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revision year 1 > GI corrections > Flashcards

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

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2
Q

what is a mechanical inhibitor of gastric acid secretion?

A

nausea

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3
Q 
what has a direct vasoconstrictive effect on BV:
angiotensin I
angiotensin II
aldosterone
renin
non of the above
A

angiotensin II

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4
Q

Where is the IVC located in relation to the peritoneum?

A

posteriorly

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5
Q

What are the two main areas of the oral cavity?

A

oral cavity proper and the vestibule

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6
Q

What is a smooth liver a sign of in conjuction with COPD?

A

RS HF- cor pulmonae

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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

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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

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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

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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

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11
Q

is oral candiasis a risk for oesophageal cancer?

A

no

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12
Q

If a patient presents with liver disease and haematemesis, what do they have>

A

oesophageal varices

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13
Q

virchow’s node is?

A

left supraclavicular lymph node

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14
Q

what cells do the GISTs originate from?

A

Cajal

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15
Q

what is the mutation of gene that causes diffuse gastric cancer?

A

CDH1

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16
Q

epithelia change in gastric intestinal cancer?

A

columnar glandular epithelium to simple columnar epithelium (intestinal epithelium)

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17
Q

are duodenal or gastric ulcers more common?

A

duodenal

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18
Q

What blood group is at risk for gastric cancer?

A

blood group A

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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

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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

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21
Q

metastases of gastric cancer

A

liver
peritoneum
umbilicus
lymph nodes

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22
Q

what type of gastrectomy do you get if tumor in proximal 1/3rd of stomach?

A

total

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23
Q

what type of gastrectomy do you get if tumor in distal 2/3rd of stomach?

A

partial

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24
Q

what type of gastritis leads to B12 deficiency and why?

A

automimmune affects intrinsic factor which is responsible for B12 absorption

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25
Q

what type of gastritis has macrolytic anaemia associated with it?

A

autoimmune

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26
Q

what type of gastritis is most likely to lead to cancer?

A

atrophic

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27
Q

causative organism for unpasteurised milk/ undercooked meat?

A

campylobacteria

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28
Q

causative organism for undercooked beef?

A

e coli

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29
Q

causative organism for cold meat/ soft cheese?

A

listeria

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30
Q

causative organism for someone returned from camping?

A

aeromas

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31
Q

causative organism for care home virus?

A

norovirus

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32
Q

causative organism for nursery?

A

rotavirus

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33
Q

causative organism for eggs?

A

salmonella

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34
Q

causative organism for rice?

A

bacillus cereas

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35
Q

causative organism for antibiotic bacteria?

A

c diff

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36
Q

causative organism for undercooked food/ milk?

A

staph aureus

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37
Q

causative organism for pork?

A

yersinia enterocolivia

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38
Q

what type of ulcer can acctually be relieved by eating/ weight gain?

A

duodenal

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39
Q

What is usually hypertropied in duodenal ulcers and why?

A

brunner’s glands

body trying to produce more mucus

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40
Q

what protein is found in gluten?

A

gliadin

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41
Q

what are the genes for coeliac?

A

HLA DQ2/DQ8

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42
Q

if a patient has a LLQ cocklicky pain what are they likely to have?

A

IBS

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43
Q

what is the underlying pathology of IBS?

A

there is no common one, and never really appears to have one

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44
Q

what may be tender on examination of IBS?

A

left iliac fossa

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45
Q

what are some red flags to watch out for in suspected IBS?

A 
family history of bowel/ovarian cancer
age >50 on first presentation
rectal bleeding
iron deficiency anaemia
weight gain/loss
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46
Q

what are the NICE guidelines on IBS diagnosis?

A

6 month history of the symptoms

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47
Q

what criteria is used to diagnose functional disorders of the colon?

A

ROME III

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48
Q

What is the Rome III criteria?

A

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
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49
Q

name the 4 classifications of IBS and why?

A 
IBS-D diahorrea
IBS-C Constipation
IBS-M mixed
IBS-P post infective
depends on main symptoms cause
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50
Q

what is the diet called that people often go on when diagnosed with IBS?

A

FODMAP

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51
Q

what investigations should you do for IBS?

A

if no red flags then none

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52
Q

d: mcburneys point and where

A

where the appendix is

one-third of the distance from the anterior superior iliac spine to the umbilicus (navel)

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53
Q

where does the sigmoid portion of the colon start anatomical landmark?

