GI (Passmed) Flashcards
When is fluid restriction preferred over giving spironolactone for ascites
IF sodium levels <125
What is the role of abdominal paracentesis
SYmptomatic relief to patients with tense ascites
What is Pellagra
Dermatitis (rash)
Dementia
Diarrhoea
What causes Pellagra
B3 deficiency
What WBC count indicates a moderal C.difficile infection
WBC <15 * 10^9
What WBC indicates severe c.difficile infection
More than 15*10^9
What antigen implies Hep B acute disease
HBsAg
What is the significant of Anti-HBs
Immunity
What does Anti-HBc imply
Previous infection
What is the investigation of choice for diagnosing primary sclerosing cholangitis
ERCP/MRCP
What needs to be checked in someone taking mesalazine
FBC
What is given for refractory Crohn’s disease
Infliximab alongside azathioprine
When is Mesalazine given to induce remission of Chron’s
If steroids fail to do so
In what disease (chron’s or UC) are granuloma’s found in
Chrohn’s
What blood vessel is repsonsibly for haematemasis from a peptic ulcer
Gastroduodenal artery
Management of nausea + raised WCC only
Non-urgent referral for upper Gi endoscopuy
What metabolic findings is associated with gastritis
Metabolic alkalosis (loss of H+ ions)
What prophylaxis is given for variceal bleeds
Propranolol
Type 1 vs Type 2 hepatorenal syndrome
Type 1 is rapid onset
What isthe first line investigation for acute mesenteric ischaemia
VBG: lactates are raised
What vitamin deficiency can reuslt in easy bruising
C
What finding is indicative of Boerhaave syndrome
Mild crepitus in the epigastric region
Alcoholic ketoacidosis vs Diabetic Ketoacidosis
Alcohol: normal glucose
Management of a head of pancreas cancer
Pancreaticoduodenectomy
Management of Barrett’s oesophagus if dysplasia is seen on biopsy
Endoscopic mucosal therapy
What is Courvoisier’s law
That painless jaundice is unlikely to be gallstones but pancreatic malignancy
How do urea levels help differentiate between an upper GI bleed and lower GI bleed
High urea levels = Upper GI Bleed
What is the iron study profile seen in haemochromatosis
Raised transferrin and ferritin with low TIBC
What stool sample specifically is needed to diagnose C.difficile infection
C.difficile toxins
What medication should be stopped in c.difficile infections
Oromorph
What shohuld paracentesis show for spontaneous bacterial peritonitis
> 250 cells/ui
What grade of hepatic encephalopathy is a coma found in
Grade IV
What hsoulud be given first, B12 or folate
B12
What is the Child-Pugh classification
Bilirubin levels
Albumin
PTT
Encephalopathy
Ascites
What is the key investigation for a suspected perforated peptic ulcer
An erect Chest X-Ray
What Bowel disease is tenesmus commonly seen in
Ulcerative COlitis
Step up management of Ulcerative Colitis
Topical Aminosalicylate for distal rectal
If not achieved in 4 weeks, add oral aminosalicylate
Management of extensive UC disease
TOpical Aminosalicylate + high dose oral aminosalicylate
If extensive disease management is not managed properly by topical and oral aminosalicylate, what should be given
Oral 5-ASA and oral corticosteroid
Management of severe colitis
IV Steroids
What drug historically causes c.difficile infections
Clindamycin
WHat is Peutz-Jeghers Syndrome
Small bowel obstruction (dur to intussuception) + blue/yellow mucosa
WHen does desferrioaxamine become first line for haemachromatosis
When Venesection is not possible
What two factors are used to decide if glucorticoid therapy is needed for alcohol hepatitis
Prothrombin time and serum bilirubin
First line investigation of appendicitis
USS abdomen
What condition (UC or Chron’s) is triggered by Stopping smoking
UC
What is the triad for refeeding syndrome
Hypokalaemia
Hypophosphataemia
Hypomagnesaemia
In what gastric disease are skin tags found
Crohn’s
Where is a mass felt in overflow constipation
Left side
How do we retain remissino in proctitis and proctosigmoiditis
