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Phase 2a Questions > GI/liver > Flashcards

GI/liver Flashcards

1
Q

Coeliac D - Serum Ab testing

A
  1. Endomysial Ab (IgA)
  2. Tissue transgultaminase Ab (IgA)
  3. Correlate w severity
  4. Indications = pers D, folate/iron deficiency and fam history or associated autoimmune D
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2
Q

Large bowel obstruction (volvulus) vs small bowel obstruction

A

Large =

  1. S present later - can distend to greater extent (large lumen, circular + longitudinal M)
  2. More constant abdo pain
    - short = colicky then diffuse and higher in abdo
  3. Late V - more faecal like
    - short = earlier and follows pain
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3
Q

Irritable Bowel Syndrome - Pharmacology

A
  1. Anti-spasmodic (Mebeverine) - pain/bloating
  2. Laxative (Mavicol) - constipation
  3. Linaclotide - C >12mths
  4. Anti-motility agents (loperamide) - diarrhoea
  5. Tricyclic antidepressants (amitriptyline) - dampen gut sensitivity
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4
Q

lBD vs IBS

A

IBD

  1. Abnormal Ix
  2. Fever
  3. S outside GI tract
  4. Blood in stools (Meleana - black poo - bleeding higher up)
  5. Weight loss
  6. Mouth ulcers
  7. Nocturnal diarrhoea
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5
Q

Ascending cholangitis- presentation

A

Reynold’s pentad

  1. Biliary colic
  2. Fever
  3. Rigor
  4. Jaundice - cholestatic - dark urine, pale stools + itching
  5. Right upper quadrant pain
  6. Murphy’s sign - pain on taking deep breath and two fingers on RUQ (gallbladder location)
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6
Q

Hepatitis - DNA or RNA

A 
A = RNA
B = DNA
C = RNA
D = Incomplete RNA - needs B
E = RNA
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7
Q

Haemochromatosis - definition

A

Inherited disorder of iron metabolism
Increased intestinal iron absorption
Iron deposition in joints / liver / heart / pancreas / pit / adrenals / skin

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8
Q

H pylori eradication (peptic ulceration)

A

Triple therapy

  1. PPI for acid suppression (Lansoprazole/Omeprazole)
  2. Clarithromycin
  3. Amoxicillin
  4. Quinolone (ciprofloxacin) - rescue therapy
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9
Q

Colorectal carcinoma - Duke’s Classification

A 
A = limited to muscularis mucosae
B = Extend through muscularis mucosae (not lymph)
C = Regional lymph nodes
D = Distant mets
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10
Q

Colorectal carcinoma - Epidemiology

A
  1. Majority in distal colon

2. Familial adenomatous polyposis (FAP) and Hereditary Non-Polyposis Colon Cancer (Lynch S) = genetic risk factors

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11
Q

Cancer - Red flags

A
  1. Weight loss
  2. Anaemia
  3. Dysphagia
  4. Upper abdo mass
  5. Persistent V
  6. Upper GI bleed (Melaena)
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12
Q

Coeliac Disease - Histology

A
  1. Villous atrophy
  2. Crypt hyperplasia
  3. Intraepithelial lymphocytes
  4. Proximal smal bowel
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13
Q

IBS - Rome III diagnostic criteria

A 
1. Abdo pain >3days/mth for >3mths 
\+ 2 of
2. Relief w defecation
3. Change in freq of stool
4. Change in form of stool
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14
Q

Helicobacter pylori

A
  1. Gastritis and peptic ulcer disease

2. Increased risk of gastric cancer

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15
Q

Ascitic tap

A
  1. Raised WCC - bacterial peritonitis
  2. Gram stain and culture
  3. Cytology - malignancy
  4. Amylase - pancreatic ascites
  5. Protein measurement - transudate (low protein) vs exudate (high protein)
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16
Q

UC vs Crohn’s disease

A

UC vs C

  1. Only colon vs whole GI tract
  2. No skip lesions vs skip lesions
  3. Circumferential and cont inflammation vs scattered
  4. C = cobble stoning
  5. Lower left quadrant pain vs abdo pain mimics appendicitis
  6. Mucosa only vs transmural
  7. No granuloma vs granuloma (non-caseating)
  8. 70% ANCA vs 70% ASCA
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17
Q

Ascites - Presentation

A
  1. Abdo swelling + distended abdo
  2. Fullness in flanks
  3. Shifting dullness
  4. Mild abdo pain
  5. Peripheral oedema
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18
Q

Alcohol unit

A

AU = % (strength) x ml / 1000

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19
Q

Diarrhoea - Antibiotic associated

A
  1. rule of C
  2. Clostridium difficile
    - result in pseudomembranous colitis (pathogen replaces normal gut flora)
20
Q

Primary Biliary Cirrhosis - Presentation

A
  1. Pruritus (itching)
  2. Lethargy
  3. Jaundice
  4. Pigmented xanthelasma (yellow fat deposits under skin - eyelids)
  5. Hepatomegaly
21
Q

