GI RECAP Flashcards by Shubham Agwan

What is angular cheilitis associated with

Iron deficiency

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What can enamel erosion be associated with

GORD

Bulimia/Anorexia Nervosa

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Where is McBurnley’s point

1/3 between the right ASIS and the umbilicus

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What is Rovsing’s sign

palpation of the left lower quadrant of a person’s abdomen increases the pain felt in the right lower quadrant - Appendicitis

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What is Russell’s sign

Calluses on knuckles of patients who regularly self-induce vomiting

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What is Murphy’s sign

the patient is asked to inhale while the examiner’s fingers are hooked under the liver border at the bottom of the rib cage. The inspiration causes the gallbladder to descend onto the fingers, producing pain if the gallbladder is inflamed

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What is Charcot’s triad and what does it indicate

right upper quadrant pain
jaundice
fever

Suggestive of ascending of ascending cholangitis

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What 2 deficiencies could cause someone to easily bruise

Vitamin C (Scurvy)
Vitamin K

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What asides from deficiencies could cause someone to easily bruise

Liver disease

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What can the TIPS procedure be used for

Ascites

Portal hypertension

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What are the ways to check for H.Pylori infection

Gastric biopsy
Urease breath test
Histology
Culture
Faecal Ag test

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Which 3 types of cells do the liver sinusoids contain

Endothelial cells - form fenestrated structure
Kuppfer cells - macrophages resident to sinusoids
Stellate (Ito) cells - storage of Vit A

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What 3 reaction types can occur in phase 1 of drug metabolism

Oxidation
Reduction
Hydrolysis

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What does phase 1 of metabolism do to a drug

Makes it more polar

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What occurs in phase 2 of drug metabolism

Conjugation

Addition of an endogenous compound to increase polarity

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What does albumin transport

Transports fatty acids, bilirubin, thyroid

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Give 2 examples of α-globulins

Caeruloplasmin, retinol binding protein

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Give 2 examples of β-globulins

Transferrin

Fibrinogen

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What length of time constitutes the difference between acute and chronic liver failure

6 Months

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What things can cause Acute liver failure

there are loads

Viral, Drug, Shock liver, Cholangitis, Alcohol, Malignancy, paracetamol, Budd-Chiari, AFLP, Cholestasis of pregnancy

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How can u treat an itch caused by liver failure or autoimmune hepatitis

sodium bicarb bath, cholestyramine or Ursodeoxycholic acid

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What is Fulminant Hepatic Failure

Jaundice + Encephalopathy in a patient with prev. normal liver

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What are the causes of Fulminant Hepatic Failure

again, there are loads

Paracetamol, Fulminant viral, Drugs, HBV, Non-A-E hepatitis, acute fatty liver of pregnancy (AFLP), mushrooms, malignancy, Wilsons, Budd-Chiari, Hep A

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What is the disease progression of NAFLD

Steatosis -> NASH -> Cirrhosis

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What is marked piecemeal necrosis seen in

Autoimmune hepatitis

Periductal ‘onion-skinning’ fibrosis seen in

PSC

Bronzed diabetic? and explain the condition

Haemochromatosis Systemic iron deposition Predisposes to hepatocell. carcinoma, diabetes, cardiac failure and impotence

Treatment for Haemochromatosis

Venesection

Kaiser-Fleisher rings seen in which disease?

Wilson's disease | Copper accumulates in liver and brain

Treatment for Wilson's disease

Copper chelating drugs | Symptomatic relief where possible

What is Budd-Chiari syndrome

Thrombosis of hepatic veins

Name some pre-hepatic causes of portal hypertension

Portal vein thrombosis or occlusion (congenital)

Name some intrahepatic causes of portal hypertension

Presinudoidal - Schistosomiasis | Postsinusoidal - Cirrhosis, alcoholic hep, congenital fibrosis

Name some post hepatic causes of portal hypertension

Budd-Chiari and venous occlusive disease

What is the preventative treatment for variceal bleeding

Beta blockers | Ligation

What is the treatment for Variceal bleeding

Sclerotherapy Balloon tamponade TIPS

What are ALT and AST

Intracellular enzymes which catabolize steps in gluconeogenesis ALT present exclusively in the liver AST less specific and also found in cardiac tissue and muscle Enzymes released into bloodstream from damaged hepatocytes

How can you tell the difference between NAFLD and Alcohol related liver disease from just liver function tests

