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OSCE > GI clinical > Flashcards

GI clinical Flashcards

1
Q

What are causes of pre-hepatic jaundice?

A

Haemolysis

  • Haemolytic anaemia
  • Blood transfusions
  • Haemolytic drugs
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2
Q

What type of billirubin is not reabsorbed in the terminal illeum?

A

Conjugated bilirubin (soluble)

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3
Q

What are causes of hepatic jaundice?

A
  • Hepatitis
  • Cirrhosis
  • Hepatic carcinoma
  • Gilbert’s syndrome
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4
Q

What are causes of post-hepatic jaundice

A 
Extrahepatic causes 
- Calculous cholecystitis 
- Carcinoma of head of pancreas
- Pancreatic oedema 
- Acalculous cholecystitis 
Intrahepatic causes 
- Swelling / fibrosis from cirrhosis
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5
Q

What is corvoirier’s sign?

A

Palpable gall bladder that is painless - sign of malignancy

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6
Q

What lab tests should be done when a patient has jaundice?

A
  • FBC
  • LFTs
  • Bilirubin fractionation
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7
Q

What kind of jaundice is indicated when indirect bilirubin is increased and ALP and AST are normal?

A

Pre hepatic cause of jaundice (haemolysis)

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8
Q

What are possible causes of GI clubbing?

A
  • Malabsorption (coeliac)
  • Inflammatory bowel disease
  • Lymphoma
  • Cirrhosis
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9
Q

What is asterixis?

A
  • Coarse flapping tremor

- Occurs with hepatic encephalopathy

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10
Q

What can cause koilonychia?

A

Hypochromic anemia, especially iron-deficiency anemia

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11
Q

What can cause hepatomegaly?

A
  • Hepatitis
  • Alcoholic liver disease
  • Right heart failure
  • Fatty infiltration
  • Biliary tract obstruction
  • Malignancy (metastatic/primary)
  • Haematological disorders
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12
Q

What is Murphy’s sign indicative of?

A
  • Gall bladder tenderness

- Acute cholecystitis

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13
Q

Courvoisier’s sign

A
  • Painless jaundice and a palpable gallbladder
  • Likely due to extrahepatic obstruction
  • Could be due to pancreatic cancer and unlikely due to gallstones
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14
Q

What are the causes of splenomegaly?

A
  • Haematological - haemolytic anaemia / leukaemias / polycythaemia ruba vera / lymphoma / myeloproliferative disease / myelofibrosis
  • Infective (endocarditis, schisto, TB, malaria)
  • Portal hypertension
  • Rheumatological disorders - Rheumatoid arthritis / SLE (lupus)
  • Rarer - sarcoidosis / amyloidosis / glycogen storagge disease
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15
Q

What are some of the causes of renal enlargement?

A
  • Hydronephrosis (urine build-up)
  • Polycystic kidney disease
  • Renal cell carcinoma
  • Neproblastoma (WIlm’s tumour) (children)
  • Solitary cysts
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16
Q

What are some causes of ascites?

A
  • Hepatic cirrhosis
  • Intra-abdominal malignancy
  • Nephrotic syndrome
  • Cardiac failure
  • Pancreatitis
  • Constrictive pericarditis
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17
Q

What pathologies should you look for in male reproductive examination?

A
  • Infection (epididymitis, orchitis, epididmyo-orchitis)
  • Torsion
  • Epididymal cysts
  • Testicular tumours
  • Indirect inguinal hernia
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18
Q

What enzyme has increased levels only in acue liver injury?

A

AST and ALT

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19
Q

What protein is decreased in patients who have had chronic liver disease or liver injury in the past?

A

Albumin

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20
Q

Which liver enzyme is found in not just the liver but may be found in the heart, muscle, idney and RBCs?

A

AST (ALT found predominantly just in the liver)

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21
Q

What other pathologies (other than hepatocellular and biliary) may cause increased AST levels?

A
  • Rhabdomyolysis
  • Acute MI
  • Haemolysis
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22
Q

What is an AST level which is double that of ALT suggestive of?

A

Alcohol as the cause of liver disease.

