Medicine - Gastroenterology Flashcards by Andrea Jayawardena

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

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intestinal angina is classically characterised by triad of…

aka chronic mesenteric ischaemia

severe
colicky post prandial abdominal pain
weight loss
abdominal bruit

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DKA treated with

IV saline and insulin infusion

patient with DKA would present with hyperglycaemia

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alcoholic ketoacidosis is managed how

managed with infusion of saline and thiamine

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smoking cessation has been shown to increase flares of what condition..

ulcerative colitis

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presentation of

painless jaundice
anti-smooth muscle antibodies
raised IgG levels

charactersitic of:

autoimmune hepatitis

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histology of Crohn’s disease?

inflammation in all layers from mucosa to serosa
goblet cells
granulomas

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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).

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The rectum itself gets an excellent supply of blood from

collaterals due to branches from the internal iliac artery.

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The rectum itself gets an excellent supply of blood from

collaterals due to branches from the internal iliac artery.

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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.

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new onset dysphagia is a red flag symptom therefore requires what…

urgent endoscopy

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patient with:

history of heart burn
odynophagia but no weight loss
systemically well

oesophagitis

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odynophagia definition

painful swallowing

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what is achalasia ?

dysphagia of both liquids and solids

heart burn

regurgitation of food

may lead to cough, aspiration pneumonia

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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

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what kind of tube may be used to stop an uncontrolled variceal haemorrhage

sengstaken-blakemore tube

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SSRIs are major risk factors for duodenal ulcers

SSRIs such as sertraline are major risk factors for duodenal ulcers

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What is Zollinger-Ellison syndrome?

excessive levels of gastrin

- usually from a gastrin secreting tumour

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correct investigations for testing for coeliac’s disease

paired tissue transglutaminase (TTG)

- IgA

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H-pylori eradication regime

PPI + amoxicillin + clarithromycin

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barium enema of a patient with ulcerative colitis may show

loss of haustrations
superficial ulceration ‘pseudopolyps’
colon is narrow and short

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presentation of the following symptoms is characteristic of what:

bloody diarrhoea
urgency
tenesmus
abdo pain esp LLQ
extra-intestinal features

ulcerative colitis

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vitamin C deficiency leads to

scurvy
- aar defective synthesis of collagen
bleeding
- capillary fragility
poor wound healing

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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