Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

KT > GI surgery > Flashcards

GI surgery Flashcards

1
Q

Why is a urine dipstick done?

A

Infection - WBC, RBC, nitrites
Haematuria
Pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why might you do a blood gas for a GI presentation?

A

If considering gastric outflow obstruction which would make you alkalotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What can cause a high haemoglobin?

A

Dehydration
Peritonitis
Pericarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What can cause a raised haematocrit?

A

Dehydration due to excess vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What can elevate WCC?

A

Infection
Active IBD
Bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does a raised urea and raised creatinine indicate?

A

Dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does a raised urea and normal creatinine indicate?

A

GI haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What can cause a low chloride?

A

Gastric outflow obstruction due to loss of hydrochloric acid in vomitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why is it important to measure TFTs?

A

Thyrotoxic can cause diarrhoea

Myxoedema can cause constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is CEA (carcinoembryonic antigen) a marker for?

A

Colonic cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is CA125 a marker for?

A

Ovarian cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is alpha-fetoprotein a marker for?

A

Primary hepatoma and teratoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is CA19-9 a marker for?

A

Non specific

Rises in pancreatitis and pancreatic cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What types of USS can be done?

A

KUB for renal tract pathology
Biliary tree and liver for gallstone disease, liver metastases or cysts
Ovaries, Fallopian tube and uterus
Endoscopic - assess and stage malignancy in upper GI tract
Transoeosphageal ultrasonography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What GI problems would you be looking for on an erect CXR?

A

Subphrenic free gas indication perforation of hollow viscus
Subphrenic bubbles indicating subphrenic abscess
Lower lobe pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How can you differentiate between a dilated large and small bowel on AXR?

A

Small bowel is arranged more centrally and has bands that transverse its entire diameter (valvulae conniventes)
Large bowel is peripheral with haustra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What might an AXR with gas in the biliary tree indicate?

A

Gallstones
Ileus
Cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is suggested by an AXR with no air in rectum?

A

Proximal obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

If there is a ground glass appearance on AXR what does this suggest?

A

Ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When is CT better than US?

A

Assess bleeding in unstable patients

Imaging pancreas, metastases, other intra-abdominal malignancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When would you do a barium or gastrografin enema?

A

Mechanical obstruction

Visualise colon proximal to stricture that a colonoscope can’t pass through

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When is a barium swallow indicated?

A

Vomiting to look for oesophageal and gastric pathology

Dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When is a barium meal indicated?

A 
Hiatus hernia
Reflux
Large gastric ulcer and tumour
Scarring of duodenum
Imaging masses arising in small bowel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What does a rigid sigmoidoscopy visualise?

A

Rectum and lower sigmoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What does a flexible sigmoidoscopy visualise?

A

Colon and splenic flexure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What does a colonoscopy visualise?

A

Up to the caecum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is an OGD (oesophagogastroduodenoscopy) used to identify?

A

Gastritis
Gastric cancer
Duodenal ulcer
Oesophageal cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is oesophageal manometry and pH monitoring used for?

A

Coordination and strength of peristaltic movements in the oesophagus and sphincter pressure
Identify cause of benign stricture of oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Where would foregut pathology cause pain?

A

Epigastric region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What comes from the foregut?

A 
Oesophagus
Upper duodenum
StomachLiver
Gallbladder and bile ducts
Pancreas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Where would midgut pathology cause pain?

A

Central region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What comes from the midgut?

A 
Appendix
Lower duodenum
Jejunum
Ileum
Caecum
Ascending colon
Proximal 2/3 transverse colon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Where does hindgut pathology cause pain?

A

Suprapubic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What comes from the hindgut?

A 
Distal 1/3 transverse colon
Descending colon
Sigmoid colon
Rectum
Anus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What can cause pain in right upper quadrant?

A 
Cholecystitis
Pyelonephritis
Hepatitis
Ureteric colic
Pneumonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What causes pain in epigastric region?

A

Peptic ulcer
Cholecystitis
Pancreatitis
MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What causes pain in left upper quadrant?

A 
Gastric ulcer
Pyelonephritis
Ureteric colic
Pneumonia
Splenic disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What causes pain in lower right quadrant?

A 
Appendicitis
IBD
Diverticulitis
Inguinal hernia
Ureteric coli
UTI
Gynaecological
Testicular torsion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What causes pain in periumbilical region?

A

Small bowel obstruction
Large bowel obstruction
Appendicitis
AAA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What causes pain in lower left quadrant?

A 
Diverticular disease
IBD
Inguinal hernia
Ureteric colic
UTI
Gynaecological or testicular torsion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What causes diffuse abdominal pain?

A 
Acute pancreatitis
Diabetic ketoacidosis
Gastroenteritis
Mesenteric ischaemia
Peritonitis
Intestinal obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is peritonitic facies?

A

Pale sweaty face with sunken eyes and grey complexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What might you find on a rectal examination and what would it suggest?

A

Tenderness - pelvic appendicitis
Boggy swelling of pelvic abscess
Large prostate gland causing urinary retention
Rectal carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What might you find on a vaginal examination and what would it suggest?

A

Vaginal discharge - salpingitis
Cervical tenderness or excitation in salpingitis or ectopic pregnancy
Retained tampon causing toxic shock
Pelvic mass - ovarian cyst, pelvic abscess, fibroid uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the signs a patient is in hypovolaemic shock?

A

Tachycardia
Hypotensive
Pale and clammy
Thready pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are the signs of generalised peritonitis?

A

Lying very still, look unwell
Tachycardia and potential hypotension
Guarding and rebound tenderness
Rigid abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are the signs of an ischaemic bowel?

A

Diffuse constant pain that is out of proportion to clinical signs
Acidotic, raised lactate, physiologically compromised
Examination will be unremarkable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

How do you diagnose an ischaemic bowel?

A

CT with contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is colic pain?

A

Abdominal pain that crescendos to become very severe then goes away e.g. ureteric obstruction or bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Why does peritonitis occur?

A

Inflammation of a viscus that irritates visceral and parietal peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What can cause difficulty with opening bowels?

A

Stenosing carcinoma of the colon
Diverticular stricture
Obstructing lesion of the rectum or anal canal
Hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What does fresh rectal blood indicate?

A

Anorectal disease

Carcinoma, polyp, perianal disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What does dark rectal blood indicate?

