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4th Year SB > GI > Flashcards

GI Flashcards

1
Q

what is important to remember about dysphagia

A

red flag symptom - requires urgent OGD to investigate

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2
Q

Hx of oesophagitis

A

May be history of reflux/heartburn.

Patient systemically well.

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3
Q

Hx of oesophageal cancer

A

Often progresses from solids  liquids

Often gives history of weight loss, anorexia, vomiting

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4
Q

Hx for oesophageal candidiasis

A

May be history of steroid use/immunocompromised e.g. HIV

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5
Q

Hx for achalasia

A

Dysphagia of both solids and liquids from the start, regurgitation (some people may do this to relieve pain)

Barium swallow – ‘bird’s beak oesophagus’

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6
Q

Hx for pharyngeal pouch

A

More common in older men

Typical symptoms include dysphagia, regurgitation, halitosis, aspiration, chronic cough

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7
Q

Hx for globus hystericus

A

Symptoms are usually intermittent.
Often have history of anxiety
Sensation of “lump in throat”

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8
Q

causes of upper GI bleeding

A

peptic ulcer
gastric erosions (due to NSAIDs)
oesophageal varices
mallory-weiss tear

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9
Q

which ulcer is relieved by eating and which is worseneed

A

Duodenal ulcers = RELIEVED by eating

Gastric ulcers = Worsened by eating

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10
Q

Tx for oesophageal varices

A

band ligation [propanolol can be given as prophylaxis of variceal haemorrhage]

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11
Q

what LFT results suggest hepatic causes

A

ALT and AST raised

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12
Q

what LFT results suggest biliary causes

A

GGT and Alk Phos raised

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13
Q

what is Hx of biliary colic

A 
RUQ pain radiating to right shoulder
LFTs normal (unless stone in CBD which will produce cholestatic picture)
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14
Q

Hx of cholecystitis

A

Murphy sign positive

Different from biliary colic as history of fever/raised WCC

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15
Q

Hx of Cholangitis (triad)

A

Charcot Triad
- Jaundice, Fever, RUQ pain

Raised WCC and CRP

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16
Q

Tx for gallstones

A

ERCP

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17
Q

what is murphy’s sign and what is it associated with

A

patient stops breathing when press on RUQ

cholecystitis

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18
Q

what is cholecystis

A

inflammation of gallbladder

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19
Q

what is Cholangitis

A

inflammation of bile duct

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20
Q

what is not seen in a cirrhotic liver

A

hepatomegaly

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21
Q

what causes hepatic encephalopathy and how can it be treated

A

ammonia build up

laxatives

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22
Q

complications of chronic liver disease

A 
Portal hypertension (oesophageal varices, caput medusae)
Ascites
Encephalopathy
Oedema
Sepsis
Clotting abnormalities
Spider naevi/Gynaecomastia
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23
Q

causes of CLD

A 
NAFLD
PBC
PSC
Haemochromatosis 
Wilson's disease 
Autoimmune Hepatitis
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24
Q

how does NAFLD present

A

Usually part of metabolic syndrome e.g. obesity, type 2 diabetes, hypertension, high cholesterol

USS = steatosis

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25
Q

how does PBC present

A

90% are females, peak presentation at 50
Lethargy/itch/jaundice

Positive anti-mitochondrial antibodies, cholestatic LFTs

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26
Q

what are cholestatic LFTs

A

ALP raised markedly compared to ALT

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27
Q

how does PSC present

A

Common in men, especially those with ulcerative colitis

USS shows biliary strictures giving a ‘beaded appearance’

Increased risk of cholangiocarcinoma

Associated with pANCA

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28
Q

how does Haemochromatosis present

A

Primary (autosomal recessive) vs secondary (iron therapy/blood transfusion)

Tiredness, arthralgia, impotence, “slate-grey skin pigmentation” and “bronzed diabetic”

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29
Q

how does Wilson’s disease

A

Autosomal recessive with accumulation of copper

Present with liver disease (hepatitis, cirrhosis) and neurological/psychiatric problems (e.g. PD due to deposition in basal ganglia).

May have Kayser-Fleischer ring.

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30
Q

how does autoimmune hepatitis present

A

F>M.

