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med > GI > Flashcards

GI Flashcards

1
Q

What are the contents of the spermatic cord?

A 
Vas deferens
Arteries
Veins
Pampiniform plexus
Genital branch of genito-femoral nerve
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2
Q

What is the mx for inguinal hernias?

A

Should always be repaired surgically due to risk of complications (particularly high if indirect hernia)

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3
Q

RFs for inguinal hernia

A 
Obesity
Constapation
Chronic cough
Heavy lifting 
Male
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4
Q

Comps associated with hernias

A

Incarcerated/irreducible
Strangulation
Obstruction

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5
Q

How would a strangulated femoral hernia px?

A

Red, tender, tense
Irreducible
Colicky abdo pain

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6
Q

What is an incisional hernia?

A

Follow the breakdown of muscle closure post surgery

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7
Q

What are the red flag features of dyspepsia?

A 
Anaemia
Loss of weight
Anorexia
Recent onset or progressive 
Melaena/ haematemesis
Swallowing difficulty
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8
Q

When should you refer for endoscopy a pt presenting with dyspepsia?

A

Dysphagia
OR
>55 with persistent/ALARM features

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9
Q

Aet of dyspepsia

A 
PUD (mainly DUODENAL rather than gastric)
Gastritis
Functional (non-ulcer) dyspepsia
Malignancy
Oesophagitis/GORD
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10
Q

Outline the management steps for a first presentation of dyspepsia in a patient under 55 with no alarm sx or dysphagia

A

1) Stop precipitating drugs, lifestyle changes, OTC antacids
2) No improvement - test for H.pylori
3) If -ve - trial PPI 4 weeks
4) no improvement - long term tx or endoscopy

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11
Q

What drugs are given to tx H.pylori?

A

PPI
Amoxicillin
Clarithromycin

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12
Q

How is H.pylori tested for?

A

Carbon-13 urea breath test

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13
Q

Major RFs for duodenal ulcers

A

H.pylori

Drugs (NSAIDs, steroids, SSRIs)

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14
Q

RFs gastric ulcers

A

H.pylori
NSAIDs
stress

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15
Q

What do chief cells of the stomach secrete?

A

Pepsinogen

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16
Q

What do parietal cells of the stomach secrete?

A

Intrinsic factor and HCl

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17
Q

What is the main comp of GORD?

A

Barrets oesophagus

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18
Q

Why might urea rise in patients with an upper GI bleed?

A

Due to protein meal (not due to renal failure)

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19
Q

Causes of small bowel obstruction?

A

ADHESIONS

HERNIAS (e.g. femoral)

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20
Q

Causes of large bowel obstruction

A

Colon Ca
Constipation
Volvulus
Diverticular stricture

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21
Q

Mx of obstruction

A 
'drip and suck'
analgesia
Blood tests (incl. amylase)
AXR
CXR
CT 
Surgery
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22
Q

What sign on AXR indicates sigmoid volvulus?

A

Coffee bean sign

23
Q

How is sigmoid volvulus managed?

A

Flatus tube or sigmoidoscopy

24
Q

Which part of the intestine does diverticular disease most commonly affect?

A

Sigmoid colon

25
Q

Which Ix is best for confirming diverticulitis?

A

CT

Avoid colonoscopy as risk perforation in acute setting

26
Q

How does diverticular disease and diverticulitis px?

A

Altered bowel habit +- left-sided colic relieved by defecation
diverticulitis = pyrexia, raised WCC, raised CRP, peritonism (sometimes)

27
Q

What is the mx for mild attacks of diverticulitis?

A

Fluids (bowel rest) +- abx

28
Q

How is severe diverticulitis mx?

A

Admit for analgesia, NBM, IV fluids, IV abx

29
Q

Comps of diverticulitis

A

Abscess formation

Perforation

30
Q

Ix in peritonitis

A

CXR
Amylase
USS/CT to confirm dx

31
Q

Mx of a patient with generalized peritonitis

A

IV fluids and abx

Consider need for surgery

32
Q

Mx for anal fissure

A

Lidocaine ointment
GTN ointment
Plenty of fibre, fluids
Laxatives

33
Q

Ix for anal fistula

A

MRI

34
Q

Mx for haemorrhoids

A

Prevent constipation
Topical anaesthetic
Rubber band ligation
Haemorrhoidectomy if large

35
Q

Which part of the bowel does acute mesenteric ischaemia affect?

A

Small bowel

36
Q

What is the classic presentation of acute mesenteric ischaemia/

A

Acute, severe abdo pain
No/minimal abdo signs
Rapid hypovolaemia and shock

37
Q

What will an ABG show in acute mesenteric ischaemia?

A

Metabolic acidosis

Raised Hb due to plasma loss

38
Q

Mx for acute mesenteric ischaemia

A

IV fluids
IV abx
LMWH

Then surgery to remove necrotic bowel

39
Q

How does chronic mesenteric ischaemia px? (rare)

A 
'Intestinal angina'
Severe, colicky post-prandial abdo pain
decreased weight (as not eating)
PR bleeding
N & V
40
Q

How does ischaemic colitis px?

A

Lower left-sided abdo pain +- bloody diarrhoea

41
Q

What is the gold standard test for ischaemic colitis?

A

Lower GI endoscopy

42
Q

Common causes of malabsorption

A

Coeliac
Chronic pancreatitis
Crohns disease

43
Q

Which serotype group is coeliac associated with?

A

HLA DQ2

44
Q

How are histological findings in coeliac disease classified?

A

Marsh criteria

45
Q

What histological type of cancer is gastric cancer?

A

Adenocarcinoma

46
Q

What is Trosiers sign?

A

Palpable Virchows node - sign of gastric cancer

47
Q

Histology of colon cancer

A

Adenocarcinoma

48
Q

How can treatment response be monitored in colon ca?

A

carcinoembryonic antigen (CEA) levels

49
Q

Ix for suspected colon ca

A

PR exam
Colonoscopy (CT if can’t tolerate)
FBC and LFT

50
Q

What are the extra-intestinal manifestations of crohns?

A 
erythema nodosum
pyoderma gangrenosum
arthritis
anterior uveitis
conjunctivitis
51
Q

Which form of IBD is associated with an increased risk due to smoking?

A

Crohns

52
Q

What are the comps of crohns disease?

A 
Small bowel obstruction
Toxic dilatation
Abscess formation
Fistulae
Perforation
Colon Ca
53
Q

How is UC managed?

A

PR aminosalicylates (e.g. mesalazine)

med (25 decks)

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