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GI exam notes Flashcards

1
Q

hepatocytes

A

liver endothelial cells

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2
Q

stomach layers

A

extra muscularis layer

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3
Q

enterocytes

A

SI: siimple columnar epithelium with a brush border

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4
Q

primary and secondary bile salts

A

primary: cholic
chendeoxycholic acid
secondary: deoxycolic and lithocholic acid

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5
Q

russels sign and murphy sign

A

murphy: cholecystitiis
russel: eating disorder

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6
Q

fractitoius disorder

A

fake symptoms for no seconday gain

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7
Q

malingering

A

fake symptoms for secondary gain e.g. benefits

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8
Q

brunnels glands

A

duodenum and neutralise chyme

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9
Q

ascities treatment

A

1: spironolactone
2: tips
3: transplant

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10
Q

treatment of itch

A

sodium bicarbonate

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11
Q

coeliac investugation

A

check IgA to make sure not deficient then TTG, if +ve then biopsy

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12
Q

arcodermatitis enteropathica

A

zinc malabsorption

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13
Q

endoscopic treatment of bleeds

A

heater probe coagulation
hemospray
clips
inject medication that causes vasoconstriction

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14
Q

crypt cells

A

large and small intestine

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15
Q

colonocytes

A

large intestine epithelium

secretes ions

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16
Q

major difference between segmentation and hasutra

A

segmentation: minutes
haustra: hours

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17
Q

causes of chronic gastritis

A

autoimmune

bacterial: H.pylori
chemical: NSAIDS alcohol

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18
Q

histology of coeiliac

A

flattened glands :no villi

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19
Q

acinar cells

A

cells of the pancreas

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20
Q

zymogens

A

pancreatic proteases

stored in inactive form, activated by proteases and stored in zymogen granules surrounded by protease inhibitors

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21
Q

tripsin

A

released from pancreas as tripsinogen and activated in duodenum by enteropeptidase so can now activate zymogens

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22
Q

cholangiocarcinoma

A

bile duct cancer

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23
Q

peyers patches

A

ileum of the SI

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24
Q

mucosal immune system parts

A

epithelium: CD8 T cells

lamina propria: CD4 t cell

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25
Q

main antibody of mucosal immunity

A

IgA

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26
Q

key features of PBC

A

t cell mediated
cholestatic LFTs
AMA
t: deoxycholic acid

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27
Q

autoimmune hepatitis

A

hepatomegaly
jaundice
must give prednisolone

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28
Q

PSC

A

liver transplant
ultrasound/ MRCP
UC

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29
Q

where does the parotid gland drain into mouth

A

2nd molar tooth

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30
Q

where does the submandibular gland drain into mouth

A

lingual caruncle

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31
Q

metoclopramide

A

inc gastric emptying via vagus nerve

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32
Q

cells and secretion of stomach

A

HCL: parietal

pepsinogen: chief
mucus: gastric pits
histamine: enterochromaffin
gastrin: G cells
somatostain: D cells

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33
Q

additional stomach secretions

A

intrinsic factor: B12 absorption
enterochromaffin: iron absorption
Ach: inc acid secretion
prostaglandin: dec acid secretion

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34
Q

faecal peritonitis

A

complication of diverticulus where the bowl perforates and faeces enter the peritoneum

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35
Q

normal portal system pressure

A

8mmHg

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36
Q

oesophagus blood supply

A

thoracic: inferior thyroid artery and vein, aorta and azygous
abdomen: left gastric artery, azygous vein

portal vein: left gastric vein

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37
Q

what causes a volvulus

A

pregnancy

severe constipation

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38
Q

portal triad

A

hepatic artery
hepatic portal vein
bile duct

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39
Q

cantor string sign

A

crohns

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40
Q

achalasia treatment

A

ca channel blocker

or b blocker

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41
Q

virchows node

A

supraclavicular bump

suggests gastric cancer

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42
Q

oxalate renal stones

A

present in crohns bc of malabsorption

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43
Q

pharyngeal pouch

A

regurg
cough
dysphagia
halitosis: bad breath

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44
Q

treatment of hepatic encelopathy

A

lactulose and rifampicin

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45
Q

meissners plexus

A

enteric nervous system in the submucosa

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46
Q

complications of coeliac

A

osteoporosis

lymphoma

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47
Q

wilsons disease complication

A

haemolytic anaemia

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48
Q

femoral hernia

A

high risk of strangulation
emergency repair
below and lateral to pubic tubercle
females

