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GI Core Conditions Flashcards

1
Q

How many people experience GORD:
Daily?
Weekly?

A

1 in 10

1 in 5

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2
Q

Who gets GORD?

A

M>F, > 40, anyone

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3
Q

Causes of GORD?

A 
Reflux of acid above the lower oeso sphincter due to:
Hiatus Hernia
Sphincter dysfunction
Acid hypersecretion
Stress
Peptic ulcers
NSAIDs
SSRIs
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4
Q

GORD risk factors?

A 
High fat diet
Spicy/acidic food
Lying down after eating 
Pregnancy
Alcohol
Smoking
Respiratory conditions
Previous GORD surgery
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5
Q

Symptoms of GORD?

A 
Heartburn 
Reflux
Acid/bile regurg
Chest pain worsened by bending down 
Excessive salivation 
Dysphagia/odynophagia
Nausea
Persistent cough
Laryngitis
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6
Q

Differential diagnoses for GORD?

A

Oesophagitis
Gastric ulcers
Infections
Barrett’s oesophagus

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7
Q

Investigations for GORD?

A

Endoscopy
Barium swallow
24 hour intraluminal pH monitoring

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8
Q

Treatment for GORD?

A 
Alginate and antacids
Metoclopramide
H2 receptor antagonists (cimetidine)
PPIs (omeprazole)
Surgery for strictures/erosive oesophagitis 
Lifestyle changes
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9
Q

Which are more common, duodenal or gastric ulcers?

A

Duodenal (2-3x more likely)

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10
Q

Who gets peptic ulcers?

A

Older women, becoming more prevalent in developed countries due to H pylori

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11
Q

Causes of peptic ulcers?

A

H pylori
Drugs (NSAIDs, steroids, aspirin)
Malignancy

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12
Q

Risk factors for gastric ulcers? (5)

A 
Smoking 
Duodenal reflux
Delayed gastric emptying
Stress
Zollinger-Ellison syndrome
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13
Q

Risk factors for duodenal ulcers?

A

Smoking
Zollinger-Ellison syndrome
Blood group O

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14
Q

Symptoms of peptic ulcer disease?

A 
Burning epigastric pain 
Comes on at night
Worse when hungry 
DU alleviated by food/milk
GU causes N+V, anorexia, weight loss
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15
Q

Differential diagnoses for peptic ulcers?

A 
Gastritis 
Malignancy
GORD
Pancreatitis 
Cholecystitis 
Biliary colic
Inferior MI
Superior mesenteric ischaemia
Referred pain (pleurisy, pericarditis)
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16
Q

Investigations for peptic ulcers?

A 
IgG serology 
C-urea breath test
Stool antigen test (H pylori)
Endoscopy 
Biopsy
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17
Q

Treatment for peptic ulcers?

A

Eradication therapy (omeprazole, clarithromycin _ amxocillin/metronidazole)
Lifestyle changes
PPIs or H2 receptor antagonists
Surgery to remove the ulcer

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18
Q

Which are more common: upper or lower GI bleeds?

A

Upper GI bleeds

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19
Q

Who has upper GI bleeds?

A

Anyone, more common as you get older

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20
Q

Causes of upper GI bleeds?

A 
NSAIDs
Peptic ulcers
Mallory-Weiss tears
Gastroduodenal erosions 
Oesopahgitis
Oesophageal varices
Malignancy
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21
Q

Risk factors for upper GI bleeds?

A

Alcohol abuse
Chronic renal failure
Increasing age
Low SEC

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22
Q

Symptoms of upper GI bleeds?

A 
Haematemesis
Dizziness
Abdo pain 
Postural hypotension 
Cool extremities
Chest pain 
Confusion/delirium 
Dehydration 
Oliguria 
Stigmata of liver disease
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23
Q

Risk assessment for upper GI bleeds?

A

Rockall score (0-3) considers age, circulation (pulse +BP), comorbidity, endoscopic diagnosis, major SRH)

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24
Q

What signs indicate Boerhaave’s syndrome?

A

Subcut emphysema

Vomiting

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25
Q

Differentials for upper GI bleeds?

A 
Gastric varices
Mallory-Weiss tears 
Neoplasm
Benign tumour
Cirrhosis
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26
Q

Investigations for upper GI bleed?

