GI cards Flashcards
Drugs that cause cholestatic pic?
hepatocellular pic?
Drugs causing cirrhosis?
phenothiazides (prochloperazide, chlorpromazine), anabolic steroids/ abx (erythromycin, co-amox, fluclox), sulfonylureas, fibrates, OCP, rare -nifedipine
hepatocellular (phenytoin, RIPE, amiodarone, methyldopa, nitrofurantoin, valporate, statins,
MAMA: methyl dops, methotrexate, amiodarone
Alcoholic vs fatty LD AST/ALT ratio?
alcoholic - AST:ALT >2
NAFLD: ALT :AST >2
salt before lime in tquila
true love and witt’s criteria?
admission crtieria for UC flare. severe: Hb <105, wcc 15+, CRP 45+/ stools 6+ admit for IV
young hepatitis, psych symptoms?
other associated factors -polyuria/ dipsia?
DX?
wilson’s disease tx penicillamine
fanconi’s syndrome - aTN
ceruloplasmin <200
raised 24 hr urine copper
gall bladder palpable painless jaundice?/ new diabetes. dx?
other RF?
tx?
do HRCT abdo, panc cancer
other signs: migratory thrombophlebitis, double duct, fatty stools, trousseau
rf: HNPCC, MEN,
pancreatoduodenctomy/ whipples. only <20% suitable for surgery
C diff tX?
dx of c-diff?
Ix?
Tx if recurring?
risks making life threatening?
PO van 10 days (1st time), 2nd: fidaxomicin, then PO vanc+ v/po metronidazole
cX: PPI, abx
CDT stool test
if recurring - PO fidaxomicin
2+ epsodes, consdier stool transplant
life threatening: toxic megacolon, hypotension, ileus
Oesophageal cancer - which is more common in developing world? where is is?
RF of each?
appearance on barium swallow
risk of this?
SCC (upper 2/3), AF: plummer vinson syndrome, achalasia
A/C - in uk/US (AF GORD, barrets, lower 1/3)
barium - apple core appearance
DX upper gi endoscopy
ris: anastomotic leak, causing mediastinitis
spontaneous bacterial peritonitis when to give proph abx?
which abx?
how do we confirm dx
RF?
when protein ascites fluid protein <15/ 9+ on child pugh score / hepato renal syndrome
give ciproflox/ norflox ntl ascites resolved
DX: paracentesis neutrophils 250+
DM, cirrhosis, skin pigmentation?
haemochromatosis. risk of HCC. most common recessive disorder. need TS/ ferritin. maintain ts <50%. dx women 55+, men 50+
HCC RF?
Hep B (worldwide), Hep C (europe), Alpha 1 antitrypsin - young, pulmonary sx, DM, male, OCP
deranged LFTs with wheeze, cough, SOB? inheritence pattern?
how to smokers present?
alpha 1 antitrypsin
deficiency causes neutrophil enzymes to destroy alveoli, ADom, smokers have sx 10 yrs earlier than non smokers
ascites which Ix shows the cause of it?
cx leading to portal hypertension
other causes?
tx?
abx to reduce the risk of spontaneous bacterial peritonitis? when would you give this?
SAAG 11+ livercirrhosis/ alchol
congestive : heart failure, constrictive pericarditis
budd chiari, portal vein thrombosis, veno occlusive disease, myxoedema
SAAG <15 - proph ciprofloxacic
SAAG11+ - nephrotic syndrome causing hypoalbuminaemia/ pancreatitis/ obstruction
tx: spironolactone, drain
risks: peritonits, dilutional hyponatraemia, hepato renal syndrome
drugs causing hepatocellular pic?
A moon is very RIPE on fen’s roof at night
paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin
suspected variceal bleed tx before?
terlipressin and abx
SE of PPI?
hyponatraemia, hypomagnasaemia
osteoporosis → increased risk of fractures
microscopic colitis
increased risk of C. difficile infections
c urea breath test should be clear of abx and ppi for how long?
no abx for 4 weeks and no ppi for 2 weeks
Features of crohns?
fistula ix and tx?
most common surgery
tx - induction/ remission?