A

Bleeding is in sigmoid colon or above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What does rectal blood that is mixed with stool indicate?

A

Bleeding is above sigmoid colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What does rectal mucus with no blood indicate?

A

IBS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What can causes tenesmus?

A

Rectal mass lesion e.g. carcinoma or large polyp

IBD affecting the rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What family history might you want to ask about if they have a change in bowel habits?

A

Familial polyposis coli
Carcinoma of the bowel
IBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What infections from foreign travel could cause a change in bowel habits?

A 
Giardiasis
Shigellosis
Salmonellosis
Campylobacter infection
Amoebic dysentery
Typhoid
Cholera
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What drug history might you want to consider if the patient has a change in bowel habits?

A

Constipation - opiates, anticholinergics, antidiarrhoeals

Diarrhoea - laxatives, antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

On examination you find pigmentation of the buccal mucosa. What does this suggest?

A

Peutz-Jeghers syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What investigations would you want to do for a change in bowel habits?

A

Bloods - FBC, TFTs, coeliac screen, CRP and ESR, CEA antigen
Stool culture and microscopy
Endoscopy /sigmoidoscopy / colonoscopy
Double contrast barium enema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What are the differential diagnoses of constipation?

A 
Small or large bowel obstruction - strictures
Functional e.g. IBS
Drugs - opioids, analgesics
Hypothyroidism
Local anorectal dysmotility - anismus
Neurological disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What are the differential diagnoses of diarrhoea?

A

Acute

  • infectious
  • traveller’s diarrhoea
  • drugs e.g. antibiotics, laxatives

Chronic

  • hyperthyroidism, thyrotoxicosis, anxiety
  • small bowel disease e.g. Crohn’s, coeliac
  • large bowel disease e.g. UC, Colon cancer, IBS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What can cause PR bleeding?

A 
Diverticulosis
Ischaemic or infective colitis
Haemorrhoids
Malignancy
Angiodysplasia
IBD
Radiation proctitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What might you see on inspection with presenting anorectal pain?

A 
Excoriated inflamed skin
Skin tags
Abscess
Small perianal opening discharging pus or faecal matter
Thrombosed piles
Perianal haematoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is the likely site of the problem if vomiting undigested food immediately after eating with associated dysphagia?

A

Oesophagitis

Gastric cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is the likely site of the problem if vomiting partially digested food soon after eating with epigastric pain?

A

Stomach duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is the likely site of the problem if vomiting bilious with partially digested food, a few hours after eating and associated abdo distension and pain?

A

Small bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is the likely site of the problem if vomiting billions, no food and associated dizziness?

A

Neurogenic

Vestibular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What are some differential diagnoses for vomiting?

A

Mechanical obstruction in oesophagus, stomach, small or large bowel
Obstruction in appendix, biliary ducts, Fallopian tube or ureter
Irritation of nerves or peritoneum or mesentery - gastritis, perforation of viscus, intra-abdominal sepsis and totted ovarian cyst
Chemically induced CNS disorders - drugs and alcohol, vestibulitis, motion sickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is the differential diagnoses for haematemesis and melaena?

A 
Duodenal ulceration
Gastric ulceration
Gastritis
Gastric cancer
Oesophagitis 
Mallory-Weiss tear
Oesophageal malignancy
Oesophageal varices
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What are oesophageal varies?

A

Dilatation of porto-systemic venous anastomoses in oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What are the differential diagnoses of dysphagia?

A 
Mechanical
 - oesophageal or gastric malignancy
 - benign oesophageal stricture
 - extrinsic compression
 - pharyngeal pouch
 - foreign body
 - oesophageal web
Neuromuscular
 - post-stroke
 - achalasia
 - diffuse oesophageal spasm
 - myasthenia gravis
 - myotonic dystrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What are the risk factors for dyspepsia?

A 
Chronic gastritis
Hypochlorhydria
H.pylori infection
Previous partial gastrectomy
Diet 
Smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What drugs do you want to ask about in abdominal distension?

A

Opioid analgesics - constipation
Psychotropic drugs - pseudo-obstruction of bowel
Alpha blockers can cause urinary retention
Corticosteroids which can cause deposition of body fat in central distribution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What are the differential diagnoses of abdominal mass and RUQ pain?

A

Cancer of hepatic flexure of colon
Distended gallbladder
Hepatomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What are the differential diagnoses of epigastric mass?

A 
Gastric tumour
Transverse colon tumour
Hepatomegaly
Pancreatic tumour
Pancreatic pseudocyst
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What are the differential diagnoses of LUQ mass?

A

Cancers of descending colon
Splenomegaly
Pancreatic pseudocyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What are the differential diagnoses of L/R flank mass?

A

Renal tumour

Polcystic kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What are the differential diagnoses of suprapubic mass?

A

Uterus - fibroids, uterine cancer, pregnancy
Ovarian mass
Distended bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What are the differential diagnoses of RIF mass?

A 
Distended caecum
Caecal tumour
Appendix mass
Crohn's disease
Ovarian mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What are the differential diagnoses of LIF mass?

A

Sigmoid colon tumour
Diverticular abscess or mass
Ovarian mass
Constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What type of jaundice do dark urine and pale stools indicate?

A

Obstructive jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What does a rapid and painful jaundice indicate?

A

Common bile duct stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What does gradual jaundice with preceding flu-like illness indicate?

A

Infectious hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What does jaundice with an insidious onset indicate?

A

Carcinoma of pancreas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What does caput medusae indicate?

A

Portal hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What does a jaundice without raised bilirubin indicate?

A

Haemolytic jaundice

Hyperbilirubinaemia e.g. Gilbert syndrome or Crigler-Najjar syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What might you see on USS of a patient presenting with jaundice?

A 
Dilated biliary ducts associated with biliary obstruction
Common bile duct stones
Architectural disturbance of liver
Metastases
Pancreatic swelling or masses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What are the differentials of weight loss?

A 
Malignancy
Colon cancer
IBD
Coeliac disease
Thyrotoxicosis
Anorexia / bulimia nervosa, depression, stress 
Malnutrition
Substance misuse
End organ failure
Diabetes mellitus type 1
Chronic inflammatory disease
Chronic infection e.g. TB
HIV / AIDs
Severe cardiorespiratory disease
Swallowing difficulties e.g. oesophageal stricture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

When is a colonoscopy indicated?

