GI (MCQBank) Flashcards
Organism that doesn’t cause bloody diarrhoea
Enterobacter (Gram -, facultatively anaerobic, rod shaped)
Organism that causes bloody diarrhoea
Salmonella
Shigella
Campylobacter jejuni
Yersinia enterolitica
E.coli
Entamoeba histolytica
Smoking effect on Crohn’s VS UC?
Worsen Crohn’s.
Protective for UC.
Age of onset for Crohn’s VS UC?
20-30 y/o for both?
What is Jalan’s diagnostic criteria for toxic megacolon?
- Radiographic evidence of colonic dilatation (>6cm)
- Any 3 of: fever >38.5, tachycardia >120, leucocytosis >10.5, anaemia.
- Any 1 of: dehydration, altered mental status, electrolyte abnormality, hypotension
who gets referred for upper GI endoscopy if they present with dyspepsia?
> =55 y/o
or have ALARMS:
Anaemia
Loss weight unintentional
Anorexia
Recent onset of progressive symptoms
Malaena/Haematemesis
Swallowing problems
commonest cause of LARGE rectal bleed for >60y/o
diverticular disease
(but overall, haemorrhoids is the most common cause of haematochezia - bleeding from the rectum)
Non-surgical treatments of haemorrhoids
rubber band ligation (put at base of haemorrhoid -> becomes strangulated -> slough off)
injection sclerotherapy (phenol injected into submucosa -> induce fibrotic reaction -> obliterate haemorrhoid vessel ->atrophy)
infrared coagulation/photocoagulation
bipolar diathermy & direct current electrotherapy
Surgical treatments of haemorrhoids
haemorroidectomy
stapled haemorrhoidectomy
haemorrhoidal artery ligation
what diseases are associated with H.pylori?
peptic ulcer disease
MALT lymphoma
gastric adenocarcinoma
Menetrier’s disease (rare high-protein gastropathy with gross hypertrophy of gastric mucosa)
coronaritis (inflammation of coronary artery)
iron-deficiency anaemia
Causes of acute pancreatitis
I GET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion
Hyperlipidaemia, Hypercalcaemia, Hypothermia
ERCP
Drugs: HIV (Didanosine, pentamidine), diuretics (furosemide, hydrochlorothiazide), chemo (L-asparaginase, azathioprine), oestrogen
diarrhoea, weight loss, hyperglycaemia, flushing attack, widespread rash
Diagnosis?
Glucagonoma
The rash is necrolytic migratory erythema.
The 4 D - diarrhoea, diabetes, DVT, depression
When palpating the left iliac fossa, there is pain in the right iliac fossa. ?diagnosis
Appendicitis
Rovsing’s sign
Intermittent diffuse abdominal pain, worse after eating meals. Pain is worsening and patient lost weight. History of HTN and current smoker.
? Diagnosis (NOT peptic ulcer disease/cancer)
Chronic mesenteric ischaemia
What is CRP? Where is it produced? What is the half-life?
C-reactive protein - acute phase protein
Produced by hepatocytes
half-life is 19 hours
What is faecal calprotecti? How is it linked to exac of IBD?
inflammatory protein found in neutrophils, macrophages and monocytes
presence in faeces is directly proportional to neutrophil migration into GI tract
90% positive predictive value for endoscopically active Crohn’s.
Haemorrhoids - what are the PR examination findings?
Nothing. The veins empty as the finger compresses them.
Portal HTN causes
- pre-hepatic
- hepatic
- post-hepatic
Pre-hepatic
- congenital atresia or stenosis
- portal vein thrombosis (idiopathic, sepsis, malignancy, hypercoagulable state, pancreatitis)
- splenic vein thrombosis
- extrinsic compression - tumours
Hepatic
- Pre-sinusoidal: schistosomiasis, congenital hepatic fibrosis, early PBC, sarcoidosis, chronic active hepatitis, copper toxin
- Sinusoidal: cirrhosis, alcoholic hepatitis, vitamin A intoxication, cytotoxic drug
- Post-sinusoidal: sinusoidal obstruction syndrome or veno-occlusive disease
Post-hepatic
- constrictive pericarditis
- Budd Chiari syndrome
- IVC blockage : thrombosis, stenosis, tumour invasion
Cancers that spread to liver
Colon
Stomach
Pancreas
Lung
Breast
Neuro-endocrine
Eye
Who gets referred for 2ww for ?colorectal cancer?
