months

78
Q

HBsAg is present for > 6 months?

A

Chronic infective

79
Q

Anti what implies immunity to hep B?

A

Anti-HBs

80
Q

Anti-HBc implies?

A

Previous infection or current Igm 6 months and above is IgG C= Caught

81
Q

HbeAg marker of ?

A

Infectivity

82
Q

Painless enlarged gallbladdermild jaundice?

A

Pancreatic or cholangicarcinoma

83
Q

Side effect of whipples also with gastric surgeries ?

A

Dumping syndrome

84
Q

Suspected pancreatic cancer imaging of choice?

A

High res CT

85
Q

Risks for pancreatic cancer?

A

increasing age smoking diabetes chronic pancreatitis HNPCC BRCA2 MEN

86
Q

Pancreatic cancer type and where in pancreas?

A

Adeno and Head

87
Q

Gradual onset diarrhoea can be several weeks ? infectious cause? and if bloody which?

A

Amoebiasis (bloody) Giardiasis (non bloody)

88
Q

Shortest exposure to onset gastroenteritis organism?

A

Bacillus cereus and staph 1-6hrs

89
Q

Flu like prodrome crampy abdo pain fever diarrhoea which may be bloody

A

Campylobacter

90
Q

Complication of campylobacter?

A

Guillian Barré

91
Q

What is budd-chiari syndrome?

A

Hepatic vein thrombosis

92
Q

Features of Budd-Chiari?

A

abdominal pain: sudden onset, severe ascites tender hepatomegaly

93
Q

Causes of Budd-Chiari?

A

polycythaemia rubra vera thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies pregnancy

94
Q

Grey turners where?

A

Sides - turning

95
Q

Cullens sign?

A

Umbilical

96
Q

Elderly female, epigastric pain, ↑lipase ↑alt ??

A

Gallstone pancreatitis

97
Q

Biliary colic associated with?

A

Eating

98
Q

4 F’s cholecystitis?

A

fat, female, 40s, fertile

99
Q

Investigation of choice for gallstones/cholecystitis?

A

USS

100
Q

Dilated bile ducts seen on USS but not stone, what investigation now?

A

MRCP

101
Q

Acut cholecystitis, when do you offer cholecystectomy within ?

A

Ideally within 1 week of onset

102
Q

Multiple co-morbidities but acute cholecystitis?

A

Cholecystotomy

103
Q

Amylase response in chronic pancreatitis?

A

Often reduced Lipase more sensitive

104
Q

USS scan in pancreatitis?

A

Yes to rule out stones

105
Q

When to CT pancreatitis?

A

If chronic or not improving

106
Q

ABX for pancreatitis?

A

No!

107
Q

Fluid type for pancreatitis?

A

Hartmanns, aggressive resuscitation

108
Q

24 hr mortality from pancreatitis reduced by doing what?

A

aggressive resuscitation

109
Q

Score for severity of pancreatitis?

A

PANCREAS - glasgow score Pa02 ↓, Age, Neutrophils ↑, Calcium↓ Renal ↑urea, Enzymes ↑, Albumin <32, Sugars >11

110
Q

Cholangiocarcinoma increased risk with?

A

Primary sclerosing cholangitis

111
Q

Most appropriate management of achalasia?

A

Balloon dilatation

112
Q

NICE says offer urgent upper GI endoscopy assess for oesophageal cancer in those with …

A

Dysphagia or if >55 with weight loss and any of abdo pain, reflux or dyspepsia

113
Q

Dysphagia differentials?

A

achalasia, pharyngeal pouch, oesophagitis, carcinoma

114
Q

Barrets oesophagus risk for which cancer?

A

Junctional, Adenocarcinoma

115
Q

Mid oesophagus associated with smoking and achalasia?

A

Squamous carcinoma

116
Q

Gold standard for oesophageal cancer investigation?

A

Endoscopy + brushings

117
Q

Asplenic patients need which vaccines?

A

pneumococcus, h. influenza, meningitis MMR

118
Q

Important next investigation when patient presents with colorectal cancer symptoms?