A

Any rectal bleeding in patient over 50 years
Symptoms suggestive of colonic bleeding
Iron deficiency anaemia
Persistent changes in bowel habit
Surveillance of IBD
Population screening for colorectal carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

When is a colonoscopy contraindicated?

A

Consent can’t be given
Suspected or known perforation
Documented acute diverticulitis
Fulminant colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What are the complications of a colonoscopy?

A 
Bleeding
Perforation
Infection
Sedative complications
Prep complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

When is a CT colonography contraindicated?

A 
Active colonic inflammation
Symptomatic colon-containing abdominal wall hernia
Recent acute diverticulitis
Recent colorectal surgery
Recent endoscopic biopsy
Colonic perforation
Bowel obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What are the complications of a CT colonography?

A 
Colonic perforation
Radiation exposure
Incidental extracolonic findings
Vasovagal reaction due to pain induced by colonic distension
Preparation complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What is a proctocolectomy?

A

All of colon and rectum are removed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What are the types of colonic polyps?

A 
Neoplastic
 - adenomas - tubular / villous / tubulovillous
Non-neoplastic
 - hyperplastic
 - inflammatory
 - hamartomas
 - lymphoid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What is familial polyposis coli?

A

Autosomal dominant condition in which hundreds of adenomas develop through colon and rectum during 2nd decade of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What are the symptoms of colonic polyps?

A 
Asymptomatic
Rectal bleeding
Mucus discharge
Tenesmus
Change in bowel habit
Anaemia
Fatigue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What are the differentials of colonic polyps?

A

Colorectal cancer
Haemorrhoids
Anal fissure
IBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What is the management of colonic polyps?

A

Surgical resection
TEMS (transanal endoscopic microsurgery)
TAMIS (transanal minimally invasive surgery)
Open surgery / laparoscopic / robotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Describe the screening for colorectal cancer

A

50-74 year olds invited ever 2 years
Faecal occult blood test
Being replaced by faecal immunochemical test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What are the risk factors for colorectal cancer?

A 
Male
Increasing age
Smoking
Alcohol
Obesity
Family history
IBD
Adenomatous polyps
Familial polyposis coli or Gardener's syndrome
Low fibre diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What are the clinical features of colorectal cancer?

A 
Change in bowel habits
Rectal bleeding
Weight loss if metastatic
Abdominal pain
Iron deficiency anaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What would be the signs of a right sided colon cancer?

A

Abdominal pain
Occult bleeding / anaemia
Mass in RIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What would be the signs of a left sided colon cancer?

A 
Rectal bleeding
Change in bowel habit 
Mucus
Tenesmus
Mass in LIF or on PR exam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What are the differential diagnosis of colorectal cancer?

A

IBD

Haemorrhoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What is removed in a right / extended right hemicolectomy?

A

Removal of right side of colon

Ileocolic, right colic and right branch of middle colic vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What is removed in a left hemicolectomy?

A

Removal of left side of colon

Left branch of middle colic vessel, inferior mesenteric vein and left colic vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What is removed in a sigmoid colectomy?

A

Middle part of colon and inferior mesenteric artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What are the clinical features of Crohn’s disease?

A 
Abdominal pain
Diarrhoea
Rectal bleeding
Mucous discharge
Perianal problems 
Oral aphthous ulcers
Systemic symptoms - malaise, anorexia, malabsorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What are the extra intestinal manifestations of Crohn’s?

A

MSK - enteropathic arthritis, metabolic bone disease
Skin - erythema nodosum, pyoderma gangrenous
Eyes - episcleritis, anterior uveitis
Hepatobiliary - cholangiocarcinoma
Renal stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What are the abnormal bloods in Crohn’s disease?

A

Anaemia, raised WCC
Low albumin
Raised CRP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

How can you differentiate between IBD and IBS?

A

Faecal calprotectin test which is raised in presence of inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What would you see on a colonoscopy of Crohn’s disease?

A

Cobblestoning of bowel

116
Q

How will you manage an acute Crohn’s episode?

A 
Fluids, nutritional support and heparin
Anti-thrombotic stocks
Corticosteroid therapy 
Add immunosuppressive e.g. azathioprine or mesalazine or methotrexate
Add biologics e.g. infliximab
117
Q

Why should anti-motility drugs be avoided in Crohn’s?

A

They can precipitate toxic megacolon

118
Q

What are the complications of Crohn’s disease?

A 
Fistula
Stricture formation which can lead to bowel obstruction
Recurrent perianal abscess
GI malignancy
Obstruction
Malabsorption, anaemia, weight loss
Osteoporosis
Increased risk of gallstones
Increased risk of renal stones
119
Q

What histological changes occur in UC?

A

inflammation of mucosa and submucosa
Crypts of Lieberkuhn are inflamed and crypt abscesses develop
Goblet cell hypoplasia

120
Q

What are the clinical features of UC?

A 
Bloody diarrhoea
PR bleeding and mucus discharge
Increased frequency
Urgency of defecation
Abdominal pain
Tenesmus
Malaise, anorexia, weight loss
121
Q

What are the differentials of UC?

A 
Crohn's
Chronic infection
Mesenteric ischaemia
Radiation colitis
Malignancy
IBS
Coeliac disease
122
Q

How will you manage an acute attack of UC?

A

Corticosteroid therapy e.g. prednisone
Add immunosuppressive agent e.g. azathioprine or methotrexate
Add biological agent e.g. infliximab
Give bisphosphonate while on corticosteroids

123
Q

What are the complications of UC?

A

Toxic megacolon
Colorectal carcinoma
Osteoporosis
Primary sclerosising cholangitis

124
Q

What are the side effects of steroids?

A 
Weight gain and abnormal fat distribution
Thin skin, easy bruising, striae
Hirsutism or hair loss
Osteoporosis
Proximal myopathy
Menstrual irregularities
Hypertension
Hypokalaemia
Impaired glucose tolerance
Depression
Growth and developmental delay in children
125
Q

What are the side effects of azathioprine?

A 
Myelotoxicity
Hepatotoxicity
Pancreatitis
GI intolerance
Susceptibility to infections
Lymphoma
Skin cancer
126
Q

What tests might you want to do for IBS?

