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EXAM 2021 > GIT > Flashcards

GIT Flashcards

1
Q

appendicitis

A

RF younger
Sx anorexia, fever, rif pain
OE rosvig pos, psoas and obturator, mcburny point tenderness.
Ix: USS,
Dx: clinica/imaging
Rx: OT.

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2
Q

ascending cholangitis - biliary tree bact infection secondary to statis of some form.

A

RF: >50, stones, primary/secondary cclorosing cholangitis, stricture of biliary tree. injury to bile duct (OT)
** Sx/OE: fever, ruq pain, jaundice.
Ix inflam markers, elevated bili/GGT/ALP; uSS/CT to identify cause of obstruction
Dx Sx and evidenc einflam (imaging/bloods)
Rx urgent OT, ERCP. amp/gent/met

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3
Q

cholecystitis

A

RF aging, FHx same, obesity, sudden weight changes, DM , pregnancy, ocp.
Sx severe RUQ pain, radiatse to back/shoudler, n/v/fever. often w colic sx
** OE (differentiates from colic), local peritonism. murphy pos. fever
Ix: USS, CBD > 6mm wall.. ECG/amylase.CXR for ddx, LFT but non specific.
Dx uss
Rx admit, lap chole, abx.

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4
Q

diveritculitis

A

RF age, smoking, obesity, low fibre diet
Sx LLQ pain, change in bowel habit, previous hx of same, n/v/fever/pr bleeding
OE usually LLQ tender, clinical sx cosntipation
Ix CT A/P w contrast
Dx CT/hx.
Rx :
- mild: tol PO intake and no comrobidity: bowel rest, simple anagliesa, low fibre diet 2-3 days.
- > 48 hours ongoing/worsenning/red sided Sx or immunosup: Aug DF BD 5 days, if severe then hospital iv gent/met/amp.

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5
Q

food intol: non immune mediated. ?sensitised nerve fibres.

A

RF: BS, hedaches…
Sx: any age, hours - days. variable reaction.
- bowel irritation, headaches, fatigue, mouth ulcers, sinus cnogestion, hives/swelling, sometimes eczema/rash
- often dose dependent…
- commonly: MSG, food additives, cereals, dairy.
Ix: elimination diet. no specific testing required.
Dx: clinical
Rx: dietary modification.

DDx oral allergy syndrome (raw fruit/veg w perioral sx/rhinitis), coeliac, tick bite (mammalian meat allergy), exercise induced food dept. allergy.

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6
Q

food alergy : igE mediated

A

RF IBS
Sx: childhood onset. allergenic reaction immediately (mins - hours), reproducible.
- rash aroudn mouth, urticaria, angioedema, vomitting, sob, anaphlyxais (varies on scale)
- commonly eggs milk peanut tree nut sesame crustaceans, wheat. soy.
Ix: skin prict tests, IgE specific allergenic test (RAST)
Dx: hx/ix.
Rx
- complete avoidance.
- non treanut/seafood allery improve w age.
- anaphylaxis managment plan.
- loratiadine vs. nocte doxylamine.
- consider referral for desensitisation.

DDx coleaic, tick bite (mammalian meat allergy), exercise induced food dept. allergy.

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7
Q

food allergy: non Ige mediated/mixed food allergy

A

coeliac
eosinophillic oesophagitis
FPIES. (food protein induced enterocollitis syndrome)
- cows milk, fish, chikcen, rice) - recurrent vomitting 1-4 hours after eating.

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8
Q

intersusseption

  • invagination of bowel onto itself
  • sequalae BO, congestion of mesenteric vessels, ischaemia of bowel wall.
A

RF: 2 months - 2 yeras. recent intussusception, meckels diveritumul, HSP, lymphoma, recent rotavirus vaccine, recent bowel surgeyr,.
Sx: intermittent abdo pain/distress (increases 12-24 hours), well between episodes. palpable abdo mass. red current jelly stools.
OE: sausage shaped mass in R abdomen. shock, peritonitis if per, distended if obstructed.
Ix: USS, can do AXR is BO/perf. but not diagnostic.
Dx: USS/clasically sx/age
Rx: analgesia, fluid bolus, NGT if BO, IV amox/gent/met, Surg review w NBM (can self reduce)

DDx

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9
Q

ischaemic colitis
- chronic ischaemic ischaemia = low flow to artery in mesentry, mild to gangrenous colitis/acute.

A

RF: vasc RF. AF. age.
Sx: severe abdo pain, bloody diarrhoea, unwell. shock. RLQ usually.
OE: degree of illness out of proprtion to clinical signs.
Ix CT, colonoscopy /biopsy gold standard.
Dx colonoscopy urgent.

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10
Q

IBD extraarticualr

A

Ank Spond
uveitis
pyoderma gangrenosum
erythema nodosum
apthous ulcers
primary sclerosis cholangitis
vte

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11
Q

coelaic

A

Ix
- TTG, IgA level . +/- EMA
anti gliadin antibody is less specific.

Mx:

  • scope to confirm + repeat at 12 months post diagnosis
  • bloods repeat at 6-12 months post GF diet to see if resolved.
  • monitor b12/folate/TSH/vit D + BMD consideration.
  • screen family members
  • consider PTH/zinc.
  • DT

watch for lymphoma. adenocarcinoma. IBD, primary billiary cirrhosis, dermatitis herpetiformus.

join coeliac society.

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12
Q

IBS Dx/OE

A

cause not clear - visceral hypersensitivity/diet/gut micro/stress.
Ddx: functional; bact.overgrowth (if bloating/flat main issue)

Dx: abdo pain/discomfort > 3 / month, for 3 months, w > 2:

1) improvement w defecation
2) onset of Sx associated w change in bowel frequency
3) onset of Sx associated w change in stool appearance.

OE: not much to find - rule out ddx: coeliac (EMA/antiTTG)/ibd (calprotectin)/pancreatic insuf (fecal elastase)

  • often associated: migraines, dysmenorrhoea, FM, anxiety/dept/reflux/urinary frequ

no specific Ix for Dx.

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13
Q

IBS Mx

A

Mx:

  • non pharma:
  • reassure no long term sequalae, explain aeitology
  • often food intolerance related: exclusion diet, gradual reintroduce once found trigger. (DT)
  • stop smoking
  • weight reduction
  • optimise diet
  • reduce gums/fizzy drinks
  • reduce etOH
  • regular meals/sleephygiene

if diarrhoea PRN loperamide
if constipatino gentle fibre - metamucila good option, avoid bran.
if abdo pain; buscopan.
+/- SSRI.

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14
Q

Crohns (IBD)

A

PC: 20s usually.
mouth to anus, skip lesions. get fistulas/perianal disease.

Sx: abdo pain, diarrhoea, weight loss, mailaise, anorexia, obstructive/fistla/blood diarrhoea. nutritional def.
NOCTURNAL BO = IBD.

clue for Dx: pos faecal calprotectin. (elevated CRP, low labumin, iron def anaemia)

Dx : scopes

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15
Q

IBD Mx

A

RF for poor outcome:
- > 5kg weight loss, unable to manage ADLs, steroids at first presentation, not eating, longterm reliance on opioids for pain.

Mx:
- no cure, goal to treat active disease/improve wellbeing/maintain steroid free remission/prevent complications.
1) sulfasalazine, c/sterods for flare; with GE
metro for fistula flares.
2) regular review for sx severity/condition review
3) annual colonoscopic surveillance if high risk; otherwise 3-5 yearly.
4) DEXA
5) monitor bloods
6) PCV, HPV/HBV. avoid live if immunosuppressed.
7) 1-3 yearly CST if on immunomodulators.
8) quit smoking
9)psychological impact.

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16
Q

UC

A

PC: large intestine/retrograde from rectum. continuous.
commonly bloody diarrhoea.
- watch for toxic megacolon complication

Mx: as above, also consider surgical removal of large intestine if severe/refractory.
localised enemas w mesalazine/PR steroid etc. THEn PO

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17
Q

IBD e/articular Sx

A
  • large joint arthorpathy
  • ank spond
    uveitis
    iritis
    episcelritis
    conjunctivitis
    pyoderma gangrenosum (ulcer)
    erthema nodosum (painful)
    apthous ulcers
    primary sclerosing cholangitis
    VTE
    gallstones
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18
Q

lactase def

A

frothy, watery, explosive diarrhoea - soon after ingestion of lactose.

most commonly associated w acute GI post infection / loss of enzyme, can go on for 1-2 weeks.
- ddx: zollinger eliison syndrome/sensory loss w Dm arthroapthy, progressive diasabiltiy w CF, whipples, tropical sprue, HIV enetropathy, coealiac spru.

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19
Q

barrets

A

relative risk increased for adenocarinoma oesphagus
absolute risk < 2% life time risk.
RF: central obesity, smoking, fhx cancer, sex,a ge, hx GORD.
Dx: endsocopy - metaplasia from squamous to columnar

Mx:
endoscopy screening program. modify RF w lifestyle changes.
consider PPI - wont regress but helps symptomatically.

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20
Q

PPI SFX

A

long term:
micronutrient def - b12/folate
OP
infections such as GE
hypomagnesemia
alopecia
photosesitivity
impaired LFTs

21
Q

EoE

A

same as GORD; but intermittent bolus obstructions.
specific food trigger often.

RF male > female, atopic hx
Dx: endoscopic appearans/histo findings. peristent gastric eosinophillia after PPI trial (GORD will improve)

if severe: risk boerhaave syndrome.

Mx:
NON PHARMA
-dietary exclusion - consider allergy patch testing
-6 food elimination: milkd, wheat, egg, soy, nuts then reintroduce.
PHARMA
-topical fluticasone (swallow MDI rather than inhale, 2 puffs BD)
-SFX: candidiasis.
final: dilatataion

22
Q

GORD red flags

A

red flags

  • dyaphagia, odonyphagia
  • haematemeis
  • weight loss
  • > 55
  • iron def +/- anaemia
  • nocturnal abdo pain
  • persistent
  • FHx?Phx barrets/GI maliganncy
  • new or changing Sx, particularly in older person
  • inadequate reponse to PPI.
23
Q

GORD Ix + HPylori

A

only Ix if red flags/Sx refractory to Rx/diagnosis unclear.

1) endoscopy, 2/4 patients will have negative endoscopye.
2) consider HPylori - post Rx confirm if negative at 6 weeks.
- do for all < 55 yo. or if any RF: (lower SES, migrant/refugee, fhx PUD/gastric cancer)

Dx otherwise based on therapeutic trial of PPI 2weeks.
- if no red flags, and improved w PPI, then reduce to prn

24
Q

GORD Mx

A

Non pharma
- raise bed head, weight loss, smoking cessation, small/regular meals,. avoid acidic foods/hot drinks, avoid lying down after eating, fluid in between meals not prior, eat > 3 hours until bed.

Pharma
- cease nsaids/bisphosphonates, avoid drugs relaxing LOS: ccb/nitrates/cholinergics
- Rx Hpylori (calrithro/amoxyl/ppi), if pos (2 weeks better)
- PRN gastrogel 10-20mL/ H2 receptor antag ranitidine 150mg,
+ PPI 20 –> if insuff 20 BD –> 40 BD if ongoing but refer at this point.
- trial PPI for 4-8 weeks; then down titrate slowly then PRN only.

25
Q

alcoholic liver disease

A

stages:
1) alcoholic fatty liver- worry when AST/ALT > 1.5
2) alcoholic hepatitis - AST usually 3 x the ALT. /rapidly progressive sx inc. RUQ pain/jaundice/fever/neutrophillia
3) alcoholic liver cirrhosis.

OE:
plethroic face
thickenend greasy skin
macroglosia
telangiectasia
suffused conjunctivae
rosacea
parotid swelling
chleitis

Ix: bloods inc. caeroplasmins/viral heaptitis, cmv for alt cause.
USS +/- fibroscan

Mx:
stop etOH, prevent progression.
MDT: DT, GE, psychiatrists/psychologist
manage withdrawl: thiamine repacement/bzd.
stop smoking/manage obesity which is often associated
vaccinate Hep B + A, and PCV/influenza.

26
Q

CLD causes

A

etOH
fatty liver
autoimmune
chronic viral
primary biliary cirrhosis
haemachromatosis
drugs
cryptogenic (no cause)

OE:
alcoholic faceies
spider naevia, caput medusae
gynaecomastia
splenomegaly (portal HTN)
ascites
hepatomegaly (vs. small and nodular)
bruising, peripheral oedema/neuorpathy
atrophied testes/spare pubic hair.

27
Q

NASH

A

cause: insulin resistance, etOH, obesity.
+/- AN, rapid weight loss, lipodystrophy, drugs inc. oestrogens. c/steroid/mtx.

increases risk DM/metabolic syndrome/cvasc disease + some cancers, can cause cirrhosis –> HCC.

spectrum

1) simple steatosis.
2) steatohepatitis (NASH)
3) cirrhosis

more likely to have cirrhosis if:
AST/ALT > 1, ALT raised, old, serum albumin + platelets low, obesity, hyperglycaemia, DM, metabolic syndrome.

uss
consider fibroscan.
and use NAFL fibrosis score.

Mx: if LFTs OK and no evidence cirrhosis/portal HTN on uss –> 6 month aggresively lifestyl changes and if LFTs still off –> GE.

28
Q

metabolic syndrome

A

fasting TIG > 1.7 or on statin
fasting HDL <1
BP > 130/85 or on Rx
FBG: > 5.6mmol/L + T2DM

aim remember: male wcc < 94, female < 80.

29
Q

haematchromatosis

A

HFE gene testing.
- only C282Y homozygotes + sometimes heterozygotes, get clinically significantly overloaded

worry re: fibrosis, cirrhosis, hcc, cardiac arrithmia, cardiomyopathy, DM , arthropathy, skin hyperpigmentation w overload.

if venesection dependent: 500mL 1-2 weekly, red cross lifeblood = free.
aim for ferritin 50-100.

screen family if homozycgote C282Y.

30
Q

Hep B

A
  • HBsAg pos = acute + anti HBc IgM
  • HBsAg pos = chronic + anti HBc IgG
  • HbSAg neg, antiHBc IgG pos + anti HBs pos = resolved infection
  • only anti HBs pos = vaccinated

Rx

  • most people clear + becomes HBsAg negative within 6 months - if still positive then chronic hep B (95% of people)
  • if fulminant hepatitis/liver failure + ongoing at 6 months = Rx.
  • Rx w specialist/prescriber for entecavir. : check HbV DNA 4-6 monthly, then 6 monthly.

if not being treated but chronic hep B: LFT 6 monthly + HBV DNA annually

31
Q

Hep C

A

RF: prison, IVDU, sexual partner w HCV, HIV, MSM, child w mum w HCV, liver disease, birth in high prevalent area. blood transusion prior 1990. tatoo/piercings

HCV antibody positive; then go and do PCR , dont need genotype now (as non pbs criteria) but if treatment resitent then do it.

Rx
- need to be a registered prescriber.
- exclude cirrhosis with biopsy/fibroscan + AST/platelet ratio.
- consider coinfection w HIV/HBV
- review meds for interactions (LFT related)
- exclude pregnancy
–> first line: direct acting antiviral drugs. 8-12 weeks.
failure : treatment non adherence, reinfection, virological failure (rare) –> specialist.

32
Q

hepatitis Rx - GP role

A

GP role if not prescriber

  • monitoring adherence
  • social support
  • drug SFx monitoring
  • level of RNA monitoring
33
Q

hep c sequalae/long term monitoring

A

sequalae: 2-5% annual risk of HCC.

  • if cirrhosis: need 6 monthly uss + AFP
  • if abnormal LFT: exclude alt causes / specialist re-refer.
  • if no CLD, no cirrhosis: no long term f/u required.
  • if RF for reinfection: repeat HCV RNA yearly after new exposures.

abstain from etOH if possible

  • 4 s.d/day = increased risk of rapidly progressive liver diasese.
  • ensure vaccines for HBV + HAV + PCV up to date
34
Q

HCV transmission info

A
  • blood/blood contact.
  • not to donate blood
  • not to share toothpaste/razor
  • mother to baby transmission is low - but possible.
  • avoid BF with cracked/bleeding nipples.
  • sexual transmission is low amongst monogamous heterosexual partners (0.5%/year) = but possible
  • needle exchange program
35
Q

autoimmune hepatitis

A

10-40 yo female
fatigue/anorexia/jaundice.
ddx alcoholic hepatitis, viral heptatitis. NAFLD

pos ANA
sm Abdy
antiLKM1
igG high

Dx: biopsy

Rx: pred, azathioprine.
3-5 yearly mortality if not Rx

36
Q

cirrhosis clinical signs/monitring

A

Sx: anorexia, nausea, vomitting, peripheral oedema, bloating/distension, bleeding tendency, drowsiness, ecephalopathy

OE:
look for alcoholic facies
spider naevi
palmar erythema
peripheral oedema/ascietes
jaundice
hepatosplenomegaly. if not small/fibrotic liver
ascites
gynaecomastia

monitorign: 6/12 uss + AFP/LFTs + regular scopes for varices assessment.
hcc risk 2-5%/year.

37
Q

complications cirrhosis

A

sbp
encephalopathy
heptaorenal syndrome
hypernatremia
portal HTN w varices
portal vein thrombosis
renal failure
often associated w OP, vit D def, malnutrition.

38
Q

primary billiary cirrhosis

A

uncommon cause of CLD
women, 30-60.

Dx: obstructive pattern of liver biochem 
AMA pos (antimit abdy).

Rx: specialist
complications: fat solubile vit def, hypercholesterolaemia, BMD.

39
Q

wilsons disease

A

genetic
copper excess
5-35yo usually
–> cirrhosis w copper accumulation
+ presents w kayser fleischer rings.

Dx: usually via corneal findings

+ caeruplasmin low.

+ high 24 hour urinary copper excretion

Rx: specialist.

40
Q

haemorrhoids

A

mx:

  • adequate fibre intake
  • hydration
  • avoid straining
  • respond to urge to defect + try not to initiatie defecation without urge
  • sitz baths for comfort
  • procetosedyl: hydrocort/ciclocaine for short term use - SFX; candidaisis, localsied SFX w dermatitis.

if bleeding: surg. / unable to reduce,

or if large thrombosed external: no Rx required - should spontneously rupture + pain settled at 102 weeks. if severe –> surg.

41
Q

proctalgia fugax

A

short attacks of sharp stabbling pain near anal area. wakes pt from sleep. painless when not having episode

no clear cause

Rx: reassurance, explanation - ?muscular spasm: local warmth, ingestion of food, firm pressure to perineum. if severe: specialist - anecdotal evidence salb/gtn/ccb

42
Q

bowel cancer prevention

A
  • identify risk per Red book/cancer network guidliens - # 1’ and 2’ realtives
  • prevention
  • adopt healthy lifestyle
  • regular exercise
  • diet low in fat, high in veggies
  • high in fibre
  • avoid smoking
  • avoid excessive alcohol
  • individual specific CRC screening
  • consider low dose aspirin if high risk bewteen 50-50 for 2.5 years.
  • early recognition of sx
43
Q

Iron def sx

A
  • reduced aeorbic work performance
  • dev delay
  • adverse pregnancy outcome
  • ipaired immune function
  • glossitis
  • pica
  • angular chelitis
44
Q

b12 def

A

Sx

  • peripheral neuropathy
  • spinal cord dmage
  • otic atrophy
  • dementia
  • angular chelitis
  • glossitis
  • Rx: IMI alternative days for 2 weeks; then 3 monthly (or if less severe just 3 monthly) , usually life long requierd
    • ensure IF negative (pernicious anaemia). /cause identified.
45
Q

pyloric stenosis (child)

A

2-6 week chronological age.

progressive non billious vomitting. often projectiled + soon after feeds. can also be blood stained

see visible gastric peristalsis + pyloric mass in RUQ (olive)

Rx: ED. concern re hypocholareamic hypokalaemic me alkalosis. Surg review

46
Q

carcinoid syndrome

A

wheezing, flushing, diarrhoea.

cause mostly liver mets from pancreatic/gut tumours

excessiev serotonin/histmine

Mx: oncology/pal acre

47
Q

hirschprungs

A

first yaer of life

vomitting, abdo distension, enterocolitis.

RF: trismy 21.

= colonic functional obstruction w assocated absence of ganglion cells.

Sx: vomitting, explosive passage of liquid/foul stools + abdo distension

usually clue: delaeyd mec.

Dx: AXR. –> ED.

48
Q

albendazole

A
  • use for tapeworm (dog/fox)

+ heliminth infection/strongyloides. (instead of ivermectin).

+ cutaneous larva migrans.

EXAM 2021 (10 decks)

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