risks of crohns
crow’s have less blood (non blood diarrhoea), skip lesions (skip through street), goblet cells, all layers, episcleritis more common - terminal ileum, bowel obstruction/ fistula
N – No blood or mucus
E – Entire GI
S – “Skip lesions” on endoscopy
T – Terminal ileum- will need ileocecal resection
S – Smoking is a risk factor (don’t set the nest on fire)
perianal disease - fistula ned MRI pelvis. tx with draining seton
induce: C/S first line
2nd - 5ASA (not as effective)
remission: azathioprine/ mecaptopurine/ methotrexate2nd line
risks: small bowel cancer, osteoporosis
UC features?
tx?
features of severe? tx? wat criteria?
remission?
bloody diarrhoea (sir has more blood), continuous lesions (down the street), likely to make a mark/ scar (PSC), and get colorectal cancer, more common to get uveitis,
C – Continuous inflammation
L – Limited to the colon and rectum (most common rectum)
O – Only superficial mucosa affected
S – Smoking may be protective
E – Excrete blood and mucus
U – Use amino salicylates
P – Primary sclerosing cholangitis
tx: topical aminoacylate then to oral if not by 4 weeks amino. then CS.
severe: 6+ stools, systemic upset. hb <105, IV methylprednisolone (truelve and witts)
remission: topical ASA OD ei+- po ASA
azathioprine: for 2+ relapses a yr
features common to both UC and crohns (IBD)
pyoderma gangrenosum, arthritis, erythema nodosum, arthritis
surgical options for UC?
ileostomy/ J pouch (ileoanal anastomosis)
What is plummer-vinson
iron deficiency anaemia, atrophic glossitis and oesophageal webs or strictures. AF - SCC
painless intermittent disphagia. indian subcontinent
bird beak’s sign, dysphagia with both solids and liquids from day 1?
achalasia: narrowing of the distal oesophagus
why do endomesial antibody in coelaic testing?
IGA antibody needed to exclude IGA deficiency or else a false negative result could arise
Acute liver disease features?
jaundice, raised PT, low albumin, renal failure
CX: Hep A/B, alcohol, paracetmaol (most common), acute fatty liver of pregnancy
72-year-old woman presents with a two day history of diarrhoea and pain in the left iliac fossa
diverticulitis
haematemesis/ melena with epigastric pain hours after eating. relieved by eating?
duodenal ulcer.
Anteriorly sited ulcers may perforate and result in peritonitis, posteriorly sited ulcers may erode the gastroduodenal artery and present with haematemesis and/ or malaena.
brisk haematemesis with finding of: prominent blood vessel is identified in the mucosa approximately 6 cm from the O-G junction on the lesser curve of the stomach?
Dieulafoy lesion (rare type of vascular malformation)
profuse painless UGIB. malnourished, gynaecomastia, spider naevi, (signs of liver failure) cx?
Variceal bleeds, give terlipressin/ abx if sus
Child-pugh score? (ABCDE)
prognosis of cirrhosis. severity. (1 - 3 points for each)
Albumin
Biliburin
Clotting
Ddilatation (ascites)
Encephalopathy
sulphasalazine SE?
Mesalasine SE
rashes, oligospermia, headache, Heinz body anaemia, megaloblastic anaemia, lung fibrosis
mesalazine: has more gI
(mebelly)upset SE, pancreatitis, interstitial neohritis, agranulocytosis, headache
metaclopramide SE?
extrapyramidal effects - extra potato
acute dystonia e.g. oculogyric crisis
(children and young adults)
diarrhoea
hyperprolactinaemia
Ascending cholangitis triad?
what is this?
raynaud’s pentad?
RUQ pain, jaundice, fever,
infection of bile duct secondary to gall stones (stasis)
+hypotension, recuced GCS
A woman hx gallstones, RUQ pain. No jaundice, temp 37.8ºC. Palpating under the right costal margin causes her to catch her breath. dx?
acute cholecystitis. Murphy’s
HLAB27 + man has weight loss, diarrhoea, low b12, darker skin that is sensitive to the light with arthirits?
whipple’s disease (rare multisstem, cuases malabsorpion
HX of scleroderma, has pale bulky stools, flatulence bloods would show?
other RF for this?
other causes of malabsorption?
low ferritin, B12, malabsortopion. scleroderma is RF for small intestine bacterial overgrowth syndrome
Rf for SBBOG - scleroderma, diabetes, tx rifaximin/ co-amox. do Dx hydrogen breath test
malabsorption cx: chronic panc, CF, panc cancer. PBC, bacterial overgrowth, coeliac, cohns, whipples disease, giardiases
young woman, seconday amernohhroea, raised ALT?
autoimmune hepatitis
Fatty stools, diarrhoea after travelling in swimming pools?
giardia lamblia ( resistant to chlorine)
if confirmed - tx tinidazole 2g dingle dose
post crohns tx iv C/S then acute pain, vomit blood?
peptic ulcer post CS tx
PBC?
