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1st Year Medicine > GI Disease > Flashcards

GI Disease Flashcards

1
Q

s/s IBS? (3)

A

Abdominal pain, bloating, change in bowel habit

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2
Q

Epidemiology IBS?

A

30-40 females

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3
Q

Rome III criteria IBS?

A

Improvement with defecation, increased stool form, increased stool frequency

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4
Q

Ix IBS?

A

CRP, FBC, plasma viscosity, antibody test for coeliacs, colonoscopy (Dx of exclusion)

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5
Q

Tx IBS?

A
  • Reduce fibre
  • regular meals
  • anti-spasmodics e.g. hyoscine
  • anti-diarrhoeals e.g. loperamide
  • anti-depressants e.g. amitryptiline
  • STOP OPIATES/CODEINE (narcotic bowel syndrome)
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6
Q

Crohns localised?

A

Can affect anywhere from mouth to anus

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7
Q

Epidemiology crohns?

A

Males + young people

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8
Q

S/s crohns? (6)

A
  • Colicky abdominal pain
  • Obstruction
  • anaemia
  • bleeding PR
  • diarrhoea
  • weight loss
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9
Q

Ix crohns?

A

Endoscopy + mucosal biopsy

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10
Q

Tx crohns?

A

Steroids -> immuosuppresants -> anti-TNF therapy

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11
Q

Complications of crohns? (6)

A

Malabsorption, anal disease, bowel obstruction, amyloidosis, perforation, malignancy, fistulas

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12
Q

Triggers for crohns? (4)

A

Smoking, infection, vasculitis, hygiene hypothesis

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13
Q

Localised UC?

A

Colon + rectum

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14
Q

Epidemiology UC?

A

Males + young people

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15
Q

Tx UC?

A

5ASA, steroids, immunosuppresants, anti-TNF

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16
Q

Cure UC?

A

SUBTOTAL COLECTOMY

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17
Q

Comps UC? (9)

A

Toxic megacolon, uveitis, colorectal carcinoma, hypokalaemia, primary sclerosing cholangitis, arthritis, pyoderma gangrenosum, anal fissure, erythema nodosum

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18
Q

Triggers UC?

A

smoking NOT associated with UC

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19
Q

Contrast crohns and UC

A

Crohns: fistulae, thickened bowel wall, segmentation, transmural inflammation granulomas
UC: no fistulae, thin wall, continuous, superficial inflammation, no granulomas

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20
Q

Acute liver disease?

A

rapid hepatic dysfunction WITHOUT prior liver disease (<6 months)

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21
Q

S/s acute liver disease? (7)

A

anorexia, lethargy, itching, jaundice, nausea, arthralgia, RUQ pain

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22
Q

Ax acute liver disease? (4 + 3 rare)

A
  • alcohol, viral, drugs (paracetamol), malignancy

* budd chiari, AFLP, cholestasis of pregnancy

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23
Q

Tx acute liver disease? (5)

A

Sodium bicarbonate, cholestyramine, ureodeoxycholic acid, fluids, increase calories

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24
Q

Fulminant hepatic failure?

A

rapid development of jaundice and encephalopathy in patient with previously NORMAL liver

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25
Q

Ax FHF? (7)

A

Paracetamol, mushrooms, viral, AFLP, malignancy, Wilsons, Budd chiari

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26
Q

Tx FHF? (5)

A

Inotropes, fluids, renal replacement, management of raised intra-cranial pressure, transplant

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27
Q

Name chronic liver diseases (>6 months) (10)

A
  • NAFLD
  • Primary biliary cirrhosis
  • Auto-immune hepatitis
  • Primary sclerosing cholangitis
  • Haemochromatosis
  • Wilsons disease
  • Alpha-1 anti-trypsin deficiency
  • Budd-chiari
  • Methotrexate
  • Cardiac cirrhosis
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28
Q

Tx NAFLD?

A

Weight loss + exercise

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29
Q

Epidemiology PBC?

