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Clinical 1 > GIT exam > Flashcards

GIT exam Flashcards

1
Q

Cushingoid appearance
Features and causes

A

Wt☝🏼 hirsuit 🦍 striae
Steroids (IBD, CAH)
Cyclosporine (tx rejection)
Tacrolimus (stop rejection)

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2
Q

Signs of portal HTN

A

Ascites
Solenomegaly
Caput medusae
Anorectal varicies

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3
Q

LFTs - hepatic markers

A

AST (+heart, skeletal muscle, RBCs, kidney, brain)
ALT (more specific liver and kidney)

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4
Q

LFTs: Cholestatic markers

A

ALP
GGT

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5
Q

Wilson’s disease
Eyes, liver, brain, kidney
Diagnosis

A

Copper transport defect - builds up
- eye: kaiser-fleischer rings
- liver: 5 yo +, hepato +/- splenomeg
- brain: 10 yo +, copper deposition in basal ganglia, tremors, sz, behavioural change
- kidney: proximal RTA

Diagnosis
Urine 24 hr copper excretion (up)
Serum copper: raised or normal
Serum ceruloplasmin: down (binds copper)

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6
Q

Peutz-jager signs

A

Hypermelanotic macules - lips, palms, soles
AD
GIT polyps
Increased risk cancer
Intussusception

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7
Q

Peripheral stigmata chronic liver disease

A

Pallor
Spider naevi, caput medusae
Xanthomata
Petechiae
Clubbing, leuconychia
Palmar erythema
Ascites

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8
Q
A

Xanthelasma - CLD

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9
Q
A

Xanthomata - CLiver D

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10
Q

1, 2, 3

A
  1. RUQ - liver: biopsy, t/p, biliary - kasai procedure
  2. Upper midline lap scar: fundoplication (look for PEG), early renal t/p
  3. Transverse upper abdo: CDH, splenectomy
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11
Q

4, 5, 6

A
  1. Below umb: gastroschisis, hernia repair, omphalocele (BWS)
  2. Port, drain, VP shunt, PD
  3. LIF colostomy RIF iliostomy
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12
Q

7, 8, 9

A
  1. RLQ - kidney t/p
  2. RIF - appendectomy
  3. Loin/ renal angle - neohrectomy, kidney biopsy
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13
Q

Congenital diaphragmatic hernia associations

A

Trisomies
Turner
Frynns syndrome: underdevelopment of nails and finger bones, hypertelorism, cleft palate

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14
Q

Hepatomegaly + jaundice DDx

A

Infants:
- biliary atresia, choledocal cyst (kasai scar)
- alagille: butterfly vertebrae, PS, triangular face, deep set eyes, vit ADEK, test: MA, clinical exome with JAG1+ NOTCH2

Infection: echovirus 11, TORCH, UTI ecoli
Alpha-1-antitrypsin
Chronic active hep
Wilson disease

Haemolysis

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15
Q

Hepatomegaly + jaundice Invx

A

Bloods: LFTs, coags + albumin (synthetic function), FBC + film (haemolysis), A1AT assay + Pi phenotype
Hep ABC serology, TORCH serology
CMV serology +/urine
Wilson: copper and ceruloplasmin

Liver US
HIDA scan (gallbladder, bile ducts)

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16
Q

Jaundice - haem causes

A

Sickle cell disease
Hereditary spherocytosis (EMA binding test)
Autoimmune haemolytic anaemias (positive direct Coombs)
G6PD

17
Q

Jaundice - no HSM or haemolysis

A

Gilbert’s
Increased unconj bili during attacks

18
Q

Causes unconjugated hyperbilirubinaemia

A

Before the liver problem
Haemolysis
Impaired conjugation: Gilbert’s, Crigler-Najjar

19
Q

Causes conjugated hyperbili

A

In the liver or gallbladder / bile duct problem
Extrahepatic bile duct obstruction
- biliary atresia
- choledochal cyst
Dubin-Johnson Syndrome: bili excretion defective
Alagille: intrahepatic biliary atresia
Heptocyte injury
- A1AT
- CF
- Hepatitis
- Glycogen storage disease (UMS)

20
Q

Hepatomegaly and not jaundiced DDx

A

Mass
- hepatoblastoma
- Wilm’s (nephroblastoma)
- secondary NB
*all more common BWS

Congenital hepatic fibrosis (infants)

Metabolic (infants)
Lysosomal storage disorder, galactosemia

Chronic disease: CF, CCF

Infection: hep a - e, EBV, CMV, toxoplasmosis

Rheum - SLE, RA

IBD

21
Q

Hepatomegaly and not jaundiced invx

A

Bloods: LFTs, coags, albumin, EUC, FBC, CRP (infection)
TORCH serology
Hep A-e serology
CMV blood and urine

BWS: methylation studies

IBD tests: stool fat crystals, fecal calprotectin

CF: sweat chloride test, r/v NBST

Imaging: liver US

Rheum: dsDNA, ANA, HLA type

22
Q

Splenomegaly alone and jaundice DDx

A

Haemolytic process
Infections
- typhoid
- septicaemia
- subacute bacterial endocarditis
Masses
- splenic cyst
- Splenic harmatoma
Malignancy:
- leukaemia
- lymphoma

Spleen US

23
Q

UA - what are you looking for in abdo exam?

A

Bilirubin: hepatic disease
Urobilinogen: hepatic dysfunction

24
Q

IBD investigations

A

Bloods: FBC (low Hb, high WCC plts)
ESR CRP up
EUC CMP
LFTs
Nutritional screen

Stool:
Gross or occult blood
Fecal calprotectin (up)
Mc+s
Endoscopy for diagnosis

25
Q

A1T1

A

Defective secretion protein x from hepatocyte
Presents: jaundice, acholic stools, hepatomegaly
Invx
- serum alpha 1 AT, Pi phenotype (Piss, Pinull null or PiZZ = disease)
- liver US + biopsy

Clinical 1 (11 decks)

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