A

at the left iliac crest

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54
Q

what is in the midgut?

A

caecum- proixmal 2/3 tranverse colon

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55
Q

what is in the hindgut?

A

distal 1/3 tranc=verse colon- rectum

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56
Q

arterial supply of the mid and hindgut?

A

superioir and inferioir mesenteric arteries

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57
Q

venous supply of the mid and hindgut?

A

superoir and inferioir mesenteric veins

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58
Q

where do the mesenteric veins drain to?

A

splenic vein then into hepatic portal system

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59
Q

lymph drainage of colon?

A

MALT tiisue

epicolic and precolic lymph nodes

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60
Q

parasympathetic nerve supply of the colon?

A

vagus and splanchic pelvic nerves (2,3,4)

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61
Q

sympathetic supple of the colon?

A

mesenteric nerves and sup + inf

inferioir hypogastric nerve

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62
Q

what type of muscle is found in the muscularis mucosa of the colon?

A

longitudinal

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63
Q

what are the taeniae coli?

A

the 3 strands of the longitudinal muscle in the colon

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64
Q

name some of the causes of RUQ pain?

A 
biliary colic
acute cholecystitis
acute cholangitis
acute hepatitis
liver abscess
Budd-Chari syndrome
Pancreatitis
Portal vein issues
Duodenal ulcer
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65
Q

causes LUQ pain?

A

splenomeagly
peptic ulcer
gastritis
splenic infarct

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66
Q

causes LLQ pain?

A 
diverticulitis
IBS
Infectious colitis
inguinal hernia
ovarian cyst
ectopic pregnancy
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67
Q

causes RLQ pain?

A 
appendicitis
infective colitis
IBD
Inguinal hernia
ectopic pregnancy
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68
Q

causes middle quadrant region?

A 
appendicitis
constipation
small/large bowel obstruction
IBD
IBS
Gastroenteritis
AAA
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69
Q

bloody diarrhoea causes

A 
colon cancer
UC
Crohns
some gasteroenteritis depending on causative agent:
C diff
shigella
capylocbactor
salmonella
pork poisoning
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70
Q

diahorrea causes

A 
gastroenteritis
travellers diahhorea
c diff
IBS
Colon cancer
Crohn's UC and coeliac
drug side effects
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71
Q

constipation common causes?

A 
poor diet
lack of exercise
IBS
old age
post operative pain
hospital environment
anxiety
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72
Q

what is splenic atropy a feature of?

A

coeliac

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73
Q

what IBD does venous thrombosis complicate?

A

Crohn’s

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74
Q

what does achalasia increase the risk of?

A

oesophageal cancer

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75
Q

can a blood culture diagnose H Pylori?

A

nope

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76
Q

what is pyoderma gangrenosum a manifestation of?

A

IBD

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77
Q

is colorectal cancer more common in which IBD?

A

crohn’s

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78
Q

is oesophageal candiasis a cancer risk?

A

nope

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79
Q

if a patient has clubbing with GI symptoms what may they have?

A

IBD

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80
Q

what is angular chelitis a manifestation of?

A

crohn’s

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81
Q

what IBD do smokers more commonly get?

A

Crohn’s

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82
Q

what are the gene mutations causing crohn’s?

A

NOD-2 and CARD15

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83
Q

symptoms of IBD

A 
bloody diahorrhea
incomplete excretion (tenemus)
lower abdo pain
abscess
clubbing
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84
Q

which IBD more commonly has bloody diahorrea?

A

UC

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85
Q

describe pathological features of UC

A

mucosal ulcerration
pseudopolyps
ireegular crypts

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86
Q

where is the locations of UC/

A

rectal/sigmoid

can spread proximally

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87
Q

what are the different parts of the colon called in UC when they get the disease?

A

procolitis
left sided procolitis
pancolitis

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88
Q

describe the pathological features of Crohn’s?

A

skip lesions
fistures, strictures
transmural inflammation
non-caseating granulomas

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89
Q

cobble stoning is indicative of what/

A

CrOHN’S

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90
Q

majority of Crohn’s is found where?

A

ileocaecal area

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91
Q

outline the investigations for IBD

A 
colonoscopy
FBC
Stool culture
AXR
Barium enema
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92
Q

Outline the treatment for IBD

A 
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
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93
Q

Does surgery cure IBD?

A

yes in UC, no in Crohns

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94
Q

complications of UC?

