GI corrections Flashcards
1
Q
what is the change in epithelium for Barrett’s oesophagus?
A
a normal stratified squamous layer of the oesophagus is replaced by simple columnar (glandular) epithelium
2
Q
what is a mechanical inhibitor of gastric acid secretion?
A
nausea
3
Q
what has a direct vasoconstrictive effect on BV: angiotensin I angiotensin II aldosterone renin non of the above
A
angiotensin II
4
Q
Where is the IVC located in relation to the peritoneum?
A
posteriorly
5
Q
What are the two main areas of the oral cavity?
A
oral cavity proper and the vestibule
6
Q
What is a smooth liver a sign of in conjuction with COPD?
A
RS HF- cor pulmonae
7
Q
What does somastatin do and how?
A
regulatescontol of HCL secretion in stomach, decreases motility, secretion and absorption in response to an increase in fatty acids, plasma amino acids and blood glucose
8
Q
Which of the following statements is true of achalasia?
a) The condition is caused by vitamin B deficiency
b) Dysphagia occurs for liquids but not solids
c) Endoscopy reveals a ‘bird’s beak appearance’
d) Balloon dilatation of the lower oesophageal sphincter is usually ineffective
e) There is an increased risk of oesophageal cancer
A
e
9
Q
Which of these is not known to cause dysphagia?
a) Cervical spondylosis
b) Diabetes mellitus
c) Old age
d) Depression
e) Multiple sclerosis
A
a
10
Q
Regarding peptic ulcer disease, which of these statements is true?
a) There is no association between socioeconomic status and H. pylori infection
b) The risk of acquiring H. pylori infection declines after childhood
c) Gastric ulcers are more common than duodenal ulcers
d) The pain of gastric ulcers is classically relieved by eating
e) The Zollinger–Ellison syndrome has no known cause
A
b- you acquire it in childhood, but the manifestation of it isnt until your older
11
Q
is oral candiasis a risk for oesophageal cancer?
A
no
12
Q
If a patient presents with liver disease and haematemesis, what do they have>
A
oesophageal varices
13
Q
virchow’s node is?
A
left supraclavicular lymph node
14
Q
what cells do the GISTs originate from?
A
Cajal
15
Q
what is the mutation of gene that causes diffuse gastric cancer?
A
CDH1
16
Q
epithelia change in gastric intestinal cancer?
A
columnar glandular epithelium to simple columnar epithelium (intestinal epithelium)
17
Q
are duodenal or gastric ulcers more common?
A
duodenal
18
Q
What blood group is at risk for gastric cancer?
A
blood group A
19
Q
If reed-sternburg (red cell) is found in left supraclavicular lymph node what type of cancer is it?
A
Hodgkins b cell lymphoma
20
Q
what cancer develops gastric linitis and what is it?
A
diffuse gastric adenocarcinoma, harding of stomach so it appears like a leather bottle
21
Q
metastases of gastric cancer
A
liver
peritoneum
umbilicus
lymph nodes
22
Q
what type of gastrectomy do you get if tumor in proximal 1/3rd of stomach?
A
total
23
Q
what type of gastrectomy do you get if tumor in distal 2/3rd of stomach?
A
partial
24
Q
what type of gastritis leads to B12 deficiency and why?
A
automimmune affects intrinsic factor which is responsible for B12 absorption
25
what type of gastritis has macrolytic anaemia associated with it?
autoimmune
26
what type of gastritis is most likely to lead to cancer?
atrophic
27
causative organism for unpasteurised milk/ undercooked meat?
campylobacteria
28
causative organism for undercooked beef?
e coli
29
causative organism for cold meat/ soft cheese?
listeria
30
causative organism for someone returned from camping?
aeromas
31
causative organism for care home virus?
norovirus
32
causative organism for nursery?
rotavirus
33
causative organism for eggs?
salmonella
34
causative organism for rice?
bacillus cereas
35
causative organism for antibiotic bacteria?
c diff
36
causative organism for undercooked food/ milk?
staph aureus
37
causative organism for pork?
yersinia enterocolivia
38
what type of ulcer can acctually be relieved by eating/ weight gain?
duodenal
39
What is usually hypertropied in duodenal ulcers and why?
brunner's glands
| body trying to produce more mucus
40
what protein is found in gluten?
gliadin
41
what are the genes for coeliac?