A

Middle-aged women

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30
Q

S/s PBC?

A

Can be asymptomatic

s/s: fatigue, itch, xanthelasma

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31
Q

Dx PBC?

A

AMA+, LFT, liver biopsy

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32
Q

Tx PBC?

A

Urseo deoxycholic acid, transplant

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33
Q

O/E auto-immune hepatitis?

A

Hepatomagaly, splenomegaly, jaundice

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34
Q

s/s auto-immune hepatitis? (4)

A

anorexia, fatigue, RUQ pain, nausea

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35
Q

Dx auto-immun hep?

A

elevated AST/ALT, biopsy

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36
Q

Tx auto-immune hep?

A

Corticosteroids (pred), azathioprine (immunosuppressant), transplant

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37
Q

Epidemiology PSC?

A

Males, associated with UC

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38
Q

Dx PSC?

A

AMA- but ANA, SMA, ANCA +
Increased ALP and bilirubin
ERCP DEFINITIVE DX

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39
Q

Comp PSC?

A

cholangiocarcinoma

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40
Q

s/s haemochromatosis?

A

No erections, “bronzed diabetic” - diabetes, liver cancer

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41
Q

Haemochromatosis?

A

Iron deposited in liver

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42
Q

Tx haemochromatosis?

A

Venesection

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43
Q

Wilsons disease?

A

Loss of function of caeruloplasmin (Cu binding protein)

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44
Q

s/s Wilsons? (4)

A

chorea-atheitoid movements, depression, changed libido/personality, KAISER-FLEISHER RINGS

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45
Q

tx wilsons?

A

Copper chelating drugs

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46
Q

A1ATD?

A

Excess tryptic activity resulting in lung emphysema + A1AT deposition in liver

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47
Q

Budd-chiari?

A

Thrombosis of hepatic veins

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48
Q

s/s budd chiari?

A

Acute: jaundice, tender hepatomegaky
Chronic: ascites

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49
Q

Dx budd chiari?

A

US of hepatic veins

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50
Q

Tx budd chiari?

A

TIPS

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51
Q

Methotrexate?

A

Tx in RA and psoriasis that can lead to liver fibrosis

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52
Q

Cardiac cirrhosis?

A

CCF with ascites/liver impairment

53
Q

Ax cirrhosis? (7)

A

alcohol, HBV, HCV, haemochromatosis, autoimmune, gallstones, NAFLD

54
Q

s/s cirrhosis?

A

Oesophageal varices, haemorrhoids, caput medusa, ascites, encephalopathy

55
Q

Tx cirrhosis?

A

Lactulose, nutrition, transplant

56
Q

s/s jaundice? (7)

A

Yellow skin/sclera, pale stools, dark urine, weight loss, abdo pain, ascites, itch

57
Q

Ix jaundice? (4)

A

US, CT, ERCP, FBC

58
Q

Hep A factfile? (3)

A
  • Faecal-oral
  • Acute hepatitis, NOT chronic
  • controled via hygiene, VACCINE
59
Q

Hep B factfile? (3)

A
  • Sex, mother -> child, blood
  • Can be chronic but uncommon
  • Vaccine
60
Q

Hep C factfile? (3)

A
  • Sex, mother -> child, blood
  • CHRONIC
  • NO VACCINE
61
Q

Hep D factfile?

A

ONLY WITH HEP B, exacerbates hep B infection

62
Q

Hep E factfile?

A
  • Faecal-oral, zoonosis, tropics
  • Not chronic
  • NO VACCINE
63
Q

Tx for hepatitis?

A

NO ANTIVIRALS if ACUTE!! If chronic, give antivirals + vaccination

64
Q

Risk factors cholelithiasis?

A

Five F’s: fat, fair, female, forty, fertile

65
Q

Comps gallstones? (7)

A

Cholecystitis, mucocoele, empyema, cholangitis, onstructive jaundice, gallstone ileus, pancreatitis

66
Q

Cholecystitis?