A

Endoscopy

LFTs, FBC, coag, cross match, Ca and Gastrin levels

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27
Q

Treatment for upper GI bleeds?

A 
Stop NSAIDs, warfarin, aspirin
Give O2 
Saline if not shocked, blood if shocked 
Omeprazole for ulcer patients 
Monitor for signs of rebleed
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28
Q

How many cases of GI bleeds are lower GI?

A

1 in 3

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29
Q

Who has lower GI bleeds?

A

Elderly

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30
Q

Risk factors for lower GI bleeds?

A 
Elderly
Coagulopathy
Anticoagulated
Liver disease 
NSAIDs 
GORD
Gastritis 
Colorectal cancer
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31
Q

Symptoms of lower GI bleeds?

A

Blood in stool (maroon –> bright red)
Abdo/rectal pain
Diarrhoea
Mucous (IBD in the young, ischaemic colitis in the old)
Blood drops in toilet (fissures/haemorrhoids)
Massive haemorrhage presents with systolic <90mmHg and Hb<6g/dL

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32
Q

Causes of lower GI bleeds?

A 
Colorectal cancer
Diverticulosis
Angiodysplasia
Proctitis 
Infective/ischaemic colitis
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33
Q

Investigations for lower GI bleeds?

A

Colonoscopy
Faecal occult blood test
Angiography (for angiodysplasia)

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34
Q

Treatment for lower GI bleeds?

A

O2, vital signs monitor, IV fluids, surgery or endoscopic haemostasis

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35
Q

Who gets Crohn’s disease?

A

Younger people
Women>Men
People of Jewish heritage

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36
Q

Causes of Crohn’s?

A

Genetics
Immune system disruption
Environmental (disease f the west)
Mycobacterium avium paratuberculosis

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37
Q

Risk factors for Crohn’s?

A 
Western diet 
Younger age (more aggressive disease)
Smoking
FHx
Intestinal parasite exposure 
Long term use of OCP 
Caucasian/Jewish
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38
Q

Symptoms of Crohn’s?

A 
Diarrhoea
Abdo pain
Weight loss
Malaise
Lethargy
Nausea/vomiting
Fever
RIF pain 
Aphthous ulcers 
Skip lesions
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39
Q

Differentials for Crohn’s?

A 
Coeliac disease 
Lactose intolerance
UC
Functional diarrhoea
GI infection (TB)
Colorectal malignancy 
Anorexia nervosa
Appendicitis
Diverticulosis
Gastroenteritis
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40
Q

Investigations for Crohn’s?

A 
Serum B12
FBC, inflammatory markers, LFTs, blood cultures 
pANCA -ve 
Saccaromyces cerevisiae Ab PRESENT 
Stool cultures 
Radiology
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41
Q

Treatment for Crohn’s?

A

Control diarrhoea (loperamide or codeine phosphate)
Glucocorticosteroids (budenoside)
Enteral nutrition
Aminosalicylates (azathioprine)
Immunosuppression with monoclonalAbs (infliximab)
Surgical resection

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42
Q

Who gets UC?

A

People of Jewish heritage

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43
Q

Causes of UC?

A

Genetics
Immune system
Environmental

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44
Q

Risk factors for UC?

A 
Western diet 
Younger age (more aggressive)
FHx
NSAIDs
Intestinal parasite exposure
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45
Q

Symptoms of UC?

A 
Diarrhoea with blood/mucous
Malaise 
Lethargy 
Anorexia + weight loss
Proctitis + blood in stool 
Urgency and tenesmus 
Distended abdomen 
PR may show blood
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46
Q

Differentials for UC?

A 
Crohn's
Functional diarrhoea 
GI infections 
Malignancy 
Diverticulitis 
Polyps 
IBS
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47
Q

Investigations for UC?

A

FBC, LFTs, U+Es, CRP
Faecal calprotectin
pANCA +ve
Saccharomyces cerevisiae Ab possible
Stool cultures
Sigmoidoscopy (rigid) shows inflamed, bleeding, fraible mucosa
AXR - lead piping (chronic) and thumbprinting (exacerbation)

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48
Q

Treatment for UC?

A

Oral aminosalicylate (azathioprine) and steroids,
Ciclosporin (cannot be used long term)
Infliximab
Surgery

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49
Q

When do patients typically present with IBS?

