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GI Flashcards

1
Q

What is a hernia

A

Protrusion of viscus through a defect in the wall

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2
Q

Comps of hernias

A

Irreducitlbe
obstruction
incarcerated
strangulated

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3
Q

RFs for inguinal hernia

A

obesity, constipation, chronic cough, male, heavy lifting

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4
Q

Types of inguinal hernia?
Where through?
Which is most likely to strangulate?

A

Indirect - through deep inguinal ring (most likely to strangulate)

Direct - through post wall of inguinal canal

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5
Q

Ix if unsure about hernia

A

USS

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6
Q

Usual pres of hernia

A

Lump +/- pain (if incarcerated)

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7
Q

Mx of small hernia

A

W+W

wt loss

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8
Q

Pres of femoral hernia?

Where?

A

Lump in groin

Inf + lat to pubic tubercle

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9
Q

DDx of femoral hernia in men?

How to differentiate?

A

Hydrocele - can get above this on examination

Cant get above hernia

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10
Q

Comp of femoral hernias?

A

high strangulation rate

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11
Q

Pres of strangulated hernia?

A

red, tender, tense, irreducible +/- colicky abdo pain + vomit + distension –> = obstruction (EMERGENCY)

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12
Q

Red flags of dyspepsia?

A 
ALARMS
Anaemia
Lost weight
Anorexia
Recent onset (in >55yo)
Melaena
Swallowing difficulty
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13
Q

Causes of dyspepsia?

A

Functional
PUD
Oesophagitis

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14
Q

Dx of functional dyspepsia?

A

Rome Criteria

6m post-pranidal fullness
Early satiety
Epigastrci pain/burn
No structural abnorm

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15
Q

Drugs causing dyspepsia?

A

Nitrates
bisphosphonates
corticosteroids
NSAIDs

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16
Q

Mechanism of PPIs?

A

Decrease expression of H+/K+ antiporter on luminal memb of parietal cells

decreased stomach acid

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17
Q

Ix in dyspepsia?

A

FBC
H. pylori [urea breath test, stool antigen]
+/- endoscopy
barium

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18
Q

Lifestyle for dyspepsia

A 
stop drugs
stop smoking
avoid aggravating foods
weight loss
antacids [gaviscon]
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19
Q

Stomach cells + function?

A 
chief cells - pepsinogen
G-cells - gastrin
parietal cells - IF, HCl
D-cells - somatostatin
Goblet cells - mucus, bicarb
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20
Q

What stops acid prod?

A

somatostatin

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21
Q

what is h pylori?

A

gram -ve

curved bacillus

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22
Q

sx of PUD?

A

fullness
bloating
early satiety
epigastric pain/burn

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23
Q

Anaemia in PUD?

A 
iron deficiency 
(bleeding ; h pylori uses Fe for growth)
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24
Q

mx of h pylori

A

Triple therapy

PPI + amox + clarithromycin/metronidazole

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25
Q

pain in DU vs GU

A

DU - post prandial (1-3h) relieved by eating

GU - on eating

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26
Q

Zollinger-Ellison syndrome?

A

gastrin-secreting tumour –> overprod of acid so recurrent peptic ulcers

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27
Q

mx of PUD?

A

PPI / H2RA

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28
Q

GORD?

A

reflux of acidic contents into oesophagus

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29
Q

What does GORD cause?

A

oesophagitis, ulceration, stricture, Barrett’s

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30
Q

Epithelial change in Barretts?

A

metaplasia

squamous –> glandular

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31
Q

RFs for GORD

A 
pregnancy 
obesity 
smoking
alcohol
fatty foods
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32
Q

pres of GORD?

A 
Heartburn - related to meals, posture
Water brash - excess salivation 
Acid brash - retrostern discomfort, regurg
Odynophagia 
Belching
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33
Q

Ix in GORD

A

Gold standard = endoscopy
FBC
Barium swallow

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34
Q

Red flag sx in dyspepsia

A 
ALARMS
Anaemia
Lost weight 
Anorexia 
Recent onset (in >55yo)
Malaena
Swallowing difficulty
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35
Q

Drugs affecting oesophageal motility?

