GI Flashcards

Question

symptoms of GORD

Answer 1

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

Answer 2

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

Answer 3

``` GORD obesity smoking M>F alcohol FH ```

Answer 4

lower 1/3rd

Answer 5

``` endoscopy Ba swallow (hiatus hernia) oesophageal manometry and pH studies ```

Answer 6

adenocarcinoma (glandular)

Answer 7

normal oesophagitis (reversible) Barrett's adenocarcinoma

Answer 8

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

Answer 9

antacids | have no healing benefit

Answer 10

PPIs | e.g. omeprazole, lansoprazole, esomeprazole

Answer 11

Nissen fundoplication

Answer 12

irreversible

Answer 13

``` more frequent surveillance optimaise PPI dose endoscopic mucosal resection (EMR) radiofrequency ablation argon ```

Answer 14

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

Answer 15

delayed gastric emptying

Answer 16

feeling of fullness N+V weight loss upper abdominal pain

Answer 17

``` idiopathic DM cannabis medications - opioids, anticholinergics systemic sclerosis ```

Answer 18

gastric emptying studies

Answer 19

``` remove precipitating factors liquid diet eat small regular meals promotility agents gastric pacemaker ```

Answer 20

endoscopy with biopsy

Answer 21

epigastric pain/burning postprandial fullness early satiety

Answer 22

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

Answer 23

H.pylori infection | NSAID use

Answer 24

organic | functional

Answer 25

PUD gastric cancer drugs - NSAIDs H. pylori infection

Answer 26

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

Answer 27

NO, only epigastric burning NO retrosternal pain

Answer 28

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

Answer 29

refer to hospital specialist

Answer 30

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

Answer 31

duodenal > gastric

Answer 32

duodenal - relieved by eating | gastric - aggravated by eating

Answer 33

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

Answer 34

Gm - microaerophilic spiral flagellated bacilli | oral-oral / faecal-oral spread

Answer 35

nothing PUD gastric cancer - adenocarcinoma, MALToma

Answer 36

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

Answer 37

13C urea breath test

Answer 38

7 days of BD: - PPI + - amoxicillin + - metronidazole or clarithromycin (or PPI and M + C is penicillin allerguc)

Answer 39

true | urease causes production of ammonium bicarbonate

Answer 40

anaemia bleeding perforation fibrosis - gastric outlet obstruction

Answer 41

vomiting of blood from the upper GI tract

Answer 42

black tarry stools from upper GI bleeding

Answer 43

pre endoscopic | Blatchford is post endoscopic

Answer 44

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

Answer 45

``` 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 ? ```

Answer 46

endoscopy - identifies cause - therapeutic manoeuvres - assess risk of re bleeding

Answer 47

``` endoscopic: adrenaline injection heater probe coagulation clips haemospray IV omeprazole IR, surgery ```

Answer 48

``` FBC U+E LFT CRP urea clotting crossmatch ABG ```

Answer 49

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

Answer 50

``` reverse anticoagulation IV pabrinex antibiotics replace electrolytes delirium tremens hypoglycaemia ```

Answer 51

transjugular intrahepatic portosystemic shuny | connects the portal vein to the hepatic vein to bypass the liver

Answer 52

ulcer - adrenaline | varices - terlipressin

Answer 53

non-selective B blocker e.g. propranolol | repeat banding

Answer 54

PR bleeding

Answer 55

local infections colitis pathologies of GI tract

Answer 56

``` haemorrhoids fissures fistulas (aorto-enteric) ulcers peri-anal disease ```

Answer 57

engorged vascular cushions

Answer 58

``` campylobacter shigella salmonella E.coli amoebiasis C.diff ```

Answer 59

IBD - crohns and UC ischaemic radiation pseudomembranous

Answer 60

false gastroenteritis <4 weeks IBD >4 weeks

Answer 61

colorectal cancer diverticular disease/diverticulitis polyps angiodysplasia

Answer 62

``` 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 ```

Answer 63

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

Answer 64

PUD - bleeding CRC IBD malabsorption - Coeliac disease

Answer 65

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

Answer 66

``` abdominal pain constipation diarrhoea bloating PR mucous nausea bladder symptoms backache ```

Answer 67

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

Answer 68

14 units per week | ideally spread over 3 days

Answer 69

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?

Answer 70

``` trauma from intoxication liver CNS GI blood heart bone - osteoporosis, myopathy pregnancy - FAS ```

Answer 71

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

Answer 72

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

Answer 73

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

Answer 74

``` macrocytosis (^MCV) anaemia bone marrow suppression folate deficiency haemolysis ```

Answer 75

``` arrhythmias HTN dilated cardiomyopathy sudden death MI stroke ```

Answer 76

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

Answer 77

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

Answer 78

chlordiazepoxide or diazepam

Answer 79

alcohol related brain damage | thiamine (B1) deficiency

Answer 80

Vit B1 - cofactor

Answer 81

mental confusion ataxia ophthalmoplegia

Answer 82

falsification of memory in clear consciousness

Answer 83

late manifestation of untreated Wernicke's encephalopathy

Answer 84

memory loss | confabulation

Answer 85

fatty liver | yes

Answer 86

``` malaise nausea hepatomegaly fever jaundice sepsis encephalopathy ascites renal failure death ```

Answer 87

``` 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 ```

Answer 88

``` ascites hepatic encephalopathy bilirubin albumin PTT ```

Answer 89

degree of compensation in CLD

Answer 90

hepatomegaly fever leukocytosis hepatic bruit

Answer 91

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

Answer 92

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

Answer 93

rare disease of hepatic venous outflow obstruction | thrombosis of hepatic veins

Answer 94

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

Answer 95

non-alcoholic steatoheaptitis

Answer 96

primary biliary cirrhosis autoimmune hepatitis primary sclerosing cholangitis drug reactions

Answer 97

