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Y3 CORE CONDITIONS > GI SYSTEM > Flashcards

GI SYSTEM Flashcards

1
Q

How many people does GORD affect?

a) 1 in 5 weekly
b) 1 in 50 weekly
c) 1 in 500 weekly
d) 1 in 5000 weekly

A

a) 1 in 5 weekly

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2
Q

What causes it GORD and what is the common symptom?

A

inappropriate relaxation of the lower oesophageal sphincter so stomach acid can travel up
Heart burn is the common symptom

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3
Q

Which one of these is not a normal oesophageal defence?

a) surface bicarbonate buffer
b) epithelial cells blocking H+ absorption/cell damage
c) acid stimulates contraction
d) cilia secrete mucus buffer for rising acid

A

d) cilia secrete mucus buffer for rising acid

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4
Q

What condition is characterised by heartburn and regurgitation that is worse when lying down and when drinking hot liquids or alcohol?

A

GORD

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5
Q

Name 4 lifestyle-related risk factors for GORD

A 
smoking
large meals (fast food)/coffee, chocolate
obesity
alcohol
stress
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6
Q

which drugs can aggravate GORD?

A

antimuscarinics
Ca channel blockers
Nitrates
NSAIDs

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7
Q

what autoimmune condition can predispose to GORD?

A

Systematic sclerosis

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8
Q

Name 2 physiological risk factors for GORD

A

pregnancy

hiatus hernia

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9
Q

What is the difference between a sliding and rolling(para-o) hiatus hernia?
Which is more common?

A

SLIDING - gastro-oesophageal junction and the stomach both displaced about the oesophageal hiatus = (80-90% of hiatus hernias)
ROLLING - GOJ same position but stomach above the diaphragm (much less common)

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10
Q

What common procedure would you use to diagnose GORD?

A

endoscopy

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11
Q

What 3 drugs might you give to treat GORD?

A

antacids
H2 receptor antagonists
PPIs

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12
Q

What complication of GORD results in intermittent dysphasia of solids?

A

Peptic stricture

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13
Q

What histological changes occur in Barrett’s oesophagus

A

Stratisfied squamous epithelium replaced by simple columnar epithelium that contains goblet cells (similar to lower GI tract)

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14
Q

What malignant neoplastic condition is associated with Barrett’s oesophagus?

A

adenocarcinoma of the esophageal

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15
Q

What condition often predisposes to Barrett’s oesophagus?

A

Hiatus hernia

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16
Q

Which type of peptic ulcer is most common?

a) duodenal
b) gastric

A

a) duodenal

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17
Q

what is the main cause of peptic ulcers in the developing world?

A

h pylori infection

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18
Q

how does h pylori damage gastric mucosa cells?

A

adheres to the mucosa cells and releases enzymes and apoptosis= binding to class 2 molecules

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19
Q

what drugs can cause peptic ulcers? Common in developed worl

A

NSAIDs (COX inhibitors)

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20
Q

What is Zolinger-Ellison syndrome?

A

Gastrin secreting tumour that causes recurrent peptic ulcer in distal duodenum and proximal jejunum

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21
Q

name three symptoms you could get with peptic ulcers

A

recurrent epigastric burning pain
nausea
anorexia
weight loss

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22
Q

What are the risk factors for peptic ulcers?

A 
Nsaids overuse
FHx
H.pylori
Zolinger-Ellisons syndrome
alcohol
smoking
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23
Q

What is the treatment for peptic ulcers

A

PPI & clarithromycin +( metronidazole or amoxicillin) = use the combination that doesn’t involve abx that has been previously used for another infection
Second line is quinolones

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24
Q

What is the invasive and non invasive test used to diagnose peptic ulcers?

A 
Invasive =endoscopy &; biopsy
Non invasive= 
Urea breath test = h..pylori
serology= IgG antibodies
 Stool sample = H.pylori monoclonal antibodies
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25
Q

What two complications of peptic ulcers result in bleeding?

A

haemorrhage

perforation

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26
Q

Which type of peptic uilcer is more likely to perforate?

A

duodenal

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27
Q

Which complication of peptic ulcers results in projectile vomiting and metabolic alkalosis

A

gastric outlet obstruction

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28
Q

how is gastric outlet obstruction treated?

A

IV fluid

electrolytes

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29
Q

What is the most common type of hernia?

A

Inguinal (70% indirect and 30% direct)

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30
Q

Who most commonly gets

a) direct inguinal hernia
b) indirect inguinal hernia

A

a) Direct commonly men over 40

b) Can affect any age but usually the young

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31
Q

On what side of the body are inguinal hernias most common?

A

right

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32
Q

Which type of inguinal hernia involves displacement of the hernial pouch through the deep inguinal ring?

A

indirect

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33
Q

Through where does the hernial pouch displace in a direct inguinal hernia?

A

Through a weakening in the floor of the inguinal canal ( fascia in the inguinal triangle)

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34
Q

Name 3 movements which will cause pain in an inguinal hernia?

A

coughing
exercise
pooing

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35
Q

how can you tell if the bowel has moved into the scrotum with an inguinal hernia?

A

if the skin above can’t be grasped

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36
Q

how are inguinal hernias treated surgically

A

laparoscopic repair

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37
Q

what condition are truss/supportive pants used as part of management of?

A

inguinal hernia

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38
Q

name a complication of inguinal hernias

A 
Strangulation
Bladder injury
Recurrence
Intestinal injury
Hydrocele
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39
Q

name 3 risk factors of inguinal hernias

A

smoking
COPD
obesity
pregnancy

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40
Q

name two surgical procedures/interventions that can predispose to inguinal hernias

A

peritoneal dialysis

appendectomy

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41
Q

are femoral hernias common or rare in terms of other hernias?