Topical azathioprine (with or without oral azathioprine)
The rest is normally oral azathiioprine
What are indications for enteral nutrition (tube feeding)
Head or neck trauma
Surgery
Coma
Dementia
Tumours of the head, neck or oesophagus
Investigations for perianal fistulas
MRI Pelvis
Management of a perianal fistula
Oral Metronidazole
What is the treatment of choice for small bowel bacterial overgrowth syndrome
Rifaximin
Risk Factors for SBBOS
Diabetes Mellitus and Scleroderma
What should be given to reduce mortality risk during paracentesis
IV human albumin solution
Management of asymptomatic gallstones
Re-assurance
What hepatitis is usually transmitted through anal-oral sex
Hepatitis A
How is Hepatitis B commonly spread
Sexual Transmission
How is Hep C typically spread
Through exposure to contaminated blood or needles
When should adults be refrred for GI cancer pathway
Occult test shows blood
40+ AND unexplained weight loss + abdo pain
50+ AND unexplained rectal bleeding
60+ AND iron deficiency anaemia or changes in bowel habit
Management of someone with rectal bleeding + abdominal pain and under 50
Refer to hospital
Where are ileostomies usually placed
Right iliac fossa
Where are colostomies typically placed
Left iliac fossa
Management of a diverticular bleed
Active surveillance - usually heal spontaneously
How to detect fistulas in the gut
CT abdomen
Where do anal fissures typically arise
Posterior margin of the anus
Management of an anal fissure
Laxatives (bulking)
What is Hartmann’s proceedure
Sigmoiectomy + stoma bag
When are loop ileostomies used
rectal cancers (diverts bowel contents away from the distal anastomoses)
What type of cancers are rectal cancers
Adenocarcinomas
What symptom is present in small bowel obstruction but not large bowel obstruction
Vomiting - no vomiting in large bowel obstruction
When are hartmann’s proceedure indicated
Emergency: Perforation or obstruction
Indication for anterior resection
upper rectal tumours (near sigmoid colon)
What is a common complication of a laproscopy
Pulmonary Emphysema
What is the daignostic test for pancreatitis
CT contrast
COmplication of acute pancreatitis
ARDS
Blockage of what duct does not cause jaundice
Cystic duct
Scending cholangitis vs cholecystitis
Ascending has dranged LFTs vs no deranged lfts in cholecystitis
First line management of an SAH
Coiling
Ferritin levels in alcohol excess
Raised
What defines mild UC
<4 stoools a day
What defines moderate UC
4-6 stools a day
What defines severe UC
> 6 stools a day
Primary screening done for suspected bowel cancer
Faecal immunochemical test
When should someone be offered bowel screening
60-74
When is a sigmoidoscopy chosen over a colonoscopy for checking for colorectal cancer
If there is rectal bleeding
If someone is unfit for sigmoidosocpy or colonoscopy, what is the investigation of choice
CT colonography
Diagnosis of acute cholecystitis if USS is uncertain
HIDA scan
What is the most common cause of small bowel obstruction
Adhesions
Describe Duke A
Cancer in boeel lining NOt muscle
Define Sukes’ B
Cancer grown into muscle layer of bowel
Define Dukes’ C
Cancer spread to lymph node
Define Duke’s D
Cancer spread to another organ
Indirect vs direcvt inguinal hernia
Indirect: Lateral to the inferior epigastric artery
Direct: Medial to the inferor epigastric artery
Management of an epigastric hernia
Lose weight/ supportive
Management for umbilical hernias
Use of a truss
Management of a unilateral inguinal hernia
Open repair with mesh (routinely)
When is a hernia truss indicated for hernias
Only when surgery is not an option (second line)
What happens in an indirect inguinal hernia when you cover the deep inguinal ring
It stops the reappearance of the lump when asked to cough
If it re-appears = direct inguinal hernia
Investigation for a hiatus hernia
Endoscopy
Barium Swallow - diagnostic
Management of Achalasia
Endosocpic injection with botulinum toxin