A

toxic megacolon
severe bleeding
rupture of bowel

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95
Q

complications Crohn’s?

A 
fistulas
abscess formation
stenosis
colon cancer
erythema nodosom
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96
Q

what type of cancer is IBD most likely to lead to? squamous, small,adeno

A

adenocarcinoma

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97
Q

what is the most common causative organism of travellers diahorrea and what are the buzzwords for it?

A

e coli

watery diahorrea preceded by cramps and nausea

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98
Q

name the two polyposis syndromes that cause colon cancer?

A

FAP

Lynch syndrome HNPCC

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99
Q

where are the majority of colon carcinomas located?

A

descending-sigmoid colon

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100
Q

where are colon tumours secondly most commonly located?

A

ileal ceacal area

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101
Q

where are colon tumours 3rd most commonly located?

A

rectum

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102
Q

describe the 4 stages of pathogenesis of colorectal cancer

A

polypoid
ulcerative
stenosing
infiltrative

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103
Q

if the symptoms are dark red stool, weight loss, bloating and abdo pain- what is it?

A

descending colon cancer

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104
Q

if symtoms are iron deficiency, papable mass in RLQ, weight loss- what is it?

A

colon cancer rigfht sided

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105
Q

if symtomsa are red stool, tenesmus, abdo pain and weight loss- what is it?

A

rectal cancer

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106
Q

what does dukes staging tell you?

A

5yr survival rate for a cancer

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107
Q

outline the investigations for colon cancer?

A

colonoscopuy w biopsy of polpys
bariuma enema
FBC
CT/PET

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108
Q

what tumour marker should you check for in colon cancer?

A

CEA

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109
Q

What surgery do you get for RS colon cancer?

A

right extended hemicolectomy

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110
Q

what surgery do you get for LS colon cancer?

A

left hemicolectomy

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111
Q

what surgery for sigmoid rectal colon cancer?

A

high anterioir resection

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112
Q

what surgery for rectal cancer?

A

APER

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113
Q

what length is short bowel syndrome?

A

less than 2m

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114
Q

what causes diverticulitis?

A

low fibre diet

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115
Q

what is a diverticulum?

A

outpouching of the gut mucosa

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116
Q

where the pain commonly associated with diverticulitis?

A

left iliac fossa

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117
Q

what artery is commonly stemnosed in gut ischaemia?

A

inferioir mesenteric artery

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118
Q

what is olgivies sndrome?

A

pseudo obstruction- acute dilitation of the colon

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119
Q

what is a volvus?

A

intestine twists around itself and mesentary supports it

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120
Q

what is intestinal failure?

A

inadequate fluid/nutrition

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121
Q

what is the treatment for bowel obstruction?

A

colonic stenting

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122
Q

what type of feeding are you given if you have IF and surgical ileus?

A

enteral

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123
Q

what type of feeding are you given if you have IF and are awaiting surgery?

A

paraenteral/enteral

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124
Q

what 3 things make up the heapatic triad?

A

biliary duct, branch of the hepatic portal vein and a branch of the hepatic artery

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125
Q

where does the liver get its nutrients from?

A

hepatic portal vein

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126
Q

what cells engulf the old RBCs and destroy them?

A

kupffer cells

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127
Q

why are aminotranferases released into the blood?

A

due to hepatocellular injury eg inflammation etc

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128
Q

what is the route of spread of hep A?

A

faecal oral

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129
Q

what is hep A associated with?

A

contaminated water/food

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130
Q

which hepatitis is the most common in tayside?

A

hep c

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131
Q

which hepatitis is the most common in th uk but has decreasing incidence?

A

Hep A

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132
Q

name the ways Hep B is contracted?

A

mom-child
sex
blood-blood ie needles
bodily fluids

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133
Q

If they have HBeAg what does it mean?

A

highly infectious

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134
Q

If they have HBsAg what does it mean?

A

currently infected

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135
Q

If they have Anti-HBs what does it mean?

A

people who have already been successfully vaccinated

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136
Q

If they have Anti-HBc what does it mean?

A

core AB, previous or ongoing infection

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137
Q

IgM anti HBc what does it mean?

A

acute infection

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138
Q

IgG anti HBc what does it mean?

A

chronic infection

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139
Q

increased HB DNA what does it mean?

A

viral load, how infectious they are

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140
Q

what Hep B antigen is found in the vaccine for Hep B?