A

rare (3%)

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42
Q

which gender do femoral hernias more commonly affect?

A

women

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43
Q

where do femoral hernias occur?

A

femoral canal

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44
Q

describe the difference between reducible and irreducible femoral hernias

A

reducible can push back through

irreducible can’t and ++painful

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45
Q

what is an obstructed femoral hernia?

A

twists with intestine

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46
Q

what is the name for the the femoral hernia emergency that blocks the intestinal blood supply and causes necrosis?

A

strangulated

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47
Q

on palpation what could be felt when feeling for a femoral hernia?

A

lump or bulge on groin below inguinal ligament

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48
Q

how does one repair a femoral hernia?

A

surgical repair

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49
Q

How common are gallstones in the UK?

a) 1 in 10
b) 1 in 50
c) 1 in 500
d) 1 in 1000

A

a) 1 in 10

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50
Q

What are the five F’s of who gets gallstones?

A

fat, forty, female, fair, fertile

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51
Q

what substance makes up 80% of all gallstones?

A

cholesterol

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52
Q

what causes cholesterol gallstones to form?

A

supersaturation from excess HMG-CoA causes stones to crystallise in bladder

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53
Q

name 2 substances that make pigmented gallstones

A

calcium, billirubinate

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54
Q

A patient produces deep brown/black gallstones.
Which of these conditions does NOT cause this
a) Crohn’s - bile salt loss in colon
b) Coeliac disease - malabsorption of bile salts
c) sickle cell anaemia
d) hereditary spherocytosis

A

b) coeliac disease

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55
Q

what would brown gallstones indicate?

A

biliary stasis or infection

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56
Q

name five risk factors for high cholesterol

A 
age
female
obesity
familial
high fat, low fibre diet
diabetes
COCP
ileal disease
Liver cirrhosis
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57
Q

What causes the pain in biliary colic?

A

Temporary blockage of the cystic duct by the gall stones causing intense abdominal pain

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58
Q

what kind of pain is often related to over indulgence in fatty food or alcohol?

A

biliary colic

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59
Q

where is pain referred to in biliary colic? How long does it last for?

A

epigastrium > right shoulder and scapula and it last for 1-4 hours

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60
Q

What is Charcot’s triad used to diagnose?

A

acute cholecystitis

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61
Q

What are the three factors in Charcot’s triad of acute cholecystitis?

A

jaundice, RUQ pain, fever (w, rigours)

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62
Q

What diagnosing testing is done for confirmation of acute cholecystitis (medical emergency)?

A

Abdominal Us, bloods including WCC, CRP and serum amylase

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63
Q

what would you expect to be high in blood test for acute cholecystitis?

A

WCC, CRP, Serum amylase, ALP, bilirubin

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64
Q

What is the name for surgical removal of the gallbladder?

A

cholecystectomy

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65
Q

How much is the patient allowed to eat during treatment for acute cholecystitis?

A

nil by mouth

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66
Q

What is the treatment for for acute cholecystitis?

A

IV fluids
Analgesia
IVcephs, fluoroquins ; tazobactam

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67
Q

what surgical procedure must be performed urgently in the case of acute cholangitis?

A

endoscopic common bile duct clearance

ERSP

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68
Q

what causes acute cholecystitis?

A

gallstone obstruction > increased secretion > distension > inflammatory response

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69
Q

name 3 severe complications of gallstones

A 
pus empyema
gangrene
perforation
peritonitis
pancreatitis
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70
Q

what timescale defines acute hepatitis?

A

less than 6 months

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71
Q

where is hepatitis more prevalent?

A

africa & middle east

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72
Q

which section of the population are more at risk from hepatitis infection?

a) elderly and immunocompromised
b) middle aged men
c) children and young adults
d) infants and pregnant women

A

c) children and young adults

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73
Q

what two public health factors increase the risk of hepatitis infection?

A

overcrowding

poor sanitation

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74
Q

what damage does the hepatitis virus do to the liver?

A

degeneration of hepatocytes

necrosis & death

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75
Q

Which is the most infective form of hepatitis?

A

A

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76
Q

How is hepatitis A spread?

A

faecal-oral

contaminated food/water

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77
Q

How is hepatitis B spread?

A

vertical ( mother to child or child to child)

or intimate contact (needles, sex, cuts)

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78
Q

How does hepatitis B stimulate liver damage?

A

immune response

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79
Q

how is hepatitis C spread?

A

blood transmission

IVDU uses

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80
Q

how is hepatitis E spread?

A

enterally - contaminated water, animals, travel

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81
Q

what infection does EBV cause?

A

infectious mononucleosis

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82
Q

what infection does CMV cause?

A

glandular fever-like

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83
Q

Name 2 sections of the population most at risk from herpes simplex

A

immunocompromised

pregnant

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84
Q

How is hepatitis transmitted in yellow fever?

A

mosquito aegypti

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85
Q

what particular serious feature does yellow fever elicit in the liver

A

necrosis

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86
Q

what test would you use to distinguish between EBV and toxoplasmosis?

a) paul-bunnel test
b) bouchard’s test
c) allen’s test
d) cullen’stest

A

a) paul bunnel test

+ve in EBV, -ve in toxoplasmosis

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87
Q

Which of these blood tests would not be raised in acute hepatitis?

a) AST/ALT
b) ESR
c) haemoglobin
d) urobilinogen

A

c) haemoglobin

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88
Q

Which antibody would indicate

a) previous infection/carrier with hepatitis
b) acute infection with hep

A

a) IgG

b) IgM

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89
Q

What is the initial symptom of hep A/B and how long does it take to resolve overall?