A 
FBC
Coeliac serology
CRP & ESR
TSH, FOBT, Iron
Faecal calprotectin
Sigmoidoscopy or colonoscopy
127
Q

What are the 4 manifestations of diverticular disease?

A

Diverticulosis - presence of diverticula
Diverticular disease - symptomatic diverticula
Diverticulitis - inflammation of diverticula
Diverticular bleed

128
Q

What are diverticula?

A

Mucosa covered by layer of peritoneum within neck and large pouch

129
Q

What are the risk factors for diverticular disease?

A 
Lack of fibre in diet
Smoking
Obesity
Family history
NSAIDs
130
Q

Describe the characteristics of diverticular pain

A 
Intermittent, colicky lower abdominal pain
Relieved by defecation
Altered bowel habit
Nausea
Flatulence
131
Q

Describe the symptoms of diverticulitis

A 
Sharp LIF pain worsened by movement
Localised tenderness and peritonitis in LIF
Systemically unwell
Palpable mass
Abdominal distension
132
Q

What are the symptoms of a vesicolic fistula?

A

Cystitis, pneumaturia and recurrent UTIs

133
Q

Why can’t you perform a flexible sigmoidoscopy in suspected diverticulitis?

A

Increased risk of perforation

134
Q

What would you see on a CT of suspected diverticulitis?

A

Thickening of colonic wall
Pericolonic fat stranding
Abscesses
Localised air bubbles or free air

135
Q

How do you manage mild diverticular disease?

A

Analgesia - avoid constipating agents

Increase oral fluid intake

136
Q

What is the conservative management of acute diverticulitis?

A

IV antibiotics, usually metronidazole
IV fluids
Bowel reset
Analgesia

137
Q

What is a Hartmann’s procedure?

A

Sigmoid colonoscopy with formation of end colostomy and closure of rectal stump

138
Q

What is the long term management of diverticular disease?

A 
High fibre diet and high fluid intake
Analgesics
Laxatives
Anticholinergics
Surgery to resect colon
139
Q

What are the complications of diverticular disease?

A 
Acute diverticulitis
Fibrosis
Perforation
Fistula formation
Obstruction
Haemorrhage
140
Q

What can cause a large bowel obstruction?

A 
Polypoid tumour
Constipation
Malignancy
Ischaemia
Diverticular or radiation stricture
Hernia
Volvulus
141
Q

What is a volvulus?

A

Twisting of segment of intestinal tract around a fixed point leading to acute mechanical bowel obstruction

142
Q

What are the symptoms of large bowel obstruction?

A

Colicky abdominal pain - if this becomes constant it suggests ischaemia
Abdominal distension
Constipation
Vomiting as a late stage

143
Q

What are the signs of large bowel obstruction?

A 
Evidence of underlying cause
Abdominal distension
Focal tenderness
Guarding or rebound tenderness
Tinkling bowel sounds
144
Q

What would you see on an AXR of a large bowel obstruction?

A

Dilated bowel
Peripheral location
Haustral lines visible
May have concurrent small bowel dilatation if incompetent ileocaecal valve

145
Q

Why is a CT scan more useful than an AXR for large bowel obstruction?

A

More sensitive
Can differentiate between mechanical obstruction and pseudo-obstruction
Demonstrate site and cause of obstruction
Demonstrate presence of metastases

146
Q

What are the differentials of a large bowel obstruction?

A 
Paralytic ileus
Small bowel obstruction
Toxic megacolon
Constipation
Endometriosis
147
Q

What is the management of a large bowel obstruction?

A

Conservative - NG tube to decompress bowel, IV fluids, catheter, analgesia
Laparotomy colonic resection

148
Q

What are the complications of a colostomy?

A 
Retraction
Prolapse
Herniation
Stenosis
Bowel obstruction
149
Q

What is the aetiology of a small bowel obstruction?

A 
Intraperitoneal adhesions
Hernia
Volvulus
Tumour
Stricture
Intramural haematoma
Gallstones, foreign body
Crohn's disease
Appendicitis
150
Q

What are the risk factors for a small bowel obstruction?

A 
Prior abdominal or pelvic surgery
Abdominal wall or groin hernia
Intestinal inflammation e.g. Crohn's
History of or increased risk for neoplasm
Prior abdominopelvic irradiation
History of foreign body ingestion
151
Q

What are the symptoms of a small bowel obstruction?

A

Colicky abdominal pain
Vomiting
Abdominal distension
Absolute constipation

152
Q

What are the signs of a small bowel obstruction?

A 
Evidence of underlying cause
Dehydration
Abdominal distension
Focal tenderness
Guarding and rebound tenderness
Tinkling bowel sounds
153
Q

What would be seen on an AXR of a small bowel obstruction?

A 
Dilated bowel
Central abdominal location
Valvulae conniventes visible
Partial SBO - gas throughout
Complete  SBO - no distal gas
Complicated SBO - air under diaphragm
154
Q

What are the differentials of a small bowel obstruction?

A 
Large bowel obstruction
Paralytic ileus
Toxic megacolon
Constipation
Infective gastroenteritis
Appendicits
Pancreatitis
155
Q

What are the risk factors for haemorrhoids?

A

Excessive straining from chronic constipation
Increasing age
Raised intraabdominal pressure e.g. pregnancy, cough, ascites
Pelvic or abdominal masses
Family history
Cardiac failure
Portal hypertension

156
Q

What are the symptoms of haemorrhoids?

A 
Painless bright red bleeding following defecation 
Pruritus ani due to mucous discharge
Rectal fullness or anal lump
Soiling
Prolapse
157
Q

What are the differentials of haemorrhoids?

A 
Malignancy
IBD
Diverticular disease
Fissure-in-ano
Perianal abscess
Fistula-in-ano
158
Q

What is the management for haemorrhoids?

A

Conservative - high fibre diet, increase fluids, laxatives, topical analgesia
Topic agents e.g. anusol, proctosedyl, diltiazem cream
Injection sclerotherapy
Barron’s bands
Cryotherapy and infrared coagulation
Haemorrhoidectomy
Haemorrhoid artery ligation

159
Q

What does diltiazem cream do to haemorrhoids?