A

HBsAg

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141
Q

how is Hep C spread?

A

blood to blood

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142
Q

what is used to investigate Hep C? why?

A

PCR as RNA virus

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143
Q

which Hep is Hep D always found in conjunction with?

A

Hep B

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144
Q

what is the spread of Hep E?

A

faecal oral

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145
Q

What countries is Hep E fpund?

A

tropics

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146
Q

what is commonly associated with Hep E?

A

contaminated/ undercooked food

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147
Q

What is the general treatment for acute hepatitis?

A

supportive

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148
Q

what is the general treatment for chronic hepatitis?

A

interferon alpha/ antiviral tenofovir

149
Q

who is autoimmune hepatitis most commonly doagnoses in?

A

young women/ middle aged after menopause women

150
Q

what does a liver biopsy of autoimmune hepatitis look like?

A

piecemeal necrosis

151
Q

what are the LFTs results for autoimmune hepatitis?

A

increased ALT and AST

152
Q

Which antibody is raised in autoimmune hepatitis?

A

ASMA- auto sm antibody

153
Q

Nmae the 2 treatments for autoimmune hepatitis?

A

corticosteroids (prednisolone) and azathioprine

154
Q

what is conjugation in the liver?

A

hepatocytes give molecules a negative charge making them hydrophilic so kidneys can excrete it

155
Q

what is lynch syndrome?

A

• Hereditary nonpolyposis colorectal cancer - genetic condition which predisposes you to colorectal cancer

156
Q

what type of mutation is lynch syndrome?

A

autosomal dominant

157
Q

what other syndrome predisposes you to colorectal cancer?

A

FAP- Familial Adenomatous Polyposis

158
Q

what pathway is alcohol brokendown by in liver?

A

cytochrome P450 pathway

159
Q

describe pathophysiology of cirrhosis?

A

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
Q

is steatosis reversible?

A

yes if its the only thing present

161
Q

what pathological feature in liver is indicative of alcoholic liver disease and how is it formed?

A

mallory’s hyaline- formed when hepatocytes get injured due to production of acetaldehyde produced in alcohol metabolism

162
Q

name some symptoms of liver disease?

A 
malnourished
spider naevi
ascites
jaundice
parathyroid enlargement
gynaecomastia
scaly skin
hepatomeagly
163
Q

why might an alcoholic have a red tongue?

A

due to vitamin B deficiency, due to being malnourised as metabolism doesn’t work

164
Q

what are the liver function test results for alcoholic liver disease?

A

increased AST, ALT and decreased albumin

165
Q

why may there be decreased amounts of albumin in the blood in alcoholic liver disease?

A

body is unable to absorb enough proetins to make sufficient quantities of albumin

166
Q

what is do you need to look for in FBC for alcoholic liver disease? why does this happen?

A

prolonged prothrombin time as this takes longer for blood to clot as liver damaged and cant produce enough clotting factors

167
Q

what is the management for alcoholic liver disease?

A

stop alcohol
diazepam for withdrawal
poss vit B suppplements

168
Q

what is the treatment for non alcoholic liver disease?

A

lose weight

169
Q

complications of alcoholic liver disease?

A

wernicke-kprasoff encephalopathy
cirrhosis
end stage liver disease
increased risk HCC

170
Q

what hepatitis is most likely to lead to cirrhosis?

A

hep c

171
Q

name a genetic disease which could lead to liver cirrhosis?

A

wilson’s disease

172
Q

what are the 2 outcomes of cirrhosis?

A

liver failure and portal hypertension

173
Q

if you see a ring of fibrosis around a regenerating liver hepatocyte and collagen deposits on pathology what is it?

A

cirrhosis

174
Q

what are the 2 types of liver cirrhosis?

A

compensated and decompensated

175
Q

presentation of compensated cirrhosis?

A

normal, body behaves as though you havent got it

176
Q

presentation of decompensated cirrhosis?

A

presents like liver failure

177
Q

what is caput medusae a sign of?

A

portal HT

178
Q

if the patient has a hepatic flap what is it due to?

A

liver failure

179
Q

what is gold standard test for cirrhosis?

A

liver biopsy

180
Q

is clubbing a symptom of cirrhosis?

A

yes

181
Q

LFTs for cirrhosis?

A

increase AST ALT GGT ALP Bilirubin

decreased albumin

182
Q

what do you look for in FBC for cirrhosis?

