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Phase 2a mocks > GI / Liver > Flashcards

GI / Liver Flashcards

1
Q

41M. Presents with tiredness, weakness and slight abdominal pain. Yellowing of eyes.
Slightly raised bilirubin, other LFTs normal.
What colour faeces would you expect him to have? Why?

A

Normal urine and normal stool.

He has Gilberts syndrome -> prehepatic jaundice -> raised uncojugated bilirubin -> Normal urine and stool

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2
Q

51F. Presents with increasing tiredness (impacting QOL) Scratching forearms - worse at night. No abdo pain but sometimes cramps due to coeliac disease.

LFTs:
- Bilirubin: 75 μmol/l (+++)
- ALT: 60 IU/I (+)
- AST: 92 IU/I (+)
- ALP: 196 IU/I (+++)
- GGT: 108 IU/l (++)

FBC: increase in IgM

Most likely diagnosis and test to perform to confirm?

A

Primary biliary cholangitis.

Blood test for anti-microbial antibodies

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3
Q

53M.
Dyspnoea, dark urine, pale stools, yellowing of sclera and pruritis.
Spirometry: FEV1:FVC = 0.68
Abnormal LFTs.

Most likely diagnosis?

A

Αlpha antitrypsin disease

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4
Q

A 26-year-old female is brought to the A&E due to Paracetamol poisoning. What’s the mechanism of action of N-acetyl cysteine?

A

Replenishes the supply of glutathione that conjugates NAPQI to ton-toxic compounds.

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5
Q

A 46-year old man presents to you with a 2-week history of confusion, malaise and abdominal pain. On examination you locate the pain to the right upper quadrant and notice jaundiced eyes. His temperature is 38.2C.
What is the best investigation to confirm the most likely diagnosis?

A

Ascending cholangitis

Contrast enhanced dynamic CT

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6
Q

Most common cause of iatrogenic chronic pancreatitis?

A

Px of ERCP

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7
Q

A 52 year-old Swedish male presents to you with fatigue and cholestatic jaundice.
ALP, bilirubin and IgM levels are increased.
Px: ulcerative colitis
Diagnosed with primary sclerosing cholangitis.

Which condition is his risk significantly increased for? What investigation would his annual check involve?

A

Colorectal/biliary system malignancy - colonoscopy

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8
Q

Which type of hepatitis virus consists of DNA?

A

Hep B

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9
Q

58M.

3 month history of fatigue, weakness, nonspecific abdominal problems and erectile dysfunction. Tachycardia, mood swings.
Bronzing of the skin and hepatomegaly.

Most likely diagnosis and first line investigation?

A

Haemachromatosis

Ferritin blood tests

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10
Q

Skip lesions on colonoscopy indicate which IBD?

A

Crohns

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11
Q

Which IBD is associated with mouth ulcers?

A

Crohns

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12
Q

What is the most appropriate first step to take in the following case:

A 55 YO man referred to a gastroenterology clinic with 6 month history of worsening dyspepsia and epigastric pain. No weight loss or history of dysphagia. No change in his bowel movements. He reports taking ibuprofen for back pain regularly.

A

Refer for upper GI endoscopy within 2 weeks to rule out serious causes before anything else.

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13
Q

5M. Underweight, fatigued, intermittent stomach pain, nausea, diarrhoea. Mother has a history of thyroid disease.

Most likely diagnosis and gold standard investigation?

A

Coeliac

Endoscopic intestinal biopsy

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14
Q

What is a pharyngeal pouch and what symptoms can it cause?

A

A posteromedial herniation of the oesophagus between the thyropharyngeus and cricopharyngeus muscles.

Symptoms: difficulty swallowing, regurgitation ,aspiration. Chronic cough but no resp symptoms. Bad breath. Midline throat lump that gurgles on palpation

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15
Q

What kind of anaemia can colorectal cause?

A

Iron deficiency anaemia

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16
Q

Likely finding on colonoscopy / biopsy with UC?

A
  • crypt abscesses
  • goblet cell depletion
  • inflammation limited to the mucosa
  • continuous inflammation (i.e. not skin lesions)
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17
Q

What is diverticulosis?

A

Asymptomatic diverticula

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18
Q

What is diverticulitis?

A

Inflammation of diverticulum - outpourings of the large intestine

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19
Q

What is diverticular disease?

A

Diverticula causing symptoms

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20
Q

What is diverticular stricture?

A

A complication of diverticulitis

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21
Q

Where is Virchow’s node?