HLA DQ2/DQ8
42
if a patient has a LLQ cocklicky pain what are they likely to have?
IBS
43
what is the underlying pathology of IBS?
there is no common one, and never really appears to have one
44
what may be tender on examination of IBS?
left iliac fossa
45
what are some red flags to watch out for in suspected IBS?
```
family history of bowel/ovarian cancer
age >50 on first presentation
rectal bleeding
iron deficiency anaemia
weight gain/loss
```
46
what are the NICE guidelines on IBS diagnosis?
6 month history of the symptoms
47
what criteria is used to diagnose functional disorders of the colon?
ROME III
48
What is the Rome III criteria?
recurrant abdominal pain/ discomfort with 2+ of the following
1. improvement on defaecation
2. onset associated with frequency of stool
3. change in appearance of stool
49
name the 4 classifications of IBS and why?
```
IBS-D diahorrea
IBS-C Constipation
IBS-M mixed
IBS-P post infective
depends on main symptoms cause
```
50
what is the diet called that people often go on when diagnosed with IBS?
FODMAP
51
what investigations should you do for IBS?
if no red flags then none
52
d: mcburneys point and where
where the appendix is
| one-third of the distance from the anterior superior iliac spine to the umbilicus (navel)
53
where does the sigmoid portion of the colon start anatomical landmark?
at the left iliac crest
54
what is in the midgut?
caecum- proixmal 2/3 tranverse colon
55
what is in the hindgut?
distal 1/3 tranc=verse colon- rectum
56
arterial supply of the mid and hindgut?
superioir and inferioir mesenteric arteries
57
venous supply of the mid and hindgut?
superoir and inferioir mesenteric veins
58
where do the mesenteric veins drain to?
splenic vein then into hepatic portal system
59
lymph drainage of colon?
MALT tiisue
| epicolic and precolic lymph nodes
60
parasympathetic nerve supply of the colon?
vagus and splanchic pelvic nerves (2,3,4)
61
sympathetic supple of the colon?
mesenteric nerves and sup + inf
| inferioir hypogastric nerve
62
what type of muscle is found in the muscularis mucosa of the colon?
longitudinal
63
what are the taeniae coli?
the 3 strands of the longitudinal muscle in the colon
64
name some of the causes of RUQ pain?
```
biliary colic
acute cholecystitis
acute cholangitis
acute hepatitis
liver abscess
Budd-Chari syndrome
Pancreatitis
Portal vein issues
Duodenal ulcer
```
65
causes LUQ pain?
splenomeagly
peptic ulcer
gastritis
splenic infarct
66
causes LLQ pain?
```
diverticulitis
IBS
Infectious colitis
inguinal hernia
ovarian cyst
ectopic pregnancy
```
67
causes RLQ pain?
```
appendicitis
infective colitis
IBD
Inguinal hernia
ectopic pregnancy
```
68
causes middle quadrant region?
```
appendicitis
constipation
small/large bowel obstruction
IBD
IBS
Gastroenteritis
AAA
```
69
bloody diarrhoea causes
```
colon cancer
UC
Crohns
some gasteroenteritis depending on causative agent:
C diff
shigella
capylocbactor
salmonella
pork poisoning
```
70
diahorrea causes
```
gastroenteritis
travellers diahhorea
c diff
IBS
Colon cancer
Crohn's UC and coeliac
drug side effects
```
71
constipation common causes?
```
poor diet
lack of exercise
IBS
old age
post operative pain
hospital environment
anxiety
```
72
what is splenic atropy a feature of?
coeliac
73
what IBD does venous thrombosis complicate?
Crohn's
74
what does achalasia increase the risk of?
oesophageal cancer
75
can a blood culture diagnose H Pylori?
nope
76
what is pyoderma gangrenosum a manifestation of?
IBD
77
is colorectal cancer more common in which IBD?
crohn's
78
is oesophageal candiasis a cancer risk?
nope
79
if a patient has clubbing with GI symptoms what may they have?