A

decreased albumin
increased prothrombin
decreased WCC and plateltes

183
Q

if you drain ascites how many neutrophils indicate spontaneous bacterial perionitis?

A

> 250mm3

184
Q

if you have cirrhosis what must you get screened for and how many months?

A

HCC every 6months

185
Q

what is the treatment for ascites? what is option if contraindicated

A

diuretic,spirolactone 1st if contraindicated frusemide

186
Q

what is the treatment for portal HT/

A

TIPSS

187
Q

what is the treatment for bacterial periotonitis?

A

ciprofloxcin/ co-trimoxazole

188
Q

chronic LD + emphysema?

A

alpha antitrypsin deficiency

189
Q

pigmentation and diabetes and chronic LD?

A

haemochromatosis

190
Q

dementia and kayser-fleischer ring and chronic liver disease?

A

wilson’s disease

191
Q

what type of mutation is haemochromatosis?

A

autosomal recessive

192
Q

what type of mutation wilsons?

A

autosomal recessive

193
Q

what type of mutation is alpha antitrypsin deficiency?

A

autosomal recessive

194
Q

if the patient has bronze skin what is it?

A

haemochromatosis

195
Q

what gene causes haemochromatosis?

A

HFE

196
Q

what is a increase in blood ferritin and transferrin saturations indicate?

A

haemochromatosis

197
Q

what is haemochromatosis cause by?

A

malabsorption of iron, leading to high concentrations in blood causing colour

198
Q

treatment haemochromatosis?

A

diet modification to reduce iron intake

199
Q

what is haemangioma?

A

common benign solid liver tumour

200
Q

what causes wilsons disease?

A

defect in copper metabolism

201
Q

what kayser-fleischer rings indicative of with tremor?

A

wilson’s disease

202
Q

what LFTs for wilson’s diseases?

A

decreased serum copper

coleruloplasmin

203
Q

management of wilsons?

A

penicillamine

204
Q

what are fulimant causes of liver failure?

A

drug overdose/viral

205
Q

what pathway does paracetamol overdose affect?

A

CP450

206
Q

What do you give to counteract paracetamol with?

A

acetylaysteine

207
Q

is cirrhosis reversible?

A

no

208
Q

what causes splenomeagly/hepatomeagly?

A

portal HT, blood cant get into liver so goes back elsewhere causing organs to become enlarged

209
Q

what disease may you hear a liver bruit?

A

HCC

210
Q

are the majority of liver cancer primary or meets?

A

mets

211
Q

what are the tests for HCC?

A 
FBC
USS
LFTS
CT/MRI
BIOPSY
212
Q

What is raised in HCC?

A

alpha fetoprotein levels

213
Q

is jaundice immediately present in HCC?

A

no often late onset as HCC progresses

214
Q

treatment for HCC?

A

chemo
chemoabaltuve tgerpay
transplant/ surgery

215
Q

what is icterus?

A

jaundice

216
Q

what causes jaundice?

A

increased plasma bilirubin due to bilirubin not being excreted due to gall/liver/kidney issues

217
Q

name the 3 types of jaundice?

A

pre hepatic, intrahepatic and posthepatic

218
Q

what causes prehaptic jaundice and eg?

A

too much haem to be broken down (bilibrubin is a waste product of this) , anaemia haemolytic

219
Q

what is the cause of intrahepatic jaundice, example and LFTs result?

A

decreased liver cell function
cirrhosis, sepsis, acute LF
increased ALT AST

220
Q

post hepatic causes of jaundice, egs and LFTs result|?

A

bile unable to leave the duct, stones, strictures and tumours, increased ALP +GGT

221
Q

why is urine dark but stools pale in jaundice?

A

if the absorbed bilirubin is mainly put into kidneys then dark urine and not absorbed faeces

222
Q

what is a complication of ascites?

A

spontaneous bacterial peritonitis

223
Q

what causes ascites?

A

invcreased BP due to portal HT and then fluid leaks out to accommodate like pulmonary oedema

224
Q

what is the most common bacterial cause of spontaneous bacterial peritonitis?

A

e coli

225
Q

what is the main cause of encephalopathy?

A

ammonia build up due to loss of ammonium metabolism

226
Q

what is encephalopathy?

A

loss in brain function due to failure of removal of toxins

227
Q

Korsakoff’s syndrome is what?

A

amnesia and conffabulation

228
Q

what type of feeding can cause gallstones and why?