A

Supraclavicular area

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22
Q

What dietary supplementation is required post ileo-caecal resection?

A

Vitamin B12

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23
Q

Describe Marsh 1

A

Only intraepithelial lymphocytes and NO crypt hyperplasia

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24
Q

Describe marsh 2

A

intraepithelial lymphocytes and crypt hyperplasia

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25
Q

Describe marsh 3a

A

intraepithelial lymphocytes and partial/mild villus atrophy

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26
Q

Describe marsh 3b

A

intraepithelial lymphocytes and subtotal/moderate villus atrophy

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27
Q

Describe marsh 3c

A

intraepithelial lymphocytes and total villus atrophy

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28
Q

42M. 2mnth history epigastric pain, weight loss. Relief from antacids. No vomiting or loose stools. Endoscopy and biopsy show inflammation.

Most likely diagnosis?

A

H.pylori gastritis

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29
Q

How do you distinguish between small and large bowel obstruction from pt history?

A

Vomiting before constipation? = small bowel

Constipation before vomiting? = large bowel

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30
Q

What is the first line investigation for coeliac disease?

A

Blood test for coeliac antibodies: IgA and TTG

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31
Q

What is the GS investigation for coeliac?

A

Duodenal biopsy

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32
Q

What is the name of the bowel cancer screen?

A

Faecal immunochemical test (FIT)

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33
Q

What is the GS investigation for acute diverticulitis?

A

CRP

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34
Q

Give 6 red flag symptoms of oesophageal cancer

A
  • weight loss
  • bleeding
  • anorexia
  • lymphadenopathy
  • vomiting
  • progressive dysphasia
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35
Q

Give 3 symptoms of GORD

A
  • heartburn
  • increased belching
  • food regurgitation
  • increased salivation
  • chronic cough
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36
Q

Give 2 causes of GORD

A
  • hiatus hernia
  • lower oesophageal sphincter hypotension
  • para oesophageal hiatus
  • abdominal obesity
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37
Q

Give 2 possible complications of GORd

A

Barrett’s oesophagus, peptic stricture

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38
Q

Give 2 causes of IBS

A
  • psychological stress
  • depression
  • anxiety
  • trauma
  • eating disorders
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39
Q

Give 2 non intestinal symptoms of IBS

A
  • painful periods
  • change in urinary frequency
  • back pain
  • joint hyper mobility
  • fatigue
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40
Q

Name 2 DD for IBS

A
  • coeliac disease
  • lactose intolerance
  • bile acid malabsorption
  • IBD
  • colorectal cancer
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41
Q

What is the diagnostic criteria for IBS?

A

Rome III criteria

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42
Q

What class of drugs are used to manage IBS?

A

Anticholinergics

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43
Q

Give 2 DD of biliary colic

A

Pancreatitis, renal colic

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44
Q

What are the 2 types of biliary colic?

A

Cholesterol biliary colic / gallstone
Bile pigment biliary colic / gallstone

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45
Q

Risk factors for biliary colic

A

Female, obese, fertile, smoking

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46
Q

How is biliary colic diagnosed?

A

Abdominal US

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47
Q

Give 2 treatment options for biliary colic

A

Stone dissolution
Shock wave lithotripsy
Laparoscopic cholecystectomy

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48
Q

Presentation: severe epicanthic pain radiating to the back, binge drinking, history of gallstones.

Most likely diagnosis and first line investigation?

A

Acute pancreatitis

Serum amylase

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49
Q

What are the first line and GS treatments for autoimmune hepatitis?

A

1st line = Prednisolone
GS = Prednisolone AND Azithioprine

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50
Q

Peritonitis causative organism - gram positive, coagulase positive

A

Staphylococcus aureus

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51
Q

Peritonitis causative organism

Gram negative bacteria, lactose fermenter (pink on MacConkey agar)

A

Klebsiella pneumoniae, E.coli

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52
Q

Define primary sclerosing cholangitis

A

A rare, chronic, cholestatic liver disorder characterised by multi focal biliary strictures and progressive liver disease.

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53
Q

How does primary sclerosing cholangitis present?

A

Insidious onset, presents with jaundice, pruritis, fatigue, ±IBS symptoms

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54
Q

What kind of cancer is associated with primary sclerosing cholangitis?

A

CHolangiocarcinoma

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55
Q

What type of jaundice is seen in primary sclerosing cholangitis and what colour urine and stool ?

A

Post hepatic jaundice, therefore raised conjugated bilirubin, therefore dark urine and pale stool

56
Q

First line treatment for alcohol withdrawal?