IBD
80
what is angular chelitis a manifestation of?
crohn's
81
what IBD do smokers more commonly get?
Crohn's
82
what are the gene mutations causing crohn's?
NOD-2 and CARD15
83
symptoms of IBD
```
bloody diahorrhea
incomplete excretion (tenemus)
lower abdo pain
abscess
clubbing
```
84
which IBD more commonly has bloody diahorrea?
UC
85
describe pathological features of UC
mucosal ulcerration
pseudopolyps
ireegular crypts
86
where is the locations of UC/
rectal/sigmoid
| can spread proximally
87
what are the different parts of the colon called in UC when they get the disease?
procolitis
left sided procolitis
pancolitis
88
describe the pathological features of Crohn's?
skip lesions
fistures, strictures
transmural inflammation
non-caseating granulomas
89
cobble stoning is indicative of what/
CrOHN'S
90
majority of Crohn's is found where?
ileocaecal area
91
outline the investigations for IBD
```
colonoscopy
FBC
Stool culture
AXR
Barium enema
```
92
Outline the treatment for IBD
```
UC only 5ASA
BOTH:
immunosupressants
anti TNF therapy
steroids
Crohn's|:
stop smoking and diet may relieve symptoms in some cases
SURGERY LAST RESORT FOR BOTH
```
93
Does surgery cure IBD?
yes in UC, no in Crohns
94
complications of UC?
toxic megacolon
severe bleeding
rupture of bowel
95
complications Crohn's?
```
fistulas
abscess formation
stenosis
colon cancer
erythema nodosom
```
96
what type of cancer is IBD most likely to lead to? squamous, small,adeno
adenocarcinoma
97
what is the most common causative organism of travellers diahorrea and what are the buzzwords for it?
e coli
| watery diahorrea preceded by cramps and nausea
98
name the two polyposis syndromes that cause colon cancer?
FAP
| Lynch syndrome HNPCC
99
where are the majority of colon carcinomas located?
descending-sigmoid colon
100
where are colon tumours secondly most commonly located?
ileal ceacal area
101
where are colon tumours 3rd most commonly located?
rectum
102
describe the 4 stages of pathogenesis of colorectal cancer
polypoid
ulcerative
stenosing
infiltrative
103
if the symptoms are dark red stool, weight loss, bloating and abdo pain- what is it?
descending colon cancer
104
if symtoms are iron deficiency, papable mass in RLQ, weight loss- what is it?
colon cancer rigfht sided
105
if symtomsa are red stool, tenesmus, abdo pain and weight loss- what is it?
rectal cancer
106
what does dukes staging tell you?
5yr survival rate for a cancer
107
outline the investigations for colon cancer?
colonoscopuy w biopsy of polpys
bariuma enema
FBC
CT/PET
108
what tumour marker should you check for in colon cancer?
CEA
109
What surgery do you get for RS colon cancer?
right extended hemicolectomy
110
what surgery do you get for LS colon cancer?
left hemicolectomy
111
what surgery for sigmoid rectal colon cancer?
high anterioir resection
112
what surgery for rectal cancer?
APER
113
what length is short bowel syndrome?
less than 2m
114
what causes diverticulitis?
low fibre diet
115
what is a diverticulum?
outpouching of the gut mucosa
116
where the pain commonly associated with diverticulitis?
left iliac fossa
117
what artery is commonly stemnosed in gut ischaemia?
inferioir mesenteric artery
118
what is olgivies sndrome?
pseudo obstruction- acute dilitation of the colon
119
what is a volvus?
intestine twists around itself and mesentary supports it
120
what is intestinal failure?
inadequate fluid/nutrition
121
what is the treatment for bowel obstruction?
colonic stenting
122
what type of feeding are you given if you have IF and surgical ileus?
enteral
123
what type of feeding are you given if you have IF and are awaiting surgery?
paraenteral/enteral
124
what 3 things make up the heapatic triad?
biliary duct, branch of the hepatic portal vein and a branch of the hepatic artery
125
where does the liver get its nutrients from?
hepatic portal vein
126
what cells engulf the old RBCs and destroy them?
kupffer cells
127
why are aminotranferases released into the blood?
due to hepatocellular injury eg inflammation etc
128
what is the route of spread of hep A?
faecal oral
129
what is hep A associated with?
contaminated water/food
130
which hepatitis is the most common in tayside?
hep c
131
which hepatitis is the most common in th uk but has decreasing incidence?