A

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
Q

what diet can lead to gallstones?

A

increased fat diiet

230
Q

what type of pain is common with gallstones?

A

cocklicky radiating to back and shoulder

231
Q

when is gallstone pain worse?

A

after eating a fatty meal

232
Q

what are the investigation for gallstones and what do you expect fromeach?

A

LFTs : ncr ALP and GGT
USS: see the stones
MRCP: see stones

233
Q

what is given to aid the itch with gallstones?

A

ursodeoxycholic acid

234
Q

what treatment to remove gallstones?

A

ERCP

235
Q

if you have recurrent gallstones what treatment may you be given?

A

cholectomsy

236
Q

what is ascending cholangitis?

A

inflammation of the bile duct

237
Q

what are the 3 tests required for most bile issues and results?

A

LFTs : incr ALP and GGT
USS: see the stones
MRCP: see stones

238
Q

if the patient has RUQ pain, fever and jaundice- what bile issue is it?

A

ascending cholangitis

239
Q

what is the treatment for ascending cholangitis?

A

7 days oral/ IV amoxicillin, gentamicin and metronizadole

ERCP to remove if gallstones are cause

240
Q

what can amoxicillin be swapped for in treatment ascending choalngitis?

A

ventamycin

241
Q

what is antibiotic treatment stepped down to in ascending cholangitis?

A

co-trimoxazole and metronizadole

242
Q

what is the cause of ascending cholangitis?

A

anything causing bile duct obstruction

243
Q

what is cholecystitis?

A

inflammation of the gallbladder

244
Q

if someone has a positive murphys sign what is it?

A

cholecystitis

245
Q

what is murphys sign?

A

wince when you press on gallbladder and they breath in

246
Q

where is the anatomical rough position of the gallbladder?

A

rs costal margin mid clavicular line

247
Q

how many hrs less than is required to have a cholecystectomy in cholecystitis?

A

<72hrs

248
Q

what do you do 1st if theyve had symptoms over 72hrs for cholecystitis?

A

medical mangement then cholecystectomy

249
Q

what is the medical management for cholecystitis?

A

same as antibiotics for cholangitis

250
Q

who gets primary biliary cholangitis?

A

females over 50

251
Q

what is PBC?

A

an autoimmune disease causing destruction of the cells lining the bile ducts

252
Q

name 2 autoimmune diseases which can cause PBC?

A

sjogrens syndrome

autoimmune hepatitis

253
Q

why do people who have PBC develop liver issues? (pathophysiology of PBC)

A

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
Q

symtoms of PBC?

A 
abdo pain
itch
fatigue
jaundice
xanthomas
255
Q

why is ALP and GGT often raised in bile issues?

A

as they are found normally in bile duct cells and when destroyed/damaged they are hence released into the blood

256
Q

what antibody is increased in PBC?

A

anti mitochondrial antibodies

257
Q

what is given for itch in PBC?

A

colestyramine

258
Q

treatment for PBC?

A

immunosupression predinsolone

259
Q

who gets primary sclerosing cholangitis?

A

males 30-40

260
Q

if someone has UC and liver problems what is it?

A

PSC

261
Q

what is PSC?

A

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
Q

what biliary disease may hepatomeagly be seen in?

A

PSC

263
Q

LFTs for PSC?

A

increase ALP
increase Bilirubin
increase AST +ALT

264
Q

autoantibodies present in PSC?

A

ANCA, ANA, ACL

265
Q

what othe test do you need to do to diagnose PSC (not LFT/ antibodies)

A

MRCP

266
Q

what is the main treatment for PSC?

A

ERCP balloon dilitation/ stent placement

267
Q

complications of PSC?

A 
cholangiocarcinoma
colorectal cancer
deficiences in fat soluble vitamins
no bile = no fat digestion
liver cirrhosis
268
Q

charcots triad is?

A

fever, abdominal pain and jaundice

269
Q

what does charcots triad suggest?

A

acute cholangitis

270
Q

if you see onion skinning fibrosis, beading of the biliary tract, UC etc what is it?

A

PSC

271
Q

What are the two most common places in biliary tract for tumour to grow?

A

distal extrahepatic or peri-hilar

272
Q

what type of tumour is a cholangiocarcinoma?

A

adenocarcinoma- glandular

273
Q

what is the only hope of a cure for cholangiocarcinoma?

