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Year 4 General Medicine > GI > Flashcards

GI Flashcards

1
Q

what is dysphagia

A

difficulty swallowing

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2
Q

what is odynophagia

A

painful swallowing

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3
Q

what are the broad causes of dysphagia

A

mechanical block
motility
others

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4
Q

what are mechanical causes of dysphagia

A

oesophageal strictures
malignancy - oes/gastric
extrinsic pressure: nodes, lung Ca, goitre, aortic aneurysm, pharyngeal pouch

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5
Q

what are motility causes of dysphagia

A

achalasia
diffuse oesophageal spasm
systemic sclerosis
neurological: MND, MG, PD, syringobulbia

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6
Q

what are other causes of dysphagia

A

oesophagitis - reflux, candidiasis, eosinophilic

globus

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7
Q

5 key questions to ask in dysphagia

A
  1. was there difficulty swallowing both solids and liquids from the start
  2. is it difficult to make the swallowing movement
  3. is swallowing painful
  4. is it intermittent or constant
  5. does the neck bulge or gurgle on drinking
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8
Q

D.Dx of dysphagia with difficulty swallowing both liquids and solids from the start

A

motility disorders e.g. achalasia

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9
Q

D.Dx of dysphagia with difficulty in making swallowing movement

A

neurological e.g. bulbar palsy

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10
Q

D.Dx of dysphagia with odynophagia

A

cancer
stricture
candidiasis
spasm

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11
Q

D.Dx of dysphagia with intermittent vs constant symptoms

A

intermittent - spasm

constant - stricture, cancer

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12
Q

D.Dx of dysphagia with gurgling/bulging

A

pharyngeal pouch

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13
Q

investigations for dysphagia

A 
FBC
U+E 
CXR - mediastinal mass? 
OGD +- biopsy 
barium swallow/fluoroscopy 
oesophageal manometry
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14
Q

symptoms of diffuse oesophageal spasm

A

intermittent dysphagia and chest pain

corkscrew appearance on barium swallow

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15
Q

what is achalasia

A

lower oesophageal sphincter fails to relax
degeneration of myenteric plexus
dysphagia to solids and liquids, regurgitation, weight loss
dilated tapering / ‘bird’s beak appearance’ oesophagus on barium swallow

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16
Q

management of achalasia

A

endoscopic balloon dilatation
Heller’s cardiomyotomy
PPIs
botox injection

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17
Q

causes of oesophageal strictures

A

longstanding GORD
radiotherapy
corrosives

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18
Q

what is globus sensation

A

non painful sensation of a lump/tightness/foreign body in the pharyngeal area

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19
Q

what is globus

A

functional oesophageal disorder characterised by globus sensation without any underlying structural abnormality

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20
Q

dysphagia is a normal part of ageing?

A

no

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21
Q

associated symptoms of dysphagia

A 
heartburn 
weight loss 
haematemesis 
anaemia 
regurgitation of food 
respiratory symptoms
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22
Q

what is GORD

A

gastro-oesophageal reflux disease

incompetent LOS leading to reflux of acidic stomach contents back into the oesophagus

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23
Q

RF for GORD

A 
abdominal obesity 
alcohol 
smoking 
pregnancy 
drugs - tricyclics, anticholinergics
hiatus hernia 
H. pylori (Gm-)
gastric acid hypersecretion 
systemic sclerosis
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24
Q

complications of GORD

A

oesophagitis
strictures
Barrett’s oesophagus
oesophageal (adeno)carcinoma

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25
Q

symptoms of GORD

A 
heartburn - retrosternal discomfort after a meal 
belching 
salivation 
odynophagia 
nocturnal asthma 
chronic cough 
laryngitis - hoarse voice
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26
Q

What is Barrett’s oesophagus

A

metaplasia of stratified squamous epithelium of the oesophagus to glandular columnar epithelium similar to that of the gastric/intestinal mucosa
occurs after longstanding GORD

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27
Q

RF for Barrett’s oesophagus

A 
GORD 
obesity 
smoking 
M>F
alcohol 
FH
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28
Q

which part of the oesophagus does Barrett’s oesophagus affect

A

lower 1/3rd

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29
Q

investigations of GORD

A 
endoscopy 
Ba swallow (hiatus hernia)
oesophageal manometry and pH studies
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30
Q

