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Go with your gut feel Flashcards

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1
Q

What does giardiasis cause?
What is found on stool MCnS?
How is it treated?
How is chronic diarrhoea investigated?

A

Travellers diarrhoea
Cysts
Metronidazole, fluid replacement (20mg/kg bolus, maintenance = with glucose)
Duodenal biopsy

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2
Q

What are the facial manifestations of Peutz-Jeghers syndrome?
Presentation?
What will a child commonly present with?

A

Oral pigmented papules on buccal mucosa
Intestinal polyposis causing colicky abdominal pain, intestinal obstruction or intussesception
Fe deficiency anaemia

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3
Q

What is the inheritance of PEutz-Jeghers syndrome?

What is the chance of a child with one parent affected inheriting the disease?

A

Autosomal dominant

50%

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4
Q

What is the presentation of hereditary haemorrhaging telangiectasia?
What is the inheritance?
What are the complications of the disease?

A

Present early in life with anaemia & occult bleeding from GIT telangiectasia
Telangiectasia commonly appear in the mouth & on the face
Inheritance = autosomal dominant
Complications = haemoptysis, pulmonary haemorrhage, shock

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5
Q

Does Crohn’s or UC have bloody diarrhoea more often?

What is the histological difference between these 2 diseases?

A

UC has bloody diarrhoea more often
UC = ulceration in mucosa only
Crohn’s = ulceration of entire thickness of bowel wall

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6
Q

What are some extra-abdominal features of Crohn’s?

A

Anal skin tags
Iritis
Skin rash

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7
Q

Where is most of the iron from the diet absorbed?
What is the ABCDH of haemochromatosis?
What blood test is diagnostic?

A 
Absorption = Duodenum 
Arthralgia 
Bronze skin 
Cardiomyopathy/Cirrhosis of liver
Diabetes (pancreatic damage)
Hypogonadism (anterior pituitary damage)
Diagnosis = Transferrin saturation
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8
Q

How does greasy food when drinking reduce its effect?

A

Delayed stomach clearance

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9
Q

How is Coeliac disease diagnosed?

What will a biopsy show?

A

Small bowel biopsy + tissue transglutaminase antibody positive + IgA deficiency + GIT symptoms following gluten-rich foods
Biopsy = Villous atrophy, crypt hypertrophy and lamina propria plasma cell infiltrate

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10
Q

Small bowel obstruction indications for surgery?

Is previous abdominal surgery an indication or contraindication?

A 
Bloods = high WCC
Continuous severe pain 
ABG = metabolic acidosis 
Failure to improve after 72hrs of medical treatment 
Previous surgery = Contraindication
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11
Q

What is an acute upper GIT complication of chronic liver disease?
Why does this occur?
What percentage will this spontaneously stop in?

A

Oesophageal varices haemorrhage
Due to cirrhosis of the liver causing shunting of portal vein blood into peripheral vasculature
50% will spontaneously stop

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12
Q

What is the first supplementary investigation for gall stones?
What does a “double wall” sign indicate?
What other investigation can also be used for treatment?
What is this treatment?

A

Abdominal U/S
Double wall = oedema
ERCP (endoscopic retrograde cholangio-pancreatography)
- sphincterotomy of the Spincter of Oddi

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13
Q

What are the 4 F’s of cholesterol stones?
What is the other type of stone?
What percentage does this stone occur in?

A

Fat, female, fertile and forty
Pigment stone
20%

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14
Q

Do splinter haemorrhages occur with cirrhosis of the liver?
What does it occur with?
What clinical signs might you see with liver cirrhosis?

A

No!
Endocarditis, RA, vasculitis & haematological malignancy
Cirrhosis = palmar erythema, spider naevia, splenomegaly, petechia, ascites

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15
Q

Where is “thumb printing” seen on AXR?
What does it indicate?
What else may be seen in this case?
How do you confirm diagnosis?

A

Transverse colon
Inflammatory bowel disease (UC or Crohn’s)
Abnormal thickening of the colon, small amount of gas distally
Dx = sigmoidoscopy & biopsy

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16
Q

What causes complete loss of normal haustra on AXR?
Is this likely to be continuous or have skip lesions?
What is the treatment?
What sort of drugs are these?

