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Fourth Year > GI > Flashcards

GI Flashcards

1
Q

Altered bowel habit- Differentials?

A

Acute gastroenteritis

Constipation

Diverticular disease

Colonic malignancy

IBD

Maldigestion/ malabsoprtion

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2
Q

causes of constipation?

A

drugs- opiates/ analgesics

functional- IBD

mechanical obstruction- e.g. strictures

hypothyroidism

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3
Q

neurological cause of chronic constipation?

A

parkinsons

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4
Q

investigations for constipation?

A

Bloods- TFT and calcium

plain abdo X-ray

sigmoidoscopy- exclude mechanical cause

colonic transit study

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5
Q

what is Hirschprungs disease?

A

neural disease that prevents peristalsis of the colon

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6
Q

who is affected by Hirschprungs?

A

teenagers/ children

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7
Q

management of hirshprungs?

A

high fibre diet

increased fluid intake

laxatives

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8
Q

most common caustive agent of travellers diarhoea?

A

E.coli

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9
Q

chronic hepatitis is hepatitis lasting how long?

A

> 6months

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10
Q

characterisitics of hepatitis?

A

increased IgG levels

Antibodies against liver proteins

Mononuclear infiltrate within the liver

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11
Q

histological characteristics of autoimmune hepatitis?

A

AIH 1- anti-smooth muscle antibodies (ASMAs)

AIH 2- liver kidney microsomal type 1 antibodies (LKM-1)

AIH 3- actin antibody, antinuclear antibodies

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12
Q

Auto immune hepatitis is common in which groups?

A

M:F ratio 1:3

ages 10-20, and 45-70

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13
Q

how do patients with AIH present?

A

50% with acute viral hepatits

non-specific: wgt loss, fatigue, abdo pain

liver specific: easy brusing, jaundice, hepatomegaly

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14
Q

long term complication of oesophageal reflux?

A

barretts oesophagus

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15
Q

which cells are present in Barretts oesophagus?

A

columnar epithelium

defined as >3cm of ce present at bottom of oesophagus

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16
Q

bilirubin is produced from which molecule?

A

haem (frm haemoglobin)

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17
Q

which cells make up the reticuloendothelial system that produce bilirubin?

A

macrophages in spleen

kupfer cells in liver

macrophages

renal tubular cells

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18
Q

normal bilirubin levels

A

1-20 umol/l

jaundice usually detectable when reaches 50 umol/l

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19
Q

causes of haemolytic jaundce (pre-hepatic)?

A

sickle cell anaemia

thallasemia

20
Q

what happens in hepatocellular jaundice (hepatic)?

A

liver is unable to excrete and/or conjugate bilirubin due to liver tissue damage

21
Q

what happens to the levels of conjugated and unconjugated bilirubin in hepatic jaundice?

A

both conjugated and unconjugated increase

22
Q

causes of hepatic jaundice?

A

cirrhosis

hepatitis

drug induced i.e. paracetamol

23
Q

what causes cholestatic juandice (post hepatic)?

A

obstruction in the bile duct

liver can conjuagte bilirbuin but cannot excrete it

24
Q

what happens to levels of conjugated an dunconjugated bilirubin in post hepatic jaundice?

A

increase in conjugated biirubin

causes very dark urine and pale stools

25
Q

causes of post hepatic jaundice?

A

primary biliary cirrhosis

primary sclerosing chlangitis

alcohol/ drugs

hepatitis

…

26
Q

how would you diagnose post hepatic juandice?

A

ultrasound to detect obstruction in biliary tree- will usually just see dilated biliary tree

then ERCP to get better image and hopefully treat

27
Q

if no obstruction is detected on ultrasound for post heptic jaunduce what should you check for?

A

test for Hep A, B and C

check copper levels if <40 yrs- WIlsons disease

28
Q

mutations in the genes coding for UDP-glucuronyl transferase results in which condition?

A

familial hyperbiliruninaemia

29
Q

causes of hepatomegaly?

A

malignancy

RHF

Alochol liver disease

fatty liver

amyloidosis

excess iron

hepatitis

30
Q

cuases of splenomegaly?

A

C- cancer

H- haematoligical malignancy

I- infection (CMV, HV, TB)

C- congestion; portal hypertension

A- autoimmune (RA, SLE)

G- glycogen stroge disorders

O- other, amyloidosis, sarcoidosis

31
Q

causes of cholangitis?

A

bacterial infection- causes ascending cholangitis

primary sclerosing cholangitis

carolis syndrome

32
Q

presentation of acute ascending cholangitis?

A

rigors, fever, abdo pain

jaundice

33
Q

how do you manage acute ascending cholangitis?

A

IV antibiotics

Urgent biliary drainage- endoscopically

34
Q

what causes acute cholecystitis?

A

blockage in cystic duct or neck of gallbladder

very likely to be gallstones

35
Q

symtpoms of cholecystitis?

A

prolonged fever

inc in WCC

Murphys sign- pain in RUQ

pain can radiate to shoulder tip

36
Q

how would you investigate cholecystitis?

A

FBC- inc in ESR, CRP and WCC

serum amylase- raised in acute pancreatitis (complication)

serum bilirubin

ALP

USS to detect stones

37
Q

how do you manage cholecystitis?

A

nil by mouth

antibiotics- cefuroxime +/-metronidazole

analgesic- diclofenac

IV fluids

consider surgery: cholescytectomy

38
Q

complications of cholecystitis?

A

bacterial infection → subsequent empyema

perforation

39
Q

investigations in chronic cholecystitis?

A

MRCP- MRI imaging to look for stones

US

40
Q

how is chronic cholecystitis treated?

A

ERCP- performed to remove stones from common bile duct

cholecystectomy

41
Q

which vitamins are stored in the liver?

A

Vitamins A, D, E, K

42
Q

antibiotics most implicated with causing C. diff?

A

clindamhycin

penicillins i.e. amoxicillin, ampicillin

3rd gen cephalosporins

43
Q

how is suspected C. diff investigated?

A

stool sample for enterotoxins produced by C. diff

44
Q

symtpoms of C. diff infection?

A

diarrhoea +/- blood

abdo pain

N&V is rare

45
Q

how is C. diff treated?

A

metronidazole 400mg for 8-10 days

should inform GP so can be prescribed alongside antibiotics in the future

46
Q
A
47
Q
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Fourth Year (11 decks)

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