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49
Q

inguinal hernia

A

superior and medial to pubic tubercle

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50
Q

indirect inguinal hernia

A

kiddos
lateral to inferior of epigastric artery
inguinal ring

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51
Q

direct inguinal ring

A

hasselbach triangle
abdo wall
disappears when cough

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52
Q

pylonephritis symptoms

A

kidney inflammation
fever
rigors
back pain

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53
Q

hepatoduodenal ligament

A

hepatic artery
hepatic duct
hepatic portal vein

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54
Q

hepatogastric ligament

A

right and left gastric vein

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55
Q

renal colic

A

pain in back in waves

blood in urine

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56
Q

lynch syndrome

A

HNPCC

mismatch repair

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57
Q

FAP

A

100s of polyps
mutation in APC tumour supressor
present young

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58
Q

angiodysplasia of the colon

A 
degenerative vascular malformation 
intermittent gi bleed (upper and lower)
>60
aortic stensois 
Treatment: endoscopic ablation of the abnormal vessels
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59
Q

prognostic indicator of alcoholic liver disease

A 
encelopathy
albumin
albumin
ascities
PT time
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60
Q

pancreatic prognostic indicator

A 
Pa02 <8pKa
Age >55
Neutrophil WBC >15
Calcium <2
Renal function Urea>16
Enzymes AST/ALT>200 LDH >600
Albumin <32
Sugar >10

3= sever, CRITICAL CARE

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61
Q

blood supply of the small intestine

A

gastroduodenal artery till bile duct then SMA and SMV

gastropancreatic and superior mesenteric nodes

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62
Q

nerve that supplies the rectum

A

s4

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63
Q

thumb printing at splenic flexure

A

ischaemic colitis

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64
Q

abdominal pain
rectal bleeding
metabolic acidosis

A

mesenteric ischaemia

65
Q

signet rings on biopsy

A

stomach cancer

66
Q

alphafeto protein

A

gastric cancer

67
Q

adrenal gland position

A

suprarenal

68
Q

ampulla of vater

A

union of the pancreatic and bile duct

69
Q

zollinger ellison syndrome

A

gastrin secreting tumour that causes hypersecretion of acid leading to gastric ulcer disease

70
Q

mallory hyaline bodies

A

alcoholic hepatitis

71
Q

coeliac trunk: where it arises and divisions

A

T12
splenic artery
hepatic artery
left gastric artery

72
Q

holes in diaphragm

A

T8: vena cava
T10: oesophagus
T12: aortic hiatus

73
Q

cheek msucle that moves food during mastication

A

buccinator

74
Q

onion skinning fibrosis and beading of bile ducts

A

PSC

75
Q

caput medusae

A

medusa from umbilicus

portal hypertension

76
Q

tinkling bowel sounds

A

bowel obstruction

77
Q 
role of gastrin 
cck 
somatostatin 
glucagon 
GLP1 GLIP
A 
inc HCL
inc bile, pancreatic protease and lipase
dec HCL and inc HCO3
hunger hormone 
inc insulin
78
Q

what gastroenteritis cause bleeding

A

e coli
shigella
salmonella
campylobacter

79
Q

first line for ascities

A

ascitic tap/ paracentesis: aspirate ascities and see if SBP(>250 cells per mm2)
then spironolactone

80
Q

serum results in haemochromatosis and wilsons and treatment

A

haemachromatosis: high iron: venesection
wilsons: low copper: pecillamine a copper chealting agent