Hep A
132
name the ways Hep B is contracted?
mom-child
sex
blood-blood ie needles
bodily fluids
133
If they have HBeAg what does it mean?
highly infectious
134
If they have HBsAg what does it mean?
currently infected
135
If they have Anti-HBs what does it mean?
people who have already been successfully vaccinated
136
If they have Anti-HBc what does it mean?
core AB, previous or ongoing infection
137
IgM anti HBc what does it mean?
acute infection
138
IgG anti HBc what does it mean?
chronic infection
139
increased HB DNA what does it mean?
viral load, how infectious they are
140
what Hep B antigen is found in the vaccine for Hep B?
HBsAg
141
how is Hep C spread?
blood to blood
142
what is used to investigate Hep C? why?
PCR as RNA virus
143
which Hep is Hep D always found in conjunction with?
Hep B
144
what is the spread of Hep E?
faecal oral
145
What countries is Hep E fpund?
tropics
146
what is commonly associated with Hep E?
contaminated/ undercooked food
147
What is the general treatment for acute hepatitis?
supportive
148
what is the general treatment for chronic hepatitis?
interferon alpha/ antiviral tenofovir
149
who is autoimmune hepatitis most commonly doagnoses in?
young women/ middle aged after menopause women
150
what does a liver biopsy of autoimmune hepatitis look like?
piecemeal necrosis
151
what are the LFTs results for autoimmune hepatitis?
increased ALT and AST
152
Which antibody is raised in autoimmune hepatitis?
ASMA- auto sm antibody
153
Nmae the 2 treatments for autoimmune hepatitis?
corticosteroids (prednisolone) and azathioprine
154
what is conjugation in the liver?
hepatocytes give molecules a negative charge making them hydrophilic so kidneys can excrete it
155
what is lynch syndrome?
• Hereditary nonpolyposis colorectal cancer - genetic condition which predisposes you to colorectal cancer
156
what type of mutation is lynch syndrome?
autosomal dominant
157
what other syndrome predisposes you to colorectal cancer?
FAP- Familial Adenomatous Polyposis
158
what pathway is alcohol brokendown by in liver?
cytochrome P450 pathway
159
describe pathophysiology of cirrhosis?
alcohol metabolism:
ethanol in liver increases permeability and increases the commensal bacteria going into cytoplasm in the liver
Once in the cytoplasm the kupffer cells then release pro inflammatory cytokines, causing inflammation, apoptosis and necrosis and fibrosis
fat metabolism therefore not completed leading to steatosis and hence cirrhosis
160
is steatosis reversible?
yes if its the only thing present
161
what pathological feature in liver is indicative of alcoholic liver disease and how is it formed?
mallory's hyaline- formed when hepatocytes get injured due to production of acetaldehyde produced in alcohol metabolism
162
name some symptoms of liver disease?
```
malnourished
spider naevi
ascites
jaundice
parathyroid enlargement
gynaecomastia
scaly skin
hepatomeagly
```
163
why might an alcoholic have a red tongue?
due to vitamin B deficiency, due to being malnourised as metabolism doesn't work
164
what are the liver function test results for alcoholic liver disease?
increased AST, ALT and decreased albumin
165
why may there be decreased amounts of albumin in the blood in alcoholic liver disease?
body is unable to absorb enough proetins to make sufficient quantities of albumin
166
what is do you need to look for in FBC for alcoholic liver disease? why does this happen?
prolonged prothrombin time as this takes longer for blood to clot as liver damaged and cant produce enough clotting factors
167
what is the management for alcoholic liver disease?
stop alcohol
diazepam for withdrawal
poss vit B suppplements
168
what is the treatment for non alcoholic liver disease?
lose weight
169
complications of alcoholic liver disease?
wernicke-kprasoff encephalopathy
cirrhosis
end stage liver disease
increased risk HCC
170
what hepatitis is most likely to lead to cirrhosis?