> =40 with weight loss and abdo pain
=50 with unexplained rectal bleeding
=60 with iron-deficiency anaemia OR change in bowel habit
Anyone with positive faecal occult blood
How to detect H.pylori?
Non-invasive test
- blood antibody test
- stool antigen test
- carbon urea breath test (14C or 13C) - MOST ACCURATE - patient will drink 14C or 13C labelled urea and then when bacterium metabolises this, we can test for carbon dioxide.
Invasive test
- endoscopy with CLO test (rapid urease test)
- histological examination
- microbial culture
Causes of raised ALP in asymptomatic patient.
PS: ALP is released by liver, bone and placenta
Normal: growth spurts in adolescence, pregnancy (3rd trimester), age-related.
Drug causes: nitrofurantoin, phenytoin, erythromycin, disulfiram
Paget’s disease
Primary biliary cirrhosis, cholestasis, hepatic cancer
Complications of gallstones
Gallbladder
- biliary colic
- acute/chronic cholecystitis
- empyema
- mucocoele
- carcinoma
Bile ducts
- obstructive jaundive
- pancreatitis
- cholangitis
Gut
- gallstone ileus
Fatigue, pruritus, steatorrhoea, dry eyes and mouth, jaundiced, xanthelasma, enlarged spleen and liver. ?diagnosis
PBC
The most common cause of
- small bowel obstruction
- large bowel obstruction
SBO: post-op adhesions, malignancy, corhn’s, incarcerated hernias
LBO: cancer
Difference between femoral VS inguinal hernia
Difference between
- gallstone
- cholecystitis
- cholangitis
All have RUQ pain
Cholecystitis: positive Murphy’s sign (inhibit inspiration due to RUQ pain on palpation). also have systemic features with fever, raised WCC and CRP
Cholangitis: Charcot’s triad: RUQ pain, jaundice, swinging pyrexia. Also, low BP, decrease or loss of consciousness (Reynold’s pentad)
SBP
- how to diagnose
- how to treat
Paracentesis (>250 cells/mm3)
cephalosporin IV 3rd gen
What happens in Gilbert’s disease?
decrease in activity of UDP-glucuronyl transferase
Therefore, drugs that cannot be used:
- atazanavir
- indinavir
- gemfibrozil
- statins with gemfibrozil
- irinotecan
AST and ALT raise - ?dignoses
AST>ALT: acute alcoholic hepatitis, acute viral hepatitis
ALT>AST: acute hepatitis, obstructive jaundice
What is the Rockall scoring system?
ABCDE
Age
BP - shock
Comorbidities such as HF, IHD, liver failure, renal failure, cancer
Diagnosis such as mallory weiss tea, upper GI malignancy
Evidence of bleeding
Used to show the outcome risk after upper GI bleed (re-bleeding or mortality)
what vitamin does carcinoid tumour cause a deficiency in?
as a result of the vitamin deficiency, what symptoms arise?
as a result of the vitamin deficiency, what is this condition called?
Vitamin B3 (niacin)
PS: carcinoid tumour creates a lot of serotonin from tryptophan metabolism. Niacin is derived from tryptophan - therefore with less tryptophan, you get less niacin.
Dermatitis, Diarrhoea, Dementia
Pellagra
4 days post-CABG. Not passed wind or stools. Abdo distended with vomit and loss of appetite. Absent bowel sounds. Xray shows distended small and large bowel loops
?diagnosis
Post-op ileus
Tx of post-op ileus
watchful waiting and supportive tx
keep NBM and IV fluids +/- NG tube
Effects of deficiency of these vitamins:
- vitamin A
- vitamin B1, B2, B3, B5, B6, B12
Retinol (A) : night blindness, dry skin
Thiamine (B1): beri-beri, wernicke korsakoff
Riboflavin (B2): angular stomatitis
Niacin (B3): pellagra
Panthothenate (B5): dermatitis, enteritis, alopecia, adrenal insufficiency
Pyridoxine (B6): convulsions, hyperirritability
Cobalamin (B12): macrocytic megaloblastic anaemia, glossitis, subacute cord degeneration, optic neuropathy, paraesthesia
what is another name for pharyngeal pouch?