A

30s-40s

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50
Q

What typically precipitates IBS?

A

A bout of gastroenteritis

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51
Q

Causes of IBS?

A

Unknown
Changes in gut bacteria/digestive ability
More sensitive to gut pain
Psychological factors
Post food poisoning
Certain foods (caffeine, fatty foods etc)

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52
Q

Risk factors of IBS?

A

Acute GI infection/inflammation
Young
Female
FHx

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53
Q

Symptoms of IBS?

A 
Diarrhoea
Constipation 
Abdo pain
Bloating
Worse on eating 
Relieved on defaecation 
Lethargy 
Nausea
Backache 
Bladder symptoms
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54
Q

Differentials for IBS?

A 
IBD
Colonic cancer 
Coeliac disease 
Gastroenteritis 
Diverticular disease 
Endometriosis 
Ovarian tumours 
Anxiety/depression 
Somatisation
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55
Q

Investigations for IBS?

A 
FBC, inflammatory markers 
Coeliac serology 
Lactose intolerance testing 
Stool culture 
Colonoscopy (malignancy suspected)
Faecal calprotectin 
CA125 (if concerned about ovarian cancer)
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56
Q

Treatment for IBS?

A 
Diet change 
Exercise
Laxatives
Antidepressants
Hypnotherapy 
Probiotics 
Smooth muscle relaxants (alverine)
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57
Q

How many people are affected by gastroenteritis every year?

A

1 in 5

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58
Q

What is the most common cause of gastroenteritis in adults?

A

Norovirus

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59
Q

Most common cause of gastroenteritis in children?

A

Adenovirus/rotavirus

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60
Q

Who gets gastroenteritis?

A

Anyone (mainly children)
Travel to foreign countries
Infants in day care
Elderly

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61
Q

Viral causes of gastroenteritis?

A

Norovirus
Rotavirus
Adenovirus

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62
Q

Bacterial cause of gastroenteritis?

A 
Campylobacter 
E coli (esp O157)
Salmonella
Shigella
Staph aureus toxins 
Bacillus cereus 
C perfringens
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63
Q

Parasitic causes of gastroenteritis?

A

Cryptosporidium spp
Entamoeba histolytica (amoebiasis)
Giardia lamblia

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64
Q

Risk factors for gastroenteritis?

A

Poor hygeine/sanitation
Compromised immune system (HIV/AIDs)
Achlorydia (esp for salmonella and campylobacter )
Food poisoning

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65
Q

Symptoms of gastroenteritis?

A

V+D, abdo pain
Blood suggests E coli, E. histolytica or if from exotic location - salmonella
Pyrexia and fatigue in adults suggests invasive organism

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66
Q

Differentials for gastroenteritis?

A 
Travellers diarrhoea
Volvulus
UTI Constipation with overflow 
gastritis 
NSAID or alcohol abuse 
IBD
Addison's 
(Pre) eclampsia
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67
Q

Investigations for gastroenteritis?

A

Stool microscopy, culture and sensitivity (if blood/mucous in immunocomp pts)
Bloods in patient is unwell
Bowel distention = imaging

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68
Q

Treatment for gastroenteritis?

A

ORS for the frail/elderly
Small light meals
Prevent infection spread (avoid work until 48 hours post diarrhoea)
Loperamide for adults with normal diarrhoea (no blood, mucous, pyrexia)
Abx for bacterial/protozoal infections (metronidazole or oral vancomycin)

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69
Q

Why are the rates of acute pancreatitis on the rise?

A

Alcohol abuse

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70
Q

At what age do you see:

a) alcohol related pancreatitis?
b) gallstone related pancreatitis?

A

a) 38

b) 69

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71
Q

Causes of acute pancreatitis?

A 
Gallstones
Alcohol 
Infections (mumps, coxsackie B)
Pancreatic tumours
Drugs (valproate, corticosteroids)
Ischaemia
Trauma
72
Q

Risk factors for acute pancreatitis?

A 
Anatomical or functional disorders (sphincter of Oddi dysfunction)
SLE
Alcohol abuse 
Hypercalcaemia
Hyperparathyroidism 
Vasculitis 
Hyperlipidaemia
73
Q

Symptoms of acute pancreatitis?