A

nitrates
anticholinergics
TCA

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36
Q

Drugs that damage gastric mucosa?

A

NSAID

bisphosphonates

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37
Q

Mx of oesophagitis?

A

PPI 2m

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38
Q

Surgical mx of GORD

A

Laparoscopic fundoplication

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39
Q

Pres of hiatus hernia

A

GORD

due to incompetent LOS

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40
Q

ix for hiatus hernia

A

CXR
barium study
endoscopy

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41
Q

mx of hiatus hernia

A

lifestyle
PPI
surgery (gastropexy)

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42
Q

ix for Barrett’s?

A

endoscopy

biopsy

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43
Q

mx of barretts?
Low grade?
High grade?

A

Low -lifestyle, PPI +/- ablation

High - oesophagectomy

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44
Q

Type of ca in oesophagus?

A

SCC (upper 2/3)

Adenocarinoma (lower 1/3)

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45
Q

Pres of oesophageal Ca?

A 
Dysphagia (solids>liquids)
Vomiting
Anorexia
Wt loss
Hiccups + retrosternal pain
hoarseness + cough
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46
Q

ix in oesophageal Ca?

A

FBC, U+E, LFT, CRP
Endoscopy + biopsy
CT/MRI
Barium swallow

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47
Q

DDx of dysphagia?

A

Oesophageal [GORD, oesophagitis, oesophageal Ca]

Neuro [CVA, achalasia, MS, MND]

Other [pharyngeal pouch, compression, scleroderma]

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48
Q

Achalasia?

A

Disorder of motility of LOS

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49
Q

Ix in achalasia? What would you see?

A

CXR - dilated oesophagus behind heart
Barium swallow - bird’s beak
Manometry

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50
Q

Mx of achalasia?

A

CCB/nitrates

+/- surgery

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51
Q

GI features of scleroderma?

A

reflux oesophagitis, delayed gastric emptying, watermelon stomach

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52
Q

Autoantibodies in scleroderma?

A

anti-topoisomerase 1
anti-centromere
anti-RNA polymerase 3

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53
Q

Mx of scleroderma GI?

A

lifestyle
PPI
Pro-motility [metoclopramide, domperidone]
Dilatation of oesophageal strictures

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54
Q

DDx of upper GI bleed?

A

PUD, mallory weiss, malignancy, varices

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55
Q

Haematemesis?

Red vs coffee ground?

A

Red = fresh, above stomach, active haemorrhage

Coffee ground = stomach/below

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56
Q

Cause of mallory weiss?

A

persistent vomiting/wretching

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57
Q

ix of mallory weiss?

A

endoscopy, FBC, U+Es

58
Q

comps of mallory weiss?

A

aspiration pneumonia
mediastinitis
hypovolaemic shock

59
Q

oesophageal varices?

A

dilated veins at junction between portal and systemic circulation

60
Q

cause of varices?

A

chronic liver disease –> portal HTN

61
Q

ix in varices?

A

endoscopy, FBC (Hb + haematocrit), clotting, U+Es, LFTs

62
Q

ix in upper GI bleed?

A

Endoscopy (within 24h - post resus)
FBC, coag, LFTs, U+Es
crossmatch
CXR

63
Q

Mx of upper GI bleed?

A

fluid resus + high flow O2
2 wide bore cannula + send bloods
(FBC/UE/LFT/crossmatch/coag)
Transfuse with blood/platelets according to major haemorrhae protocol

64
Q

Mx of UGI bleed?

A

Mechanical clips
Thermal coagulation with adrenaline
FIbrin/thrombin with adrenaline

65
Q

Mx of oesophogeal variceal bleed?

A

Band ligation

Endoscopic injection of N-butyl-2-cyanoacrylate

66
Q

Pres of bowel obstruction

A

N+V
pain
failure to pass bowel movements
distension

67
Q

Bowel sounds in obstruction?

A

High pitched

68
Q

Silent bowel sounds?

69
Q

ix in obstruction?

A

FBC, U+Es, group, crossmatch
fluid charts
AXR - supine + erect

70
Q

AXR in obstruction?