White woman ages 60YO. Anti AMA, Raised IGM
inflammation and damage to small bile ducts causing fibrosis . autoimmune.
AF: systemic sclerosis, RA,m thyoid, sojrens,
Tx: ursodeoxycolic acis
Gilbert’s disease?
caution with which meds?
safe?
hereditary benign, -decreased UDP glucuronyl transferase.
caution:gemfibrozil (with statin+),irinotecan, hiv tx (atazanivr/indinavir)
safe- paracetamol
previous peptic ulcer, now bloating and epigastric pain when eating. trialled antacids and PPI?
do c -urea breath test.
H pylori - tx clarithromycin, PPI, amoxicillin/ metro
biliary colic +fever/ wcc/ crip?
acute cholecystitis
gluconoma 6 Ds?
diarrhoea, dVT, DM, rash - necrolytic migratory erythema (itchy, painful), dermatosis, depression
drugs that cx diarrhoea?
SSRIs, ppi, acei, allopurinol, theophylline, antacids, metformin, nsaids, thyroxine,
constipation red flags?
WL, bleeds rectal, 6 weeks+ chasnge in bowels, loss of appetite, Fe deficiency, abdo pain
fatigue, jaundice, pruritus, steatorrheoa, dry eyes, dry mouth, xanthalasma, enlarged liver and spleen?
PBC (autoimmune inlfammation and damage to small bile ducts)
antimicrobial antibodies
vasc RF, 50+, pain after eating, weight loss, anxiety to eat
chronic mesenteric iscaemia (rare)
other types od bowel ischaemia - acute (common) and colonic (most favourable and common)
appendicitis features?
anorexia, RIF pain, fever, furred tongue, rosvigs (more pain toughing LIF)
early change in bowel habit, LIF pain, WL, rectal bleed, tenesmus?
LEft sided colon cancer (adenocarcinoma)
Right sided colon cancer sx?
RIF mass, anaemia, late presentation,occult bleeding
surgical tx for colorectal cancer?
hemicolectomy,
anterior resection- for high sigmoid or low rectum
abdo-perineal resection (tumours in low rectum)
vitamin def: bloodshot itchy eyes, cracked red lips at angle of mouth?
riboflavin/ vit b2
vit b3 / niacin deficinecy?
pallegra
vit b5 def? panthothentate?
dermatitis, enteritis, alopecia, adrenal insufficiency
pre hep cx of portan htn?
splenic vein/ portal vein thrombosis (spesis, malignancy, pancreatits, high coag state), congenital atresia/ stenosis, extrinsic 0 tumours
Rule of cx with PSC?
Male, FH. fibrosis and infiltration of intra and extra bile ducts.
AF: UC, cholangiocarinoma (risk), colorectal carcinoma, MRCP dx. PANCA, ANA, anti SMA
t1dm, ALT 200-300, IGG, ANA and SMA, raised PT?
Autoimmune hepatitis . tX C/s azathiprine
tanned skin, t1dm, arthralgia, loss of libido, fatigue?
haemochromatosis, Arec, transferrin >45%
triad: cirrhosis, DM, skin pigmentation. RSK HCC, hypogonadism, cardiomyopathy, amen
Patient with biliary colic and dilation ALP 300, CBD dilatd 10mm+
ERCP and sphincterectomy.
patients needing cholecystectomy:
recent cholangitis, recent acute pan, ALP 2x normal, dilated CBD 10mm+
choledocholithiasis
gallstones in common bile duct
cholecystolithiasis - gallstones in GB
real q: carcinoid syndrome presents with weakness, dermatitis, confusion. which vitamin deficiency?
what is carcinoid sx?
DX?