A

surgery

274
Q

what is the prognosis for collangiocarcinoma?

A

5 months

275
Q

who most commonly gets pancreatic cancer?

A

males over 70, african americans

276
Q

what type of cancer is pancreatic cancer?

A

adenocarcinoma

277
Q

name some risk factprs fro pancreatic cancer?

A

smoking
diabetes
BRCA 2 mutation
chronic pancreatitis

278
Q

where are the majority of tumours found in the pancreas?

A

head and neck

279
Q

what type of pain is associated with pancreatic cancer and where does it radiate to?

A

mid epigastric pain, radiates to mid/lower back

worse when lying flat

280
Q

if a pateint with potential pancreatic cancer presents with new onset diabetes, where is the tumour?

A

accinar glands

281
Q

if a pateint with potential pancreatic cancer presents with obstructive jaundice, where is the tumour?

A

head and neck

282
Q

name some of the blood biomarkers in pancreatic cancer?

A

Ca19-9

increased CEA and amylase and lipase levels

283
Q

what is Ca19-9 indicative of?

A

pancreatic cancer

284
Q

do the lFTs and FBC biomarkers diagnose pancreatic cancer?

A

no

285
Q

LFTs for pancreatic cancer?

A

increased:
bilirubin
ALP
AST and ALT

286
Q

name the procedure by which pancreatic cancer can be treated?

A

Whipple’s

287
Q

what must be done pre surgery for pancreatic cancer?

A

must do adjuvant chemo to shrink tumour

288
Q

what is the prognosis for pancreatic cancer?

A

bad

289
Q

pneumonic for pancreatitis causes?

A 
I GET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpian biyes
Hyper ca thyroid and lipud
ERCP
Drugs
290
Q

what enzymes are released when pancreas get damaged?

A

proteases, amylases and lipases

291
Q

what is a consequence of protease relaese?

A

vascular damage

292
Q

consequence of lipase being realsed by pancrease?

A

fatty necrosis

293
Q

if someone has epigastric pain that radiates to back and is relived by sitting forward what do they have?

A

pancreatitis

294
Q

what is grey turners sign?

A

lumbar redness

295
Q

what is cullens sign?

A

umbilical redness

296
Q

what do turner and cullens sign indicate?

A

pancreatitis

297
Q

what is increased in FBC for pacreatitis?

A

amylase and lipase

298
Q

What is the score called that clinicians use to assess whether or not pancreatitis is the cause of the epigastric pain?

A

PANCREAS

299
Q

Mangement of pancreatitis?

A

ERCP if gallstones
Supportive
ABx if abscess
Surgery if necrotic

300
Q

what type of surgery is recommended for gallstones when not critically unwell?

A

laparoscopic cholectysocpy

301
Q

if your doing the hydrogen breath test what MUST be avoided?

A

smoking

302
Q

what fats do you need to lower cholesterol?

A

UNSAT

303
Q

what is hepatic venous outflow obstruction, presnting with destended veins up to IVC called?

A

BUdd Chiari syndrome

304
Q

what is a haemorrhoid?

A

swollen veins in the lower part of rectum and anus.

305
Q

what is rectal prolapse?

A

when your guts come out of your hole

306
Q

what score is required to calculate malnutrition?

A

MUST

307
Q

how do you calculate BMI?

A

weight/ height^2

308
Q

d: dysentry

A

infectious diahorrhea

309
Q

what type of gastroenteritis is bloody?

A 
shigella
enterohaemorrhagic e coli
camplycobactor
salmonella
c diff
yersina the pork one
cmv
310
Q

name the nerve that supplies the rectum?

A

s4 inferior rectal nerve

311
Q

abdo pain and diahorrhea after sour milk and shell fish is caused by what

A

campylobacter

312
Q

what do parietal cells release?

A

gastric acid

Intrinsic factor

313
Q

what do cheif cells release?

A

lipase and pepsin

314
Q

what do mucus cells release?

A

HCO3 in mucucs

315
Q

what do d cells secrete?

A

somostatin

316
Q

what do g cells secrete?

A

gastrin

317
Q

what do enterochromaffin cells secrete?

A

histamine

318
Q

f: histamine

A

stimulates gastric acid production

319
Q

f: somostatin

A

inhibits acid production

320
Q

f; gastrin

A

stimulates acid production

321
Q

f: ghrenlin

A

hunger signal

322
Q

f: serotonin

A

causes contraction of gut and inhibits gastric acid secretion for digestion

323
Q

what releases serotonin?