A

PR examination 30% in rectum and can be felt

119
Q

Most appropriate diagnostic investigation for colorectal cancer?

A

Urgent Colonoscopy with biopsy

120
Q

Tenesmus more common in cancer of with gi area?

A

Rectum

121
Q

When is faecal occult blood testing offered?

A

Every 2 years 60-74yrs

122
Q

Lower 3rd of rectum cancer which op?

A

Abdomino-perineal resection end colostomy

123
Q

Upper 2/3 rectum cancer op?

A

Anterior resection (take rectum and sigmoid) temp ileostomy or anastamosis

124
Q

When is hartmanns op used what is it?

A

left hemicolectomy + end colostomy (emergency obstruction open op usually cancer)

125
Q

Anastamosis types?

A

Colorectal usually end to end, side to side and end to side ileocolic or rectal

126
Q

Spouted usually on right stoma, liquid contents?

A

Ileostomy

127
Q

Flush to skin can be anywhere almost faeculent content stoma?

A

Colostomy

128
Q

Stoma points to remember?

A

Say would digitate if contipated, involve stoma nurses. Output monitoring important

129
Q

Anal fissure treatment?

A

Fluids, fibre, analgesia, GTN BD, diltiazem in secondary care

130
Q

Perianal abscesses more likely in who?

A

IBD and diabetes

131
Q

Grading of haemmhoroids

A

1- no prolapse 2- prolapse straining but reduce alone 3- prolapse manually reduced 4- Irreducible

132
Q

Grade 2 haemorrhoids what can be done?

A

Band ligation

133
Q

Small bowel should be

A

3cm

134
Q

LArge bowel should be less than ?cm

A

6cm

135
Q

Caecum should be less than ?cm

A

9cm

136
Q

Line across diameter of bowel likely to be which one?

A

Small venae commitantes

137
Q

Lines that do not cross entire width of bowel liekly to be which type of bowel?

A

Large due to haustra

138
Q

Lack of haustra may indicate?

A

Chronic colitis, lead pip/drainpipe

139
Q

SBO symptoms?

A

Vomiting early, may still pass stool

140
Q

LBO symptoms?

A

Constipation and then faeculent vomititng

141
Q

Causes of SBO?

A

Adhesions Hernias Tumours Strictures (IBD)

142
Q

Causes of LBO?

A

Usually cancer, can be diverticularl or volvulus

143
Q

Diagnosis of diverticular imaging?

A

Flexi sig, non acute phase

144
Q

Primary biliary cholangitis treated with?

A

urodeoxycholic acid

145
Q

Antibodies and LFTs in primary biliary cholangitis?

A

IgM and anti antimitochondrial. ALP GGT and bilirubin also raised

146
Q

Worsening dysphagia, weight loss and changes in voice diagnosis?

A

Oesophageal carcinoma

147
Q

Dysphagia associated with eye problems and ptosis?

A

Myasthenia gravis

148
Q

Most common organism for SBP?

A

E.coli

149
Q

Gilbert’s syndrome is a rise in what?

A

Unconjugated hyperbillirubinaemia

150
Q

What disease most likely to increase risk of liver cancer?

A

Hep B is carcinogenice without cirrhosis

Hep C rarely causes HCC without cirrhosis

151
Q

Which antibodies specifically for coeliac?

A

IgA ttg

152
Q

Abdo pain nothing better or worse, blood and Leuko on urine which investigation?

A

CT non contrast, likely stones

153
Q

Barretts oesophagus dysplasia not metaplasia management?

A

Endoscopic intervention regardless of dysplasia grade, ablation or resection

154
Q

ANCA ALP and UC ?

A

Primary sclerosing cholangitis

155
Q

Inferior mesenteric artery at which vertebral level?

A

L3

156
Q

Toxic mega colon features axr?