A

Epigastric pain
N+V
Radiates to back
Tenderness and guarding
Reduces/absent bowel sounds in late stages
Severe necrotising pancreatitis leads to Cullen’s (periumbilical) and grey Turner’s (right flank)
Jaundice/cholangitis if gallstones

74
Q

Differentials for acute pancreatitis?

A 
Acute mesenteric ischaemia
Cholangitis
Cholecystitis 
Ectopic pregnancy 
Diabetic ketoacidosis 
Perforated duodenal ulcer 
Atypical MI
75
Q

Investigations for acute pancreatitis?

A 
Serum amylase (3x normal levels = diangosis)
Serum lipase 
FBC, LFTs, U+Es, inflammatory markers 
CXR
Abdo US
CT/MRI
76
Q

Treatment for mild acute pancreatitis?

A 
Normal ward 
Pain relief 
IV fluids 
NBM
Abx if specific infection 
No imaging
77
Q

Treatment for severe acute pancreatitis?

A 
STEP UP TO HDU 
Necrosis = IV Abx
Enteral nutrition 
Surgery if necrosis 
Percutaneous catheter to drain 
Hyperbaric O2 therapy
78
Q

Who gets chronic pancreatitis?

A

M>F, >40 years old

79
Q

Causes of chronic pancreatitis?

A

Reduced bicarb excretion –> activation of pancreatic enzymes
Genetic
Autoimmune (PBC and sjorgens have assocaiteions)
Abnormal pancreas
Biliary tract disease

80
Q

Risk factors for chronic pancreatitis?

A 
Alcohol
Smoking 
Anatomical or function disorders 
SLE 
Hypercalcaemia
Hyperparathyroidism 
Vasculitis
81
Q

Symptoms of chronic pancreatitis?

A 
Epigastric pain 
Radiates to back 
N+V 
Anorexia 
Severe weight loss 
Exocrine ad endocrine insufficiency 
Cholangitis and jaundice
82
Q

Differentials for chronic pancreatitis?

A 
Cholangitis
Cholecystitis 
Crohn's
Gastritis 
Mesenteric artery ischaemia
Peptic ulcers 
Pneumonia
MI 
AAA
Acute hepatitis
83
Q

Investigations for chronic pancreatitis?

A 
Serum amylase. serum lipase, LFTs, FBC, inflammatory markers, BM, creatinine
CXR
Abdo US
CT/MRI
Faecal elastase levels 
PABA test
Secretin stimulation test 
Diagnostic ERCP
84
Q

Treatment for chronic pancreatitis?

A 
Stop drinking alcohol 
Stop smoking 
Analgesia - amitriptylline 
Enzyme replacements if malabsorption occurs 
Restrict fat in diet if steatorrhoea is present 
Insulin if diabetes develops 
Vitamin supplements may be needed 
Surgery
85
Q

What types of gallstones are there?

A

Cholesterol (80% in the Western world)
Pigment
Mixed

86
Q

Who gets gallstones?

A 
Fat 
Female 
Fertile
Forty
Fair
87
Q

What causes gallstone precipitation?

A

Lack of melatonin

Melatonin inhibits cholesterol secretion and enhances its conversion to bile

88
Q

Risk factors for gallstones?

A 
Increasing age
Female
FHx
Multiparity 
Obesity 
Rapid weight loss
High fat, low fibre diet 
OCP 
DM
Cirrhosis
89
Q

Symptoms of gallstones?

A 
Asymptomatic
Biliary colic
Crescendoing abdo pain 
Worse on eating fatty foods
Epigastric pain --> shoulder tip
N+V 
Cholecystitis = +ve Murphy's sign
90
Q

Differentials for gallstones?

A 
Reflux
IBS
Pancreatitis 
Right colon cancer 
Atypical peptic ulcers 
Renal colic
91
Q

Investigations for gallstones?

A 
LFTs, FBC
ECG
CXR
Abdo US
Biliary scintigraphy using technetium derivatives of iminodiacetate (outlines the biliary tree apart from in acute cholecystitis)
92
Q

Treatment for gallstones?

A

Cholecystectomy
Stone dissolution
Stone wave lithiotripsy

93
Q

When is hepatitis A mainly seen?

94
Q

What is the most common cause of acute hepatitis?

A

Hepatitis A

95
Q

How is Hep A spread?