81
Q

granulomas and IBD

A

crohns:non caseating granulomas

82
Q

hep B or hep C acute

A

hep B: jaundice, asia

hep c acute: asymptomatic

83
Q

prolonged laxative use

A

melanosis coli
brown pigmentation of coli
asymptomtic
causes death to colonic mucosa so lots of macrophages

84
Q

recurrent peptic ulcers

A

gastrinoma: test gastrin levels

neuroendocrine tumour

85
Q

Peutz Jeghers syndrome

A

multiple polyps
brown pigements at hand feet face
inc risk of cancer
dominant

86
Q

UC endoscopy screening

A

low risk: every 5 years
medium risk: 3 years
high risk: annual

87
Q

inc in ethogenicity

A

bigger

88
Q

hyatid disease

A

sheep farming
uncooked meat
cysts: mainly liver or lung
drain with albendazole

89
Q

cannot identify bleeding cause

A

capsule endoscopy

90
Q

resistant c diff

A

faecal transplant:

bacterial flora from a healthy donor is given b=via enema

91
Q

gilberts syndrome

A 
jaundice
genetic
pre hepatic jaundice
if stressed/ fatigues or viral illness can get an isolated rise in bilirubin
benign
92
Q

pain at night and relieved by milk

A

duodenal ulcer

93
Q

diagnosis of achalasia

A

oesophogeal manometry study

94
Q

dysphagia:

1) solids and liquids from start?
2) is it difficult to initiate a swallowing movement?
3) odonophagia?
4) intermittent or constant and worsening?
5) does the neck gurgle/ bulge?

A

1) yes: achalasia/ motility problem
no: structure
2) yes: blaber palsy, esp if cough on doing so
3) ulcer, malignancy, virus
4) intermittent: oesophogeal spasm, constant/ worsening: malignant
5) pharyngeal pouch

95
Q

treatment of achalasia

A

endoscopic balloon dilation

hellers cariomyotomy

96
Q

acute and prophylactic management of gasto-oesophogeal varices`

A

acute: banding or sclreotherapy
prophylaxis: b blocker

97
Q

carcnoid tumour

A

neuroendocrine tumour of enterochromaffin cells

98
Q

haemochromotosis

A

bronzed diabetic
tired
slate grey pigemntation

99
Q

anti mitochondrial

A

PBC

100
Q

ANTI SM

A

autoimmune

101
Q

TTG

A

coeliac

102
Q

ANA

A

autoimmune

103
Q

anti GBM

A

goodpastures

104
Q

ANCA

A

vasculitis

105
Q

cantor string om CXR

A

crohns

106
Q

leadpipe colon

A

UC

107
Q

achalasia pharmacological treatment

A

B-blocker

Ca channel antagonist

108
Q

halitosis

A

bad breath

109
Q

coffee bean xray

A

sigmoid volvulus

110
Q

corkscrew xray

A

midgut volvulus

111
Q

birdspeak oesophagus

A

achalasia

112
Q

hepatic encelopathy treatment

A

rifampicin and lactulose

113
Q

gene in lynch vc FAP

A

lynch:HNPCC
FAP: APC

114
Q

beta oxidation/lipolysis

A

fatty acid conversion to acetyl co A
- fatty acid to acyl coA (2ATP)
-acyl CoA to creatinine to cross memb then back to acyl CoA
beta oxidised

115
Q

lipogenesis

A

acetyl CoA to citrate (TCA) to cross memb then back to acetyl Co-A. activated to menalyl Co-A by acetyl CoA carboxylase. acetyl A and menayl coA a are precursors for fatty acid synthesis.

116
Q

amylase and lipase levels in hyperglycaemia induced pancreatitis

A

reduced

117
Q

calcium and peptic ulcer

A

hypercalcaemia

118
Q

increase alpha-fetoprotein

A

hepatocellular carcinoma

119
Q

apart from dec acid, other role of PGE2

A

inc mucus and bicarbonate secretion

120
Q

treatment of budd chairi

A

1) angicoagulation
2) angioplasty + thrombolysis
3) TIPS
4) in rapid developing ascities liver transplant

121
Q

ESR

A

monitors inflammation

122
Q

scalloping on endoscopy

A

coeliac

HIV

123
Q

diarrhoea in immunocompromised

A

isospara belli

crpytosporidium

124
Q

palmar arythema

A

liver cirrhosis

125
Q

pyoderma gangrenosum

erythema nodosum

A

Crohns and UC

126
Q

tropical sprue

A 
chronic diarrhoea
weight loss
vitamin b12
folate deficiency 
give b spec: tetracycline and folate supplement
127
Q

what is the meckels diverticulum a remnant of?

A

vitello intestinal duct

128
Q

coeliac disease grading

A 
0=normal 
1=increased lymphocytes
2= crypt hyperplasia 
3=blunt villi
4=total villious atrophy and atrophic crypts
129
Q

C13 breath test

A

eradication of H.pylori

130
Q

gold standard for H.pylori

A

breath test

131
Q

h.pylori antibody

A

IgG … chronic

132
Q

hep C investigation

A

1) hep C antibody

2) hep C RNA and genotype

133
Q

treatment of hep C

A

genotype 1: PEG interferon, protease inhibitor and ribavirin

134
Q

anal fissure: symptoms and treatment

A

pain on defecation
bloody stools
laxatives and GTN cream

if does not resolve surgery

135
Q

hypercalcaemia

A

lethargy
nausea
confusion
stones

136
Q

proctitis syndrome

A

blood and tenesmus

ceftriaxome for goonorrhea

137
Q

budd chairi symptoms and affected vessel

A

hepatomegaly
abdominal pain
ascities
hepatic vein affected`

138
Q

complication of e.coli and how to diagnose it

A

haemolytic uremic syndrome :

  1. haemolytic uremia
  2. acute kidney injury
  3. low platelet
139
Q

foecal occult blood

A

screening for colorectal cancer

detects blood not visible by eye

140
Q

alpha fectoprotein

A

liver tumour

141
Q

cancer antigen 19-9

A

pancreas

142
Q

carcinoembryonic antigen

A

large intestine

143
Q

ca 125

A

ovarian maligancy

144
Q

ACEI levels

A

low: obstructive pulmonary disease, hypothyroidism
high: sarcoidosis, PBC, hyperthyroidism

145
Q

AMA

A

PBC

146
Q

ANA

A

autoimmune:

  • hepatitis
  • rheumatoid
147
Q

ANCA

A

vasculitis
PSC
IBD
autoimmune

148
Q

ct of bowel obstruction

A

transition point of collapsed(black filled with air)/ distented bowel

149
Q

management of painful hernia

A

surgery: suggests strangulation

150
Q

paralytic ileus

A

disruption of the normal propulsive activity of the GI tract due to peristalsis failure
risk factors: recent surgery, inflammation
treatment: drip and suck

151
Q

ogilvies syndrome

A

acute dilation of the bowel in the absence of any bowel obstruction in the acutely unwell

152
Q

haemorrhoids

A

enlarged vascular cushion in the lower rectum/anal canal
painless bleeding
not mixed with stool usually bright red on paper

colonoscopy if red flags >55

treatment: grade 1: topical corticosteroid
grade 2: rubber band ligation
grade 3: rubber band ligation
grade 4: surgical haemorrhoidectomy

153
Q

rectal prolapse

A

protruding pass from anus especially during defecation
mucus and blood are common
poor anal tone

154
Q

anal prolapse

A

tear in the anus while passing a constipated stool

multiple fissures think crohns

155
Q

fistula in ano

A

opening in the peri-anal skin
most commonly due to ano-rectal abscess
can be due to: crohns, carcinoma or TB

156
Q

hod you test for wilsons

A

serum ceruloplasmin

157
Q

ESR

A

inflammmation

158
Q

causes of AF

A

chest infections
valve disease
alcoholism
MI

GI (4 decks)

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