A

UC
Skip lesion
Sulfasalazine (oral) or Mesalamine (oral or PR)
5-ASA (5-aminosalicyclic acid) = anti-inflammatory drugs

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17
Q

How does endometriosis affect the bowel?

How does this present?

A

Can cause tethering of the colon to endometrial tissue

Can present as cyclical rectal bleeding, linked to menstrual cycle

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18
Q

1wk of diarrhoea after overseas trip. Tenesmus, frequent small volume stools with blood and mucus.
What is the most likely organism?
What needs to occur before treatment is started?
What is the treatment?

A

Shigella species
Stool MC&S with antibiotic susceptibility testing
Generally self-limiting (average 7d)
Antibiotics = Azithromycin, Ciprofloxacin & Ceftriaxone

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19
Q

What are the most common causes of hypertriglyceridaemia?

What is an acute complication?

A

Obesity, alcoholism, hypothyroidism, insulin resistance

Acute pancreatitis

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20
Q

Opposite which tooth is the opening of the parotid duct?
What 3 structures pass through here?
What is the innervation?

A

2nd upper molar
Facial nerve, external carotid artery & retromandibular vein (superficial temporal & maxillary veins)
Parasympathetic = glossopharyngeal + otic ganglion -> auriculotemporal nerve
Sympathetic = superior cervical ganglion

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21
Q

Painful mouth ulcers, red halo’s found on inside of cheeks and lips
What are these?
What disease’s are associated with these signs?

A

Aphthous stomatitis

Coeliac, IBD and reactive arthritis

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22
Q

What is seen on abdominal U/S for cholecystitis?

A

Pericholecystic fluid
Distended gall bladder
Thickened wall
+ U/S Murphy’s sign

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23
Q

What antibiotics are used for cholecystitis?
What other type of drugs are used?
What is definitive treatment?
How soon does this need to be performed?

A

Gentamicin (4mg/kg) + amoxicillin
NSAID (Diclofenac) and anti-emetics (Ondansetron)
Laparoscopic cholecystectomy <48hrs

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24
Q

What are 5 complication’s of gall stones?
When is ERCP indicated?
What is the prophylactic antibiotic

A

Pancreatitis, cholecystitis, obstructive jaundice, cholangitis, gallstone ileus
Indications = Recurrent biliary pain or pancreatitis when gall stone is suspected of being underlying cause but not identified on U/S
Antibiotic = Cefazolin + DVT prophylactic

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25
Q

What are 4 steps of post-operative care for laparoscopic cholecystectomy?

A

Analgesia = narcotics 1 day, simple 1 days
Ambulance day of surgery
2 weeks until return of activity
Monitor for infection/gall stone ileus/bile duct injury (LFT’s)

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26
Q

What is acalculus cholecystitis?

In what percentage does it occur?

A

Gall bladder inflammation caused by biliary stasis leading to gallbladder distension, venous congestion & decreased perfusion
5% of patients

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27
Q

What is Charcot’s triad?
What does it indicate?
What is the major complication?

A

RUQ pain, fever and jaundice
Cholangitis
Sepsis + multi-organ failure

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28
Q

What are 3 types of dysphagia?

What are 3 disease of each?

A

Mechanical - oesophageal cancer, stricture, external pressure (retrosternal goitre)
Motility - achalsia, diffuse oesophageal spams, systemic sclerosis
Combination

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29
Q

What are 5 important questions to ask for dysphagia?

One disease for each

A

Solids, liquids or both? both = motility, solid = stricture
Difficulty actual swallowing motion? bulbar palsy
Intermittent or worsening? intermittent = spasm, worseing = cancer
Painful? ulceration
Gurgling sound and neck bulge? pharyngeal pouch

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30
Q

What is achalasia?
Presentation ?
Treatment?

A

The lower oesophageal sphincter fails to relax
dysphagia (both), regurgitation, substernal cramps, weight loss
Endoscopic balloon dilitation and PPI (omeprazole)

31
Q

What does LDL transport?
Where does it transport this substance to?
Where does HDL transport this same substance?

A

Cholesterol
From the liver to other organs
From organs to liver for elimination in bile

32
Q

What is the 6 steps in the life cycle of HIV?

