GI & Surgery Flashcards
Features of UC
- Continous disease
- Distorted crypt architecture - bifid crypts
- Absesses
- No inflammation beyond submucosa
- Drainpipe colon
Epidemiology of UC
More common in women slightly
Smoking is protective
Features of CD
- Affect anywhere from mouth to anus
- Skip lesions
- Transmural inflammation
- Granulomas
- Cobblestoning
- Rose thorn ulcers
- Goblet cells
Epidemiology of CD
More common in females slightly
More common in smokers
Index to assess CD Activity
Harvey-Bradshaw index
Radiological finding for mucosal oedema
Thumb-printing
Monitoring colonic inflammation
Fecal-Calcoprotectin
4 Extra-colonic manifestations of IBD
- Erythema Nodosum = tender lumps on both shins
- Pyoderma Gangrenosum = Tissue necrosis on legs
- Arthritis
- Occular Inflammation
First Line for IBD remission
Oral Aminosalicylates
Azothioprine
- MOA
- Active metabolite
- SE
- Interaction
- Affects Purine (A+G) synthesis decreases T cells
- 6-Mercaptopurine to 6-TGN = immunosupressive
- Neutropenia
- Allopurinol
Cyclosporin
- Clinical Indication
- MOA
- Rescue therapy
- Calcineurin inhibitor reduces T cell activation
Methotrexate
- MOA
- SE
- Folate antimetabolite
- Fibrosis, mylosupression and hepatotoxic
Ab elevated in autoimmunity and the main target for biological therapies (cytokine inhibitors)
TNF-alpha
3 opiate based anti-motility agents
- Codeine phosphate
- Loperamide
- Diphenoxylate (Pethidine)
2 Antispasmodics
- Mebevarine
- Peppermint oil
2 Anticholonergics for IBS
- Dicycloverine
- Hyacine
The pro-drug combination used for bowel prep
-Sodium Picosulphate + Magnesium citrate
Protein requirements for men and women
- Men = 9g/day
- Women = 7.5g/day
3 types of enteral feeding method and requirements
-NG
-NJ
-PEG - percutaneous endoscopic gastrostomy
A functioning GIT, PEG used for <4-6wks
Refeeding syndrome pathophysiology and risk factors
- Increased insulin secreted=increased PO4 causes coma
- Alcohol and lower BMI
Manage non variceal bleed
- ABCD
- Scope within 24hrs (4hrs in emergancy)
- No PPI
Manage variceal bleed
- Terlipressin
- Cautery
- Consider IV broad spec Ab’s
MOA Terlipressin and main contraindication
- Vasopressin anologue and vasoconstricter
- Pregnancy
Diverticulosis and area most affected
Multiple diverticulum within the bowel (protrusions of conlonic mucosa through muscularis externa)
-Sigmoid
Diverticular Disease
- Bleeding (most common cause LGI bleed)
- Painless
Diverticulitis
- Inflammation of diverticulum or whole sections of bowel
- Absesses and perforation can occur
Acute Mesenteric Ischaemia (Ischaemic colitis) and main risk factor
- Inadequate perfusion through mesenteric vessels
- AF
Most common cause LGI bleed in under 50’s
Anorectal causes eg Heammorhoids
Histological type of anal cancer and main risk factor
- Squamus cell carcinoma
- HPV
Where are gastric ulcers most commonly found
Lesser curvature of the stomach
Where duodenal ulcers most commonly found
First part of the duodenum (cap)
H.Pylori
- Mechanism of survival
- Site of colonisation
- Gram stain
Produces Urease to buffer the acid to survivable conditions
- Antrum
- Gram -
2 main tests of H.pylori
- C13 Breath test
- Ag stool test
Triple therapy and duration for H.pylori
-Amoxicillin, Clarithromycin + Metronidazole
Drug interaction with Clarithromycin
Statins = increased myositis risk
Zollinger Ellison syndrome
Pancreatic gastrinoma hypersecretes causing multiple ulcers
3 Crystalloid fluids used in recuss
- 0.9% Nacl
- 5% Dextrose
- Hartmanns
Why are Colloids less commonly used for fluid replacement
Anaphylaxis
Oesophageal Varices
Dilated collateral vessels secondary to portal hypertension, running through the oesophageal mucosa
Most common causes of gastroenteritis in adults and children
-Gram staining
- Campylobacter-adults
- E.Coli-kids
- Gram - (like most GI bacteria)
5 Causative antibiotics for C.diff infection
- Clindamycin
- Cephalosporin
- Co-Amoxiclav
- Ciproflucloxacin
- Penicillins
Diagnostics and management of C.diff infection
- Stool sample (within 24hrs)
- Isolate
- Vancomycin + Metronidazole
3 Main risks of using Vancomycin
- Nephrotoxic
- Ototoxic
- Rapid Infusion can cause: Red Man Syndrome - Histamine overelease
3 Diagnostic measures for coeliac disease
- Total IgA
- IgA-tTg
- EMA - less specific
Coeliac associated conditions
- Increased cancer risk
- Hyposplenism
- IgA Deficiency
- Dermatitis herpatiformis
Define volvolus its most common site, risks and a possible cause
Loop of bowel most commonly in the sigmoid that can cause obstruction and ischaemia.