A

Nausea and anorexia with jaundice development

3-6 weeks

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90
Q

With which variant of hepatitis would you be most likely to be asymptomatic?

A

Hepatitis C

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91
Q

which organs may be enlarged with hepatitis A/B?

A

liver

spleen

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92
Q

what would happen to the skin,lymph, urine and stools in hepatitis A and B infection?

A

jaundice = gets darker as the disease progresses
dark urine
pale stools
lymphadenopathy

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93
Q

what syndrome distinguishes hep A and B?

A

immunological syndrome - rash, fever, polyarthritis and rarely glomerulonephritis

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94
Q

name 4 conditions is hep C associated with?

A

diabetes
lichen planes
non hodgkin’s lymphoma
Sjogren’s syndrome

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95
Q

consumption of what is stopped in the first few weeks of hepatitis treatment?

A

alcohol

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96
Q

What are symptoms of Hep C?

A

Flu
Jaundice
Abdominal

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97
Q

what antivirals could you give for variants of hepatitis such as EBV, CMV, herpes simplex?

A

acyclovir, ganciclovir

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98
Q

what could you give in the case of hepatitis C to prevent chronic infection?

A

interferon

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99
Q

what are the common complications of acute hepatitis B and C?

A

chronic hepatitis
cirrhosis
carcinoma

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100
Q

Is an acute GI bleed more like to affect older or younger people?

A

older

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101
Q

how common is acute GI bleed?

a) 50 per 100,000
b) 125 per 100,000
c) 1 per 100,000
d) 10 per 100,000

A

b) 125 per 100,000

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102
Q

name 4 risk factors for acute GI bleed

A 
Alcohol abuse.
Chronic renal failure.
Non-steroidal anti-inflammatory drug (NSAID) use.
Age.
mallory-weiss tears
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103
Q

which one of these are the clinical feature of an acute upper GI bleed?

A

haematemesis
melaemia
dark blood and clots in stool
Indication of shock

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104
Q

name 5 physiological causes of acute GI bleed

A 
peptic ulcer burst
mallory-weiss tear
oesophago-gastric varices
Malignancy= gastric carcinoma 
Oesophagitis
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105
Q

name 2 iatrogenic causes of acute GI bleed

A

drugs - aspirin, NSAIDs, corticosteroids

alcohol intake

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106
Q

what kind of infection could cause an acute GI bleed?

A

viral haemorrhagic

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107
Q

what is a mallory-weiss tear?

A

mucosa tear from sudden increase of pressure due to retching , excessive vomiting

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108
Q 
what kind of acute GI bleed would these features predispose towards?
diverticular disease
ischaemic colitis
anal fissures
haemorrhoids
A

lower

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109
Q

what risk assessment is used to re-assess for rebleeding and mortality in acute GI bleed?

Explain the criteria

A

Rockall risk assessment

age = 1 (60-79), 2(>80)
Shock= 1(tachy), 2 (+hypo)
co-morbidities 1( CF + IHD), 2( liver or renal failure + malignancy)

After gastroscopy
Diagnosis
Stigmata of recent haemorrhage

Out of 11

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110
Q

what endoscopic treatment is available for acute GI bleed?

A

bands or stents

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111
Q

when would it be necessary to give a blood transfusion in the case of acute GI bleed?

A

Hb= <100

sepsis

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112
Q

Who does appendicitis affect?

a) elderly
b) children
c) all age groups
d) infants

A

c) all age groups

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113
Q

what is the common cause of appendicitis?

A

lumen of appendix obstructed w faecolith

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114
Q

describe the pain pattern of appendicitis

A

abdo pain starting in umbilicus and moving to right iliac fossa (McBurney’s point)

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115
Q

what signs would be elicited during abdo palpation in appendicitis?

A

Tenderness, gaurding and rebound at the McBurney’s point

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116
Q

name 3 symptoms of appendicitis

A 
pain
nausea
vomiting
anorexia
(diarrhoea)
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117
Q

what imaging procedures might you use to diagnose appendicitis?

A

ultrasound

CT

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118
Q

name 2 differential diagnoses for appendicitis

A 
crohn's
Gastroenteritis
Pelvic inflammatory disease
Colitis
Kidney stones
Cystitis (UTI)
IBS
Constipation
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119
Q

describe the urgent treatment required for appendicitis

A

laparoscopic removal/surgery

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120
Q

what conservative management would be suggested for appendicitis?

A

iv fluids, abx

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121
Q

name 2 complications of appendicitis

A

abscess
peritonitis
gangrene

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122
Q

Complete this pneumonic for causes of small and large bowel obstructions:

If People Could Fly, Heaven’s A Nice View

A 
iscaemic strictures
pseudo-obstruction
crohn's
foreign body
hernia
atresia
neoplasm
volvulus
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123
Q

name a specific cause of small bowel obstruction

A

superior mesenteric artery syndrome (SMA/AA compress duodenum)

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124
Q

name 4 specific causes of large bowel obstruction

A

diverticulitis/diverticulosis
IBD
fecal compaction
narcotics

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125
Q

name 3 general symptoms of bowel obstruction

A

abdo pain/ distension
constipation
vomiting/ fecal vomiting

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126
Q

how do you distinguish between small bowel obstruction pain and large bowel obstruction pain?