Often associated with other autoimmune conditions

May present with non-specific symptoms e.g. malaise, fatigue, nausea, abdominal pain

Presence of anti-smooth muscle antibodies and elevated IgG

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31
Q

what organisms have a 1-6 hour incubation period

A

Staph Aureus

Bacillus cereus

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32
Q

what organisms have a 12-48 hour incubation period

A

Salmonella

E. Coli

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33
Q

what organisms have a 48-72 hour incubation period

A

Shigella

Campylobacter

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34
Q

what organisms have an incubation period longer than 7 days

A

Giardia

Amoebiasis

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35
Q

who is E. Coli associated with and what is a complication of it

A

common amongst travellers

associated with HUS

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36
Q

how does campylobacter present

A

abdominal pain, fever, diarrhoea

can be due to chicken/turkey

common cause of family outbreaks

most common cause of outbreaks in UK labs

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37
Q

how does bacillus cereus present

A

due to rice being left out at room temperature

“chinese takeaway”

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38
Q

how does giardiasis present

A

presents with abdo pain, flatulence, bloating and non-bloody diarrhoea

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39
Q

how does cholera present

A

profuse severe watery diarrhoea

describes as “rice-water” diarrhoea

associated with dehydration

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40
Q

how does Amoebiasis present

A

Profuse bloody diarrhoea and abdominal pain. May present as liver abscess –> fever, RUQ pain

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41
Q

what are symptoms of IBD

A

abdo pain
diarrhoea
PR bleeding
weight loss

clubbing 
mouth ulcers 
erythema nodosum 
pyoderma gangrenosum 
arthritis
42
Q

what are features of Crohns

A

location

  • anywhere in GI tract
  • skip lesions

pathology

  • thickened bowel and stricture
  • transmural inflammation
  • granulomas present

moderate cancer risk

Symptoms

  • fistulae common
  • extra GI rare
43
Q

Tx for Crohns

A

Steroids
Immunosuppressant (eg azathioprine 1st line)
Anti-TNF

44
Q

what are features of UC

A

location

  • colon and rectum
  • rarely skips

pathology

  • mucosal ulceration and thin wall
  • superficial inflammation
  • no granulomas

high cancer risk

Symptoms

  • fistulae rare
  • extra GI common
45
Q

Tx for UC

A

1st line = 5ASA eg Mesalazine

Steroids
Immunosuppressants
Anti-TNF

46
Q

Treatment for IBS

A

Reduce fibre, exercise, reduce caffeine intake

1st line = according to predominant symptom
Anti spasmodics e.g. mebeverine, buscopan
Anti diarrhoeals e.g. loperamide

2nd line = Anti depressants e.g. amitriptyline

47
Q

Sx of coeliac

A

Abdominal pain
Abdominal bloating
Fatigue, weight loss
Anaemia, vitamin deficiencies (iron, folate, B12)

48
Q

Ix for coeliac disease

A

1st line = anti TTG antibodies

Gold Standard = duodenal biopsy

49
Q

A 75 year old man presents with his wife to the GP with a 2 year history of intermittent problems with swallowing. His wife has noticed halitosis and a cough at night. He has hypertension as his past medical history. There are no red flag symptoms such as weight loss. What is the most likely diagnosis?

A

Pharyngeal pouch

50
Q

A 53 year old woman presents to the GP with fatigue and itch. These symptoms have been going on for 10 months. Routine blood tests reveal the following. What is the likely diagnosis?

Raised Bilirubin
Raised ALP
Raised ALT

ALP much higher than ALT

A

Primary Biliary Cirrhosis

51
Q

A 28 year old woman with chronic left iliac fossa pain and alternating bowel habit is diagnosed with irritable bowel syndrome. Despite treatment with antispasmodics, laxatives and anti-motility agents, there has been no significant improvement in her symptoms. What is the most appropriate next step?

A

Low Dose TCA

52
Q

A 40 year old man is admitted to hospital with decompensated liver disease of unknown aetiology. As part of a liver screen the following results are obtained. What is this man’s hepatitis B status?

Anti HBs = positive
Anti HBc = negative
HBs antigen = negative

A

Previous immunisation to hepatitis B

53
Q

A 30 year old woman develops severe vomiting 4 hours after having lunch at a local restaurant. What is the most likely causative organism?

