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Revision Qs > GI Medicine > Flashcards

GI Medicine Flashcards

1
Q

3 sources of ALP?

A

Liver
Bone
Placenta

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2
Q

Causes of an isolated ALP?

A

Pregnancy
Adolescence
Bone - tumour, Paget’s disease, osteomalacia

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3
Q

Major causes of raised ALP + GGT?

A

Bile duct obstruction
PSC
Cholestasis - drug induced
Liver malignancy

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4
Q

3 causes of an isolated raised bilirubin?

A

Haemolytic anaemia
Gilbert’s syndrome
Crigler-Najjar

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5
Q

5 broad areas of causes of acute abdomen?

A 
Inflammation
Obstruction
Ischaemia
Perforation
Rupture
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6
Q

Inflammatory causes of acute abdomen?

A

‘Itises’ - appendicitis, diverticulitis, cholecystitis/angitis pancreatitis, salpingitis

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7
Q

Ischaemic causes of acute abdomen?

A

Strangulated hernia
Volvulus
Thromboembolism
Ovarian cyst torsion, testicular torsion

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8
Q

Perforation causes of acute abdomen?

A

Perforated ulcers, tumours etc
Diverticulum
Biliary pancreatitis
Bowel perforation (toxic megacolon)

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9
Q

Rupture causes of acute abdomen?

A

AAA
Ovarian cyst rupture
Ectopic pregnancy rupture

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10
Q

What are the 4 cardinal signs of GI obstruction?

A

Pain (colicky)
Vomiting
Bloating/distension
Absolute constipation

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11
Q

What symptoms does gastric outflow obstruction/upper GI obstruction cause?

A

Vomiting - undigested food

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12
Q

What symptoms does high small bowel obstruction cause?

A

Colicky pain

Vomiting, may be bilous if below ampulla of vater

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13
Q

Common cause of terminal ileal obstruction?

A

IBD - crohns

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14
Q

Symptoms of lower GI obstruction?

A

Central colicky pain
Vomiting - may be brown, feculent
Abdominal distension

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15
Q

What symptoms can sigmoid colon obstruction cause?

A

Colicky pain
Vomiting late feature
Distension
Absolute constipation

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16
Q

What normal anatomical feature can prevent perforation in end-colon obstruction?

A

Ileo-cecal valve incontinence

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17
Q

Underlying pathophysiology of GORD?

A

Incompetence of lower esophageal sphincter

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18
Q

Complications of GORD?

A

Oesophagitis
Ulcers
Strictures
Barretts oesophagus -> adenocarcinoma

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19
Q

What is Zollinger-Ellison syndrome?

A

Gastrin-secreting tumours leading to chronic or recurrent duodenal ulcers

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20
Q

What is the triad of tumours involved in MEN1!

A

Parathyroid
Pituitary
Gastrin-secreting - Zollinger Ellison

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21
Q

What common GI complaint can steroids cause?

A

GORD

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22
Q

2 rashes associated with IBD?

A

Erythema nodosum

Pyoderma gangrenosum

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23
Q

What effect does smoking have on UC?

A

Makes it better

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24
Q

What effect does smoking have on Crohn’s disease?

A

Makes it worse

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25
Q

Which IBD does smoking make worse (ie quitting makes symptoms better)?

A

Crohns

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26
Q

What part of the GI tract does UC affect?

A

Universally rectum, ascends upwards but colon only

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27
Q

What does biopsy show in UC?

A

Intramural lesions - only part way through thickness of biopsy but all the way along

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28
Q

Where does crohns typically affect?

A

Ileo-colic (but anywhere from mouth to anus)

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29
Q

What does biopsy show on Crohn’s disease?

A

Transmural skip lesions

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30
Q

What is a known complication of Crohn’s disease which can result in vomiting, pain and abdominal distension?

A

Strictures - stenosis

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31
Q

In which IBD is surgery less helpful?

A

Crohn’s

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32
Q

What immunology blood results are suggestive of autoimmune hepatitis?

A

Raised IgG
Raised ANA
Raised ASMA (anti-smooth muscle autoantibodies)

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33
Q

Typical sex and age of presentation for AIH?

A

Female 15-25 or 45-55

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34
Q

What liver enzymes are typically elevated in AIH?

A

Transaminases +/- ALP, GGT

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35
Q

What is the pathophysiological background of primary biliary cirrhosis (PBC)?

A

Autoimmune destruction of interlobular bile ducts (Herring canals) leading to intrahepatic cholestasis

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36
Q

What does the intrahepatic cholestasis in PBC cause?

A

Inflammation, scarring, fibrosis and cirrhosis

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37
Q

Common early symptoms of PBC?