A

SMALL - colicky, intermittent w vomiting
LARGE - lower, last longer
less vomiting

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127
Q

give an example for the following causes of gastric outlet (anorectal) obstruction

1) functional
2) mechanical
3) force vector
4) impaired sensitivity

A

1) sphincter/pelvic floor issues
2) enterocoele
3) prolapse
4) megacolon

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128
Q

how do you treat emergency bowel obstruction

A

surgical stents or obstruction removal

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129
Q

why would you consider giving an NG tube for small bowel obstruction?

A

resolve dehydration

surgical removal

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130
Q

what surgical treatment might you give for infantile bowel obstruction or congenital bowel abnormalities

A

temporary stoma

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131
Q

name 4 bowel complications that could occur following/during bowel obstruction

A

bowel perforation and ischaemia
electrolyte imbalance
dehydration
Respiratory complications such as aspiration

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132
Q

how many times a year could developing world children expect to get infective gastroenteritis?

A

3-6

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133
Q

what group of people are also prone to getting infective gastroenteritis

A

Travellers
Elderly
The young n
Homosexual men

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134
Q

what type of diarrhoea are clostridium perfringens , clostridium difficile and vibrio cholerae likely to cause?

A

watery diarrhoea

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135
Q

what type of diarrhoea is toxigenic e. coli likely to cause?

A

watery travellers diarrhoea

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136
Q

what time of diarrhoea are salmonella and campylobacter jejuni likely to cause?

A

watery diarrhoea

137
Q

As well as water diarrhoea what other symptom do you get with s.aureus and bacillus cereues?

A

Severe vomiting

138
Q

what type of diarrhoea is caused by bacterial enterotoxins or adherence?

A

watery diarrhoea

139
Q

what type of diarrhoea is caused by mucosal invasion or cytotoxic damage of bacteria?

A

dysentery= inection of the intestives causing diarrohea with blood or mucus

140
Q

name three organisms that cause dysentery in travellers

A

shigella= most common in UK
salmonella (food poisoning)
campylobacter (food poisoning)

141
Q

what type of diarrhoea is caused by invasive/haemorrhagic e coli?

A

dysentery

142
Q

what type of diarrhoea is caused by yersonia, vibrio parahaemolyticus and c. difficile?

A

dysentery

143
Q

name 2 complications of infective gastroenteritis

A

AKI
perforation
septicaemia

144
Q

what antibiotic treatment would you recommend for gastroenteritis caused by salmonella shigella and cholera?

A

ciprofloxacin

145
Q

what antibiotic would you recommend for gastroenteritis caused by campylobacter

A

azithromycin

146
Q

what antibiotic would you recommend for gastroenteritis caused by invasive e coli

A

amoxicillin

147
Q

what antibiotic would you recommend for treatment of clostridium?

A

met/vanc

148
Q

name an antidiarrhoeal

A

loperamide

149
Q

what kind of drug is metoclopramide?

A

anti-emetic

150
Q

name 2 common causes of Crohn’s and Ulcerative Colitis

A

genetic mutations
impaired mucus barrier function
defective intestinal defensins

151
Q

which three of these pathogens can contribute towards Crohn’s disease?

a) e coli
b) c difficile
c) s aureus
d) mycobacterium paratuberculosis
e) h influenzae
f) bacteria dysbiosis

A

a) e coli
d) m paratuberculosis
f) bacteria dysbiosis

152
Q

which is more common - Crohn’s or Ulcerative Colitis?

A

Ulcerative Colitis

153
Q

Which inflammatory bowel disease affects just the colon to rectum as opposed to the whole bowel?

A

Ulcerative Colitis

154
Q

Which inflammatory bowel disease is transmural as opposed to affecting just mucosal-depth?

A

Crohn’s

155
Q

which inflammatory bowel disease would be described as having a cobblestone appearance?

A

Crohn’s

156
Q

which inflammatory bowel disease would be described as having polyps and crypt abscesses?

A

ulcerative colitis

157
Q

which inflammatory bowel disease results in goblet cell depletion?

A

ulcerative colitis

158
Q

which inflammatory bowel disease is characterised by skip lesions?

A

Crohn’s

159
Q

which inflammatory bowel disease is characterised by langerhans granulomas

A

Crohn’s

160
Q

how would you differentiate between blood and mucus from UC and Crohn’s

A

UC - urgent w blood &mucus &; tenesmus

Crohn’s - diarrhoea w weight loss

161
Q

with which inflammatory bowel disease are you likely to get aphthous mouth ulcers?

A

ulcerative colitis

162
Q

What is a severe complication of ulcerative colitis

A

colon is grossly dilated and gas filled w mucosal islands

163
Q

what complication is a huge risk of toxic megacolon?

A

perforation

164
Q

If a blood test showed raised ESR, CRP with anaemia and hypoalbuminaemia, what condition could this indicate?

A

inflammatory bowel disease

165
Q

what would a sigmoidoscopy NOT show in ulcerative colitis?

a) inflammation
b) redness
c) clots
d) bleeding

A

c) clots

166
Q

which inflammatory bowel disease is perinuclear anti-neutrophil cytoplasmic antibody (pANCA) present in?

A

ulcerative colitis

167
Q

what organism is it important to exclude in stool tests for inflammatory bowel disease?

A

c diff

168
Q

in the management of Crohn’s disease, what drugs would be given to induce remission

A

glucocorticosteroids

anti-TNF antibodies

169
Q

For which stage of treatment of Crohn’s disease would azathioprine and methotrexate be given alongside anti-TNF antibodies?