-Constipation
Define intussusception and give the USS sign most associated with this
Retraction/telescoping of the bowel (most common ileocecally).
-Bulls eye sign
Barretts
- Site
- Transformation (HINT: B before C)
- Risk
- Bottom 3rd of the eosophagus
- Squamus cell epithelium turns to columnar. Metaplasia
- Transformation to Adenocarcinoma
Oesophageal Adenocarcinoma
- Frequancy
- Site
Most common oesophageal malignancy
-Bottom 3rd of the oesophagus
Oesophageal Squamus cell carcinoma
- Site
- Associated infection
- Upper third of oesophagus
- HPV
Feature of malignant dysphagia over benign cause (strictures)
Progressive dysphagia (solid to liquid)
TNM staging (number levels)
- T1-T4
- N0-N3
- M0-M1
Gatric cancer
- Histological subtype
- Genetic factor
- Most common site affected
- Treatment
- Adenocarcinoma
- P53 tumor supression loss, asian population
- Antrum
- Gastrectomy with neoadjuvant chemo
Colon Cancer
- Histological subtype
- Barium signs
- Most common sites
- Metastasis site
- Treatment
- Adenocarcinoma
- Apple Core sign
- Sigmoid and Rectum
- Liver
- Surgical resection and neoadjuvant chemo
Where do rectal cancers commonly metastasise
Lungs
Why use a CT over a colonoscopy for malignany investigations
Elderly patient may be too frail to tolerate bowel prep or colonoscopy.
Reason for ALT/AST elevation
Hepatocellular inflammation
Reasons fo GGT elevation
- Alcohol
- Fatty Liver disease
- Biliary disease
3 Immunoglobulins and their marker function
HINT: A-A, G-GemmaIC
- IgG = Autoimmune hepatitis
- IgM = Primary Biliary Cirrhosis
- IgA = Alcoholic Liver disease
3 signs of liver disease associated with excess oestrogen
- gynaecomastia
- spider nevi
- palmar erythema
Process of alcoholic liver disease
steatosis - steatohepatitis (alcoholic hepatitis) - cirrhosis
Markers for alcoholic liver disease
- High ALT/AST
- High GGT
- Mallory Bodies (damaged hepatocytes from hepatitis)
Manage Ascites
- Salt restriction
- Diuretics
Wilsons disease
Diagnostics
Treatment
Copper deposition
- 24hr copper excretion and serum copper
- Copper chelation
Haemachromatosis
Diagnositics
Treatment
Increased iron absorption
- Serum ferritin
- Bloodletting and decreased dietary iron
Markers of pre hepatic Jaundice
- Blood bilirubin (C)
- Blood bilirubin (U)
- ALP
- Pruritis
- Splenomegaly
- Urine Bile salts
- Urine and stool features
Normal (C) Blood bilirubin \++ (U) Blood bilirubin -ALP -No Pruritis -Splenomegaly -No urine bile salts -Normal stool and urine
Causes Pre-hepatic (hemolytic) jaundice
- Hemolytic anemias
- HUS
- Transfusion rections
Markers of hepatic Jaundice
- Blood bilirubin (C)
- Blood bilirubin (U)
- ALP
- Pruritis
- Splenomegaly
- Urine Bile salts
- Urine and stool features
\++ (C) Blood bilirubin \++ (U) Blood bilirubin High ALP No Pruritis Spenomegaly No urine bile salts Normal stool, Dark urine
Causes Hepatic jaundice
- Hepatocellular disease
- Hepatitis
- Cirrhosis
- Hepatotoxicity
- Gilberts
Gilberts sydrome
Familial decreased enzyme activity causing painless jaundice
Markers of post-hepatic Jaundice
- Blood bilirubin (C)
- Blood bilirubin (U)
- ALP
- Pruritis
- Splenomegaly
- Urine Bile salts
- Urine and stool features
\++ (C) Blood bilirubin Normal (U) Blood bilirubin -Very high ALP -Pruritis -No splenomegaly -Urine Bile salts -Dark urine and pale stools
Causes of post-hepatic Jaundice
- Bile duct deformity
- Choleliathiasis
- Bile duct tumors
- Pancreatic cancer
- CF
- Pregnancy
Hepatitis A (commonest hepatitis)
- Transmission
- Acute or Chronic
- Diagnostics
- Fecal-oral
- Acute
- HEPAIgm, High ALT
NB (Causes extrahepatic symptoms e.g. joint paint and pancreatitis)
Hepatitis B
- Transmission
- Acute or Chronic
- Diagnostics
- Microscopic features
- Sex,blood,childbirth
- Acute & Chronic
- HBsAg, High ALT
- Ground-glass hepatocytes
Antibodys of Hepatitis B clinical relevance:
- HBsAg
- anti-HBs
- anti-HBc
- HBvDNA
- Hallmark of active infection