A

TATT

Pruritis

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38
Q

What is an intrahepatic cholestatic picture of LFTs?

A

Raised ALP and GGT

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39
Q

What are 4 diagnostic blood test markers of PBC?

A

Anti-mitochondrial Abs (AMA)
Raised IgM
Cholestatic picture - raised GGT and ALP

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40
Q

Which of PBC/PSC is autoimmune?

A

PBC

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41
Q

What will PBC eventually lead to?

A

Liver cirrhosis

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42
Q

Early treatments of PBC?

A

UDCA

Questran

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43
Q

What vitamin supplementation can be given for PBC?

A

Fat-soluble (ADEK)

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44
Q

Underlying pathophysiology of PSC?

A

Intra - and extra-hepatic bile duct sclerosis, scarring and eventually cirrhosis

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45
Q

What other GI condition does PSC have a big link with?

A

UC

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46
Q

In whom is PSC more common?

A

Young males

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47
Q

Under what circumstances is PSC often diagnosed?

A

Often in the context of UC with deranged LFTs

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48
Q

What feature of early PSC may distinguish it from PBC?

A

Still have TATT, pruritis etc.

RUQ pain may be present

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49
Q

What 3 conditions may result from PSC?

A

Cholangiocarcinoma
Liver cirrhosis
Liver cancer

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50
Q

2 blood tests indicative of PSC?

A

ANCA

IgG

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51
Q

What can ERCP/MRCP show in PSC?

A

Beading of the bile ducts

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52
Q

What does disappearance of the psoas outlines on AXR indicate?

A

Bleed

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53
Q

What 2 veins converge to form the hepatic portal vein?

A

Splenic vein

Superior mesenteric vein

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54
Q

What 3 classic liver disease signs does portal hypertension cause?

A

Caput medusae (collateral vessels)
Varices (portocaval anastamoses)
Ascites

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55
Q

What 2 vessels converge to form the hepatic vein?

A

Hepatic portal vein

Hepatic artery

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56
Q

What signs are more indicative of someone being in acute than chronic liver failure?

A 
RUQ pain
Nausea and vomiting 
Fever
Encephalopathy
Clotting dysfunction - PT up to 100
Late on - jaundice
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57
Q

What is the spectrum of non-alcoholic fatty liver disease?

A

Fatty liver -> NASH -> NASH cirrhosis

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58
Q

What common antibiotic used for treatment of cellulitis can cause LFT derangement?

A

Flucloxacillin

59
Q

What are 2 signs on examination that are more common in ALD than non-ALD?

A

Parotid megaly

Dupuytrens contracture

60
Q

What is the underlying problem in pre-hepatic jaundice?

A

Increased bilirubin production - usually haemolysis

61
Q

What type of bilirubin is high in pre-hepatic jaundice?

A

Unconjugated bilirubin

62
Q

Describe the typical colour in pre-hepatic jaundice?

A

Lemon tinge jaundice

63
Q

What are the urine and stools like in pre-hepatic jaundice?

A

Normal because unconjugated bilirubin is not water soluble so doesn’t enter urine

64
Q

What is the underlying pathophysiology of intrahepatic jaundice?

A

Altered excretion - liver causes e.g. Hepatitis, cirrhosis, cancers

65
Q

Under what circumstances can you get pale stools and pruritis in intrahepatic jaundice?

A

If this is coexistent cellular cholestasis

66
Q

What is the underlying pathology behind cholestatic jaundice?

A

Obstruction of bile ducts

67
Q

What symptoms does obstructive jaundice typically yield?

A 
Itching
Pale stools
Dark urine
Abdominal pain
Weight loss, fever, anorexia
68
Q

What is the itching, pale stools and dark urine due to in obstructive jaundice?

A

Bile salts normally make stools dark but as they can’t reach GI tract they get absorbed into the bloodstream (pale stools). They are also insoluble so get peed out making pee dark. They are also irritant so cause itching

69
Q

Major causes of acute pancreatitis?

A

Gallstones
Drugs
Alcohol
Trauma

70
Q

What are the symptoms of acute pancreatitis?

A

Severe epigastric pain radiating to back

Fever, anorexia, nausea and vomiting, tachycardia, sweating

71
Q

What is elevated classically in acute pancreatitis but not necessarily in chronic?

A

Serum amylase

72
Q

Management of acute pancreatitis?

A

Supportive - fluid, analgesia etc.
Get CT/USS or MRCP
ERCP particularly used to treat stones
Other surgery

73
Q

What is the major cause of chronic pancreatitis?

A

Alcohol

74
Q

What symptoms are more typical of chronic pancreatitis than acute?