A

maintenance of remission

170
Q

What additional drug is added to the maintenance of remission programme for crown’s disease if it treating the perianal area?

A

ciprofloxacin and metronidazole

171
Q

what percentage of Crohn’s sufferers require surgical intervention?

a) 10%
b) 2%
c) 80%
d) 50%

A

c) 80%

172
Q

what two surgical procedures could be performed for inflammatory bowel disease?

A

resection

ileostomy/colostomy bag

173
Q

which type of inflammatory bowel disease would you give aminosalicylates (5-ASA) for?

A

ulcerative colitis

174
Q

suggest an immunosuppressant you could give in serious cases of ulcerative colitis

A

IV infliximab or oral ciclosporin

175
Q

suggest an immunosuppressant to use for long term maintenance therapy of ulcerative colitis

A

azathioprine

176
Q

which part of the bowel wall does microscopic colitis affect?

A

lamina propria

177
Q

what occurs to the collagenous layer in in collagenous colitis?

A

thickens

178
Q

with what group of conditions in collagenous colitis associated with?

A

autoimmune

179
Q

what bowel disease is characterised by an inappropriate immune reaction to microbes or substances in the lumen?

A

IBD

180
Q

what immune cells induce inflammation and tissue damage in inflammatory bowel disease?

A

toll-like receptors

181
Q

what is the difference between type 1 and type 2 inflammatory bowel disease attacks?

A

type 1 - acute self limiting

type 2 - long term

182
Q

What is the complications of

a) Chron’s
b) Ulcerative colitis

A

a) Obstruction, abscesses, fistulae and slight increase in risk of colon cancer
b) Haemorrhage, toxic mega-colon and marked increase risk of colon cancer

183
Q

how many people report symptoms of irritable bowel disease?

a) 1 in 100
b) 1 in 500
c) 1 in 5
d) 1 in 2

A

c) 1 in 5

184
Q

which gender is more likely to be affected by irritable bowel syndrome?

A

female

185
Q

Name 3 mental disorders can be risk factors and triggers for irritable bowel syndrome?

A

stress
affective disorders
abuse
eating disorders

186
Q

what criteria is used to assess the change in stool frequency and form in irritable bowel disease? Gold standard diagnosis

A

rome 3 criteria

187
Q

what 2 sexual/genital problems can arise with IBS?

A

dysmenorrhoea

dyspareunia

188
Q

name 3 urinary symptoms that can arise with IBS

A

frequency
urgency
nocturne
incomplete emptying

189
Q

name 2 lifestyle symptoms that can arise with IBS

A

fatigue
poor sleep
headaches

190
Q

name 2 complications associated with IBS

A

chronic fatigue

fibromyalgia (chronic pain)

191
Q

what section of the population does pancreatitis commonly affect?

A

middle aged, elderly men

192
Q

where is pain characteristically present and referred to in pancreatitis?

A

sudden severe dull epigastric pain that radiates to the back or below the left scapula

193
Q

name 2 symptoms of acute pancreatits

A

pain
nausea
vomiting

194
Q

what is cullen’s sign?

A

umbilical bruising

195
Q

what is grey-turner’s sign?

A

flank bruising

196
Q

what do cullen’s and grey-turner’s signs indicate?

A

necrotising pancreatitis

197
Q

name 2 signs that would be present on abdo exam of a patient with acue pancreatitis

A

guarding
tenderness
absence of bowel sounds

198
Q

what is the I GET SMASHED pneumonic for causes of acute pancreatitis?
What is the most common 4?

A 
I- Idiopathic *
G - gallstones*
E - ethanol*
T - trauma*
S - steroids
M - mumps
A - autoimmune
S - scorpion bited
H - hyperlipidaemia
E - ERCP
D - diabetes, drugs
199
Q

which of these drugs is NOT a risk factor for acute pancreatitis?

a) DMARDs
b) NSAIDs
c) methotrexate

A

b) NSAIDs

200
Q

What is the two most common causes of periductal necrosis of the pancreas

A

Alcohol consumption

Gall bladder disease = blocking the bile duct and causing back preasure in the main pancreatic duct

201
Q

what does the trapping of digestive enzymes in the pancreas result in (in terms of cellular pathogenesis)

A

cellular necrosis

202
Q

name 6 differential diagnoses for acute pancreatitis

A 
Renal failure.
Ectopic pregnancy.
Diabetic ketoacidosis.
Perforated duodenal ulcer.
Small bowel perforation/obstruction.
Ruptured or dissecting aortic aneurysm.
203
Q

what enzyme would be increased in blood tests to diagnose pancreatitis?

A 
amylase= can also be indicative of pertionitis, infarction or perforation
Lypase= more specific
204
Q

what radiological tests would you want to perform on a patient with suspected acute pancreatitis?

A

ultrasound (gallstones)
chest x-ray (perforation)
CT (essential)
MRI (assess damage)

205
Q

what 3 diagnostic scores are available for assessment of acute pancreatitis?

A

Ranson criteria >3 severe
Glasgow prognostic score >3 severe
APACHE score

206
Q

what analgesia would you suggest for a patient with acute pancreatitis?

A

tramadol &; other opiates

Not morphine due to its s/e on the sphincter of oddi

207
Q

would you recommend an NG tube in a patient with pancreatitis and why?