- Immunity (vaccination)
- Previous infection
- Viral load
Hepatitis C
- Transmission
- Acute or Chronic
- Diagnostics
- Marked complication
- Sex, blood, drug use
- Acute and chronic
- HEPCAb
- Cryoglobulinemia: cold sensitive Ab’s causing tissue damage
Hepatitis D
- Transmission
- Acute or Chronic
- Can only co-infect with hepatitis B
- Sex, blood, childbirth, iv drug use
- Acute
Hepatitis E
- Transmission
- Acute or Chronic
- Diagnostics (HINT M-has 1 A in it)
- Fecal-oral (seafood)
- Acute
- HEVIgM: Active
- HEVIgG: Recovery
Which hepatitis has no current vaccine
Hepatitis C
Which forms of hepatitis are linked closely to hepatocellular carcinoma
B and C
What is the mainstay antiviral treatment for hepatitis C
Ribavarin
Presenting features of autoimmune hepatitis and diagnostics
- Middle aged women
- Amenorrhea
- Jaundice
- Rash
- AutoAb’s = ANA,AMA,SMA,LKM1/2/3
What is the active ingrediant of paracetamol and its toxic bi product
- Acetaminophen
- NAPQI
How do we treat paractamol toxicity
- Activated charcoal
- Acetylcistine
How does oestrogen link to development of hepatocellular carcinoma
Elevated oestrogen is linked to hepatocellular adenoma wich can ocassionally develop into cancer
3 systemic side effects of portal hypertension
- Oesophageal varices
- Haemmorhoids
- Caput Medusa
Choleliathisis
- Risk factors
- Formation
- LFT’s
- Women, over 50
- Cholesterol increases stone production
- Often normal but may show mild +ALP/ALT and bilirubin
Diagnostics and sign
- USS
- Murphys sign - gallbladder pain on palpation (inspiration)
Cholestasis
-Diagnostics
Biliary obstruction - from anything, eg tumor, stones, cholangitis, alcohol
+ALP +GGT +5-Nucleotidase (obtruction marker)
Cholecystitis
- Mechanism
- Diagnostic signs/symptoms
-Inflammation caused by blockage - different to colic as the stones are stuck in the cystic dut or neck of the gallbladder
-Murphys sign, pain, fever
+WCC, +CRP, +ALP, +Bilirubin
Cholangitis
- Ascending vs Sclerosing (HINT: A next to B in the alphabet)
- Mechanism
- Charcots triad
- Ascending=Bacterial infection, Sclerosing=autoimmune
- Obstruction causes bacterially contaminated bile to back up intot the blood when its usually flushed out
- Fever, Jaundice, Pain
3 Risk Factors for cholangiocarcinoma
- Primary Sclerosing Cholangitis
- IBD
- Liver disease
Diagnositics for pancreatitis (acute and chronic)
Acute: -serum amylase -serum lipase (more specific) Chronic -Fecal elastase
Grey turners sign and Cullens sign
Grey Turners = Flank bruising
Cullens = Peri-umbilical bruising
Give a therapeutic intervention for steatorrhea with chronic pancreatitis
Pancreatin replacement enzymes
Pancreatic CA
- Histopathology
- Main area affected
- Symptoms early and late
- Adenocarcinomas
- Head of pancreas
- Painless jaundice and then back pain
Rarer types of pancreatic tumor and associated genetic defect
Neuroendocrine tail tumors = insulomas
MEN-1 syndrome
Tumor marker for colorectal cancer
CEA
Tumor marker for liver cancer
AFP
Tumor marker for Biliary cancer
CA19-9
Budd-Chiari syndrome
- Mechanism
- Diagnostics
Blockage of hepatic veins via tumors/Polycythemia vera
-USS
What is a major side effect of Metocloperamide and how do you revers it
- Extra-pyramidal
- Anti-cholinergic: Procyclidine
Causes of acute pancreatitis
I = Ideopathic G = Gallstones E = Ethanol T = Trauma S = steroids M = Mumps A = Autoimmune S = Scorpion stings H = Hyperlipidemia, hypercalcemia and hypothermia E = ERCP D = Drugs
How are COPD, pancreatitis, choleliathisis, cholangitis. autoimmune hepatitis and malignancy related
Alpha-1-antitrypsin deficiency
3 Features of Ileostomy
-Placement
- Liquid waste
- Spout
- Electrolyte imbalance common
-R Iliac fossa
3 Features of Colostomy
-Placement
- Solid waste
- Flush
- Electrolytes more stable
-L iliac fossa
Big SE of IV acetylcystine and how to overcome this
- Vomiting and nausea
- Add Ondansetron
