GI

Question 1

dysphagia - key questions for hx

Answer 1

how long being going on
solids or liquids
pain
weight loss
pmhx eg immunocompromised, systemic sclerolsis (affects motility of esophagus)
meds - anticholingergics (can affect motility)
smoking/ alcohol - malignancy risk

Question 2

haemoglobin level for blood transfusion for gi bleed

Answer 2

below 70

Question 3

haemoglobin level for blood transfusion for gi bleed

Answer 3

below 70 - but not always

Question 4

drugs used to prevent future gi bleeding

Answer 4

ppi, h pylori abx, varicies prevention - bb, second look endoscopy - gastric ulcers

Question 5

drugs used to prevent future gi bleeding

post endoscopy care

Answer 5

ppi, h pylori abx, varicies prevention - bb, second look endoscopy - gastric ulcers

Question 6

definition of diarrhoea

Answer 6

3 or more loose stools a day

Question 7

what is gluten

Answer 7

protein found in wheat

Question 8

first line antibodies for coaeliacs

Answer 8

ttg and antibodies (bc of iga deficiency)

Question 9

Metabolic ketoacidosis with normal or low glucose

Answer 9

Alcohol ketoacidosis

Question 10

What is rosvings sign

Answer 10

when you press on left iliac fossa and elicit right iliac fossa pain
Positive means appendicitis

Question 11

What is a hartmanns procedure

Answer 11

An emergency Hartmann’s procedure involves resection of their rectosigmoid colon. An end colostomy is formed and rectal stump sewn. It is indicated by perforation of the rectosigmoid bowel, and subsequent peritonitis. Causes of perforation include colon cancer, diverticulitis, and trauma. Colostomies are brought out on the left side of the abdomen, and sewn flush with the skin.

Question 12

What advice should you give a pt who is having an upper GI endoscopy who is on a PPI

Answer 12

If a patient is taking a proton pump inhibitor or H2 receptor blocker then it should be stopped at least 2 weeks prior to the endoscopy as it could mask serious underlying pathology such as gastric cancer

Question 13

What is the 2 ww criteria for upper gi scope

Answer 13

dysphagia
upper abdominal mass consistent with stomach cancer

Patients aged >= 55 years who’ve got weight loss, AND any of the following:
upper abdominal pain
reflux
dyspepsia

Question 14

signs of liver disease

Answer 14

Spider naevi
Clubbing
Jaundice
Loss of secondary sexual hair
Gynaecomastia
Ascites
Splenomegaly
Peripheral oedema

Question 15

what’s in the child pugh score

Answer 15

Bilirubin 
INR 
Albumin 
Ascites 
Hepatic encephalopathy

Question 16

which antibiotic is associated with Hepatitis and cholestatic jaundice

Answer 16

flucloxacillin

Question 17

what blood picture do statins cause to LFTs

Answer 17

Hepatic picture (raised AST/ ALT)
Not cholestatic (raised ALP, normal AST/ ALT)
Statins most commonly cause a mild transaminitis (a raise in ALT or AST). Elevations in these enzymes occur in approximately 2% of individuals taking statins. Despite this, you can safely prescribe statins in patients with mild liver dysfunction (e.g non-alcoholic fatty liver disease patients) as long as you monitor the LFTs.

Question 18

How do nsaids affect the liver

Answer 18

Most commonly cholestatic picture
NSAIDs can cause a spectrum of liver disease ranging from dose-dependent hepatotoxicity to cholestatic hepatitis. Ibuprofen classically causes a cholestatic hepatitis.

Question 19

how does co-amoxiclav affect liver

Answer 19

Cholestatic picture
Co-amoxiclav can cause cholestatic hepatitis. The onset is 1-6 weeks after completing a course and is more likely to occur with treatment courses exceeding 14 days. Nausea and jaundice are the main symptoms. The illness is usually mild but can be more severe in the elderly.

Question 20

how much paracetamol is considered an overdose

Answer 20

> 150mg/kg/24 hrs

Question 21

what is the effects of a cp450 inhibitor vs inducer

Answer 21

inhibitor - increases plasma drug concentrations - need to lower dose
inducer - decreases plasma drug concentrations - therapeutic effect of drug is lost

Question 22

list some common cp450 inhibitors

Answer 22

macrolides - eg clarythromycin, erythromycin
amioderone
fluoxetine
cipro

Question 23

list some common cp450 inducers

Answer 23

carbamazepine
rifampicin
alcohol
st johns wort

Question 24

list some adverse consequences in liver disease, and that you should consider when prescribing for patients with liver disease

Answer 24

Encephalopathy (sedatives, antipsychotics, opioids)
Ascites (NSAIDs, sodium)
Varicies (NSAIDs, antiplatelets)
Bleeds/ coagulopathies (anticoagulants etc)