hep c
171
name a genetic disease which could lead to liver cirrhosis?
wilson's disease
172
what are the 2 outcomes of cirrhosis?
liver failure and portal hypertension
173
if you see a ring of fibrosis around a regenerating liver hepatocyte and collagen deposits on pathology what is it?
cirrhosis
174
what are the 2 types of liver cirrhosis?
compensated and decompensated
175
presentation of compensated cirrhosis?
normal, body behaves as though you havent got it
176
presentation of decompensated cirrhosis?
presents like liver failure
177
what is caput medusae a sign of?
portal HT
178
if the patient has a hepatic flap what is it due to?
liver failure
179
what is gold standard test for cirrhosis?
liver biopsy
180
is clubbing a symptom of cirrhosis?
yes
181
LFTs for cirrhosis?
increase AST ALT GGT ALP Bilirubin
| decreased albumin
182
what do you look for in FBC for cirrhosis?
decreased albumin
increased prothrombin
decreased WCC and plateltes
183
if you drain ascites how many neutrophils indicate spontaneous bacterial perionitis?
>250mm3
184
if you have cirrhosis what must you get screened for and how many months?
HCC every 6months
185
what is the treatment for ascites? what is option if contraindicated
diuretic,spirolactone 1st if contraindicated frusemide
186
what is the treatment for portal HT/
TIPSS
187
what is the treatment for bacterial periotonitis?
ciprofloxcin/ co-trimoxazole
188
chronic LD + emphysema?
alpha antitrypsin deficiency
189
pigmentation and diabetes and chronic LD?
haemochromatosis
190
dementia and kayser-fleischer ring and chronic liver disease?
wilson's disease
191
what type of mutation is haemochromatosis?
autosomal recessive
192
what type of mutation wilsons?
autosomal recessive
193
what type of mutation is alpha antitrypsin deficiency?
autosomal recessive
194
if the patient has bronze skin what is it?
haemochromatosis
195
what gene causes haemochromatosis?
HFE
196
what is a increase in blood ferritin and transferrin saturations indicate?
haemochromatosis
197
what is haemochromatosis cause by?
malabsorption of iron, leading to high concentrations in blood causing colour
198
treatment haemochromatosis?
diet modification to reduce iron intake
199
what is haemangioma?
common benign solid liver tumour
200
what causes wilsons disease?
defect in copper metabolism
201
what kayser-fleischer rings indicative of with tremor?
wilson's disease
202
what LFTs for wilson's diseases?
decreased serum copper
| coleruloplasmin
203
management of wilsons?
penicillamine
204
what are fulimant causes of liver failure?
drug overdose/viral
205
what pathway does paracetamol overdose affect?
CP450
206
What do you give to counteract paracetamol with?
acetylaysteine
207
is cirrhosis reversible?
no
208
what causes splenomeagly/hepatomeagly?
portal HT, blood cant get into liver so goes back elsewhere causing organs to become enlarged
209
what disease may you hear a liver bruit?
HCC
210
are the majority of liver cancer primary or meets?
mets
211
what are the tests for HCC?
```
FBC
USS
LFTS
CT/MRI
BIOPSY
```
212
What is raised in HCC?
alpha fetoprotein levels
213
is jaundice immediately present in HCC?
no often late onset as HCC progresses
214
treatment for HCC?
chemo
chemoabaltuve tgerpay
transplant/ surgery
215
what is icterus?
jaundice
216
what causes jaundice?
increased plasma bilirubin due to bilirubin not being excreted due to gall/liver/kidney issues
217
name the 3 types of jaundice?
pre hepatic, intrahepatic and posthepatic
218
what causes prehaptic jaundice and eg?
too much haem to be broken down (bilibrubin is a waste product of this) , anaemia haemolytic
219
what is the cause of intrahepatic jaundice, example and LFTs result?
decreased liver cell function
cirrhosis, sepsis, acute LF
increased ALT AST
220
post hepatic causes of jaundice, egs and LFTs result|?
bile unable to leave the duct, stones, strictures and tumours, increased ALP +GGT
221
why is urine dark but stools pale in jaundice?