A

Reduce size of haemorrhoid, reduce anal sphincter tone which increases blood flow and promotes healing

160
Q

When is a haemorrhoidectomy indicated?

A

Recurrent prolapse
Acutely thromboses piles
Failure to respond to conservative therapies
Unsuitable for banding or injection

161
Q

What are the complications of haemorrhoids?

A 
Thrombosis
Ulceration
Gangrene
Skin tags
Perianal sepsis
162
Q

What is an anal fissure?

A

Tear in mucosal lining of anal canal characterised by pain on defecation and rectal bleeding

163
Q

What are the risk factors of an anal fissure?

A

Inflammation or trauma to anal canal - constipation, diarrhoea, vaginal birth, anal sex
IBD
Chronic disease - extrapulmonary TB, malignancy, HIV

164
Q

What are the clinical features of an anal fissure?

A

Intense pain post-defecation
Pain out of proportion to fissure size
Bleeding
Itching

165
Q

What are the differentials of an anal fissure?

A 
Haemorrhoids
Anal fistula
Crohn's disease
UC
Anal cancer
166
Q

What is the management of an anal fissure?

A 
Reduce risk factors
Increase fluid and fibre intake
Analgesia
Stool softening laxatives
Topical anaesthetics - lidocaine
GTN cream or diltiazem cream
Surgical - botox injections or lateral sphincterotomy
167
Q

What are the 4 types of anal fistulae?

A

Inter-sphincteric
Trans-sphincteric
Supra-sphincteric
Extra-sphincteric

168
Q

What are the risk factors for an anal fistula?

A

IBD
Systemic disease - TB, diabetes, HIV
History of trauma to anal region
Previous radiotherapy to anal region

169
Q

What are the symptoms and signs of an anal fistula?

A 
Recurrent perianal abscess
Intermittent rectal pain
Intermittent pruritus
Intermittent or continuous discharge onto perineum
Excoriated or inflamed perianal skin
External opening on perineum may be seen
170
Q

What is the Goodsall rule for anal fistula?

A

Clinically predict trajectory of fistula tact depending on location of external opening
External opening posterior to transverse anal line means fistula tract will follow a curved course to posterior midline
External opening anterior to transverse anal line means fistula tract will follow straight radial course to dentate line

171
Q

What are the differentials of an anal fistula?

A

Anal abscess
Anal fissure
Anal ulcer

172
Q

What are the symptoms of an appendicitis?

A 
Abdominal pain initially periumbilical then to RIF
Vomiting
Anorexia
Nausea
Diarrhoea or constipation
173
Q

What would you find on examination of a suspected appendicitis?

A 
Tachycardia, tachypnoea
Pyrexia
Rebound tenderness and percussion pain over McBurney's point
Signs of guarding if perforated
Rovsing's sign
Psoas sign
174
Q

What is Rovsing’s sign?

A

RIF pain on palpation of LIF

Indicative of right sided local peritoneal irritation

175
Q

What is psoas sign?

A

RIF pain with extension of right hip

Suggests inflamed appendix abutting psoas major muscle in retrocaecal position

176
Q

What would you see on a CT of appendicitis?

A

Enlarged appendiceal diameter with occluded lumen
Appendiceal wall thickening
Periappendiceal fat stranding
Appendiceal wall enhancement

177
Q

What are the complications of an appendicitis?

A 
Perforate
Generalised peritonitis
Surgical site infection
Appendix mass
Pelvic abscess
178
Q

What is the aetiology of pancreatitis?

A 
I GET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimune
Scorpion venom
Hyperlipidaemia / hypothermia / hypercalcaemia
ERCP
Drugs e.g. azathioprine, NSAIDs or diuretics
179
Q

What are the symptoms and signs of acute pancreatitis?

A 
Sudden onset severe epigastric pain
Nausea and vomiting
Epigastric tenderness with guarding
Haemodynamic instability due to inflammatory responses
Cullen's sign, Grey Turner's sign
180
Q

What is included in the modified Glasgow coma score pancreatitis?

A 
PO2 <8
Age >55
WCC >15 
Ca <2mmol/L
Renal function - urea >16mmol/L
Enzymes - AST >200, LDH >600
Albumin <32g/L
Sugar >10mmol
181
Q

What are the differential diagnoses of acute pancreatitis?

A 
AAA
Renal calculi
Chronic pancreatitis
Aortic dissection
Peptic ulcer disease
182
Q

What are the complications of acute pancreatitis?

A 
Hypovolaemic shock
Haemorrhagic pancreatitis
Pseudocyst formation
Infected necrosis
ARDS
SIRS
Chronic pancreatitis
183
Q

What is the aetiology of chronic pancreatitis?

A

Chronic alcohol abuse
Idiopathic
Metabolic - hyperlipidaemia, hypercalcaemia
Viral - HIV, mumps, coxsackie
Bacterial
CF
Autoimmune pancreatitis, SLE
Obstruction of pancreatic duct - stricture formation, neoplasm
Congenital - pancreas divisum, annular pancreas

184
Q

What are the differentials of chronic pancreatitis?

A

Acute cholecystitis
Peptic ulcer disease
Acute hepatitis
Sphincter of Oddi dysfunction

185
Q

What are the risk factors for peptic ulcer disease?

A 
H.pylori
NSAIDs
Corticosteroid use
Previous gastric bypass surgery
Physiological stress
Zollinger-Ellison syndrome
186
Q

What are the symptoms of peptic ulcer disease?

A 
Epigastric or retrosternal pain that is exacerbated by eating
Nausea
Bloating
Post-prandial discomfort
Early satiety
187
Q

What is the difference between gastric and duodenal ulcers?

A

Gastric are worsened by food, duodenal are relieved by food
Gastric peaks at 50yo, duodenal peak at 25-30yo
45% gastric are associated with. H.pylori, 85% of duodenal are associated with H.pylori

188
Q

What are the differentials of peptic ulcer disease?

A 
Acute coronary syndrome
Gastrooesophageal reflux
Gallstone disease
Gastric malignancy
Pancreatitis
189
Q

What are the complications of peptic ulcer disease?

A

Perforation
Haemorrhage
Pyloric stenosis
Anaemia

190
Q

What are the risk factors for GORD?

A 
Age
Obesity
Male
Alcohol
Smoking
Caffeinated drinks
Fatty or spicy foods
Family history
191
Q

What are the clinical features of GORD?