A

Faecal-oral

96
Q

Incubation of Hep A?

A

2-6 weeks, most infectious 2-3 weeks post infection

97
Q

Risk factors for Hep A?

A 
Poor sanitation 
Men who have sex with men 
Sexual practices with oro-anal contact 
Sweage/lab workers 
HIV
Travel to high risk areas 
Receiving factor VIII and IX 
Not vaccinated
98
Q

Symptoms of Hep A?

A

Flu-like prodrome (precedes icterus phase)
Poor appetite
Pressure/pain from enlarged liver
Skin rash
More developed stages: jaundice, dark urine, pale stools, abdo pain, pruritus

99
Q

Differentials for Hep A?

A 
Drug induced liver injury 
Ischaemic hepatitis
HIV
CMV
Other forms of viral hepatitis
100
Q

Investigations for Hep A?

A

IgM Ab for HAV appears with symptoms and persists for 3-6 months
IgG appears soon after IgM and persists for years (indicates previous infection or immunisation)
LFTs, PTT
US if concern about cause

101
Q

Treatment for HAV?

A

Immune system can deal with it
Analgesia
Fluids
Admit if vomiting/systemically unwell

102
Q

Where is HBV more prominent?

A

Africa
Middle East
Far East

103
Q

How is HBV spread?

A

Parenterally

Vertical transmission is common

104
Q

Hep B E Ag +ve is associated with?

A

High replication rates

More infectious disease

105
Q

Incubation of HBV?

A

2-3 months

106
Q

Risk factors for HBV?

A 
Alcohol use
Poor sanitation 
Needle sharing 
MWHSWM
HIV +ve
Sexual contact 
Liver disease 
O-A contact 
Lab/sewage workers
107
Q

Symptoms of HBV?

A 
Anorexia/nausea 
RUQ ache 
Insidious onset 
Malaise, fatigue 
Slight fever 
Aching joints/muscles 
Headache 
More advance = jaundice
108
Q

Differentials for HBV?

A 
Drug induced 
Ischaemic 
Wilson's 
Acute fatty liver of pregnancy 
Other forms of hepatitis
109
Q

Investigations for HBV?

A 
HBsAg
HBeAg
Anti-HBe
Anti-HBs
Anti-HB core 
Quantitative Hep B viral DNA
HBV genotype 
HDV serology 
LFTs, FBC
Autoantibody screen 
Check for HCV
110
Q

Treatment for HBV?

A

Stop alcohol
Stop unnecessary drugs
Pts with E Ag HBV or decompensated liver disease get 48 weeks of peginterferon alpha-2a

111
Q

What percentage of IVDUs have hep C?

112
Q

How is HCV spread?

A

Parenteral transmission

113
Q

Who gets HCV?

A 
IVDU 
Male 
>40 (worse prognosis)
Drink alcohol 
Co-infection with HIV, HBV
Immunosuppressed 
Obese 
DM
114
Q

HCV incubation?

115
Q

How many genotypes of HCV are there? Which requires the most treatment?

A

3
Genotype 1 requires most treatment
Can be cross infected

116
Q

Risk factors for HCV?

A 
IVDU
Blood transfusions
Pregnancy/BF
Sexual intercourse (rare)
Needlestick 
Non-sterile piercings/tattoos/medical equipment
117
Q

Symptoms of HCV?

A

Often asymp
Chronic infections –> malaise, lethargy, weakness, anorexia
Acute: jaundice and deranged LFTs
75% –> chronic (cirrhosis + HCC)

118
Q

Differentials for HCV?

A 
Drug induced 
Ischaemic
Wilson's 
Acute fatty liver of pregnancy 
Other hepatitis types
119
Q

Investigations for HCV?

A 
Anti-HCV serology (+ve 3 months post exposure)
HCV RNA (shows ongoing activity)
Anti HCV Abs (remain for life) 
Baseline US
Biopsy 
LFTs
120
Q

Treatment for Hep C?

A

Uncomplicated + acute = supportive
Early interferon may prevent complications (unlicensed)
Peginterferon alpha 2-a (SC, weekly)
Daily (oral) ribavirin
Genotype 1 requires bocepavir and telaprevir

121
Q

Who gets HDV?

A

5% of HBV carriers

IVDUs

122
Q

How is it transmitted?