A

Chlordiazepoxide

57
Q

What is the most common cause of liver cirrhosis?

A

Chronic alcohol abuse

58
Q

Give a complication of ascites

A

Bacterial peritonitis

59
Q

Give 4 RFs for developing a hernia

A
  • lifting heavy weights
  • previous abdominal surgery
  • chronic cough
  • straining while defacating
60
Q

What causes median accurate ligament syndrome (MALS)?

A

Compression of the coeliac artery

61
Q

50F. Recurrent RUQ pain, 20 min episodes after meals especially with fatty food. No fever/chill, episodes always resolve. Px hyperlipidaemia, morbid obesity, poly cystic ovarian disease.

Most likely diagnosis?

A

Gallstones

62
Q

List 5 causes of hepatocellular cancer

A

Alcoholic liver disease,
Non alcoholic fatty liver disease,
Viral hepatitis,
Autoimmune hepatitis,
Wilsons disease,
Haemochromatosis

63
Q

List as many causes of pancreatitis as you can

A

IGETSMASHED is the mnemonic to learn for this.
• Idiopathic
• Gallstones
• Ethanol (alcohol)
• Trauma
• Steroids
• Mumps
• Autoimmune
• Scorpion venom/spider bite
• Hyperlipidaemia, hypothermia, hypercalcaemia
• ERCP
• Drugs

64
Q

Explain the Pathophysiology behind hepatitis

A
  • hepatitis is inflammation of the liver
  • something causes liver injury which activated the inflammatory response, causing infiltration of inflammatory cells and liver cell necrosis
  • if chronic, this causes progressive fibrosis and cirrhosis, and therefore chronic liver disease
  • causes of the initial injury include infection (bacterial/virus/parasite), medication, alcohol, autoimmune etc
65
Q

Treatment of ruptured appendix -> peritonitis

A

Urgent appendectomy and clean the cavity
IV antibiotics for several days, then oral antibiotics for 2-4ths

66
Q

You see a 31-year-old male patient in your clinic who has been diagnosed with Wilson’s disease. Name 2 signs you might expect to see and what causes them?

A
  • Keyser-Fleischer rings due to copper deposits in the iris
  • Neurological signs due to copper deposits in the CNS
67
Q

A 43 -year-old female patient presents in A and E with fever, RUQ pain, jaundice, hypotension, confusion. What is the name of this presentation and what is the most likely diagnosis?

A

Charcots Triad

Ascending cholangitis

68
Q

A 51-year-old female patient presents with in your clinic and you diagnose her with PBC. What clinical features might you expect to see?

A

• Pruritus, with or without jaundice is the most common presenting complaint
• Hepatosplenomegaly
• Xanthelasma
• Raised serum alkaline phosphatase or autoantibodies
• Steatorrhea
• Malabsorption of fat-soluble vitamins

69
Q

Treatment for paracetamol overdose?

A

N-acetyl-cysteine AND activated charcoal within 1 hr of ingested substance

70
Q

Name 4 abnormal results expected in ruptured oesophageal varices

A
  • anaemia
  • raised bilirubin
  • low albumin
  • raised AST/ATL/ALP
  • increased prothrombin time
71
Q

2 conditions that cause bronze skin pigmentation

A
  • Haemochromatosis
  • Addisons disease
72
Q

4 signs or symptoms of hepatitis

A
  • fever
  • RUQ pain
  • headache
  • jaundice
  • nausea/vomiting
73
Q

What is Morpheys sign and which condition gives a positive murpheys sign?

A

Murphy’s sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive

74
Q

Name 2 signs that appear on the abdomen as colour changes during acute pancreatitis

A

-Grey Turners sign (flank brushing)
- Cullens sign (bruising around the umbilicus)

75
Q

Name the types of diarrhoea

A
  • secretory
  • osmotic
  • exudative
  • inflammatory
  • dysentery
76
Q

What symptoms would indicate inflammatory diarrhoea?

A

Severe diarrhoea (very watery), blood in stool, fever, abdominal pain, tenesmus

77
Q

List 3 symptoms of small bowel obstruction

A
  • abdominal distension
  • vomiting/nausea
  • constipation
  • intermittent abdominal pain
78
Q

What abdo radiograph finding would confirm diagnosis of small bowel obstruction?

