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Gastrointestinal and Gen Surgery > GI > Flashcards

GI Flashcards

1
Q

What is peptic ulcer disease?

A

A break/ulceration in the mucosa of the stomach (gastric ulcer) or duodenum (duodenal ulcer) which are most common

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2
Q

What are the most common causes of peptic ulcer?

A

H. pylori infection - damages mucosal cells

Long term use of NSAIDS - makes gastric mucosa more susceptible to damage

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3
Q

What is the presentation of peptic ulcers?

A
  • Epigastric pain
  • Dyspepsia (indigestion)
  • Haematemesis “coffee ground”
  • Pain worsens when eating (Gastric ulcer)
  • Pain before eating/relieved by eating (duodenal ulcer)
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4
Q

What can cause increased stomach acid secretion?

A

Alcohol, smoking, caffeine, spicy foods

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5
Q

How to diagnose peptic ulcers?

A
  • Endoscopy and biopsy for visualisation of ulcer and exclude malignancy
  • Urea breath test or stool antigen test for H. pylori
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6
Q

What is the Mx for peptic ulcers?

A
  • Avoid trigger foods, limit caffeine and alcohol
  • PPI to decrease stomach acid secretion e.g. lansoprazole
  • Abx e.g. Clarithromycin (if allergic to penicillin offer metronidazole)
  • Stop medications e.g. NSAID
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7
Q

What is bowel ischaemia?

A

Occurs when blood supply (mesenteric arteries) to the bowel is interrupted due to emboli

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8
Q

RF for bowel ischaemia?

A

Heart disease, AF, Valvular disease. elderly

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9
Q

Symptoms of bowel ischaemia?

A

Acute onset severe abdominal pain (generalised)

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10
Q

What are the common causes of small bowel obstruction?

A

Adhesions (Scar tissue from previous surgery causing kinks in bowel), second most common are hernias

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11
Q

What is the most common cause of large bowel obstruction?

A

Colorectal malignancies

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12
Q

What are volvulus and different types?

A 
Twisting of bowel around itself and mesentery.
Sigmoid volvulus (coffee bean shaped)
Caecal volvulus (fetal lie)
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13
Q

What are the symptoms of bowel obstruction?

A

Increasing abdominal distention. diffuse pain, worsening abdominal pain

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14
Q

What is the Mx of bowel obstruction?

A
  • NBM
  • IV fluids

-Surgical resection (cutting out part of tissue)

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15
Q

What is constipation and faecal impaction?

A

Constipation is a variety of symptoms e.g. difficulty passing stools, incomplete emptying

Faecal impaction is retaining of faeces in body

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16
Q

What are the symptoms of constipation?

A
  • sensation of incomplete defecation
  • <3 bowel movements weekly
  • difficult passing stools
  • Faecal impaction: Hx of hard stools
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17
Q

What are the red flags symptoms?

A

-Weight loss
-Anaemia
-Mealena (digested blood on defecation)
refer urgently 2ww suspicious of colorectal malignancy

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18
Q

What is the Mx of constipation and faecal impaction?

A
  • Increase dietary fibre intake
  • Fluid intake
  • Stop medications e.g. NSAIDS
  • Bulk forming laxative e.g. isphagula husk for constipation
  • Osmotic laxative e.g. bisacodyl for faecal impaction
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19
Q

What is ulcerative colitis?

A

Long lasting inflammation and ulcers in inner lining of colon and rectum

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20
Q

CLOSEUP acronym?

A

UC (CLOSE U-ulcerative)

  • Continuous inflammation
  • Limited to colon and rectum
  • Only superficial mucosa
  • Smoking is protective factor
  • Excrete blood and mucus
  • Use of amino salicylates
  • Primary sclerosing cholangitis
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21
Q

NESTS acronym?

A

Crohns

  • No blood/mucus
  • Entire GI tract affected
  • Skip lesions on endoscopy
  • Terminal ileum most effected of small bowel
  • Smoking is RF
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22
Q

RF for IBD?

A

<30 years, FHx

Smokers RF for Crohns but protective factor for UC

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23
Q

Symptoms specific to UC and CD?

A

Non specific - diarrhoea, abdo pain, weight loss,

UC- blood and mucus in stools

CD-acute exacerbations (feeling better then worse), erythema nodosum

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24
Q

Investigations for IBD?

A
  • Faecal calprotectin - screening test specific to IBD
  • Endoscopy and biopsy for diagnosis
  • Abdo xray: lead piping, and toxic megacolon suggest chronic UC, thumbprinting suggest IBD
  • CRP for inflammation
  • Imagin will show cobblestone appearance and complications of Crohns
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25
Q

Mx of Crohns?

A

1st line

-Steroids e.g, oral prednisolone

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26
Q

Complications of Crohns?

A
  • Anal fissures
  • Fistulas (abnormal passageway between organs)
  • Bowel obstruction
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27
Q

Mx of UC?

A

1st line

-Use of aminosalicylates e.g. mesalazine

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28
Q

What is achalasia?