A

Staph Aureus

54
Q

diarrhoea in HIV/AIDS

A

crytosporidum

55
Q

thumb printing at splenic flexure

A

ischaemic colitis

56
Q

examples of 5-HT3 Receptor Antagonist anti-emetics

A

Dolasetron
Odansetron
Mirtazipine

57
Q

examples of Dopamine Antagonist anti-emetics

A

Olanzapine
Metoclopramide
Haloperidol

58
Q

examples of anti-histamine anti-emetics

A

cyclizine

59
Q

examples of Anti-Cholinergics anti-emetics

A

Hyoscine

60
Q

Tx of ascites

A

spironolactone

61
Q

ix for chronic pancreatitis

A

CT Pancreas with contrast

62
Q

difficulty swallowing, painful swallowing, heart burn, but no Sx of systemic upset

A

oesophagitis

63
Q

diagnostic Ix for PSC

A

MRCP as non invasive

64
Q

treatment of h pylori

A

amox/metronidazole + clarithromycin + PPI for 7 days

65
Q

what is seen on x-ray in haemochromatosis and what do the blood results show

A

chondrocalcinosis

raised serum transferrin and ferritin

66
Q

what is seen on investigation in wilsons disease

A

reduced serum caeruloplasmin
reduced serum copper
increased urinary copper

67
Q

what is the first marker of Hep B infection

A

HBsAg

[causes production of anti-HBs]

68
Q

what implies current infectious disease of Hep B

A

HBsAg

69
Q

the presence of what implies immunity in Hep B

A

Anti-Hbs

70
Q

what does anti Hbc imply

A

previous or current infection

71
Q

what is a marker of infectivity

A

HbeAg

72
Q

what results imply immunisation

A

Anti-Hbs + ve

all other negative

73
Q

what results imply previous Hep B infection, and NOT a carrier

A

Anti-Hbc +ve

HbsAg -ve

74
Q

what results imply previous Hep B infection, and a carrier

A

Anti-Hbc +ve

HbsAg +ve

75
Q

mx of gallstones

A

laparoscopic cholecystectomy

76
Q

tx of acute cholecystitis

A

cholecystectomy within 48 hours

IV Cefuroxime

77
Q

tx for acute cholangitis

A

IV piperacillin-tazobactam

ERCP

78
Q

blood test that if rasied most suggestive of pancreatitis

A

serum lipase

79
Q

surgical treatment for pancreatic cancer if person fit enough

A

Whipple procedure

80
Q

what can you not eat / drink when on warfarin

A

green leaf veg

cranberry juice

81
Q

what can you not drink on a statin

A

grapefruit juice

82
Q

tx of ascities caused by liver cirrhosis

A

spironolactone

83
Q

what do D cells secrete and what is the function of that chemical

A

somatostatin

inhibits HCL secretion

84
Q

what do G cells secrete and what is the function of that chemical

A

gastrin

stimulates HCL secretion

85
Q

what do ECL cells secrete and what is the function of that chemical

A

histamine

stimulates HCL secretion

86
Q

what do parietal cells secrete and what is the function of that chemical

A

HCL, intrinsic factor

87
Q

what do chief cells secrete and what is the function of that chemical

A

pepsinogen

88
Q

Ix for salmonella

A

stool culture

89
Q

Ix for ecoli

A

stool culture

90
Q

Ix for norovirus

A

stool PCR

91
Q

Ix for shigella

A

stool culture

92
Q

Ix for campylobacter

A

stool culture

93
Q

Ix for giardia

A

stool microscopy

94
Q

Ix for C. Diff

A

stool toxin

95
Q

Ix for cholera

A

stool culture [and microscopy]

96
Q

what is treatment for bloody diarrhoea

A

ciprofloxacin

97
Q

Ix and tx for malaria

A

ix = serial thick and thin blood film

tx = chloroquine, primaquine

98
Q

what is most common cause of encephalitis

A

HSV - 1

99
Q

what is most common cause of genital warts

A

HSV - 2

100
Q

CT shows ring lesions ? and person has cat

A

Toxoplasma Gordii

101
Q

what food are the common microbiology causing gastroenteritis associated with

A 
staph aureus = meat
bacillus = rice
salmonella = poultry, dairy 
campylobacter = poultry 
listeria = cheese
e coli = raw meat
crytosporidum = cows

4th Year SB (22 decks)

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