if the absorbed bilirubin is mainly put into kidneys then dark urine and not absorbed faeces
222
what is a complication of ascites?
spontaneous bacterial peritonitis
223
what causes ascites?
invcreased BP due to portal HT and then fluid leaks out to accommodate like pulmonary oedema
224
what is the most common bacterial cause of spontaneous bacterial peritonitis?
e coli
225
what is the main cause of encephalopathy?
ammonia build up due to loss of ammonium metabolism
226
what is encephalopathy?
loss in brain function due to failure of removal of toxins
227
Korsakoff's syndrome is what?
amnesia and conffabulation
228
what type of feeding can cause gallstones and why?
total parenteral nutrition as it puts viatmins directly into blood therefor bypassing the digestive system and the gall bladder becomes immobilised leading to separation of bile into stones
229
what diet can lead to gallstones?
increased fat diiet
230
what type of pain is common with gallstones?
cocklicky radiating to back and shoulder
231
when is gallstone pain worse?
after eating a fatty meal
232
what are the investigation for gallstones and what do you expect fromeach?
LFTs : ncr ALP and GGT
USS: see the stones
MRCP: see stones
233
what is given to aid the itch with gallstones?
ursodeoxycholic acid
234
what treatment to remove gallstones?
ERCP
235
if you have recurrent gallstones what treatment may you be given?
cholectomsy
236
what is ascending cholangitis?
inflammation of the bile duct
237
what are the 3 tests required for most bile issues and results?
LFTs : incr ALP and GGT
USS: see the stones
MRCP: see stones
238
if the patient has RUQ pain, fever and jaundice- what bile issue is it?
ascending cholangitis
239
what is the treatment for ascending cholangitis?
7 days oral/ IV amoxicillin, gentamicin and metronizadole
| ERCP to remove if gallstones are cause
240
what can amoxicillin be swapped for in treatment ascending choalngitis?
ventamycin
241
what is antibiotic treatment stepped down to in ascending cholangitis?
co-trimoxazole and metronizadole
242
what is the cause of ascending cholangitis?
anything causing bile duct obstruction
243
what is cholecystitis?
inflammation of the gallbladder
244
if someone has a positive murphys sign what is it?
cholecystitis
245
what is murphys sign?
wince when you press on gallbladder and they breath in
246
where is the anatomical rough position of the gallbladder?
rs costal margin mid clavicular line
247
how many hrs less than is required to have a cholecystectomy in cholecystitis?
<72hrs
248
what do you do 1st if theyve had symptoms over 72hrs for cholecystitis?
medical mangement then cholecystectomy
249
what is the medical management for cholecystitis?
same as antibiotics for cholangitis
250
who gets primary biliary cholangitis?
females over 50
251
what is PBC?
an autoimmune disease causing destruction of the cells lining the bile ducts
252
name 2 autoimmune diseases which can cause PBC?
sjogrens syndrome
| autoimmune hepatitis
253
why do people who have PBC develop liver issues? (pathophysiology of PBC)
loss of immune tolerance to self mitochondiral proteins, t cell mediated reaction starts to attack cells lining ble duct allowing leakage of bilirubin and cholesterol into blood and eventually the start to attack liver etc
254
symtoms of PBC?
```
abdo pain
itch
fatigue
jaundice
xanthomas
```
255
why is ALP and GGT often raised in bile issues?
as they are found normally in bile duct cells and when destroyed/damaged they are hence released into the blood
256
what antibody is increased in PBC?
anti mitochondrial antibodies
257
what is given for itch in PBC?
colestyramine
258
treatment for PBC?
immunosupression predinsolone
259
who gets primary sclerosing cholangitis?
males 30-40
260
if someone has UC and liver problems what is it?
PSC
261
what is PSC?
narrowing and hardening of bile ducts leading to obstruction of the bile ducts causing back pressure of bile into liver and eventually leads to cirrhosis
262
what biliary disease may hepatomeagly be seen in?
PSC
263
LFTs for PSC?
increase ALP
increase Bilirubin
increase AST +ALT
264
autoantibodies present in PSC?
ANCA, ANA, ACL
265
what othe test do you need to do to diagnose PSC (not LFT/ antibodies)
MRCP
266
what is the main treatment for PSC?