GORD is more likely to cause adeno / squamous cell carcinoma of the oesophagus

A

adenocarcinoma (glandular)

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31
Q

what are the steps in the pathogenesis of adenocarcinoma of the oesophagus

A

normal
oesophagitis (reversible)
Barrett’s
adenocarcinoma

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32
Q

lifestyle modifications in the management of GORD

A 
smoking cessation 
lose weight 
prop up the bed head 
reduce alcohol 
avoid provoking factors 
small regular meals
avoid eating right before bed
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33
Q

pharmacological symptomatic relief for GORD

A

antacids

have no healing benefit

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34
Q

What medications can be used for GORD that have healing and symptomatic relief

A

PPIs

e.g. omeprazole, lansoprazole, esomeprazole

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35
Q

what surgical procedure is available for GORD

A

Nissen fundoplication

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36
Q

Barrett’s oesophagus is ir/reversible

A

irreversible

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37
Q

management of oesophageal dysplasia

A 
more frequent surveillance 
optimaise PPI dose 
endoscopic mucosal resection (EMR)
radiofrequency ablation 
argon
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38
Q

what is a hiatus hernia

A

the fundus of the stomach slides through a weakness in the diaphragm

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39
Q

what is gastroparesis

A

delayed gastric emptying

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40
Q

symptoms of gastroparesis

A

feeling of fullness
N+V
weight loss
upper abdominal pain

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41
Q

causes of gastroparesis

A 
idiopathic 
DM 
cannabis 
medications - opioids, anticholinergics 
systemic sclerosis
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42
Q

investigation for gastroparesis

A

gastric emptying studies

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43
Q

management of gastroparesis

A 
remove precipitating factors 
liquid diet 
eat small regular meals 
promotility agents 
gastric pacemaker
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44
Q

how can patients with Barrett’s oesophagus be surveilled

A

endoscopy with biopsy

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45
Q

Barrett’s oesophagus is a premalignant condition for oesophageal adenocarcinoma, true or false

A

true

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46
Q

what is dyspepsia

A

epigastric pain/burning
postprandial fullness
early satiety

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47
Q

what are the ALARM Symptoms?

A 
A - anaemia 
L - loss of weight 
A - anorexia 
R - recent onset 
M - malaena/haematemesis 
S - swallowing difficulties
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48
Q

RF for dyspepsia

A

H.pylori infection

NSAID use

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49
Q

broad causes of dyspepsia

A

organic

functional

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50
Q

organic causes of dyspepsia

A

PUD
gastric cancer
drugs - NSAIDs
H. pylori infection

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51
Q

what is functional dyspepsia

A

all the symptoms of dyspepsia with no underlying organic pathology
usually associated with IBS
normal endoscopy and H. pylori -

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52
Q

dyspepsia is burning in the epigastrium and retrosternal pain?

A

NO,
only epigastric burning
NO retrosternal pain

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53
Q

management of dyspepsia

A

in the absence of ALARM Symptoms:
consider lifestyle advice and antacids
H. pylori test and treat

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54
Q

management of dypepsia with ALARM Symptoms or >=55yr

A

refer to hospital specialist

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55
Q

symptoms of PUD

A 
dyspepsia 
epigastric pain radiating to the back 
nocturnal symptoms 
aggravated/relieved by eating 
relapsing and remitting
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56
Q

which is more common duodenal or gastric ulcers

A

duodenal > gastric

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57
Q

duodenal ulcers are aggravated/relieved by eating and gastric ulcers are aggravated/relieved by eating

A

duodenal - relieved by eating

gastric - aggravated by eating

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58
Q

RF/causes of PUD

A

H. pylori
drugs - NSAIDs, steroids, SSRIs
gastric acid hypersecretion
smoking

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59
Q

what is H. pylori

A

Gm - microaerophilic spiral flagellated bacilli

oral-oral / faecal-oral spread

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60
Q

complications of H. pylori infection

A

nothing
PUD
gastric cancer - adenocarcinoma, MALToma

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61
Q

how long should you stop PPIs before OGD

A

2 weeks

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62
Q

investigation for H. pylori

A

13C urea breath test OR
stool antigen test OR
lab serology (not very accurate)

