Medicine - Gastroenterology Flashcards
Patient with
- HTN
- T2DM
- AF
acute 12 hr hx severe abdominal pain + bloody diarrhoea
Pain out of proportion to sign
this strongly suggests :
acute mesenteric ischaemia
intestinal angina is classically characterised by triad of…
aka chronic mesenteric ischaemia
- severe
- colicky post prandial abdominal pain
- weight loss
- abdominal bruit
DKA treated with
IV saline and insulin infusion
patient with DKA would present with hyperglycaemia
alcoholic ketoacidosis is managed how
managed with infusion of saline and thiamine
smoking cessation has been shown to increase flares of what condition..
ulcerative colitis
presentation of
- painless jaundice
- anti-smooth muscle antibodies
- raised IgG levels
charactersitic of:
autoimmune hepatitis
histology of Crohn’s disease?
- inflammation in all layers from mucosa to serosa
- goblet cells
- granulomas
The splenic flexure marks the point where
the majority of blood supplied changes from the superior mesenteric artery (SMA) to the inferior mesenteric artery (IMA).
The rectum itself gets an excellent supply of blood from
collaterals due to branches from the internal iliac artery.
The rectum itself gets an excellent supply of blood from
collaterals due to branches from the internal iliac artery.
A 52-year-old male presents with central chest pain and vomiting. He has drunk a bottle of vodka. On examination, there is some mild crepitus in the epigastric region. What is the likely diagnosis?
oesophageal perforation
The Mackler triad for Boerhaave syndrome: vomiting, thoracic pain, subcutaneous emphysema. It typically presents in middle aged men with a background of alcohol abuse.
new onset dysphagia is a red flag symptom therefore requires what…
urgent endoscopy
patient with:
- history of heart burn
- odynophagia but no weight loss
- systemically well
oesophagitis
odynophagia definition
painful swallowing
what is achalasia ?
dysphagia of both liquids and solids
heart burn
regurgitation of food
may lead to cough, aspiration pneumonia
transverse colon being >6cm in diameter in combination with signs of systemic upset
may indicate
toxic megacolon
needs aggressive medical therapy for 24-72 hrs
what kind of tube may be used to stop an uncontrolled variceal haemorrhage
sengstaken-blakemore tube
SSRIs are major risk factors for duodenal ulcers
SSRIs such as sertraline are major risk factors for duodenal ulcers
What is Zollinger-Ellison syndrome?
- excessive levels of gastrin
- usually from a gastrin secreting tumour
correct investigations for testing for coeliac’s disease
- paired tissue transglutaminase (TTG)
- IgA
H-pylori eradication regime
PPI + amoxicillin + clarithromycin
barium enema of a patient with ulcerative colitis may show
- loss of haustrations
- superficial ulceration ‘pseudopolyps’
- colon is narrow and short
presentation of the following symptoms is characteristic of what:
- bloody diarrhoea
- urgency
- tenesmus
- abdo pain esp LLQ
- extra-intestinal features
ulcerative colitis
vitamin C deficiency leads to
- scurvy
- aar defective synthesis of collagen - bleeding
- capillary fragility - poor wound healing
signs of liver decompensation
jaundice
confusion
occurs due to build up of toxic products within the body
gilberts syndrome is an unconjugated or conjugated hyperbilirubinaemia
unconjugated hyperbilirubinaemia
hence would not cause dark urine or pale stools
as conjugation enables water solubility
long term use of PPI can lead to…
- osteoporosis and fractures
- due to malabsorption of calcium and magnesium
how do PPIs work
- cause irreversible blockade of H+/k+ ATPase
- in gastric parietal cell
what should always be examined in young males presenting with RIF pain
- examine scrotum
- testicular problems: infection and torsion
patient presents with dysphagia.
came on gradually, initially only with solid food but now with soft foods
has vomitted on a few occasions
no nausea or change in appetite
previously fit and well
does not smoke or drink
likely cause of symptoms?
oesophageal malignancy
- progressive nature of symptoms suggests growing obstruction
what severity index is used to assess severity of ulcerative colitis in adults ?
Truelove and Witt’s severity index
how is flare of ulcerative colitis treated?