A

Chronic or recurrent epigastric pain
Diarrhoea, weight loss
Malnutrition

75
Q

What test is more suitable than serum amylase when looking for chronic pancreatitis?

A

Fecal elastase

76
Q

3 risk factors for pancreatic cancer?

A

Smoking
Alcohol
Chronic pancreatitis

77
Q

What is the typical picture of cancer of the head of the pancreas?

A

Obstructive jaundice - painless jaundice and itching

In the context of weight loss, TATT, deranged LFTs

78
Q

What can be inserted via ERCP to improve bile flow in blocked or obstructed ducts?

A

Biliary stents

79
Q

What is Murphys sign?

A

Acute pain on inspiration when palpating just under gallbladder
Positive in acute cholecystitis

80
Q

Is jaundice likely in acute cholecystitis?

A

No as no bile duct involvement

81
Q

What is cholangitis?

A

Inflammation of the common bile duct normally due to gallstones

82
Q

What is ascending cholangitis/biliary sepsis?

A

Sepsis as a result of bacteraemia which is ascendant from GI tract via ampulla of vater. Stone blockage of CBD allows bacteria to pass through wall into blood

83
Q

Charcot’s triad of cholangitis?

A

Fever
Obstructive Jaundice
RUQ pain

84
Q

Management of cholangitis?

A

ERCP to remove stones

Later cholecystectomy particularly if recurrent

85
Q

What does a cholangiocarcinoma typically cause?

A

Painless jaundice and deranged LFTs

86
Q

What tumour marker is raised in cholangiocarcinoma?

A

Ca19-9

87
Q

What condition can give rise to silver stools?

A

Peri-amullary carcinoma - tumour causes obstructive jaundice (pale stools) and also melena (black stools)

88
Q

What are the 3 types of gallstone?

A

Cholesterol
Pigment stones
Mixed

89
Q

What types of gallstones are radiographically visible?

A

Mixed/pigment stones with high calcium

90
Q

What is the relationship between eating fatty foods and cholecystitis?

A

Eating fatty foods causes pain due to increased bile and stone blockage

91
Q

Differentiating factors between cholecystitis and cholangitis?

A

Murphys sign positive in cholecystitis

Jaundice in cholangitis only

92
Q

What is a gallstone ileus?

A

Complication of chronic cholecystitis whereby a gallstone gets into small intestine and causes obstruction, usually at ileocecal valve

93
Q

History suggestive of gallstone ileus?

A

Recurrent RUQ pain as indicative of chronic cholecystitis

Followed by acute abdomen - signs of lower GI obstruction

94
Q

Where does the majority of intussusception occur in kids? What symptoms does this cause?

A

Ileo-coecal

So causes lower GI obstruction Sx

95
Q

At what ages does intussusception typically occur?

A

5-12 months

96
Q

What is the most common type of intussusception?

A

Simple telescoping I.e. Non-pathological lead point

97
Q

What 2 signs on examination are suggestive of intussusception?

A

Palpable sausage-shaped mass in RUQ

Dances sign - no bowel in RLQ

98
Q

What stool is typical of intussusception?

A

Mucoid, Redcurrant diarrhoea

99
Q

Typical USS sign of intussusception?

A

Target/donut sign

100
Q

What investigation is first line for intussusception?

A

Abdominal US

101
Q

Why is GORD so common in kids?

A

Functional immaturity of the lower esophageal sphincter

102
Q

When does childhood GORD normally resolve by?

A

1 year

103
Q

Symptoms of childhood GORD?

A

Recurrent regurgitation and non-forceful vomiting

Abdo pain presenting as crying, non-feeding, FTT, behavioural problems

104
Q

What constitutes an apparent life threatening event in kids in the context of GORD?

A

Cyanosis, apnoea, floppy baby (decreased tone), choking/gagging

105
Q

Complications of childhood GORD?

A

Sandifer syndrome
Oesophagitis -> herniae, strictures
Aspiration pneumonia, wheeze, cough etc.

106
Q

Initial management of childhood GORD?

A

Conservative - food thickeners, postural changes, high frequency low volume feeds

107
Q

What is a common differential for GORD in kids?

A

Cows milk protein allergy

108
Q

3 causes of unconjugated jaundice in young kids?

A

Rhesus haemolytic disease of newborn
Breast milk jaundice
Hypothyroidism

109
Q

What is physiological jaundice in young kids?

A

Occurs after 24 hours due to breakdown of fetal Hb, poor bilirubin metabolism and short lifespan of neonatal rbcs. Peaks at 3-4 days and is settled by 2 weeks

110
Q

What is the importance of physiological jaundice?

A

Unconjugated bilirubin is lipid soluble so can end up crossing BBB and depositing in basal ganglia, causing kernicterus

111
Q

What is kernicterus?