ERCP balloon dilitation/ stent placement
267
complications of PSC?
```
cholangiocarcinoma
colorectal cancer
deficiences in fat soluble vitamins
no bile = no fat digestion
liver cirrhosis
```
268
charcots triad is?
fever, abdominal pain and jaundice
269
what does charcots triad suggest?
acute cholangitis
270
if you see onion skinning fibrosis, beading of the biliary tract, UC etc what is it?
PSC
271
What are the two most common places in biliary tract for tumour to grow?
distal extrahepatic or peri-hilar
272
what type of tumour is a cholangiocarcinoma?
adenocarcinoma- glandular
273
what is the only hope of a cure for cholangiocarcinoma?
surgery
274
what is the prognosis for collangiocarcinoma?
5 months
275
who most commonly gets pancreatic cancer?
males over 70, african americans
276
what type of cancer is pancreatic cancer?
adenocarcinoma
277
name some risk factprs fro pancreatic cancer?
smoking
diabetes
BRCA 2 mutation
chronic pancreatitis
278
where are the majority of tumours found in the pancreas?
head and neck
279
what type of pain is associated with pancreatic cancer and where does it radiate to?
mid epigastric pain, radiates to mid/lower back
| worse when lying flat
280
if a pateint with potential pancreatic cancer presents with new onset diabetes, where is the tumour?
accinar glands
281
if a pateint with potential pancreatic cancer presents with obstructive jaundice, where is the tumour?
head and neck
282
name some of the blood biomarkers in pancreatic cancer?
Ca19-9
| increased CEA and amylase and lipase levels
283
what is Ca19-9 indicative of?
pancreatic cancer
284
do the lFTs and FBC biomarkers diagnose pancreatic cancer?
no
285
LFTs for pancreatic cancer?
increased:
bilirubin
ALP
AST and ALT
286
name the procedure by which pancreatic cancer can be treated?
Whipple's
287
what must be done pre surgery for pancreatic cancer?
must do adjuvant chemo to shrink tumour
288
what is the prognosis for pancreatic cancer?
bad
289
pneumonic for pancreatitis causes?
```
I GET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpian biyes
Hyper ca thyroid and lipud
ERCP
Drugs
```
290
what enzymes are released when pancreas get damaged?
proteases, amylases and lipases
291
what is a consequence of protease relaese?
vascular damage
292
consequence of lipase being realsed by pancrease?
fatty necrosis
293
if someone has epigastric pain that radiates to back and is relived by sitting forward what do they have?
pancreatitis
294
what is grey turners sign?
lumbar redness
295
what is cullens sign?
umbilical redness
296
what do turner and cullens sign indicate?
pancreatitis
297
what is increased in FBC for pacreatitis?
amylase and lipase
298
What is the score called that clinicians use to assess whether or not pancreatitis is the cause of the epigastric pain?
PANCREAS
299
Mangement of pancreatitis?
ERCP if gallstones
Supportive
ABx if abscess
Surgery if necrotic
300
what type of surgery is recommended for gallstones when not critically unwell?
laparoscopic cholectysocpy
301
if your doing the hydrogen breath test what MUST be avoided?
smoking
302
what fats do you need to lower cholesterol?
UNSAT
303
what is hepatic venous outflow obstruction, presnting with destended veins up to IVC called?
BUdd Chiari syndrome
304
what is a haemorrhoid?
swollen veins in the lower part of rectum and anus.
305
what is rectal prolapse?
when your guts come out of your hole
306
what score is required to calculate malnutrition?
MUST
307
how do you calculate BMI?
weight/ height^2
308
d: dysentry
infectious diahorrhea
309
what type of gastroenteritis is bloody?
```
shigella
enterohaemorrhagic e coli
camplycobactor
salmonella
c diff
yersina the pork one
cmv
```
310
name the nerve that supplies the rectum?
s4 inferior rectal nerve
311
abdo pain and diahorrhea after sour milk and shell fish is caused by what
campylobacter
312
what do parietal cells release?
gastric acid
| Intrinsic factor
313
what do cheif cells release?
lipase and pepsin
314
what do mucus cells release?