B3 niacin (+tryptophan) - causes pallegra, hypoalbuminsm
carcinoid syndrome (liver mets re;ease seratonin into circulaion) skin flushing, bronchospasm, diarrhoea,
Dx: urine 5-HIAA-hydroxyindoleacetic acid, plasma chomrogranin A (mets)
TX: somatostatin analogue, octreotide
radionuclide therapies
what is zenker diverticulum? (actual q)
pharyngeal pouch. outpouching at level of hypopharynx. palpable swelling in neck, its of coughing, regurgitated food at night. tx myotomy
Small bowel obs vs llarge bowel?
SMO: cx incarterated hernias, intemrittent pain, adhesions, tinkling B/S, obstruction sx. central gas shadow, now gas in large bowel. tx drip and suck
LBO - cancers
Persistent diarrhoea 2 weeks cause?
most common traveller’s cause?
most commone GE in englans/ wales?
giardia lamblia/ cyclospora spp
commoon travellers - e.coli
england/ wales - norrovirus
rotavirus - child
blood diarrhoea cx? - infections?
(bloody diarrhoea isnt SEXY, it’s SEECSY)
salmonella ecoli, enteramamoeba, campylobacter/CMV, d.diff, shigella/ schistosomiasis, entamoeba, yersinia
consider clarithromycin tx
c diff - vanc
Medications causing blooding diarrhoea?
abx, antacids (with MG), SSRI, PPI, statins, vit c, metformin, laxitives, chemo, cholicine, digoxin, abx, acei, allopurinol
Rf colorectal cancer?
most common site?
prigmented lesions of lips/ face/ palms and soles with FH?
DM, absbestsos, familial adenomatous polyposis, HNPCC, peutrz-jegher’s, UC, DM, early menopause nullipatiry, late first pregnancy.
FIT rules out. 10+ - do colonoscopy
rectum, then sigmoid
peutz-jegher’s
H Pylori associated with?
peptic ulcer, MALT lymphoma, gastric adenocarcinoma, menetrier’s disease, coronaritis, Fe deficiency anaemia. (not oesophageal canceR)
complications of coeliac?
before testing, how much gluten do patient need to eat?
FTT, delayed puberty, OP, anaemia, b12 deficiency
eat 2 meals for last 6 days
Rockall score includes? (acute UGIB mortalitiy)
co-morbitiies, age, shock, endoscopic findings, stigmata of acute bleed
What are alarm sx? in GOrd that raise liklihood of oesophagitis/ peptic stricture/ cancer?
anaemia, dysphagia, ahaematemsis, melaena, persisence vomitin, WL. if any of these sx/ 55+, refer to urgent endoscopy
dysphagia both solids and liquids, regurg, night coughing, GORD?
achalasia 0 failure of LOS relaxation. loss of peristaliss in distal oesphagus
central abdo pain radiating to back, better sitting forwards?
scores involved?
drug causes?
acute panc,
cullens- umbillicus, grey turnerys - flanks
GLASGOW (PANCREAS): Pa02,<8, Age 55+, neutrophils 15+. Ca<2, Renal (urea 16+), Enzymes (LDH 600+, AST 200+, Albumin <32, sugar 10+
Drug cx: HIv drugs, diuretics, chemo, azathioprine, oestrogen
IBS ROME criteria Dx?
What diet is recced?
recurrent abdo pain 1 day+/week in 3 months (onset 6months +) and 2+ of related to defecation/ change in frequency of stool/ stool form
diet: low FODMAP
most common cx of LGIB requiring hospital admission?
diverticular disease
RUQ pain, right shoulder pain, vomiting, fever, guarding?
Acute cholecystitis
hispanic, persistent RUQ pain, palpable mass, jaundice, anorexia?
GB carcinoma
RUQ pain, fever, jaundice?
acute cholangitis - abs cephalosporin+metronidaole
Abdo pain, jaundice, ascites, hepatomegaly, CT caudate lobe hypertrophy, occluded hepatic veins?
Buddchiari. post hepatic cx or portal HTN. (pobstruction to hepatic venous flow). common underlying thrombotic disease, TX: TIPS
post cholecystectomy, hc of dyspepsia. CXR showed pneumoperitoneum?
most common perforation of abdo viscus (ulcer) common after abdo surgery
Cx of retroperitoneal haemorrhage sign?
Grey turner’s acute pan, AAA ruptured, rupturex ectopic, blunt trauma
Blumberg sign
rebound tenderness (peritonitis)
dispepsia with regurg, CXr showed retrocardiac air bubble in intrathoracic portion of stomach?
hiatus hernia
Electrolyte causes of constipation?
high calcium autonomic nervous system, smooth muscle hypertrophy,
others: low K, hypothyroid, high MG, high PTH, t1DM
UC, 40YO, pruritus, fatigue?
PSC
50YO RA, pruritus, xanthelasmis lesions around eye, heatosplenomegaly, jaundice?
PBC
acute abdo pain, vomit, absolute constipation, AXR - dilated loop large bowel full of air, inverted U
sigmoid volvulus. LLQ colicky pain
Actual Q: test to exclude crohns?
faecal calprotectin
Prehepatic causes portal HTN?
intrahepatic?
post hepatic?
obstruction of portal/splenic vein, thrombosis, sepsis, tymour, fistula
intrahepatic: schistosomiasis, hepatitis, PBC, drugs, cirrhosis (mos tcommon)
Post hepatic: budd-chiari, constrictive pericarditis, IVC stenosis/ thrombosos/ tumour
RLQ pain, N+V, fever, red tender mass below inguinal ligament? woman parous
femoral hernia inferior and lateral to pubic tubercule 4x women high strangulation risk
. (but inguinal is more common in women)
rf for gastric cancer?
diet, smoking, blood group A, hypogammaglobulaenmia, H pylori, men, age 55+, post gastrectomy, pernicious anaemia, atrophic gastritis, poor, menetrier’s disease
Haemorrhoids grades and tx?
external vs internal?
most common cause of haematochezia
1- not below anal canal, not prolapse,
2 - reduce spontaneously - rubber band?
3 need manual reduction
4 - cant be reduced - need haemorrhoidectomy - rick of urine retention pos top
external distal to dentate line, internal- vascular rich inside anal - need proctoscopy/ sigmoidoscopy
painless haematochezia dropping into faeces?
internal haemorrhoids
HPV anal region name?
condylomata acuminata
Isolated ALP rise cx?
paget’s - bone
nitrofurantoin, phenytoin, erythromycin, disulfiram
pregnancy 3rd trim
adolescents,
40-65YO women (50% higher than 30YO)
CKS: if abnormal UCB(<3x rasied)?/ gilberts?
check in 1-3 months. if no rise, d/c
exclude haemolysis coombs, haptoglobin, LDH, FBC, reticulocyte, film
things associated with reduced risk of colorectal cancer?
NSAIDS, aspirin, Mg, folate, fruit, veg, fibre, dairy
20YO F, 2 day pain in RLQ, 6KGWL?
crohn’s disease
areas more prone to mesenteric ischaemia?
splenic flexure, rectosigmoid junction
bowel obstruction vs post operative leus?
ileus 3 days+ hs abscent/ hypoactive BS. obstruction has high pitched. distended abdo. tx with NBM abd NG for relief if vomiting
diarrhoea cx: bloody 6 hrs after eating hamburger at BBQ, has AKI and anaemia 8YO?
e.coli (most common cx in developed countries)
2 day blody diarrhoea, travelling, resolved then had painful knee?
cambylobacter - AF with reactive arthritis
bloody diarrhoea - resolves after, then 1 year after had pain, fevers, scleral icterus, tender RUQ
entamoeba histolytica
patient with UC, how to survey for colorectal cancer?
colonoscopy 1-5 yrs with multiple biopsies, regular intervals to chekc for dysplasia
45 YO, had appendectomy, has colicky abdo pain vomiting, distended abdo, tender, BS hyperactive
small bowel obstruction
Cx of amylase raised?
4 x is pancrreatitis likely (then returned to normal 3-5 dayafter)
renal failure, ectopic pregnancy, DKA, perforated duodenal ulcer, mesenteric ischaemia/infarction
factors pointing to toxic megacolon?
fever, tachycardia, leuocytosis, anaemia, dehydration/ GCS, U+e not normal, low BP, do AXR (erect) to show 6cm+ colonic dilation.
avoid barium enema due to risk of perforation
what is maydl’s hernia?
type of incarcerated hernia in W, obstructed loop of bowel within peritoneal cavity
Richter’s hernia?
anti-mesenteric wall of the intestine potrudes through fascial defect of abso wall. noted in laparoscopic port sites.
50YO man small tense red irreducable lump in lower abdomen right sid lateral edge of rectus muscle at semilunar line (coatal arch of pubic tubercule)
Spigelian hernia