A

(1) entry (binding and fusion), (2) reverse transcription, (3) integration, (4) replication (transcription and translation), (5) assembly, and (6) budding and maturation.

33
Q

What are 2 types of anti-retroviral medications?

Is atopic dermatitis or seborrheic dermatitis more common in HIV/AIDS patients?

A

Entry inhibitors
Nucleoside reverse transcriptase inhibitors
Protease inhibitor’s
Seborrheic dermatitis

34
Q

What does the falciform ligament attach to?
What does the free edge contain?
What is this also known as?

A

Attaches anterior surface of liver to the anterior abdominal wall
Ligamentum teres, remnant of the umbilical vein
Round ligament of the liver

35
Q

What two ligaments does the lesser omentum contain?

What is the portal triad? And which ligament does this run through?

A

Hepatoduodenal and hepatogastric ligaments

Portal triad = hepatic artery proper, portal vein and common bile duct - runs through the hepatoduodenal

36
Q

What is the clinical triad of mesenteric arterial occlusion?
How is it diagnosed?
Treatment?

A

Older patient, AF with severe abdominal pain out of proportion to physical examination
CT angiography or mesenteric arteriogram
NBO, IV fluids, unfractionated heparin (weight-based), gentamicin, amoxicillin/ceftriaxone + metronidazole, PPI’s and 02

37
Q

What is Mallory-Weiss syndrome?
What are the two most common risk factors?
What is used for diagnosis, investigation and treatment?
What is the treatment?

A

Mucosal lacerations in the distal oesophagus and proximal stomach secondary to a sudden increase in intra-abdominal pressure
Alcohol use and hiatus hernia
Upper endoscopy
Treatment = Endoscopic repair + acid suppression (omeprazole 20mg OD 2wks)

38
Q

What type of drug is Ranitidine? MoA?

What type of drug is Pantoprazole? MoA?

A

H2- receptor blocker = inhibition of histamine at H2-receptors of the gastric parietal cells
Proton pump inhibitor = inhibits the parietal cell H+/K+ ATP pump

39
Q

What sort of muscle type does the internal anal sphincter contain?
What nerves supply this muscle?
What chemical causes relaxation of this?

A

Smooth muscle
Non-adrenergic non-cholinergic nerves
Nitric oxide

40
Q

What are some GIT manifestations of diabetic autonomic neuropathy?
What is the pathophysiology for these diseases?

A 
GORD = decreased lower oesophageal sphincter tone + delayed gastric emptying + increased fluid secretion 
Gastroparesis = disordered motility via vagaries nerve dysfunction 
Diarrhoea = medications + disorder motility + increased fluid secretion small intestine bacterial overgrowth + exocrine pancreatic insufficiency
41
Q

What is the pathophysiological mechanism of lactose intolerance?
How is it diagnosed?
Treatment?

A

An absolute or relative enzyme deficiency causing lactose to be converted into hydrogen gas & other short-chain fatty acids in the colon
Clinical features + lactose hydrogen breath test
Dietary restriction + enzyme replacement + calcium & vitamin D supplements (if necessary)

42
Q

Barrett’s oesophagus pathophysiology?

Diagnosis?

A

Chronic acid reflux causing intestinal columnar metaplastic changes
Endoscopy documenting columnar epithelium in distal oesophagus + histoscopic signs of specialised intestinal metaplasia
Radio frequency ablation +/- endoscopic resection

43
Q

Familial adenomatous polyposis; autosomal dominant or recessive?
What gene is it associated with?
When does it present?
What is the classic number of polyps?
Where are they found?
What % of untreated patients will get cancer?

A

Autosomal dominant - mutation in APC gene
Presents = 20-40yrs
>100 polyps found in the colorectal area
100% of patients will get cancer if untreated

44
Q

Severe malnutrition followed by nasogastric nutrition - what metabolic symptom is likely to develop?
Which metabolic abnormalities cause paralytic ileus?

A

Hypophosphatemia

Paralytic = Hypokalaemia and hypercalcaemia

45
Q

What are 3 drugs used to treat GORD?
Example of each
What is the mechanism of action of each?