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63
Q

investigation for H. pylori retesting following eradication therapy

A

13C urea breath test

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64
Q

management of H. pylori

A

7 days of BD:

  • PPI +
  • amoxicillin +
  • metronidazole or clarithromycin

(or PPI and M + C is penicillin allerguc)

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65
Q

H. pylori increases the pH of its environment, true or false

A

true

urease causes production of ammonium bicarbonate

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66
Q

complications of PUD

A

anaemia
bleeding
perforation
fibrosis - gastric outlet obstruction

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67
Q

what is haematemesis

A

vomiting of blood from the upper GI tract

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68
Q

what is malaena

A

black tarry stools from upper GI bleeding

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69
Q

Rockall score is pre/post endoscopic

A

pre endoscopic

Blatchford is post endoscopic

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70
Q

RF/common causes of upper GI bleeding

A 
PUD 
oesophageal varices 
Mallory-Weiss tear 
oesophagitis 
gastritis 
duodenitis 
drugs - NSAIDs, steroids, anticoagulants 
malignancy
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71
Q

initial management of upper GI bleeding

A 
ABCDE 
IV access with large bore cannula - IV fluids and bloods 
oxygen 
assess patient for stigmata or bleeding and cirrhosis 
urine output - catheter 
check drugs 
do Rockall/Blatchford score
ECG, CXR 
Major haemorrhage protocol? transfusion 
IV omeprzole ?
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72
Q

what investigation should be done for upper GI bleeding

A

endoscopy

  • identifies cause
  • therapeutic manoeuvres
  • assess risk of re bleeding
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73
Q

definitive management of bleeding peptic ulcers

A 
endoscopic: 
adrenaline injection 
heater probe coagulation 
clips 
haemospray 
IV omeprazole 
IR, surgery
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74
Q

blood tests for upper GI bleeding

A 
FBC 
U+E 
LFT 
CRP 
urea 
clotting 
crossmatch 
ABG
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75
Q

definitive management of variceal bleeding

A 
IV terlipressin 
endoscopic variceal ligation - banding 
sclerotherapy 
Sengstaken-Blakemore balloon / balloon tamponade - if all fails 
TIPS - IR 
transplant
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76
Q

considerations for variceal bleeding

A 
reverse anticoagulation 
IV pabrinex 
antibiotics 
replace electrolytes 
delirium tremens 
hypoglycaemia
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77
Q

what is TIPS procedure

A

transjugular intrahepatic portosystemic shuny

connects the portal vein to the hepatic vein to bypass the liver

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78
Q

bleeding PU - adrenaline/terlipressin

bleeding varices - adrenaline/terlipressin

A

ulcer - adrenaline

varices - terlipressin

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79
Q

prophylaxis of variceal bleeding

A

non-selective B blocker e.g. propranolol

repeat banding

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80
Q

What is haematochezia

A

PR bleeding

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81
Q

what can causes of PR bleeding be broadly grouped into

A

local
infections
colitis
pathologies of GI tract

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82
Q

what are local causes of PR bleeding

A 
haemorrhoids 
fissures 
fistulas (aorto-enteric)
ulcers 
peri-anal disease
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83
Q

what are haemorrhoids

A

engorged vascular cushions

84
Q

what are infectious causes of PR bleeding

A 
campylobacter 
shigella 
salmonella 
E.coli 
amoebiasis 
C.diff
85
Q

what types of colitis cause PR bleeding

A

IBD - crohns and UC
ischaemic
radiation
pseudomembranous

86
Q

PR bleeding with gastroenteritis has symptoms for more than 4 weeks, true or false

A

false
gastroenteritis <4 weeks
IBD >4 weeks

87
Q

what are pathological causes of PR bleeding

A

colorectal cancer
diverticular disease/diverticulitis
polyps
angiodysplasia

88
Q

list causes of diarrhoea

A 
gastroenteritis 
IBS 
IBD 
CRC
chronic pancreatitis 
laxative abuse 
lactose intolerance 
diverticular disease 
overflow diarrhoea 
bacterial overgrowth 
C.diff
thyrotoxicosis 
carcinoid 
Pellagra 
amyloid 
drugs: antibiotics, PPI, cytotoxics, digoxin, alcohol
89
Q

