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Finals > GI > Flashcards

GI Flashcards

1
Q

what part of GI tract does UC affect

A

from ileoceacal valve - rectum (terminal ileum)
affects it continuously
limited to submucosa

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2
Q

what part of GI tract does crohn’s affect

A

mouth to anus
skip lesions
full thickness of mucosa

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3
Q

investigations in IBD

A

bloods: FBC (anaemia), LFT’s (primary sclerosing cholangitis), ESR and CRP, U&E’s
stool: high calprotectin, rule out infection

colonoscopy and biopsy for crohn’s - skip lesions, rose thorn ulcers, cobblestoning, goblet cells, granulomas

flexi sig for UC- crypt abscesses, goblet cell depletion, inflammation

dilated loops of bowel on imaging

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4
Q

what are the extra-gastrointestinal manifestations of crohn’s

A

episcleritis, erythema nodosum, clubbing, arthritis, pyoderma gangrenosum, anaemia

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5
Q

what are the GI complications of crohn’s

A

adhesions, fistulae, strictures, obstruction, aphthous oral ulcers

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6
Q

what are the extra-gastrointestinal manifestations of UC

A

PSC, uveitis, episcleritis, clubbing, arthritis, colorectal cancer, osteoporosis, pyoderma gangrenosum, erythema nodosum

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7
Q

what are the red flags in dyspepsia

A 
ALARMS
iron deficient anaemia
weight loss
anorexia
recent/progressive onset
Melena/hematemesis
swallowing difficulty
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8
Q

list some differential diagnosis of haematemesis

A

peptic ulcer, mallory-weiss, oesophageal varices, oesophageal rupture, oesophagitis, gastritis, malignancy, nose bleed, drugs

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9
Q

how can you assess risk of upper GI bleeding and how to assess if need medical intervention

A

rockall risk score

glasgow-blatchford

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10
Q

if patient is shocked/massive GI hemorrhage what actions should you take

A

secure airway and NBM
IV access- 2 large cannula
bloods - coagulation, G&S, crossmatch 4-6 units
monitor UO
activate major haemorrhage protocol
transfuse O -ve, clotting factor and platelets

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11
Q

if patient is hemodynamically stable and has GI bleed what actions do you take

A 
rockall and glasgow-blatchford score
fluids and blood resus
FFP and vitamin K
platelets if <50
endoscopy ASAP if big or within 24h
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12
Q

management of variceal bleed

A

correct coagulopathy and fluid and blood resus
terlipressin and Abx
endoscopic variceal band ligation

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13
Q

investigation of dyspepsia in an person under 60 with no ALARMS symptoms

A

urea breath test/ stool antigen test for H. Pylori
triple therapy: clarithromycin, PPI, amoxicillin

if -ve for H. Pylori 4-8 weeks PPI

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14
Q

who needs endoscopy in dyspepsia?

A

> 60

or <60 with ALARMS

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15
Q

describe pain pattern in duodenal and gastric ulcers

A

gastric- worse after eating

duodenal - worse when hungry

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16
Q

2nd line treatment of ulcers/dyspepsia

A

h2 antagonist - ranitidine

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17
Q

what is barrett’s oesophagus and what does it predispose to

A

metaplasia of squamous to columnar epithelia due to acid

dysplasia to adenocarcinoma

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18
Q

diagnostic criteria for IBS

A

> 1 day abdo pain in last 3 months

  • related to defecation
  • change in frequency
  • change in form of stool
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19
Q

most common cause of SBO + other causes

A

adhesions, hernias, tumours, strictures, foreign body

intussusception, pyloric stenosis and atresia in children

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20
Q

most common cause of LBO

A

tumours, strictures, adhesions (diverticulosis), fecal impaction, volvulus

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21
Q

what can cause ileus

A

surgery, endocrine - diabetes, hypokalaemia, infarct, inflammation, drugs - opiods, anticholinergic)

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22
Q

investigations in bowel obstruction

A

AXR (erect, supine and CXR)

  • SBO: dilated loops of bowel and air fluid level proximal to obstruction, no gas in colon
  • LBO: air fluid level in colon and dilated bowel proximal to obstruction

CT abdo

bloods: metabolites, lactate, FBC, blood gas

23
Q

which antibodies are found in PBC

A

IgM, anti mitochondrial, anti smooth muscle

24
Q

who gets PBC and assoc conditions

A

middle aged women

sjogren’s, RA, systemic sclerosis, thyroid disease

25
Q

how does PBC present

A

middle aged women

lethargy and itch (also hyperpigmentation, jaundice, clubbing, RUQ pain)

26
Q

management of PBC

A

ursodeoxycholic acid

prednisolone

27
Q

what is PSC (where does it affect). antibody?