A

Dyspepsia
Heartburn
Burning retrosternal pain made worse after meals, lying down, bending over or straining
Chronic cough or nocturnal cough
Waterbrash
Recurrent laryngitis, sore throat, asthma

192
Q

What are the red flags for GORD?

A 
Dysphagia
Weight loss
Early satiety
Malaise
Loss of appetite
Vomiting
Iron deficient 
Mass
193
Q

What are the differential diagnoses of GORD?

A

Malignancy
Peptic ulceration
Oesophageal motility disorders
Oesophagitis

194
Q

What treatment can be given for GORD?

A

PPI
H2 antagonist e.g. ranitidine
Alginates e.g. gaviscon

195
Q

What are the complications of GORD?

A

Barrett’s oesophagus
Aspiration pneumonia
Oesophagitis and oesophageal stricture
Oesophageal cancer

196
Q

What is achalasia?

A

Oesophageal dysmotility syndrome
Decreased peristalsis
increased lower oesophageal sphincter tone
Progressive problem with swallowing solids and liquids

197
Q

What is the treatment for achalasia?

A

Calcium channel blockers
Dilatation at OGD
POEM NOTES

198
Q

What can cause a benign oesophageal stricture?

A 
GORD
Oesophagitis
Hiatus hernia
Corrosives
Surgical anastomosis
199
Q

How can you treat a benign oesophageal stricture?

A

Dilatation - mechanical or balloon

Acid suppressive therapy e.g. PPI

200
Q

What are the types of oesophageal cancer?

A

Squamous cell carcinoma

Adenocarcinoma

201
Q

What are the clinical features of oesophageal cancer?

A 
Dysphagia
Feeling of lump in throat not associated with eating
Regurgitation
Weight loss
Odonyphagia or hoarseness
202
Q

What are the differential diagnoses of oesophageal cancer?

A

Benign oesophageal stricture
Barrett’s oesophagus
Achalasia

203
Q

How can you manage oesophageal cancer?

A

Oesophagectomy
If squamous: chemo-radiotherapy + surgery
if adenocarcinoma: chemo-radiotherapy + oesophageal resection
Palliative - oesophageal stent, radio & chemotherapy, photodynamic therapy, RIG
Analgesics and nutritional support

204
Q

What is Barrett’s oesophagus?

A

Intestinalisation of distal oesophageal non-keratinising stratified squamous epithelium

205
Q

How do you manage Barrett’s oesophagus?

A

PPI and surveillance
HALO (radiofrequency ablation)
EMR / ESD

206
Q

What can cause an upper GI bleed?

A 
Peptic ulcer bleed - duodenal or gastric
Oesophageal varices
Mallory-Weiss tear
Oesophagitis / gastritis
UGI malignancy
Vascular lesions
Clotting disorders
Dieulafoy lesion
Drugs
207
Q

What are the clinical features of an upper GI bleed?

A 
Haematemesis
Melaena
Abdominal discomfort
Dizziness and SOB
Tachycardia, hypotension, tender abdomen
208
Q

When is a Sengstaken Blakemore tube indicated?

A

Unstable patients with massive variceal bleeding if:

  • endoscopy isn’t available
  • endoscopy doesn’t control the bleeding
209
Q

What are the contraindications of a Sengstaken Blakemore tube?

A

History of oesophageal stricture

Recent oesophageal or gastric surgery

210
Q

What are the complications of a Sengstaken Blakemore tube?

A 
Airway obstruction
Oesophageal rupture
Aspiration pneumonitis
Pain
Ulcer of lipids, mouth, tongue
Oesophageal and gastric mucosal erosions
211
Q

What are the pre-hepatic causes of jaundice?

A

Excessive RBC breakdown causing unconjugated hyperbilirubinaemia
Haemolytic syndrome
Gilbert’s syndrome
Criggler-Najjar syndrome

212
Q

What are the hepatocellular / intrahepatic causes of jaundice?

A 
Alcoholic liver disease
Viral hepatitis
Iatrogenic - erythromycin, isoniazid, phenytoin, valproate, COCP
Hereditary haematochromatosis
Autoimmune hepatitis
Primary biliary / sclerosing cholangitis
Hepatocellular carcinoma
213
Q

What are the post-hepatic causes of jaundice?

A

Obstruction of biliary damage
Intraluminal causes e.g. gallstones
Mural causes - cholangiocarcinoma, strictures, drug-induced cholestasis
Extra-mural causes - pancreatic cancer, abdominal masses

214
Q

What is the pattern of LFTs for an obstructive jaundice?

A

High bilirubin
High ALP
Normal ALT

215
Q

What is the pattern of LFTs for a hepatocellular jaundice?

A

Very high ALT
Varying bilirubin
Raised ALP
Increased PT

216
Q

What is included in a liver screen of jaundice?

A

Acute liver injury

  • viral serology - hep A, B, C, E, CMV, EBV
  • non infective markers e.g. paracetamol level, caeruloplasmin, ANA antibody, IgG

Chronic liver injury

  • viral serology - hep B, C
  • non infective markers - caeruloplasmin, ferritin and transferrin saturation, tissue transglutaminase antibody, alpha 1 antitrypsin, autoantibodies
217
Q

What are the risk factors for a gastric cancer?

A 
Male
H.pylori infection
Increasing age
Smoking
Alcohol consumption
High salt intake
Family history
Pernicious anaemia
Gastric polyps, FAP
218
Q

What are the symptoms of gastric cancer?

A 
Vague
Dyspepsia
Dysphagia
Early satiety
Melaena
Vomiting
Anorexia, weight loss, anaemia
219
Q

What are the 2 types of bile salts and what are they made of?

A

Primary - cholic + chenodeoxycholic acid

Secondary - deoxycholic + lithocholic acid

220
Q

Why do gallstones occur?

A

Too much absorption of water from bile
Too much absorption of bile acids from bile
Too much cholesterol in bile
Inflammation of epithelium

221
Q

What are the 3 types of gallstones?

A

Cholesterol
Pigment stones
Mixed stones

222
Q

What are the 2 types of pigment gallstones and what are they associated with?

A

Black - associated with haemolytic disease

Brown - associated with chronic cholangitis and biliary parasites

223
Q

What are the risk factors for gallstones?