A

Acid suppressors - whatever - neutralise gastric acid
H2 receptor blockers - ranitidine - block histamine receptor of gastric parietal cells
PPI’s - omeprazole - inhibit the H+/K+ ATP pump

46
Q

What are the 3 types of motor disorders of the Oesophagus?
How are they diagnosed?
What is the treatment for each?

A

Achalasia = Barium study “bird beak” narrowing of LES -> Dilation of LES with ballon + PPI’s
Scleroderma = clinical features + decreased peristalsis on manometry
Diffuse Oesophageal Spasm = barium x-ray showing ‘corkscrew pattern’, nitrites or Ca channel blockers or anticholinergics or long oesophageal myotomy

47
Q 
What are the 6 classical features of duodenal ulcers?
What is the most common cause?
How is it diagnosed?
How is it treated?
Pre-Malignant?
A

Epigastric pain, burning, pain 1-3hrs after meal, relieved by food and antacids, interrupts sleep, periodic nature
H.pylori - urea breath test, serology or histology
Triple therapy = PPI’s, Amoxicillin 1g bid + Clarithromycin 500mg bid
NOT pre-malignant

48
Q

Where are Virchow’s, Sister Mary Joseph and Irish’s node’s located?
What pathology do they indicate?
What are some clinical features that also indicate this pathology?
What hereditary disease is associated with this pathology?

A 
Virchow’s = left supraclavicular 
Sisters = umbilical 
Irish’s = left axillary 
Gastric carcinoma 
Ulcer fails to heal, haematemeis, malena, constitutional, epigastric mass
Hereditary diffuse gastric carcinoma
49
Q

What layer does a peptic ulcer infiltrate?
H.pylori and NSAID use cause ulcers where more likely?
Which type of ulcer always need biopsy?
What is fasting serum gastrin used for?

A

Defects in the mucosa that penetrates the muscularis mucosal layer
H = duodenal. N = gastric
Gastric
Zollinger-Ellison syndrome

50
Q

What are parietal cells stimulated by and what do they secrete?
What do chief cells secrete and what stimulates them?
What do G-cells secrete and what stimulates them?
What do each of the secretions do?

A 
Parietal = Histamine, ACh and Gastrin -> HCl- (digest food) and intrinsic factor (B12 absorption/Pernicious anaemia)
Chief = vagal input -> Pepsinogen (converted to Pepsin -> protein enzyme) and gastric lipase (digests triglycerides)
G-cells = H+ -> gastrin (stimulates parietal cells)
51
Q

What is contained in the inguinal canal in males vs females?

What is the role of the gubernaculum?

A 
Males = spermatic cord, genitofemoral (motor) and ilioinguinal (sensory)
Females = round ligament 
Males = attaches inferior gonad to scrotum
Women = ovaries to uterus, becoming the ovarian ligament
52
Q 
Coeliac disease
What genes are implicated?
Facial signs?
Skin sign?
Treatment?
A

Genes = HLA DR3-DQ2 and/or DR4-DQ8
Aphthous ulcers and aphthous stomatitis
Dermatitis herpetiformis
Gluten-free diet

53
Q 
Which of these diseases cause unconjugated hyperbilirubinaemia and why?
Gilbert's?
Hereditary spherocytosis?
Biliary atresia?
Biliary cholangitis?
A

Conjugated = Biliary atresia and cholangitis
- Obstruction of biliary flow causes retention of conjugated bilirubin within the hepatocytes
Unconjugated = Gilberts and spherocytosis
- hemolysis releases unconjugated bilirubin from haemoglobin

54
Q

What age group is intussusception most common cause of obstruction?
Presentation?
Classical triad?
Investigation? What does it show?

A

6-36 months
Sudden onset of intermittent, severe, crampy, progressive abdominal pain with vomiting
Abdominal pain, palpable mass and red currant jelly stools
Ultrasound showing bulls eye or coiled springs

55
Q

What are the 4 layers of the colonic wall?
What layer is incomplete/absent when diverticulum develop?
What causes this incompleteness?
Diverticulitis: pain or painless?

A

Mucosa, submucosa, muscular and serosa
Muscular
Arterial insertion
PAIN!

56
Q

What is the role of the submucosa plexus?

A

Plexus that controls local intestinal secretion and absorption.

57
Q

Appendicitis pain goes from visceral to parietal or parietal to visceral?