A

enterochromaffin like cells

324
Q

what is leukonychia and what causes it?

A

white nails and hypoalbuminaemia

325
Q

what is koilonychias and what causes it?

A

nail spooning and iron deficiency anaemia

326
Q

what is the name of the pelvic floor muscle that is important in urination and defecation?

A

levator ani muscle

327
Q

name the 3 branches of the coeliac trunk?

A

splenic, hepatic and left gastric

328
Q

what level does the coeliac trunk trifurcate?

A

t12

329
Q

what is the lowest part of the peritoneal cavity when supine?

A

hepatorenal recess/ morrisons pouch

330
Q

what is the name for the area between the rectum and uterus in females?

A

rectouterine pouch/ pouch of douglas

331
Q

area between rectum and bladder in males?

A

rectovesical pouch

332
Q

what is the 1st line antibiotic for bloody diarrhoea gastroenteritis?

A

ciprofloxacin

333
Q

what are the folds in the stomach and gall bladder called?

A

rugae

334
Q

what are the folds and inlets in SI called?

A

plicae circulares

335
Q

what is the ligment called inbetween the 2 liver folds?

A

falciform

336
Q

what is the junction where SI, pancreas and bile duct join called?

A

ampulla of vater

337
Q

what is the sphincter called at si, pancreas and bile duct called?

A

sphincter of oddi

338
Q

if you see a big tortuos vein at coeliac axis what is it?

A

splenic artery

339
Q

what is a carcinoid tumour?

A

one that secretes hormone etc

340
Q

treatment for carcinoid tumour and how it works?

A

somostatin analogue- blocks secretions

341
Q

what investogation do you do if you suspect appendix issue or ovarian?

A

laproscopy

342
Q

what is a good indicator of BMI when you cant weigh?

A

upper mid arm circumferance

343
Q

what is the treatment for eosinophilic oesophagitis?

A

montelukast

344
Q

if they have neurogenic dypshagia what is a good treatment?

A

percutaneous endoscopic gastromy tube

345
Q

what is the treatment for recurrent aspiration pneumonia?

A

radiologically inserted gastrostomy tube

346
Q

if you suspect colon cancer in a patient but their frail and immobile what investigation do you do?

A

CT colonography

347
Q

what is the common infection people get after travelling in Russia or somewhere in asia, with abdo pain and diarrhoea?

A

giarda

348
Q

what investigation is done for giarda?

A

distal duodenal biopsy

349
Q

what is schillings test for?

A

vit b12 deficiency

350
Q

calcification on AXR?

A

gallstones/ pancreatitis depends where are

351
Q

in haemoptysis what is contraindicated?

A

non invasive ventilation

352
Q

what is first line for acute pancreatitis emergency?

A

fluid resus

353
Q

is amylase included in severity assessment for acute pancreatitis?

A

nah man

354
Q

what type of inheritance is sickle cells anaemia?

A

autosomal recessive

355
Q

what is given as prophylaxis for oesophageal varices?

A

non selective beta blockers propanolol/nadalol

356
Q

what oral lesion is it if immunosuppreseed and white patch that cant be scraped off?

A

oral hairy leukoplakia

357
Q

what ABG result can excessive alcohol cause?

A

metabolic acidosis

358
Q

what level of amylase could be considered diagnostic of acute pancreatitis?

A

> 1000

359
Q

what affect does aspirin have on gastric mucosa?

A

reduces surface mucus secretion leading to ulccers

360
Q

what is the treatment for oral candiasis?

A

nystatin

361
Q

if theres lesions on the lips etc what deficiency is it likely to be?

A

vit c scurvy

362
Q

if theres pain with fresh anal bleeding what is it likely to be/

A

anal fissure

363
Q

if a pateinet is obese has chronic constipation and is itcy what is it likely to be?

A

haemorrhoid

364
Q

russell’s sign?

A

self induced vomitting

365
Q

if you have ALT>1000 ml what is it caused by?

A

viral hepatitis

366
Q

what is 1st line treatment for recuurent c diff infection?

A

faecal transplant

367
Q

can you get liver cirrhosis with hep a?

A

no disease is normall self limiting

368
Q

if someone has epigastric pain and duodenal ulcers what do you want to do?

A

CXR and look for air trapped under the diaphargm

revision year 1 (7 decks)

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