A 
Fat
Female
Fertile
Forty
Family history
Haemolytic anaemia
Malabsorption
224
Q

What are the symptoms of biliary colic?

A

Sudden dull and colicky pain in RUQ
Pain can radiate to epigastrium, back or right shoulder
Precipitated by consumption of fatty foods
Nausea and vomiting

225
Q

What are the differential diagnoses of gallstone disease?

A

GORD
Peptic ulcer disease
Acute pancreatitis

226
Q

What are the complications of gallstone disease?

A 
Mucocele
Mirizzi syndrome
Gallbladder empyema
Ascending cholangitis
Chronic cholecystitis
Perforated gallbladder
Bouveret's syndrome and gallstone ileum
Choledocholithiasis
Pancreatitis
227
Q

Why does conjugated bilirubin cause dark urine?

A

It is water soluble

228
Q

What can cause a low albumin and low protein?

A

Advanced cirrhosis
Alcoholism
Protein malnutrition
Chronic inflammation

229
Q

What can cause a raised ALP?

A

Biliary obstruction
Bone disease
Pregnancy
Certain malignancies

230
Q

Why does blockage of a common bile duct prevent clotting factors being produced?

A

Vitamin K is fat soluble

Blockage of a common bile duct prevents fat absorption so stops vitamin K absorption

231
Q

What are some non hepatic causes of deranged LFTs?

A 
Drugs
Right heart failure
Sepsis
Coeliac disease
Haemolysis
Hyperthyroidism
Lower lobe pneumonia
232
Q

What conditions are anti-smooth muscle autoantibodies found in?

A

Autoimmune hepatitis type 1

233
Q

What conditions are anti-mitochondrial autoantibodies found in?

A

Primary biliary cholangitis

234
Q

What conditions are anti-nuclear autoantibodies found in?

A

Autoimmune hepatitis type 1

SLE

235
Q

What drugs can cause deranged LFTs?

A 
TB antibiotics
Sodium valproate
Methotrexate
Methyldopa
Amiodarone
Statins
Paracetamol
Phenytoin
Fluconazole
Nitrofurantoin
Sulfonylureas
236
Q

What are the 3 consequences of cirrhosis?

A 
Reduced metabolic capacity
 - coagulopathy
 - reduced albumin
 - hypoglycaemia
Portal hypertension
 - ascites
 - hypersplenism
 - varices
 - hepatic encephalopathy
Impaired immunity
237
Q

What can cause cirrhosis?

A 
Non-alcoholic fatty liver
Alcohol
Drug induced
Viral hepatitis
Biliary disease
Autoimmune
238
Q

What are the consequences of portal hypertension (SAVE)?

A 
Splenomegaly
Ascites
Varices
Encephalopathy
Hepatorenal syndrome
239
Q

What is the definition of diarrhoea?

A

Abnormal passage of loose or liquid stools at least 3 times a day and or a volume of stool greater than 200g/day

240
Q

What drugs can cause diarrhoea?

A 
Antibiotics
Cytotoxics
Laxatives
PPI
Digoxin
NSAIDs
Propranolol
241
Q

What are the causes of acute diarrhoea?

A

Viral - norovirus, rotavirus, enteric adenovirus
Bacterial - salmonella, campylobacter, shigella, S.aureus
Parasitic - cryptosporidium parum

242
Q

What are the causes of chronic diarrhoea?

A

Colonic - IBD, microscopic colitis, colorectal cancer
Small bowel - coeliac, crown’s, bile salt malabsorption, lactose intolerance, small bowel bacterial overgrowth
Pancreatic - pancreatitis, pancreatic cancer, fibrosis
Endocrine - hyperthyroidism, diabetes, Addison’s disease, hormone secreting tumous
Drugs, alcohol, factitious

243
Q

What are the mechanisms of diarrhoea?

A 
Osmotic
Malabsorption
Secretory e.g. E.coli
Inflammatory e.g. Crohn's, UC
Neoplastic
Ischaemic
Post-irradiation
244
Q

What is the child-pugh scoring system used for?

A

Assess prognosis of chronic liver disease and cirrhosis

245
Q

What does a bioavailability of 20% mean?

A

An oral dose of 100mg would be an equivalent exposure to an IV dose of 20mg

246
Q

What is the consequence of cholestasis on drug handling?

A

Decreased absorption
Lipid soluble medicines may be reliant on the action of bile salts to aid their absorption
Drugs may be less well absorbed so there will be lower plasma concentrations and reduced efficacy e.g. with digoxin

247
Q

What is the effect of ascites on pharmacokinetics and what drugs is this likely to affect?

A

Increases distribution

Water soluble medicines may distribute into ascetic fluid decreasing concentrations e.g. gentamicin

248
Q

What is the effect of low albumin on pharmacokinetics and what drugs is this likely to affect?

A

Decreased distribution
Affects highly protein bound drugs
Increased free concentrations e.g. phenytoin

249
Q

What is the effect of a high bilirubin on pharmacokinetics and what drugs is this likely to affect?

A

Decreased distribution
Highly protein bound medicines will be effected. Bilirubin displaces highly bound protein drugs from their binding sites increasing the free concentrations of these drugs e.g. phenytoin

250
Q

What are the 3 types of reactions in phase 1 drug metabolism?

A

Hydrolysis
Oxidation
Reduction

251
Q

What is the difference between Crohn’s and UC?

A

Crohn’s affects entire tract, UC only affects colon
UC inflammation is continuous and mucosal, Crohn’s has skip lesions and is deep / transmural
Blood is more common in UC
Nausea and vomiting is more common in Crohn’s
Abdo pain is severe and continuous in Crohn’s but is intermittent in UC
Smoking worsens Crohn’s but reduces UC symptoms
Surgery is more effective for UC

252
Q

What are the signs of an IBD flare up?

A 
Bloody diarrhoea
Nocturnal symptoms
Urgency
Mucous
Changes in bloods
253
Q

What 5 factors are included in the Harvey Bradshaw index for Crohn’s disease activity?