A

Dilated jejunum and/or ileum, Absence of gas in bowel distal to the obstruction

79
Q

Describe the supportive management of small bowel obstruction

A

‘Drip and suck’ management

  • make the pt nil by mouth
  • insert a nano gastric tube to decompress to bowel
  • start IV fluids to correct electrolyte imbalance
  • urinary catheter and fluid balance
  • analgesia as required
  • anti emetics
80
Q

List 3 causes of gastritis

A

Helicobacter pylori infection,
Non-steroidal anti-inflammatory drugs (NSAIDs),
alcohol abuse,
Bile reflux,
Autoimmune-related,
Mucosal ischaemia,
Bacterial invasion of the gastric wall.

81
Q

What investigation would be done if infective gastritis is suspected?

A
  • helicobacter pylori urea breath test
  • helicobacter Pylori faecal antigen test
82
Q

Name 3 clinical features of haemorrhoids

A
  • bright red bleeding i.e. fresh blood on toilet paper and outside of stool
  • discomfort / pain when defacating
  • pruritis ani
  • mucus discharge
83
Q

What are haemorrhoids?

A

Swelling and inflammation of veins in the rectum and anus

84
Q

Describe the two types of haemorrhoids

A

Internal haemorrhoids: arise internally, are painless, can prolapse, covered in mucus

External haemorrhoids: form at the anal opening, painful, covered with skin

85
Q

Give the non surgical and surgical treatment options for haemorrhoids

A

Non surgical: stool softeners, high fibre diet, adequate fluid intake, topical analgesia, topical hydrocortisone

Surgical: band ligation, haemorrhoidectomy, sclerotherapy

86
Q

GORD, non pharmacological management options

A
  • weight loss
  • healthy eating
  • smoking cessation
  • eat smaller meals
  • eat evening meal several hours before going to bed
  • reduce alcohol consumption
87
Q

Describe the macroscopic features of Crohns

A

Affects any part of the GI tract (from mouth to anus)
Skip lesions
Cobblestone mucosa

88
Q

Describe the microscopic features of Crohns

A

Transmural inflammation
Granuloma
Goblet cells present

89
Q

List 5 causes of acute diarrhoea

A
  • bacterial e.g. salmonella
  • viral e.g. rotavirus
  • food allergy
  • anxiety
  • constipation w overflow
90
Q

Give 2 examples of antibodies that if raised cause suspicion for coeliac

A

IgA-tTG, IgA-EMA

91
Q

List 5 RFs for colorectal carcinoma

A
  • increasing age
  • alcohol
  • smoking
  • low fibre diet
  • UC / Crohn’s disease
  • family history
  • PMH cancer
92
Q

Name 3 non invasive tests for H.pylori infection

A
  • C-urea breath test
  • blood / serological testing / IgG antibody detection
  • stool antigen test
93
Q

List 4 potential complications of diverticulitis

A
  • large bowel perforation -> peritonitis
  • fistula formation to the bladder or vagina
  • large bowel obstruction
  • bleeding, possibly large volumes
  • mucosal inflammation
94
Q

What is the first line drug used to treat haematemesis from ruptured oesophageal varices?

If this drug if contraindication what drug should be used instead?

A

IV Terlipressin (vasodilator, controls variceal bleeding)

If contraindicated (e.g. IHD) then IV somatostatin should be used

95
Q

List 3 DD for acute appendicitis

A
  • ectopic pregnancy
  • UTI
  • diverticulitis
  • perforated ulcer
96
Q

What is the function of the gallbladder ?

A

Store and concentrate bile

97
Q

What are the majority of gallstones made from?

A

Cholesterol

98
Q

What is gallstone ileus?

A

Impaction of the gallstone in the small intestine

99
Q

How are Mallory Weiss tears usually treated?

A

Endoscopic haemostasis

100
Q

3 most common causes of pancreatitis?

A
  • gallstones
  • alcohol
  • trauma
101
Q

What blood test result is sensitive and specific for pancreatitis?

A

Raised serum lipase

102
Q

What is the name of the scoring system that is used to predict the severity of pancreatitis?

A

Modified Glasgow criteria

103
Q

What might be found on surgical exploration of post abdominal surgery necrotising fasciitis?

A
  • grey, necrotic tissue
  • lack of arterial bleeding
  • thromboses vessels
  • ‘dishwater’ pus
  • lack of resistance to dissection
  • non-contracting muscles
104
Q

Name a highly sensitive investigation for intestinal inflammation

A

Faecal calprotectin

105
Q

Give 2 extraintestinal signs of inflammatory bowel disease

A

Clubbing
Aphthous ulcers
Iritis
Conjunctivitis
Episcleritis
Arthritis
Erythema nodosum
Fatty liver changes
Perianal disorders e.g. skin tags, fistulae, etc.