A

Visceral to parietal

58
Q

What are the 3 section of the mucosal layer?

What does each layer do?

A

Mucous epithelium - secretory function in stomach and absorptive + secretory in small and large bowel
Lamina propria - contains blood and lymph vessels to support avascular mucosa
Muscularis mucosae - inner circularly orientated and outer longitudinally orientated, for peristalsis

59
Q

Where is Meissner’s and Auerbach’s plexus located?

A 
Meissner's = in the submucosal layer 
Auerbach's = between double layer of smooth muscle in the muscularis externa
60
Q

What are the 4 cells of the stomach?

How many layers of muscle does the stomach have?

A 
Mucous neck cells
Parietal cells
G cells
Chief cells 
3 layers - outer longitudinal, middle circular and inner oblique
61
Q

What is the role/path of the visceral peritoneum at the lesser and greater curvature of the stomach?

A 
Lesser = extends upwards to the liver to form the lesser omentum 
Greater = continues downwards and drapes over the intestines as the greater omentum
62
Q

What are the 4 regions of the stomach?

What is there rough location +/- function?

A

Cardia - surrounds opening of the stomach
Fundus - round portion superior and lateral, primary storage function
Body - large cent`ral portion
Pyloric part - antrum (connects to body), pyloric canal, pylorus (connects to duodenum)

63
Q

What keeps pepsin from digesting stomach cells?

A

pepsin is secreted in an inactive form called pepsinogen
stomach epithelial cells are protected from gastric juice by a layer 1-3mm thick of alkaline mucus secreted by surface mucous cells and mucous neck cells

64
Q

What are the 3 phases of deglutition?

Activity of each

A

Voluntary - movement of tongue
Pharyngeal - activation of deglutition centre on medulla and lower pons, closes air passageways
Oesophageal - relaxation of UOS, peristalsis, relaxation of LOS

65
Q

Which hepatitis is most commonly associated with Hep B?
What hepatitis viruses are RNA? DNA?
Which are chronic and which are acute?

A 
Hep D
RNA = A, C, D and E
DNA = B
Chronic = B, C and D
Acute = A and E
66
Q

What is the role of alpha 1-antitrypsin?
What disease’S can this lead to?
Treatment for these diseases

A

Prevents the breakdown of elastin by elastase
Hepatic cirrhosis, Respiratory emphysema and pancreatitis
avoid smoking, IV infusion of the A1AT protein and transplantation

67
Q

What are 5 different options for anti-emetics?

What does each do?

A

Metoclopramide - Dopamine antagonist, increases gastric motility and increases LOS tone
Ondansetron - serotonin antagonist CNS and PNS
Droperidol - dopamine antagonist in chemoreceptor trigger zone
Dexamethasone - unknown
Prochlorperazine - dopamine antagonist

68
Q

What are 4 different causes of fistulas’?

A

Cancer
Inflammatory
Radiotherapy
Obstetric complication/Mesh implants

69
Q

What causes constipation…
Hypo or Hyperkalaemia?
Hypo or Hypercalcaemia?

A

Constipation = hypokalaemia and hypercalcaemia

70
Q 
Which infections are associated with bloody diarrhoea vs watery..
Campylobacter?
Shigella?
E.coli?
Giardiasis?
Cholera?
A 
Bloody = shigella, campylobacter and e.coli
Watery = cholera and giardiasis
71
Q

What does AST stand for?
Where is AST found?
What does ALP stand for?
Where is ALP found?

A

AST = Aspartate aminotransferase
Hepatocytes, brain and myocardium
ALP = Alkaline Phosphatase
Canalicular and sinusoidal membranes of the liver, as well as bone, intestine and placenta

72
Q

What is used to treat hepatic encephalopathy?

What is its mode of action?

A

Lactulose

Reduces diffusion of ammonia from colon into blood plus promotes growth of bacteria in bowel plus laxative effect

73
Q

Where are most colon cancers found?

Where are the least found?

A 
Most = rectosigmoid
Least = transverse colon
74
Q

Causes of raised AST/ALT?

Isolated ALP rise?

A 
Severe = drugs, hypoxia and acute viral hepatitis 
Mild = infection, fatty liver, alcohol
ALP = bone disease

GIT/Gen Surg (2 decks)

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