Ratio of AST: ALT can point to likely cause of elevation In NAFLD, AST: ALT is typically less than 1:1 2:1 indicates alcohol-related liver disease lets get wASTed

What is GGT and what can cause it to be elevated

GGT found in hepatocytes and biliary epithelial cells | Raised GGT can be caused by Alcohol, pancreatic disease, renal failure, COPD, diabetes, post-MI

What can cause elevated ALP and GGT

Bile duct obstruction, PSC, PBC, drugs causing cholestasis, malignancy

What are the 3 types of gallstones

Cholesterol Pigmented (bilirubin) Mixed

What can cause excess cholesterol in bile

Female, Obesity, Diabetes, Genetic

What can cause excess bilirubin in bile

excess haemolysis (e.g. haemolytic anaemias)

What is biliary colic caused by

Gallstone impacting in cystic duct

What is pain, which radiates to the back, associated with

Pancreatitis

What is Grey Turner's sign

Bruising of the flanks

What is Cullen's sign

Periumbilical bruising

Which enzymes are involved in autodigestion of pancreatic tissue

Proteases break down blood vessels causing haemorrhage | Lipases break down the fat tissue surrounding the pancreas

What are some causes of Chronic Pancreatitis

CAMP: CF, Alcohol, Malnourishment, Pancreatic duct obstruction

How does chronic pancreatitis result in diabetes

Replacement of pancreas by chronic inflammation and scar tissue, Destruction of endocrine acini and islets so no insulin or glucagon produced

What length of bowel indicated Short Bowel Syndrome

<200cm

How would you describe a diverticulum

Mucosal herniation through muscle coat

What is Meckel's Diverticulum

Incomplete regression of vitellointestinal duct Asymptomatic finding Symptomatic in children: Rectal bleeding, obstruction, perforation which can mimic appendicitis

What are most cancers of the mouth

Squamous Cell Carcinoma | >90% of oral cancers

Where can oral cancer present

Soft palate, floor of mouth, ventral tongue and borders | Rarely on hard palate, dorsum of tongue

What are the symptoms of a left-sided colorectal malignancy

blood PR altered bowel habit obstruction

What are the symptoms of a right-sided colorectal malignancy

anaemia | weight loss

What is HNPCC

Hereditary nonpolyposis colorectal cancer

What is FAP

Familial Adenomatous Polyposis

Which out of FAP and HNPCC has more polyps

FAP (>100 polyps) | HNPCC usually has <100

What gene is mutated in FAP

APC gene

What gene is mutated in HNPCC

Mutation in DNA mismatch repair gene

Name 3 tumours of the endocrine pancreas

Gastrinoma Insulinoma Glucagonoma

What can a gastrinoma cause

Zollinger-Ellison syndrome | Acid hypersecretion can lead to peptic ulcers

What can an insulinoma cause

Produces insulin, causing the body to store sugar rather than burn it, hypoglycaemia

What can a glucagonoma cause

Produces glucagon, increases blood sugar, hyperglycaemia

What type of hypersensitivity is Coeliac disease

Type IV

What happens in coeliac disease

``` Immune reaction (T cells) to Gliadin in wheat fluid, gluten in small intestine Causes damage to enterocytes and decreases absorption ```

What is the mnemonic for causes of Malabsorption

``` These Defo Cause Absorption Problems Tropical sprue Disaccharide deficiency Coeliac/Crohn’s A-beta-lipoproteinemia Pancreatic insufficiency ```

What is the weekly limit for alcohol

14 units spread over 3 days for men and women cmon it's the 21st century

What is the treatment for tropical sprue

Tetracycline and Folic Acid

What is Schilling's test for

Pernicious anemia

What is Pernicious anaemia

Vitamin B12 deficiency

Define diarrhoea

3 or more loose stools in 24 hours

What organisms classically have a short incubation period

Staph Aureus | Bacillus Cereus

What organisms classically have a medium incubation period

Clostridium Perfringens | Salmonella

What organisms classically have a long incubation period

E. Coli | Campylobacter

What is the sepsis 6 bundle

3 Gives and 3 Takes Give O2, Fluid & Antibiotics Take FBC, Lactate, Urine output

The triad of which signs/symptoms suggest Budd Chiara syndrome

Abdominal pain Tender hepatomegaly Ascites

What is the most common type of hernia

Inguinal

Define a hernia

Abnormal protrusion of a viscus outwith its normal body cavity