Zenker diverticulum
Jaundice, pale stools, dark urine. Bilirubin level 35, ALP 300. USS showed stone obstructing common bile duct & dilating to 13mm. ?Management
ERCP with sphinterotomy
High risk for cholecystectomy if:
- recent cholangitis
- recent acute pancreatitis
- abnormal LFTs (ALP >2x)
- dilated CBD >10mm
Risk factors for gastric cancer
- increasing age ie >55
- men
- poor socio-economic status
- H.pyleori
- low fresh fruit/veg
- high salt & preservatives
- smoking
- atrophic gastritis, pernicious anaeamia, post-gastrectomy
- Blood group A
Tx of anal fissure:
Acute VS Chronic
ACUTE
1st line: high fibre diet, adequtae fluid intake, stiz bath, laxative (bulk-forming -> lactulose)
- lubricants such as petroleum jelly
- topical anaesthetics
- analgesia (topical analgesia (lidocaine 5% ointment)
CHRONIC
try the above techniques first
- topical GTN BD for 6-8 weeks
- if not effective after 8 weeks -> ?sphincterotomy or botox infection,
First line tx of proctatitis
Rectal aminosalicylate - suppositories or enemas
Serologic tests to differentiate UC from Crohn’s.
UC : p-ANCA positive
Crohn’s: ASCA antibodies
Names of all vitamin B
B1 - thiamine
B2 - riboflavin
B3 - niacin
B6 - pyridoxine
B9 - folic acid
B12 - cyanocobalamin
what is mirizzi syndrome
common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder
modified glasgow score for pancreatitis
> =3 means pancreatitis
atrophic glossitis, iron deficiency anaemia, oesophageal webs/strictures
?diagnosis
plummer vinson sydrome
AKA Paterson-Brown-Kelly syndrome, sideropenic dysphagia, sideropenic nasopharyngopathy, waldenstrom-kjellberg syndrome
PC: painless, intermittent dysphagia- usually solid food
Tx: iron replacement, endoscopic dilatation or argon plasma coagulation therapy
how to diagnose spontaneous bacterial peritonitis from paracentesis?
total polymorphonuclear neutrophils in ascites >250cell/microL.
tx: 3rd generation cephalosporin
what drug causes raised ALP?
nitrofurantoin
phenytoin
erythromycin
disulfiram
metabolic causes of constipation
hypercalcaemia
diabetes (with autonomic neuropathy)
hyperparathyroidism
hypermagnesaemia
hypokalaemia
hypothyroidism
uraemia
which diarrhoea organism is linked with reactive arthritis and Guillain Barre syndrome?
campylobacter
which diarrhoea organism is linked with haemolytic uraemic syndrome?
EHEC
patient with stone obstructing CBD - who gets ERCP+sphincterotomy and who gets cholecystectomy?
Cholecystectomy:
- recent cholangitis
- recent acute pancreatitis
- abnormal LFT (ALP >2x normal)
- dilated CBD >10mm
another name for pharyngeal pouch
zenker diverticulum
how to calculate the units of alcohol according to the % on bottle?
[volume (ml) x %ABV]/1000
For example (to calculate one week): 2 pints of 4% lager every night and 2 standard sized glasses of 12% wine on friday and saturday:
[7 x 2 x (568 x 4)/1000] + [2 x 2 x (175 x 12)/1000] = 40 units
diarrhoea with facial flushing
?diagnosis
glucagonoma
for patients who have IBD for >10 years, they are at risk of colorectal cancer. what is the surveillance mechanism?
colonoscopy and multiple biopsies