A

Achalasia is a motility disorder of oesaphagus

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29
Q

Px of achalasia?

A
  1. The oesophageal sphincter will not relax properly, and so food cannot pass into the stomach
  2. The peristaltic contractions of the oesophagus do not propagate properly, and so the oesophagus will gradually become more and more dilated.
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30
Q

Investigations for achalasia?

A

Barium swallow will show birds beak appearance.

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31
Q

Mx of achalasia?

A

Removal of oesophageal sphincter

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32
Q

What is acute pancreatitis?

A

Inflammation of pancreas, pancreatic enzymes attack pancreatic tissue (amylase and lactase)

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33
Q

Main symptoms and signs of pancreatitis?

A

Epigastric pain radiate to back
Cullen’s - bluish discolouration on umbilicus
Grey turner’s - bluish discolouration around flank

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34
Q

Diagnosis of pancreatitis?

A

-Amylase is raised (3x increase)

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35
Q

Causes of pancreatitis?

A

IGETSMASHED!

IDIOPATHIC
GALLSTONES
ETHANOL
TRAUMA
STEROIDS
MUMPS
AUTOIMMUNE
SCORPION BITE
HYPERLIPIDEMIA 
ERCP (procedure)
DIURETICS e.g. thiazide
36
Q

How to assess severity of pancreatitis?

A 
PANCREAS Mneumonic for Glascow score (1 point for each answer)
P – Pa02 < 60
A – Age > 55
N – Neutrophils (WBC > 15)
C – Calcium < 2
R – uRea >16
E – Enzymes (LDH > 600 or AST/ALT >200)
A – Albumin < 32
S – Sugar (Glucose >10)

Score of 3 or more - severe pancreatitis and refer to ICU

37
Q

What is Murphy’s sign?

A

Placing the hand on RUQ causes the patient to gasp during inspiration. This is usually seen in cholecystitis.

38
Q

What is Rovsing’s sign?

A

Palpation of LIF causes pain in RIF.

39
Q

What is Mallory weiss tear?

A

Tear in the mucosa layer at the gastro-oesophageal junction, characteristically will present with haematemesis bright red blood.

40
Q

Hepatitis B vaccination offers protection against infection with Hepatitis B and which other virus?

A

Hepatitis D, vaccination against Hepatitis B additionally provides immunity to the Hepatitis D virus, due to the fact that the hepatitis D virus requires the presence of the hepatitis B virus

Hep B-direct contact with blood, bodily fluids, transmission can occur during pregnancy, can develop into chronic Hepatitis

Hep D - only contracted if you have Hep B.

Vaccine

41
Q

How is Hep A contracted?

A

Hep A found in contaminated food and water, oral-faecal transmission

42
Q

What can cause referred pain to shoulders?

A

Gallstones, ruptured ovarian cyst, MI

43
Q

What does raised ALT indicate?

A

ALT is found in high concentrations within hepatocytes and enters the blood following hepatocellular injury. It is, therefore useful marker of hepatocellular injury.

44
Q

What does raised ALP indicate?

A

ALP is particularly concentrated in the liver, bile duct and bone tissues. ALP is often raised in liver pathology. It is a useful indirect marker of cholestasis/cholangitis.

45
Q

What are the causes of decreased albumin?

A

Liver cirrhosis, nephrotic syndrome causes excessive loss of albumin.

46
Q

Causes of acute hepatocellular injury?

A

Poisoning (paracetamol overdose), Hep A or B

47
Q

Causes of chronic hepatocellular injury?

A

Alcoholic fatty liver disease, non-alcoholic fatty liver disease, chronic hepatitis Hep B, cirrhosis

48
Q

Cause of increased PT time?

A

Liver disease and dysfunction

49
Q

What are the common causes of cirrhosis?

A

Alcoholic liver disease (most common), Hep B or Hep C

50
Q

What is cirrhosis?

A

End stage liver disease, chronic inflammation and hepatocellular damage that is irreversible

51
Q

What are the symptoms and signs found in cirrhosis?

A

Jaundice, spider naevi, palmar erythema, ascites, gynecomastia (males) and erratic menstruation (female)

52
Q

What are the LFT’s for cirrhosis and other investigations needed?

A 
LFT's 
Bili raised
ALT raised
ALP raised
Albumin decreased
PT raised

Liver biopsy - abnormal liver nodules and abnormal hepatocytes

USS of liver: abnormal nodules and screen for HCC

53
Q

Complications of cirrhosis?

A
  • HCC - hepatocellular carcinoma
  • Portal hypertension
  • Oesophageal varices cause upper GI bleed and haematemesis
  • Hepatic encephalopathy can cause confusion
54
Q

What is the Mx for varices?

A

Vasopressin to vasoconstrict blood vessel e.g. Terlipressin

55
Q

Causes of Upper GI bleed?

A

Peptic ulcer disease, Oesophageal varices, Mallory-weiss tear, malignancy of stomach or duodenum

56
Q

Causes of Lower GI bleed?