106
Q

Inherited colon cancer; what is the pattern of inheritance?

A

Autosomal dominant

107
Q

What is the commonest dermatological manifestation of IDB?

A

Erythema nodosum

108
Q

List 4 causes of raised bilirubin in urine

A
  • common bile duct stone
  • hepatocelluar carcinoma
  • pancreatic cancer
  • viral hepatitis
109
Q

What is the pathogenesis of epigastric pain caused by NSAIDs

A

NSAIDs cause a reduction in mucus and bicarbonate secretion in the stomach causing epigastric pain after eating

110
Q

Where is the remnant of the viteline duct?
What pathology is it associated with?

A

In the distal ileum
Associated with Meckel’s diverticulum

111
Q

Describe the ABG results of metabolic acidosis

A
  • low pH
  • normal O2/CO2
  • low bicarbonate
112
Q

What does the anion gap tell you about metabolic acidosis?

A

High anion gap = more acid being produced/ingested eg diabetic ketoacidosis

Low anion gap = loss of bicarbonate causing acidosis eg diarrhoea

113
Q

What part of the bowel is most likely to perforate during obstruction?

A

Caecum

114
Q

Where does UC most commonly start?

A

Rectum

115
Q

Where does Crohn’s most commonly affect?

A

Ileum

116
Q

Where does coeliac most commonly affect?

A

Duodenum

117
Q

What type of hernia is a hernia below the pubic tubercle most likely to be?

A

Femoral hernia

118
Q

What is Reynold’s pentad?

A

CHarcots triad (upper abdo pain, fever, jaundice) + shock (hypotension, tachycardia) + altered GCS

119
Q

What is ascending cholangitis most commonly caused by?

A

E.coli

120
Q

Describe the acute management steps of a ruptured oesophageal varices

A
  • ABCDE management (including fluid replacement, maybe balloon tamponade to stop bleeding)
  • Terlipressin (ADH analogue, for hypovolaemia)
  • prophylactic antibiotics
121
Q

What is the difference between exudate ascites and transudate ascites? Give an example of each

A

Exudate = higher protein content. Caused by peritonitis

Transudate = lower protein content. Caused by budd-chiari, heart failure, liver cirrhosis, portal hypertension)

122
Q

Give 2 causes of iron overload

A
  • hereditary Haemochromatosis
  • repeated blood transfusions
123
Q

What two results may be shown in a blood test that can help confirm the diagnosis of appendicitis?

A

Raised C-reactive protein
Raised white cell count / neutrophils / leukocytes

124
Q

List 8 signs of appendicitis

A
  • fever
  • abdominal pain
  • vomiting
  • anorexia
  • nausea
  • constipation
  • tachycardia
  • guarding
  • rebound tenderness
  • pain on movement
125
Q

How do you treat delirium tremens in wernickes encephalopathy?

A

Chlorodiazepoxide and lorazepam

126
Q

What is the triad of wernickes encephalopathy?

A
  • confusion
  • ataxia
  • opthalmoplegia
127
Q

Give 5 signs of liver failure, other than ascites

A
  • spider naevi
  • clubbing
  • jaundice
  • palmar erythema
  • bruising
  • oedema
  • anorexia
128
Q

Give 3 complications of alcoholic liver disease

A
  • hepatocellular carcinoma
  • oesophageal varices
  • portal hypertension
129
Q

Explain why liver failure leads to ascites

A

Low albumin levels cause oncotic pressure to be lower than hydrostatic pressure, causing fluid to leak into the abdominal cavity
Portal hypertension

130
Q

What is the name given to green/brown rings around the cornea in Wilsons disease?

A

Kayser-Fleischer rings

131
Q

Haemachromatosis: what gene is affected, what inheritance pattern?

A

HFE gene (homeostatic iron regulator)
Autosomal recessive

132
Q

Give 2 signs of haemachromatosis

A

Bronze skin pigmentation
Hepatomegaly

133
Q

Give 3 symptoms of Haemochromatosis

A
  • fatigue
  • arthralgia
  • erectile dysfunction
134
Q

Describe the vomit in peptic ulcer

A

‘Coffee ground’ haematemesis

135
Q

GI cancer red flags

A
  • unexplained weight loss
  • melena (blood in stool)
  • family history of bowel or ovarian cancer
  • change in bowel habit and over age 50
  • nocturnal symptoms
  • anaemia
  • raised inflammatory markers

Phase 2a mocks (11 decks)

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