- If ALT is greater than AST the liver disease is most likely not caused by alcohol

23
Q

What does an AST:ALT ratio above 5 indicate?

A

Extrahepatic cause e.g:

  • Rhabdomyolysis
  • Acute MI
24
Q

What is HELLP syndrome?

A

Complication of pregnancy

  • Haemolysis (elevated LDH)
  • Elevated liver enzymes (AST and ALT)
  • Low platelets
25
Q

What pathologies can lead to AST and ALT levels in the 1000s?

A
  • Drug toxicity
  • Acute viral hepatitis
  • Ischaemic hepatitis
  • Acetaminophen overdose
26
Q

What are the tests of synthetic function in the liver?

A
  • Prothrombin time
    Internation normalised ratio
  • Platelet count
  • Albumin level
27
Q

What is the term for low blood cell count?

A

Pancytopenia

28
Q

What is the term for low platelet count?

A

Thrombocytopenia

29
Q

What is the term for low white cell count?

A

Leukopenia

30
Q

What etiologies cause an increase in ALP?

A

High bone turnover or bone loss:

  • Bone metastases
  • Paget’s disease of bone
  • Hyperthyroidism
  • Hyperparathyroidism

Pregnancy

31
Q

What other than biliary and hepatocellular disease may cause increased GGT levels?

A
  • Alcohol abuse
  • Diabetes
  • Phenytoin (anti-convulsant)
  • Renal failure
32
Q

What hereditary disease may cause a significantly low ALP?

A

Wilson’s disease

33
Q

What substance is responsible for the brown colour of stool?

A

Stercobilin

  • Conjugated bilirubin is broken down into urobilinogen which is in turn broken down into stercobilin
  • Intestinal bacteria in the colon break dwon both substances to create stercobilin
34
Q

What substance gives urine its yellow colour?

A

Urobilin (aka urochrome)

- Broken down from urobilinogen

35
Q

What can high bilirubin cause?

A

In severe cases seizures

36
Q

What is the syndrome called which is caused by high bilirubin in neonates?

A

Kernicterus

37
Q

What does Charcot’s triad indicate?

A

Cholangitis

38
Q

What are the 3 components of Charcot’s triad?

A
  • RUQ pain
  • Fever
  • Jaundice
39
Q

What are the 5 components of Reynold’s pentad?

A
  • RUQ pain
  • Fever
  • Jaundice
  • Hypotonia
  • Altered mental status
40
Q

What is given in cholecystitis and cholangitis?

A
  • IV fluids
  • Analgesics
  • Antibiotics
41
Q

What can cause cholangitis?

A
  • Obstruction
  • Pancreatitis
  • Strictures
42
Q

What may cause gall stones (cholelithiasis)?

A
  • Increased cholesterol (obesity, old, female, weight loss)

- Decreased emptying of gallbladder (fasting, pregnancy, spinal cord injury)

43
Q

What are black pigment gallstones caused by?

A
  • Haemolysis
  • Sickle cell
  • Thalasemia
44
Q

What are brown pigment gallstones caused by?

A

Infection

45
Q

What may be a complication of cholelithiasis?

A

Gallstone illeus

46
Q

What is the treatment of choledecholithiasis?

A
  • ERCP
  • Analgesics
  • Antiobiotics
47
Q

What are cholethiasis treated with?

A
  • Oral bile acid
  • Lithotripsy
  • Cholecystectomy
48
Q

What can choledicholithiasis cause?

A

Pancreatitis

49
Q

What are the causes of cholecystitis?

A
  • Obstruction
  • Parasites
  • Acalculus cholecystitis (TPN, sickle cell, DM)
50
Q

What may cause cholangitis?

A
  • Obstruction most common cause
  • Pancreatitis
  • Strictures
51
Q

What enzyme is increased in pancreatitis?

A

Amylase

52
Q

What are the upper left and right regions of abdomen called?

A

Right and left hypochondrium

53
Q

What is the middle region of the abdomen called?

A

Periumbilical region

54
Q

What is the upper medial region of the abdomen called?

A

Epigastric region

OSCE (10 decks)

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