HCO3 in mucucs
315
what do d cells secrete?
somostatin
316
what do g cells secrete?
gastrin
317
what do enterochromaffin cells secrete?
histamine
318
f: histamine
stimulates gastric acid production
319
f: somostatin
inhibits acid production
320
f; gastrin
stimulates acid production
321
f: ghrenlin
hunger signal
322
f: serotonin
causes contraction of gut and inhibits gastric acid secretion for digestion
323
what releases serotonin?
enterochromaffin like cells
324
what is leukonychia and what causes it?
white nails and hypoalbuminaemia
325
what is koilonychias and what causes it?
nail spooning and iron deficiency anaemia
326
what is the name of the pelvic floor muscle that is important in urination and defecation?
levator ani muscle
327
name the 3 branches of the coeliac trunk?
splenic, hepatic and left gastric
328
what level does the coeliac trunk trifurcate?
t12
329
what is the lowest part of the peritoneal cavity when supine?
hepatorenal recess/ morrisons pouch
330
what is the name for the area between the rectum and uterus in females?
rectouterine pouch/ pouch of douglas
331
area between rectum and bladder in males?
rectovesical pouch
332
what is the 1st line antibiotic for bloody diarrhoea gastroenteritis?
ciprofloxacin
333
what are the folds in the stomach and gall bladder called?
rugae
334
what are the folds and inlets in SI called?
plicae circulares
335
what is the ligment called inbetween the 2 liver folds?
falciform
336
what is the junction where SI, pancreas and bile duct join called?
ampulla of vater
337
what is the sphincter called at si, pancreas and bile duct called?
sphincter of oddi
338
if you see a big tortuos vein at coeliac axis what is it?
splenic artery
339
what is a carcinoid tumour?
one that secretes hormone etc
340
treatment for carcinoid tumour and how it works?
somostatin analogue- blocks secretions
341
what investogation do you do if you suspect appendix issue or ovarian?
laproscopy
342
what is a good indicator of BMI when you cant weigh?
upper mid arm circumferance
343
what is the treatment for eosinophilic oesophagitis?
montelukast
344
if they have neurogenic dypshagia what is a good treatment?
percutaneous endoscopic gastromy tube
345
what is the treatment for recurrent aspiration pneumonia?
radiologically inserted gastrostomy tube
346
if you suspect colon cancer in a patient but their frail and immobile what investigation do you do?
CT colonography
347
what is the common infection people get after travelling in Russia or somewhere in asia, with abdo pain and diarrhoea?
giarda
348
what investigation is done for giarda?
distal duodenal biopsy
349
what is schillings test for?
vit b12 deficiency
350
calcification on AXR?
gallstones/ pancreatitis depends where are
351
in haemoptysis what is contraindicated?
non invasive ventilation
352
what is first line for acute pancreatitis emergency?
fluid resus
353
is amylase included in severity assessment for acute pancreatitis?
nah man
354
what type of inheritance is sickle cells anaemia?
autosomal recessive
355
what is given as prophylaxis for oesophageal varices?
non selective beta blockers propanolol/nadalol
356
what oral lesion is it if immunosuppreseed and white patch that cant be scraped off?
oral hairy leukoplakia
357
what ABG result can excessive alcohol cause?
metabolic acidosis
358
what level of amylase could be considered diagnostic of acute pancreatitis?
>1000
359
what affect does aspirin have on gastric mucosa?
reduces surface mucus secretion leading to ulccers
360
what is the treatment for oral candiasis?
nystatin
361
if theres lesions on the lips etc what deficiency is it likely to be?
vit c scurvy
362
if theres pain with fresh anal bleeding what is it likely to be/
anal fissure
363
if a pateinet is obese has chronic constipation and is itcy what is it likely to be?
haemorrhoid
364
russell's sign?
self induced vomitting
365
if you have ALT>1000 ml what is it caused by?
viral hepatitis
366
what is 1st line treatment for recuurent c diff infection?
faecal transplant
367
can you get liver cirrhosis with hep a?
no disease is normall self limiting
368
if someone has epigastric pain and duodenal ulcers what do you want to do?
CXR and look for air trapped under the diaphargm