A

Inflam of gallbladder ass. with gallstones

67
Q

Acute cholecystitis? Chronic?

A
  • Acute: gallstones obstruct cystic duct + become infected

* Chronic: wall thickened due to fibrosis but not distended

68
Q

Dx cholecystitis?

A

US, CT, MRCP

69
Q

TX cholecystitis?

A

IV antibiotics, fluids, nil by mouth, cholecystectomy (laparoscopically)

70
Q

Biliary colic?

A

Stone impacts in cystic duct

71
Q

S/s biliary colic?

A

RUQ pain, radiates to back/shoulder, nausea

72
Q

Gallstone ileus?

A

Small bowel obstruction -> gallstones impact in distal ileum

73
Q

Tx gallstone ileus?

A

Urgent enterotomy, interval cholecystectomy in 3 months

74
Q

Tx gallstone in CBD?

75
Q

S/s acute pancreatitis? (5)

A

epigastric pain, anorexia, nausea, grey turner’s sign, cullen’s sign

76
Q

Ax pancreatitis?

A

I GET SMASHED
* Idiopathic, gallstones, ERCP, trauma, scorpion sting, mumps, autoimmine, steroids, hyperlipidaemia/calcaemia, ethanol, drugs

77
Q

Acute pancreatitis?

A

Autodigestion of acini due to release of pancreatic enzymes

78
Q

Dx pancreatitis?

A

CXR (pleural effusion, sentinel loop), CT, MRI, ERCP, FBC, AMYLASE, CRP, Ca
ALL PATIENTS WITH AP, U/S within 24 HOURS admission

79
Q

Ax chronic pancreatitis? (2)

A

Cystic fibrosis, ALCOHOL

80
Q

Epidemiology small bowel ischaemia?

A

Eldery + arteriopaths

81
Q

s/s SB ischaemia? (4)

A

Sepsis, shock, poorly localised pain, increased amylase (often confused with pancreatitis)

82
Q

Tx SB ischaemia?

A

Revascularise intestine + remove dead tissue

83
Q

Diverticular disease?

A

Mucosal herniation through muscle coat (affects sigmoid colon)

84
Q

Ax diverticular disease?

A

Low fibre, increased intraluminal pressure

85
Q

s/s diverticular disease?

A

LIF pain, altered bowel habit, septic

86
Q

Dx diverticular disease?

A

Ba enema, sigmoidoscopy

87
Q

Tx diverticular disease?

A
  • uncomplicated - IV antibiotics

* complex - percutaneous drainage

88
Q

Meckel’s diverticulum?

A

Incomplete regression if the vitello-intestinal duct

89
Q

s/s meckel’s diverticulum?

A

Normally asymptomatic, but can mimic appendicitis

90
Q

Small bowel cancer types?

A
  • Primary (rare): lymphomas, carcinoid (found in appendix - carcinoid syndrome), carcinoma
  • Secondary (common)
91
Q

Oesophageal cancer (benign vs malignant)

A
  • Benign: squamous, papilloma

* Malignant: squamous cell, adenocarcinoma (barrett’s)

92
Q

Oral cancer?

A

Squamous cell carcinoma

93
Q

A/x oral cancer?

A

Tobacco, alcohol, oral sex

94
Q

S/s oral cancer?

A

Ulcer (>2 weeks), numbness, pain, voice change, dysphagia

95
Q

Stomach cancer? Benign vs malignant

A

Benign: polyps
Malignant: carcinoma, lymphoma, GI stromal tumours, maltoma (ass. w H.pylori)

96
Q

A/x gastric cancer? (3)

A

H.pylori, pernicious anaemia, Lynch syndrome (HNPCC)

97
Q

Colorectal cancer? benign vs malignant

A
  • Benign: adenoma (must be removed as can become adenocarcinoma), lipoma
  • Malignant: adenocarcinoma, sarcoma
98
Q

Tx colorectal cancer?