A

YES

  • aspiration to avoid abdo distension & asp pneumonia
  • NG feeding
208
Q

name two systemic complications of acute pancreatitis

A

systemic inflammatory response syndrome
multiple organ dysfunction
disseminated intravascular coagulopathy

209
Q

name 2 pancreatic complications of acute pancreatitis

A

abscess
necrosis
empyema

210
Q

name 2 lung complications of acute pancreatitis

A

pleural effusion
pneumonia
Acute respiratory distress syndrome
Atelectasis

211
Q

name a kidney complication of acute pancreatitis

A

AKI

212
Q

name 3 GI/liver complications of acute pancreatitis

A 
bleeding
paralytic iliac
jaundice
CBD obstruction
portal vein thrombosis
213
Q

name 2 metabolic complications of acute pancreatitis

A

hypoglycaemia
hyperglycaemia
hypercalcaemia

214
Q

what is the major cause of chronic pancreatitis?

A

alcohol

215
Q

name 2 other causes of chronic pancreatitis

A 
metabolic
hereditary
autoimmune
recurrent acute 
obstruction
216
Q

how does trypsin play a role in the pathogenesis of chronic pancreatitis?

A

increase in trypsin causes plugs which cause calcification and blockage of pancreas

217
Q

how does alcohol interfere with trypsin in chronic pancreatitis?

A

impairs calcium regulation and promotes trypsinogen

218
Q

suggest a drug for each of these types of pain management for chronic pancreatitis

a) tricyclic antidepressant
b) neuropathic pain relief
c) NSAID

A

a) amitryptilline
b) pregabilin
c) naproxen/ibuprofen

219
Q

what drug might you recommend for autoimmune chronic pancreatitis?

A

steroids

220
Q

name 2 complications of chronic pancreatitis

A

diabetes
ascites
pancreatic cancer
pseudocyst/cyst

221
Q

suggest a carcinoma characterised by dysphagia, pain when swallowing, hoarse voice and haemoptysis?

A

oesophageal carcinoma

222
Q

what type of oesophageal cancer is most common in the developing world?

A

squamous cell (epithelia)

223
Q

what type of oesophageal cancer is most common in the developed world

A

adenocarcinoma (glands)

224
Q

where in the oesophagus does adenocarcinoma develop?

A

lower 1/3

225
Q

name risk factors for

a) squamous cell esophageal cancer
b) esophageal adenocarcinoma

A

a) tobacco, alcohol, poor diet (red meat), hot drinks

b) obesity, smoking and acid reflux

226
Q

is prognosis for oesophageal carcinoma good or bad?

A

poor because of late diagnosis

13-18% survival after 5 years

227
Q

What is the symptoms of gastric carcinoma?

A 
Heartburn/ upper abdo pain
nausea &amp;; vomiting
appetite loss and weight loss 
Jaundice, 
Dysphagia, 
Melena
228
Q

what is the main cause of gastric carcinoma?

A

h pylori

229
Q

name 2 other risk factors/causes of gastric carcinoma

A 
pickled veg and smocked meat
smoking
familial
age >55
Male
Pernicious anaemia and peptic ulcer disease
230
Q

how is prognosis for gastric cancer?

A

poor

231
Q

what is the most common type of pancreatic cancer?

A

adenocarcinoma

232
Q

name 4 risk factors for development of pancreatic cancer

A 
smoking
obesity
diabetes, chronic pancreatitis, H.pylori infection/ stomach ulcers
genetics
red meat consumption
233
Q

which rank is pancreatic cancer in terms of cause of death in the UK?

a) 1st
b) 5th
c) 50th
d) 20th

A

b) 5th
25% survival rate after a year
5% after 5 years

234
Q

name 2 main causes of cirrhosis

A

alcohol
hepatitis (a & b)
20% of Hep C cause cirrhosis

235
Q

name 3 fat/diet related causes of cirrhosis

A

obesity
hyperlipidaemia
hypertension
diabetes

236
Q

name an iron disorder that can cause cirrhosis

A

haemochromatosis

237
Q

name 2 gallstone disorders that can cause cirrhosis

A

billiary cirrhosis

gallstones

238
Q

how is autoimmune hepatitis cirrhosis treated?

A

steroids

239
Q

name 3 complications of cirrhosis

A 
infective ascites
liver failure
hepatic encephalopathy
bleeding
liver cancer
240
Q

why can ascites cause shortness of breath?

A

restriction of diaphragm

241
Q

what sign would you elicit in an abdominal exam for ascites?

A

shifting dullness and fluid thrill

242
Q

name 3 symptoms possible with ascites due to portal hypertension

A 
leg swelling
bruising
gynaecomastia
haematemesis
encephalopathy
243
Q

how much fluid must accumulate in peritoneal cavity to be closed as ascites?

A

more than 1500ml

244
Q

which of these doesn’t cause ascites?

a) budd-chiari syndrome
b) kwashiorkor
c) crohn’s disease
d) constrictive pericarditis

A

c) crohn’s disease

245
Q

which of these doesn’t cause ascites?

a) cirrhosis
b) metastatic cancer
c) liver disease
d) heart failure
e) pancreatitis
f) renal failure

A

f) renal failure

246
Q

what is marasmus?

A

lack of protein and calories leading to malnutrition

247
Q

what is kwashiorkor?

A

lack of protein

248
Q

if a patient presents with rigidity, guarding, rebound tenderness, peritonitis and sudden severe abdo pain, what might you suspect?

A

perforated viscus

249
Q

give 2 examples of a perforated viscus

A

peptic ulcer
bowel
appendix
penetrating trauma

250
Q

which one of these best describes SIRS?

a) toxic, hypotensive, tachypnoea/cardic, febrile
b) hypertensive, bradypnoea/cardia, febrile

A

A

251
Q

what kind of disorder is coeliac disease?

