GI and surgery Flashcards
Discuss the use of and mechanism of action for terlipressin
Use in variceal oesophageal bleeds
Vasoconstriction
Discuss key diagnostic features for haemorrhoids
Rectal bleeding
Itching and pain/discomfort
Swelling around the anus
Aside from band ligation and attempts to cease bleeding what other therapy should be initiated in an acute oesophageal variceal bleed?
Antibiotics
Mechanism of action and clinical use of metoclopramide
Dopamine antagonist
Antiemetic and prokinetic effects however patient can suffer dystonic reactions
What is the first line treatment for dystonic reactions?
Procyclidine (anti-cholinergic)
What property of methylnaltrexone makes it an effective therapy against opioid induced constipation
Cannot cross blood brain barrier
Diminished peripherally mediated opioid side effects without effecting central analgesic effects
Mechanism of action and use of Bupivacaine
Locals anaesthetic - sodium channel blocker preventing depolarisation and therefore pain impulses to central pain centres
A patient needs to be started on clarithromycin, which drug should be stopped that has a major interaction with clarithromycin?
Simvastatin
Clarithromycin is a potent inhibitor of CYP3A4 and can therefore lead to large increase in amount of simvastatin levels increasing risk of myopathy and rhabdomyolysis
What values does the blatchford score use to assess severity of GI bleed
Blood urea
Haemoglobin
Systolic bp
Other markers: pulse, melaena, syncope, hepatic disease and heart failure
List histological/pathological features of ulcerative colitis
Crypt abscesses
Inflammation confined to mucosa
Pseudopolyps
What does a positive Cullen’s sign suggest in the assessment of acute pancreatitis
Periumbilical discolouration due to haemorrhagic pancreatitis (blood vessel auto-digestion)
State the possible causes of raised amylase
Acute pancreatitis Malignancy of pancreas, ovaries and lungs Cholecystitis Biliary disease Severe gastroenteritis Infection of salivary glands e.g. mumps
Typically how raised is serum amylase to be diagnostic for acute pancreatitis
3 times the upper limit of normal range
However does not have to be raised if other symptoms are suggestive of pancreatitis
Recommend management of adult patient with C. difficile
Metronidazole and discontinuation of causative antibiotic
Fluid and electrolytes
What is kind of epithelia is the oesophageal mucosa
non-keratinising stratified squamous
Discuss the appropriate resuscitation of a haemodynamically unstable patient with an upper GI bleed
Large bore IV catheters Crystalloids retore to vital sign HDU monitor if indicated central venous monitoring Vital sin and urine output monitored
State pathological features of Ulcerative colitis
o Irregular surface
o Diffuse crypt architectural distortion
o Diffuse chronic inflammatory cell infiltrate, rich in plasma cells
o Crypt abscesses (The colonic mucosa of active ulcerative colitis shows “crypt abscesses” in which a neutrophilic exudate is found in glandular lumens of crypts of Lieberkuhn. The submucosa shows intense inflammation.
o The glands demonstrate loss of goblet cells and hyperchromatic nuclei with inflammatory atypia)
o Inflammation confined to mucosa/submucosa
Pseudopolyps (islands of oedematous mucosa)
Treatment for dystonic reaction caused by therapy with dopamine antagonists
Procyclidine (anti cholinergic)
Describe the symptoms of venous incompetence
Leg pain, aching, itching, swelling, pigmentation, and eczema and ultimately ulceration
Outline the Dukes classification Of bowel cancer
A - invasion confined to mucosa B - infiltration through muscle B2 - through bowel wall C - node involvement D - distant metastases
What test is diagnostic (along with clinical history) for primary biliary cirrhosis
Antimitochondrial antibodies
The most common causative pathogen of food poisoning in the UK
Campylobacter
Histological features of Crohn’s
Transmural chronic inflammation Lymphoid aggregates Presents in skip lesions Crypt architecture preserved Granulomatous Fissuring ulcers
A 25 year old man presents with fatigue and joint pain, on examination you note is skin is quite tanned but otherwise non-remarkable
His blood tests reveal deranged LFTs, raised Ferritin and transferrin saturation
Subsequent genetic testing was positive, what is the most likely mode of inheritance
Autosomal recessive
Haemochromatosis - deranged LFT and iron overload
Discuss possible complications of primary biliary cholangitis
Those of cirrhosis, osteoporosis, malabsorption of fat-soluble vitamins (A,D,E,K) due to cholestasis and decreased bilirubin in the gut lumen results in osteomalacia and coagulopathy,hepatocellular carcinoma
Features and causes of acute liver failure
Jaundice, coagulopathy, and hepatic encephalopathy
Vital hepatitis, yellow fever, leptospirosis, paracetamol overdose
Management of paracetamol overdose
IV acetylcysteine
Activated charcoal
Anti-emetic
Features of Primary sclerosing cholangitis and associated complications
Chronic progressive cholestatic liver disease, characterised by inflammation and fibrosis of the intrahepatic and/or extrahepatic bile ducts, resulting in diffuse, multi-focal stricture formation. It is often associated with inflammatory bowel disease.