99
Q

Inherited colorectal carcinoma? (2)

A

HNPCC (Lynch): DNA mismatch repair

FAP: defect in tumour suppressor gene

100
Q

Liver lesions? Benign vs malignant

A

Primary (rare)
* Benign: adenoma (ass. with contraceptive), hemangioma, focal nodular hyperplasia (ass. w hemangioma), cysts
Malignant: HCC (alfa fetoprotein marker), fibro-lamellar carcinoma, hepatoblastoma, intrahepatic cholangiocarcinoma

101
Q

Gallbladder cancer?

A

Adenocarcinoma (ass. w gallstones)

102
Q

Bile duct cancer?

A

Cholangiocarcinoma (ass. w UC and PSC), adenocarcinoma

103
Q

Pancreatic cancer?

A

Exocrine: adenocarcinoma
Endocrine: gastrinoma, insulinoma, gluconoma

104
Q

Ax appendicitis? (5)

A

Faecoliths (dehydration), parasites, tumours, lymphoid hyperplasia

105
Q

s/s appendicits? (4)

A

Vomiting, WCC, RIF pain, abdo pain

106
Q

Coeliac disease?

A

Type IV hypersensitivity to gliadin, associated with HLA gene defect

107
Q

s/s coeliacs? (9)

A

dermatitis herpetiformis, childhood diabetes, flatulence, abdominal discomfort, weight loss, bloating, anaemia, steatorrhoea

108
Q

Dx coeliacs?

A

Duodenal biopsy, transglutaminase (tTGA) test

109
Q

Comps coeliacs? (3)

A

T cell lymphoma, small bowel carcinoma, gallstones

110
Q

s/s sepsis? (7)

A

Fever, chills, rigors, nausea/vomiting, constipation/diarrhoea, malaise, anorexia

111
Q

Tx sepsis?

A

BUFALO

  • Blood culture
  • Urine output (hourly)
  • Fluid resuscitation (IV)
  • Antibiotics (IV)
  • Lactate and FBC
  • Oxygen high flow
112
Q

Antibiotics for strep and enterococci?

A

Amoxicillin/vancomycin

113
Q

Antibiotics for ve- coliforms?

A

Gentamicin

114
Q

Antibiotics for ve- anaerobes?

A

Metronidazole

115
Q

Histo of oesophagus?

A

Stratified squamous epithelium with glands in submucosa (unlike rest of GI tract EXCEPT duodenum)

116
Q

Ax reflux oesophagitis? (4)

A

Defective sphincter, hiatus hernia, pregnancy, OBESITY

117
Q

Barrett’s oesophagus?

A

replacement of stratified squamous epithelium with columnar (intestinal metaplasia)
* red velvety lower oesophagus

118
Q

Tx Barrett’s? (2)

A

PPI, aspirin

119
Q

Allergic oesophagitis?

A

Corrugated (spotty) oesophagus

* Males, young, asthma

120
Q

Tx allergic oesophagitis?

A

Steroids, cromoglycate, montelukast

121
Q

Ax gastritis?

A

Autoimmune, bacterial (H.pylori), chemical

122
Q

Ax peptic ulcers? (2)

A

H.pylori, NSAIDs

123
Q

Tx peptic ulcers?

A
  • Duodenal require no follow-up

* Gastric require follow up due to risk of malignancy

124
Q

Dx H.pylori? (4)

A
  • Urease breath test, biopsy, culture, faecal Ag test
125
Q

Dyspepsia s/s? (3)

A
  • Epigastric pain/burning
  • Post-prandial fullness
  • Early satiety
126
Q

Tx dyspepsia?

127
Q

s/s upper bowel obstruction?

A

Vomit larg evolumes

128
Q

s/s large bowel obstruction? (2)

A

Colociky abdo pain, vomiting (possibly faeculent)

129
Q

s/s bowel obstruction in general? (5)

A

Distention, visible peristalsis, lack of abdo tenderness, centre of abdo is resonant, high pitched tinkling sound

1st Year Medicine (3 decks)

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