A

Diverticular disease, IBD, Infectious diarrhoea, anal fissure, haemorrhoids

57
Q

Causes of isolated increased bilirubin?

A

Haemolytic anaemia, Gilbert’s syndrome (mild liver disorder where liver cannot process bilirubin properly)

58
Q

What is Charcot’s triad and associated with?

A

Jaundice, fever and RUQ pain linked with cholangitis inflammation of bile duct system.

59
Q

Cholangitis vs cholecystitis symptoms?

A

Cholecystitis - Murphys sign, lasting several hours, right shoulder tip pain

Cholangitis - jaundice,

60
Q

First line remission Mx for Crohns?

A

1st line on remission

-Immunosuppressant drug e.g. azathioprine can cause thrombocytopenia

61
Q

What is the tumour marker for hepatic cellular carcinoma?

A

alpha-fetoprotein

62
Q

What is tumour marker Ca19-9 associated with?

A

Pancreatic cancer

63
Q

What is primary sclerosing cholangitis (PSC)?

A

Intrahepatic or extrahepatic ducts become strictured and fibrotic.

64
Q

What is primary sclerosing cholangitis associated with?

A

UC

65
Q

Who is typically affected by primary sclerosing cholangitis?

A

Middle aged man with UC

66
Q

Presentation of cholangitis?

A

Jaundice, RUQ pain, pruritus, cirrhosis

67
Q

What are the investigations associated with PSC?

A
  • ALP raised (cholestatic picture, so ALP raised early on)

- MRCP will show bile duct lesions or strictures

68
Q

What is the Mx of PSC?

A

Liver transplant

69
Q

What is primary biliary cirrhosis PBC?

A

Immune system attacks small bile ducts within liver, in particular intralobar ducts (canals of hering).

70
Q

Who is affected by PBC?

A

Middle aged women with autoimmune diseases or rheumatoid conditions.

71
Q

What are raised Anti-mitochondrial antibodies and Anti-nuclear antibodies associated with?

A

Primary biliary cirrhosis (autoimmune condition)

72
Q

Stages of liver disease

A

healthy liver- fatty liver - fibrosis of liver- cirrhosis-hepatocellular carcinoma (HCC)

73
Q

Presentation of gallstones (cholelithiasis)?

A

RUQ pain, after fatty meal.

74
Q

What is the function of spleen?

A
  • Fights invading germs in the blood (the spleen contains white blood cells)
  • controls the level of blood cells (white blood cells, red blood cells and platelets)
  • filters the blood and removes any old or damaged red blood cells
75
Q

What investigations are positive for autoimmune hepatitis?

A
  • Raised IgG levels
  • Liver biopsy showing inflammation
  • ANA Antinuclear antibody +ve
  • SMA Anti-smooth muscle antibody +ve
76
Q

What is used to check adequate response to Hepatitis B immunisation?

A

Anti-HBs is checked 4 months later.

77
Q

What is the first line medication for Primary Biliary Cholangitis?

A

Ursodeoxycholic acid slows disease progression.

78
Q

What is refeeding syndrome?

A

Refeeding syndrome describes the metabolic abnormalities which occur on feeding a person straight after starvation causes: hypophosphataemia, hypokalaemia and hypomagnesaemia. Usually affects those anorexic.

79
Q

What are the RF for developing clostridium difficile infections (name 5)?

A
  • Use of PPI
  • Treated with broad spectrum antibiotics
  • stayed in hospital, healthcare setting
80
Q

What are the clinical features of c. dificile infections?

A

Watery diarrhoea

Painful abdo cramps

Dehydration

81
Q

Mx for c. difficile infections?

A

Mild - PO metronidazole

Moderate/severe - PO vancomycin

82
Q

What is charcots triad?

A

Charcots triad is upper abdo pain, fever, jaundice that is due to biliary obstruction, called cholangitis (inflammation of bile duct system).

83
Q

Treatment for hepatic encephalopathy

A

Oral lactulose - reduces production of ammonia by bacteria

84
Q

What can cause dyspepsia (name 6)

A

Aspirin, alcohol, caffeine, NSAIDS, steroids, steroids, macrolides e.g. clarithromycin

85
Q

What Abx given to shigella/salmonella causing gastroenteritis?

A

Ciprofloxacin

86
Q

What is the common complication of liver failure?

A

Infection - result from decreased phagocyte action, reduced complement levels and multiple medical interventions which are often invasive. Patients often present atypically, with no fever or raised white cell count.

Cerebral oedema + raised intracranial hypertension

Bleeding

Hypoglycaemia

87
Q

What is INR and an increase will indicate what?

A

A normal INR is 1.0. Each increase of 0.1 means the blood is slightly thinner (it takes longer to clot). INR is related to the prothrombin time (PT). If there is serious liver disease and cirrhosis, the liver may not produce the proper amount of proteins and then the blood is not able to clot as it should.

Gastrointestinal and Gen Surgery (1 decks)

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