RF for C.diff infection

A 
4 C antibiotics: 
- cephalosporins 
- ciprofloxacin (quinolones)
- clindamycin 
- co-amoxiclav 
PPIs 
increased age
90
Q

what GI pathology should you rule out in someone with iron deficiency anaemia

A

PUD - bleeding
CRC
IBD
malabsorption - Coeliac disease

91
Q

what is IBS

A

irritable bowel syndrome is a functional disorder where the patient experiences symptoms but there is no underlying organic pathology

92
Q

symptoms of IBS

A 
abdominal pain 
constipation 
diarrhoea 
bloating 
PR mucous 
nausea 
bladder symptoms 
backache
93
Q

management of IBS

A 
education and explanation 
healthy diet 
constipation - biscodyl 
diarrhoea - bulking agent, loperamide 
bloating/colic - antispasmodic
94
Q

what is the recommended alcohol limit for men and women

A

14 units per week

ideally spread over 3 days

95
Q

what are the CAGE questions in relation to alcohol

A

ever felt the need to Cut down?
have people Annoyed you by criticising your drinking?
ever felt Guilty about your drinking?
ever had an Eye opener to steady nerves in the morning?

96
Q

what organs in the body can alcohol affect

A 
trauma from  intoxication 
liver 
CNS 
GI
blood 
heart 
bone - osteoporosis, myopathy 
pregnancy - FAS
97
Q

how does alcohol affect the liver

A

fatty liver
alcoholic hepatitis
cirrhosis –> portal HTN, varices, ascites, poor nutrition

98
Q

how does alcohol affect the CNS

A 
atrophy 
poor memory 
neuropathy 
fits 
falls 
Korsakoff's 
Wernickes encephalopathy 
confabulation 
delirium tremens 
dementia 
cerebellar degeneration
99
Q

how does alcohol affect the gut

A 
obesity 
D+V 
oesophagitis 
aspiration 
acute pancreatitis 
peptic ulceration 
varices - oesophageal, umbilical, rectal 
cancer - liver, CRC, pancreas, gastric 
oesophageal rupture
100
Q

how does alcohol affect the blood

A 
macrocytosis (^MCV)
anaemia 
bone marrow suppression 
folate deficiency 
haemolysis
101
Q

how does alcohol affect the heart

A 
arrhythmias 
HTN 
dilated cardiomyopathy 
sudden death 
MI 
stroke
102
Q

signs of alcohol withdrawal

A 
starts within 10-72 hr of last drink
tachycardia 
hypotension 
tremor 
confusion 
fits 
hallucinations - visual, tactile
103
Q

initial management/investigations for alcohol withdrawal

A

ABCDE + NEWS
FBC, U+E, LFT, creatinine, electrolytes, glucose, clotting
IV pabrinex

104
Q

definitive management for alcohol withdrawal

A

chlordiazepoxide or diazepam

105
Q

what is Wernicke-Korsakoff syndrome

A

alcohol related brain damage

thiamine (B1) deficiency

106
Q

what is thiamine

A

Vit B1 - cofactor

107
Q

what is the triad of Wernicke’s encephalopathy

A

mental confusion
ataxia
ophthalmoplegia

108
Q

what is confabulation

A

falsification of memory in clear consciousness

109
Q

what is Korsakoff’s encephalopathy

A

late manifestation of untreated Wernicke’s encephalopathy

110
Q

features of Korsakoff’s

A

memory loss

confabulation

111
Q

what is steatosis and is it reversible

A

fatty liver

yes

112
Q

clinical features of the spectrum of alcoholic liver disease

A 
malaise
nausea 
hepatomegaly 
fever 
jaundice 
sepsis 
encephalopathy 
ascites 
renal failure 
death
113
Q

stigmata of chronic liver disease and portal HTN

A 
finger clubbing
leukonychia (hypoalbuminaemia)
asterixis / flap
spider naevi 
caput medusae 
ascites 
gynaecomastia 
palmar erythema 
Dupuytrens 
jaundice 
tremor 
encephalopathy 
hepatomegaly and splenomegaly 
low albumin 
prolonged PTT 
thrombocytopaenia
114
Q

what factors are assessed in the Child-Pugh score

A 
ascites 
hepatic encephalopathy 
bilirubin 
albumin 
PTT
115
Q

what does the Child-Pugh score assess

A

degree of compensation in CLD

116
Q

characteristic features of alcoholic hepatitis

A

hepatomegaly
fever
leukocytosis
hepatic bruit

117
Q

what is CLD

A

chronic liver disease has a duration of >6 months
essentially progresses to cirrhosis
recurrent inflammation and repair with fibrosis

118
Q

causes of CLD/cirrhosis from most to least common

A 
alcohol 
NAFLD ie bad diet 
hepatitis C 
PBC 
autoimmune hepatitis 
hepatitis B 
haemochromatosis 
PSC 
Wilsons disease 
alpha1 antitrypsin 
Budd chiari 
methotrexate
119
Q

what is budd chiari syndrome

A

rare disease of hepatic venous outflow obstruction

thrombosis of hepatic veins

120
Q

what is NAFLD

A

non-alcohol related fatty liver disease
associated with metabolic syndrome
fatty liver / steatohepatitis in absence of other cause

121
Q

what is NASH

A

non-alcoholic steatoheaptitis

122
Q

what are examples of autoimmune liver disease

A

primary biliary cirrhosis
autoimmune hepatitis
primary sclerosing cholangitis
drug reactions

123
Q

features of PBC

A 
autoimmune destruction of small sized bile ducts 
middle aged women 
fatigue 
itch 
xanthelasma
124
Q

investigations for PBC

A

AMA +
cholestatic LFTs
liver biopsy

125
Q

treatment of PBC

A

urseo deoxycholic acid

126
Q

features of autoimmune hepatitis

A 
F>M
associated with other autoimmune conditions 
may present acutely
hepatomegaly, splenomegaly
jaundice 
stigmata of CLD 
deranged LFTs 
malaise, fatigue, nausea, abdominal pain, anorexia
127
Q

investigations for autoimmune hepatitis

A 
^ AST + ALT 
^ IgG 
rule out other causes 
autoimmune antibodies 
biopsy showing interface hepatitis
128
Q

management of autoimmune hepatitis

A

corticosteroids

azathioprine

129
Q

what is PSC

A

autoimmune destruction of large and medium sized bile ducts

130
Q

PSC is more associated with crohns/UC

A

UC

131
Q

what can PSC progress to

A

cholangiocarcinoma

CRC

132
Q

what is haemochromatosis

A

AR condition of iron overload

increased iron absorption in the gut results in iron deposition in the body

133
Q

what organs can haemochromatosis affect

A 
liver cirrhosis 
cardiomyopathy 
pancreas 
bronzed diabetic 
hypogonadism
134
Q

management of haemochromatosis

A

venesection

135
Q

what is Wilsons disease

A

AR condition with caeruloplasmin mutation

resulting in massive copper deposition especially in liver and basal ganglia

136
Q

features of Wilsons disease

A

liver disease
altered personality
choreaform
Kaiser Fleisher rings - eyes

137
Q

management of Wilsons disease

A

copper chelation - penicillamine

138
Q

what is alpha1 antitrypsin disease

A

mutation in A1AT gene

139
Q

features of alpha1 antitrypsin disease

A 
lung emphysema (COPD like image)
liver disease
140
Q

management of alpha1 antitrypsin disease

A

supportive

141
Q

what is cardiac cirrhosis

A

secondary to right heart failure/HTN

  • congenital
  • rheumatic fever
  • constrictive pericarditis
142
Q

what are the components that make up the portal vein

A

SMV
splenic vein + gastric vein
IMV

143
Q

what is the main blood supply to the liver

A

hepatic portal vein

144
Q

describe blood flow to and from the liver

A

O2 from hepatic artery + nutrients from HPV enter liver

central vein –> hepatic vein –> IVC –> RA of heart

145
Q

sites of portocaval anastamosis

A

oesophageal and gastric
umbilical
retroperitoneal
haemorrhoidal

146
Q

what are clinical signs of portal HTN in terms of portocaval anastamosis

A

oesophageal and gastric varices
caput medusae - umbilical
rectal varices

147
Q

what is the normal portal venous pressure

A

5-8mmHg

148
Q

causes of portal HTN

A

prehepatic - portal vein thrombosis

intrahepatic - cirrhosis, schistosomiasis, ALD, budd chiari

149
Q

signs of decompensated cirrhosis

A 
jaundice 
ascites 
encephalopathy 
easy bruising 
variceal bleeding 
liver failure
150
Q

should you avoid NSAIDs in the case of ascites

A

yes - causes Na and fluid retention

151
Q

management of ascites

A 
reduce salt
diuretics - spironolactone 
paracentesis 
TIPS
transplant
152
Q

what is spontaneous bacterial peritonitis

A

translocated bacterial infection of ascites

E.coli, klebsiella

153
Q

treatment of hepatic encepahlopathy

A

look for cause and reverse
lactulose to clear gut and reduce absorption of ammonia
rifaximin - antbx which reduces ammonia absorption also

154
Q

what is fulminant hepatic failure

A

clinical syndrome resulting from massive necrosis of liver cells leading to severe impairment of liver function

155
Q

causes of liver failure

A

infection - viral hepatitis
drugs - paracetamol
vascular - budd chiari
others - alcohol, autoimmune, genetic conditions, malignancy, HELLP syndrome

156
Q

signs of liver failure

A 
jaundice 
hepatic encephalopathy 
fetor hepaticus - pear drops breath 
asterixis / flap
apraxia 
signs of CLD
157
Q

what is the cause of hepatic encephalopathy

A

liver failure results in a build up of ammonia which is carried to the brain and glutamine is produced, excess glutamine results in cerebral oedema

158
Q

what does the following mean in ascitic fluid cytology:
neutrophils >250
protein >25g/l
protein <25g/l

A

neutrophils >250 - SBP
protein >25g/l - exudate
protein <25g/l - transudate

159
Q

what is spironolactone

A

aldosterone antagonist
diuretic
promotes excretion of Na and retention of K

160
Q

what are furosemide and bumetanide

A

loop diuretics

161
Q

what is the commonest liver tumour

A

metastases

breast, bronchus, GI tract

162
Q

what is the commonest primary liver tumour

A

HCC

163
Q

blood tests for liver cancer

A

FBC
U+E
LFT
aFP

164
Q

RF for HCC

A

viral hep B+C
cirrhosis (and all its causes)
aflatoxin
FH

165
Q

what is cholangiocarcinoma

A

biliary tree cancer

166
Q

what is the commonset benign liver tumour

A

haemangioma

167
Q

list benign liver lesions

A 
haemangioma 
adenoma 
cysts 
focal nodular hyperplasia 
fibroma
168
Q

RF for pancreatic carcinoma

A 
male 
age 
smoking 
alcohol 
carcinogens 
DM 
chronic pancreatitis 
central obesity 
^ red meat
169
Q

presenting features of pancreatic carcinoma

A 
painless jaundice 
weight loss 
diabetes 
acute pancreatitis 
hypercalcaemia 
Courvoisier's sign 
organomegaly
170
Q

prognosis for pancreatic cancer?

A

poor

171
Q

what are carcinoid tumours

A

tumours of enterochromaffin cell origin (neuroendocrine)
capable of producing 5HT
site: appendix, ileum, rectum

172
Q

features of carcinoid tumours

A 
bronchoconstriction 
flushing 
diarrhoea 
CCF
^5HIAA levels
173
Q

what surgical procedure may be done for pancreatic cancer

A

Whipple’s procedure

174
Q

clinical features of UC

A 
bloody diarrhoea 
>4weeks
abdominal pain 
tenesmus 
night rising 
urgency 
weight loss 
finger clubbing
175
Q

extra GI features of UC

A

eyes - iritis, episcleritis, uveitis, conjunctivitis
liver - PSC, fatty liver
MSK - arthritis, AS
nutritional deficits

176
Q

IBD investigations

A 
FBC 
U+E 
LFT 
CRP 
stool culture - rule out infection 
colonoscopy
177
Q

complications of UC

A 
toxic megacolon 
perforation 
bleeding 
CRC
PSC
cholangiocarcinoma
178
Q

pathophysiology of UC

A 
surface inflammation (ucosa and submucosa)
continuous pattern 
pseudopolyps 
crypt abscesses
depletion of goblet cells 
mucosal ulcers 
Th2 disease
179
Q

site of UC

A

starts at rectum and moves proximally along large bowel

never goes beyond ileocaecal valve

180
Q

classification of UC

A

mild <4 motions
moderate 4-6
severe >6

181
Q

management of mild -moderate UC (induction of remission)

A

topical / oral 5ASA e.g. sulfasalazine or mesalazine

steroids, but wean these down

182
Q

management of severe UC (induction of remission)

A 
admission 
IV fluids 
IV hydrocortisone 
prophylactic LMWH for VTE
assess need for surgery
183
Q

clinical features of crohns disease

A 
diarrhoea >4weeks 
urgency 
abdominal pain 
weight loss 
failure to thrive 
malaise 
peri-anal disease: skin tags, fistulae, abscess, strictures
184
Q

extra GI features of crohns

A 
aphthous ulcers 
finger clubbing 
eyes - episcleritis, uveitis, conjunctivitis
arthritis 
erythema nodosum 
gallstones
185
Q

complications of crohns

A 
toxic megacolon 
SBO 
fistulae
abscesses 
strictures 
perforation 
bleeding
186
Q

site of crohns

A

whole GI tract can be affected

mouth to anus

187
Q

pathophysiology of crohns

A 
transmural inflammation --> fistulae
skip lesions, patchy 
increased goblet cells 
granulomatous 
cobblestone appearance
188
Q

management of crohns

A

steroids
immunosuppressants - azathioprine
biologics - anti-TNF infliximab

189
Q

what is scurvy

A 
vit C deficiency 
gingivitis 
halitosis 
anorexia 
muscle pain 
oedema
190
Q

what is beriberi

A

vit B1 deficiency (thiamine)

191
Q

what is dry beriberi

A

neuropathy

192
Q

what is wet beriberi

A

heart failure with oedema

193
Q

what is pellagra

A

niacin deficiency (B3)

194
Q

what are the 4Ds of pellagra

A

dermatitis
diarrhoea
dementia
death

195
Q

what is refeeding syndrome

A

clinical findings in those that are severely malnourished and are receiving nutritional support

196
Q

RF for refeeding syndrome

A 
eating disorders 
alcoholism 
depression 
fasting 
vomiting 
prolonged NBM
197
Q

clinical features of refeeding syndrome

A

arrhythmias
abdo pain, vomiting
weakness
SOB

198
Q

there is hypo/hyperphosphataemia in refeeding syndrome

A

HYPO
phosphataemia
kalaemia
magnesaemia

199
Q

what is parenteral feeding

A

feeding through IV

ie not through the GI tract

200
Q

indications for OGD

A 
dysphagia 
dyspepsia 
GORD 
weight loss 
haematemesis/malaena
vomiting 
upper abdo mass 
coeliac 
oesophageal varices 
upper GI bleed - therapeutic management
201
Q

indications for sigmoidoscopy

A

PR bleeding
CIBH
IBD

202
Q

indications for colonoscopy

A 
CIBH 
polyp surveillance 
IBD 
cancer surveillance 
genetics eg FAP
203
Q

indications for ERCP

A

obstructive jaundice
CBD stones
gallstone pancreatitis

204
Q

steroids can mask a silent GI perforation, true or false

A

true

205
Q

for severe colitis, by which day would you expect response to treatment

A

by day 3 there should be some response but if not you can wait till day 5
If by day 5 there is no response, call the surgeons

206
Q

what criteria do you use for patients with eating disorders

A

MARSIPAN

207
Q

risks of refeeding syndrome

A 
rapid drop in phosphate, magnesium or potassium 
arrhythmias 
death 
constipation 
increased adverse effects of drugs 
distress 
self harm

Year 4 General Medicine (16 decks)

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