- iv corticosteroids
- e.g. prednisolone
state some of the Truelove and Witt’s severity index
- temperature greater than 37.8
- HR > 90bpm
- anaemia, Hb < 105g/L
- erythrocyte sedimentation rate greater than 30 mm/hour
clostridium difficile is gram positive or gram negative
gram positive
72 y/o female
- being treated for recent infection with oral cefuroxime
- presents to ED with abdominal pain and diarrhoea
- hypotensive 95/47
- t.cardic 120 bpm
- fever 38.1
- RR 18
what is likely diagnosis
life-threatening clostridium difficile
presentation of abdominal pain and diarrhoea associated with second generation cephalosporin antibiotics
42 y/o male with jaundice, pruritus and abdominal pain
PMH- ulcerative colitis, biliary colic, DM
Bloods reveal - raised ALP , positive ANCA
likely diagnosis
primary sclerosing cholangitis
in spontaneous bacterial peritonitis: what is the most common organism found in ascitic fluid culture?
Escherichia coli
diffuse hepatic injury resulting from acute hypo perfusion is known as
ischaemic hepatitis
- marked increase in aminotransferase
what type of cells would be found on biopsy of patient with gastric adenocarcinoma ?
signet ring cells
woman with gallstones present with pain in RUQ
examination
- not jaundiced
- temp of 37.8
palpating under right costal margin causes her to catch her breath
what sign is ellicted?
what condition is this?
acute cholecystitis
scenarios - Murphy’s sign
72 y/o male presents with heart failure, T2DM & persistent dull ache in RUQ
blood tests show mild elevation of alanine aminotransferase level
patient most likely has?
- congestive hepatomegaly
23 y/o student recently returned from trip to North Africa, presents with anorexia, nausea, mild RUQ and lethargy
bloods show marked elevation of AAT
suggestive of:
viral hepatitis
ascending cholangitis presents with which triad
- fever
- ruq pain
- jaundice
10 y/o presents with 2 day history of abdominal pain + anorexia
- tender over mcburneys point
- rebound and percussion tenderness
diagnosis ?
acute appendicitis
prophylactic IV antibiotics should be given prior to appendicectomy
pseudomembranous colitis most likely caused by
clostridium difficile
trans jugular intra-hepatic portosystemic shunt (TIPS) procedure connects what two veins
hepatic vein to portal vein
what is first line antibiotic fo patients with clostridium difficile infection
metronidazole
what part of the bowel is most likely affected by ulcerative colitis?
the rectum
71 y/o pt with 2 year hx of intermittent problems with swallowing.
he has halitosis and is coughing at night.
PMH T2DM, otherwise well.
weight stable, good appetite,
most likely diagnosis?
pharyngeal pouch
27 y/o male.
rigidity, cog wheeling, bradykinesia, ataxia, slurred speech.
OE
- lack of coordination
- ascites
- splenomegaly
- oesophageal varices
memory loss, slow thinking processes, possible psychosis
likely diagnosis
Wilsons disease
68 y/o
- t2dm
- features of septic shock
- ruq tenderness
- not jaundiced
- no stones in gall bladder
- normal calibre bile duct
most likely diagnosis
acalculous cholecystitis
patient with known gallstones, admitted with high fever and jaundice.
OE
- extremely unwell
- abdomen soft
- mild RUQ tenderness
characteristic of:
cholangitis
- features of jaundice, fever and systemic sepsis
34 y/o 3 day hx colicky ruq pain radiating to back.
pain now constant.
temp 38.5
localised peritonism in RUQ
characteristic of:
acute cholecystitis
- fever
- ruq pain
- Murphy’s sign
anti-dsNA primarily associated with
SLE
- systemic lupus erythematous
anti-ccp highly specific for
rheumatoid arthritis
ANCA antibodies are associated with
small vessel vasculitides
c-ANCA primarily associated with
granulomatosis with polyangitis and eosinophilic granulomatosis with polyangitisi
50 y/o presenting with
- fatigue
- erectile dysfunction
- arthralgia
earliest signs of:
haemochromatosis
budd-chiari syndrome occurs due to
obstruction of the hepatic vein
budd-chiari syndrome typically presents with
RUQ pain
painful ascites
PPIs can cause hyponatraemia
PPIs can cause hyponatraemia