``` autoimmune destruction of small sized bile ducts middle aged women fatigue itch xanthelasma ```

Answer 98

AMA + cholestatic LFTs liver biopsy

Answer 99

urseo deoxycholic acid

Answer 100

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

Answer 101

``` ^ AST + ALT ^ IgG rule out other causes autoimmune antibodies biopsy showing interface hepatitis ```

Answer 102

corticosteroids | azathioprine

Answer 103

autoimmune destruction of large and medium sized bile ducts

Answer 104

cholangiocarcinoma | CRC

Answer 105

AR condition of iron overload | increased iron absorption in the gut results in iron deposition in the body

Answer 106

``` liver cirrhosis cardiomyopathy pancreas bronzed diabetic hypogonadism ```

Answer 107

venesection

Answer 108

AR condition with caeruloplasmin mutation | resulting in massive copper deposition especially in liver and basal ganglia

Answer 109

liver disease altered personality choreaform Kaiser Fleisher rings - eyes

Answer 110

copper chelation - penicillamine

Answer 111

mutation in A1AT gene

Answer 112

``` lung emphysema (COPD like image) liver disease ```

Answer 113

supportive

Answer 114

secondary to right heart failure/HTN - congenital - rheumatic fever - constrictive pericarditis

Answer 115

SMV splenic vein + gastric vein IMV

Answer 116

hepatic portal vein

Answer 117

O2 from hepatic artery + nutrients from HPV enter liver | central vein --> hepatic vein --> IVC --> RA of heart

Answer 118

oesophageal and gastric umbilical retroperitoneal haemorrhoidal

Answer 119

oesophageal and gastric varices caput medusae - umbilical rectal varices

Answer 120

prehepatic - portal vein thrombosis | intrahepatic - cirrhosis, schistosomiasis, ALD, budd chiari

Answer 121

``` jaundice ascites encephalopathy easy bruising variceal bleeding liver failure ```

Answer 122

yes - causes Na and fluid retention

Answer 123

``` reduce salt diuretics - spironolactone paracentesis TIPS transplant ```

Answer 124

translocated bacterial infection of ascites | E.coli, klebsiella

Answer 125

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

Answer 126

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

Answer 127

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

Answer 128

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

Answer 129

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

Answer 130

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

Answer 131

aldosterone antagonist diuretic promotes excretion of Na and retention of K

Answer 132

loop diuretics

Answer 133

metastases | breast, bronchus, GI tract

Answer 134

FBC U+E LFT aFP

Answer 135

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

Answer 136

biliary tree cancer

Answer 137

haemangioma

Answer 138

``` haemangioma adenoma cysts focal nodular hyperplasia fibroma ```

Answer 139

``` male age smoking alcohol carcinogens DM chronic pancreatitis central obesity ^ red meat ```

Answer 140

``` painless jaundice weight loss diabetes acute pancreatitis hypercalcaemia Courvoisier's sign organomegaly ```

Answer 141

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

Answer 142

``` bronchoconstriction flushing diarrhoea CCF ^5HIAA levels ```

Answer 143

Whipple's procedure

Answer 144

``` bloody diarrhoea >4weeks abdominal pain tenesmus night rising urgency weight loss finger clubbing ```

Answer 145

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

Answer 146

``` FBC U+E LFT CRP stool culture - rule out infection colonoscopy ```

Answer 147

``` toxic megacolon perforation bleeding CRC PSC cholangiocarcinoma ```

Answer 148

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

Answer 149

starts at rectum and moves proximally along large bowel | never goes beyond ileocaecal valve

Answer 150

mild <4 motions moderate 4-6 severe >6

Answer 151

topical / oral 5ASA e.g. sulfasalazine or mesalazine | steroids, but wean these down

Answer 152

``` admission IV fluids IV hydrocortisone prophylactic LMWH for VTE assess need for surgery ```

Answer 153

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

Answer 154

``` aphthous ulcers finger clubbing eyes - episcleritis, uveitis, conjunctivitis arthritis erythema nodosum gallstones ```

Answer 155

``` toxic megacolon SBO fistulae abscesses strictures perforation bleeding ```

Answer 156

whole GI tract can be affected | mouth to anus

Answer 157

``` transmural inflammation --> fistulae skip lesions, patchy increased goblet cells granulomatous cobblestone appearance ```

Answer 158

steroids immunosuppressants - azathioprine biologics - anti-TNF infliximab

Answer 159

``` vit C deficiency gingivitis halitosis anorexia muscle pain oedema ```

Answer 160

vit B1 deficiency (thiamine)

Answer 161

neuropathy

Answer 162

heart failure with oedema

Answer 163

niacin deficiency (B3)

Answer 164

dermatitis diarrhoea dementia death

Answer 165

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

Answer 166

``` eating disorders alcoholism depression fasting vomiting prolonged NBM ```

Answer 167

arrhythmias abdo pain, vomiting weakness SOB

Answer 168

HYPO phosphataemia kalaemia magnesaemia

Answer 169

feeding through IV | ie not through the GI tract

Answer 170

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

Answer 171

PR bleeding CIBH IBD

Answer 172

``` CIBH polyp surveillance IBD cancer surveillance genetics eg FAP ```

Answer 173

obstructive jaundice CBD stones gallstone pancreatitis

Answer 174

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

Answer 175

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

GI Flashcards

(207 cards)