A

1) General well being
2) Abdominal pain severity
3) Number of liquid stools per day
4) Abdominal pass
5) Complications - joint pain, uveitis, erythema nodosum, mouth ulcers, skin ulcers, anal fissure, new fistula, abscess, fever without infectious cause

254
Q

What 6 factors are included in the simple clinical colitis activity index for UC disease activity

A

1) General wellbeing
2) Bowel frequency in day
3) Bowel frequency in night
4) Urgency of defecation
5) Blood in stool
6) Complications

255
Q

What is the mechanism of 5-ASA?

A

Acts locally on colonic mucosa

Reduces inflammation

256
Q

What are the side effects of 5-ASA?

A 
Arthralgia
Cough
Diarrhoea
Dizziness
Fever
GI discomfort
Headache
Leucopenia
Nausea and vomiting
Skin reactions
257
Q

What is the mechanism of thiopurines?

A

Intracellular purine analogue and alkylation
Decreased nucleic acid synthesis
DNA damage

258
Q

What are the contraindications of thiopurines?

A

Hypersensitivity
Active infection
Bone marrow impairment
Live vaccines

259
Q

What are the side effects of thiopurines?

A 
Dizziness
Flu like symptoms
Nausea and vomiting
Myelosuppression
Pancreatitis
Sun toxicity
260
Q

What are the 1st line biologics for Crohn’s?

A

Infliximab

Adalimumab

261
Q

What are the 1st line biologics for UC?

A

Infliximab

Adalimumab

262
Q

What is grade 1 ascites?

A

Mild ascites detectable only by USS

263
Q

What is grade 2 ascites?

A

Moderate ascites manifested by moderate symmetrical distension of abdomen

264
Q

What is grade 3 ascites?

A

Large or gross ascites with marked abdominal distension

265
Q

What are the causes of ascites?

A

Hypoalbuminae - nephrotic syndrome, malnutrition
Activation of RAAS
Portal hypertension - cirrhosis, alcoholic hepatitis, acute liver failure, hepatic vena-occlusive disease, HF, constrictive pericarditis
Peritoneal disease - malignant ascites, infectious peritonitis, peritoneal dialysis

266
Q

What are the clinical features of ascites?

A 
Distended abdomen with central resonance and dullness in flanks
Painless
Weight gain
SOB
Early satiety
Shifting dullness
Signs of liver disease
267
Q

What does an ascitic tap that is clear / straw coloured indicate?

A

Liver cirrhosis

268
Q

What does an ascitic tap that is cloudy indicate?

A

Spontaneous bacterial peritonitis, perforated bowel, pancreatitis

269
Q

What does an ascitic tap that is bloody indicate?

A

Malignancy
Haemorrhage
Pancreatitis

270
Q

What does an ascitic tap that is chylous indicate?

A

Lymphoma
TB
Malignancy

271
Q

What can cause a low serum ascites-albumin gradient?

A 
Malignancy
Infection - TB
Pancreatitis
Nephrotic syndrome
Hepatic vein thrombosis
Budd-Chiari syndrome
Hypothyroidism
272
Q

What can cause a high serum ascites-albumin gradient?

A 
Cirrhosis
Hepatic failure
Venous occlusion
Fulminant hepatic failure
Alcoholic hepatits
Hepatocellular carcinoma
Right ventricular failure
Constrictive pericarditis
Meig's syndrome
273
Q

How can ascites be managed?

A 
Avoid alcohol, low salt diet
Spironolactone
Add in furosemide as adjunct
Therapeutic paracentesis
Transjugular intrahepatic portosystemic shunt
274
Q

What are the clinical features of autoimmune hepatitis?

A

Fatigue, arthralgia, anorexia, nausea
Bruising, rashes
Pruritus
Signs of chronic liver disease - spider nave, palmar erythema, hepatomegaly / splenomegaly, oedema

275
Q

How is autoimmune hepatitis treated?

A

High dose corticosteroid
Azathioprine
Transplant

276
Q

What are the signs of cirrhosis?

A 
Leukonychia
Clubbing
Palmar erythema
Spider naevi
Dupuytren's contracture
Xanthelasma
Gynaecomastia
Loss of body hair
Hepatomegaly
277
Q

What can cause liver failure?

A 
Infections
Drugs - paracetamol overdose, isoniazid
Toxins - carbon tetrachloride
Veno-occlusive disease
Alcohol
Fatty liver disease
Primary biliary / sclerosing cholangitis
Haematochromatosis
Autoimmune hepatitis
Alpha1 antitrypsin deficiency
Wilson's disease
Malignancy
278
Q

What are the causes of iron deficiency anaemia?

A

Malabsorption - dietary, coeliac, post gastrectomy, drugs e.g. PPI, tetracyclines
Blood loss - NSAIDs, anticoagulants, peptic ulcer disease, menorrhagia, malignancy, frequent blood donation, haemorrhoids, oesophageal varices
Increased physiological requirements - pregnancy, infancy

279
Q

What are the clinical features of iron deficiency anaemia?

A 
Tiredness or fatigue
Headache
Muscle aches
SOB
Palpitations
Angina
Intermittent claudication
Hair loss
Pallor
Tachycardia
Systolic murmur
Angular stomatitis and glossitis
Brittle nails and koilonychia
280
Q

What would the FBC and iron studies show for an iron deficient anaemia?

A

Low MCV, MCHC and haemoglobin

Low Fe, low ferritin

281
Q

What are the differentials of iron deficiency anaemia?

A

Thalassaemia
Anaemia of chronic disease
Sideroblastic anaemia
Lead poisoning

282
Q

What are the causes of GI malabsorption?

A 
Coeliac disease
Chronic pancreatitis
Crohn's disease
Decreasing bile - primary biliary cholangitis, ileal resection, biliary obstruction
Pancreatic insufficiency - pancreatic cancer, CF
Small bowel mucosa
Bacterial overgrowth
Infection
Intestinal hurry
283
Q

What are the clinical features of malabsorption?

A 
Diarrhoea
Weight loss
Lethargy
Steatorrhoea
Bloating
Anaemia, bleeding disorders, oedema, metabolic bone disease, neurological features
284
Q

What are the clinical features of coeliac disease?

A 
Steatorrhoea, diarrhoea
Abdo pain
Bloating 
Nausea and vomiting
Aphthous ulcers
Angular stomatitis
Weight loss, fatigue, weakness
Osteomalacia
285
Q

What would the bloods show in coeliac disease?

A

Low Hb
Low B12, low ferritin
Anti-transglutaminase

KT (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions