GI SYSTEM Flashcards
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) 1 in 5 weekly
What causes it GORD and what is the common symptom?
inappropriate relaxation of the lower oesophageal sphincter so stomach acid can travel up
Heart burn is the common symptom
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
d) cilia secrete mucus buffer for rising acid
What condition is characterised by heartburn and regurgitation that is worse when lying down and when drinking hot liquids or alcohol?
GORD
Name 4 lifestyle-related risk factors for GORD
smoking large meals (fast food)/coffee, chocolate obesity alcohol stress
which drugs can aggravate GORD?
antimuscarinics
Ca channel blockers
Nitrates
NSAIDs
what autoimmune condition can predispose to GORD?
Systematic sclerosis
Name 2 physiological risk factors for GORD
pregnancy
hiatus hernia
What is the difference between a sliding and rolling(para-o) hiatus hernia?
Which is more common?
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)
What common procedure would you use to diagnose GORD?
endoscopy
What 3 drugs might you give to treat GORD?
antacids
H2 receptor antagonists
PPIs
What complication of GORD results in intermittent dysphasia of solids?
Peptic stricture
What histological changes occur in Barrett’s oesophagus
Stratisfied squamous epithelium replaced by simple columnar epithelium that contains goblet cells (similar to lower GI tract)
What malignant neoplastic condition is associated with Barrett’s oesophagus?
adenocarcinoma of the esophageal
What condition often predisposes to Barrett’s oesophagus?
Hiatus hernia
Which type of peptic ulcer is most common?
a) duodenal
b) gastric
a) duodenal
what is the main cause of peptic ulcers in the developing world?
h pylori infection
how does h pylori damage gastric mucosa cells?
adheres to the mucosa cells and releases enzymes and apoptosis= binding to class 2 molecules
what drugs can cause peptic ulcers? Common in developed worl
NSAIDs (COX inhibitors)
What is Zolinger-Ellison syndrome?
Gastrin secreting tumour that causes recurrent peptic ulcer in distal duodenum and proximal jejunum
name three symptoms you could get with peptic ulcers
recurrent epigastric burning pain
nausea
anorexia
weight loss
What are the risk factors for peptic ulcers?
Nsaids overuse FHx H.pylori Zolinger-Ellisons syndrome alcohol smoking
What is the treatment for peptic ulcers
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
What is the invasive and non invasive test used to diagnose peptic ulcers?
Invasive =endoscopy &; biopsy Non invasive= Urea breath test = h..pylori serology= IgG antibodies Stool sample = H.pylori monoclonal antibodies
What two complications of peptic ulcers result in bleeding?
haemorrhage
perforation
Which type of peptic uilcer is more likely to perforate?
duodenal
Which complication of peptic ulcers results in projectile vomiting and metabolic alkalosis
gastric outlet obstruction
how is gastric outlet obstruction treated?
IV fluid
electrolytes
What is the most common type of hernia?
Inguinal (70% indirect and 30% direct)
Who most commonly gets
a) direct inguinal hernia
b) indirect inguinal hernia
a) Direct commonly men over 40
b) Can affect any age but usually the young
On what side of the body are inguinal hernias most common?
right
Which type of inguinal hernia involves displacement of the hernial pouch through the deep inguinal ring?
indirect
Through where does the hernial pouch displace in a direct inguinal hernia?
Through a weakening in the floor of the inguinal canal ( fascia in the inguinal triangle)
Name 3 movements which will cause pain in an inguinal hernia?
coughing
exercise
pooing
how can you tell if the bowel has moved into the scrotum with an inguinal hernia?
if the skin above can’t be grasped
how are inguinal hernias treated surgically
laparoscopic repair
what condition are truss/supportive pants used as part of management of?
inguinal hernia
name a complication of inguinal hernias
Strangulation Bladder injury Recurrence Intestinal injury Hydrocele
name 3 risk factors of inguinal hernias
smoking
COPD
obesity
pregnancy
name two surgical procedures/interventions that can predispose to inguinal hernias
peritoneal dialysis
appendectomy
are femoral hernias common or rare in terms of other hernias?
rare (3%)
which gender do femoral hernias more commonly affect?
women
where do femoral hernias occur?
femoral canal
describe the difference between reducible and irreducible femoral hernias
reducible can push back through
irreducible can’t and ++painful
what is an obstructed femoral hernia?
twists with intestine
what is the name for the the femoral hernia emergency that blocks the intestinal blood supply and causes necrosis?
strangulated
on palpation what could be felt when feeling for a femoral hernia?
lump or bulge on groin below inguinal ligament
how does one repair a femoral hernia?
surgical repair
How common are gallstones in the UK?
a) 1 in 10
b) 1 in 50
c) 1 in 500
d) 1 in 1000
a) 1 in 10
What are the five F’s of who gets gallstones?
fat, forty, female, fair, fertile
what substance makes up 80% of all gallstones?
cholesterol
what causes cholesterol gallstones to form?
supersaturation from excess HMG-CoA causes stones to crystallise in bladder
name 2 substances that make pigmented gallstones
calcium, billirubinate
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
b) coeliac disease
what would brown gallstones indicate?
biliary stasis or infection
name five risk factors for high cholesterol
age female obesity familial high fat, low fibre diet diabetes COCP ileal disease Liver cirrhosis
What causes the pain in biliary colic?
Temporary blockage of the cystic duct by the gall stones causing intense abdominal pain
what kind of pain is often related to over indulgence in fatty food or alcohol?
biliary colic
where is pain referred to in biliary colic? How long does it last for?
epigastrium > right shoulder and scapula and it last for 1-4 hours
What is Charcot’s triad used to diagnose?
acute cholecystitis
What are the three factors in Charcot’s triad of acute cholecystitis?
jaundice, RUQ pain, fever (w, rigours)
What diagnosing testing is done for confirmation of acute cholecystitis (medical emergency)?
Abdominal Us, bloods including WCC, CRP and serum amylase
what would you expect to be high in blood test for acute cholecystitis?
WCC, CRP, Serum amylase, ALP, bilirubin
What is the name for surgical removal of the gallbladder?
cholecystectomy
How much is the patient allowed to eat during treatment for acute cholecystitis?
nil by mouth
What is the treatment for for acute cholecystitis?
IV fluids
Analgesia
IVcephs, fluoroquins ; tazobactam
what surgical procedure must be performed urgently in the case of acute cholangitis?
endoscopic common bile duct clearance
ERSP
what causes acute cholecystitis?
gallstone obstruction > increased secretion > distension > inflammatory response
name 3 severe complications of gallstones
pus empyema gangrene perforation peritonitis pancreatitis
what timescale defines acute hepatitis?
less than 6 months
where is hepatitis more prevalent?
africa & middle east
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
c) children and young adults
what two public health factors increase the risk of hepatitis infection?
overcrowding
poor sanitation
what damage does the hepatitis virus do to the liver?
degeneration of hepatocytes
necrosis & death
Which is the most infective form of hepatitis?
A
How is hepatitis A spread?
faecal-oral
contaminated food/water
How is hepatitis B spread?
vertical ( mother to child or child to child)
or intimate contact (needles, sex, cuts)
How does hepatitis B stimulate liver damage?
immune response
how is hepatitis C spread?
blood transmission
IVDU uses
how is hepatitis E spread?
enterally - contaminated water, animals, travel
what infection does EBV cause?
infectious mononucleosis
what infection does CMV cause?
glandular fever-like
Name 2 sections of the population most at risk from herpes simplex
immunocompromised
pregnant
How is hepatitis transmitted in yellow fever?
mosquito aegypti
what particular serious feature does yellow fever elicit in the liver
necrosis
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) paul bunnel test
+ve in EBV, -ve in toxoplasmosis
Which of these blood tests would not be raised in acute hepatitis?
a) AST/ALT
b) ESR
c) haemoglobin
d) urobilinogen
c) haemoglobin
Which antibody would indicate
a) previous infection/carrier with hepatitis
b) acute infection with hep
a) IgG
b) IgM
What is the initial symptom of hep A/B and how long does it take to resolve overall?
Nausea and anorexia with jaundice development
3-6 weeks
With which variant of hepatitis would you be most likely to be asymptomatic?
Hepatitis C
which organs may be enlarged with hepatitis A/B?
liver
spleen
what would happen to the skin,lymph, urine and stools in hepatitis A and B infection?
jaundice = gets darker as the disease progresses
dark urine
pale stools
lymphadenopathy
what syndrome distinguishes hep A and B?
immunological syndrome - rash, fever, polyarthritis and rarely glomerulonephritis
name 4 conditions is hep C associated with?
diabetes
lichen planes
non hodgkin’s lymphoma
Sjogren’s syndrome
consumption of what is stopped in the first few weeks of hepatitis treatment?
alcohol
What are symptoms of Hep C?
Flu
Jaundice
Abdominal
what antivirals could you give for variants of hepatitis such as EBV, CMV, herpes simplex?
acyclovir, ganciclovir
what could you give in the case of hepatitis C to prevent chronic infection?
interferon
what are the common complications of acute hepatitis B and C?
chronic hepatitis
cirrhosis
carcinoma
Is an acute GI bleed more like to affect older or younger people?
older
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
b) 125 per 100,000
name 4 risk factors for acute GI bleed
Alcohol abuse. Chronic renal failure. Non-steroidal anti-inflammatory drug (NSAID) use. Age. mallory-weiss tears
which one of these are the clinical feature of an acute upper GI bleed?
haematemesis
melaemia
dark blood and clots in stool
Indication of shock
name 5 physiological causes of acute GI bleed
peptic ulcer burst mallory-weiss tear oesophago-gastric varices Malignancy= gastric carcinoma Oesophagitis
name 2 iatrogenic causes of acute GI bleed
drugs - aspirin, NSAIDs, corticosteroids
alcohol intake
what kind of infection could cause an acute GI bleed?
viral haemorrhagic
what is a mallory-weiss tear?
mucosa tear from sudden increase of pressure due to retching , excessive vomiting
what kind of acute GI bleed would these features predispose towards? diverticular disease ischaemic colitis anal fissures haemorrhoids
lower
what risk assessment is used to re-assess for rebleeding and mortality in acute GI bleed?
Explain the criteria
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
what endoscopic treatment is available for acute GI bleed?
bands or stents
when would it be necessary to give a blood transfusion in the case of acute GI bleed?
Hb= <100
sepsis
Who does appendicitis affect?
a) elderly
b) children
c) all age groups
d) infants
c) all age groups
what is the common cause of appendicitis?
lumen of appendix obstructed w faecolith
describe the pain pattern of appendicitis
abdo pain starting in umbilicus and moving to right iliac fossa (McBurney’s point)
what signs would be elicited during abdo palpation in appendicitis?
Tenderness, gaurding and rebound at the McBurney’s point
name 3 symptoms of appendicitis
pain nausea vomiting anorexia (diarrhoea)
what imaging procedures might you use to diagnose appendicitis?
ultrasound
CT
name 2 differential diagnoses for appendicitis
crohn's Gastroenteritis Pelvic inflammatory disease Colitis Kidney stones Cystitis (UTI) IBS Constipation
describe the urgent treatment required for appendicitis
laparoscopic removal/surgery
what conservative management would be suggested for appendicitis?
iv fluids, abx
name 2 complications of appendicitis
abscess
peritonitis
gangrene
Complete this pneumonic for causes of small and large bowel obstructions:
If People Could Fly, Heaven’s A Nice View
iscaemic strictures pseudo-obstruction crohn's foreign body hernia atresia neoplasm volvulus
name a specific cause of small bowel obstruction
superior mesenteric artery syndrome (SMA/AA compress duodenum)
name 4 specific causes of large bowel obstruction
diverticulitis/diverticulosis
IBD
fecal compaction
narcotics
name 3 general symptoms of bowel obstruction
abdo pain/ distension
constipation
vomiting/ fecal vomiting
how do you distinguish between small bowel obstruction pain and large bowel obstruction pain?
SMALL - colicky, intermittent w vomiting
LARGE - lower, last longer
less vomiting
give an example for the following causes of gastric outlet (anorectal) obstruction
1) functional
2) mechanical
3) force vector
4) impaired sensitivity
1) sphincter/pelvic floor issues
2) enterocoele
3) prolapse
4) megacolon
how do you treat emergency bowel obstruction
surgical stents or obstruction removal
why would you consider giving an NG tube for small bowel obstruction?
resolve dehydration
surgical removal
what surgical treatment might you give for infantile bowel obstruction or congenital bowel abnormalities
temporary stoma
name 4 bowel complications that could occur following/during bowel obstruction
bowel perforation and ischaemia
electrolyte imbalance
dehydration
Respiratory complications such as aspiration
how many times a year could developing world children expect to get infective gastroenteritis?
3-6
what group of people are also prone to getting infective gastroenteritis
Travellers
Elderly
The young n
Homosexual men
what type of diarrhoea are clostridium perfringens , clostridium difficile and vibrio cholerae likely to cause?
watery diarrhoea
what type of diarrhoea is toxigenic e. coli likely to cause?
watery travellers diarrhoea
what time of diarrhoea are salmonella and campylobacter jejuni likely to cause?
watery diarrhoea
As well as water diarrhoea what other symptom do you get with s.aureus and bacillus cereues?
Severe vomiting
what type of diarrhoea is caused by bacterial enterotoxins or adherence?
watery diarrhoea
what type of diarrhoea is caused by mucosal invasion or cytotoxic damage of bacteria?
dysentery= inection of the intestives causing diarrohea with blood or mucus
name three organisms that cause dysentery in travellers
shigella= most common in UK
salmonella (food poisoning)
campylobacter (food poisoning)
what type of diarrhoea is caused by invasive/haemorrhagic e coli?
dysentery
what type of diarrhoea is caused by yersonia, vibrio parahaemolyticus and c. difficile?
dysentery
name 2 complications of infective gastroenteritis
AKI
perforation
septicaemia
what antibiotic treatment would you recommend for gastroenteritis caused by salmonella shigella and cholera?
ciprofloxacin
what antibiotic would you recommend for gastroenteritis caused by campylobacter
azithromycin
what antibiotic would you recommend for gastroenteritis caused by invasive e coli
amoxicillin
what antibiotic would you recommend for treatment of clostridium?
met/vanc
name an antidiarrhoeal
loperamide
what kind of drug is metoclopramide?
anti-emetic
name 2 common causes of Crohn’s and Ulcerative Colitis
genetic mutations
impaired mucus barrier function
defective intestinal defensins
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) e coli
d) m paratuberculosis
f) bacteria dysbiosis
which is more common - Crohn’s or Ulcerative Colitis?
Ulcerative Colitis
Which inflammatory bowel disease affects just the colon to rectum as opposed to the whole bowel?
Ulcerative Colitis
Which inflammatory bowel disease is transmural as opposed to affecting just mucosal-depth?
Crohn’s
which inflammatory bowel disease would be described as having a cobblestone appearance?
Crohn’s
which inflammatory bowel disease would be described as having polyps and crypt abscesses?
ulcerative colitis
which inflammatory bowel disease results in goblet cell depletion?
ulcerative colitis
which inflammatory bowel disease is characterised by skip lesions?
Crohn’s
which inflammatory bowel disease is characterised by langerhans granulomas
Crohn’s
how would you differentiate between blood and mucus from UC and Crohn’s
UC - urgent w blood &mucus &; tenesmus
Crohn’s - diarrhoea w weight loss
with which inflammatory bowel disease are you likely to get aphthous mouth ulcers?
ulcerative colitis
What is a severe complication of ulcerative colitis
colon is grossly dilated and gas filled w mucosal islands
what complication is a huge risk of toxic megacolon?
perforation
If a blood test showed raised ESR, CRP with anaemia and hypoalbuminaemia, what condition could this indicate?
inflammatory bowel disease
what would a sigmoidoscopy NOT show in ulcerative colitis?
a) inflammation
b) redness
c) clots
d) bleeding
c) clots
which inflammatory bowel disease is perinuclear anti-neutrophil cytoplasmic antibody (pANCA) present in?
ulcerative colitis
what organism is it important to exclude in stool tests for inflammatory bowel disease?
c diff
in the management of Crohn’s disease, what drugs would be given to induce remission
glucocorticosteroids
anti-TNF antibodies
For which stage of treatment of Crohn’s disease would azathioprine and methotrexate be given alongside anti-TNF antibodies?
maintenance of remission
What additional drug is added to the maintenance of remission programme for crown’s disease if it treating the perianal area?
ciprofloxacin and metronidazole
what percentage of Crohn’s sufferers require surgical intervention?
a) 10%
b) 2%
c) 80%
d) 50%
c) 80%
what two surgical procedures could be performed for inflammatory bowel disease?
resection
ileostomy/colostomy bag
which type of inflammatory bowel disease would you give aminosalicylates (5-ASA) for?
ulcerative colitis
suggest an immunosuppressant you could give in serious cases of ulcerative colitis
IV infliximab or oral ciclosporin
suggest an immunosuppressant to use for long term maintenance therapy of ulcerative colitis
azathioprine
which part of the bowel wall does microscopic colitis affect?
lamina propria
what occurs to the collagenous layer in in collagenous colitis?
thickens
with what group of conditions in collagenous colitis associated with?
autoimmune
what bowel disease is characterised by an inappropriate immune reaction to microbes or substances in the lumen?
IBD
what immune cells induce inflammation and tissue damage in inflammatory bowel disease?
toll-like receptors
what is the difference between type 1 and type 2 inflammatory bowel disease attacks?
type 1 - acute self limiting
type 2 - long term
What is the complications of
a) Chron’s
b) Ulcerative colitis
a) Obstruction, abscesses, fistulae and slight increase in risk of colon cancer
b) Haemorrhage, toxic mega-colon and marked increase risk of colon cancer
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
c) 1 in 5
which gender is more likely to be affected by irritable bowel syndrome?
female
Name 3 mental disorders can be risk factors and triggers for irritable bowel syndrome?
stress
affective disorders
abuse
eating disorders
what criteria is used to assess the change in stool frequency and form in irritable bowel disease? Gold standard diagnosis
rome 3 criteria
what 2 sexual/genital problems can arise with IBS?
dysmenorrhoea
dyspareunia
name 3 urinary symptoms that can arise with IBS
frequency
urgency
nocturne
incomplete emptying
name 2 lifestyle symptoms that can arise with IBS
fatigue
poor sleep
headaches
name 2 complications associated with IBS
chronic fatigue
fibromyalgia (chronic pain)
what section of the population does pancreatitis commonly affect?
middle aged, elderly men
where is pain characteristically present and referred to in pancreatitis?
sudden severe dull epigastric pain that radiates to the back or below the left scapula
name 2 symptoms of acute pancreatits
pain
nausea
vomiting
what is cullen’s sign?
umbilical bruising
what is grey-turner’s sign?
flank bruising
what do cullen’s and grey-turner’s signs indicate?
necrotising pancreatitis
name 2 signs that would be present on abdo exam of a patient with acue pancreatitis
guarding
tenderness
absence of bowel sounds
what is the I GET SMASHED pneumonic for causes of acute pancreatitis?
What is the most common 4?
I- Idiopathic * G - gallstones* E - ethanol* T - trauma* S - steroids M - mumps A - autoimmune S - scorpion bited H - hyperlipidaemia E - ERCP D - diabetes, drugs
which of these drugs is NOT a risk factor for acute pancreatitis?
a) DMARDs
b) NSAIDs
c) methotrexate
b) NSAIDs
What is the two most common causes of periductal necrosis of the pancreas
Alcohol consumption
Gall bladder disease = blocking the bile duct and causing back preasure in the main pancreatic duct
what does the trapping of digestive enzymes in the pancreas result in (in terms of cellular pathogenesis)
cellular necrosis
name 6 differential diagnoses for acute pancreatitis
Renal failure. Ectopic pregnancy. Diabetic ketoacidosis. Perforated duodenal ulcer. Small bowel perforation/obstruction. Ruptured or dissecting aortic aneurysm.
what enzyme would be increased in blood tests to diagnose pancreatitis?
amylase= can also be indicative of pertionitis, infarction or perforation Lypase= more specific
what radiological tests would you want to perform on a patient with suspected acute pancreatitis?
ultrasound (gallstones)
chest x-ray (perforation)
CT (essential)
MRI (assess damage)
what 3 diagnostic scores are available for assessment of acute pancreatitis?
Ranson criteria >3 severe
Glasgow prognostic score >3 severe
APACHE score
what analgesia would you suggest for a patient with acute pancreatitis?
tramadol &; other opiates
Not morphine due to its s/e on the sphincter of oddi
would you recommend an NG tube in a patient with pancreatitis and why?
YES
- aspiration to avoid abdo distension & asp pneumonia
- NG feeding
name two systemic complications of acute pancreatitis
systemic inflammatory response syndrome
multiple organ dysfunction
disseminated intravascular coagulopathy
name 2 pancreatic complications of acute pancreatitis
abscess
necrosis
empyema
name 2 lung complications of acute pancreatitis
pleural effusion
pneumonia
Acute respiratory distress syndrome
Atelectasis
name a kidney complication of acute pancreatitis
AKI
name 3 GI/liver complications of acute pancreatitis
bleeding paralytic iliac jaundice CBD obstruction portal vein thrombosis
name 2 metabolic complications of acute pancreatitis
hypoglycaemia
hyperglycaemia
hypercalcaemia
what is the major cause of chronic pancreatitis?
alcohol
name 2 other causes of chronic pancreatitis
metabolic hereditary autoimmune recurrent acute obstruction
how does trypsin play a role in the pathogenesis of chronic pancreatitis?
increase in trypsin causes plugs which cause calcification and blockage of pancreas
how does alcohol interfere with trypsin in chronic pancreatitis?
impairs calcium regulation and promotes trypsinogen
suggest a drug for each of these types of pain management for chronic pancreatitis
a) tricyclic antidepressant
b) neuropathic pain relief
c) NSAID
a) amitryptilline
b) pregabilin
c) naproxen/ibuprofen
what drug might you recommend for autoimmune chronic pancreatitis?
steroids
name 2 complications of chronic pancreatitis
diabetes
ascites
pancreatic cancer
pseudocyst/cyst
suggest a carcinoma characterised by dysphagia, pain when swallowing, hoarse voice and haemoptysis?
oesophageal carcinoma
what type of oesophageal cancer is most common in the developing world?
squamous cell (epithelia)
what type of oesophageal cancer is most common in the developed world
adenocarcinoma (glands)
where in the oesophagus does adenocarcinoma develop?
lower 1/3
name risk factors for
a) squamous cell esophageal cancer
b) esophageal adenocarcinoma
a) tobacco, alcohol, poor diet (red meat), hot drinks
b) obesity, smoking and acid reflux
is prognosis for oesophageal carcinoma good or bad?
poor because of late diagnosis
13-18% survival after 5 years
What is the symptoms of gastric carcinoma?
Heartburn/ upper abdo pain nausea &; vomiting appetite loss and weight loss Jaundice, Dysphagia, Melena
what is the main cause of gastric carcinoma?
h pylori
name 2 other risk factors/causes of gastric carcinoma
pickled veg and smocked meat smoking familial age >55 Male Pernicious anaemia and peptic ulcer disease
how is prognosis for gastric cancer?
poor
what is the most common type of pancreatic cancer?
adenocarcinoma
name 4 risk factors for development of pancreatic cancer
smoking obesity diabetes, chronic pancreatitis, H.pylori infection/ stomach ulcers genetics red meat consumption
which rank is pancreatic cancer in terms of cause of death in the UK?
a) 1st
b) 5th
c) 50th
d) 20th
b) 5th
25% survival rate after a year
5% after 5 years
name 2 main causes of cirrhosis
alcohol
hepatitis (a & b)
20% of Hep C cause cirrhosis
name 3 fat/diet related causes of cirrhosis
obesity
hyperlipidaemia
hypertension
diabetes
name an iron disorder that can cause cirrhosis
haemochromatosis
name 2 gallstone disorders that can cause cirrhosis
billiary cirrhosis
gallstones
how is autoimmune hepatitis cirrhosis treated?
steroids
name 3 complications of cirrhosis
infective ascites liver failure hepatic encephalopathy bleeding liver cancer
why can ascites cause shortness of breath?
restriction of diaphragm
what sign would you elicit in an abdominal exam for ascites?
shifting dullness and fluid thrill
name 3 symptoms possible with ascites due to portal hypertension
leg swelling bruising gynaecomastia haematemesis encephalopathy
how much fluid must accumulate in peritoneal cavity to be closed as ascites?
more than 1500ml
which of these doesn’t cause ascites?
a) budd-chiari syndrome
b) kwashiorkor
c) crohn’s disease
d) constrictive pericarditis
c) crohn’s disease
which of these doesn’t cause ascites?
a) cirrhosis
b) metastatic cancer
c) liver disease
d) heart failure
e) pancreatitis
f) renal failure
f) renal failure
what is marasmus?
lack of protein and calories leading to malnutrition
what is kwashiorkor?
lack of protein
if a patient presents with rigidity, guarding, rebound tenderness, peritonitis and sudden severe abdo pain, what might you suspect?
perforated viscus
give 2 examples of a perforated viscus
peptic ulcer
bowel
appendix
penetrating trauma
which one of these best describes SIRS?
a) toxic, hypotensive, tachypnoea/cardic, febrile
b) hypertensive, bradypnoea/cardia, febrile
A
what kind of disorder is coeliac disease?
autoimmune
what mouth symptom does coeliac disease share with ulcerative colitis?
apthous ulcers
what occurs to the intestines during coeliac disease?
villous atrophy
what blood disorder do patients with coeliac disease often suffer from?
anaemia
name 2 risk factors for coeliac disease
genetics
other autoimmune diseases e.g. DMT1, thyroiditis
what is a complication of coeliac disease?
may increase risk of intestinal cancer
Is gastric ulcer or duodenal ulcer symptoms better once the patient eats food?
Duodenal ulcer
Which type of inguinal hernia enters the scrotum and what is the consequence?
Indirect inguinal hernia
Can cause pain by having dragging sensation
Lying down relieves the symptoms of which hernia?
Direct inguinal hernia
Which inguinal hernia can be manually reduced?
Indirect inguinal hernia
What congenital abnormality causes indirect inguinal hernia?
Congenital absence of the closure of the processes vaginalis
What ethnicity has a protective factor to gall stones?
Asians/Africans
What are the symptoms of cholelithiasis?
Asymptomatic as the gall stones are in the gall bladder
What is cholecystitis?
It is prolonged obstruction of the cystic duct leading to inflammation of the gall bladder
What are the initial symptoms of Choledocholithiasis?
Usually asymptomatic with abnormal liver enzyme production
What are the two serious complications of Choledocholithiasis?
Cholangitis and acute pancreatitis
What is the treatment for Choledocholithiasis?
ERCP +/- Cholecystectomy
What is the cause of cholangitis?
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
What additional symptoms as well as the charcots triad do you get in acute cholangitis?
Reynolds Pentad which is mental state change and sepsis
What systemic involvements are their in cholecystitis?
Increase in heart rate but decrease in BP Increase WCC Increase CRP Increase bilirubin Increase ALP
Is their systemic involvement in biliary colic?
No
What would be indicate a obstructive jaundice in a blood test?
Raised biliruibin
What sign is elicited in acute cholecystitis
Murphys sign
What occurs in positive Murphy’s sign?
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
What bacteria commonly cause cholangitis?
Gram +/- and anearobes
Such as E.coli, enterococcus, bactericides
What is spectrum of gall stones?
Cholithiasis –> biliary colic –> acute cholecystitis –> Choledocholithiasis –>cholangitis
What is the most common type of viral hepatitis?
Hep c
What needs to be present for a hep D infection to occur?
The patient needs to have hep B virus first to survive in the body
What are non virus causes of hepatitis?
Excess alcohol and autoimmune
What are the symptoms of alcohol causing hepatitis?
Usually asymptomatic but can get sudden jaundice and liver failure
If acute pancreatitis is caused by
a) gall stones
b) alcohol
what is the presentation?
a) Immediately after eating large meal
b) 6-12 hours after drinking alcohol
What further inflammatory manifestations can occur as a complication of acute hepatitis?
Myocarditis
Vasculitis
Arthritis
What renal complication can arise from acute hepatitis?
AKI
What can exacerbate pain caused by acute pancreatitis?
Lying down
Drinking and eating ( especially fatty food)
What antibody is related to chronic pancreatitis?
IgG4
What is a diverticulum?
It is a abnormal sac or pouch at a weakening of the intestines
What is Merckel’s diverticulum?
It is present at birth
Most common cause of infective gastroenteritis?
Norovirus
Most common cause of infective gastroenteritis in children?
Rotavirus
What are the three Abx given for appendicitis?
Amoxicillin
Metronidazole
Gentamicin
What iso Rovsing sign for appendicitis?
You put pressure on the left iliac fossa but get pain on the right illiac fossa
`What is paralytic ileus?
The bowel ceases to function and no peristalsis
Is their a physical obstruction in paralytic ileus?
No physical obstruction but malfunction in the nerves and the muscles in the intestines which impairs digestive movement
What are the symptoms of paralytic ileus?
No pain or bowel sounds
What are the causes of paralytic ileus?
Electrolyte imbalance
Gastroenteritis
Pancreatitis
Appendicitis
What are the risk factors of IBS?
Female
Life events
Low fibre diet
Stress/ anxiety
What is the cardinal sign of IBS?
Abdominal pain
What is the 1st line treatment of IBS?
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
What is the second line treatment for IBS?
TCA such as amitriptyline
Or
SSRIs
Which IBD is caused by smoking?
Chrons disease
Smoking has protective effect of UC as it reduces inflammation
What are the risk factors of developing IBD?
FHx NSAIDS use High sugar and fat intake Chronic stress and depression Obesity Absence of breast feeding
What group of people are prone to IBD?
White caucasian and young (<30)
Jewish are also have high risk
What is the main symptom of Chron’s disease?
Abdominal pain with cramps which get worse after eating
Unintentional weight loss
Extreme fatigue
How do you diagnose Chron’s disease?
Bloods
Stool sample
Colonoscopy
Small bowel enema
What are the risk of ileostomy used for IBD?
Dehydration
Mechanical problems
Pyschosexual problems
What specific surgical operation is done for ulcerative colitis?
Ileo-anal pouch
What is a risk factor specifically for oesophageal adenocarcinoma?
Acid reflux–> increase the development of Barrets oesophagus
Is obesity a risk factor for both types of oesophageal carcinoma?
No a increase risk only for ACC as increase risk of acid reflux and therefore Barrets oesophagus
What are the risk factors for gastric carcinoma?
Age >50
Male
Associated with socio-economic deprived areas
Diet with low veg and fruit but high salt and preservatives
What common metastasis of gastric carcinoma?
Liver, lung ,intestines, bones and lymph
What are the symptoms of colerectal cancer?
Anaemia Rectal bleeding Constant Change in bowel movements Weight loss fatigue Mass either in the left or right colon
Is left colon cancer or right colon cancer at a greater advance stage when symptoms are present?
Right is at a more advanced stage when symptoms are present
What are the risk factors for colorectal cancer?
Age DM Sedentary life style Obesity DM High alcohol intake Smoking FHx Hereditary Non Polyps Colerectal Cancer IBD Radiation exposure and occupation risk (asbestos)
What 3 drugs reduce the risk of colerectal cancer?
Vitamin supplements containing folic acid and calcium, Aspirin and NSAIDS
Deficiency in what mineral is common in cirrhosis?
Zinc
What are the symptoms of liver cirrhosis?
Itching Jaundice Ascites Easy bruising Duptreyns contractor Spider nevi Peripheral oedema and pleural effusion Fatigue
What are Esophageal varices and what causes it?
Dilation of veins in the oesophagus caused by portal hypertension due to cirrhosis
What is Budd Chiari syndrome ?
Blockade of the drainage of portal vein causing triad of Abdo pain Ascites Hepatomegaly leading to cirrhosis
What is the treatment for ascites?
Diuretics and paracentesis
What is the complication of ascites?
Bacterial peritonitis
Hepatorenal syndrome
thrombosis
What is hepatorenal syndrome?
Rapid deterioration of kidney with patients with liver cirrhosis
What is malnutrition?
Nutritional level is too low or too high
What are cause of malnutrition?
Infectious disease Malignancy Obesity Anorexia lack of breast feeding bariatric surgery
Starvation is a complication of malnutrition. What is the consequence of starvation?
Short stature Thin body Fatigue Swallowen legs and abdomen Frequent infections
What is a complication of perforated viscus?
SIRS
What are the DD of perforated viscus?
AAA
Aortic dissection
Mesenteric ischaemia
What are the symptoms of coeliac disease
Chronic diarrhoea Malabsorption Aphthous mouth ulcers Lack of appetite Abdominal distention Failure to thrive
What drug does peptic stricture respond to?
PPI’s
What are the two most commonest causes of acute pancreatitis?
Excessive alcohol consumption
Gall stones
What are the signs for severe acute pancreatitis?
Hypotension, Pyrexia, Tachypnoe Acute ascites Pleural effusions, Cullen's sign and Grey Turner's sign
In what group of patients do you see barrets oesophagus?
Obese middle aged men
What can appendicites be confused with?
ilietis
Meckels diverticulum
Lymphadenitis
What 3 viral infections can cause acute pancreatitis?
Coxsackie B, hepatitis and mumps
What are the two groups of chronic pancreatitis?
Large duct and smal duct pancreatitis
Who gets large and small duct pancreatitis and what is the features?
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
What are the two important life style changes for treatment of pancreatitis?
Stop alcohol
Stop smocking= worsen the prognosis
What is the common surgical treatment of pancreatitis?
ERCP
what position elevies the pain of acute pancreatitis?
Fetal position= bending over and curling up