A

Parenterally

123
Q

What is HDV?

A

A defective single strand RNA that requires the presence of HBsAg to replicate

124
Q

Difference between co-infection and superinfection?

A 
Co-infection = acquired at the same time 
Superinfection = HBV acquired first then subsequent HDV infection
125
Q

Risk factors for HDV?

A

Sharing neeldes
MWHSWM
HIV
Blood transfusions

126
Q

Symptoms of HDV?

A 
Anorexia
Nausea 
RUQ ache 
Insidious onset 
Malaise, lethargy 
Fever 
Aching muscles/joints 
Headaches 
Skin rash 
Later = jaundice
127
Q

Investigations for HDV?

A

Anti-HDV Ab
LFTs
Hep B investigations

128
Q

Treatment for HDV?

A

Interferon a and lamivudine

Transplantation

129
Q

In what cases of HEV are mortality rates high?

A

Pregnancy and intrauterine infections

130
Q

How is HEV spread?

A

Faecal-oral route

131
Q

Incubation of HEV?

132
Q

Risk factors for HEV?

A 
Alcohol
Poor sanitation 
Needle sharing 
MWHSWM 
HIV 
Oral-anal contact 
Lab/sewage workers 
Liver disease
133
Q

Symptoms of HEV?

A 
General malaise 
Slight fever 
Nausea 
Anorexia 
Taste changes 
RUQ ache 
Aching joints/muscles 
Headache 
Skin rash 
More developed = jaundice
134
Q

Differentials for HEV?

A 
Drug induced 
Wilson's 
Ischaemic hep 
Acute fatty liver of pregnancy 
Other hep causes
135
Q

Investigations for HEV?

A

IgM anti-HEV Ab

HEV RNA can be detected in serum or stools

136
Q

Treatment for HEV?

A

Supportive

No documented cases of chronic infection

137
Q

What is the most common surgical emergency?

A

Appendicitis

138
Q

Who gets appendicitis?

A

Mainly teenagers and young adults
More common in the West
M>F (slightly)

139
Q

Causes of appendicitis?

A

Faecal matter trapped in appendix causing blockage and allowing bacteria to multiply
IBD

140
Q

Risk factors for appendicitis?

A 
Age (11-20)
Male 
Low fibre, high refined carbs 
FHx
GI infections (amoebiasis)
Bacterial gastroenteritis 
Mumps
Adenovirus
141
Q

Symptoms of appendicitis?

A

Abdo pain that begins paraumbilical and then localises to the RIF (McBurneys point)
N+V
Anorexia
Rebound tenderness due to localised peritonitis
Fever + tachycardia suggest peritonitis

142
Q

Differentials for appendicitis?

A 
Bowel obstruction 
Strangulated hernia 
Perforated ulcer 
Acute terminal ileus due to Crohn's 
Pancreatitis 
Diverticulitis 
Ruptured ectopic 
Ovarian torsion 
Ovarian cyst rupture 
Testibular torsion 
Renal calculi 
UTI
143
Q

Investigations for appendicitis?

A 
Abdo exam
US and CT 
Urinalysis 
FBC, inflammatory markers 
Cross match and coag screen
144
Q

Treatment for appendicitis?

A

Open/laproscopic appendectomy

Abx to prevent infection

145
Q

Whats percentage of obstructions are small bowel?

146
Q

Who gets small bowel obstructions?

A

Often seen in those with dementia, MS, Parkinson’s, quadreplegia

147
Q

Causes of small bowel obstruction?

A 
Adhesions 
Hernias 
Crohn's 
Intussusception (children)
Malignancy
148
Q

Risk factors for small bowel obstruction?

A 
Paralytic ileus 
Intestinal pseudo-obstruction (Ogilive's syndrome)
Post-operative ileus/strictures 
Congenital GI malformations
Meconium ileus in CF 
Hirschsprung's 
Malignancy (rare - would be in caecum)
149
Q

Symptoms of small bowel obstructions?

A 
Abdo colic 
Abundant vomiting 
Late = absolute constipation 
Quickly progressing 
Severe pain + tenderness suggests perforation 
Distention 
Visible peristalsis
150
Q

Differentials for small bowel obstruction?

A 
Gastroenteritis 
Ischaemia of the gut 
Pancreatitis 
Perforation 
Peptic ulcers 
LBO 
Consider MI
151
Q

Investigations for SBO?