A

Encephalopathy secondary due unconjugated jaundice, may result from ‘physiological’ jaundice in kids

112
Q

What is opisthotonos?

A

Back arching secondary to kernicterus

113
Q

Causes of early jaundice (less than 24 hours)?

A

Acute intravascular haemolysis - rhesus disease, ABO, G6PD, spherocytosis

114
Q

What is TPN jaundice?

A

Jaundice as a result of TPN, resulting in stodgy enterohepatic circulation and raised bilirubin

115
Q

What is Crigler-Najjar?

A

Glucoronyl transferase deficiency -> massive unconjugated bilirubin so pre-hepatic jaundice

116
Q

When and in whom does pyloric stenosis present?

A

Boys with a family history

At 2-7 weeks birth age regardless of gestational age

117
Q

Clinical features of pyloric stenosis?

A

Vomiting - increasing frequency over time eventually becoming projectile
Hunger post-vomiting
Faltering growth

118
Q

Diagnosing pyloric stenosis?

A

Test feed: look for olive-like mass in RUQ and visible gastric peristalsis

119
Q

What is the definitive management of pyloric stenosis?

A

Pyloromyotomy

120
Q

What is Meckels Diverticulum?

A

Ileal remnant of vitello-intestinal duct which can contain ectopic gastric mucosa

121
Q

If symptomatic, how can Meckels Diverticulum present?

A 
Severe rectal bleeding
As intussusception (pathological lead point), diverticulitis or volvulus
122
Q

Investigation for Meckel Diverticulum?

A

Technetium scan (shows ectopic gastric mucosa)

123
Q

What is malrotation/volvulus?

A

Improper attachment of gut mesentery, predisposing to malrotation of gut

124
Q

2 ways that malrotation can present?

A

Obstruction (bilous vomiting, abdo pain, distension)

Ischaemic bowel if blood supply compromised

125
Q

Major RFs for NEC?

A

Prematurity
Low birth weight
PDA

126
Q

When does NEC typically present?

A

3-10 days after birth, although can be up to 3 months

127
Q

Early signs of NEC?

A

Non-specific (feeding problems, vomiting, abdo distension, sepsis)

128
Q

GI Sx of NEC?

A

Abdo distension, erythema, visible abdo loops
Altered stool pattern (blood Mucoid) and bilous vomiting
Decreased bowel sounds

129
Q

What investigation is diagnostic and must be done urgently if suspecting NEC?

A

AXR - pneumatosis intestinalis (gas in bowel wall)

130
Q

Clinical features of duodenal ulcers?

A

Burning ‘right’ epigastric pain
Pain is often 2-3 hours after eating but initially relieved by food
Nocturnal pain

131
Q

Which form of peptic ulcer is worse when hungry and relived by eating? Why?

A

Duodenal ulcer, because eating makes pyloric sphincter close and so gastric juices stop emptying down

132
Q

Clinical features of gastric ulcers?

A

Burning ‘left’ epigastric pain worse within 1 hr of food

Often related to anorexia, weight loss

133
Q

What is Dubin Johnson syndrome?

A

Isolated raised conjugated bilirubin (no LFT derangement)

134
Q

4 RFs for diverticular disease?

A

Age (>50)
Smoking
Obesity
Low dietary fibre

135
Q

Describe the pain associated with diverticular disease?

A

Non-specific LLQ pain, worse on eating and eased by flatus and passing stool

136
Q

What is the difference in diverticular disease presentation between Asian and non-Asian populations?

A

RLQ more common in Asians

137
Q

Symptoms of diverticulitis?

A

CIBH - usually diarrhoea, bloody, may be frank haemorrhage
LLQ pain and pseudo-obstruction
Fever, tachycardia
Anorexia, nausea, vomiting

138
Q

Most common complication of diverticulitis? When is it most likely to occur?

A

Abscess formation; most likely after 1st acute presentation

139
Q

Common fistulae associated with diverticular disease?

A

Colovesicular

Colovaginal

140
Q

Appropriate investigation for diverticulitis? What should be avoided in the acute phase?

A 
CT
Avoid endoscopy (do as OP) but do flexisig if bleeding
141
Q

What defines prolonged jaundice? Causes?

A

Lasts over 14 days (/21 if preterm)
Common causes are breast milk, hepatitis, Galactosaemia, UTI, biliary atresia, TPN related, hypothyroidism, haematoma (instrumental delivery), Criggler Najjar etc.

142
Q

When has physiological jaundice usually settled down by?

A

10-14 days - any longer consider prolonged jaundice

143
Q

Rash associated with coeliac disease?

A

Dermatitis herpetiformis

Revision Qs (28 decks)

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