A

Distended loops of bowel proximal to obstruction

71
Q

AXR in paralytic ileus?

A

fluid levels + distended small bowel throughout

72
Q

AXR in perforation?

A

gas under the diaphragm

73
Q

mx of uncomplicated obstruction?

A

fluid resus
correct electrolytes
intestinal decompression (NG tube)

74
Q

If no diagnosis in obstruction, what do you do?

A

laparotomy

consent for stoma

75
Q

Cause of sigmoid volvulus?

A

chronic constipation

76
Q

complication of sigmoid volvulus?

A

venous infarction –> perforation, faecal peritonits

77
Q

AXR of sigmoid volvulus?

What other ix do you do?

A

Coffee bean sign

CT - assess bowel wall ischaemia

78
Q

Mx of sigmoid volvulus?

A

Urgent admission + decompression (sigmoidoscope + flatus tube)

If recurrent - resect sigmoid colon

79
Q

Paralytic ileus?

who does it occur in?

A

no peristalsis

elderly with lots of co-morbs

80
Q

mx of paralytic ileus?

A

resus, bowel decompression (NG tube)

81
Q

Pres of pseudo obstruction?

A

absence of mechanical obstruction

abdo pain, bloating, N+V, obstipation, massive distension

82
Q

AXR of pseudo-obsruction?

83
Q

Mx of pseudo-obstruction?

A 
treat cause
IV fluids
Endoscopic decompression (NG tube)
Metoclopramide (prokinetic + antiemetic)
IV neostigmine
84
Q

Hirschprungs?

A

Abscence of PSNS ganglion cells in myenteric + submucosal plexus of rectum

85
Q

Pres of Hirschprungs?

A

failure to pass meconium within 48h

abdo distension

86
Q

ix in hirschprungs?

A

Rectal biopsy
AXR - dilated lower bowel
anal manometry in older children

87
Q

pres of intra abdo abscess?

A

fever + pain
swinging pyrexia
palpable mass

88
Q

pres of peritonitis?

A 
pain 
anorexia
N+V
high fever
tachycardia
rebound tenderness
guarding
89
Q

ix in peritonitis?

A

FBC, U+E, LFT, amylase, lipase, blood cultures
peritoneal fluid [culture+amylase]
AXR, CXR (air under the diaphragm)

90
Q

mx of abdo abscess?

A

metronidazole + 3rd gen ceph + surgical drainage

91
Q

mx of peritonitis?

A

IV fluids
IV abx [metronidazole + cefotaxime]
surgery

92
Q

what is Rovsings sign

A

palpation of LLQ increases pain in RLQ –> appendicitis

93
Q

ddx appendicitis

A 
GI obstruction 
constipation 
perforation
diverticulitis
crohs
testicular torsion
ectopic
DKA
94
Q

ix in appendicitis

A

UTI, pregnancy test, FBC, CRP, USS

95
Q

mx appendicitis

A

appendicectomy
IV fluids
analgesia
IV metronidazole + cefotaxime

96
Q

what is deverticulum?

A

herniation of mucosa through think colonic muscle

97
Q

mx of diverticulitis

A

coamoxiclav

+/- surgery

98
Q

mx ischaemic bowel

A

Resus - O2, IV fluids

Papaverine relieves spasm
Heparin if thrombosis
surgery

99
Q

pres of chronic mesenteric ischaemia?

A

AKA intestinal angina

wt loss, postprandial pain, fear of eating

100
Q

RFs for chronic mesenteric ischaemia

A

smoking, HTN, DM, hyperlipidaemia

101
Q

ix for chronic mesenteric ischaemia

A

angiography

FBC, LFT, U+Es

102
Q

mx of chronic mesenteric ischaemia

A

nitrates
anticoag
bypass surgery

103
Q

causes of malabsorption

A

coeliac
Crohns
CF

104
Q

ix of malabsorption

A 
FBC, LFT, ESR, CRP
iron studies
folate
b12
clotting
auto-antibodies (tTG)
faecal elactase
ileocolonoscopy + biopsy
105
Q

genetics in coeliac

106
Q

histology coeliac

A

villous atrophy

crypt hyperplasia

107
Q

pres of coeliac

A 
IBS 
chronic fatigue
diarrhoea
wt loss
anaemia
108
Q

skin features of coeliac

A

dermatitis herpetiformis

109
Q

antibodies in coeliac

A

tTG IgA

EMA IgA

110
Q

mx of coeliac

A

lifelong gluten free diet

Ca/vit D supplements
Annual r/v

111
Q

similar disease to coeliac? whats the difference on biopsy?