A

autoimmune

252
Q

what mouth symptom does coeliac disease share with ulcerative colitis?

A

apthous ulcers

253
Q

what occurs to the intestines during coeliac disease?

A

villous atrophy

254
Q

what blood disorder do patients with coeliac disease often suffer from?

A

anaemia

255
Q

name 2 risk factors for coeliac disease

A

genetics

other autoimmune diseases e.g. DMT1, thyroiditis

256
Q

what is a complication of coeliac disease?

A

may increase risk of intestinal cancer

257
Q

Is gastric ulcer or duodenal ulcer symptoms better once the patient eats food?

A

Duodenal ulcer

258
Q

Which type of inguinal hernia enters the scrotum and what is the consequence?

A

Indirect inguinal hernia

Can cause pain by having dragging sensation

259
Q

Lying down relieves the symptoms of which hernia?

A

Direct inguinal hernia

260
Q

Which inguinal hernia can be manually reduced?

A

Indirect inguinal hernia

261
Q

What congenital abnormality causes indirect inguinal hernia?

A

Congenital absence of the closure of the processes vaginalis

262
Q

What ethnicity has a protective factor to gall stones?

A

Asians/Africans

263
Q

What are the symptoms of cholelithiasis?

A

Asymptomatic as the gall stones are in the gall bladder

264
Q

What is cholecystitis?

A

It is prolonged obstruction of the cystic duct leading to inflammation of the gall bladder

265
Q

What are the initial symptoms of Choledocholithiasis?

A

Usually asymptomatic with abnormal liver enzyme production

266
Q

What are the two serious complications of Choledocholithiasis?

A

Cholangitis and acute pancreatitis

267
Q

What is the treatment for Choledocholithiasis?

A

ERCP +/- Cholecystectomy

268
Q

What is the cause of cholangitis?

A

It is infection of the bile duct caused by bacteria ascending from the junction with the duodenum due to partial obstruction of the bile duct by gall stones

269
Q

What additional symptoms as well as the charcots triad do you get in acute cholangitis?

A

Reynolds Pentad which is mental state change and sepsis

270
Q

What systemic involvements are their in cholecystitis?

A 
Increase in heart rate but decrease in BP
Increase WCC
Increase CRP
Increase bilirubin
Increase ALP
271
Q

Is their systemic involvement in biliary colic?

A

No

272
Q

What would be indicate a obstructive jaundice in a blood test?

A

Raised biliruibin

273
Q

What sign is elicited in acute cholecystitis

A

Murphys sign

274
Q

What occurs in positive Murphy’s sign?

A

Palpation of the sub costal margin during inspiration will cause the patient to catch their breath as the inflamed gall bladder would contact the hand

275
Q

What bacteria commonly cause cholangitis?

A

Gram +/- and anearobes

Such as E.coli, enterococcus, bactericides

276
Q

What is spectrum of gall stones?

A

Cholithiasis –> biliary colic –> acute cholecystitis –> Choledocholithiasis –>cholangitis

277
Q

What is the most common type of viral hepatitis?

A

Hep c

278
Q

What needs to be present for a hep D infection to occur?

A

The patient needs to have hep B virus first to survive in the body

279
Q

What are non virus causes of hepatitis?

A

Excess alcohol and autoimmune

280
Q

What are the symptoms of alcohol causing hepatitis?

A

Usually asymptomatic but can get sudden jaundice and liver failure

281
Q

If acute pancreatitis is caused by
a) gall stones
b) alcohol
what is the presentation?

A

a) Immediately after eating large meal

b) 6-12 hours after drinking alcohol

282
Q

What further inflammatory manifestations can occur as a complication of acute hepatitis?

A

Myocarditis
Vasculitis
Arthritis

283
Q

What renal complication can arise from acute hepatitis?

A

AKI

284
Q

What can exacerbate pain caused by acute pancreatitis?

A

Lying down

Drinking and eating ( especially fatty food)

285
Q

What antibody is related to chronic pancreatitis?

A

IgG4

286
Q

What is a diverticulum?

A

It is a abnormal sac or pouch at a weakening of the intestines

287
Q

What is Merckel’s diverticulum?

A

It is present at birth

288
Q

Most common cause of infective gastroenteritis?

A

Norovirus

289
Q

Most common cause of infective gastroenteritis in children?

A

Rotavirus

290
Q

What are the three Abx given for appendicitis?

A

Amoxicillin
Metronidazole
Gentamicin

291
Q

What iso Rovsing sign for appendicitis?

A

You put pressure on the left iliac fossa but get pain on the right illiac fossa

292
Q

`What is paralytic ileus?

A

The bowel ceases to function and no peristalsis

293
Q

Is their a physical obstruction in paralytic ileus?

A

No physical obstruction but malfunction in the nerves and the muscles in the intestines which impairs digestive movement

294
Q

What are the symptoms of paralytic ileus?

A

No pain or bowel sounds

295
Q

What are the causes of paralytic ileus?

A

Electrolyte imbalance
Gastroenteritis
Pancreatitis
Appendicitis

296
Q

What are the risk factors of IBS?

A

Female
Life events
Low fibre diet
Stress/ anxiety

297
Q

What is the cardinal sign of IBS?

A

Abdominal pain

298
Q

What is the 1st line treatment of IBS?

A

Dietary advice –> high fibre diet (FODMAP diet)
Life style advice and help
Laxatives such as Movicol
Antispasmodic agents = Mebeverine or peppermint oil derivative
Anti motility agent = loperamide

299
Q

What is the second line treatment for IBS?