Paracetamol overdose - Metabolic changes

A
  1. Raised ALT/AST
  2. Hypoglycaemia (inhibit gluconeogenesis)
  3. Raised creatinine
  4. Metabolic acidosis
  5. Prolonged prothrombin time
22
Q

Wernicke-Korsakoff encephalopathy

A
  1. Neurological symptoms (ataxia, confusion and nystagmus)
  2. From alcohol withdrawal
  3. IV thamine
23
Q

Appendicitis - perforation

A

Peritonitis

  • Sudden onset
  • Acute severe abdo pain
  • General collapse
  • Shock
  • Lying still + hands on abdo
24
Q

Duodenal ulcer - Clinical presentation

A
  1. Recurrent burning epigastric pain (specific, night and hungry)
  2. N
  3. Anorexia and weight loss
25
Q

Hernia - Common sites

A
  1. Inguinal
  2. Femoral
  3. Hiatus
  4. Incisional (site of prev excision)
26
Q

Obstruction - Bowel sounds

A
  1. Increased bowel sounds

2. Tympanic percussion (air/gas)

27
Q

Operation?

A
  1. Medically fit
  2. Resectable
  3. Metastasis
28
Q

Steroids - SE

A
  1. Osteoporosis
  2. Immunosuppression
  3. Hyperglycaemia
  4. Growth in kids
  5. Skin thinning
29
Q

Functions of stomach

A
  1. Store food
  2. Digest food
  3. Defence against pathogens
  4. Secrete intrinsic factor - B12 absorption
  5. Regulate emptying into duodenum
30
Q

Malabsorption - definition

A

Failure to fully absorb nutrients - destruction of epi or problem in lumen.
Food undigested

31
Q

Haemochromatosis - gross iron overload

A 
Classic triad
1. Bronze skin pigmentation (melanin deposition)
2. Hepatomegaly
3. DM
Raised serum ferritin
32
Q

Appendicitis - Pain

A
  1. Peri-umbilical
  2. Migrates to R iliac fossa (McBurney’s point)
    - Parietal peritoneum
  3. No somatic innervation in visceral peritoneum
  4. No laterality to visceral unmyelinated C fibre pain signals
33
Q

Malaria - Jaundice

A
  1. Pre-hepatic Jaundice
  2. Unconjugated bilirubin
  3. Normal stool
  4. Normal urine
34
Q

Hepatitis - faeco-oral transmission

35
Q

Coeliac D - Pathophysiology

A
  1. Prolamin alpha gliadin
    - resitant to digestion due to high glutamine + proline
  2. Pass through epi - deaminated by tissue transglutamase - increase immunogenicity
  3. BInd to APC - DQ2 or DQ8 activate T cells
  4. Inflammatory cascade
36
Q

Coeliac D - Clinical presentation

A
  1. Stinking stools / steatorrhoea (poor fat absorption)
  2. Bloating
  3. Abdo pain
  4. Osteomalacia (soft) –> osteoporosis
  5. Diarrhoea
37
Q

Primary Biliary Cirrhosis - Blood

A
  1. High alkaline phosphate
  2. High serum cholesterol
  3. Anti-mitochrondrial antibodies (AMAs)
  4. High serum IgM
38
Q

Functions of liver

A
  1. Glucose and fat metabolism
  2. Detoxification and excretion
  3. Protein synthesis
  4. Defence against infection
39
Q

Haemochromatosis - Liver biopsy

A

Perl’s stain –> identify iron

40
Q

Alcoholic Liver Disease - Diagnosis

A
  1. Fatty liver
    - High MCV
    - High ALT and AST
    - Ultrasound/CT = fatty infiltration
  2. Alcoholic hep
    - Leucocytosis
    - High serum bilirubin / ALT / AST / alkaline phosphate
    - Raised GGT
41
Q

Crohn’s Disease - S outside GI tract

A
  1. Peri-anal abcess
  2. Skin tags
  3. Anal strictures
  4. Aphthous oral ulcerations
  5. Clubbing
42
Q

Prednisolone - action

A
  1. Upregulate anti-inflammatory genes

2. Down regulate pro-inflammatory genes

43
Q

Prednisolone - SE

A
  1. Immunosuppression
  2. Hypertension
  3. Thin skin
  4. Mood disturbance
  5. Adrenal suppression
44
Q

GORD - risk factors

A
  1. Hiatus hernia
  2. Loss of oesophageal function
  3. Central obesity
  4. Gastric acid hypersecretion
  5. Slow gastric emptying
45
Q

GORD - Alarm bell signs

A

Endoscopy

  1. Weight loss
  2. Haematemesis (vomit blood)
  3. Dysphagia
  4. Melaenia
  5. Recent onset
46
Q

GORD - Diagnosis

A
  1. Only if alarm bell signs
  2. Endoscopy
  3. Ba swallow
47
Q

GORD - Treatment

A
  1. Antacids (Mg trisilicate mixture)
  2. Alginates (gaviscon)
  3. Proton pump inhibitor (lansoprazole)
  4. H2 receptor antagonist (cimetidine)

Phase 2a Questions (14 decks)

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