A

inflammation and fibrosis of intra and extra hepatic bile ducts. P ANCA +ve

28
Q

associations of PSC

A

UC, crohns, HIV

29
Q

investigations and management in PSC

A 
LFTs
ANCA
USS
MRCP
ERCP stent
30
Q

causes of acute pancreatits

A

gallstones, trauma, alcohol, drugs, ERCP, infection, CF, autoimmune - sjrogrens

31
Q

presentation of pancreatitis

A

pain radiating to back, worse lying down better when forward
shock
cullen’s sign - periumbilical ecchymoses
grey-turners sign - flank ecchymosis

32
Q

investigations in pancreatitis

A 
amylase
lipase - more specific
haematocrit and FBC
LFTs
CT/ MRI/ USS
33
Q

how to assess serverity of pancreatitis

A

modified glasgow score/ APACHE

34
Q

complications of pancreatitis

A

abcess, haemorhage, necrosis, oedema, diabetes

35
Q

what is rovsings sign

A

press LIF in appendicitis and pain is felt in RIF

36
Q

presentation of ascending cholangitis

A

charcots triad: RUQ pain, rigors, jaundice (+hypotension and confusion = reynolds pentad)

37
Q

what causes prehepatic jaundice

associated symptoms

A

haemolysis - GPD6, thallassaemia, malaria, SCD, SLE
dark stool, normal urine
increased conjugated bilirubin and urobilinogen

38
Q

what causes intrahepatic jaundice

associated symptoms

A

liver damage, hepatitis, cirrhosis
pale stool, dark urine
raised conjugated and unconjugated bilirubin

39
Q

what causes post hepatic jaundice

associated symptoms

A

cholestasis
pale stools , dark urine
raised conjugated bilirubin and low urobillinogen

40
Q

where does the copper get depositied in wilsons disease

A

liver, brain, eyes - keiser-fleisher rings, kidneys (renal tubular acidosis, haemolysis

41
Q

investigations in wilsons disease and treatment

A

low serum copper and caeroloplasmin
increased urinary copper
penicillamine

42
Q

presentation of haemachromotosis

A

fatigue, erectile dysfunction, bonze skin, DM, cardiomyopathy, arthritis

43
Q

investigations and management of haemachromotosis

A

gene analysis, high transferrin and ferritin
venessection
?iron chelation

44
Q

name 4 types of laxatives and specific examples of each

A

bulk forming - ispaghula husk
stimulant - sodium picosulfate, senna
fecal softeners - docusate, glycerol suppository
osmotic - lactulose, movicol

45
Q

name 2 syndromes associated with colorectal Ca

A

hereditary non polyposis (aged 40 with 3 +ve family members over 2 generations - amsterdamn criteria)

Familial adenomatous polyposis

46
Q

staging of bowel cancer

A

Dukes

47
Q

investigations in NAFLD

A

ALT>AST
hypoechogenicity on USS
ELF blood tests
NAFLD fibrosis score

48
Q

what does coffee bean sign indicate on AXR

A

sigmoid volvulus

49
Q

what does fetus sign indicate in AXR

A

ceacal volvulus

50
Q

how can you differentiate between LB and SB on AXR

A

small bowel - can see folds all the way across, more central

large bowel - folds dont go all the way across, more peripheral

51
Q

What imaging do you do for ?perforation and what do you see?

A

erect CXR - gas under the diaphragm

52
Q

what view are most chest x rays done in?

A

PA

53
Q

what is thumbprinting indicative off on AXR?

A

inflammation - IBD

Finals (18 decks)

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