Liver failure
Cholangiocarcinoma
Hepatocellular carcinoma
ascending cholangitis
From where does the bleeding occur in ischaemic colitis?
Splenic flexture (watershed)
Which clinical sign?
In cholecystitis there is pain or catch of breath elicited on palpation of right hypochondirium during inspiration
Murphy’s sign
Rovsing’s sign
palpation of the left lower quadrant of the abdomen increases the pain felt in the right lower quadrant. This may be an indicator of appendicitis, although it is not positive in all cases
McBurney’s point
The site where the pain from appendicitis is usually most severe on palpation. The point is on the right side of the abdomen, approximately one-third of the distance from the anterior superior iliac spine to the umbilicus
Likely diagnosis of a 50 year old male presenting with fever, RUQ pain and jaundice, he is obese and has a history gallstones
Ascending cholangitis
Management of Ascending Cholangitis
Antibiotic therapy - piperacilin and tazobactam
Biliary drainage
intensive supportive care
Most common cause of hereditary colorectal cancer
HNPCC
Clinical features of Left sided colonic cancer
Constipation and large bowel obstruction
Alternating bowel habits
Retal bleeding
Decreased stool calibre
Levels of which protein should be checked to ensure immunity 4 months after hepatitis B vaccination
Anti-HBs implies immunity (either exposure or immunisation). It is negative in chronic disease
A 65-year-old woman presents with jaundice, weight loss and passing clay-coloured stools. She also describes recurrent bouts of colicky RUQ abdominal pain. On examination a mass is palpable in the RUQ
Cholangiocarcinoma
A 40-year-old man with a history of back pain presents with epigastric pain and passing black, tarry stools. His pain is relieved by eating
duodenal ulcer
Which form of inflammatory bowel disease is there increased risk of colorectal cancer?
Ulcerative colitis
Radiological features of Crohn’s disease?
- Kantor’s string sign
- Proximal bowel dilation
- Rose thorn ulcers
- Bowel wall thickening
Risk factors for acute mesenteric ischaemia
atrial fibrillation, heart failure, chronic kidney failure, being prone to forming blood clots, and previous myocardial infarction
70 year old female presents with severe abdominal pain after eating and diarrhoea, on investigation she is hypotensive and an ABG reveals metabolic acidosis
Mesenteric ischaemia
Papulovesicular lesions on the extensor aspects of a patients arm, along with a hx of steatorrhoea, bloating and abdominal pain, is characteristic of which disease?
Coeliac
A 45-year-old woman presents with fatigue and pruritus. Blood tests show a raised bilirubin, ALP and IgM level
Primary biliary cirrhosis
A 40-year-old woman presents with acute onset of upper abdominal pain and ascites. She has been on the combined oral contraceptive pill for 7 years. On examination she has tender hepatomegaly. There is no hepatojugular reflux and no lower limb oedema. Cardiovascular exam revealed no medical abnormalities. She is known to have polycythaemia vera of 10 years’ duration.
Budd-Chiari syndrome
A patient presents semi-stuporous but responds to verbal stimuli, they are confused and grossly disorientated, which grade of hepatic encephalopathy is this?
Grade 3
What is Courvoisier’s law?
states that in the presence of jaundice an enlarged gall bladder is unlikely to be due to gallstones - that is, pancreatic carcinoma or cholangiocarcinoma