A

Transverse colon dilated massively and v unwell

157
Q

Typical LFTs in autoimmune hepatitis

A

Autoimmune hepatitis is more likely to show predominantly raised ALT / AST on LFTs than ALP Anti smooth muscle antibody

158
Q

Risk of refeeding syndrome electrolytes?

A

Hypophosphataemia

159
Q

A history of heartburn Odynophagia but no weight loss and systemically well

A

Oesophagitis

160
Q

Steroid use and pain on swallowing?

A

Likely candidiasis

161
Q

SSRI major risk for which gi problem?

A

Duodenal ulcer

162
Q

Which hepatorenal syndrome worse?

A

Type 1 rapid onset

163
Q

Investigation of choice in primary sclerosing cholangitis

A

ERCP

164
Q

Dysphagia, iron deficiency and glossitis.

A

Plummer Vinson

165
Q

Signet ring cells gi biopsy?

A

Gastric adenocarcinoma

166
Q

First line treatment of UC?

A

Aminosalycylate

167
Q

Methotrexate used in which ibd?

A

Crohns

168
Q

Triad of mesenteric ischaemia?

A

Soft abdo, Acute severe pain, rapid hypovolaemia

169
Q

Treatment of mesenteric ischaemia?

A

ABX, LMWH, Fluids and laparotomy

170
Q

Causes of GI bleed?

A

Oesophagitis Oesophageal varices Mallor Weiss tear Gastritis Gastric ulcer Gastric malignancy Duodenal ulcer Angiodysplasia

171
Q

Score to calculate GI bleed before endoscopy?

A

Glasgow Blatchford

172
Q

Hb threshold for transfusion in upper GI?

A

<7 aim for 8 or more

173
Q

Platelets and vit k in upper gi bleed?

A

<50plts and PT>13.5

174
Q

ANy bleed what will you do?

A

Set of obs Oxygen, suction Cannula and bloods Fluid challenge Catheter GB score score Senior help 72 hour PPI infusion

175
Q

Additional steps if suspected variceal bleed?

A

Terlipressin 2mg IV stat Ciprofloxacin 200mg IV BD

176
Q

Post endoscopy treatment for variceal bleeding?

A

Terlipressin 2mg QDS for 5 days Cipro for 72hrs continue PPI Propranolol repeat ligation of varices

177
Q

Triple therapy for H.pylori? When?

A

Clarithromycin + metro or amox +PPI usually causes duodenal ulcers

178
Q

What must be done in gastric ulcers post endoscopy?

A

Re-scope- much higher chance of cancer

179
Q

Glasgow score meaning?

A

0 likely ok consider for discharge, 1 or greater probs needs scoping >6 50% bad

180
Q

Wernickes encephalopathy triad?

A

Ataxia, confusion ophthalmoplegia

181
Q

Treatment of wernickes?

A

2 pairs of IV pabrinex tds for 5 days prevent korsakoffs

182
Q

Ulcer most likely to perforate?

A

Anterior duodenal ulcer

183
Q

Unconjugated bilirubin is what cause of jaundice?

A

Pre-hepatic

184
Q

Causes of jaundice- Pre- intra and post hepatic?

A

Pre- gilberts,haemolysis Intra- Hepatitis, alcohol, medication, psc Gallstones carcinoma

185
Q

Intra-luminal, mural and extra mural causes of jaundice?

A

Intra-Stones Mural- Stricture of carcinoma Extra mural pancreatic cancer or abdo mass

186
Q

Dark urine what type of bilirubin?

A

Conjugated as can be excreted

187
Q

What is shown ?

A

oesophagitis

188
Q

What is this investigation what does it show?

A

Barium swallow, Achalasia

189
Q

Histology of coeliac? Where is the biopsy taken from?

A

Presence of intra-epithelial lymphocytes, villous atrophy, and crypt hyperplasia

Taken from duodenum

190
Q

Most common symptoms and signs of coeliac?

A

IDA, Folate and rarely b12 deficiency.

Iga deficiency, Diarrhoea, Bloating, Pain and discomfort, dermatittis herpetiformis, weight loss, fatigue

Finals (16 decks)

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