A

TCA such as amitriptyline
Or
SSRIs

300
Q

Which IBD is caused by smoking?

A

Chrons disease

Smoking has protective effect of UC as it reduces inflammation

301
Q

What are the risk factors of developing IBD?

A 
FHx
NSAIDS use
High sugar and fat intake
Chronic stress and depression
Obesity
Absence of breast feeding
302
Q

What group of people are prone to IBD?

A

White caucasian and young (<30)

Jewish are also have high risk

303
Q

What is the main symptom of Chron’s disease?

A

Abdominal pain with cramps which get worse after eating
Unintentional weight loss
Extreme fatigue

304
Q

How do you diagnose Chron’s disease?

A

Bloods
Stool sample
Colonoscopy
Small bowel enema

305
Q

What are the risk of ileostomy used for IBD?

A

Dehydration
Mechanical problems
Pyschosexual problems

306
Q

What specific surgical operation is done for ulcerative colitis?

A

Ileo-anal pouch

307
Q

What is a risk factor specifically for oesophageal adenocarcinoma?

A

Acid reflux–> increase the development of Barrets oesophagus

308
Q

Is obesity a risk factor for both types of oesophageal carcinoma?

A

No a increase risk only for ACC as increase risk of acid reflux and therefore Barrets oesophagus

309
Q

What are the risk factors for gastric carcinoma?

A

Age >50
Male
Associated with socio-economic deprived areas
Diet with low veg and fruit but high salt and preservatives

310
Q

What common metastasis of gastric carcinoma?

A

Liver, lung ,intestines, bones and lymph

311
Q

What are the symptoms of colerectal cancer?

A 
Anaemia
Rectal bleeding 
Constant Change in bowel movements
Weight loss
fatigue 
Mass either in the left or right colon
312
Q

Is left colon cancer or right colon cancer at a greater advance stage when symptoms are present?

A

Right is at a more advanced stage when symptoms are present

313
Q

What are the risk factors for colorectal cancer?

A 
Age
DM
Sedentary life style 
Obesity
DM
High alcohol intake 
Smoking
FHx
Hereditary Non Polyps Colerectal Cancer
IBD
Radiation exposure and occupation risk (asbestos)
314
Q

What 3 drugs reduce the risk of colerectal cancer?

A

Vitamin supplements containing folic acid and calcium, Aspirin and NSAIDS

315
Q

Deficiency in what mineral is common in cirrhosis?

A

Zinc

316
Q

What are the symptoms of liver cirrhosis?

A 
Itching
Jaundice
Ascites
Easy bruising 
Duptreyns contractor
Spider nevi
Peripheral oedema and pleural effusion
Fatigue
317
Q

What are Esophageal varices and what causes it?

A

Dilation of veins in the oesophagus caused by portal hypertension due to cirrhosis

318
Q

What is Budd Chiari syndrome ?

A 
Blockade of the drainage of portal vein causing triad of
Abdo pain
Ascites
Hepatomegaly 
leading to cirrhosis
319
Q

What is the treatment for ascites?

A

Diuretics and paracentesis

320
Q

What is the complication of ascites?

A

Bacterial peritonitis
Hepatorenal syndrome
thrombosis

321
Q

What is hepatorenal syndrome?

A

Rapid deterioration of kidney with patients with liver cirrhosis

322
Q

What is malnutrition?

A

Nutritional level is too low or too high

323
Q

What are cause of malnutrition?

A 
Infectious disease
Malignancy
Obesity
Anorexia
lack of breast feeding
bariatric surgery
324
Q

Starvation is a complication of malnutrition. What is the consequence of starvation?

A 
Short stature
Thin body 
Fatigue
Swallowen legs and abdomen
Frequent infections
325
Q

What is a complication of perforated viscus?

A

SIRS

326
Q

What are the DD of perforated viscus?

A

AAA
Aortic dissection
Mesenteric ischaemia

327
Q

What are the symptoms of coeliac disease

A 
Chronic diarrhoea 
Malabsorption
Aphthous mouth ulcers
Lack of appetite
Abdominal distention 
Failure to thrive
328
Q

What drug does peptic stricture respond to?

A

PPI’s

329
Q

What are the two most commonest causes of acute pancreatitis?

A

Excessive alcohol consumption

Gall stones

330
Q

What are the signs for severe acute pancreatitis?

A 
Hypotension,
Pyrexia, 
Tachypnoe
Acute ascites
Pleural effusions, 
Cullen's sign and Grey Turner's sign
331
Q

In what group of patients do you see barrets oesophagus?

A

Obese middle aged men

332
Q

What can appendicites be confused with?

A

ilietis
Meckels diverticulum
Lymphadenitis

333
Q

What 3 viral infections can cause acute pancreatitis?

A

Coxsackie B, hepatitis and mumps

334
Q

What are the two groups of chronic pancreatitis?

A

Large duct and smal duct pancreatitis

335
Q

Who gets large and small duct pancreatitis and what is the features?

A

Large= Men usually get it. It is dilation and dysfunction of the large ducts and diffuse calcification. On imaging it’s easily seen

Small duct= mainly females, less diffuse calcification and looks normal on imaging

336
Q

What are the two important life style changes for treatment of pancreatitis?

A

Stop alcohol

Stop smocking= worsen the prognosis

337
Q

What is the common surgical treatment of pancreatitis?

A

ERCP

338
Q

what position elevies the pain of acute pancreatitis?

A

Fetal position= bending over and curling up

Y3 CORE CONDITIONS (15 decks)

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