A

tropical sprue (incomplete villous atrophy)

112
Q

mx of tropical sprue

A

fluid replacement

tetracycline 6-12m

113
Q

Node indicates gastric ca

A

virchow’s node

114
Q

ix in gastric cancer?

A

FBC, LFT, flexible endoscopy/gastroscopy + biopsy

CT abdo for mets

115
Q

mx of gastro Ca

A

surgery
chemo
nutrional support

116
Q

MALT lymphoma?

A

mucos-assosciate lymphoid tissue

Subtype of NHL

117
Q

assosciations with MALT tumours?

A

H.pylori

C.jejuni

118
Q

mx of MALT

A

eradicate H. pylori –> can cause remission in early disease

119
Q

mx of advanced MALT?

A

eradicate H pylori
rituximab
chemo
surgery

120
Q

ix in carcinoid tumour?

A

plasma chromogranin A
24h urinary 5-HIAA
endoscopy
CT/MRI

121
Q

medical mx of carcinoid tumour

A

octreotide

radio/chemo

122
Q

genetic causes of colorectal ca

123
Q

ix in colorectal ca

A

PR + colonoscopy + biopsy

FBC, LFT, CEA, FOB, CT

124
Q

screening for colorectal ca

A

60-75

2 yearly FOB; if +ve then colonoscopy

125
Q

Dx of IBS

A

6m history of ABC (abdo pain, bloating, changed habit)

relieved by defecation

126
Q

Ix of IBS

A

r/o DDx

FBC, ESR, CRP
coeliac screen 
Ca-125
faecal calprotectin 
FOB
127
Q

mx of IBS

A

lifestyle, diet, destress

diarrhoea - loperamide
bloating - peppermint oil
constipation - ispaghula
abdo pain - buscopan

128
Q

UC vs Crohns?

A

UC [continuous disease, ulcers, polyps, confined to mucosa and submucosa]

Crohns [rectal sparing, skip lesions, mucus cobblestone, transmural granulomatous inflam]

129
Q

Non- GI manifestations of Crohns?

A 
erythema nodosum
pyoderma gangrenosum 
arthritis
iritis 
conjunctivitis
130
Q

pres of Crohns?

A

Diarrhoea (>6w) +/- blood
abdo pain
wt loss

131
Q

ix in Crohns

A

FBC, U+Es, LFT, ESR/CRP
faecal calprotectin
stool MC+S
ileocolonoscopy + biopsy

132
Q

mx of Crohns?

A

induce remission –> oral pred
maintain remission –> azathioprine
smoking cessation

133
Q

UC ix?

A 
FBC, U+Es, LFT, ESR/CRP
faecal calprotectin
stool MC+S
sigmoidoscopy + biopsy
p-ANCA
134
Q

mx of UC?

A

induce remission –> mesalazine +/- pred

maintain remission –> oral mesalazine

135
Q

mx of severe exacerbation of UC?

A

admit + IV hydrocortisone + IV fluids

+/- IV ciclosporin

136
Q

types of laxative?

A

bulk forming - ispaghula
softener - arachis oil
stimulant - senna, docusate
osmotic - lactulose

137
Q

Which toxin –> HUS

138
Q

Xray signs of small bowel obstrucion

A

central
multiple bowel loops
ladders

139
Q

xray signs of large bowel obstruction

A

1 big loop
peripheral
haustrations

140
Q

Boars sign?

A

pain under R scapula in cholectystitis

141
Q

ix in acute pancreatitis?

A

serum lipase

142
Q

ix in chronic pancreatitis?

A

urine amylase

Finals (20 decks)

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