A 
Abdo exam 
Check for femoral hernias 
AXR 
FBC, U+E, creatinine, cross match 
CT + US
152
Q

Treatment for SBO?

A

IV fluids
Decompression
Laparotomy with removal of obstruction if gangrenous tissue is present

153
Q

What condition commonly presents with LBO?

A

Colorectal cancers

154
Q

Who gets LBO?

A

> 70 years old

155
Q

Causes of LBO?

A

Carcinoma
Sigmoid volvulus
Diverticular disease

156
Q

Risk factors for LBO?

A 
Colorectal cancers 
Paralytic ileus 
Intestinal pseudo-obstruction 
Post-operative ileus 
Congen GI malformations 
Meconium ileus in CF 
Hirschsprung's
157
Q

Symptoms for LBO?

A 
Pain 
Tenderness 
Tinkling bowel sounds 
Absolute constipation 
Distention 
Severe pain + tenderness suggest perforation
158
Q

Differentials for LBO?

A 
Gastroenteritis 
D+V tinkling 
Ischaemia of the gut 
Perforation 
Pancreatitis 
Peptic ulcers 
Consider ovarian carcinoma
159
Q

Investigations for LBO?

A 
Abdo exam
AXR
US + CT 
FBC, U+E cross match, creatinine 
Enema if suspicious of low level obstruction 
Water soluble enema for adhesions
160
Q

Treatment for LBO?

A 
IV fluids
Decompression 
Colorectal stents 
Defunctioning colostomy 
Sigmoid volvulus may be managed with a flexible sigmoidoscope or rectal tube 
Persistent volvulus = RESECTION
161
Q

What % of groin herniae are femoral?

162
Q

Who gets femoral hernias?

A

Parous women, middle aged/elderly

163
Q

Causes of femoral hernias?

A 
Chronic constipation 
Chronic cough
Heavy lifting 
Obesity 
Straining to urinate (enlarged prostate)
164
Q

Risk factors for femoral herniae?

A

Obesity

Smoking

165
Q

Symptoms of femoral herniae?

A

Lump in groin, lateral and inferior to the pubic tubercle (large may bulge over the inguinal ligament)
Cough impulse
Reduces when relaxed/supine
Can be reducible/non-reducible/strangulated/obstructed

166
Q

Differentials for femoral hernias?

A 
Inguinal hernia 
Lymph node in groin 
Ectopic testes 
Psoas abscess 
Psoas bursa 
Li[oma 
Hydrocele 
Varicocele
167
Q

Investigations for femoral hernia?

A

Mainly clinical exam
Exploration at surgery
Herniography may be performed for groin pain

168
Q

Treatment for femoral hernia?

A

Surgery (low, transinguinal or high approach) that involves dissecting the sac and reducing its contents, ligating the sac and closing the inguinal and pectineal ligaments
LA or GA
Laproscopic studies seem promising

169
Q

What is the most common type of hernia?

170
Q

Who gets inguinal hernias?

171
Q

Causes of inguinal hernias?

A 
Chronic constipation 
Chronic cough 
Heavy lifting 
Obesity 
Straining to urinate
172
Q

Risk factors for inguinal hernias?

A 
Infants (male, premature)
Male
Obese
Constipation 
Chronic cough
Heavy lifting
173
Q

Symptoms of an inguinal hernia?

A

Swelling in groin
Severely painful
Cough impulse
May be reducible
Enlarges with time due to fibrous adhesions (may stop being reducible)
Examine standing and supine, ask to cough
Can become strangulated
Congenital inguinal hernias need urgent surgical repair

174
Q

Differentials for inguinal hernias?

A 
Femoral hernia
Hydrocele
Varicocele 
Spermatic cord hydrocele
Lymph node
Abscess
Bleeding 
Undescended testes
175
Q

Investigations for inguinal hernias?

A

US

Herniography with XR contrast in peritoneum

176
Q

Treatment for inguinal hernias?

A

Small = none
More complicated = reduction/excision of sac and closure of defect
Lapro if bilateral/recurrences
Surgery can be day case
Avoid driving/lifting for 7 days post-repair
In children herniotomy (ligation and excision of patent processus vaginalis) is performed

Year 3 (9 decks)

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